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Burnout: is this more than COVID fatigue?

25 Jun 2020

2020 has been quite year, and the Covid crisis did not come at a time of peace, harmony and abundance in primary care. At the end of 2019, we were acknowledging a crisis in the medical profession and particular general practice of stress, overload and burnout.

More info PDF

Burnout: is this more than COVID fatigue?

2020 has been quite year, and the Covid crisis did not come at a time of peace, harmony and abundance in primary care. At the end of 2019, we were acknowledging a crisis in the medical profession and particular general practice of stress, overload and burnout.

So, if you are suffering right now, it may be in response to the fall-out from the Covid situation, but think carefully, could this be something more for you or a colleague?

  • Stress is a high energy state where everything is go,go,go – you do not have the resources to meet the demands upon you.
  • Burnout is a low energy state: you have run out of energy to do anything and feel demotivated. You may feel like your work is meaningless.

If you are struggling, you are not alone, help is out there, but please do get help, you matter. There are links to sources of support in the article. If you are OK right now, reading this article may help you to spot a colleague who isn’t.

Burnout and how to avoid it is an important topic on our Mental Health Course and in this article taken from the Mental Health handbook we cover:

  • How to spot burnout in yourself and others?
  • Why it matters
  • The role of the workplace
  • What we can do about it

Click 'PDF' to read the full article.

Change: choosing our new normal

18 Jun 2020

Primary care did the most incredible pivot over the early phases of the Covid crisis, moving from face to face consultations to virtual consultations in the space of about a week! For many of our practices, this bypassed all our usual decision making and change management processes, and to paraphrase Nike, we “Just Did It”.

More info PDF

Change: choosing our new normal

Primary care did the most incredible pivot over the early phases of the Covid crisis, moving from face to face consultations to virtual consultations in the space of about a week! For many of our practices, this bypassed all our usual decision making and change management processes, and to paraphrase Nike, we “Just Did It”.

And now, we are starting to unpick this. Of the changes we made, what will we keep, what will we go back to? Will our patients agree with us? Will our team?

Some may be hankering to go back to the way things were, others feel that that would be a disaster. The best solution will probably be different for different teams and different practices.

Last week we covered conflict and we may find referring back to this helpful as we support our teams through this decision making and change process. We hope that this article from our LMT course will be helpful. Click 'PDF' to read it.

COVID-19: Conflict in a time of COVID

Read the latest version of our COVID-19 Update: Conflict in a time of COVID FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 emotional and psychological survival: where are YOU and your TEAM now?

Read the latest version of our COVID-19 emotional and psychological survival: where are YOU and your TEAM now?  FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: Supporting our rheumatology patients

Read the latest version of our COVID-19 Update: Supporting our rheumatology patients FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: Remote Consulting Domestic Abuse

Read the latest version of our COVID-19 Update: Remote Consulting Domestic Abuse FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: The Role of Primary Care in Care Homes

Read the latest version of our COVID-19 Update: The Role of Primary Care in Care Homes FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: Supporting our patients during Ramandan

Read the latest version of our COVID-19 Update: Supporting our patients during Ramandan FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: COPD and Asthma during the COVID-19 pandemic

Read the latest version of our COVID-19 Update: COPD and Asthma during the COVID-19 pandemic FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: Coronavirus COVID-19

Read the latest version of our COVID-19 Update: Coronavirus COVID-19 FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19: symptom control (including end-of-life care)

Read the latest version of our COVID-19: symptom control (including end-of-life care) FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19: End of Life Care Discussions

Read the latest version of our COVID-19: End of Life Care Discussions FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: Standard Operating Procedures

Read the latest version of our COVID-19: Standard Operating Procedures FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: Death in the community

Read the latest version of our COVID-19 Update: Death in the community FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19 Update: Clinical assessment and management in the community

Read the latest version of our COVID-19 Update: Clinical assessment and management in the community FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19: Workload prioritisation

Read the latest version of our COVID-19 Update: Workload prioritisation FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19: Drug and disease pitfalls to avoid

Read the latest version of our COVID-19: Drug and disease pitfalls to avoid FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19: Remote contraception and abortion advice

Read the latest version of our COVID-19: Remote contraception and abortion advice FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

COVID-19: Remote Consulting Survival Guide

Read the latest version of our COVID-19 Update: Remote Consulting Guide FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

Join us for a FREE webinar on surviving remote consulting. Join Dr Osman Bhatti, Red Whale presenter and self-confessed digital enthusiast, and Dr Hussain Gandhi (Dr Gandalf of eGPlearning), who will be appropriately socially distancing rather than sat together on the Red Whale sofa.

