The concept of managed care evolved in the USA as a way of containing costs and promoting quality in health care. Some vital lessons can be learned from this experience, and many of its benefits can be applied to the UK as the NHS internal market develops. However, there are also pitfalls which it is equally important to avoid. This is the first book to provide an in-depth analysis of the contracting techniques seen in managed care. The author is in the rare position of being an NHS manager with practical experience of the US health care system, and has produced a first hand contemporary guide to managed care, highlighting its strengths and weaknesses and its relevance to the UK. To set the current debate about the future of the internal market and GP fundholding in context, the author offers a critical review of the NHS reforms and current management and clinician competencies. Citing American experience of the role of doctors in management, he demonstrates both the power and limitations of such initiatives.

'How many general practitioners ended up in their roles thanks to a faint breeze nudging them in a given direction? How many successes resulted from failure? Some of the most successful practices were built up from nothing, and some of the happiest doctors spent time not being doctors. Despite the element that fate plays in career paths it is prudent to make plans - ' A career in general practice offers many options for further professional development. While some GPs prefer to concentrate primarily on their practice, others find additional fulfillment in teaching, research or international collaboration. Whichever path you choose, general practice promises a rewarding and exciting experience. This inspiring new book emphasises there is no single career path in general practice. Without being prescriptive, its practical approach helps you make life-changing decisions, prompts self-analysis and equips you with the tools to remain flexible, positive and reflective about your career. 'So - have you got what it takes to practise the 'medicine plus' which is today's general practice? This book, written and edited by colleagues many of whom have far more street cred than I, will help you decide. If you have, I wish you luck, fulfilment, and the gratification that comes from being a catalyst for good in the lives of your fellow human beings. If you have a role teaching and mentoring the next generation of GPs, you will find this book a persuasive ally. But if you decide that hospital medicine is your preferred option - well, that's fine. There would be no shame, if you find the ladder to general practice too steep, in settling for becoming a brain surgeon.' Roger Neighbour, in the Foreword 'Lively, extremely informative and engaging' Professor Roger Jones, Editor, British Journal of General Practice

Tax planning can lead to considerable efficiencies, but few GPs have been trained as businessmen. This book in "The Business Side of General Practice" series, provides a guide to the regulations, identifies the pitfalls and opportunities and shows how to maximize the income retained by the practice. John Dean is known for his writing on financial management in general practice and has also written "Making Sense of Practice Finance" (Radcliff).

Churchill's Guide to UK Medicolegal Essentials provides a no-nonsense guide to managing those everyday clinical scenarios that have potential or obvious legal implications. With a clear, practical and easy-to-read style, it takes you through everything that you need to know including the UK legal systems, complaints handling, clinical governance and risk management, disciplinary procedures, and how the law relates to alcohol, drugs, mental health and end of life. This is an ideal book for medical, nursing, dental and paramedic students preparing for exams or interviews, all grades of healthcare professionals, police staff, and anyone needing a brief overview of the legal intricacies of medical practice. Defines the law of England and Wales, Scotland and Northern Ireland Provides tips on preparing a police statement, appearing in court and obtaining forensic samples Scenarios and questions to bring the law to life Filled with practical advice to help you understand and minimise risks to your practice Covers risk management, which is central to Government health policies An enhanced eBook version is included with purchase. The eBook allows you to access all the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud Comprehensive update of all areas of medical law New chapter on the Sexual Offences Act 2003 New questions and scenarios to test your knowledge and understanding

This book presents the latest knowledge on both the physiological and the microbiological aspects of wound healing. Fresh insights into the process of cutaneous wound healing are described, which involves tissue regeneration and repair processes consisting of a sequence of molecular and cellular events. The management of infected wounds is then discussed in detail, covering the roles of traditional medicine practices, novel anti-infective formulations, non-antibiotic approaches, and probiotic bacteria. A section devoted to the interdisciplinary approach to wound care addresses topics including in vitro and in vivo research models, the development of advanced wound dressings, tissue engineering, and the potential applications of bioscaffolds. The authors are all leading researchers in the field. This book is an attempt to showcase current research status and future directions in the area of wound-healing research, which must be of interest to a large group of readers and researchers interested in this field.

The daily work of General Practitioners can seem at once simple and immensely complicated. The routine nature of the consultation appears on the surface to be straightforward, but carries within it myriad layers of meaning. The options for diagnosis and treatment within a single consultation, or when combined in the overall pattern of the day, can seem huge. A basic understanding of complexity theory can provide GPs with a way to face the more bewildering aspects of their job. This book provides a concise and clear introduction to complexity, tailored specifically for the primary care environment. GPs and their colleagues throughout primary care will find this book assists them in working more efficiently, more effectively and more enjoyably.

