Background Good medical practice for general practitioners, published by the Royal College of general practitioners in 2008, highlights the standard of practice for GPs in the delivery of care to patients. GPs need to have an adequate level of knowledge and competence about various specialties so that patients can be well managed at primary care level. Current changes in the NHS means management of long-term conditions such as Diabetes mellitus (DM) and Rheumatoid arthritis (RA) are moving into community settings. It is essential primary care physicians possess adequate knowledge and skills to manage these long-term conditions. More NHS trusts and GP surgeries within the United Kingdom are employing the use of “shared care protocols” for RA patients. These patients need optimal care in between outpatient follow up appointments.
Objectives 1)To assess the confidence of GPs in the assessment, and management of RA compared to DM.
2)To explore the confidence of GPs in reviewing monitoring tests for RA compared to DM.
3)To explore the confidence of GPs in the practical use of newer drug therapy in RA and DM.
Methods The survey was carried out using a questionnaire based proforma administered by the interviewer. Questionnaires were distributed to GPs across the east midlands during various GP educational study days over 6 months. The proforma had initially been piloted and redesigned. Data from 100 respondents were collected and analysed using online software.
Results N=100. Over a third of GP respondents were experienced GPs with greater than 15years experience. 20%(20)of respondents were not confident in assessing patients with suspected RA compared to DM. All GPs were very confident in assessing patients with suspected DM.
50% of respondents reported that they were not confident in assessing for tight control and complications related to DM. Only 2% (2) were not confident in doing this when related to DM. Over half of the GPs were confident in reviewing monitoring tests related to DM compared to 19%(19) of GPs in reviewing monitoring tests related to RA.
Regarding newer drug therapy 25%(25) were not confident in the use of recent drugs (gliptins) in patients with DM, compared to 83%(83) that were not confident in use of recent drugs (anti-TNFs) in patients with RA.
35%(35) of GPs were confident in using monitoring parameters such as HbA1c in DM compared to 16%(16) of the same cohort who reported that they were confident in the use of CRP for patients with RA. The remainder were not confident in the use of CRP as a monitoring tool in RA.
Conclusions This study was the first of its kind comparing knowledge on managing two chronic autoimmune conditions managed in primary care. We found that overall GPs had less confidence in diagnosis, management and use of monitoring tests in RA when compared to DM. We recommended that GPs need continuous primary care education in rheumatology to update their in this rapidly developing specialty This can be either as web based learning or master classes in rheumatology delivered locally or nationally by a rheumatologist.
General Practitioners Committee of the BMA and the Royal College of General Practitioners. Good Medical Practice for General Practitioners London: RCGP, 2008.
General Medical Council. Good Medical Practice London: GMC UK, 2006.
Disclosure of Interest None Declared