Date
Title
Durati CPD
Topics
on
credits
covered
/TIME claimed
17/05/ Update on
1
2012 medicines
managementmeeting at
Windy
LaneMedical
Group.
1
Prescribing
QoF audit
2011-2012
Presentation
by the
practice
support
pharmacist C.
Rivett.
13/05/ Substance
2012 misuse in
primary care.
bmjlearning
audio module
by Dr C.
Gerada
Drug
safety
Prescribing
expenditur
e/QIPP
initiatives
and cost
benefits for
the
practice
and North
of Tyne.
1
1
Reflections
Impact of prescribing errors and lack
of monitoring on patient safety as
the PRACtICe Study showed.
The Heart Failure Audit and COPD
audits showed large numbers of
patients without clinical
review/annual recall.
Cost benefits from Glucosamine,
switching to standard prednisolone
and to Erythromycin tablets.
Further actions
Aware of risks: incomplete information,
dose or strength errors, timing errors,
frequency errors, as well as drugs
most commonly associated (statins,
warfarin, amoxycillin, prednisolone,
diclofenac, ibuprofen, acyclovir,
flucloxacillin, fucibet).
Use of clinical computer systems may
help prevent errors.
Use of templates and improvement of
the recall systems
New template for lithium.
Improve self-monitoring for warfarin
patients.
Introduce new QIPP initiative for
gluten-free products
Need to know how and when to refer.
Initial
consultatio
Do a basic needs check and see what the
n
patient wants. Check for blood-borne
Referrals
viruses.
and key
Emergency or acute problems.
workers.
Child protection issues. Pregnancy.
Types of
substitutes. Older drug users.
Engage patient. Congratulate patient for
seeking help.
GPs should work within their limits of
confidence.
Always confirm that a patient is a user
before prescribing substitute medication.
Treat each individual patient in their own
merit.
Methadone and Buprenorphine.
Naloxone as adjunct treatment.
10/05/ QoF changes 1.5
2012 2012-2013
and update on
the HIV social
services care
in Newcastle.
Meeting at
Windy
LaneMedical
Group.
1.5
30/04/ Multiple
2012 Sclerosis
RCGP online
course
3
RCGP
essential
knowledge
update 9.
3 hours
online.
post-course
score:100%.
3
Clinical
QoF
criteria for
the year
2012-2013.
QoF changes for new year: focus on
dementia, diabetes, AF and CHADS2
score, PVD, osteoporosis, depression.
We discussed cases of housebound
patients whose diabetic and other QoF
checks were not done because acute
home visits were a priority.
The HIV
HIV and social care Newcastle.
social
services at Blue Sky trust and Body Positive
Royal
Northeast teams. Patients do not need to
Victoria
inform GP that they are HIV positive.
Informary
Newcastle.
Prevalence and
risk factors
Common
presentation
Impact on life
Prevalence is 164/100,000. Men are
more likely to have progressive disease
from the outset.
It is increasingly recognised in children
worldwide. There is an interesting
environmental link to vitamin d deficiency.
It's important to differentiate between
true vertigo and ataxia.
Steroids do not affect the final outcome of
a relapse.
Differentiate between distress and
demyelination.
To look into the new changes in more detail
and be aware of how new guidance might
affect referrals (dementia) and diagnosis
(HbA1c in diabetes).
Appreciate the role of the HIV social
services especially in a practice like ours
with large number of HIV patients. Referral
guidance.
Early suspicion of MS in patients with optic
neuritis and vertigo. i remember the case of
a 32 year old women that I met a few
months ago and admitted to Hospital
immediately due to severe unilateral
headache and vertigo and turned out to
have an isolated episode of demyelination.
Important issues to have in mind are also:
effect on life insurance and review on
each consultation how much the patient
wants to know about prognosis of
disease once the diagnosis has been
established.
