General practice Resources

This article examines the transition process from paediatric to adult healthcare for young people with complex medical needs, focusing on how to increase the involvement of general practice. Poorly managed transitions can lead to increased morbidity and mortality in young adults. Guidelines, including those from the Care Quality Commission (CQC, 2014) and the National Institute for Health and Care Excellence (NICE, 2023), recommend greater involvement of general practice in the transition process, yet limited guidance is offered on implementation. To identify opportunities to improve the transition process, an audit within a specific region was conducted to assess current practices. This identified a small cohort of patients undergoing transition. Based on these findings and consultations with stakeholders, a series of targeted interventions were developed. These included using a dedicated SNOMED code to track transition, use of care coordinators to address additional vulnerabilities, and implementation of a ‘Transition on a page’ document to streamline communication between general practice and secondary care. Although several challenges prevented a pilot from proceeding as planned, the proposals were approved by the local integrated care board (ICB) and disseminated by clinical governance leads to all general practice staff for ongoing embedding. The hospital transition team will review implementation to assess impact. This project highlights a nationwide issue requiring further action to establish effective transition practices across healthcare settings.

Chronic urticaria is a relatively common complaint in clinical practice. It often has an unknown aetiology or a difficult-to-avoid trigger and although rarely life-threatening, it has a profound impact on quality of life, reaching beyond the 
impairment directly related to physical symptoms. All these aspects make its management complex and often frustrating both from a patient and professional perspective. Most patients with urticaria will be seen first in primary  care, often by practice or community nursing staff. With good knowledge on diagnosis and management, up to 80% of these patients can be managed adequately in primary care.

When I first started in general practice in 1990 I worked with a general practice nurse (GPN), a health visiting team, a district nursing team, a community psychiatric nurse (CPN), a social worker and a benefits advisor, and we were accountable for the 24/7 expert generalist cover for our registered list of 8,500 people.

 I entered general practice after a decade of training and experience as a general and vascular surgeon and it took me some while to adjust to the shock of realising that my mindset, attitudes and beliefs, drummed into me through medical school and beyond, had to be reframed: I had to become an expert generalist.