Teaching and Learning in Primary Care has been specially designed for undergraduate and vocational teaching. It combines both practical advice and theory covering day-to-day teaching and learning in the real world. It also encourages trainers to become more involved in teaching and supervising. This essential guide provides vital guidance and support to general practitioners with teaching responsibilities, undergraduate healthcare lecturers and tutors and healthcare professionals in primary care.

American medicine attracts some of the brightest and most motivated people the country has to offer, and it boasts the most advanced medical technology in the world, a wondrous parade of machines and techniques such as PET scans, MRI, angioplasty, endoscopy, bypasses, organ transplants, and much more besides. And yet, writes Dr. Eric Cassell, what started out early in the century as the exciting conquest of disease, has evolved into an overly expensive, over technologized, uncaring medicine, poorly suited to the health care needs of a society marked by an aging population and a predominance of chronic diseases. In Doctoring: The Nature of Primary Care Medicine, Dr. Cassell shows convincingly how much better fitted advanced concepts of primary care medicine are to America's health care needs. He offers valuable insights into how primary care physicians can be better trained to meet the needs of their patients, both well and sick, and to keep these patients as the focus of their practice. Modern medical training arose at a time when medical science was in ascendancy, Cassell notes. Thus the ideals of science--objectivity, rationality--became the ideals of medicine, and disease--the target of most medical research--became the logical focus of medical practice. When clinicians treat a patient with pneumonia, they are apt to be thinking about pneumonia in general--which is how they learn about the disease--rather than this person's pneumonia. This objective, rational approach has its value, but when it dominates a physician's approach to medicine, it can create problems. For instance, treating chronic disease--such as rheumatoid arthritis, diabetes, stroke, emphysema, and congestive heart failure--is not simply a matter of medical knowledge, for it demands a great deal of effort by the patients themselves: they have to keep their doctor appointments, take their medication, do their exercises, stop smoking. The patient thus has a profound effect on the course of the disease, and so for a physician to succeed, he or she must also be familiar with the patient's motivations, values, concerns, and relationship with the doctor. Many doctors eventually figure out how to put the patient at the centre of their practice, but they should learn to do this at the training level, not haphazardly over time. To that end, the training of primary care physicians must recognize a distinction between doctoring itself and the medical science on which it is based, and should try to produce doctors who rely on both their scientific and subjective assessments of their patients' overall needs. There must be a return to careful observational and physical examination skills and finely tuned history taking and communication skills. Cassell also advocates the need to teach the behavior of both sick and well persons, evaluation of data from clinical epidemiology, decision making skills, and preventive medicine, as well as actively teaching how to make technology the servant rather than the master, and offers practical tips for instruction both in the classroom and in practice. Most important, Doctoring argues convincingly that primary care medicine should become a central focus of America's health care system, not merely a cost-saving measure as envisioned by managed care organizations. Indeed, Cassell shows that the primary care physician can fulfill a unique role in the medical community, and a vital role in society in general. He shows that primary care medicine is not a retreat from scientific medicine, but the natural next step for medicine to take in the coming century.

Patient-Centered Care Series Series Editors: Moira Stewart Judith Belle Brown and Thomas R Freeman Primary care clinicians are often unfamiliar with new and effective methods for detecting substance abuse problems in their earliest stages and the majority of patients with substance abuse problems remain undiagnosed. Substance Abuse is written by primary care clinicians and focused to meet the needs of primary care providers demonstrating how the patient-centered clinical method can assist clinicians in learning how to diagnose this complex psychosocial disorder. This book describes how to use state-of-the-art screening techniques and how to understand and motivate patients to decrease or eliminate harmful use of alcohol and drugs. It presents the latest scientific findings and gives examples of using a patient-centered approach as well as describing specific communication skills with samples of dialogue illustrating their use in helping substance-abusing patients. This is essential reading for all family doctors paediatricians gynaecologists psychiatrists nurses social workers psychologists and all clinicians whose practices include substance abusing patients. It will also appeal to counsellors education personnel and all professionals working with substance abusing individuals. For more information on other titles in this series please click here

"Many counsellors who work in primary care find it difficult to explain to colleagues in the primary care team what they actually do with clients behind the closed door of their room. In this book the author brings to life in a gripping way what really does go on when a counsellor sees a patient in the primary healthcare setting. It's good to read for once a book that describes so realistically and movingly the minute-by-minute account of what actually happens, not a book describing clever therapists getting it right all the time. The book should be required reading for newly appointed non-clinical managers of counselling services and for primary healthcare staff about to start working with a counsellor as a member of their team." - Graham Curtis Jenkins in his Foreword

