The Royal College of General Practitioners (RCGP) runs a variety of programmes designed to raise the profile of specific clinical areas in primary care. The RCGP Clinical Priority Programme aims to raise the profile and increase awareness of important or underrepresented clinical areas in primary care. The current RCGP clinical priorities are cancer, liver disease, mental health, physical activity and lifestyle, and sepsis.1
RCGP Spotlight projects run for 1 year and cover a specific area of work that either complements an existing clinical priority, or takes a prescriptive ‘awareness raising’ approach. The 2018/19 Spotlight projects are on values and evidence, dermatology, efficient multimorbidity management, end of life care, inflammatory bowel disease (IBD), Lyme disease, menstrual wellbeing, syncope, and deafness and hearing loss.2
The RCGP has identified these as important topics for primary care, and this issue of Guidelines in Practice includes a number of articles focusing on these key areas.
The 2018/19 RCGP inflammatory bowel disease spotlight project is focused on flare management, and long-term condition management. The 2019 IBD Standards, published in May, include 59 statements that cover key stages of the patient journey and essential elements of an IBD service, including flare management and ongoing care and monitoring.
Dr Kevin Barrett (RCGP Clinical Champion) and Jackie Glatter discuss how implementation of the 2019 IBD Standards will improve patient‑centred care, with a focus on the 23 statements from the IBD Standards that are particularly relevant to primary care. The article includes a useful pathway for the investigation of lower gastrointestinal symptoms in primary care. At the end of the article the authors provide some handy top tips for GPs and commissioners. You can also test your knowledge after reading the article using the multiple-choice questions in this issue.
The RCGP dermatology spotlight project is focused on improved lesion diagnosis in primary care. Skin lesions are a common presentation in general practice, many of which can be diagnosed based on history and clinical examination. There is a need for better recognition of non‑malignant skin lesions in primary care, because the majority of skin lesions referred urgently via 2-week wait for suspected skin cancer are found not to be malignant. Dr James Thambyrajah uses case studies to illustrate different types of skin lesion, how they can be managed in primary care, and when referral is required.
Mental health is one of the RCGP’s clinical priorities, with the aims of increasing recognition of the vital role that primary care plays in the management of mental illness, and ensuring that primary care colleagues can provide high quality mental health care. In June, results from a study funded by NHS Digital, the Department of Health and Social Care, and the National Institute for Health Research were published, showing that the prevalence of non‑suicidal self-harm increased from 2.4% to 6.4% between 2000 and 2014.3 Accurate prevalence figures for self‑harm are difficult to ascertain; it is a hidden problem that mostly relies on people self-reporting. Self-harm is associated with an increased risk of suicide, so it should always be taken seriously as an effective consultation may be an opportunity to save a life.
Dr Dominique Thompson distils recommendations from relevant guidance into top tips on how GPs can best support patients who self-harm. Dr Thompson provides tips on identifying self-harm and recognising its different forms, addressing the underlying issues behind the self‑harm, and practical support to offer patients to help them to stop. The article includes some suggested questions and phrases to use in a consultation with a patient who self-harms.
Also in this issue is a piece on the role of the practice-based clinical pharmacist in managing patients with hypertension. Muhammad Siddiqur Rahman describes how pharmacists can support the wider primary care team and patients alike by conducting patient reviews, optimising antihypertensive medication, and providing non-pharmacological intervention advice.
Applications for new RCGP spotlight projects open for a 3-month period in October each year. What do you think should be in the spotlight for 2019/20?
- Royal College of General Practitioners website. Clinical priorities. www.rcgp.org.uk/clinical-and-research/our-programmes/clinical-priorities.aspx (accessed 24 July 2019).
- Royal College of General Practitioners website. Spotlight projects 2018–2019. www.rcgp.org.uk/clinical-and-research/our-programmes/clinical-priorities/spotlight-projects-2018-to-2019.aspx (accessed 24 July 2019).
- McManus S, Gunnell D, Cooper P et al. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. Lancet Psychiatry 2019; 6 (7): 573–581.