General practitioner with special interest Health Dictionary

An outdated term for the tertiary stage of SYPHILIS.... general paralysis of the insane

A statutory body set up by the Dentists Act which maintains a register of dentists (see DENTAL SURGEON), promotes high standards of dental education, and oversees the professional conduct of dentists. Membership comprises elected and appointed dentists and appointed lay members. Like other councils responsible for registering health professionals, the General Dental Council now comes under the umbrella of the new Council for Regulatory Excellence, a statutory body. (See APPENDIX 7: STATUTORY ORGANISATIONS.)... general dental council

See DENTAL SURGEON.... general dental services

A form of practice in which medical practitioners provide a wide range of primary health care services to people.... general practice

A hospital providing a variety of services, including medicine and surgery, to meet the general medical needs of the community it serves.... general hospital

Insurance which covers the risk of loss for most accidents and injuries to third parties (the insured and its employees are not covered) which arise from the actions or negligence of the insured, and for which the insured may have legal liability, except those injuries directly related to the provision of professional health care services (the latter risks are covered by professional liability insurance).... general liability insurance

A statutory body of elected and appointed medical practitioners and appointed lay members with the responsibility of protecting patients and guiding doctors in their professional practice. Set up by parliament in 1858 – at the request of the medical profession, which was concerned by the large numbers of untrained people practising as doctors – the GMC is responsible for setting educational and professional standards; maintaining a register of quali?ed practitioners; and disciplining doctors who fail to maintain appropriate professional standards, cautioning them or temporarily or permanently removing them from the Medical Register if they are judged un?t to practise.

The Council is funded by doctors’ annual fees and is responsible to the Privy Council. Substantial reforms of the GMC’s structure and functions have been and are still being undertaken to ensure that it operates e?ectively in today’s rapidly evolving medical and social environment. In particular, the Council has strengthened its supervisory and disciplinary functions, and among many changes has proposed the regular revalidation of doctors’ professional abilities on a periodic basis. The Medical Register, maintained by the GMC, is intended to enable the public to identify whom it is safe to approach to obtain medical services. Entry on the Register shows that the doctor holds a recognised primary medical quali?cation and is committed to upholding the profession’s values. Under revalidation requirements being ?nalised, in addition to holding an initial quali?cation, doctors wishing to stay on the Register will have to show their continuing ?tness to practise according to the professional attributes laid down by the GMC.

Once revalidation is fully established, there will be four categories of doctor:

Those on the Register who successfully show their ?tness to practise on a regular basis.

Those whose registration is limited, suspended or removed as a result of the Council’s disciplinary procedures.

Those who do not wish to stay on the Register or retain any links with the GMC.

Those, placed on a supplementary list, who do not wish to stay on the main Register but who want to retain a formal link with the medical profession through the Council. Such doctors will not be able to practise or prescribe.... general medical council (gmc)

The statutory body that regulates the professions of ophthalmic OPTICIAN (optometrist) and dispensing optician. It promotes high standards of education and professional conduct and was set up by the Opticians Act 1958.... general optical council

Housing not specifically designed for a particular user group.... mainstream housing / general needs housing

A long-term care facility unit with services specifically for persons with particular diseases, disorders or injuries.... special care unit

Labelling regulations require every dispensed product, i.e. a container of medicine, lotion, tablets, ointment, etc, to be labelled with the following particulars:–

1. Name of the patient.

2. Name and address of the herbal practitioner.

3. Directions for use of the remedy.

4. Liquid preparations for local or topical use to be clearly marked: For external use only.

Statutory Instruments: Medicine (Labelling) Regulations 1976 No. 1726. Medicines (Labelling) Regulations 1977 No. 996. ... labelling of herbal products by a practitioner

(in Britain) any of the groups that work with NHS foundation trusts to represent the views of patients and other interested parties in setting the strategic direction of the trust. They are often formed around specific disease categories or patient groups (e.g. deaf patients, children in care).... community interest group

in the USA, a paraprofessional or subprofessional health-care worker who is allowed to provide a limited amount of treatment to patients, usually under the supervision of a licensed practitioner, such as a physician. Examples include a nurse practitioner or occupational therapist.... dependent practitioner

see general practitioner.... family practitioner

A general practitioner (‘family doctor’; ‘family practitioner’) is a doctor working in primary care, acting as the ?rst port of professional contact for most patients in the NHS. There are approximately 35,000 GPs in the UK and their services are accessed by registering with a GP practice – usually called a surgery or health centre. Patients should be able to see a GP within 48 hours, and practices have systems to try to ensure that urgent problems are dealt with immediately. GPs generally have few diagnostic or treatment facilities themselves, but can use local hospital diagnostic services (X-rays, blood analysis, etc.) and can refer or admit their patients to hospital, where they come under the supervision of a CONSULTANT. GPs can prescribe nearly all available medicines directly to their patients, so that they treat 90 per cent of illnesses without involving specialist or hospital services.

