Font Size


Menu Style



International Primary Care Association

from the editor...

We shall be through a month or so of 2017 by the time this issue is published. Donald Trump will have been inaugurated. The Supreme Court in UK will probably have decided as to whether Parliamentary consent is required to trigger Article 50 for Britain’s exit from the EU…………………The runes are not good reading.  

Trump is likely to ditch Obamacare which was designed to make healthcare an affordable reality for those that are not wealthy. It has been much maligned by the private sector corporations who clearly see it as a mechanism for reducing their profits. In the UK, if the Supreme court decision rules in favour of Gina Miller, the plaintiff who challenged the notion that the government did not require parliamentary approval, then a short-lived sigh of relief will be heard from the approximately 25% of the NHS, who make the EU component of its workforce. This will not avert the crisis of unfilled GP posts,, the haemorrhage of doctors leaving for life and careers abroad (Australia, New Zealand, Canada…..). Jeremey Hunt’s increase in medical student numbers will not catch up for over 15years, assuming Medicine is a choice that teenagers will make. Unlikely, as this last round of University entry, as never before, had medical school places available in clearance. Hunt has managed a first at least.

Prime Minister May gave an early 2017 interview on Sky which appeared to lead to a sharp drop in the value of the pound. Sir Ivan Rogers, the EU Ambassador has resigned, maybe he was pushed, as he issued a properly prepared civil service reality check, stating that Britain’s plan for Brexit was a muddle and trade negotiations may take 10 years!! Whistleblowers and the messengers are treated with equal disdain in politics and the NHS. Theresa
May has provided some soundbites. She has substituted Cameron’s “Big Society”, with the “Shared Society”. It has the identical wooliness that came with the meaningless phrase “Brexit Means Brexit”. She did provide a little hope by promising additional support, including money for Mental Health. As a cynic I suspect this is playing to the gallery, particularly the £15 million mental health fund i.e. organisations must compete for it, presumably because there is not enough cash allocated. I rest my case.

At least let us get back to reality with the papers in this issue. The prevalence of depression is such that £290m was the NHS spend in 2015 on antidepressants. There is increasing evidence of their potential harmful effects, which have been neatly highlighted by Schlezak & Kripalani (p6). Febrile seizures are a terrifying experience for any parent, with the worry of potential permanent cerebral damage to the child. Newton and Cotton provide a timely contribution on how to manage the acute phase and a proforma on how to address the issues that will be raised by parents and carers (p16).

This issue tackles two chronic diseases. One poorly understood and rarely makes the headlines, Occupational Asthma (OA) by Feary and Cullinan (p23) and Diabetes, which is hardly out of the news headlines or health sections. The inability to recognize and manage OA can blight careers and health and accounts for about 15% of new asthmas diagnosed in adulthood. The inexorable rise in diabetes may well bankrupt the NHS unless major steps are taken to prevent its development and better manage it when diagnosed. The article by Prashanth (p35) focuses on diabetic neuropathies, which once established are not reversible but need to be identified early and managed to prevent even worse chronic debilitating effects.

Finally, the juxtaposition of a pregnant woman being treated with antiepileptic drugs (AED) is addressed succinctly by Kinney and Morrow(p49). The role of the GP is a key element in managing those in confinement at a time when they feel vulnerable and with the burden of knowing that AEDs can cause congenital foetal abnormalities.

A true mixed bag of medical issues which should keep the readers well engrossed in the cold winter months. The next issue will cover aspects of colonic cancer, revisit depression but this time concentrating on the younger ages groups (children and adolescents), a tour around the red eye and much more………..

Do remember that for your appraisal and revalidation you could do a lot worse than attempt the CPD activity available on line for each of the contributions that will permit you to assess your knowledge base and skills.

Please email comments and suggestions to me.

Professor Ram Dhillon


Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: Clinical Focus Primary Care
Read 16513 times Last modified on Wednesday, 01 March 2017 12:47

Post and reply comment

Make sure you enter the (*) required information where indicated. HTML code is not allowed.


BBC News Feed

Get in touch

Give us a call at
+44 207 637 3544

Email us at
info @


International Primary Care Association
73 Newman Street, London, W1T 3EJ