nmrcgp for consultants

If you find anything you feel would be helpful to others, please email me here.

Dermatology

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

1. PRIMARY CARE MANAGEMENT

The knowledge base

Symptoms
Key issues in the diagnosis of skin problems will be eliciting of the appropriate signs and symptoms and subsequent investigation and / or referral of people presenting with:
• hair loss
• a disorder of their nails
• itch (also known as pruritis)
• pigmented skin lesions
• skin rashes
• signs of infections of the skin
• bruising or purpura
• lumps under the skin
• photosensitivity

Common and/or important skin conditions
• Eczema
• Psoriasis
• Generalised pruritus
• Urticaria and Vasculitis
• Acne and rosacea
• Infections (bacterial, viral and fungal)
• Infestations including scabies and head lice
• Leg ulcers and lymphoedema
• Skin tumours (benign and malignant)
• Disorders of hair and nails
• Drug eruptions
• Other less common conditions such as the bullous disorders, lichen planus, vitiligo, photosensitivity, pemphigus, pemphigoid, discoid lupus, granuloma annulare and lichen sclerosus

Investigations
• Ability to take specimens for mycology from skin, hair and nail
• Basic interpretation of histology reports
• Skin biopsy

Treatment
• Those commonly used in primary care (including an awareness of appropriate quantities to be prescribed)
• Principles of protective care (sun care, occupational health and hand care)
• An awareness of specialised treatments, such as retinoids, ciclosporin, phototherapy and methotrexate
• The skills to perform curettage, cautery and cryosurgery

Emergency care
• Acute treatment of people presenting with skin problems or symptoms thought to be due to skin problems and appropriate referral if necessary. Including:
• Angioedema and Anaphylaxis
• Meningococcal sepsis
• Disseminated herpes simplex
• Erythroderma
• Pustular psoriasis
• Toxic epidermal necrolysis
• Stevens-Johnson syndrome
• Necrotising fasciitis

Prevention
This will involve the following risk factors
• Sun exposure
• Fixed factors: family history and genetics
• Occupation and care of the hands

Genetics
• Describe how genetic factors influence the inheritance of common diseases such as psoriasis and atopic eczema.

Specific problem-solving skills
• Intervene urgently when patients present with an emergency skin problem (see ‘knowledge base’ for examples).
• Demonstrate a reasoned approach to the diagnosis of skin symptoms using history, examination, incremental investigations and referral.

2. PERSON CENTRED CARE

• Appreciate the importance of the social and psychological impact of skin problems on the patient’s quality of life, including, for example, the effects of disfigurement.
• Identify the patient’s health beliefs regarding skin problems and either reinforce, modify or challenge these beliefs as appropriate.

3. PROBLEM SOLVING SKILLS

The knowledge base

Investigations
• Ability to take specimens for mycology from skin, hair and nail
• Basic interpretation of histology reports
• Skin biopsy

Prevention
This will involve the following risk factors
• Sun exposure
• Fixed factors: family history and genetics
• Occupation and care of the hands

Genetics
• Describe how genetic factors influence the inheritance of common diseases such as psoriasis and atopic eczema.

4. COMPREHENSIVE APPROACH

• Advise patients appropriately regarding lifestyle interventions including skin protection and occupational health advice.
• Describe the side effects of common medicines used to prevent and treat other conditions that may cause skin problems.

5. COMMUNITY ORIENTATION

• Describe the rationale for restricting certain investigations and treatments in the management of skin problems e.g. prescribing of retenoids, access to phototherapy.
• Understand the importance of occupational risk in the aetiology of skin disease

6. HOLISTIC APPROACH

• Recognise how disfigurement and cosmetic skin changes fundamentally affect patients’ confidence, mood and interpersonal relationships
• Appreciate the importance of the social and psychological impact of skin problems on the patient’s quality of life, including, for example, the effects of disfigurement.
• Recognise the impact that skin problems have on fitness to work.
• Appreciate the importance of the social and psychological impact of skin problems on the patient’s family, friends, dependents and employers.

• Empower patients to self-manage their skin conditions as far as practicable e.g. eczema.

All these 6 domains have a

7. Contextual Aspect

• Recognise how common skin problems are amongst the general population.
• Recognise the risk of inappropriate referrals and under-referral.
• Describe the need for close collaboration with primary care and specialist services in the management of many skin problems e.g. pigmented lesions, psoriasis.

8. Attitudinal Aspect

• Ensure that skin problems are not dismissed as trivial or unimportant by health care professionals.
• Empower patients with chronic skin problems to manage the effects of disfigurement.

9. Scientific Aspect

• Understand and implement the key national guidelines that influence healthcare provision for skin problems (e.g. the NHS cancer plan 2000).