StethascopePrimary Care

When should you be concerned about an underlying cause in a child gaining weight?

Ask an expert: child and adult obesity

A 7 year old boy comes into your GP clinic with his parents who have concerns that there may be a possible underlying medical cause for his rapid gain in weight over the previous 18 months. You assess him to see whether or not he needs referral to secondary care.

What kind of questions would you ask and when would you be concerned?

Check your answer in our new module Ask an Expert: child and adult obesity. Adrian Park and Ken Ong offer expert answers to questions from GPs on obesity, including how to advise people about diet and activity, when to refer people for bariatric surgery, and the nutritional impact of surgery.

"This was very good indeed. Really useful pointers for me as a GP to help with obesity and weight related issues generally...."

"Really useful for this year’s flu vaccine day at the Practice!"

Influenza vaccinations

Our module on Influenza vaccination provides a guide to the effectiveness of and contraindications to the influenza vaccine and when to recommend it.

"This module helped me to understand the high incidence and severity of influenza, and the rationale behind the increased influenza vaccination campaigns with greater coverage over the last few years. I have also been given information that I can share with patients who have questions about vaccination."

“Best module I’ve done in the last 6 months”

Guideline focus: Stop smoking interventions and services (NICE)

Consultant hepatologist Dr Stuart McPherson answers GPs’ questions on alcohol related liver disease (ARLD), including a practical approach to interpreting and investigating abnormal liver function tests (LFTs), tips on deciphering complex drinking patterns, understanding when to refer to specialist services, and knowing how you can support and monitor patients with alcohol related problems with a view to improving their prognosis.

The module has been recently updated and has had great reviews from GPs:

"Best module I’ve done in the last 6 months. I needed to do it twice. Really really relevant. Also challenging. Enjoyed. Thank you."

“Really useful module for having a framework to manage patients who [are] often difficult to maintain a pattern of structured care for."

“Good and challenging."

Do you find assessment of the red eye a challenge at times?

Quick tips: examination for red eye and eye trauma

We can help increase your confidence in examining the eye in just 10 minutes with our Quick tips: examination for red eye and eye trauma module. This short video module gives advice and clinical pointers for GPs on managing red eye and eye trauma in primary care, with a practical demonstration of eye examination, eyelid eversion, and eye irrigation. It also includes seven steps to highlight red flags in your examination and has recently been updated with new content on eye trauma.

"An excellent brief summary outlining a methodical approach to diagnosis and management of red eye with simple instructions about red flags"

New module on smoking cessation

Guideline focus: Stop smoking interventions and services (NICE)

A 31 one year old man attends your surgery for a medication review. He’s a smoker and you ask him about his current smoking behaviour, and he tells you he sometimes thinks about quitting, but that he has never actually tried. You explain to him the help available and offer him a referral to a local stop smoking service, but he declines. He does say, however, that he’s interested in trying an e-cigarette.

What would you advise?

Our new guideline focus module: Stop smoking interventions and services (NICE) covers the practical implications of NICE guideline NG92 for GPs, including how to offer very brief advice, what advice to offer about e-cigarettes, nicotine replacement therapy and stop smoking treatment, and the importance of behavioural support when helping someone to stop smoking.

Are you up to date on the new FSRH Obesity guideline?

Ask an expert: Contraception in primary care

Nadine is a 25 year old woman and has been using depot medroxyprogesterone acetate (DMPA) as contraception for the past year. She has come in for review as would like to continue with this. She has no past medical history of note. She has a BMI of 38. She smokes 20 cigarettes a day and has been given smoking cessation advice but has no plans to give up.

A high BMI on its own does not restrict the use of DMPA, but what about in combination with smoking? Does this change things?

In May 2019 the FSRH published new guidance on the provision of contraception to women who are overweight and women with obesity. Our ask an expert module on Contraception in primary care has been updated with a new question to summarise what this guideline update means for your practice.

"The best module I have taken in a long time. Very good."

