InnovAiT: Education and inspiration for general practice

Around 3.8% of the UK population are registered as having diabetes according to the prevalence data from the Quality and Outcomes Framework (QoF). There is a strong evidence base that good control of blood glucose levels, blood pressure levels and the use of statin therapy reduces the risk of developing microvascular complications (retinopathy, nephropathy and foot problems) and macrovasular complications (heart attacks and strokes).

Thyroid disorders are among the most common medical problems under GP follow-up, with a prevalence rate of approximately 1 in 20. It is approximately 10 times more common in women than men.

Primary care is where most diagnoses of pituitary adenoma are made and pituitary adenomas are responsible for almost all pituitary problems. They typically present with a combination of symptoms of space occupation, hypopituitarism and/or inappropriate hormone secretion. As early diagnosis with optimal initial management and expert follow-up in the long-term help minimize morbidity, it could be argued that once conspicuous features of classical hormone-excess phenotypes such as acromegaly or Cushing's disease have emerged, diagnosis has been unduly delayed, even though the adenomas themselves are intrinsically benign.

With an aging population in the UK, an ever increasing percentage of a GP's workload is spent with the care of older people.

Osteoporosis occurs mostly in postmenopausal women and patients taking long-term corticosteroids. In women, the lifetime risk is 40% and men have a much lower but still significant risk of 13%. The survival rates after hip fracture vary with the patient's age, for women between the ages of 65–69 years 1-year survival is 11%, while for men over 90 the figure is 67%. Hip fractures and other osteoporotic fractures can have an enormous impact on a patient's mobility and quality of life, leading to increase use of social care services and informal carers. The cost of osteoporosis and fractures is immense, this cost not only relates to the initial hospital care but also ongoing social care costs. Each admission from fractured hip can cost the NHS over £8,000. The main aim of treatment is to prevent fractures and to reduce the both morbidity and mortality.

We live in an ageing society. Since the early 1930s, the number of people aged over 65 has more than doubled and today, a fifth of the population is over 60 (Fig. 1). This has implications for prescribing in primary care. Prescription drug usage increases with age. One in three NHS prescriptions is issued to a patient over the age of 65 years, and 90% of these prescriptions are for repeat medications. Furthermore, adverse drug events are common reasons for hospital admission in the over-75 age group, accounting for 5–17% of admissions. Many are avoidable. This article aims to outline the principles of prescribing for older people in primary care.

Rural General Practice is not a well-defined entity. The lack of locally accessible services, both medical and social, demands that a rural practice develops care pathways and service delivery that differs from urban practices. This, and the nature of a personal list in a defined community, inevitably shifts the balance between proactive and reactive care. W. H. Auden summed up a little of what the essence of rural practice is: well grounded and practical advice given within the context of patients and community; all our patients die (acknowledging an increasingly unspoken fact) and our relationship with them on that journey between birth and death is the essence of all general practice.

This month's Crammer's Corner looks at how the RCGP curriculum has been approached by trainees and educators since it was introduced last year and presents an alternative way to visualize the curriculum.