Exclude infection by checking for pyrexia Advise patients to check their contracts at
and doing a urine test.
work because under the Equality Act they
might not be required to tell their employer
Relapse rates are reduced during 2nd
about their disability unless they are in the
and 3rd trimesters of pregnancy but tend Armed Forces of their disability might impact
to increase in the first 3 months poston health and safety at work. However they
30/04/ Clinical
2012 commissionin
g groups.
1
1
RCGP course
online
The role of
CCGs and
consortia.
PbC and why it
was largely
seen as
ineffective.
partum. Fertility is not affected.
are legally obliged to inform the DVLA of
their condition. Everyone with MS is
covered under the Equality Act.
PCTs and SHAs will be abolished.
Everyone needs to be involved, even
trainees. Shared leadership.
Health and Wellbeing boards will be set
up in local authorities to ensure that the
commissioning of health and social care
services is co-ordinated. Health Watch
England will oversee public engagement
in the commissioning process.
Discussion of reasons why GPs might be
seen or not as best placed to oversee
commissioning.
Stages:

To realize the financial risks will be shared
among the practices involved in a
commissioning group.
To develop new skills and familiarize
myself with the language and practices of
other professionals.
needs assessment-analyze and
plan.



02/05/ advanced
2012 consultation
skills at
bmjlearning.c
om
3
3
BMJ learning
audio modules.
Dr R.
Neighbour,
former
President of the
RCGP.
Model of
consultation.
design pathways.
specify and procure.
deliver and improve.
Five steps of the consultation:
I have reflected on the advice given on how
to avoid running late and whether trying to
connecting, summarizing, handing over (to solve the wrong problems and not having
the patient and agree the plan), safety
the full agenda from the start might be a
netting and housekeeping (no leftover
reason for this.
feelings between consultations).
to try to summarize early and often would
help avoid this. the first 2 minutes of the
consultation are crucial in understanding
what the real problem is. the earlier we
ask patient to summarize the easier it will be
to identify this.
23/04/
2012
08/03/ Triptans audit, presented by 0.5
2012 another doctor.
Palliative care update
presentation at the practice
meeting at Windy
LaneMedical Group.
0.5
Triptan
auditmigraine.
Audit: use of triptans in migraine.
problems with using higher than
Multidisciplinary
meeting and
discussion.
recommended doses (more than 6 per
I will re-examine recent
cases of migraines that I
have seen in the practice
and review prescriptions
and maximum doses
given and overall plan.
month).
I have also reflected on the
palliative care case since it
consider staring with sumatriptan and upon is quite a common one and
raises issues regarding
review give another 6 does per month on
ensuring patient safety
repeat prescription.
but also screening early
for depression in cancer
patients.
counsel patient regarding medication
perhaps arranging transfer
overuse headaches.
of patient to respite care
earlier as a place of safety
while awaiting assessment
if not successful, can try an alternative or
from the CAT team could
start prophylaxis.
have been an option.
cannot use two different triptans together.
Palliative care case: 72 year old man with 2
separate cancers + mass in pancreas. Ongoing
investigations. Has overdosed on several
occasions. Suffers with long-term
depression. Was seen by practice Registrar on
6/3 – threatened to kill himself if she left. GP
Important change: switch
from diamorphine to
morphine on 1st May 2012.
Registrar arranged for CAT team to visit – did
not turn up whilst she was there, she stayed
until 8pm. Psychiatrist informed Registrar that
all was well and patient was not sectioned at
that time. He was then admitted to Comfort
House on respite care. To date still in Comfort
House and it is unknown when he will be
discharged.
05/03/ Bleeding problems in
2012 contraception RCGP
module e-GP
0.5
0.5
Clinical
examination
and
contraceptiv
e pill
options.
speculum examination is useful in bleeding.
i reflected upon my ways of
communicating and
counselling patients on
bimanual examination is useful only if there is
deep pelvic pain/dyspareunia or heavy
initial and long-term
bleeding.
bleeding patterns and how i
can improve those in order
not to forget pregnancy testing, cervical smear if to minimize concerns and
discontinuation.
due or in defaulters and STI checks.
