Volume 9 Issue 1 - 2015 http://ipcauk.org Sat, 20 Oct 2018 11:28:13 +0000 Joomla! - Open Source Content Management en-gb from the editor... http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/218-from-the-editor http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/218-from-the-editor

The annual winter tempest to hit the NHS is blowing. The Times and Independent newspapers recently carried stories that the service is £2 billion in the red and this is even before the winter pressures have commenced.

 

The general conclusion was that more financial squeeze can only come with reduction in services and staff. This simply will not equate with the standards of care deemed an absolute after the Staffordshire and other medical scandals, and which identified lack of staff, clinical and nursing, as the core issue leading to unnecessary patient fatalities. The experience of many clinicians is that NHS employers are making unilateral decisions to increase workloads as permissible under the consultant contract and tugging on the usual mantra of, “doom, gloom and services being decimated”. Such scaremongering and crying wolf has become an annual pantomime that staff are simply hardened against, which are viewed as shallow attempts to balance the books. The BMA and the Hospital Specialists and Consultants Association will have to plenty of requests from clinical staff to examine what is legally allowed.

 

The government has sleep walked into a series of time consuming and bruising battles. The deficit requires a choice between cutting/pruning services or a finesse with the usual accounting procedures, identifying the lie of their commitment to have a world class NHS. Its policies on staffing have given rise to confrontations with consultants, junior doctors and general practitioners. A triple battlefront, something even Napoleon would have thought about and dismissed!

 

The juniors are at the threshold of a new contract about to be foisted in them, without negotiation and agreement. The mutterings (I am unable to print language that was truly used) simply ask, “Who can be asked to accept additional work and less pay, greater contributions to a pension with a lower final payout and classifying a normal day/working week as way beyond the usual hours and days”?

 

The consultants’ contract is being altered primarily to include the ability of the employer to enforce weekend working to provide a full 7 day service. No one has seen how this will be funded. The NHS can barely finance the present service. Hundreds of millions are spent on locums as there are too few clinical and nursing staff to deliver the 5 day week. Will staff be forced to work 7 days a week? Where does this leave work/life balance, so important to the well-being of individuals. Burnout will be a major issue and more commonly seen.

 

General Practitioners will also have a new contract to ensure a 7 day delivery of services. The evidence is that it is not popular with patients with the majority of vanguard practices discontinuing the service. Strangely, even patients do not wish to be sitting for hours on end in a GP surgery at weekends, when they could be with family and friends. The government has once again flexed its power, as a monopoly employer, and this time it may end up not being able to bandage over the consequences. Juniors are looking to overseas opportunities, consultants and GPs are hemorrhaging well before official retirement age and nursing and other staff are opting to work for medical locum agencies. As one of my colleagues observed, “The NHS ship may well sink if 1000 junior staff decide to resign/move on”. Politicians beware!

 

I hope that you will enjoy this issue with excellent contributions on the theme of supplements in the form of Vitamin D disorders (p.8), in pregnancy (p.16) and joints (p.34). Sexual dysfunction in adults (p.24) will be a common issue seen in primary care and this article provides core knowledge. GPs also have access to blood tests, routine or otherwise, and Dr Allard and her colleagues succinctly embody the management of the common blood disorders which you are likely to encounter (p.42).

 

Professor Ram Dhillon

Editor

Email: ram.dhillon@rila.co.uk

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    info@ipcauk.org (Editor Admin) Volume 9 Issue 1 - 2015 Mon, 30 Nov 2015 08:47:52 +0000
    Universalism and Targeting: Vitamin D Deficiency in British children and adolescents http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/219-universalism-and-targeting-vitamin-d-deficiency-in-british-children-and-adolescents http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/219-universalism-and-targeting-vitamin-d-deficiency-in-british-children-and-adolescents

    Abstract

    Vitamin D deficiency causes health problems in children and adolescents in the UK. Impacts on bone mass in particular in children and adolescents are significant and the costs of treating sequelae in adulthood high. Many guidelines exist to tackle the problem, but compliance with these by patients (and doctors!) is not perfect. For improvements to be made at a population level we suggest that a universal approach to vitamin D needs to be taken, together with specific targeting of key at risk groups such as children and adolescents. Educating at risk mothers and children now will improve the health awareness of the adult population in years to come.

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      info@ipcauk.org (Editor Admin) Volume 9 Issue 1 - 2015 Mon, 30 Nov 2015 08:54:32 +0000
      Dietary supplements in pregnancy – are they necessary? http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/220-dietary-supplements-in-pregnancy-are-they-necessary http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/220-dietary-supplements-in-pregnancy-are-they-necessary

      Abstract

      By definition, a woman having a healthy uncomplicated pregnancy, who has a normal balanced diet, does not need dietary supplements. The justification for routine population supplementation therefore depends upon the incidence of deficiency in that particular population, and the balance between the benefits of supplementation for those who have a deficient diet and the harms that can occur from excessive consumption of individual nutrients in those who are already replete. General guidelines for the detection of individual deficiency are outlined, together with suggested nutritional supplements to correct them.

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        info@ipcauk.org (Editor Admin) Volume 9 Issue 1 - 2015 Mon, 30 Nov 2015 08:57:46 +0000
        Sexual Dysfunction in Adult Men and Women http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/221-sexual-dysfunction-in-adult-men-and-women http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/221-sexual-dysfunction-in-adult-men-and-women

        Abstract

        Sexual dysfunctions affect both men and women and include Delayed Ejaculation, Male Erectile Disorder, Female Orgasmic Disorder, Female Sexual Interest-Arousal Disorder, Genito-Pelvic Pain Disorder/Penetration Disorder, Male Hypoactive Sexual Desire Disorder, Premature Ejaculation and Substance-Medication Induced Sexual Dysfunction. Untreated sexual dysfunctions may cause significant distress and interpersonal difficulty in some individuals or couples. The diagnosis of sexual dysfunctions includes a thorough medical history and evaluation, followed by the appropriate medical, psychological and psychosocial treatment interventions.

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          info@ipcauk.org (Editor Admin) Volume 9 Issue 1 - 2015 Mon, 30 Nov 2015 09:00:54 +0000
          The Role of Supplements in Joint Health http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/222-the-role-of-supplements-in-joint-health http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/222-the-role-of-supplements-in-joint-health

          Abstract

          Herbal supplements are in widespread use in all medical specialties. Evidence that supports their efficacy and safety is often lacking and the GP, physician or specialist nurse are left with very little objective advice to give patients. In this article, an update is given on a range of supplements used in musculoskeletal medicine with the specific purpose of informing health care providers and allowing them to offer the best advice on their use.

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            info@ipcauk.org (Editor Admin) Volume 9 Issue 1 - 2015 Mon, 30 Nov 2015 09:05:12 +0000
            Common Blood Disorders & how to recognise them in primary care http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/223-common-blood-disorders-how-to-recognise-them-in-primary-care http://ipcauk.org/index.php/clinical-focus-primary-care/cf-volume-9-n1/item/223-common-blood-disorders-how-to-recognise-them-in-primary-care

            Abstract

            General Practitioners are commonly faced with abnormalities of the full blood count. This can vary from thrombocytopenia, to lymphocytosis to eosinophilia, amongst others. We aim to provide practical guidance for managing these problems in primary care, with reference to various professional guidelines where appropriate. The approach to other disorders such as lymphadenopathy, paraproteins, haemochromatosis, as well as antibodies in pregnancy, is also discussed. The approach to anaemia has been covered in a separate linked article.

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              info@ipcauk.org (Editor Admin) Volume 9 Issue 1 - 2015 Mon, 30 Nov 2015 09:07:20 +0000