Multimorbidity: time to deliver the Emperor’s clothes

Bruce Guthrie, Professor of Primary Care Medicine at the University of Dundee in Scotland, says there isn’t a big bang solution to multimorbidity. Reblogged with permission from CMAJ Blogs.

Multimorbidity is usually defined as present when people have two or more chronic conditions. It’s an idea that appeals to medical generalists because it makes clear that specialist care that only focuses on one of those conditions may sometimes be too narrow, particularly when someone has very many conditions or when the conditions they have are very different. Physical and mental health conditions are the exemplar of the latter, with many countries having separate services for each that rarely communicate or consider the interaction between mind and body. Continue reading


Does patient and public involvement have an impact on primary care? (P)PG Tips from the front line

Jess Drinkwater, NIHR In-Practice Fellow in the University of Leeds Academic Unit of Primary Care and a GP in Bradford shares her tips on how involving patients and the public impacts primary care.

Patient and public involvement in general practice, in the form of Patient Participation Groups (PPGs), has existed since the 1970s. The stated aim is to involve patients in service improvement activities to ensure more patient centred general practice services.

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Academic primary care – the exciting place to be

Dan Richards-Doran, from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, writes about our recent keynote address from Simon Stevens.

NHS England Chief Executive Simon Stevens stressed the importance of academic primary care in answering some of biggest challenges faced by the NHS in his speech to the SAPC 44th Annual Conference in Oxford this week.

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Greater GP access: a panacea for rising Accident and Emergency use?

In our second post about GP access, Fiona MacKichan, Lecturer in Medical Sociology at the Centre for Academic Primary Care, University of Bristol, puts forward a case that quality of access to primary care, rather than quantity, may have greatest impact on A&E attendance.

GP access has become a focus of governmental response to rising A&E attendance. Outlining a ‘new deal for general practice’ on 19 June Jeremy Hunt cited safeguarding hospital capacity as a key driver for 7 day primary care access. The logic is that a significant proportion of A&E visits are for problems that could be managed in primary care and lack of available GP appointments drives people to A&E.

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Inter-arm difference in blood pressure and mortality

An analysis of data from several studies confirms previous reports that a difference in blood pressure between arms (known as the inter-arm difference) is linked with a greater risk of dying from cardiovascular disease. Chris Clark, NIHR Clinical Lecturer in General Practice and Primary Care from the Primary Care Research Group, University of Exeter Medical School explains the latest meta-analysis.

When blood pressure is measured a significant minority of people have different readings in their left and right arms.For example, based on our previous studies, a difference in the systolic (higher) readings of 10mmHg or more is seen in approximately 10% of adults with hypertension, 7% with diabetes or 4% of a general adult population. Studies which have followed up people with these inter-arm differences over a number of years have shown increased rates of death compared to those without.

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Mr Grumpy becomes Mr Happy

Rebecca Porter, from the Community and Health Research Unit (CaHRU) in the School of Health and Social Care at the University of Lincoln
talks about how pharmacists can work with patients to help them manage their insomnia, rather than prescribing over-the-counter medication.

We have all experienced that dreaded night, constantly tossing and turning and looking at the clock thinking “if I go to sleep now I’ll get at least 4 hours” and the horrible “leave me alone or I may just bite your head off” feeling the next day. For most of us, this is a one-off event. For a third of the UK population, insomnia can be a continual factor in their lives; affecting all aspects of quality of life.

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What is the solution to the GP workforce crisis?

Puja Verma, GP Trainee at Norwich Medical School, University of East Anglia, briefly describes work looking into the best strategies to recruit and retain GPs, the data from which will be published soon.

The UK is facing a GP workforce crisis as care shifts from hospitals to the community without enough GP’s to meet the demand. Too many GPs are leaving general practice and not enough junior doctors are choosing it as a career.

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Supporting people with medically unexplained syndromes

Keynote speaker Rona Moss-Morris gives an insight into her upcoming talk tomorrow to the SAPC Conference audience on medically unexplained syndromes. Rona is Professor of Psychology as Applied to Medicine at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. Reblogged with permission from CMAJ Blogs.

I am delighted to be presenting a keynote talk to the upcoming SAPC conference on a topic very dear to my heart. My interests in this area began as long ago as 1988 when I moved from South Africa to take up a post in a small East Coast town in New Zealand. One of the first patients referred to me, let’s call him Mr X, had a mysterious illness called Tapanui Flue. A previous high level athlete and school teacher, he was experiencing overwhelming and disabling fatigue. So there I was, new kid on the block in a strange country, faced with a condition I had never heard off and a very distressed patient. Still to this day I regret the fact that I wasn’t much help to Mr X. I subsequently learned that he more than likely had CFS/ME and so began my research career. 25 years later I am confident that if I knew then what I know now – I could have made a difference to this patient. However, many of these patients are still failed by our current system, and I hope to elucidate in my talk on Thursday as to why this might be.

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GP’s first impressions and the diagnosis of early cancers

Olga Kostopoulou, from Imperial College London, recommends that attempts to improve the diagnosis of early cancers should target the early stages of the diagnostic process.

Cancer survival in England is worse than in other European countries. Poor cancer survival has been partly attributed to late diagnosis. Unfortunately, diagnosing cancer, especially in its early stages, is difficult. Many patients do not experience so-called ‘alarm symptoms’, such as rectal bleeding, severe weight loss and haemoptysis, which could alert the GP to the possibility of cancer. In fact, in many cancer cases, patients present with more subtle symptoms, which are common in other conditions.

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