CLICK link to sign up for the webinar. https://www.gp-update.co.uk/webinars/OWREM250320

COVID-19: An emotional and psychological survival guide

Read the latest version of our COVID-19:  An emotional and psychological survival guide FREE on GPCPD.com.

COVID-19 Pearls have moved to GPCPD.com so that with the ever shifting landscape of the COVID-19 crisis, you will be guaranteed to always have access to the latest and most up to date version of our Pearls. GPCPD.com does have some paid for content but please rest assured that we will keep access to the COVID-19 Pearls free for all users at all times. 

For instructions on how to access our Pearls on GPCPD click here to watch a short instruction video. Alternatively, you can read full instructions by clicking the PDF button. 

Are there any high-risk features that should alert us to consider bladder or renal cancer?

05 Mar 2020

Regarding the risk of primary care symptoms for all urological cancers, the only high-risk feature in primary care is visible haematuria.

More info PDF

Are there any high-risk features that should alert us to consider bladder or renal cancer?

Regarding the risk of primary care symptoms for all urological cancers, the only high-risk feature in primary care is visible haematuria.

Having said this, not all patients with bladder or renal cancer experience visible haematuria. So, how do we determine who we should refer for further investigation? And when might non-visible haematuria be significant?

We will look closely at issues around prostate cancer in next week’s webinar being run in association with Macmillan Cancer Support. But meanwhile, as a urological cancer taster…..

There are 10,000 new cases of bladder cancer (the incidence is decreasing) and nearly 13,000 new cases of kidney cancer (renal cell carcinoma) per year in the UK. Around 50% of people survive these cancers for 10 or more years.

It is estimated that about one-third of cases of bladder and renal cancer are preventable. The major risk factors for bladder and kidney cancers include:

  • Smoking.
  • Overweight and obesity.
  • Occupational exposure to industrial chemicals, e.g. aromatic amines found in the dye, textile, pesticide and rubber industries (bladder cancer only).
  • Family history of an affected first-degree relative.
  • Radiation exposure, e.g. pelvic irradiation for other cancers.
  • Schistosomiasis for bladder cancer (rare in UK population).

Regarding the risk of primary care symptoms for all urological cancers, the only high-risk feature in primary care was visible haematuria, with a PPV of 5.1% in a BJGP study.

Having said this, not all patients with bladder or renal cancer experience visible haematuria, so, if investigations are restricted to this group alone, some diagnoses will inevitably be delayed. The low PPV of other symptoms, even in clusters, makes selecting other groups for urgent investigation difficult.

For non-visible haematuria in those over 60y, the PPV is >3 only if also presenting with dysuria or with a raised WBC count.

Antiplatelets and anticoagulants may contribute to haematuria, but for those with non-visible haematuria on these medications, 10% will have pathology (this is in line with the background population). So, we should not attribute haematuria to these drugs without investigating.

Women experience more delays in diagnosis of bladder cancer than men.

Remember, bladder cancer is an industrial disease for a small proportion of patients, and they may be entitled to compensation.

Also remember to store test sticks in the correct container with the lid closed – prolonged exposure to air or damp may give a false positive result. Check the guidance for the brand you use in your surgery, and check expiry dates!

Click on the PDF to see our summary of the NICE guidance, and BMJ and BJGP articles, on bladder and renal cancer.

What do we need to consider when we are asked for a prescription to postpone periods?

27 Feb 2020

Partial metabolism of norethisterone to ethinyloestadiol means that we should be thinking carefully when asked to prescribe norethisterone in order to postpone periods. What is the risk, and what are the main contraindications?

More info PDF

What do we need to consider when we are asked for a prescription to postpone periods?

