Long-term conditions Resources

There are three million people living with cancer in the UK, which is predicted to rise to nearly 3.5 million by 2025 (Macmillan Cancer Support, 2024). The GP Contract (NHSE Contract Letter 2024/25) has protected the cancer indicators in the Quality Outcomes Framework (QOF), which are that every person should be offered an opportunity to discuss their diagnosis and be informed of the support available to them from primary care within three months of diagnosis, and a structured cancer care review should be offered within twelve months of diagnosis. General practice nurses (GPNs) already have expertise in long-term condition management and could deliver the same for people living with cancer, but
most do not feel confident to do so. This article includes the author’s personal reflections on her role and the development of personalised care within primary care.

Preventing and managing wound infection has sometimes resulted in inappropriate prescribing of antibiotics and overuse of topical antimicrobial wound dressings. This is partly due to the difficulties in identifying the early signs of wound infection and uncertainty as to who is at risk. This article guides the reader through the importance of considering antimicrobial stewardship (AMS), how to identify at-risk patients, how to reduce the risk through wound bed preparation, and how to identify wound infection. When reviewing wound infection management strategies, it particularly focuses on the role of non-medicated wound dressings, which are becoming a viable alternative to traditional antimicrobial dressings such as silver and iodine.

Lipoedema affects 11% of women worldwide (Buck and Herbst, 2016) and has a significant physical and psychosocial impact. It commonly presents as a disproportionate distribution of body fat in the lower extremities — symptoms include tenderness, pain, bruising and large fat nodules. Treatment is often similar to lymphoedema management and includes decongestive therapy, compression garments and skin care. This article presents a patient case study. It looks at the physical and psychological impact of lipoedema on the patient and the significant improvements seen with the use of juxtafit compression garments. The patient’s treatment included the intervention of general practice nursing and tissue viability services, demonstrating the importance of multidisciplinary working.

The ability to recognise the need for debridement is a vital skill for general practice nurses (GPNs), since it is an important part of preparing the wound for healing. Debridement removes dead tissue within the wound that can otherwise provide a physical barrier to healing, while also providing an ideal environment for micro-organisms, increasing the risk of infection. In order for healing to progress, it is important to debride the wound promptly. Failure to do so can result in wound chronicity and an associated impact on resources and patient quality of life. While there are different methods of debridement available, this article focuses on autolytic and mechanical, explaining how they work and their benefits and limitations.

Despite the availability of effective treatments, uncontrolled asthma is associated not only with mortality, but also morbidity affecting health-related quality of life. The aims of asthma management are to achieve control of symptoms, reduce the risk of exacerbations, and limit the future risk of fixed airway obstruction. Poor asthma control can arise from inadequate treatment, poor adherence to medications, poor inhaler technique, poor perception of control, along with risk factors such as psychosocial/emotional and altered breathing patterns, as well as comorbidities such as rhinitis, depression or obesity. This article focuses on the role of general practice nurses (GPNs) in the management of asthma, with particular emphasis on medications. It also looks at the benefits and drawbacks of short-acting ßeta-2 agonists, inhaled corticosteroids and longacting ß2 agonists, as well as non-pharmacological interventions.

Highly exuding wounds can affect people of all ages, often causing distress, anxiety and social isolation. Managing these challenging wounds can also represent a significant cost to the NHS. This article looks at exudate and the difference between normal and excessive exudate and examines the causes of a high volume of exudate and its effect on the patient. Exudate assessment is an important part of holistic assessment, which is also explored in the article. Strategies GPNs can employ to manage exudate, including wound dressings and other devices, are then discussed.

Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD), particularly as the disease progresses. This article looks at the nutritional issues facing patients with COPD, including the effects of medication, social and psychological issues. It outlines the role that general practice nurses (GPNs) can play by implementing the newly updated ‘Managing Malnutrition in COPD’ guidance. The guidance encourages incorporation of nutritional screening into COPD care pathways and the optimisation of nutritional intake for those at medium and high risk of malnutrition via dietary advice and oral nutritional supplementation, where appropriate. It also provides practical tips for patients with COPD to help manage common barriers to eating, such as shortness of breath, dry mouth and taste changes.

Surgical wound dehiscence develops when the edges of a surgical incision separate along the suture line due to infection or suboptimal healing, leading to an open wound. Surgical wound dehiscence can have a significant impact on the patient’s quality of life, increases the demands on healthcare professionals’ time and is costly to the health economy. Over 50% of patients with surgical wound dehiscence are managed in the community and treating these types of wounds is challenging. General practice nurses (GPNs) need to be aware of those patients that are more likely to present with surgical wound dehiscence and take a preventative approach, as well as understanding the principles of best practice for assessment and management when caring for this group of patients.

Appropriate and accurate assessment and management of lower limb wounds requires a timely, holistic assessment of the patient and their wound, including the recording of an ankle-brachial pressure index (ABPI) (Wounds UK, 2019a). A manual ABPI procedure requires advanced skills, using a handheld ABPI device, and is undertaken by a healthcare professional who is appropriately trained. In addition, the procedure is time consuming, taking a minimum of 40 minutes, and is subjective in its results, based on the technique and skill of the operator. This article describes an innovative service evaluation project that has seen the introduction of 20 automated ABPI machines into 19 general practices and a community vascular clinic in Staffordshire. The project has included the development of a care pathway, recruitment of wound champions, and training within each of the practices. Evaluation of the project is ongoing but tracks ABPI readings, assessment and wound management of patients, onward referrals and outcomes for patients, to ensure that the project’s potential to improve patient care is realised.

Psoriasis is a chronic inflammatory skin condition that can have a debilitating impact on patients. It affects 2% of the UK population (Gelfand et al, 2005), and although it can develop at any age, usually occurs in adults rather than children (NHS Choices, 2015). General practice nurses (GPNs) will often encounter patients with psoriasis in their dayto- day practice, but can lack confidence when advising these patients on the effective management of the condition. This article outlines the causes of psoriasis and provides practical advice for GPNs on assessment and treatment in primary care. The author also outlines the psychological effects of psoriasis, and discusses referral guidelines.