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.

One day conference: Practice Management

A big thank you to everybody who made today’s conference so enjoyable.  There was a real buzz and it was good to see and hear trainees getting involved with the different scenarios.  Hopefully you now appreciate the joy of agreeing annual leave between colleagues, sorting out planning for the impending Winter crisis and can balance the books of the Practice where you work!  Special thanks and mention to Dr Pete Lane who organised and ran today’s conference.  Pics are now up on the Gallery page.

Update

The RCGP annual conference took place this week in Harrogate against the backdrop of increasing media attention on seven day opening of GP surgeries.  Earlier in the week the Prime Minister shared his vision for patients to have the “chance to visit a GP in the evening or at weekends”Concerns have been raised about how the current GP workforce would be able to meet this demand when we are struggling to cope with the current workload.  I wonder how, as GP trainees, you feel about the prospect of working significantly different hours to those you “signed up for” when you accepted your place on the GP training scheme?

 

Another controversial idea was that floated by Dr Clare Gerada with regards the independent contractor status of GPs.  Dr Gerada has suggested that GPs should be “salaried to the NHS”.  An interesting summary of the pros and cons can be found in a document Dr Gerada published in 2009 for the RCGP.  I suspect this will continue to be a contentious topic of debate that, if it comes to pass, may have a bearing on your own professional plans as a GP trainee.  What would you choose?

 

If you would like to see more then check out the videos of Jeremy Hunt and Dr Clare Gerada delivering their speeches at the conference.

 

Away from the conference, NICE have released “Diagnostic guidance” on the use of Faecal calprotectin.  This is a test used to help differentiate between patients with irritable bowel syndrome and those with inflammatory bowel disease (Crohn’s disease and Ulcerative Colitis).  On the surface of it this would seem to be a useful test for GPs who frequently see patients with bowel symptoms. I would recommend having a look at the guideline – even though I am not entirely certain if the test is available in Barnsley yet.

 

Results of the CSA review

The independent review of the Clinical Skills Assessment (CSA) has now been published. The General Medical Council (GMC) commissioned the review amidst growing concerns from groups such as the British Association of Physicians of Indian Origin (BAPIO) about the failure rate for International Medical Graduates (IMGs) taking part in the CSA.  Further details of the review can be found at bmj.com.

 

Despite the conclusion suggesting that “it is the preparedness of UK graduates that may be an explanation for the differences between these two groups” and observing that the “CSA is not a culturally neutral examination” the author of the report, Prof Aneez Esmail, has allegedly accused the GMC and RCGP of “mis-representing” his report.

 

In 2010 the Yorkshire and Humber Deanery published a report looking at the experience of IMGs.  The results of this report seem to support some of the conclusions from the CSA review and may be useful for trainees and their trainers to take into account. Our hope is that all trainees on the Barnsley VTS get a better understanding of the culture of the local communities within which they work.

 

Social Media

As technology has advanced social media has become an every day part of our lives.  As doctors it can be a valuable tool for educational purposes and for meeting and talking to colleagues.  The majority of us will also use it in our own social lives outside of the medical sphere.

 

However, the use of social media can also pose challenges for doctors.  As GP trainees you will work within relatively small populations of patients who are often part of close-knit communities.  Many of those patients will have access to social media and therefore potential access to you and your views.  Earlier this year the RCGP produced The Social Media Highway Code which aims to provide some principles to help doctors use social media effectively and in a responsible manner – I would definitely suggest you have a look!

 

The GMC have issued guidance on social media and medical defence organisations are taking an interest.  Personally, I feel that social media has a huge amount to offer when it comes to sharing ideas, discussing issues and also providing a source of support.  Are you willing to give it a go?

Update

As the new ST 1 trainees settle in, we hope that those ST 3 trainees who have recently left are doing well in their new jobs and enjoying life as independent GPs.

 

In other news…Dr Iolanthe Fowler is looking to re-form a South Yorkshire Trainee Forum.  This sounds like an excellent opportunity for any trainees who may be interested in sharing and exchanging ideas with other GP trainees.  Further details can be found here.

 

There is also an exciting opportunity for those GP trainees who are currently starting ST 2.  The Yorkshire and Humber Deanery are advertising an Out Of Training Opportunity (OOPE) to two destinations: New Zealand and South Africa.  These would commence from August 2014 and last for one year.  Further details can be found here.

 

Finally, on the 21st September, the RCGP Sheffield Faculty is hosting an AiT Fair at the Workstation in Sheffield.  There are a number of speakers with topics ranging from “How to survive GP training” to “Life long learning”.  The flyer for the event can be found here.

 

As always, please feel free to contact one of us, or Rose, if you have any questions, or are experiencing any problems.

Learning Disability

We would like to say thank you to Joanne Brown for kindly talking to us about the Learning Disability DES and how it is being implemented in Barnsley.  The Cardiff Checklist provides a comprehensive template that can be used to aid the annual health check for patients with learning disabilities.

 

The barriers that patients with learning disabilities face in accessing health care services have been highlighted in a number of reports: the Confidential Inquiry into Premature Deaths of People with Learning Disabilities and Death by Indifference: 74 deaths and counting.

 

As a GP Trainee caring for patients with learning disabilities you will need to consider the varied ways in which you may be able to support patients and their relatives.  We have included a number of resources that we found helpful, however they are by no means exhaustive:

 

Mental HealthChanging Minds, Changing Lives (Mental Health Foundation/Foundation for People with Learning Disabilities) and Enabling People with Mild Intellectual Disability and Mental Health Problems to Access Healthcare Services (RCPSYCH)

 

Future Care PlanningThinking Ahead: a planning guide for families (Foundation for People with Learning Disabilities)

 

Sexual HealthEqual Access to Breast and Cervical Screening for Disabled Women (National Screening Programmes) and Behind Closed Doors: preventing sexual abuse against adults with a learning disability (MENCAP)

 

DementiaLearning Disabilities and Dementia (Alzheimer’s Society) and Dementia and People with Learning Disabilities (RCPSYCH)

 

Further resources can be found on the RCGP learning resources website.

Welcome!

A warm welcome to all the new GP trainees who are starting on the Barnsley GP Training Scheme tomorrow.  We hope that you enjoy your time on the scheme and if you have any questions, or problems, please let us know!  The first VTS half day release is next wednesday – please check the calendar.