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International Primary Care Association

Clinical Focus Primary Care


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. 

The festive season would be over by the time this issue reaches you. We certainly need glad tidings. There are national and international calamities disrupting our economic and health related wellbeing. The Greek economic crisis may well have enveloped Italy and other Eurozone countries with the detrimental effect on the EU economy. As about 40% of UK exports are to Europe this will undoubtedly have a major negative impact on our GDP and therefore on public services. The austerity measures introduced by the government have prevented a financial UK meltdown but at what cost? The NHS will lose £20 billion over 5 years and all other public key sectors are similarly affected, education, welfare, police, councils. However, let us not forget the less obvious targets for reductions in support, such as children’s services, domestic violence….


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