For unscheduled bleeding with the progestogenonly injection, implant or intrauterine system, a
COC may be used for up to 3 months if there
are no medical contraindications. The COC can
be administered in the usual cyclical manner or
continuously without a pill free week.
a patient who is bleeding
after several months of
using a certain
conctraceptive method
needs a physical
examination.
impact-i have also reflected
on a large number of cases
that i have recently seen
with unscheduled bleeding
with hormonal contraception
and on how i have managed
them.
05/03/ Hormonal problems with
2012 pills
0.5
0.5
RCGP module e-GP
Important
consideratio
ns during
OC
counselling.
Women with moderate or severe pre-existing
acne, or a tendency to have acne when
younger, should be advised that the IUS
LNG_IUS may make this condition worse.
Some women using combined hormonal
contraception complain of severe headaches at
onset of menses. These headaches result from
a sharp drop in circulating steroids at the end of
the cycle.
careful counselling before
prescribing.
consider personal history
and emotional reasons
before attributing side
effects to the pill.
They seem to be more common with combined
hormonal contraception users than in natural
cycles.
Tricycling (running 3 packs together) may help
to reduce the frequency of headaches, however
this is outside of the product licence.
07/02/ Dementia update
2012
doctors.net.uk module
0.5
0.5
NICE
risperidone is the only anti-psychotic licensed
guidancefor management of BPSD.
doctors.net.
Antipsychotics increase the risk of strokes.
uk
the atypical antipsychotics generally have a
more acceptable side-effect profile.
NICE recommends im lorazepam, haloperidol
or olanzapine in extreme cases of acute
agitation/aggression in the elderly.
07/02/ Alcohol and substance
2012 misuse among doctors
bmjlearning podcast
0.5
0.5
bmjlearning
video
module-Dr
Clare
Gerada
Alcohol and drug addiction among doctors right
through all professional groups.
GPs and Anaesthetists have got more access to
certain drugs.
to encourage use of
psychosocial methods of
intervention in cases of mild
to moderate BPSD
especially when discussing
with patients' relatives and
carers in nursing homes
etc.
Learn to develop coping
mechanisms to deal with
stressful situations and look
after one’s self.
Main risk factors: stressful jobs and access to Support colleagues who are
drugs. Also doctors tend to put their work above going through a difficult
themselves.
time.
Doctors fear confidentiality issues about
themselves.
high incidence of cirrhosis among doctors.
Remember that recovery
rates are very high among
doctors and encourage
colleagues to seek help
rather than getting
isolated.
If we realize that a
colleague has an alcohol
problem: 1. Do not panic
since they are likely to have
had this problem for a long
time, 2. speak to the person
directly and advise them to
seek help. Trust the system
and involve BMA or GMC if
necessary.
06/12/ Generalized Anxiety
2011 disorder
0.5
0.5
Diagnosis
and
manageme
nt of GAD in
primary
care
differences between GAD and other conditions
like anxiety, depression and panic
attacks. interesting figures re: prevalence and
outcomes, choice of psychological therapies
and their individual roles.
first of all exclude substance
misuse and depression, and
follow a more structured
approach in terms of
choice of drug and
psychological therapy.
i have reviewed a recent
case of a 32 year old lady
that I saw at the practice
who was eventually
diagnosed with GAD by
clinical psychologist with the
use of detailed
questionnaires. She is now
a lot more settled after
starting appropriate
medication.
6
6
Update on
the
Manageme
nt of type 2
diabetes
screening for type 2 diabetes. role of sitting time
and physical inactivity in obesity and mortality
rates. The role of gliptins. diabetic eye disease.
DVLA update June 2011. case stories with
management problems.
be able to advise patients
re: newest DVLA guidance
and hypoglycaemia
prevention while driving.
doctors.net.uk module with
quiz.
score: 70%
28/09/ Diabetes update-seminar at
2011 the Centre for Life
Newcastle.
