Royal College of General Practitioners - Online Learning Environment

Atopic conditions such as asthma, eczema, allergic rhinitis (hay fever) and food allergy commonly present in primary care. In the last few years we have seen tragic deaths from food allergies make the headlines, and we know that over 2% of children in the UK are affected by peanut allergy, with estimates of lifetime prevalence for any food allergy reaching around 20%. Allergic rhinitis is even more common, affecting up to 50% of the population worldwide; it is often seen as a mere summer inconvenience but is more significant than this, being associated with poorly controlled asthma and impaired performance in school exams and at work. The National Review of Asthma Deaths serves as a timely reminder that allergy is a key consideration in severe asthma, with trigger factors being recorded for under half of those featured in the report. Eczema also has a significant effect on quality of life; children with eczema are more likely to be bullied, to miss school, and to have poor school performance than their peers and are at a higher risk of depression than the general population.

The RCGP allergy hub provides a variety of resources to help learners to improve their knowledge on allergy. The eLearning course on allergy has four modules which between them cover all of the atopic conditions already discussed. A pre and post course MCQ allows users to test the improvement in their knowledge after doing the course.

There are also a variety of podcasts which cover different aspects of the diagnosis and management of allergy in primary care, particularly the difference between IgE mediated and non-IgE mediated allergy. Non-IgE mediated allergy can be more difficult to diagnose, because symptoms may present some time after the allergen was ingested, and may not be initially recognised as being allergic in origin. The connection between asthma and allergic rhinitis is discussed, using the concept of the one-airway theory. Pollen food syndrome, otherwise known as oral allergy syndrome, is also the subject of a podcast; whilst this allergy is usually mild and short lived, it can cause anxiety if oral symptoms are incorrectly interpreted as the start of a more sever reaction. In many of our courses and podcasts we attempt to do some myth busting, so that patients can access accurate information from their GPs, and any incorrect assumptions can be challenged. Finally, there are four short screencasts which provide bite-sized updates for the time-pressed GP who wants to know more about eczema, peanut allergy, asthma or allergic rhinitis.

References:

• https://cks.nice.org.uk/topics/food-allergy/
• https://cks.nice.org.uk/topics/allergic-rhinitis/ 
• https://cks.nice.org.uk/topics/eczema-atopic/ 
• Walker S, Khan-Wasti S, Fletcher M et al. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol. 2007 Aug;120(2):381-7. 
• de la Hoz Caballer B, Rodríguez M, Fraj J, Cerecedo I, Antolín-Amérigo D, Colás C. Allergic rhinitis and its impact on work productivity in primary care practice and a comparison with other common diseases: the Cross-sectional study to evAluate work Productivity in allergic Rhinitis compared with other common dIseases (CAPRI) study. Am J Rhinol Allergy. 2012 Sep-Oct;26(5):390-4 
• Royal College of Physicians. Why asthma still kills. May 2014. https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills

Atopic eczema, also known as atopic dermatitis, is a chronic inflammatory skin disorder which most frequently presents in childhood. It can have physical complications including infection with bacteria and viruses – infection can sometimes be life-threatening, particularly in the case of eczema herpeticum. Those with eczema are also more likely to experience psychological issues than the general population. Children with eczema have higher rates of bullying, impaired school performance, missed school and behavioural problems than their peers and sleep disturbance is a significant issue for both adults and children with eczema. Eczema is linked to other atopic conditions and education on these can be found on the allergy hub.

The atopic dermatitis hub has a two-module eLearning course which uses a case-based approach to educate about the primary care approach to eczema, including history, examination, rational use of investigations where appropriate, initial management and when to refer. There is a lot to cover in the first eczema consultation and so a whole podcast is devoted to this, with another podcast on the holistic approach to eczema.

References:

• https://cks.nice.org.uk/topics/eczema-atopic/

 

This 30 minute session will provide you with information on the presentation of colorectal cancer, particularly looking at the reasons behind late presentation and the implications of this. Diagnostic and screening investigations are explored, and next steps following referral to the cancer pathway are discussed.

This course was developed in partnership with UCLH Cancer Collaborative.

Start Colorectal Cancer

 

There is an important link between chronic obstructive pulmonary disease (COPD) and nutritional status, with malnutrition having a profound impact on disease progression and general functioning.

