Resources

For many nurses working in general practice, chronic obstructive pulmonary disease (COPD) is a familiar condition. From carrying out annual reviews to supporting people living with the symptoms of cough, phlegm, breathlessness and managing their effect on day-to-day living, most general practice nurses (GPNs) will have some experience of supporting people living with COPD. Increasingly, though, GPNs are having to consider comorbidities as part of the review, as for many people living with COPD, this will be just one of the long-term conditions they have already been diagnosed with or of which they will be at risk. In this article, the relationship between COPD and other long-term conditions will be highlighted, along with recommendations about how to identify and manage comorbidities in order to holistically optimise outcomes.

Heart failure (HF) is a clinical syndrome distinguished by the inadequate pumping of the heart. It represents a prolonged condition that impacts approximately one million individuals in the UK, a figure surpassing the toll of other ailments such as cancers and strokes. Recognising symptoms like fatigue, fluid retention, and breathlessness can often present a challenge, given that patients may be asymptomatic, and these symptoms are not always specific to heart failure. The utilisation of a simple blood test, such as NT-pro BNP, followed by advanced diagnostics like echocardiography and magnetic resonance imaging (MRI) scans, hold pivotal importance for achieving timely diagnosis, implementing targeted therapies, reducing mortality rates, reducing hospital admissions, and decelerating the progression of the disease. Simultaneously, this approach works towards enhancing the quality of life for patients and reducing health inequality gaps. The recent 25in25 summit convened by the British Society for Heart Failure (BSH) brought together stakeholders from other countries to discuss and address HF mortality rates. This resulted in the participants collaboratively formulating and signing a declaration with the aim of reducing HF mortality in the first year after diagnosis by 25% within the next 25 years.

Group clinics were one of 10 high impact actions for primary care in 2016. In randomised controlled studies, they improve self-management of type two diabetes and demonstrate positive impacts on: key biometrics, knowledge of diabetes, quality of life, patient-initiated behaviour changes and empowerment. These changes sustain in those from low-income underserved communities. They also improve adherence with quality and outcomes framework standards, reduce A&E visits among vulnerable people with diabetes, and build trust between clinicians and patients. There is evidence that group clinics improve access, reduce waiting times and free up clinician time. They are especially well suited to general practice nursing’s caseload. Introducing group clinics upskills nurses and the whole primary care team, and return joy and autonomy to nursing through deeper connections with patients and by providing the opportunity for nurses to reimagine and revitalise repetitive chronic disease reviews. This is highly motivating and supports retention. Their time has come.

Moisture-associated skin damage (MASD) is an umbrella term to describe the trauma that occurs when there is prolonged exposure to moisture. Incontinence-associated dermatitis (IAD) is an MASD condition caused by urinary and/or faecal incontinence. It often causes significant pain and has a negative impact on an individual’s quality of life. Prompt diagnosis of IAD is key to successful management, but the early symptoms of erythema and redness may not be obvious in those with a dark skin tone. Delays in assessment and treatment mean that maceration, infection and the development of pressure ulcers become more of a risk. This is compounded by the lack of education and awareness of the significance of skin tone in relation to wound care. This article is based on published research, together with the practical experience of healthcare professionals at the Complex Wound Clinic (CWC) in North West London. The aim is to highlight the importance of considering skin tone when managing IAD. This can be achieved by using a validated skin tone assessment tool which shows a range of six skin tones. The importance of skin tone is a critical subject as the latest 2021 Census data shows that in England and Wales, 18% belong to a black, Asian, mixed or other ethnic group (Gov.UK, 2021 Census data).

This article looks at amenorrhoea and oligomenorrhoea, both of which can be a cause of concern for those women affected. Such issues can be difficult for clinicians to diagnose and treat, because of variations in bleeding patterns, complicated history in some patients, and associated problems. Signs and symptoms, causes, diagnosis, treatment, and complications are covered here, in the hope that general practice nurses (GPNs) and non-medical prescribers will feel more confident in recognising concerns and can then get earlier investigations and treatment, thus reducing the risk of complications and improving quality of life for women affected.

As a novice or an expert (Benner, 1985), abdominal presentations can be intriguing and puzzling. It is vital to take a good patient history and conduct a systematic physical assessment, and to think about immediate management (this might be simple pain management or helping with moving bowels) and to consider the longer term — changes to the signs and symptoms, not resolving despite treatment or good management, weight loss or bleeding. Always heed the patient’s intuition — and yours. Monitoring the abdominal problem, the patient keeping a diary if symptoms are sporadic, and giving worsening care advice are as much a part of treatment as medications and investigations. Low thresholds for review include the above but should also be considered in vulnerable populations such as the very young and very old who can deteriorate quickly, and those with pre-existing and long-term conditions, e.g. malignancy and being immunocompromised.This article should be used as an adjunct to an accredited theoretical course with a completed and successful competency assessment.

Prescribing by a variety of professionals continues its progression in response to the growing demands for health care. Prescribing by nurses was initiated in the 1990s and supported by the National Prescribing Centre’s ‘prescribing pyramid’ or seven steps or principles for good prescribing (NPC, 1999). This article explores a new prescribing consultation model (RAPID-CASE), which is composed of elements from the prescribing pyramid and the Competency Framework for all prescribers (Royal Pharmaceutical Society [RPS], 2021). The RAPID-CASE consultation model is applied to a clinical scenario to illustrate how it can guide a systematic approach to decision-making, using the example of a lower limb skin tear injury.

Here, Laura King, senior asthma practitioner, North-East London, explains why the time is now to pre-emptively act to avoid asthma attacks, which commonly peak in children and young people during mid-September.

Here, Callum Metcalfe-O’Shea, advanced nurse practitioner diabetes specialist and co-chair for the Norfolk Health Professionals Diabetes Forum, looks at how remission in type 2 diabetes can be achieved in some cases. Definitions of remission are explored as well as the challenges patients may face. Dietary advice and pharmacological interventions are considered to help general practice nurses (GPNs) structure their approach in achieving remission for suitable patients with type 2 diabetes.

I enjoyed reading and reflecting upon the leadership topic covered in this issue’s ‘practice matters’ piece. For me, it is timely, as I feel it’s an important time for general practice nurses to lead in advocating for the value and importance of our role and proactively promote our work within the general practice team. While urgent care has driven general practice recently and attracted resources, long-term conditions are equally important and if not adequately resourced and managed will just continue to drive up the demand for urgent care.