“Really great and concise article. Good update"

How confident do you feel managing surgical site infections in primary care?

Surgical site infection: a primary care focus on prevention and management

At least 5% of operations carried out in secondary care are complicated by surgical site infection.

Minor surgical site infections can be difficult to diagnose, as there is no single validated diagnostic tool. It is not always easy to distinguish between infection and the inflammatory process involved in normal healing, due to an overlap of symptoms and signs including heat, redness, swelling, and pain. Because of this, clinicians may use antibiotics inappropriately, adding to the risk of antibiotic resistance.

Our module Surgical site infection: a primary care focus on prevention and management covers both prevention and treatment of surgical site infections, and will help you to feel more confident answering patients’ questions about postoperative wounds.

"Very good empirical advice here and evidence based throughout"

"Really helpful sensible clear guidance"

New module on chronic rhinosinusitis

Step by step: How to diagnose and manage patients with chronic rhinosinusitis in primary care

A 45 year old woman attends your morning surgery. She has had a “stuffy” nose for the last six months. She says she often feels like she has to clear her throat, and she also has clear nasal discharge. On anterior rhinoscopy, her nasal mucosa looks pale and there is hypertrophy of the turbinates. The rest of her examination is normal. There is nothing of note in her past medical history. You make a clinical diagnosis of chronic rhinosinusitis.

What should you do next?

Check your answer in our new module: Step by step: How to diagnose and manage patients with chronic rhinosinusitis in primary care, which covers how to distinguish chronic rhinosinusitis from other similar conditions, what treatment to start in primary care, and when to refer to a specialist.

How can you improve outcomes for patients with frailty?

Clinical pointers: frailty

You see an 85 year old man who is moderately frail and partially sighted. You are trying to establish a care and support plan (CSP) in partnership with your patient. His main goal is to remain able to go to the park with his dog.

His main concerns are that his mobility is limited by his arthritis and he has lost his ability to drive because of his poor vision. On good days he is able to use a stick to walk slowly to the park with his dog, but there are also bad days that he has to spend at home.

How would you work with him to help him achieve his goal?

Check your answer in our new clinical pointers module on frailty which includes practical videos to help you to assess and objectively measure frailty, plan the care of older people who are frail to improve their outcomes, and prevent progression of frailty.

"A really useful and practical approach to assessment and care and support planning"

New clinical pointers module on faltering growth

faltering growth

Paul is 3 months old and was born four weeks early with mild respiratory distress. He was discharged after a short stay in special care. His mother has had difficulty breastfeeding, so is giving him expressed breast milk. He taking 3 ounces of expressed milk every two to three hours during the day and sleeps for six hours at night, managing about 22 ounces in 24 hours. His health visitor shows you his growth chart as she is concerned his weight gain has crossed the centile lines. He currently only weighs 4.5 kg, having been born at 2.2 kg on the 9th centile. He frequently has small milky vomits. He seems otherwise well. 

What should you advise?

Check your answer in our new moduleclinical pointers: faltering growth. In this module, Dr Nicola Pritchard provides some insight into practical primary care issues for GPs when assessing children for faltering growth, including advice on when you should be concerned, and when you can be reassuring. 

"Excellent and practical!!"

Updated module on bulimia nervosa

Clinical pointers: Bulimia nervosa in primary care

A 23 year old man, Iqbal, presents to your practice with dizziness. On questioning you find out that he exercises for two to three hours each day at the gym. You wonder whether he may have an eating disorder.

To screen for a possible diagnosis of bulimia nervosa, what kind of initial questions would it be appropriate to ask?

Check your answer in our updated clinical pointers module: Bulimia nervosa in primary care.

Patients may not present in primary care directly with concerns that they have an eating disorder so it is important to look out for this in consultations. This practical module offers a guide to recognising bulimia nervosa in primary care, as well as to the diagnosis and initial management of potential complications, and available treatments.

"Excellent distillation of essential information."