Most GPs work in groups of self-employed individuals, who contract their services to the local Primary Care Trust (PCT) – see below. Those in full partnership are called principals, but an increasing number now work as non-principals – that is, they are employees rather than partners in a practice. Alternatively, they might be salaried employees of a PCT. The average number of patients looked after by a full-time GP is 1,800 and the average duration of consultation about 10 minutes. GPs need to be able to deal with all common medical conditions and be able to recognise conditions that require specialist help, especially those requiring urgent action.

Until the new General Medical Services Contract was introduced in 2004, GPs had to take individual responsibility for providing ‘all necessary medical services’ at all times to their patient list. Now, practices rather than individuals share this responsibility. Moreover, the contract now applies only to the hours between

8.00 a.m. and 6.30 p.m., Mondays to Fridays; out-of-hours primary care has become the responsibility of PCTs. GPs still have an obligation to visit patients at home on weekdays in case of medical need, but home-visiting as a proportion of GP work has declined steadily since the NHS began. By contrast, the amount of time spent attending to preventive care and organisational issues has steadily increased. The 2004 contract for the ?rst time introduced payment for speci?c indicators of good clinical care in a limited range of conditions.

A telephone advice service, NHS Direct, was launched in 2000 to give an opportunity for patients to ‘consult’ a trained nurse who guides the caller on whether the symptoms indicate that self-care, a visit to a GP or a hospital Accident & Emergency department, or an ambulance callout is required. The aim of this service is to give the patient prompt advice and to reduce misuse of the skills of GPs, ambulance sta? and hospital facilities.

Training of GPs Training for NHS general practice after quali?cation and registration as a doctor requires a minimum of two years’ post-registration work in hospital jobs covering a variety of areas, including PAEDIATRICS, OBSTETRICS, care of the elderly and PSYCHIATRY. This is followed by a year or more working as a ‘registrar’ in general practice. This ?nal year exposes registrars to life as a GP, where they start to look after their own patients, while still closely supervised by a GP who has him- or herself been trained in educational techniques. Successful completion of ‘summative assessment’ – regular assessments during training – quali?es registrars to become GPs in their own right, and many newly quali?ed GPs also sit the membership exam set by the Royal College of General Practitioners (see APPENDIX 8: PROFESSIONAL ORGANISATIONS).

A growing number of GP practices o?er educational attachments to medical students. These attachments provide experience of the range of medical and social problems commonly found in the community, while also o?ering them allocated time to learn clinical skills away from the more specialist environment of the hospital.

In addition to teaching commitments, many GPs are also choosing to spend one or two sessions away from their practices each week, doing other kinds of work. Most will work in, for example, at least one of the following: a hospital specialist clinic; a hospice; occupational medicine (see under OCCUPATIONAL HEALTH, MEDICINE AND DISEASES); family-planning clinics; the police or prison services. Some also become involved in medical administration, representative medicopolitics or journalism. To help them keep up to date with advances and changes in medicine, GPs are required to produce personal-development plans that outline any educational activities they have completed or intend to pursue during the forthcoming year.

NHS GPs are allowed to see private patients, though this activity is not widespread (see PRIVATE HEALTH CARE).

Primary Care Trusts (PCTs) Groups of GPs (whether working alone, or in partnership with others) are now obliged by the NHS to link communally with a number of other GPs in the locality, to form Primary Care Trusts (PCTs). Most have a membership of about 30 GPs, working within a de?ned geographical area, in addition to the community nurses and practice counsellors working in the same area; links are also made to local council social services so that health and social needs are addressed together. Some PCTs also run ambulance services.

One of the roles of PCTs is to develop primary-care services that are appropriate to the needs of the local population, while also occupying a powerful position to in?uence the scope and quality of secondary-care services. They are also designed to ensure equity of resources between di?erent GP surgeries, so that all patients living in the locality have access to a high quality and uniform standard of service.

