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Hot Topics Blog

Spring 2019 Hot Topics Course Preview

Simon Curtis - 12 Mar, 2019

The Hot Topics GP Update course is a fun, inspiring and informative day packed with learning points to take away to use in practice. We make it easy for you to maintain focus on the day by keeping our presentations short, sharp and focussed with lots of opportunity for interaction, including using live Q&A polls with your smartphone. We use clinical cases weaved in to bring the literature and guidelines to life. All the material is 100% independent and free from any external influence.

All the presented material will be completely new compared to Spring 2018.

All delegates on the course will receive:

  • The detailed 350 page Hot Topics paper book
  • A bigger electronic version of the book, including even more Hot Topics. This is hyperlinked to all the original references and is instantly searchable
  • The NB Medical App, across which you can access the full content of the digital course book or just the Keep it Simple Summaries (KISS)
  • Pre and post course MCQs to assess learning
  • The Webcast version of the course following the course so that they can revise and see the material again
  • The personal email address of the presenters of the course for post course follow up questions

Topics that we shall cover on the day will include:

  • Cardiovascular medicine

o  Primary prevention in older people

  • What do the evidence and guidelines tell us about managing CV risk in older people, including use of BP lowering medication and statins…how do we balance benefits and risks?

o  TIA, new evidence and guidance looking at dual antiplatelet treatment in acute treatment

o  Stable angina, overview of new guidelines and management update

o  Which antiplatelets should be used in which CV conditions, and for how long?

  • Mental Health

o  Depression in children and young people, new NICE guidance and management options for primary care

o  Treatment resistant depression

o  Insomnia…if not benzos or zopiclone, then what next?

  • Musculoskeletal

o  Inflammatory arthritis: an update on new guidelines on rheumatoid arthritis and SLE, and what GPs need to be aware of with the new biologic treatments

  • Respiratory

o  COPD

  • new NICE guidance on management and also treatment of exacerbations
    • what is the place for triple therapy?

o  Bronchiectasis, diagnosis and management of flare ups

  • Women’s Health

o  HRT update, including mode of delivery and also micronized progesterone

o  Nausea and vomiting in pregnancy

o  Tailored pill taking

  • ENT

o  Acute hearing loss

  • Prescribing Hot Topics

o  New concerns regarding paracetamol in frailty, quinolones and ACE inhibitors

o  In England only, the new 2019 QOF prescribing quality improvement domain

  • Cancer

o  Testing times…

o  Cases based on recent papers on colorectal cancer and FIT tests, myeloma, testicular cancer and LUTs and prostate cancer

  • Thyroid

o  Subclinical hyperthyroidism

o  Thyroid, fertility and pregnancy

  • End of Life Care

o  Update on new guidelines and the Daffodil Standards

o  In England only, the new 2019 QOF end of life quality improvement domain

  • Infections

o  As reported cases rise, an update on measles

o  New NICE/PHE antibiotic guidance

o  Complicated UTIs, including recurrent and catheter related

  • Gastroenterology

o  Barrett’s oesophagus

o  Haemochromatosis genotypes

  • Paediatrics

o  Recurrent cough in children

  • Miscellaneous cases to end the day

As ever, we like to keep it practical and pragmatic whilst also considering many of the broader issues and challenges we face. And we like to have a laugh too!

We look forward to seeing you!

Simon, Neal, Siobhan, Kate, Zoe, Ahmed, Rob, Stephanie, Sarah, Duncan, Mark and Will

The NB GP Team


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GP Horizon the secure place online to learn from GP colleagues

Rima Aboud - 26 Mar, 2019

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GP Horizon is a closed, private and supportive forum created by me, a salaried GP, for professional discussions between GPs.

Every day we are faced with clinical questions we don’t know the answer to, but a GP colleague somewhere will… but where do we go to ask? 

GP Horizon was created for the simple reason that I wanted to be able to ask clinical questions to a pool of GPs, receive a quick response from a GP colleague and have this time tracked to utilise it for my own learning and CPD. 

I qualified as a GP in 2015 and was so used to attending my weekly VTS sessions I assumed that meeting up with my First5 group, at least monthly, was the natural next step. However, it wasn’t until qualified that I appreciated the value of having protected time to discuss the trials and tribulations of General Practice, and more importantly, to have answers to the questions that aren’t covered in the guidelines, or to work out what the next best step would be in an unusual presentation.

I found that I was often texting GP friends in between patients to ask a quick non-urgent question. Sometimes this worked well, but often my friends would be in their own clinic and fielding their own questions, on holiday, or simply didn’t know the answer!

This led to the idea of texting a whole community of GPs in a supportive and collaborative environment which inspired me to develop GP Horizon - a secure and (really) simple way to post questions to other GPs. GP Horizon can be compared to a giant WhatsApp group for GPs. You can post clinical questions on the GP Horizon Forum, reply to other posts or simply read through posts for your own learning. However, GP Horizon differs from WhatsApp because the amount of time you spend on it is tracked so you can collate CPD hours and download a certificate for your appraisal. It is also secure as only verified GPs are given access to the GP Horizon Forum. We have around 1,500 GPs already using GP Horizon. It is FREE to download via the Apple App Store or Google Play Store. 

