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The Credit Crunch is well and truly entrenched and despite the rhetoric of our political
masters it will undoubtedly worsen. We shall all be affected on a personal level, but there
will be a tightening of expenditure on public services, including the NHS. Already we hear
mutterings on the likely clampdown on pay awards. Unlike the fi nancial sector the NHS will not
be rewarded with large handouts to keep the service World Class. The NHS, and by extrapolation,
a healthy population, is less essential to the economy than a stable financial sector.

The NHS will be expected to function within very rigid and tight monetary constraints. I suspect
that this may bring into sharp relief aspects of recent reorganisations and edicts that may
assist us. One such avenue is the ability of GPwSIs to take a lead not only in Commissioning
but be prime movers in implementing and delivering Treatment Closer to Home, Reducing
referrals to secondary Care and blah blah blahThis is on the premise that primary care
can provide cost effective, not cheaper services, for many patients, who at present are in the
secondary care firmament.

Such a shift, and I believe an absolute necessary one, can only be sold to secondary and
patients provided the GPwSI services can ensure high standards of clinical care, equivalent,
if not in some circumstances better, than is being delivered in hospitals. This requires support
to develop requisite clinical skills, which of a necessity are rarely acquired in the usual time
frame required by administrators e.g. a half day, day or weekend. Medicine is about Pattern
Recognition, and this takes time, months to acquire, by regular immersion in the desired
milieu e.g. diabetes, cardiology, ENT etc.

Secondly, we MUST ensure that the accreditation of new and re-accreditation of established
GPwSIs, which came into effect, by way of a DH policy, over 12 months ago, is executed by
PCTs. For example the latter group of GPwSIs mentioned, should have ALL been through the
re-accreditation process by 31st March 2009! The responsible body, PCTs, in large part will not
meet this deadline, even in the coming months!! Maybe the GPwSIs should take the lead and
lean on their PCTs to implement this most important aspect of continued accreditation.

I am delighted to inform you that many of the above mentioned issues, but particularly the
GPwSI (re) accreditation will be a focus during a conference being organised by Rila on
14th May 2009, in Central London. Although the morning is concerned with clinical issues in
ENT, all GPwSIs in ENT and those with more than a passing interest in ENT are very welcome
to attend. The afternoon workshops should appeal to a much wider GP audience e.g. GP
commissioners, PBC leads, PEC chairs etc. Details are in the body of this issue.

Allergy has become a rather large focus for ENT, but it is the dawn of the Hay fever Season!
The articles on ENT provide insight into Microsuction of the Ear, an art for GPwSIs and some
Nurse Practitioners in ENT. You will be better informed as to who to refer to such colleagues
in primary care and which patients should have hospital based care. The contribution on
Discharging Ears is excellent as it will assist heightened diagnostics in this all too common
problem encountered in primary care.

Continuing the theme of Hay Fever, the article on Watery Eyes, covers this and other important
clinical aspects of this symptom. Oesophageal carcinoma is a dreadful disease and its
increasing prevalence is discussed and pointers on features that may lead to quicker diagnosis
and hopefully improved outcomes is discussed.

Chronic diseases e.g. diabetes, COPD, ischaemic heart disease etc consume 20 billion of
NHS resources per year. Many of these are related to long term lifestyle, with increasing levels
of obesity a manifestation. Managing obesity in the community is an important function of
health promotion and contained herein is an article that will enable you to be better equipped
to understand the issues and make a small contribution to reducing the long term harmful
medical consequences. The cynic may argue that if this fails we can rely on Pharma to provide
a pill or two to mitigate the consequences of obesity. Statins perhaps fall into this category,
but medication may be fraught with unwanted side effects. We visit the contentious question
of liver function in this protean group of drugs.

Finally, I should be delighted to receive editorial suggestions and copy on topics of value to
primary care. Please feel free to contact me via the publishers.