One way in which this is beginning to happen is through the introduction of more overt CLINICAL GOVERNANCE. PCTs devise and help their member practices to conduct CLINICAL AUDIT programmes and also encourage them to participate in prescribing incentive schemes. In return, practices receive payment for this work, and the funds are used to improve the services they o?er their patients.... general practitioner (gp)

(GHQ) a reliable screening tool published in 1978 for identifying minor psychiatric disorders, still frequently used for research in the general population. The 28-question version (GHQ28) is most commonly used, but the GHQ is available in lengths from 12 to 60 questions.... general health questionnaire

a rolling survey carried out annually (1971–2007) in Great Britain by the *Office for National Statistics. It included questions about the household and questions to be completed by all individuals aged over 16 within the household. It covered a wide variety of topics, such as health, employment, pensions, education, and income. It was succeeded (2007–12) by the general lifestyle survey. See also census.... general household survey

It is sometimes not possible to achieve worthwhile results from herbal medicine without due regard to the quality and type of food that enters the body. Suggested foods are those which experience has shown to assist recovery and conserve body energies that might otherwise be diverted towards elimination of metabolic wastes.

“A good and proper diet in disease is worth a hundred medicines and no amount of medication can do good to a patient who does not observe a strict regimen of diet.” (Charaka Samhita 300AD)

A healthy diet helps maintain the immune system, builds up reserves and hastens recovery from illness.

A good general diet includes foods low in fat, salt and high in fibre. All white sugar and white sugar products (chocolates, sweets, etc) should be replaced with natural sugars (honey, dates, figs, molasses, raisins etc). It should contain plenty of raw fresh fruit and vegetables; best prepared in a juice-press.

Vegetables should be conservatively cooked in very little water with little salt in a covered vessel. At least one mixed raw vegetable salad should be taken daily. Bread can be replaced by jacket potato, Soya- bean flour products or ripe bananas. Puddings, pastry and suety meals should be avoided.

Lean meat should be restricted to two or three parts a week with liberal inclusion of oily fish. Tofu, a Soya bean product, is an excellent alternative to meat. Three or four eggs, only, should be taken weekly.

Dairy produce (milk, butter, cream) contain cholesterol which thickens the blood, blocks arteries and increases resistance against the heart and major blood vessels, and should be taken sparingly.

Accept: Garlic, Onions, Lecithin, Muesli or Oatmeal porridge for breakfast or at other times during the day, yoghurt, honey.

Reject: fried foods, biscuits, confectionery.

Salt: replace with powdered Garlic, Celery or Kelp.

Alcohol: replace with fresh fruit or raw vegetable juices. Coffee is a risk factor raising cholesterol concentration; Dandelion coffee, Rutin or any one of many herbal teas available offer alternatives.

Avoid over-eating and meals when tired. Foods should be well masticated without liquid drinks; dry- feed. Plenty of liquid drinks, water etc should be taken between meals.

Supplements: Vitamin C 200mg, Vitamin E 200iu, morning and evening. Evening Primrose oil. Efamol produce a combined Evening Primrose and Fish oil capsule.

Dietary fibre can prevent certain colonic diseases. Treatment of disease by diet is preferred to drugs because it has the advantage of being free from side-effects. ... diet - general

 Pain along a nerve, i.e. pain in the shoulders from pressure on a spinal nerve serving the neck.

Alternatives. Black Cohosh, Cactus, Chamomile, Lady’s Slipper, Ginseng, Hops, Jamaica Dogwood, White Willow, Wild Lettuce, Valerian.

Chamomile tea (mild analgesic).

Tablets/capsules. Any of the above.

Formula. Ginseng 4; Black Cohosh 2; Skullcap 2; Mistletoe 1; Motherwort 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily. Children: see: DOSAGE. Cayenne pepper (Capsicum) sometimes successful.

Topical. Poultice: Chamomile, Hops, Linseed or Bran. Acute cases (cold), chronic cases (hot). Grated or bruised Horseradish root. Evening Primrose oil. Hot Cider vinegar, Tincture Arnica or Hypericum. Aromatherapy. 2 drops each: Juniper, Lavender, Chamomile to 2 teaspoons vegetable oil. Light massage. Diet. High protein. Calcium-rich foods.

Supplements. Vitamin B-complex, B6, B12, Niacin, Magnesium, Dolomite, Zinc.

See: FACIAL and INTERCOSTAL NEURALGIA; DYSMENORRHOEA (neuralgia of the womb). ANTISPASMODICS. ... neuralgia, general

Loss of sensation and consciousness induced to prevent the perception of pain throughout the body during surgery. General anaesthesia is usually induced by intravenous injection of a barbiturate drug and maintained by inhalation of anaesthetic gases such as halothane, which may be introduced into the lungs via an endotracheal tube. During the anaesthetic, the pulse, blood pressure, and other vital signs are continuously monitored.

General anaesthetics have become much safer, and serious complications are rare.

However, severe pre-existing diseases such as lung or heart disorders increase the risks.

