Pulse articles from August 2003

Pulse archives from August 2003

#140k for out-of-hours GPs.(Brief Article)
August 4, 2003... GPs can earn up to #140,000 a year to work out-of-hours as the first signs of a lucrative post-contract market emerge. Co-ops and deputising services have said they are increasing rates to tempt GPs to work shifts, with #100,000 a year now...

Locums in pay spat over BMA `price fixing bias'.(Brief Article)
August 4, 2003... Locums are demanding their share of the windfall from the new contract after launching a furious attack on the BMA for favouring the interests of GP principals, writes Ian Cameron. The row has broken out over the BMA's four-year battle to...

GP escapes unharmed after seven-hour hostage ordeal.(Brief Article)
August 4, 2003... A GP has escaped unharmed after a seven-hour siege at his surgery in which he was allegedly held hostage at knifepoint. Dr John Aherne, 53, was left shaken by the ordeal at his practice in Kettering, Northamptonshire. Police have...

GPs risk legal action over poor depression notes.
August 4, 2003... GPs are failing to keep adequate notes to show they manage patients on antidepressants appropriately. The findings of a major study prompted a warning from medicolegal experts that GPs could be hauled before the GMC and face legal claims...

GP enhanced service cash beats promises.(Brief Article)
August 4, 2003... Primary care trusts have allocated #329 million for enhanced services this year, the Department of Health has revealed. In a letter to GPC chair Dr John Chisholm, health minister John Hutton said trusts in England had set aside 4 per cent...

Flaws in risk charts mean many statins not needed.(Brief Article)
August 4, 2003... Part of the recent explosion in the NHS statin prescribing bill may have been unnecessary, Government-funded research suggests. Flaws in the Framingham coronary risk prediction charts published in the BNF mean GPs are dramatically...

Practices struggle in recruiting GPs.(Brief Article)
August 4, 2003... The number of GP posts lying vacant for more than three months has doubled over the past two years, casting doubt on Government claims that the workforce crisis is easing. Official data released last week shows 3.3 per cent of all GP posts...

48-hour access target lies in ruins.
August 4, 2003... The credibility of the 48-hour access target is in tatters after figures from a massive Government survey revealed more than two-fifths of patients are waiting more than two days to see their GP. The finding from the 2003 NHS patient survey...

Continually demoralised.(general practitioner standards)(Brief Article)
August 4, 2003... Dr Lakshmi Narayana says GPs in his primary care trust are continually demoralised by the access target. Halton PCT in Cheshire received one of the worst ratings in the 2003 National Patient Survey, but Dr Narayana said GPs were struggling...

Smear risks leaflet may threaten GP income.
August 4, 2003... The Government's drive to provide women with `clear, honest and balanced' information about the pros and cons of cervical cancer screening could cause almost one in 10 women to shun a smear test. New research shows the proportion of women...

GP angry over judges' MMR ruling.(measles, mumps, rubella vaccine)(Brief Article)
August 4, 2003... A GP has hit back at Court of Appeal judges who branded her evidence on MMR safety `junk science'. Dr Jayne Donegan, a GP in Herne Hill, south London, had given evidence for two mothers who last week lost their appeal against a High Court...

GP attacks PCO `hit squads'.(Brief Article)
August 4, 2003... Dr Graham Robinson believes Government plans to bring in outside managers to run zero-starred PCOs if their rating fails to improve would be `disastrous'. Dr Robinson, professional executive committee chair at zero-starred Vale of...

GPs facing lottery over when they get IT cash.
August 4, 2003... GPs are facing chaos over IT funding because of Government delays in giving primary care organisations guidance on their responsibility to pick up the tab. A Pulse survey has found most PCOs are refusing to reimburse GPs or are only paying...

Diabetes tsar shows GPs can hit quality pay targets.
August 4, 2003... GPs providing standard diabetes care can achieve the same levels of disease control over 10 years as seen in the landmark UK Prospective Diabetes Study, research shows. GP diabetes experts welcomed the findings from a study commissioned by...

Doctors more likely to die violent death.(Brief Article)
August 4, 2003... Doctors run a lower risk than other graduates of dying from cardiovascular disease or lung cancer. But they are at greater risk of alcohol-related death. Former medical students were twice as likely as former arts students to die from...