This course explains why patients with COPD may not achieve adequate nutritional intake. Assessing nutritional status, using the ‘MUST’ screening tool enables clinicians to advise on appropriate management. This module will explain the ‘MUST’ tool and discuss the treatment options for malnutrition including food fortification and oral nutritional supplements.

This course was developed in partnership with Nutricia.

Start COPD and Nutrition

This module looks at the initial steps to be taken to create a more inclusive primary care environment for LGBTQ+ patients. Small interventions in the practice and the consultation can have a positive impact upon  LGBTQ+ patient satisfaction and outcomes.

An educational grant was received from the Government Equalities Office for the production of the course. Editorial and content decisions were made solely by the RCGP.

Return to LGBTQ+ Health Hub

Why does primary care need to know about women’s health?

The 2022 women’s health strategy showed that women spend a significantly greater proportion of their lives in ill health and disability compared to men; a majority of women who responded to the survey felt that there had been times when their voices were not listened to when accessing healthcare. Specific concerns were that symptoms were not taken seriously, that significant self-advocacy was needed to reach a diagnosis, and that there were limited opportunities to discuss the possible treatments. There are a variety of medical needs and life stages which are specific to women, including cervical and breast screening, dysfunctional menstruation, the need for contraception, care during pregnancy and the postnatal period, and management of the menopause. Breast cancer, which is vastly more common in women than in men, is the commonest UK cancer, with two other female specific cancers (uterus and ovary) listed in the 20 most common UK cancers. Cancers of the cervix and vulva are less common (with cancer of the cervix reducing in incidence due to HPV vaccination), but it remains important that we maintain a high index of suspicion for symptoms which could represent a malignancy of any part of the female tract.

This hub concerns illnesses and life stages which are relevant to those of the female sex, and so the words woman/women/female and the pronouns she/her are used throughout the resources. Some of our patients for whom these illnesses and life stages are relevant will have a gender identity which is not female. Their chosen pronouns should be respected and used.

Women’s health eLearning

This hub contains courses which cover the main female cancers – endometrial, cervical, vulval and ovarian, as well as information about prevention of, and screening for, breast cancer. The course on endometriosis discusses the presentation and initial decision making process around whether to treat empirically in primary care or refer for a diagnosis. The decision on whether a formal diagnosis, only available via laparoscopy, is necessary at first presentation, needs to be made by the woman and her GP and will depend on a variety of factors including severity of symptoms and whether there is a current wish to conceive. There is also a course on heavy menstrual bleeding (HMB) which starts from the assessment of a patient with HMB and discusses the current guidelines and how to assess the risk of endometrial pathology and use this to make decisions about whether to treat empirically, investigate in primary care, or refer at first presentation.

The course on contraception covers all currently available methods and uses an interactive approach, case studies and videos to provide education about the mode of action and efficacy of each method, the common myths and how to refute them, and broader issues which women seeking contraception may want to consider. Concepts such as quick-start and bridging contraception are also discussed. The menopause and hormone replacement therapy (HRT) is covered in a module aimed at generalists which discusses the identification and management of the menopause and perimenopause, what women need to know about HRT and how to start it, as well as the specific features that apply to women with premature ovarian insufficiency (POI), many of whom will need referral to secondary care.

The hub also contains a variety of podcasts. Some of these cover the same subjects as the courses – a podcast sometimes allows more in depth discussion of an aspect of care where management may not be clear-cut; where there is a podcast and a course, they usually cover different facets of the condition and so it is worth accessing both resources. There are also podcasts on subjects which do not have a course on the hub, such as influenza (flu) vaccination in pregnant women, and women’s health and migraine.

References:

• https://www.gov.uk/government/calls-for-evidence/womens-health-strategy-call-for-evidence/outcome/results-of-the-womens-health-lets-talk-about-it-survey
• https://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/common-cancers-compared#heading-Zero

Healthcare inequalities are unfair and avoidable differences in health across the population, and within different groups in society. People who live in areas of high deprivation and who are from certain ethnic minority communities are at higher risk of health inequalities, which are linked to the wider determinants of health, such as where we are both and grow up and the conditions in which we live, work and age. The NHS Long Term plan has the reduction of health inequalities at its core and aims to ensure exceptional quality healthcare for all, ensuring equitable access, excellent experience and optimal outcomes. The RCGP health inequalities hub contains three eLearning courses, as well as other resources.

