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The planned NHS reforms have kept our medical leaders and politicians verybusy over the last few months. The focus has been on the process ofcommissioning and who should have control of the financial levers, theproblem of the private sector cherry picking the lucrative elements and conflict ofinterest of GPs. The previous structure of PCTs was mired in stagnation, planningblight with an emphasis on managing the finances and not the delivery of care. Anyreform that allows us to put clinicians at the front end of the decision makingprocess will be better than what we have had in the past, even if there are wartson the new framework. The public still trust doctors more than most otherprofessional groups, including politicians!
The amount of airwaves and TV time together with acreage of print dedicatedto the reforms gives an impression that clinicians are obsessing with the intricaciesof the planned changes. Having spoken to numerous colleagues most are gettingon with their patient caring responsibilities. Those GPs with a bent for finance andmanagement have self-selected to engage with the implementation of the reformsand many of them, despite some reservations, see them as a move in the rightdirection. My own take is that it is the monitoring and scrutiny of the process, theclinical and non-clinical components, that needs to be robust so that risks areminimised. More recently, it is reported that the government and Mr Lansley maybe backtracking on aspects of the reforms. I have my doubts. This policy wasagreed by Mr Lansley and his deputy, a liberal democrat minister, so the coalitionparties are at one. Some lip service of a pause in the process will be offered butthat will be a smokescreen.
This issue, happily, contains no articles on the NHS reforms but an array ofclinical disorders relevant to daily primary care practice. Mark and Young-Min havepenned an excellent overview of Temporal Arteritis, an infrequent but not to bemissed cause of headache. The protean presentation of Polycystic OvarianSyndrome is discussed by Kalkat and Irani and the role of the GP highlighted. It isopportune to have Worsnop and Craythorne address the issue of Skin Cancer.Many of you will be performing minor skin surgery and so will be required to complywith the Specialty frameworks for Dermatology & Skin Surgery just published bythe DH. This article will assist in addressing some of the requirements.
The use of Insulin in managing type 2 diabetes is now an increasing option butin which patient. Dr Page has provided a comprehensive review of what you needto know. Pater West has provided a cogent article on those heart sink patients withDizziness and Imbalance. Ali and Baghla address the issue of Plantar Heel Pain,a very common presenting ailment in the community. Finally, Professor Brian Ellis,a recently retired Consultant Urologist, gives his thoughts on how to best structurea local urology service, with a major role for primary care physicians.
All contributors have spent considerable effort in devising the Assessments,which provide the reader with evidence of Verifiable CPD, which can be includedin their Personal Portfolio and used in appraisal. The assessments have to becompleted online. Successful completion allows a Certificate to be downloaded.
I would also be delighted to receive letters and comments and suggestions onfuture editorial content.
Happy reading and a Happy Easter.