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In order to integrate genomic medicine into routine patient care and stratify personal risk, it is increasingly important to record family history (FH) information in general/family practice records. This is true for classic genetic disease as well as multifactorial conditions. Research suggests that FH recording is currently inadequate.To provide an up-to-date analysis of the frequency, quality, and accuracy of FH recording in UK general/family practice.An exploratory study, based at St Leonard's Practice, Exeter-a suburban UK general/family practice. Selected adult patients registered for over 1 year were contacted by post and asked to complete a written FH questionnaire. The reported information was compared with the patients' electronic medical record (EMR). Each EMR was assessed for its frequency (how often information was recorded), quality (the level of detail included), and accuracy (how closely the information matched the patient report) of FH recording.Two hundred and forty-one patients were approached, 65 (27.0%) responded and 62 (25.7%) were eligible to participate. Forty-three (69.4%) EMRs contained FH information. The most commonly recorded conditions were bowel cancer, breast cancer, diabetes, and heart disease. The mean quality score was 3.64 (out of 5). There was little negative recording. 83.2% of patient-reported FH information was inaccurately recorded or missing from the EMRs.FH information in general/family practice records should be better prepared for the genomic era. Whilst some conditions are well recorded, there is a need for more frequent, higher quality recording with greater accuracy, especially for multifactorial conditions.Taking a family history (FH) of disease can be a quick, cost-effective way of gathering genetic information. Genetic medicine is beginning to transform healthcare, so it is important to gather FH information. General practitioners, also known as family physicians, are in the best position to gather FH information as they regularly see multiple family members. Research suggests that FH recording in general/family practice is not yet good enough. This study aimed to find the areas for improvement by measuring the frequency, quality, and accuracy of FH recording. This study looked at 62 patients’ records in one UK general practice. Patients were asked to give up-to-date FH information in a questionnaire which was compared with their record. The study found that some conditions were often recorded. The most commonly recorded condition was heart disease. The conditions that are more likely to reflect the family environment, such as depression, were less frequently recorded. Recordings often included the side of the family the condition affected. Recordings rarely included the age that the relative was affected. The information was not very accurate, as most of the information from patient questionnaires was missing from the records. Research should now focus on how to improve recording.

The exceptional advances in genomic medicine in the last two decades, since the sequencing of the human genome, have already had a major impact on healthcare in the UK. Until recently this was predominantly in secondary and tertiary care, but we must now integrate ‘mainstream’ genomics in primary care. So far integration has of necessity been empirical, but must progress towards implementation research. We describe recent work undertaken by the RCGP and the NIHR CRN outlining areas where research is needed to fully integrate genomics into routine primary care and secure the future of these exciting developments.

Reilly et al ’s article on GP scholarship1 is important and we warmly support it. They rightly state that academic general practice should be ‘integrated and accessible to grass roots GPs’ . Secondary care has long had its teaching hospitals and long trumpeted the academic triad of good service for patients, teaching, and research all in the same place. GPs should seek to replicate …

OBJECTIVES To map current practice regarding discussions around resuscitation across England and Scotland in patients with cancer admitted acutely to hospital and to demonstrate the value of medical students in rapidly collecting national audit data. METHODS Collaborators from the Macmillan medical student network collected data from 251 patient encounters across eight hospitals in England and Scotland. Data were collected to identify whether discussion regarding resuscitation was documented as having taken place during inpatient admission to acute oncology. As an audit standard, it was expected that all patients should be invited to discuss resuscitation within 24 hr of admission. RESULTS Resuscitation discussions were had in 43.1% of admissions and of these 64.0% were within 24 hr; 27.6% of all admissions. 6.5% of patients had a "do not attempt resuscitation" order prior to admission with a difference noted between patients receiving palliative and curative treatment (8.5% and 0.39%, respectively, p

The negative phrase ‘the worried well’ is being increasingly used, particularly by policymakers and now by some clinicians as well. Usually, it describes a group of patients who are perceived as using health services inappropriately or disproportionately, when other more deserving patients should be given attention. It thus reflects the old idea of the deserving and undeserving poor, and is equally distasteful. There are numerous other reasons why we believe that this term is always inappropriate and should therefore never be used. The ‘worried well’ are not a clearly defined group — the only shared characteristic being that the doctor does not see pathology. Patients with this label could range from someone with a concerning symptom that turns out to be nothing, to someone with severe health anxiety. The term suggests that these patients are well; however, for some patients, the condition of health anxiety, for which the term ‘worried well’ is often used, is a serious and potentially debilitating condition. When investigated, one group labelled as ‘worried well’ were found to have substantial mental illness1 and therefore these patients need medical help.2 For doctors, it is wrong to imply that …

General practice computer systems are remarkably sophisticated but their potential is underused. In contrast many private sector businesses use IT meticulously to measure performance. For example, many retail stores know exactly how sales change according to how they position goods in the shop or even how they alter the lighting. Following Drucker,1 the father of management theory, ‘If you don’t measure it, you can’t manage it.’ Drawing on research and data collection performed at a practice over 30 years, we suggest that there are eight core management statistics that are easily available to every general practice. These make it possible for GPs to understand exactly what is happening in the practice. The core data are: the number, the age/sex structure and the duration of registration of the registered patients, the annual consultation rate, the average duration of face-to-face GP consultations, level of continuity of care, and measures of routine appointment provision and availability. All GPs already understand the importance of knowing the number of patients registered with the practice and this figure is commonly used when describing a general practice. This is available for the population nationally, regionally, and for individual practices. It is particularly helpful to know the proportion of older patients, since they have many more health problems, which helps planning. This is freely available to all practices on the Public Health England Practice Profiles …

This study examined lesbian and gay couples in an attempt to understand associations among participants’ outness and a variety of outcomes: social support, self-esteem, relationship satisfaction, and sexual satisfaction. Participants were 144 gay and lesbian couples (N = 288 participants, M age = 33.74 years) from the Southern New Jersey and Philadelphia areas; the majority of the participants were White. Participants completed surveys assessing their outness as well as their health and wellness. Analyses used Actor Partner Interdependence Models; results revealed that both participants’ and their partners’ outness predicted their social support. No other actor, partner, or interaction effects were significant. These findings are discussed in terms of their possible applications for programming and interventions for LGBTQ+ people.