InnovAiT: Education and inspiration for general practice

As we launch into the second volume of InnovAiT, it is easy to forget that training for general practice became compulsory less than 30 years ago. General practice is a relatively new specialty of medicine, and the National Health Service that we work in, together with its concept of health care for all, is just 60 years old. It is often helpful to understand the context of the past, and this special editorial aims to provide a ‘Back to the Future’ glance of general practice and how it has evolved into the respected specialty that it is today.

Menopausal symptoms and their management are a common presenting complaint. Due to media hype and inconsistent reporting, there are many misconceptions about hormone replacement therapy (HRT) and alternative therapies. This article outlines the physiology and clinical effects of the menopause and the indications and implications of HRT. It will cover natural and surgical menopause and will not cover other metabolic and genetic causes for ovarian failure.

Breast lumps are a common presenting symptom in general practice. As a GP it is important to know how to manage them. Breast lumps can be a sign of breast cancer but 85% have innocent explanations. However, women presenting with a breast lump often assume that they have breast cancer and this can cause a great deal of anxiety. This article aims to overview the common causes of breast lumps, their assessment and management.

Ovarian cysts and tumours are a relatively common finding among women of many ages, particularly with the wider use of regular physical examinations and ultrasound. Although the finding of an ovarian mass can be a source of considerable anxiety, most of those in younger women are not malignant and may be able to be managed entirely within primary care. However, malignant tumours of several varieties occur and many will require investigation and management by secondary care.

Our clinical records are changing. The familiar world of a patient's record being kept by a general practice with no links to the outside world has already passed. New ways of working are arriving on our desktops daily. This paper looks at the implications of these changes.

Acute conjunctivitis is common. About 2–5% of general practice consultations are related to eye conditions and approximately 40% of these are concerned with conjunctivitis. Thus, on average, a full-time general practitioner sees a patient with conjunctivitis every week. The most common presentation is with a red eye. The main tasks are to exclude potentially serious causes of a red eye and then decide whether the conjunctivitis is infective, allergic or due to other causes so that suitable management can be initiated.

Sore throat is a common condition in primary care. As many as 1 in 10 people suffer recurrent episodes of tonsillitis. The cost per year to the NHS for primary care consultations, before investigation and treatment, for sore throats is estimated at 60 million pounds. It is also estimated that 35 million work and school days are lost in the UK per year because of sore throats.

Sinusitis is a common diagnosis in primary care, and around the third to fifth commonest reason for prescription of antibiotics. Yet, a recent Cochrane review of effectiveness of antibiotic for acute sinusitis concluded that antibiotics have only a small treatment effect with 80% of patients getting better within 2 weeks without antibiotic as against 90% in those given antibiotic. Why is this, and how can we target appropriate treatment to those who will benefit?

A recent article in the British Medical Journal (Everitt et al., 2006), looking at various options for the management of uncomplicated acute infective conjunctivitis (AIC), suggested that a delayed prescription of anti-infective eye preparations was the most appropriate choice. Up to this point, I routinely prescribed chloramphenicol or fusidic acid for all patients presenting with AIC and the partners at my practice agreed their management approach was the same as mine. A literature search of Medline, Cochrane Library and BMJ.com, using search strings ‘infective conjunctivitis’, ‘delayed prescribing’ and ‘conjunctivitis-delayed prescribing’ revealed further evidence for withholding treatment.