nmrcgp for consultants

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Respiratory Medicine

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

• Manage primary contact with patients who have a respiratory problem.
• Demonstrate a consistent, evidence-based approach to antibiotic prescribing for respiratory infections.
• Co-ordinate care with other primary care health professionals, such as practice nurses, district nurses and physiotherapists to enable chronic disease management and pulmonary rehabilitation.
• Apply the guidelines for emergency admission of patients with an acute exacerbation of asthma, to help reduce preventable deaths.
• Explain the indications for urgent referral to specialist services, especially for patient with suspected lung cancer.
• Describe the indications for home oxygen therapy and home nebulisers, and evaluate individual patient’s requirements for these.

The knowledge base

Symptoms
• Breathlessness, cough, wheeze, chest pain, sputum production, haemoptysis.

Common and/or important conditions
• Upper respiratory tract infections: Sore throats and colds, tonsillitis, peri-tonsillar abscess, epiglottitis, laryngitis and tracheitis
• Lower respiratory tract infections: Influenza, bronchiolitis, bronchitis and pneumonia (of any cause)
• Acute non-infective respiratory problems: Allergy and anaphylaxis, hypersensitivity pneumonitis, pulmonary embolus, pneumothorax, aspiration of a foreign body
• Chronic lower respiratory problems: Chronic cough, asthma, chronic obstructive pulmonary disease (COPD), tuberculosis, cystic fibrosis, chronic interstitial lung diseases
• Lung cancer

Investigation
• Serial peak flow measurement, including patient diaries
• Reversibility testing using peak flow meter
• Spirometry
• Knowledge of secondary care investigations and treatment including lung function assessment, Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI)

Treatment
• Understand principles of treatment for common conditions managed largely in primary care – upper and lower respiratory tract infections, asthma, COPD, allergic reactions and anaphylaxis.
• Inhaler technique for using commonly used devices.

Emergency care
• Acute management of people presenting with shortness of breath
• Acute management of anaphylaxis
• Management of exacerbations of asthma and COPD
• Understand indications for emergency referral of people with asthma, COPD and anaphylaxis

Prevention
• Smoking cessation assessment, advice and management.
• Vaccination against influenza, Streptococcus Pneumoniae, Haemophilus Influenza b, Diphtheria and Pertussis.
• Health education advice and patient self-management plans for people with asthma and COPD
• Understand avoidance of triggers and prophylaxis for allergic conditions
• Investigation of people with family history of genetic respiratory disease e.g. cystic fibrosis

2. PERSON CENTRED CARE

• Identify the patient’s health beliefs regarding smoking and either reinforce, modify or challenge these beliefs as appropriate.
• Negotiate a patient self-management plan for asthma in partnership with the patient.
• Communicate prognosis truthfully and sensitively to patients with incurable disabling respiratory conditions, such as COPD and metastatic lung cancer, and share uncertainty when the patient wants this information.
• Demonstrate empathy and compassion towards patients with incurable disabling respiratory conditions.
• Utilise disease registers and data recording templates effectively for opportunistic and planned monitoring of respiratory problems to ensure continuity of care between different health care providers.

3. PROBLEM SOLVING SKILLS

The knowledge base

Symptoms
• Breathlessness, cough, wheeze, chest pain, sputum production, haemoptysis.

Specific problem-solving skills
• Utilise knowledge of the relative prevalence of respiratory problems to assist diagnosis.
• Describe the alarm symptoms for lung cancer.
• Recognise particular groups of patients at higher risk of acquiring a respiratory infection e.g. asthmatics and those with other underlying lung pathology, HIV/AIDS, immune-compromised, alcoholics, the frail (old and young)
• Explain the role of serial peak flow measurement, reversibility testing and spirometry in the diagnosis of asthma and COPD.
• Intervene urgently when patients present with a respiratory emergency e.g. anaphylaxis, inhaled foreign body, epiglottitis etc.

Moved from psychomor skills:

• Describe how to use peak flow diaries and evaluate the results.
• Describe and assess technique for using common inhaler types.
• Interpret the results from spirometry.

4. COMPREHENSIVE APPROACH

• Assess the likelihood of occupational exposure as a cause of respiratory disease (e.g. COPD).
• Recognise that breathlessness may have several co-existing causes (e.g. simultaneous cardiac and respiratory disease) and determine optimum management for these.
• Consider safety issues when prescribing home oxygen therapy.

5. COMMUNITY ORIENTATION

• Understand the current population trends in the prevalence allergic and respiratory conditions in the community.
• Appreciate the importance of the social and psychological impact of respiratory problems on the patient’s family, friends, dependents and employers.
• Consider safety issues when prescribing home oxygen therapy

6. HOLISTIC APPROACH

• Appreciate the importance of the social and psychological impact of respiratory problems on the patient’s family, friends, dependents and employers.
• Appreciate the disability suffered by people with chronic respiratory problems.
• Empower patients to self-manage their conditions as far as practicable.
• Recognise the stigma associated with smoking when giving health promotion advice to ensure the doctor-patient relationship is not damaged.

All these 6 domains have a

7. Contextual Aspect

• Understand the current population trends in the prevalence allergic and respiratory conditions in the community.
• Recognise the central role of primary care in managing asthma and COPD.
• Recognise that sub-optimal care and poor adherence to medication contribute to unnecessary deaths from asthma.
• Recognise that lung cancer is the leading cause of cancer deaths in both men and women, often affecting young patients.

8. Attitudinal Aspect

• Ensure that personal opinion regarding smoking does not influence management decisions for people with respiratory problems.

9. Scientific Aspect

• Understand and implement the key national guidelines that influence healthcare provision for respiratory problems (e.g. the BTS / SIGN guidelines on asthma management, the NICE guidelines on COPD management).
• Understand the evidence regarding antibiotic prescribing in upper respiratory tract infections.