Resources

Here, Laura King, senior children and young people’s asthma practitioner for North-East London, explores the core themes for good asthma education, often called the ‘brilliant basics’. No matter how severe a patient’s asthma is, this is key learning that patients and their families/carers need to understand if they are going to manage their asthma effectively.

In the second part of our Monitoring matters series, Callum Metcalfe-O’Shea, advanced nurse practitioner and UK professional lead for long-term conditions with the Royal College of Nursing (RCN), discusses the role of weight management in relation to long-term conditions. For the purpose of this article, again the term long-term conditions will cover type 2 diabetes, asthma, chronic obstructive pulmonary disease (COPD), autoimmune
rheumatic diseases and inflammatory bowel disease (Crohn’s/colitis). With advances and changes in how weight is addressed in general practice, this article highlights key issues faced and helps general practice nurses (GPNs) to recognise the value they play in supporting patients in their healthcare journey. Treatment options are also considered when appropriate in condition-related areas only.

The national influenza vaccination programme of the United Kingdom is highly successful, changeable and progressive and can feel relentless in its delivery. When the national flu immunisation programme plan for 2024 to 2025 (as known as ‘the annual letter’) was published on 12th March 2024, initially it seemed that this year would have very few changes to the programme, when compared to those of the last few years (UK Health Security Agency [UKHSA], 2024). However, since then there have been two versions of a statement of amendment, the second due to loss of a valuable vaccine type (UKHSA, 2024), and a pertinent letter from NHS England concerning the start dates for the programme (NHS England, 2024). These changes should not be a surprise to any immuniser, especially those who have been involved in the flu vaccination programmes in previous years. Changes often happen in the lead up to, and even after, the start of the
programme. Our national immunisation programmes (NIPs) are never static for long. They are changeable due to such things as changing epidemiology, differing vaccine types or supply, new evidence, national advice or recommendations being implemented and shared with the field regularly.

The amount of migration and people seeking asylum in the UK is increasing due to people leaving their country as a result of fear of persecution. There is a lack of knowledge regarding migrants’ rights to healthcare and barriers which exist trying to access this, including in the primary care setting. This literature review explored the experience of accessing services in the primary care setting from the viewpoint of asylum seekers and refuges (ASRs) and thematic analysis was conducted. The three themes identified were barriers to accessing primary care for ASRs, increased and inappropriate use of emergency services, and risks to public health. As it is a human right to seek asylum from persecution and receive appropriate healthcare in the host country, it is important that primary care is accessed by this population. This will help to prevent inappropriate attendance in emergency departments and promote seeking help before serious illness ensues. 
Primary care should provide compassionate and non-judgemental care to encourage a trusting relationship and promote
health-seeking behaviour.

Fractional exhaled nitric oxide (FeNO) testing is a simple, safe, non-invasive test which is suitable for use in primary care provided it is carried out by a competent clinician who can interpret the results. Raised FeNO levels can only be found when type-2 airway inflammation is present (Wang et al, 2023). FeNO testing is currently regarded as an optional test to identify eosinophilic asthma for those with an intermediate probability of asthma. The question is, could FeNO testing lead to a more personalised approach for the management of airways diseases? This article discusses the current recommendations, the relevance of FeNO testing, along with the limitations and ways to utilise FeNO testing in a primary care setting.

Childhood constipation is a common and often distressing condition affecting both the child and their family. It is frequently encountered in primary care settings and, if not managed effectively, can lead to significant physical and psychological morbidity. Effective management hinges on a comprehensive approach that encompasses assessment, diagnosis, treatment, and understanding the psychological impacts. This article covers the critical aspects of assessing and diagnosing childhood constipation, including abdominal examination, recognising red flags and differential diagnoses, further investigations, and the psychological implications of the condition. It also delves into the causal reasons for childhood constipation, its effects on the child’s well-being, parental frustrations due to poor management, and treatment options available.

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.

The mental health of children and young people (CYP) has markedly declined in recent years, a trend significantly accelerated by the Covid-19 pandemic. Accessing support for mental health issues is highly variable with long waiting lists for specialist child and adolescent mental health services (CAMHS) and inconsistent provision of mental health support in schools and educational institutions, meaning that supply does not meet demand. There is a gap in support for CYP who need a greater level of support than is currently available in education settings, but do not require specialist mental health
treatment (King’s Fund, 2024). Mental health issues may manifest as primary complaints in primary care settings or may be discovered incidentally during the evaluation of related physical or social problems. Consequently, it is imperative for general practice nurses (GPNs) to be able to recognise and accurately assess mental health issues that present to them. They should also be equipped to offer appropriate signposting, advice and guidance, as well as to facilitate necessary escalation or referral to specialist services when required. This article, the first in our series on CYP and mental health, focuses on history-taking and initial assessment.

Pernicious anaemia is a rare condition which is classed as an autoimmune disease. It is most frequently diagnosed in those over the age of 60, but can occur at any age. It presents with variable symptoms, many of which are shared with those of other diseases, making the condition difficult to diagnose, leading to missed diagnosis and a greater risk of
complications. This article gives an overview of its diagnosis, management, and  complications, with the aim of helping general practice nurses (GPNs) and non-medical prescribers recognise symptoms and get early treatment, reducing the risk of long-term adverse effects and improving quality of life for all those affected by this complex disease.

The role of general practice nurses (GPNs) in providing immediate and necessary care for lower leg wounds was the focus of a recent webinar hosted by the Legs Matter coalition and the Royal College of Nursing (RCN) General Practice Nursing Forum committee. Here, Katy Smyth, academy teacher at Accelerate CIC and chair of the RCN GPN Forum, explains the focus of the event and why it is important to raise awareness of this topic within primary care.