Resources

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.

Our garden is in full bloom, and we have had a lovely spell of sunny weather. We were even treated to the northern lights above our house last week— worth being woken up for at 1.00am! It’s not just the garden and the weather I feel excited about, the first in our podcast series is now live, ‘Heart failure in primary care — role of GPNs’ (www.journalofpracticenursing. co.uk/course/heart-failure-in-primary- care-role-of-gpns/details) and you can join my colleague Susan and I as we sit down for a ‘coffee break’ chat about heart failure, admittedly half an hour is more than I normally get for a coffee break! However, making this time to sit and talk was hugely beneficial, and I learnt so much that now helps in practice. I hope you can make the time to watch it and please share what you found useful and any ideas for future discussion on this GPN community platform.

What most people are looking for when they visit their general practice is certainty. They might want to know the exact cause of their chronic pain, or precisely how long it might take for statins to bring down their cholesterol levels, or any number of other questions

In the UK, approximately 1.5 million individuals aged 65 or older are believed to be affected by heart valve diseases, such as aortic stenosis and mitral regurgitation. Projections indicate that this figure will double by 2046 and soar to 3.3 million by 2056. This is due to an ageing population (British Heart Foundation [BHF], 2018).

Research shows that there could be up to 200,000 people in the UK with Lynch syndrome, but 95% of them do not know that they have it because of a lack of testing (Bowel Cancer UK, 2023). As healthcare professionals, it is vital to follow the evidence to determine who may be affected by Lynch syndrome in order that they can have appropriate screening to decrease their risk of bowel cancer. Those leads are largely found in two ways; through testing those with bowel cancer to see if they have Lynch syndrome so that their relatives can be tested to see if they have also inherited the condition, this is done in secondary care. The second is found through identifying individuals with what are termed ‘high risk’ family histories so that they can be tested for Lynch syndrome. This can be achieved in primary or secondary care.

For the purpose of this article, the long-term conditions covered in relation to hypertension are diabetes, asthma/chronic obstructive pulmonary disease (COPD), autoimmune rheumatic diseases and inflammatory bowel disease (Crohn’s/colitis), which for general practice nurses (GPNs) are often managed routinely in daily practice. This article not only explores why monitoring is required while reviewing the diagnosis of hypertension and long-term conditions, but also considers the impact on existing disease trajectories. In addition, both pharmacological and non- pharmacological measures are discussed for patient-centred 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.

Whooping cough, also known as pertussis, continues to pose a significant threat to public health, particularly impacting infants and children with its devastating effects. The current outbreak has reignited concerns about the resurgence of this highly contagious disease and the importance of vaccination in preventing its spread. Indeed, at the time of writing, UK Health Security Agency (UKHSA, 2024a) data showed that in the first quarter of 2024 there were 2793 cases of whooping cough in England, three times as many cases than in the whole of 2023, with the very sad deaths of five infants. This article delves into the history of whooping cough, exploring its origins, transmission dynamics, and the evolution of vaccination programmes. By examining past outbreaks and vaccination strategies, this article aims to understand the challenges posed by pertussis and the critical role that vaccination plays in controlling its spread. From the introduction of whole-cell pertussis vaccines in the 1950s to the development of acellular vaccines in the 1980s, the article traces the progress of vaccination efforts and their impact on disease control. Through an analysis of current outbreak data and vaccination trends, it assesses the effectiveness of existing vaccination programmes and explores strategies for enhancing vaccine coverage to mitigate the resurgence of whooping cough outbreaks.