HARD TIMES
This December’s BJGP has a strong focus on groups within the population at particular risk of physical and mental health problems: vulnerable people. The plight of vulnerable children is graphically described in Camila Batmanghelidjh’s moving leader, which is a challenge to us all to provide better services and more receptive facilities for children in need. Her description of her charity Kids Company — which supports around 36 000 children, young people and vulnerable adults — is an inspiring account of what can be achieved with commitment and drive. Bridget Osborne reminds us of the shocking statistics on suicide and depression among farming communities, who may well be facing another challenging winter this year. Other vulnerable groups discussed in the Journal include homeless men and people with intellectual disabilities, both of which are the subjects of stimulating Debate & Analysis articles this month. Paramjit Gill and Adrian Hegenbarth’s editorial on the ways in which socially-excluded patients can be socially included in general practice is a further challenge, not just to clinicians and health and social care professionals, but to commissioners and health service managers, who need to think hard about ensuring equity and comprehensiveness in the provision of services and the arrangements for these problematic groups to access care.
The clinical research this month also takes on some fairly challenging patient groups, including those with chronic renal disease, in which blood pressure control has been shown, in a cluster randomised controlled trial conducted by Scherpbier-de Haan and colleagues, to be improved by structured shared care. Alex Dregan and colleagues have used the Clinical Practice Research Database linked with Cancer Registry data to take another look at alarm symptoms and their relationship to diagnostic delay, reporting worse cancer outcomes in some patients presenting without alarm symptoms, a finding which is counterintuitive and certainly requires further studies to understand the ingredients of systems designed to enhance the early diagnosis of cancer in primary care. Hepatitis C is still a major problem, both in terms of ascertainment and treatment, and Brew and colleagues’ narrative systematic review provides some evidence that hepatitis C treatment can be safely and effectively delivered in primary care; although there are now strong signs that an oral ‘polypill’ for hepatitis C may be available within the next year or two.
One of my favourite cartoons shows a cat owner wagging his finger at the little creature sitting by her litter tray, saying ‘Never, ever think outside the box!’ Sad, then, to be saying goodbye to Trish Greenhalgh and her Outside the Box column as she moves on to a new job in her medical school as Dean for Research Impact. We wish you well Trish, as long as you never, ever use the word ‘impact’ as a verb. ‘I’ words have become the bane of many of our lives. How many issues are waiting to be resolved? Try to get through a day without using the wretched word! And what about iconic: a Hermitage-full of icons is referred to every weekend in every Sunday supplement.
Two quick pieces of news. One is the launch of the 3-year Sowerby Innovation Fellows Programme to foster early-stage GP-led innovations in primary care by tackling the constraint of lack of protected time by providing paid sessional ‘time to innovate’. The programme is the result of a generous grant from the Peter Sowerby Foundation which will be administered for the RCGP by its Clinical Innovation and Research Centre (CIRC). Each year five ‘Sowerby Innovation Fellows’ will be appointed for 12 months to pursue work designed to have a measurable benefit in terms of patient outcomes, quality of working lives for those working in general practice, or by transformation of the way services are delivered.
The other is that you will soon see a new website for the BJGP, and as we finalise it, we would be really grateful for any comments for improvement: please contact newbjgp{at}rcgp.org.uk.
- © British Journal of General Practice 2013