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International Primary Care Association

Clinical Focus Volume 6 N2


Phew! Andrew Lansley and the coalition must be relieved that the Health and Social Care Bill has finally been passed. It seems have had more alterations than a wedding suit and now one only hopes it fits the purpose. Opposition continued to the bitter end. Members of the Royal College of Surgeons, managed to muster the minimum number of sponsors to call an EGM to debate the RCS’s approach to the legislation. In the event the debate voted in favour of “Critical participation”, rather than aligning to several other august professional bodies who took a stance of “Open opposition”. The Bill has come to pass, which frankly was inevitable.

We must now work together to ensure that we engage in a constructive manner, in implementation, for the benefit of our patients. Carping about privatisation, closures, defects in training…….are no longer options. In a democracy we have to accept this legislation, the alternative being anarchy.

The Bill really does put primary care and GPs, in the form of Clinical Commissioning Groups, at the heart of the NHS. In the short time leading to the enactment of the bill and subsequently, my personal experience is that our colleagues in primary care will and are the key decision makers and with it the whole integration and communication process between primary and secondary care will improve immeasurably.

The role of the private sector will undoubtedly increase but there is a whiff of unfairness in the processes that the DH has agreed for tendering. Small and medium sized businesses and social enterprise organisations will have a tough job navigating the tendering and contracting processes, an activity which the big boys can manage with consummate ease. The DH needs to relook at this urgently before the whole process falls into disrepute and/or is challenged legally.
I am delighted to see the Wilkie and Chalmers paper on “Acute cough in adults”. This is a major presenting symptom in primary care and if not assessed appropriately will consume huge quantities of resource. This article simplifies the complex and streamlines the decision making process for such patients.

It is salutary to learn that childhood and adolescent eating disorders frequently continue into adulthood. They really can become Long Term Conditions. Dr Rao provides an insight into a psychiatric area which is the staple diet of the health sections of many newspaper dailies, peddling unnecessary mystique and myth. He deftly enables the condition to be understood and provides suggestions on its management.

Did you know that Cow Milk Protein Allergy is the commonest cause of death from anaphylaxis in children? Read Ware, Apps and Michie’s article to learn how this allergy may present with a confusing kaleidoscope of symptoms across multiple organ systems.

Individual Clinical Commissioning Groups (CCGs), perhaps with mergers, will now comprise tens of thousands of patients. Simon Page, writing on thyroid disease, highlights that for every 10000 size list there will be ~200 patients requiring thyroxine for hypothyroidism, ~100 who will have subclinical hypothyroidism and ~60 will suffer hyperthyroidism. It’s worth getting to grips with this paper for an overview of thyroid disease as you will encounter patients with such pathology.

Tucker, Knox-Cartwright and Ursell address the burgeoning incidence of Age-related Macular Degeneration (AMD). The consequences of a low birth rate and increasing longevity have resulted in an ageing population. The public and doctors will become increasingly confronted with this disease. It is vital that sufferers are picked up early in primary care so that a rapid diagnosis and use of appropriate therapy can save the vision.

In the UK clinical depression is managed mostly in primary care. However, a large proportion of depression is linked to the presence of a Long Term Condition. Alan Cohen’s article provides the startling statistic that in a list size of 10000, 2500 will have a long term condition of which 500 will have associated depression. This latter group consume extraordinarily huge amounts of resource in which addressing the management of depression will lead to clinical gains and in a time of austerity a contribution towards the £20 billion savings over the next 5 years!

Please let me have your thoughts on future areas you would like covered. I would also value correspondence on any of the editorial content by emailing me at the Rila address.


Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: editorial, clinical focus primary care
Read 3829 times Last modified on Tuesday, 03 May 2016 14:37
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