GP Horizon is also available on the web at www.gphorizon.com.

Dr. Rima Aboud

General Practitioner


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How to help teenagers with mental health problems?

Simon Curtis - 21 Mar, 2019

Sarah aged 15 comes to see you with her Mum. Over the last few months she has become quieter, withdrawn, not seeing friends or going out as much. She has stopped going to her dance class and other things that she used to enjoy. She is now not wanting to go to school, and has started to self-harm through scratching. How can we help?

This is a consultation and a scenario we are all way too familiar with. The mental & emotional health of children and young people is a massive Hot Topic both for us as a society and for us as health care professionals. Late last year NHS England produced a new report on the mental health of children & young people. It confirmed what we know: the problem is huge. One in eight five to 19 year olds have at least one significant mental health problem, rising to one in four of young women aged 17 to 19. The survey scratched under the surface and found a strong link with low self-esteem, bullying and cyber-bullying.

So, we know that is the problem, we know our CHAMS colleagues are completely over-stretched and the RCGP and others have called for more and faster access for mental health services for children and young people. CHAMS can only see the very apex of this huge pyramid of need, so how can we help Sarah?

Earlier this year NICE produced a new DRAFT guideline for children and young people, and the definitive guideline is to be published in April. The headline is to offer digital CBT via an app or web interface as first step option for mild depression. It is not clear yet how this will be delivered, but in the meantime there are some great resources out there that we can signpost Sarah and her family to.

Young Minds is a great resource offering support, signposting, guidance and advice. Kooth offers free, safe and anonymous on-line support and counselling for young people. For digital CBT, there are a number of courses and resources available (although there is often a fee) specifically designed for young people such as Living Life to the Full-YP , Mood Gym young minds and MoodJuice. For parents, Happy Maps is a great resource for signposting resources and help in your area. The NHS apps page has a great section on mental health self-help apps, such as the brilliant Calm Harm which helps young people to manage the urge to self harm. I think it’s really worth some time looking at some of these apps, downloading them and demonstrating them in the consultation (I do this especially with Calm Harm) to help boost user engagement.

So, although we often feel helpless there are lots of resources we can help to signpost people to for self-help and support, and this is emblematic of the zeitgeist of lifestyle medicine, social prescribing and greater engagement with voluntary organisations. However, the most important way you can help Sarah is through you being you. Never underestimate the therapeutic potential of human kindness. Experience has also taught me that that first consultation, when someone has taken the brave step to cross the threshold to come to see you is pivotal to future therapeutic success, no matter how late it is or how tired you are. You need to cover a lot (risk assessment, alcohol, drugs, bullying, safeguarding issues etc.) which will take several consultations, and to do that you need to build trust. This takes time, but the rewards for you will be great and for Sarah could be life-changing.  


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ADHD Prescribing

Ahmed Rashid - 7 Mar, 2019

Around three or four decades ago, it became fashionable in psychiatry to classify mental disorders into distinct diagnostic categories. The rationale was that it would move people away from circular arguments about aetiology, and towards practical and reliable disease definitions that would be useful for clinicians and academics. This led to a huge number of new disease labels, one of which was ADHD.

Of course, inattentive, impulsive, and hyperactive children have always existed, and it’s difficult to quantify the exact effect of labelling children with a disease name, rather than approaching them ‘the old-fashioned way’, whatever that might be.

As every GP knows, the diagnosis of diseases like ADHD is far from straightforward. They prompt us to do the difficult job of drawing lines between the normal and the abnormal, when those lines are often grey and blurred. With ADHD, it’s further complicated by the media and celebrity discourse about the disease. Hillary Clinton, for example, has suggested that the medical profession are too quick to diagnose children whose problems are simply normal characteristics of childhood.

It’s not just celebrities and politicians though. The concerns about overmedicalisation have also been raised from within the medical profession. Shifting definitions and commercial influences have been suggested as important drivers, and it has been noted that elevated medication costs, adverse events, and psychological harms are all potential consequences.

So where does that leave us, as frontline GPs?

In a recently published systematic review that I contributed to, studies that investigated medication taking in ADHD patients and their carers were synthesised. It highlighted a complex array of factors that contribute to decisions about whether to take medications, including acceptance of the diagnostic label, anticipated and actual side effects of medications, and the external influences of school, friends, and the media. An important theme was the concept of ‘trade-offs’, as families described having to weigh up the numerous positive and negative consequences of medications on various aspects of their lives.

The 2018 NICE guideline on ADHD reaffirms that diagnosis and initiation of treatment should be done in secondary care. However, as trusted family doctors and patient advocates, we will clearly be called on for advice and support. Indeed, the new guideline is much more explicit than previous versions in outlining strategies for sharing decisions relating to ADHD management: there is more focus on involving families, more specific recommendations on conversations around medication adherence, as well as proactive encouragement to discuss patient preferences around discontinuing or changing medication.

Although our role in ADHD is primarily to support secondary care colleagues, we are well placed to help families make sense of diagnostic and treatment uncertainties, and support them to make decisions that work for them. 


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