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International Primary Care Association

Clinical Focus Primary Care


Skin cancer is the most common cancer in the United Kingdom and incidence rates are increasing. This article explains the common presentation, clinical features, referral guidelines, management and prognosis of both non-melanoma skin cancer (basal cell carcinoma and squamous cell carcinoma) and melanoma.


This article discusses key issues which underpin the theoretical and practical aspects of initiation and maintenance of insulin therapy in patients with Type 2 Diabetes (T2D). It is a complex area with many different insulin preparations, injection devices and regimens. The intention is to provide guidance to help Primary Care teams better understand some of the issues around insulin management in T2D.


Plantar Heel pain is one of the most commonly encountered problems of foot pain in active adults over the age of 40. One in ten people will experience heel pain, and for many the problem will have a significant impact upon their daily activities. This article focuses on the differential diagnosis, investigations and management of plantar heel pain in primary care. An evidenced based approach is presented for the treatment of plantar fasciitis, especially considering the multitude of treatment modalities available.


Whilst dizziness, vertigo and imbalance may be due to systemic disease, they commonly originate from the vestibular system. The presence of vertigo, in particular, implies vestibular involvement. This article will address the diagnosis and management of vestibular dysfunction in adults, highlighting the three commonest causes which can be diagnosed and treated in a primary care setting, and stressing the “red flags” that should trigger referral to more specialist services.


This paper represents personal reflections on the evolution of urology service provision over the past 30 years and offers a possible scenario for such provision in the future. I qualified forty years ago; those were the days when consultants were revered and their senior registrars worked hard to ensure that their masters were never disturbed out of hours; now it seems to be the consultants who work hard so that the ‘juniors’ can stay in bed! There were plenty of ‘Sir Lancelot Spratt’ (the senior surgeon in Richard Gordon’s film ‘Doctor in the House’1) characters about; one of whom undertook an open prostatectomy on my father. A few days later, when he found out that I was due to start at medical school later that year, I was summoned to watch him operate. After removing a kidney and leaving his senior registrar to ‘make good and close’, he took me into the senior surgeon’s sitting room and gave me a few pointers for the future. The most memorable ‘tip’ was that as soon as I had a consultant job I should buy a Rolls Royce car. “Borrow the money if you have to” he said but remember you are in the only job in which you will be respected more for it… and you can double your fees straight away!

Globally, cervical cancer is the second most common cancer in women with half a million new cases diagnosed annually and a quarter of a million deaths. The UK has one of the best cervical cancer screening programmes in the world, but even with this there are three thousand new cases of cervical cancer each year in the UK and a thousand deaths. Six percent of these deaths are in women under thirty.

Human papillomaviruses are DNA viruses that infect epithelial (skin or mucosal) cells. They are described as “genotypes” and numbered in order of their discovery.

HPV – structure

The virus particle or virion consists of a protein coat encapsidating a circular DNA molecule about 8000 base pairs (8kb) in size. High resolution electron microscopy reveals the virion to be a particle of about 55nm in diameter

The psychosocial effects of HPV-related disease may be related to the disease itself, its treatment and the knowledge that the disease is caused by HPV, a sexually transitted infection. There are also psychosocial consequences from the cervical screening programme, even among women who do not have disease.


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International Primary Care Association
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