The first course provides an introduction to health inequalities, introducing terms such as the wider determinants of health, the index of multiple deprivation, the inverse care law and the intersectionality between multiple factors. A case study approach is used to help learners consider how they might reduce health inequalities in their area. The second module looks at leadership in this area, considering how a practice might put in place measures to reduce health inequalities among their patients and what challenges this might bring.

The second course is on inclusion health. Inclusion health groups are those who are most likely to suffer health inequalities – they include those experiencing homelessness, victims of modern slavery and vulnerable migrants. The course discusses how practices can be welcoming to these patients, how to make sure that they are not deterred from registering by unnecessary administration, and how to manage consultations with those in inclusion groups, within the confines of NHS general practice.

The third course discusses the principle of allyship and bystander intervention, how to avoid unintentional microaggressions, and the NHS’ policy towards racism. It covers situations that might arise in practice, such as what to do if a patient asks to see a white doctor, and the interventions that have been recommended to reduce the fact that black and ethnic minority doctors are more likely than white doctors to be referred to the GMC. A case study illustrates how a practice might deal with a patient who makes a racist comment.

The rest of the hub contains other resources in the area of health inequalities. This includes an interview and a webinar with Professor Sir Michael Marmot, who has led research groups on health inequalities for over 40 years and has written key reviews in this area, including ‘Fair Society, Healthy Lives’. There is also a podcast about the use of social prescribing link workers to reduce health inequalities and a section about increasing vaccine uptake to reduce health inequalities – this was linked to the COVID-19 vaccine, but many aspects are relevant to other vaccinations. Finally there are links to other resources, including on ‘missingness’, when patients do not attend appointments and may be harmed by this, and resources about addressing the increase in health inequalities that has been seen since the COVID-19 pandemic.

References:

• https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/

This is a recording of a live webinar that took place on 28 October 2024. This recording will be available to view until 28 April 2025.

Prescribing of medication is the most common intervention in general practice, bringing considerable benefit to patients, but with associated risks. Around two-thirds of prescriptions issued in primary care are repeat prescriptions, and this means that it is very important to have robust systems in place to ensure best use of these medicines. This includes a careful balance between ease of access to repeat medicines and safety considerations, and also effective medication review. Along with the Royal Pharmaceutical Society, the RCGP has recently developed a Repeat Prescribing Toolkit, funded by NHS England. This webinar will focus on how to ensure safe and effective repeat prescribing and medication review, and will showcase the new Toolkit.

Learning objectives:

•    To increase awareness of some of the major risks in repeat prescribing
•    To identify the key elements of a safe repeat prescribing system
•    To increase awareness of the potential benefits of using the RPS/RCGP Repeat Prescribing Toolkit
•    To identify effective approaches for undertaking essential monitoring prior to medication review
•    To identify the range of approaches that GPs (and wider primary care teams) can adopt to ensure safe and effective medication reviews

• Dr Emma Salik, GP, Faculty Education Lead, RCGP Beds & Herts 

• Dr Tony Avery OBE, GP and Professor of Primary Health Care, University of Nottingham, and National Clinical Director for Prescribing for NHS England
• Clare Howard, FFRPS FRPharmS and Q

• GP registrar rate - £15
• Members rate - £20
• Non-members rate - £30

Sleep disorders are very common in the population as a whole, and even more common in patients seen in primary care. This course aims to educate primary care clinicians about the diagnosis and management of insomnia in adults. It will discuss normal sleep architecture,  differentiation of insomnia from other sleep disorders, and both non-pharmacological and pharmacological management. The two eLearning modules are supported by a micro-site where four practical case studies are presented, to put the learning into practice.

Idorsia Pharmaceuticals UK Ltd funded this eLearning project.  Content was developed via a Collaborative Working Agreement with final editorial decisions resting with the RCGP.

UK-DA-00381  Date of preparation: April 2024

Time to complete this course:
30 minutes

Date of publication:
March 2016

Reviewed and updated:
September 2020

Reviewed and updated:
July 2023

This course aims to educate GPs about the diagnosis and management of chronic oedema and lymphoedema. It also considers related topics such as the causes of chronic oedema and the management of lipodermatosclerosis.

This course was developed in partnership with LSN.  This course is FREE to RCGP members and GP registrars. If you are non-member, you can purchase it on the RCGP website.

Start Lymphoedema course