Minor after effects such as nausea and vomiting are usually controlled effectively with antiemetic drugs.... anaesthesia, general

a registered nurse with advanced training and experience who assumes some of the duties and responsibilities formerly assumed only by a physician. Such nurses can practise in hospital or community settings within various domains of clinical activity, which may be condition-specific (e.g. diabetes, breast care), client-specific (e.g. children, the elderly, the homeless), or area-specific (e.g. general practice, dermatology).... nurse practitioner

part of *NHS Resolution that provides advice and support to NHS trusts and health authorities in England, Wales, and Northern Ireland regarding concerns about the performance of individual doctors, dentists, and pharmacists. The emphasis of the service is on local resolution. It was formerly known as the National Clinical Assessment Service (NCAS).

Information from the NHS Resolution website... practitioner performance advice

(SEN) the requirements of children who have difficulties in learning or in accessing education. Children with SEN can be supported via mainstream schools or may attend a *special school. Children identified as having SEN that cannot be met by a mainstream school should be assessed by their local authority, which may issue a statement of special educational needs. This statement describes the child and the additional help needed.... special educational needs

a type of NHS trust that provides services across the NHS in England, rather than in a single defined geographical area. There are four special health authorities, which exist as arms-length bodies of the Department of Health and Social Care, independent of government: *NHS Blood and Transplant, *NHS Business Services Authority, *NHS Resolution and *NHS Counter Fraud Authority.... special health authority

WHAT THE LAW REQUIRES. The consulting herbalist is covered by Part III of The Supply of Herbal Remedies Order, 1977, which lists remedies that may be used in his surgery on his patients. He enjoys special exemptions under the Medicines Act (Sections 12 (1) and 56 (2)). Conditions laid down for practitioners include:

(a) The practitioner must supply remedies from premises (apart from a shop) in private practice ‘so as to exclude the public’. He is not permitted to exceed the maximum permitted dose for certain remedies, or to prescribe POM medicines.

(b) The practitioner must exercise his judgement in the presence of the patient, in person, before prescribing treatment for that person alone.

(c) For internal treatment, remedies are subject to a maximum dose restriction. All labels on internal medicines must show clearly the date, correct dosage or daily dosage, and other instructions for use. Medicines should not be within the reach of children.

(d) He may not supply any remedies appearing in Schedule 1. Neither shall he supply any on Schedule 2 (which may not be supplied on demand by retail).

He may supply all remedies included in the General Sales List (Order 2129).

(e) He must observe requirements of Schedule III as regards remedies for internal and external use.

(f) He must notify the Enforcement Authority that he intends to supply from a fixed address (not a shop) remedies listed in Schedule III.

(g) Proper clinical records should be kept, together with records of remedies he uses under Schedule III. The latter shall be available for inspection at any time by the Enforcement Authority.

The practitioner usually makes his own tinctures from ethanol for which registration with the Customs and Excise office is required. Duty is paid, but which may later be reclaimed. Accurate records of its consumption must be kept for official inspection.

Under the Medicines Act 1968 it is unlawful to manufacture or assemble (dispense) medicinal products without an appropriate licence or exemption. The Act provides that any person committing such an offence shall be liable to prosecution.

Herbal treatments differ from person to person. A prescription will be ‘tailored’ according to the clinical needs of the individual, taking into account race as well as age. Physical examination may be necessary to obtain an accurate diagnosis. The herbalist (phytotherapist) will be concerned not only in relieving symptoms but with treating the whole person.

If a person is receiving treatment from a member of the medical profession and who is also taking herbal medicine, he/she should discuss the matter with the doctor, he being responsible for the clinical management of the case.

The practitioner can provide incapacity certificates for illness continuing in excess of four days for those who are employed. It is usual for Form CCAM 1 5/87 to be used as issued on the authority of the Council for Complementary and Alternative medicine.

General practitioners operating under the UK National Health Service may use any alternative or complementary therapy they choose to treat their patients, cost refunded by the NHS. They may either administer herbal or other treatment themselves or, if not trained in medical herbalism can call upon the services of a qualified herbalist. The herbal practitioner must accept that the GP remains in charge of the patient’s clinical management.