Patient and public involvement in health and social care has become a key element of government policy, and the need to listen and act on the views of patients and the public is an increasingly integral part of the planning and delivery of healthcare. This new edition has been completely revised and updated, providing practical information on the new responsibilities under clinical governance and Health Improvement Programmes, including useful website links and contact details. It offers clear and straightforward practical advice and provides an introduction to the new structures and processes being set up to enable patients and the public to be more influential in designing and delivering healthcare services. This book is essential reading for all healthcare professionals including doctors, nurses and therapists, and those with management responsibilities, as well as policy shapers and patient organisations.

How can a doctor best understand the emotions and behaviour of his or her patients? An effective and deeply satisfying route is through an appreciation of literature and the profound understanding its authors have of the human predicament. In this extraordinary and enlightening volume general practitioner John Salinsky guides the reader through some of the world's finest works. In each chapter he describes a classic novel short story play or poem revealing them to be easily accessible and enjoyable. He shows how parallels can be drawn between characters in literature and in the consulting room. Developed from his long-running column in the journal Education for Primary Care (formerly Education in General Practice) Dr Salinsky's book gives doctors a new perspective on the doctor-patient relationship and provides unique support to communication skills.

Contents:
1. Why Do We Use Satins? 2. How Do We Assess Dyslipidaemia? 3. What Are the Statins and How Do They Work? 4. Who Should Receive Statin Therapy? 5. What About Statin Use in the Elderly? 6. What Does the Future Hold? 7. Glossary of Terms

Featuring highly illustrated, evidence-based information along with high-quality videos, A Practical Guide to Joint & Soft Tissue Injection is the definitive guide to effective injection procedures that can be performed with simple equipment in a variety of settings. Expanded and updated for the fourth edition, this practical, award-winning guide thoroughly explains the rationale and step-by-step technique for each procedure, helping you offer patients immediate relief from pain and discomfort. Covers a full range of musculoskeletal disorders, chalazions, keloids, warts, and occipital neuralgia, as well as the use of corticosteroids, viscosupplementation, and dry needling. Contains new sections on Orthobiologics, Musculoskeletal Ultrasound, and Advanced and Adjunctive Techniques. Includes all-new content on facial/head nerve blocks, treatment of intersection syndrome, hamstring tendon/ischial bursa, gluteal pain syndrome, Baker's cyst, and midfoot joint injections. Features new coverage of auricular battlefield acupuncture, barbotage, tendon brisement, fenestration, nerve hydrodissection, capsular hydrodilatation/hydroplasty, and percutaneous tenotomy with debridement. Includes 25% more video content, with all videos shown from the operator's viewpoint. Features full-color illustrations and photographs that help you identify landmarks and determine exactly how to proceed. Discusses anatomy and landmarks, when to refer, indications and contraindications, special medical conditions, equipment, complications, coding and billing, and much more. Provides helpful appendices with consent forms, aftercare handouts, and information on documentation. Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.

Information is vital for healthcare professionals striving to keep their practice current and based on the best available evidence. The Internet is playing an increasingly crucial role in life long learning of health professionals and is becoming the most practical way to access publications on clinical guidelines systematic reviews and for updating users about the key aspects of health policy. This book covers the diversity and variable value of material available on the Internet and takes a fresh approach to coping with information overload. It illustrates how simple techniques such as making and using smart maps concept maps and mind maps can help clinicians keep up-to-date and how these methods can be applied to particular areas of healthcare. It provides numerous case studies in key areas including mental health child health primary care and care of the elderly. Mapping Health on the Internet is essential reading for all healthcare professionals and will assist in their learning and continuing professional development.

Guidelines are powerful instruments of assistance to clinicians capable of extending the clinical roles of nurses and pharmacists. Purchasers and managers perceive them as technological tools guaranteeing treatment quality. Guidelines also offer mechanisms by which doctors and other health care professionals can be made more accountable to their patients. But how can clinicians tell whether a guideline has authority and whether or not it should be followed? Does the law protect doctors who comply with guidelines? Are guideline developers liable for faulty advice? This timely book provides a comprehensive and accessible analysis of the many medical and legal issues arising from the current explosion of clinical guidelines. Featuring clear summaries of relevant UK US and Commonwealth case law it is vital reading for all doctors health care workers managers purchasers patients and lawyers.

