Leadership

We (the TPDs) attended a meeting hosted by the Deanery regarding the topic of leadership as part of the GP training.  A number of questions were raised: what is leadership, why should we be looking at leadership and how are we/could we incorporate leadership into our training programmes?  The deanery has been looking at leadership in detail over recent months and now have webpage with useful tips and links.  There was a general concensus that we do not always recognise that what we are teaching on the half day release is indeed related to leadership.  It was also apparent, after listening to the First5 GPs who spoke at the meeting, that very few of us think that we are “leaders” – even though as part of our day to day job as GPs we need numerous leadership skills in order to function effectively.

 

There is no way of doing justice to the topic of leadership in such a short post, however, if you are interested and wanted to find out more there a number of websites which are worth checking out such as the NHS Leadership Academy, the RCGP and the London Leadership Academy toolkit.

 

 

Prescription and Over the Counter Medication Addiction

Addiction to prescription medication and over the counter medicines has a significant effect on patients’ lives and can present a challenging clinical scenario for GPs.  Although it is not always as obvious as other forms of addiction, for example, to illegal drugs such as heroin or cocaine, it probably affects much larger numbers of patients.  There are two links to Radio 4 programmes which are both very interesting.

 

The first programme focuses on the role of the GP – I will leave it to you decide whether or not it accurately reflects what we as GPs are really thinking and doing.  The second programme looks at how over the counter medications can lead to very severe addiction problems.  If you are looking for practical, hands-on clinical advice the RCGP have a section on their website dedicated to the above problems – see the factsheets at the bottom of the page.

 

 

Update

NICE have just released their updated guidelines on lipid modification for both primary and secondary care.  These have led to a lot of debate about the pros and cons of reducing the threshold for starting statins in patients with a cardiovascular risk of 20% to 10%.  It may also have ramifications in terms of workload for general practice in terms of monitoring statin use.

 

Health Education England have also just released their report on how to shore up the falling numbers of GPs.  The report focuses on the shift of hospital training jobs to general practice, although how this work when current GP training vacancies are underfilled is yet to be seen.

 

Finally, there was an excellent Radio 4 programme on assisted dying. There is currently a bill going through the House of Lords and the debate on Radio 4 is very thought provoking, especially as caring for dying patients forms such an important part of a GP’s daily work.

 

GMS contract 2014/15

The General Medical Services (GMS) contract for 2014/15 has now been published.  This contains all the relevant guidance about the new contract changes agreed between the Government and GPs.  For those of you in General Practice over the next year you may well come across concepts such as the “Named GPs for over 75s” and Quality and Outcomes Framework (QOF) changes.

Prescribing Safety Indicators

The latest British Journal of General Practice (BJGP) contains an interesting article about medicines safety.  The authors identify a list of potentially dangerous medication situations (e186 and e187).  We felt that this sort of list may offer itself towards an audit or two!  The pdf can be found here (and is currently free online).

Communication skills and Improv

Thank you to Ryan Offutt who came to do a session on how the art of Improvisation can highlight communication skills and hopefully improve them too.  Ryan helps organise and run a group called MB Improv (based in Sheffield) and it struck me at the recent South Yorkshire GP Conference earlier this year what a fresh and innovative method improvisation was for teaching communications skills.

 

Improvisation is steadily gathering an evidence base to support its use in medical education (see the following link from pubmed) and hopefully the feedback from today’s session will further support our decision to include it as part of the GP training programme.

 

This clip is of one of Ryan’s warm up games – enjoy!

Neutropaenic Sepsis

The topic of neutropaenic sepsis was central to one of the SEAs we covered today at the half-day release session.  For those trainees who would like to read and learn a bit more about this potentially fatal condition I have attached the following links.

 

Although NICE guidance on the condition with regards management in Primary Care is limited to just four lines the advice is quite succinct and easy to follow:

 

“suspect neutropaenic sepsis in patients having anticancer treatment who become unwell…refer immediately for assessment in secondary or tertiary care.”

 

The Map of Medicine pathway highlights clinical signs that patients with neutropaenic sepsis may present with and once again stresses the importance of immediate referral to hospital.  Finally, the following YouTube clip (North West London Cancer Network) offers a patient’s first hand experience of neutropaenic sepsis and other good clinical advice.

 

Neuropathic Pain

NICE have released an update to their guideline on neuropathic pain.  First line medications now include Amitriptyline, Duloxetine, Gabapentin and Pregabalin.  During your training in General Practice you will see patients who experience neuropathic pain and for whom you may need to prescribe medications such as the ones above.  It is worth understanding how they work, how you prescribe them, what monitoring they may require and what the typical side effects might be.

 

Although neuropathic pain is only one form of chronic pain it would seem to account for a significant proportion of patients presenting with chronic pain.  It is important to consider how chronic pain may affect all aspects of a patient’s life and the limitations the pain may impose.  Paintoolkit.org is a website which provides resources and advice which may be useful both to doctors and patients.

 

An on-line CPD module can be found via Pulse.

 

Update

It has been a busy week with the publication, by NHS England, of the Urgent and Emergency Care Review and also the GP Contract for 2014/15.  The role of GPs in providing prompt same day access was highlighted in both reports, forming part of a plan to ease some of the pressure currently faced by emergency departments and also addressing the desire to reduced unplanned admissions.

 

The GP contract included some significant changes including the removal of a number of QOF points and areas.  The “headline” change would seem to be the enhanced service to reduce unplanned admissions and to provide proactive case management for patients identified by risk profiling.  Specific ways to support this would be direct telephone access to a patient’s GP for Emergency Departments and Paramedics and improving same day access.  In addition, all patients aged 75 years of age or older will have a named accountable GP who will co-ordinate their care and Practice boundaries will be removed.  NHS England will co-ordinate urgent same day care for those patients registered away from their home.  The push to harness the power of the internet continues and patients should have online access to their summary care record and be able to book online appointments and request medication (see the RGCP document Patient Online: The Road Map).

 

It is important to note that money is being recycled to enable these changes rather than new funding being directed to General Practice.  Perhaps with this in mind, the RCGP have started a campaign “Put Patients First: Back General Practice” to campaign for additional resources.  There is a lot interesting information in the campaign brief and you can sign receive updates either through Twitter or Facebook.

 

There will be a lot of changes in General Practice over the coming months, some of which will be very challenging.  I think that as GP trainees it is important you consider how you would approach these challenges and what the pros and cons may be.