InnovAiT: Education and inspiration for general practice

Dyspepsia is a very common condition affecting 40% of the adult population of the UK in any given year. Many of these will self-treat with over-the-counter (OTC) preparations including antacids and alginates. Only 2% of the population will present dyspepsia symptoms to their GP. Prescribed drugs and endoscopies cost the health service £600 million a year. A further £100 million is spent on OTC treatment for dyspepsia.

Irritable bowel syndrome (IBS) is one of the commonest causes of gastrointestinal (GI) consultations in primary and secondary care—it accounts for approximately 3% of all GP consultations. IBS has a prevalence of between 10% and 20%; however, most people (75%) never consult a GP. It is a relapsing and remitting condition and those who do present to general practice have a wide range of symptoms including abdominal pain, bloating, change in bowel habit, fatigue, nausea, backache and bladder symptoms. IBS symptoms can be distressing, leading to time off work, reduced social functioning and a reduced quality of life. This article will outline the key aspects of diagnosing and managing IBS in general practice including highlighting the new NICE guidelines for the diagnosis and management of IBS in adults (published February 2008).

Ulcerative colitis (UC) and Crohn's disease are collectively termed inflammatory bowel disease (IBD). Both UC and Crohn's disease are chronic, relapsing-remitting diseases characterized by acute, non-infectious inflammation of the gut. Diarrhoeal diseases likely to be IBD have been described for centuries. King Alfred (849–899 AD) suffered from an illness which caused pain on eating, discomfort, and much embarrassment. This affliction plagued the King from the age of 20, without remission. At the time the illness was thought to be due to witchcraft or a punishment for the King's infidelities. In retrospect, however, the illness was probably IBD. Despite this, UC was not formally described until 1859, and Burrill B. Crohn did not describe the disease later named after him until 1932.

Testosterone deficiency in older men as a result of testicular failure is commonly termed the ‘andropause’ or ‘male menopause’. This is a misleading term as it implies a sudden and complete cessation of male sex hormone production and resulting loss of fertility. In reality, the process is more of a gradual decline with reduction, and not cessation, of testosterone production. As a result, other terms have also been used to describe the same phenomenon. These include ‘symptomatic late onset hypogonadism’, ‘androgen deficiency (or decline) of the ageing male’, or ‘partial androgen deficiency in ageing males’.

The prevalence of symptomatic benign prostatic hypertrophy (BPH) in Europe varies from 14% for men in their fourth decade to more than 40% in their sixth. Assuming an overall prevalence of symptomatic BPH of 30%, in the UK, would mean that approximately 4 million men aged more than 40 years suffer from the condition.

Prostate cancer is the most common cancer in men—it accounts for approximately 23% of all new male cancer diagnoses and is responsible for 13% of cancer deaths in men, second only to lung cancer (24%). Approximately, 34 986 new cases are diagnosed each year and 10 000 men die from prostate cancer every year in England and Wales. It is predicted to overtake lung cancer as a cause of death in the future. Worldwide it is the sixth most common cancer. The incidence varies widely by ethnic group around the world. The lifetime risk of being diagnosed with prostate cancer in the UK is 1 in 14 men (though many more will die with undiagnosed prostate cancer). It is estimated that 15–30% of men over 50 will have histological evidence of prostate cancer. At 80 years, approximately two-thirds will have detectable prostate cancer. Despite this high prevalence only one in four will die from the disease, hence the phrase ‘Men are more likely to die with prostate cancer than from it’.

Through a number of different mechanisms, practice-based commissioning (PBC) was intended to improve patient care. Firstly, it was meant to increase clinician involvement in the commissioning of new services for patients. Secondly, PBC made it easier for GPs to develop new services themselves. Thirdly, through the greater familiarity of local budgets and Payment by Results (PBR), GPs were meant to feel financially accountable for their referral decisions.

The aim of this project was to see if and how practice-based commissioning (PBC) can be used to set up a pulmonary rehabilitation (PR) service for my practice and the neighbouring practices within our PBC consortium.

This issue of Crammer's Corner considers how to approach learning those topics encountered in general practice that do not appear to have a RCGP curriculum statement of their own and how to tackle those topics that appear more than once in the curriculum.