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International Primary Care Association

Clinical Focus Primary Care

from the editor...

Since my last editorial the medico-political remain the same but the calamities seem to have risen, confusion reigns and decision making is blighted.  

Brexit still hovers over the European workers in the NHS with so far no guarantee they will be allowed to stay. Jeremy Hunt, amazingly still the Secretary of State for Health, has decided on an extra 1500 places a year for medical schools from 2018 onwards to finally overcome any need for foreign doctors to work in the NHS. Without asking medical schools (can they cope?), postgraduate training programmes (can they cope?), how long will it take to have any effect (10 years is the lowest estimate, so what to do in the interim?), a significant number of trained doctors leave and go abroad immediately after qualification (how is this to be prevented?) and so it goes on and on and on….The picture of “Knee jerks”, well known in medical circles, is the apposite image this policy conjures up.

When is an imposition not an imposition? Another conundrum thrown into the medical arena by Mr Hunt. The junior doctors contract has come into effect but it may be actioned by trusts at their discretion and with local variation. So what was all the posturing by the Department of Health on the absolute need for the new contract to deliver a safe effective 7day service. The phrase, “7day service”, has barely been uttered, recently, by Hunt and his followers. It was a pretty nonsensical sound bite without any basis so good riddance, but I do, “Smell a U turn”, well recognized in political circles, or at least a “Z plasty”, well recognized in medical circles, with a very lengthy vertical element!

Oh, and, let us save £20 billion while we are coping with everything else!!

Patients! Oh yes, lest we forget, we are here to tend the sick and needy. This issue has an abundance for the reader with a big focus on Cardiology. Hoole et al (p. 140) visit the Acute Coronary Syndrome, a condition, if missed as a cause of chest pain amongst the other common causes of such symptoms, could be catastrophic for the patient. The ageing population has led to Atrial Fibrillation now becoming a major component of primary care diagnosis and ongoing care and monitoring. Boylan et al (p. 153) provide the key features for primary care physicians to manage this dramatic increase in incidence. With statins in the news, usually courtesy of the Daily Mail, we have a timely and considered view on the incidence of complications of statins and whether we are actually advising patients correctly. Wood and
Francis (p. 185) have neatly encapsulated the arguments and shown if they withstand scrutiny.

Banbury et al (p. 171) have summarized the issue of Somatic Symptom Disorders., conditions where no physical cause can be identified to explain the patients’ complaints. The increasing burden of such patients in primary care means that physicians need much better understanding of the disorder, which is aptly provided in this contribution. This issue includes an overview of “Urinary Tract Infections”, which is an extremely common diagnosis made in primary care and will, in the main, be managed in the community. Al-Wali et al (p. 195) provide the key to better diagnosis and management but also the red flags which should alert the community to seek an early secondary care opinion.

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. Ideas for future contributions should be emailed to me directly.


Professor Ram Dhillon


Additional Info

  • Authors: Professor Ram Dhillon
  • Keywords: Clinical Focus Primary Care
Read 17644 times Last modified on Tuesday, 25 October 2016 17:02

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