Primary care Resources

There are three million people living with cancer in the UK, which is predicted to rise to nearly 3.5 million by 2025 (Macmillan Cancer Support, 2024). The GP Contract (NHSE Contract Letter 2024/25) has protected the cancer indicators in the Quality Outcomes Framework (QOF), which are that every person should be offered an opportunity to discuss their diagnosis and be informed of the support available to them from primary care within three months of diagnosis, and a structured cancer care review should be offered within twelve months of diagnosis. General practice nurses (GPNs) already have expertise in long-term condition management and could deliver the same for people living with cancer, but
most do not feel confident to do so. This article includes the author’s personal reflections on her role and the development of personalised care within primary care.

Obesity rates have skyrocketed globally over the last few decades. Obesity presents a public health emergency because of its numerous associated comorbidities. Waist-to-height ratio is a useful add-on to body mass index (BMI) to quantify health risks and monitor progress. The causes of obesity are complex and they necessitate a degree of empathy from healthcare professionals caring for those with the condition. Researchers believe that the obesity epidemic will not begin to improve without significant governmental policy changes. Many weight loss diets exist, but no diet stands out as more favourable at the one-year follow-up mark, as maintenance of the weight lost is uncommon. This article discusses the physiology of weight changes, emphasising the crucial role of energy balance. Energy density is a useful concept for patients to understand to help identify foods which will fill them up and help facilitate a reduced energy intake. Protein and fibre are also highlighted as focus nutrients. Exercise is important for various reasons, but on its own will not usually lead to weight loss. Sleep is an often neglected yet important factor to consider in obesity management.

This article, the first in a two-part series, aims to raise awareness of upper airway disorders, as defined by the recently published upper airway disorders position paper from the Royal College of Speech and Language Therapists (RCSLT; Haines et al, 2021). It provides a summary of the aetiology and clinical presentations for persistent throat symptoms, refractory chronic cough, and inducible laryngeal obstruction. These disorders are primarily related to laryngeal dysfunction, rather than lower airways disease, virus, or infection. Recognising the immense time pressures within clinical practice, tables have been included that could be provided to support patients with understanding their symptoms. Part two will look at managment approaches, including self-care strategies, and advice on where to refer people presenting with upper airway disorder symptoms.

Self-harm has increased significantly over the past few years. The restrictions due to the Covid pandemic are thought to be a contributing trigger for an individual to self-harm. Patients who present to healthcare systems with self-harm injuries can be met with indifference and lack of understanding by healthcare professionals who do not have the knowledge and skills to deal with individuals who have complex mental health needs. General practice nurses (GPNs) who care for patients with self-harm injuries should be able to offer empathy, understanding, and know how to refer and signpost to ensure that timely intervention can be made to the most appropriate mental health team or allied worker. This article explores how Covid-19 has impacted on self-harm, the important aspects of assessment to consider when a patient presents with a self-harm injury, and discusses interventions that may assist in the management of such wounds in clinical practice 

The first piece of this two-part series explored the context for leadership in general practice nursing, our role as leaders, and perceived barriers to nurses fully utilising their leadership potential in the general practice setting. Here, Jaqui Walker, general practice nurse/advanced nurse practitioner (GPN/ANP), Falkirk, explores why we should lead, who can lead, leadership styles and behaviours for ANP/GPNs, and how to develop leaders. Written from the political setting of Scotland, this article is applicable to nurses across the four nations of the UK and suggests, as part of our leadership skills, we should all make ourselves aware of the context within which we work.

People experiencing long-term physical conditions are predominantly cared for within primary care settings by nurses. These patients are two-to-three times more likely to develop mental health problems as a result of the detrimental impact of their illness on their physical and social functioning. They are also more likely to disclose mental health issues to nurses working in primary care — therefore, general practice nurses (GPNs) need to be able to recognise both mental distress and mental illness to ensure that their patients receive appropriate assessment, care and management. This article discusses the prevalence of mental health problems in patients with long-term physical conditions and how nurses in primary care settings can recognise, assess and support them.

Frailty is becoming increasingly recognised as a long-term condition associated with ageing that should be primarily managed in primary care. Diagnosing frailty identifies a high-risk population group and highlights areas of clinical importance that can be treated and managed. In 2017, NHS England introduced new elements into the GP contract, which require practices to identify moderately and severely frail patients, and to offer a clinical review to those who are severely frail (NHS England, 2017b). This review should include assessment of falls risk, medication review and seeking of permission to activate the enriched Summary Care Record (SCR). This article examines the general practice nurses’ role in the care and support of older people who live with frailty, and gives guidance on how to review medication, assess falls risk and use the SCR to ensure patients’ wishes and care preferences are recorded.

There is a variability and inconsistency in how GPs carry out cancer care reviews (Meiklejohn et al, 2016). Many people report feeling abandoned after treatment finishes (Scottish Cancer Experience Survey 2015/16). This article looks at an evaluation undertaken by NHS Lanarkshire as part of the Macmillan Transforming Care after Treatment (TCAT) programme to ascertain the acceptability and feasibility of general practice nurses (GPNs) taking on the role of delivering cancer care reviews using a Macmillan Holistic Needs Assessment Tool. After Macmillan cancer training, 10 GPNs invited people with a new diagnosis to a cancer care review. A concerns checklist was sent to the patients before the review. Four hundred people were invited, with 250 accepting the offer. People reported that the time afforded by the GPN was valued and they saw them as a point of contact in the future. Fatigue, pain and worry were the top three concerns raised. It was concluded that, with training, GPNs can offer quality-assured cancer care reviews and therefore shift some of the workload from GPs.