"Many of the problems that are encountered in the everyday consultation are diffuse, with important psychosocial components, and are the products of the social contexts in which patients are located. All of these figure prominently in this book, as does the ever growing problem of chronic illness. Measuring the performance of general practitioners figures prominently in some of the activities of the primary care trusts, but not all that can be counted counts, and this is why this book is both interesting and important. Listening to patients and engaging with their affective and social problems remains central to the work on the general practitioner." Carl May, in the Epilogue "At a time when GPs are concentrating as never before on bio-medical aspects of their work, this book is a very timely reminder of the importance of inter-personal aspects of the care that we provide for patients. Simon Cocksedge argues that listening is work, and he describes the choices that we have during consultations to allow the patient to express their problems, the importance of listening to the development of long term relationships with patients and the importance of 'being with' patients during important life experiences." Martin Roland, in the Foreword 'This book has arisen from reflections on patients' everyday stories in my work as a general practitioner. Over several years I have reflected on the mandate that general practitioners are given by society to listen and be available if required. The field of study is the everyday business of being a family doctor and the inter- and intra-personal phenomena that arise as a result.' Combining analysis of detailed accounts by general practitioners of their everyday work with theoretical argument, this book is an invaluable read for medical professionals in primary care, students of medicine and nursing, GP tutors and all healthcare professionals directly involved with patients.

Written by many of the world's leading lactation experts, the Textbook of Human Lactation incorporates evidence-based scientific knowledge to address key topics of importance in breastfeeding such as Anatomy and Biochemistry, Immunobiology, Breastfeeding Management in Infant and Mother, Maternal and Infant Nutrition, and Medications and Breastfeeding. Specific and detailed information is provided on the following: Complete description of the anatomy and physiology of the lactating breast Detailed explanation of the immunobiology of human milk Description of difficult syndromes and conditions in the infant and breastfeeding mother, and how to overcome these challenges Thorough discussion of the of the emotional and physiological component of breastfeeding, especially as it relates to mother/infant co-sleeping Detailed description of the nutritional competition and components of human milk Explanation of the science of drug transport into human milk, and the use of medications in breastfeeding mothers Discusses breastfeeding in the context of important topics such as infertility, polycystic ovary syndrome (PCOS), vitamin D, birth spacing, and family planning.

Exciting papers by leading researchers are integrated in this volume with presentations having direct clinical relevance: thus, the latest scientific advances in aging research are coupled with reports on how these advances are being applied to longevity medicine.

Topics include oxidative stress, genetic/biochemical mechanisms, hormone therapy, nutrition, fitness, and exercise, all as they pertain to aging.

In exploring the links between the latest basic gerontological research and the practice of longevity medicine, the current challenges faced by both scientists and clinicians engaged in combating aging and its consequences are presented here. This volume is readily accessible to the educated reader who is interested in learning more about how to reduce the negative impact of aging on human health and longevity.

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Practical General Practice is a highly practical manual, specifically designed for use during the consultation process. Containing over 1000 conditions, the unique underlying structure of the book allows the GP to see immediately what treatment is recommended and why. All recommendations are highly specific - giving a firm guide to the GP during the consultation process rather than a list of possibilities that the GP might wish to consider. It is thirty years since the first edition of this textbook was published. Since then there have been five editions, a wealth of new research and numerous new guidelines to improve the practice of evidence-based medicine. The seventh edition brings Practical General Practice right up to date with more robust guidance than has ever previously been possible. Bullet points for action which give the GP an immediate summary of the issues that must be covered in the consultation. Bullet points of the key evidence which justifies those recommendations. All chapters thoroughly revised, to reflect changes in the evidence, and in major guidelines, since the last edition. NNT values provided when available Appendices give the latest guidelines for management of various clinical conditions in general practice. New editorial team New research and guidelines relating to evidence-based medicine included Greater focus on international guidelines and opinion New introductory chapter, Principles and Practice of Primary Care, taking account of topics relevant to the MRCGP exam Appendices thoroughly revised and updated Many contributors new to this edition New chapters on Ethics, Diabetes and Long-term conditions Extensively revised combined chapter on palliative care and end of life issues Now with accompanying free e-book on Expert Consult for the first time Now in full colour

Medical partnerships are highly complex legal and financial entities. This book navigates the reader through the key issues and deals with the less tangible aspects such as partnership dynamics and organisational behaviour. Examples illustrate common difficulties and offer possible choices. It is clear, practical and readable and essential for all GPs entering a partnership. It is also relevant for GPs currently in partnerships, practices considering their partnership deed, Senior House Officers and GP registrars.