BMJ 26 May 2007 Vol 334

Primary care research in the UK is still largely a cottage industry, kept going as much by enthusiastic part-timers as by big-hit professors. That may change when the “big five” English medical schools set up their National School for Primary Care Research in England. Or will it? There have been false dawns before (the Mant Report) and nothing has yet happened to make a career in research attractive to the ablest young GPs. Meanwhile, separate hierarchies still exist in Scotland, Wales and Northern Ireland.

Australian studies a decade ago showed that few patients discharged with heart failure understood their drug therapy or took it properly. Since then, heart failure nurses have been extensively deployed to help these patients in the UK, with the aim of postponing death and reducing hospital admissions, and evidence suggests that they succeed to begin with, but that the effect wears off after a year or so, as you’d expect with any lethal, progressive disease. Could simply sending in a community pharmacist for a post-discharge visit and one follow-up be equally effective? No: in this study it produced slightly worse outcomes for death and readmission than usual care.

It may well be that community pharmacists, for all their undoubted good intentions, are not best placed to weight up complex therapeutic options and communicate effectively with patients over 80. It’s not as if young GPs, with nine years’ training, find it particularly easy. Nor in fact do older GPs with thirty years’ experience. This “qualitative discourse analysis” strongly suggests that pharmacists should confine themselves to other tasks.

Our understanding of the connection between the psyche and the bowel has advanced little since Charles Wesley wrote his wonderful poem, Wrestling Jacob (1742), which includes the unfortunate lines,
To me, to all, thy bowels move –
Thy nature and thy name is LOVE.

Should GPs have better access to psychological treatments for irritable bowel syndrome? I read this review with interest but I really can’t answer the question. If I had better access to cognitive behavioural therapy, correction, if I had any access to CBT, I would certainly send lots of patients with IBS along, but that would be because so many have other problems.