Partial metabolism of norethisterone to ethinyloestadiol means that we should be thinking carefully when asked to prescribe norethisterone in order to postpone periods. What is the risk, and what are the main contraindications?

Given the sheer array of problems women can have with their periods (which we will be covering in detail in our Deep Dive webinar), it isn’t surprising that sometimes we get requests to postpone menstruation. These requests may relate to holiday plans or be for other reasons.

Discussions about the length of the holiday and prescribing the appropriate quantity of norethisterone take a short amount of time. 

We might even prescribe on request without such a discussion. But should we be thinking this through more carefully?

MHRA guidance highlights important contraindications. Partial metabolism to ethinyloestadiol means that, at therapeutic doses, we need to be thinking about VTE risk and assessing this as we would for combined hormonal preparations.

Click on the PDF to see our summary of a J Fam Plann Reprod Health Care review article and MHRA guidance relevant to prescribing norethisterone in order to postpone periods.

Tight foreskins – what can we do short of circumcision?

18 Feb 2020

Phimosis may be simply physiological and cause no problems. It may be secondary to an underlying skin disease. So, what do we need to look for, and what are the treatment options?

More info PDF

Tight foreskins – what can we do short of circumcision?

Phimosis may be simply physiological and cause no problems. It may be secondary to an underlying skin disease. So, what do we need to look for, and what are the treatment options?

Phimosis may be physiological. It may be primary. It may be secondary to an underlying skin disorder. Whichever of these, and whether child or adult, your patient is likely to feel embarrassed about discussing the problem and awkward about physical examination.

If asymptomatic, it requires no treatment. But if it does require treatment, what should we offer? When might topical corticosteroids be appropriate and when should we refer?

Click on the PDF to see our summary of a BMJ review on phimosis and the British Association of Paediatric Urologists' statement on circumcision.

There are many other health issues that men might feel embarrassed or awkward about discussing with us! We too might feel uncertain about these issues.


Click to join us for our Deep Dive webinar: Men's Health Laid Bare.

We'll be coming to you live on Thursday 27 February 2020 at 8pm. Do you feel muddled by men's health? Perplexed by prostatitis? Bamboozled by testosterone bloods? We will tackle the issues of erectile dysfunction, the male menopause and much more!

We will cover:

  • Erectile dysfunction, including important initial investigations.
  • The role of PSA testing in these men.
  • Treatment and drug interations.
  • Testosterone deficiency - diagnosis, investigation and monitoring.
  • Quinolone prescribing following the NICE guidance on acute prostatitis released in 2018.

The format:

There will be an opportunity to take part in interactive polls, download some fantastic resources to support your practice, and ask our team your burning questions.

Join us live on Thursday 27 February 2020 at 8pm and then on demand from the next day.

An adrenal incidentaloma is noted on the scan report - what do you do next?

13 Feb 2020

The CTKUB scan showed a single small renal stone. However, that wasn't the only thing on the scan result: it reports a small lesion in the right adrenal gland, but unfortunately doesn't give you any advice on what to do next! So, what do you do?

More info PDF

An adrenal incidentaloma is noted on the scan report - what do you do next?

The CTKUB scan showed a single small renal stone. However, that wasn't the only thing on the scan result: it reports a small lesion in the right adrenal gland, but unfortunately doesn't give you any advice on what to do next! So, what do you do?

You request a CTKUB. By the time you get the result, the patient has already rung to tell you that have "passed the little blighter", and indeed the scan showed a single small stone that was likely to come out on its own. However, that wasn't the only thing on the scan result: it reports a small lesion in the right adrenal gland, but unfortunately doesn't give you any advice on what to do next! So what do you do?

  • All adrenal incidentlomas need referring to endocrinology but take a history first: features such as hypertension, flushes or Cushingoid appearance that are pertinent to the referral may affect how quickly the patient is seen.
  • Most (85%) are benign and produce no hormones.
  • Lesions<4cm that are lipid-rich and produce no hormones are often left alone and need no ongoing monitoring, but that is a decision for the endocrinologists: our job is to refer!

Click on PDF to see our summary of 2018 BMJ Clinical Update on adrenal incidentalomas.

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