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International Primary Care Association

Clinical Focus Primary Care

Phew! Andrew Lansley and the coalition must be relieved that the Health and Social Care Bill has finally been passed. It seems have had more alterations than a wedding suit and now one only hopes it fits the purpose. Opposition continued to the bitter end. Members of the Royal College of Surgeons, managed to muster the minimum number of sponsors to call an EGM to debate the RCS’s approach to the legislation. In the event the debate voted in favour of “Critical participation”, rather than aligning to several other august professional bodies who took a stance of “Open opposition”. The Bill has come to pass, which frankly was inevitable.


The process of GP accreditation and re-accreditation for Minor Surgery is a developing area, which has been slow to become mainstream. It needs to be fit for purpose, non-threatening and robust to withstand criticism. This article discusses how this may be achieved, with a process already tried and tested, and why such a requirement is absolutely necessary.


Acute cough is a common and challenging presentation. While the majority of patients have a self-limiting illness, cough can be the presenting symptom of a number of serious disorders. History and physical examination can identify most of the “red flag” signs and symptoms indicating the need for further investigation.


CMPA (Cow’s Milk Protein Allergy) is a relatively common condition in infancy that often presents to primary carers with a diverse range of symptoms. Accurate diagnosis, management and engagement with health professionals is essential to optimising outcomes and saving unnecessary expenditure. Cow’s milk allergy is the most common cause of death from food related anaphylaxis in children in the United Kingdom; although rare it makes this a significant topic for review and regular re-evaluation. A number of specific algorithms are available to assist general practitioners and paediatricians with this process. Management is usually based on dietary elimination, dietetic support and symptom management. A referral to Hospital services should be made if a diagnosis is in doubt, or if symptoms are severe or poorly controlled.


Depression is more common in people with long term physical health conditions (LTC). The presence of depression in people with an LTC, is likely to adversely affect the management of that LTC, and the individual is likely to consume more health care resources.


Eating Disorders are a group of mental disorders that have abnormal eating patterns in common in their presentation. They generally have their onset in childhood and adolescence but may be chronic and extend into adult life. There is an emphasis on the role of primary care in coordination of their management. 


Age-related macular degeneration (AMD) is an increasingly common cause of blindness in the UK. Patients commonly present to primary care and the correct diagnosis with rapid referral to access new treatments may save their vision.


Thyroid disease is common. In a Primary Care group practice of 10,000 patients there are likely to be over 200 with hypothyroidism who require thyroxine replacement therapy and a further 100 who have subclinical disease. Hyperthyroidism is less common but with a prevalence of 0.7% a typical practice is likely to have 50-70 patients with clinical disease, and a further  50-70 with subclinical disease. A clear understanding of the diagnostic issues involving thyroid disease and key management issues are therefore essential. 


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