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There was a lot of discussion last month around the announcement of the NHS Long Term Plan and what this means for general practice— Dr Jonathan Griffiths reflects on this in the View from the ground piece. Further details have since emerged in the form of a 5-year GP General Medical Services (GMS) contract framework from 2019/20. The contract provides details on the funding support available for over 20,000 additional primary care staff, to include clinical pharmacists, physician associates, physiotherapists, community paramedics, and social prescribing link workers. 

The integration of clinical pharmacists in general practice started several years ago and the positive impact of this is starting to be realised. We have therefore commissioned a new series—Pharmacist focus—in which we aim to share details of how practice-based pharmacists can support the management of patients with chronic conditions. This issue includes the first clinical piece in this series, which focuses on type 2 diabetes.

Involving practice pharmacists in the care of people with type 2 diabetes has the potential to improve health outcomes for patients and reduce GP workload, while providing value for money to practices through meeting QOF requirements and cost-effective prescribing. Muhammad Siddiqur Rahman discusses the important role that practice pharmacists have in supporting people who are at high risk of developing type 2 diabetes, reviewing patients who have a new diagnosis of type 2 diabetes, and the ongoing management of patients with type 2 diabetes. The article serves as a guide for clinical practice pharmacists who are keen to get involved in running diabetes clinics, as well as GPs and other practice staff who are seeking the support of clinical practice pharmacists in their practice to help manage workload.

Being overweight or obese is a risk factor for type 2 diabetes, as well as other chronic diseases such as hypertension, cardiovascular disease, and musculoskeletal problems. Although the risks associated with overweight and obesity are significant, it is a modifiable risk factor, and primary care clinicians are in an ideal position to help people make informed choices about their weight and long-term health. Brief interventions are proven to successfully motivate people to change behaviour and so techniques that have traditionally been used to motivate people to quit smoking or reduce alcohol consumption may also help people to lose weight.

Initiating a conversation with a patient about their weight can seem challenging, but many people welcome the opportunity. Jane Diggle and Dr Pam Brown provide top tips for primary care clinicians on raising the topic of weight with people who are overweight or obese, identifying opportunities to engage with patients to motivate behavioural change, and supporting people to set realistic goals and adopt sustainable lifestyle changes.


Top tips: talking about weight

Jane Diggle and Dr Pam Brown

Continuing the theme of chronic conditions, Professor David Halpin highlights key recommendations from the updated strategy on the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD) from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). 

Multidimensional assessment of COPD based on spirometry, symptoms, exacerbation risk, and presence of co-morbidities remains essential. Escalation of therapy is based on the patient’s predominant treatable trait—dyspnoea or exacerbations—explained through a new algorithm designed to guide choice of follow-up pharmacological treatment.

Professor Halpin summarises the strategies for initial and follow-up treatment, describes how to escalate and de-escalate pharmacotherapy, and explains how blood eosinophil count can be used as a biomarker to guide use of inhaled corticosteroids. Use the multiple-choice questions to test your updated knowledge after reading the article. Implementation actions for clinical practice-based pharmacists are also provided.

Emphysema CT scan

GOLD 2019 report: a step towards personalised medicine

Image source: © Pr Michel Brauner/ISM/Science Photo Library

Professor David Halpin

Last but by no means least, this issue includes an article on a medico-legal topic: covert administration of medication. Covert medications are those that are given to a patient without their knowledge, sometimes disguised in food or drink—they can only be administered to mentally incompetent persons in exceptional circumstances. Dr Maria Dyban describes the circumstances in which covert medication may be considered, who should be involved in the decision to administer medications covertly, and UK law and guidance relevant to covert medication.