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International Primary Care Association

Clinical Focus Volume 7 N3

From the editor...

The chill of winter will have reached all of us with the publication of this issue, made worse by the government’s belligerent stance on public sector pay freeze, including NHS workers, despite the talk of an economic recovery. The comfort of improving economic statistics and numbers are not the same as the experience of rising food, transport and fuel bills, little prospect in acquiring a decent job and a reduction in public services.

Poor planning in medical manpower, and a lack of focused investment has produced the spectre of massive strain on emergency services this winter. The UK simply does not produce enough of home-grown medical or nursing personnel which leads to a clinical brain drain from other countries such as the Philippines, India, Pakistan, Nigeria, Ghana….This problem is coupled with the disruption of frequent NHS re-organisations and a management heavy structure, despite the reforms, culminating in poor or absent decision making, which results in further deterioration of services.We have heard the low rumbling of political stances commence during the party political conference season and this will crescendo to the next election. I am not optimistic that the NHS will fare well but am having a bet on a further restructure within the lifetime of the next government.


This issue of Clinical Focus may provide a modicum of relief from the usual doom and gloom. It is stuffed with high quality education. There has been a massive push on identifying and treating patients with arrhythmias, particularly atrial fibrillation. Diana Gorog and Vias Markides have provided an excellent summary of “Palpitations”, (page 152). We have two addiction related topics, “Pathological Gambling”, by Kaspar, Mitter and Bowden-Jones (page 164) and “Treatment of Substance Misuse”, by Critchlow and Lee (page 210). Both of these conditions consume huge resources from the individual concerned and by the NHS more generally. Their increasing incidence may be due to our present economic downturn!

The recent media frenzy of a “Cure for Dementia”, from research performed in Leicester, was ultimately the discovery of a new portion of the degenerative pathway that may be disrupted by new drugs, as yet undiscovered, but providing a potentially fruitful line of investigation. Islam and Carter’s article on “Detecting Dementia” (page 169), pushes us back to the here and now, and leaves the hype to the media.

With primary care expected to delivery many more services, which traditionally were cared for in secondary care, it is timely to read Dedicoat’s article on “The management of TB in primary care”, (page 179) and Hamann and Sengupta’s contribution on addressing the Issue of “Back Pain in primary care”, (page 188). This triplet of articles focusing on managing conditions in the community is completed by Robinson and Dudley’s piece on, “The Overactive bladder in primary care”, (page 198).

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 a core requirement in revalidation.

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