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Europe and the NHS are always near the top of the media agenda, usually to report negatives. The little Englander mentality has gripped some sections of the community who are keen to leave the EU and, subsequently, still envisage UK sitting at all the top tables for decision making. In psychiatric terms this is termed “Delusional”. This is an oft state of consciousness in many of our political masters. Additionally, austerity is effecting us all but it would be worse if UK was not part of the EU and as we come out of this present blight being part of the EU will allow us access to a market of some 450 million people!

This storm in the chattering classes has deflected the government from its core goal; to get the economy back on track and concentrate on other issues not least the near collapse of A&E services coupled with making the recent NHS reforms work. The former has been a direct result of the GP contract negotiated by the previous administration permitting doctors to opt out of out of hours. It will be interesting to see how this is tackled without major sweeteners to the medical profession!

The reforms, which in part were very sensible, are being thwarted of by the lack of succession planning of the move from PCTs to CCGs in all departments from finance, procurement to IT. I have had several SMEs complaining bitterly of the lack of coherence in procurement which allows much larger companies to succeed in contractual tenders. There is a serious risk of the NHS monopoly turning into a beast resembling a duopoly or triopoly. This needs addressing as the whole procurement process, and the reforms, will otherwise fall into rapid disrepute.

One issue is that the present cutbacks have had a detrimental and significant effect on the services providing support for people suffering domestic violence. So many times one hears about, “not joining up the dots”, which has resulted in major incidences, including murder. Sohal and Feder have provided an excellent overview of this “Unacceptable and under recognised problem in primary care”.

The “Falls agenda”, which was a laudable approach to prevent major morbidity in the elderly has worked well but there is still considerable room for further gains. Ali and Conroy give us a timely reminder of those small steps that can accumulate in major cost savings in this area not to mention improved outcomes.
Human longevity has its bonuses but the drawbacks may be considerable. Lower urinary tract symptoms, of infrequent occurrence 70 years ago, are now common in males. Ayres and Anderson demystify the problem. Demineralisation leading to osteoporosis is a major concern, mainly in postmenopausal women, but can also afflict the older man. Coupled with falls this is a dangerous mix. An update to manage its increasing prevalence is provided by Batten and Isaacs.

Critchlow and Gail assist us in identifying those who may be involved in substance misuse. This problem should, in the main, be picked up in primary care, but how? Read on. Meanwhile Nunns and Grant have produced an elegant summary, with plenty of illustrations, of “Vulval disorders” which present to GPs.

As always correspondence on the content and suggestions for future features are most welcome. Please email me at the address shown. Happy educational reading and do try out the “Verifiable CPD” at the end of most articles. This is going to be a core requirement in revalidation.

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Read 5837 times Last modified on Tuesday, 03 May 2016 14:38

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