Editorial

The defining role of GPs is enacted in consultations with patients. It is easy to appreciate just from the increasing complexity evident in articles and management guidelines within any issue of InnovAiT that consultations require more time, not just knowledge and skills. Yet the signs are there every day that we don’t have enough time or have too much to do in the time available. How often each day do we apologise for keeping patients waiting?

I trust that some protection from the full force of work pressure in UK general practice is being afforded to you, enough protection to allow for learning without the pressure of often unrealistic time constraints. Whatever time we allow for consultations, there are many and varied ways that it will not match the time required by us and our patients. Like the sutures cut for a demanding and difficult surgeon, the time for any consultation can end up either too short or too long! GPs are more often struggling to find enough time to complete satisfactory consultations with patients, many of whom have been waiting weeks for their appointments. Not surprisingly, levels of patient satisfaction have been falling, according to NHS surveys, along with GP job satisfaction. Is ‘delight and elegance’ in the conduct of consultations, cited by Roger Neighbour in his introduction to the second edition of The Inner Consultation, surviving the squeeze?

Work for GPs, apart from time spent consulting, has expanded and now represents a bigger proportion of general practice workload. Fear not. Measures are being taken at many levels and in many ways to address workload. We are for example working with new professional colleagues, changing how we consult, working at scale and trying to recruit more GPs. How will we measure the success of such initiatives? Will there be any less pressure on the time available for consultations? Will a proliferation of different initiatives have unintended consequences? After all, many things that happen outside consultations have a big influence on what goes on within consultations. If we are to maintain and improve the quality of our care and protect the time available for consultations, we need to understand these influences. We can then participate fully in making or resisting any changes intended to benefit patients, the discipline of general practice, job satisfaction and the professional standards we believe in. We are keen to highlight some of the new initiatives being introduced within practices and beyond in upcoming issues of InnovAiT and to receive your articles about them. Tell us what you think.

In this issue, Lucy Delaney provides some guidance on getting patients to improve their health by increasing physical activity. Rachael Marchant runs through cancer prevention, earlier diagnosis of cancer and what we can do to improve cancer outcomes. If you have been scratching your head and feeling confused when considering ACR results, then the article on proteinuria by Lauren Copeland and Keith Gillis will shed some light for you. Nephrotic syndrome will hopefully not be a regular diagnosis, but spotting it will be easier after reading the article by Thuvaraka Ware. Prompt diagnosis and action is also the order of the day with endocrine emergencies, and the article from Apurva Mishra and Marc Quinn picks out important diagnoses with guidance on timely management. How confident are you in your advice when a parent is concerned about their child’s need for circumcision? After reading Elizabeth Osinibi’s clear update on the subject, I am sure you will give good advice with confidence. The excellent article on goal setting in patients with multi-morbidity by Alice Shiner et al. is full of useful ideas that will inform consultations, preferably long enough to apply the methods with aplomb.

I hope you enjoy this issue of InnovAiT, not just the feature articles but also the short, themed articles offering up gems within News and Views, sage advice From the Trainer, invaluable learning tips from Crammer’s Corner and challenge from this month’s AKT questions. We hope more of you will feel inspired to write something, short or feature length, and send it to us at the usual address. If you need some help, we can provide a Buddy, suggest titles and advise on how to submit articles. Take as much time as you need to capture delight and elegance before letting loose for publication.