Editorial

There is a global shortage of doctors and unsurprisingly of primary care physicians. It is perhaps then not a surprise that according to a 2022 survey by the US-based Commonwealth Fund in 10 high-income countries, primary care physicians report an increase in workload. We of course need to recruit and retain more GPs. In keeping with this aim, we need to look after each other and hope that the NHS, true to its principles of equality and fairness, looks after its workforce, including new recruits. Is this happening?

Understanding the experiences of the workforce in primary care is not something we do often or well, despite the fact that 90% of consultations are in primary care. The first ever pan-London survey of the primary care workforce in March 2022 revealed that half of respondents had personally experienced discrimination. Black, Asian and other ethnic minority doctors make up over 40% of all NHS doctors, are paid less and are more likely to face disciplinary action than their white, UK-trained counterparts, according to the Medical Workforce Race Equality Standard (MWRES) report published by NHS England in 2021. The MWRES has developed an action plan to tackle inequalities and look after our workforce better. A more valued and respected workforce brings higher overall patient satisfaction, and such a plan must surely help workforce recruitment and retention.

As part of this plan, more training by the royal colleges is promoted to enlighten on the importance of understanding differential attainment in training, recruitment and the workplace more generally. There are principles within this that resonate with many aspects of behaviour in the workplace, and impact, for example, on teaching communication skills and giving feedback. Enlightenment should be good for all of us, including our patients. I commend the MWRES action plan and the learning resources that have been developed by NHS England and the College to tackle the causes of differential attainment, including the recognition of hidden disabilities arising from neurodiversity.

The workforce crisis demands that we recruit more GPs. In this issue Maxwell Cooper et al. describe how primary care theory is taught in Brighton and Sussex Medical School. The theme of tackling inequality runs through their teaching and serves to dispel some myths and preconceptions about primary care.

Donal Shanley et al. describe a condition that may get overlooked. Relative energy deficiency in sport needs to be recognised and correctly managed. This article should help this and greater awareness for the benefit of patients developing or likely to develop this condition.

We are encouraged to carry out regular reviews for patients with learning disabilities. Anne Bonnici-Mallia et al. give guidance on the recognition of dementia in patients with Down syndrome. This could easily be overlooked; this article highlights the importance of closer observation and engagement with older patients, not least when conducting routine reviews.

Natasha Freeman describes the assessment and management of patients with vulval pruritus. The differential diagnosis is varied and quite long, including the possibility of premalignant changes. A tailored history and examination help determine the appropriate management and referral pathway. Alongside correct medical treatment, information on the principles of vulval care for patients and where to access further information is outlined.

Emma Thornton considers polycystic ovarian syndrome, one of the most common endocrine disorders affecting women of reproductive age with diverse implications for health. Delay in diagnosis can cause patient dissatisfaction. This article gives advice on how to avoid both.

Post-coital bleeding can be alarming for patients and prompt demands for urgent appointments. There are no national guidelines in the UK on post-coital bleeding and this may contribute to inconsistent management. Naila Ahmed explores the causes and gives helpful guidance on diagnosis and management.

If you are struggling with exams, assessments or completing any aspects of your training then make sure you discuss these with your trainer, Educational Supervisor or Program Director. You may need general help and workplace adjustments or more specific help with your learning. More help is available once your problems are better understood. Some trainees need help from the Professional Support Unit. If you want to describe your experience of receiving such help, then please write something for the benefit of others in a similar predicament. We need you to realise your true potential. We must ensure that good education helps us achieve equality in opportunities and better overall performance of our healthcare system.

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