See: MEDICINES ACT 1968, LABELLING OF HERBAL PRODUCTS, LICENSING OF HERBAL REMEDIES – EXEMPTIONS FROM. ... herbal practitioner

a legal and ethical standard in medical care and treatment. A doctor has both an ethical and a legal obligation to maximize a patient’s welfare or wellbeing. When cases have gone to court, the judiciary has been clear that the concept of best interests extends beyond the purely medical. The principle of *autonomy requires that a patient with *capacity is in the best position to determine what is in his or her best interests. Where a patient lacks capacity, health-care professionals must act in his or her best interests. Under the Mental Capacity Act 2005, a doctor must take account of the patient’s wishes and try to determine what he or she would have wanted, possibly with reference to an advance directive (see advance directive, decision, or statement), an appointed proxy, or an *independent mental capacity advocacy service. The interests of children are especially important, and doctors must be particularly vigilant where there is a potential conflict of interests, as when reporting cases of suspected child abuse or recruiting for paediatric research.... best interests

(secure hospitals) hospitals for the care of mentally ill patients who are also dangerous and must therefore be kept securely. The level of security can be low, medium, or high. Most (but not all) patients are there compulsorily under a hospital order made by a court according to the *Mental Health Act 1983.... special hospitals

(in Britain) an education establishment for children with *special educational needs. The identification and assessment of those needing to attend a special school may occur long before school age. Special schools exist for children with different types of need, including physical disability and hearing impairment. Special education for children with severe disabilities may start as early as two years.... special school

(in medical ethics) the situation in which a health professional is subject to potential or actual pressures that may conflict with his or her obligation to promote the *best interests of the patient over and above all else. A conflict of interest arises from a particular context or situation and may threaten a doctor’s integrity and undermine trust between professional and patient. For example, a drug company may encourage a doctor to prescribe a particular medicine, which may not be the treatment of choice for a patient, or contractual financial disincentives may discourage a doctor from providing a more expensive treatment of choice for a patient. In medical research, there is always a potential conflict between protecting the individual and benefiting society. Particular problems of this kind occur in randomized controlled trials (see equipoise; intervention study). Doctors will always experience competing pressures and it is important for them to be able to recognize and then, where possible, disclose, resolve, or mitigate morally problematic conflicts.... conflict of interest

(GMC) the regulatory body of the medical profession in the UK, which was established in 1858 by the Medical Act and has statutory powers. It licenses doctors to practise medicine and has the power to revoke licences or place restrictions on practice. The governing body of the GMC, its Council, comprises 12 members, 6 of which are medically qualified and 6 of which are not. Its purpose is to protect, promote, and maintain the health and safety of the public by ensuring proper standards in the practice of medicine and medical education and training. Following various high-profile cases involving malpractice, there has been a shift in the role of the GMC from one of simple registration to that of *revalidation of doctors.

GMC website: includes the Council’s guide to Good Medical Practice... general medical council

(GP) a doctor working in the community who provides family health services to a local area. General practitioners (also known as family doctors or family practitioners) may work on their own or in a group practice in which they share premises and other resources with one or more other doctors. GPs are usually the first port of call for most patients with concerns about their health. They look after patients with wide-ranging medical conditions and can refer patients with more complex problems to specialists, such as hospital consultants. Some GPs with additional training and experience in a specific clinical area take referrals for assessment and treatment that may otherwise have been referred directly to hospital consultants; these are known as GPs with a special interest (GPwSI or GPSI). Most GPs work solely within the *National Health Service but a few work completely privately. The current model of general practice allows for GPs to provide general medical services (GMS), the terms and conditions of which are governed by a national contract which is usually negotiated on an annual basis, or personal medical services (PMS), the terms and conditions of which are governed by locally negotiated contracts within a broad framework. The new primary care contract (nGMS contract) came into force in April 2004, allowing GPs to opt out of weekend and night (*out-of-hours) service provision for patients registered with their practice. In this period, patient care is usually provided by an out-of-hours cooperative or deputizing service. At the same time the government also introduced the *Quality and Outcomes Framework (QOF) as a means to improve the quality of care provided. Most GPs are *independent contractors although more recently there has been an increase in the number of salaried GPs. GPs may employ a variety of staff, including *practice nurses, *nurse practitioners, and counsellors.... general practitioner

1. the expression of concern about performance or competence that is privileged at law by virtue of the Public Interest Disclosure Act 1998. The statute provides that where an employee acts in good faith in questioning the behaviour or performance of another member of staff or an organization, he or she should be protected from such penalties as disciplinary procedures, suspension, or dismissal. See also whistle-blowing. 2. circumstances in which *confidentiality can be breached because there is a serious risk of physical harm to an identifiable individual or individuals. The basis on which confidentiality can be breached in the public interest were defined in the case of W v Egdell, in which the court held that the risk had to be of physical harm to identifiable person(s) and must not be merely ‘fanciful’. Where there is a serious risk of physical harm to a specific person, there is an entitlement but not a duty to breach confidentiality, and the *General Medical Council requires that doctors must be prepared to justify their decision either way.... public interest disclosure