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International Primary Care Association

Clinical Focus Primary Care


Paediatric sepsis is an important cause of morbidity and mortality in children. However, in a primary care setting it remains uncommon. This is a review of the current understanding of paediatric sepsis together with evidence-based advice about its recognition and management in primary care.



The incidence of self-harm is increasing in the UK. It is the single best predictor of completed suicide and is associated with poor outcomes in terms of emotional wellbeing and educational attainment. The majority of patients do not present to medical services after an episode of self-harm and so GPs play an important role in identifying the problem, reducing stigma and providing support.


Self-harm is associated with a broad range of risk factors related to emotional distress rather than severe mental illness. It is commonly associated with misuse of alcohol and other substances. Other important risk factors are adverse life events such as unemployment and relationship difficulties, as well as a history of current or past abuse or institutional care. In young people precipitating factors can include arguments with parents and stressors at school such as exam pressures, bullying or cyber bullying.


Self-harm is stigmatised by the general public and medical professionals, so there is a need to approach the subject with sensitivity, respect and acceptance. Self-harm is a behaviour, rather than a diagnosis in itself. It can be seen as a symptom of an underlying mental or personal difficulty, or serve a function for the patient; exploring these reasons can guide management, which focuses on the underlying difficulties. Actively involve the patient in the management plan, asking about their preferences and previous experiences of treatment. High risk patients with a severe mental illness or active suicidal thoughts should be urgently referred on to mental health services for further assessment. Patients at low risk may be supported in primary care, and those in between can be referred to non-urgent mental health or social services, or a 3rd party organisation.

A very Merry Xmas and A Happy and Prosperous 2016 to all our readers.


We leave 2015 with the Chancellor agreeing to pump in an extra £6 billion into the NHS and the government retreating from the unnecessary confrontation with junior doctors. The cash is welcome to ease general and the upcoming winter pressures but unless there is a concomitant restructure to minimize the bureaucracy much of the money will not be directed at frontline services but on bean counters. Bean counters incentivized to attain, and generally failing, the meaningless central government health targets, and being paid very well to do so. This smacks of and mirrors in many respects what we all loath about the financial industry which almost single-handedly ruined the UK economy, but purportedly was working in the public’s best interests!


Cerebral Palsy (CP) describes a group of permanent disorders of movement and posture, attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. It is commonest cause of physical impairment in children. With recent advances in medical and surgical care, many children with previously fatal problems are now surviving to adulthood. Many of these conditions until recently have been unfamiliar to those working predominately in adult practice. Transition is defined as a “purposeful, planned process that addresses the medical, psychosocial, educational/vocational needs of adolescents and young adults with chronic physical and medical conditions as they move from child centered to adult oriented health care systems”.


Acute kidney injury (AKI) is common and serious. While it is usually cared for in hospital, it is no less important in primary care. AKI typically arises first in the community and is often not completely resolved at hospital discharge. Primary care has a role both in prevention and follow up of AKI. Surveillance for new chronic kidney disease (CKD) is recommended in guidelines. In this article we compare the diagnostic criteria for AKI and CKD, what a diagnosis means in primary care, and the role of primary care in monitoring for CKD after AKI.


Alcohol is a leading cause of physical, psychological and social harm. In this review, we explain the current categorisation of alcohol use disorders in the context of these harms. We then discuss the rationale and recommended methods for screening for these disorders in primary care, and the principles of treatment.


Teenage pregnancy is frequently encountered by general practitioners who are often the teenager’s first encounter with the health services. Despite falling rates and intense government initiatives over the past decade to address high rates of teenage pregnancy, the United Kingdom continues to have one of the highest teenage birth rates in Western Europe. Teenagers have unique social and medical issues in pregnancy which require careful management from their general practitioners to help optomise pregnancy outcomes and reduce recurrence of repeat pregnancy.

Trust! Defined by the OED as, “Firm belief in the reliability, truth, or ability of someone or something”. This month’s healthcare news is deluged with the “loss in trust between clinical staff and the government”. It is the words, truth and reliability, which interest me in the definition.



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International Primary Care Association
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