Editorial

I am delighted to have been asked to write the editorial for this month’s special edition and conscious of the big shoes I temporarily fill. I can normally be found writing the InnovAiT blog, but it is lovely to have this further opportunity to reflect on what makes InnovAiT a journal I am very proud to support.

I have a portfolio of roles, as many of us do, and another I enjoy is in clinical leadership. I work within a Clinical Commissioning Group (CCG), soon to transition to an Integrated Care Board (ICB) as part of the overarching Integrated Care System (ICS). Speaking to my GP peers, much of this change feels a bit distant and remote from daily GP work, but the transition will change how providers (including the acute hospitals, community trusts, mental health trusts and of course primary care) work and collaborate to plan and coordinate patient care. The CCGs are comprised of GP practices in membership, but with primary Care Network (PCN) development and the developing Neighbourhoods and Place based partnerships, primary care leadership will change dramatically. I find my role hugely rewarding, but occasionally challenging, especially with the relentless and urgent needs of the pandemic; something we are all familiar with. I recommend you maintain a good understanding of organisational changes as they will shape the way we work.

One of the positives for us as a family in pandemic lockdown, was the offering of National Theatre At Home. It was a chance to be transported to another world and we were able to watch plays that we would ordinarily not have taken trips to see. The children were captivated particularly by the Madness of King George III. The horror at treatments he endured provoked lots of questions. We discussed his affliction and the current understanding that mental illness was the cause, although, for a long time it was thought to be porphyria, a haematological condition. This prompted yet more questions from the children and reminded me why I admire haematology as a specialty, a specialty encompassing in-depth knowledge, laboratory skills, management of long-term conditions and conditions sadly more life limiting.

This issue may not shed light on King George III, but our light will shine on haematology, a specialty we need to understand well and I hope better from the articles in this issue. We start this month with an article on interpreting the full blood count by Martin Haywood, and one to bookmark for the end of surgery when you go through your list of results. Dominique Forrest’s article on platelet disorders is similarly a fantastic resource to read, but also to have to hand.

Thalassaemias are among the most common genetic disorders worldwide, but depending on your practice population, their heterogeneity means they are not often managed or considered in primary care. The article by Johanna Wong, gives a clear overview of the different forms and key management options. In some areas of the country, you may have a locally commissioned service to pay the practice for taking on additional workload, such as the monitoring of monoclonal gammopathy of undetermined significance (MGUS). There are many benefits for the patient, but it requires a good level of knowledge by the primary care clinician. Fortunately, Vui Yung Chieng and Rod Sampson are help the acquisition of this knowledge with their synopsis of this pre-malignant plasma cell disorder.

Lymphoma for GPs by Samuel Merriel contains clear guidance and a comprehensive management plan for common presenting symptoms. Emma Hyde-Nero et al., in diagnosing leukaemia, describe when we should speak to a haematologist or admit patients, and not make a 2-week rule referral. They also outline key symptoms and discuss emergency leukostasis, which has a 1-week mortality of 40%; so important not to miss.

Other haematological emergencies can be as dramatic and are outlined by Amy Tannatt Nash and Harry Hambleton. They give a clear patient perspective on what to expect and how patients should be managed, which is so helpful when giving support to patients.

So yet again, pandemic or not, this month’s edition contains great clinical information to keep you up to date, as well as regular offerings such as our AKT questions and the topical nuggets within News and Views. I hope you enjoy reading the articles as much as I have.

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ORCID iD

Dr Amy Dissanayake http://orcid.org/0000-0003-0244-8880