90 VOLUME 6 • NUMBER 2 • JUNE 2014 J OURNAL OF PRIMARY HEALTH CARE EDITORIALS FROM THE EDITOR CORRESPONDENCE TO: Felicity Goodyear-Smith Professor and Goodfellow Postgraduate Chair, Department of General Practice and Primary Health Care, The University of Auckland, PB 92019 Auckland, New Zealand f.goodyear-smith@ auckland.ac.nz Felicity Goodyear- Smith MBChB, MD, FRNZCGP, Editor J PRIM HEALTH CARE 2014;6(2):90–91. Variability, regulation and clinical practice O ur lead paper reports a large unexplained variation between general practices in the rate of acute hospital use, once the clini- cal complexity, comorbidity and demographics of the practice populations have been taken in to account. 1 This indicates that the variation relates to general practitioner (GP) behaviour rather than to patient characteristics. Rather than blaming those with high admission rates, our guest edito- rialist Professor Kevin Grumbach suggests that identifying what GPs with low rates of avoidable acute care services do to keep their patients out of hospital could provide valuable learning for poorer performing practices. 2 In general, monitoring the performance of GPs is considered valuable to help maintain and improve practice standards. This has led to the Medical Council in New Zealand (NZ) making regular practice reviews (RPR) compulsory for doctors practising under the Inpractice continuing profes- sional development programme (recertification for doctors not vocationally registered). In our Ethics column this issue, Dr Katharine Wallis examines whether RPR will really help improve practice quality and safety, or whether it will merely in- crease cost and reduce access to health care, while engendering further public mistrust in the medi- cal profession. 3 For all potential benefits, there are also costs. Whether the gains from increased scrutiny and regulation outweigh the price is yet to be tested. Clinical research predominates in this issue, with a focus on community-based care for all age ranges. A Viewpoint article discusses childhood dental caries, a common and potentially serious condition, especially in Maori and Pacific chil- dren. 4 The authors highlight the need for early identification of high-risk children and referral to community-based oral health services. Changes in children’s moles are worrying, but are much less likely to be melanoma in the young, and especially in adolescents with rapid naevi growth during puberty, than in adults. The paper in this issue by Cheng et al. 5 demonstrates that examina- tion by a virtual clinic using teledermatoscopy significantly reduces the need to refer children to specialist services, and allows assessment and reassurance to take place in community settings. A number of studies assess strategies to support patients in adopting more healthy lifestyles. Patel and colleagues explore GPs’ views about promoting pedometer use to improve motiva- tion to keep active, 6 and Keogh et al. 7 describe a community-based exercise programme for older adults which is shown to increase physi- cal fitness and have good retention rates after two years. The social nature of such group activities may have additional benefits. A study by Crowley and colleagues has found that a personal nutrition and exercise training course for medical students increases their awareness of dietary choices, but only translates into increased likelihood that they will counsel patients in healthy lifestyle behaviour in a small minority of students. 8 Research by Ball et al. 9 examines the variability of nutritional advice given by GPs during consultations. In our Back to Back debate this month, we ad- dress the topical issue of plain packaging for cigarettes. Promoting this strategy is the Hon. Tariana Turia, author of the proposed Smoke-free Environments (Tobacco Plain Packaging) Bill. 10 She elegantly explains why plain packaging will reduce the glamorous image of smoking, espe- cially for the young, and hence should reduce tobacco consumption. 11 In opposition, Jeff Rogut, CEO of the Australasian Association of Conveni- ence Stores, argues that this Bill will hurt small retailers, and that there is no evidence it will lead to a decrease in the rate of smoking. 12 The