Primary Care Diabetes
Society
the new IFCC absolute standard for HbA1c from
01/10/2011 and the limitations in its use.
08/09/ Review of Acute admissions 1
2011 at practice meeting
1
Windy LaneMedical Group
review of
acute
admissions
and ways to
avoid them
need to look into acute admissions from care
homes for UTIs, COPD, heart failure, simple
colds etc that could have been avoided by
improving the services provided.
need to develop a CBT service.
look into ways to improve care of heart failure
patients and patients in care homes.
18/08/ Fever in children-guidelines
2011 update at practice meeting
1
1
NICE
guidance
One of the doctors presented a review of the
NICE guidance and practice care over the past
3 years.
Quality Improvement
Activity.
familiarize myself with
certain templates on EMIS
relevant to the above in
order to improve quality of
care.
need to improve
documentation: heart rate,
respiratory rate and
temperature.
key priorities to implement: results and analysis.
all GPs to have tympanic membrane
thermometers.
practice have ordered pulse oximeters and
axillary thermometers for all doctors.
04/08/ iron absorption-discussion
2011 at practice meeting
Windy LaneMedical Group
1
1
iron
absorption
and erectile
dysfunctionupdates
iron absorption:80% of iron is absorded in the
diet of a non vegetarian person comes from
foods other than meat. particular useful ironcontaining foods are pulses, beans, bread,
breakfast cereals. vit c containing foods aid
absorption.
erectile dysfunction: (from bmj 10 min
consultation)avoid concurrent use of nitrates for
improve advice given to
parents. effect of ibuprofen
lasts for 8 hours.
1. when giving diet advice
to vegetarian patients who
present with iron
deficiency.
2. counsel patients with ED
properly before use of
medication.
24hrs (after sidenafil/vardenafil) and 48 hrs
(tadalafil). testosterone levels can be low after
an illness temporarily. ace-inhibitors may
improve ED. bloods should be done to assess
CVD risk generally.
14/09/ Safeguarding children single 1
2011 agency training.
1
NHS North of Tyne
meeting, Racecourse,
Newcastle.
27/03/ Safeguarding Children
2012 multi-agency training.
6
6
1
1
Kenton Centre, Newcastle.
6 hours CPD.
03/11/ CPR and AED update
2011 November 2011 at Windy
LaneMedical Group
12/04 Safeguarding children
/2012
e-learning module
1.5
1.5
Face to face
single
agency
training
by being aware of the inter-agency roles and
Group B
responsibilities.
Course for
Safeguardin
g Children. by undestanding and following the protocols
and procedures when there are concerns for a
Newcastle
child's welfare.
Safeguardin
g Children
Board.
49.5
by being more alert and
proactive and efficient.
also important to send a
report ahead of the case
conference if we cannot
attend even if we have no
concerns.
I need to familiarize myself
with the Newcastle model
for service delivery and
have up-to-date contact
details for people that I
might need to involve.
need to be up to date with recent changes in the By being able to help in
guidelines of the UK Resuscitation Council. case of an emergency at
the practice or anywhere
else.
Virtual
College eacademy
module.
1.5 CPD hours.
Test score 90%.
Total Courses, meetings,
numb seminars and e-learning
er of modules
hours
spent
recognise alarming signs and how to
communicate with colleagues effectively.
domestic violence. Freedom Programmes for
women. MARAC and MAPPA agencies.
49.5
Reflective Learning PUN/DENs
how to ask a child or a carer questions about
an unexplained injury.
do not use leading questions when interviewing a
child.
document the exact words.
recognise features that should alert us to the
possibility of an non-accidental injury.
watch for carer's reaction and interaction
between carer and child.
neglect and emotional abuse are more difficult to
detect and can happen in any family regardless of
financial situation.
need to be aware that
regular contact with
families whose standards
are very low can make a
worker tolerant of this
while someone who does
not know them would find
their ways unacceptable.