Foreword

The pace of change in general practice seems to be accelerating, and there has been a lot of change for the fourth edition of the Oxford Handbook of General Practice. For this new edition, we welcome Dr Matt Burkes as Guest Editor. He has recently finished GP training and has been responsible for the chapters on mental health and skin problems.

Since the last edition of the OHGP, clinical general practice has moved on apace with new treatments, guidelines, and care pathways, changing the way in which we work. There has been a continued move of work from secondary care to primary care to enable patients to be cared for closer to home, and our ageing population means that many of our patients have multiple morbidities that must be managed simultaneously. Furthermore, GPs must continue to provide high-quality care within an environment of increasing public expectation and decreasing financial resources.

The administration of general practice in the UK is also changing, as the devolved nations’ healthcare systems move further apart. GP practices in the UK now need to meet standards imposed by the Care Quality Commission, and perhaps the biggest change is the abolition of Primary Care Trusts (just in England) and their replacement with GP-led commissioning through Clinical Commissioning Groups.

Revalidation has also become a reality. All GPs in the UK registered with the General Medical Council must demonstrate their fitness to practise every five years. Perhaps unsurprisingly, GP training is changing too. General practice has traditionally had the shortest training of all specialties in the UK. The need for a widening clinical skills and knowledge base, improved generalist skills to promote health, prevent disease and manage people with complex problems in a variety of different settings, and improved public health and leadership skills have led to a successful bid by the RCGP to enhance and lengthen GP training to prepare GPs fit for the future.

To address all these factors, within the non-clinical sections of this new edition of the OHGP, we have included new sections on revalidation, enhanced and extended GP training, commissioning, changes to benefits for low income, sickness and disability, and Care Quality Commission registration. In addition, as well as updating all the clinical information in line with current guidance within the clinical sections of this edition, we have included photographs within the text for the first time. Due to space limitations, we have used these initially just within the dermatology and ophthalmology chapters, and we hope that you will find them useful.

As always, we welcome any feedback from our readers. We would also like to thank the many of you who have contacted us to point out errors, omissions, and ways to improve the OHGP in the past. It is thanks to you and the feedback that you provide that the OHGP continues to develop to meet your day-to-day needs.

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