Doubts cast on NICE antipsychotic advice.(National Institute for Clinical Excellence)(Brief Article)
August 4, 2003... A systematic Government review has found no conclusive evidence atypical antipsychotic drugs offer better value for money in schizophrenia than their conventional counterparts - despite costing over 17 times more on average. The National...

`Stupendous efforts' by GPs on CHD stalled by poor tests access.(coronary heart disease)
August 4, 2003... The Government has praised GPs' `stupendous' efforts in meeting standards in the national service framework for heart disease. But heart tsar Dr Roger Boyle has admitted lack of access to the BNP heart failure test and echocardiography could...

UK measles cases increase four-fold.(Brief Article)
August 4, 2003... The incidence of measles has soared four-and-a-half times in just a year. According to the European Commission, some 96 per cent of cases occurred in unvaccinated patients - up from 70 per cent the previous year. There were 327 reported...

Practice nurses gripe over pay rises by GPs.(Brief Article)
August 4, 2003... Half of practice nurses would prefer to be employed by a primary care organisation rather than directly by a GP, a survey has found. Only between 15 and 20 per cent of practice nurses are currently employed by PCOs. Sara Richards,...

Junior doctors' hours cut will add to GP workload.(Brief Article)
August 4, 2003... GPs could face greater demand for home visits and an increase in workload as a result of cuts in junior doctors' hours, the BMA has warned. The first phase of new European Union working time laws will cut the working week of junior doctors...

Death rate checks would cast suspicion on 1 in 20 GPs.(Brief Article)
August 4, 2003... A system of monitoring mortality rates at GP practices would only have detected Harold Shipman a year before his arrest, new research has found. The study also revealed analysing death rates to warn of possible problems in future would...

GPs recruited Shipman despite drug confession.(Harold Shipman)(Brief Article)
August 4, 2003... Harold Shipman's former colleagues hired him even though he told them he had convictions for drug-related offences, a GP has told the inquiry. Dr Geoffrey Bills, a former GP at Donneybrook Practice in Hyde, Manchester, sat in Shipman's...

BMA demands a #140 fee to halt solicitors' `fishing trips'.(Brief Article)
August 4, 2003... The BMA is pushing the Government to give GPs the power to charge solicitors up to #140 an hour for access to medical records. In a move aimed at ending lawyers' `fishing trips' through patient records before they decide whether to take on...

Branch surgeries vital for patients.(Brief Article)
August 4, 2003... Branch surgeries have a vital role in aiding access to the NHS, according to Dr Jonathan Stead whose research found patients valued them highly, even if they had lesser facilities. Dr Stead, a GP in a research practice in Silverton, Devon,...

New pressure facing GPs on referral rates.(Brief Article)
August 4, 2003... GPs could face greater scrutiny of referral rates after a key document on the new GMS contract advised primary care organisations to establish `demand management targets'. The competency framework from the National Primary and Care Trust...

Anti-smoking services face collapse as cash plundered.
August 4, 2003... Smoking cessation services in England are lurching from one cash crisis to another as primary care trusts plunder `ring-fenced' funding to plug gaps elsewhere. Smoking cessation co-ordinators have warned this will leave them struggling to...

Talking POINTS.
August 4, 2003... Dr Abayome McEwen is a non-principal and GP tutor in Epping Forest, Essex. She has beeen a GP for 23 years. Jo Carlowe spoke to her about the hot topics in her practice. Primary care organisations The GPC claims some PCOs are abusing...

Letter: No - it is not fair to criticise GPs for paediatric skills.(Letter to the Editor)
August 4, 2003... You asked: is it fair to criticise GPs' paediatric skills (July 21). I retired nearly seven years ago after some 36 years in practice. It is my belief that one of the most important things for any doctor to discover is the extent of his or...

EDITORIAL COMMENT: GPs must keep up their good work unheralded.
August 4, 2003... A visitor from Mars, noting the way GPs are nagged at to see patients quickly, to be polite to them when they do see them, and to provide some sort of competent service, would assume GPs were a stroppy and sub- standard lot, despised by their...

Letter: Be realistic with guidelines in the NSF for children.(Letter to the Editor)
August 4, 2003... I was puzzled by the apparent ignorance of those drawing up the proposed national service framework for children (News report, July 21) on assessing paediatric patients in the community. The population we look after in general practice is...

Letter: Why should ousting PCT senior management demoralise GPs?(Letter to the Editor)
August 4, 2003... In your report `No-star PCTs facing private takeovers' Dr Mike Dixon, chair of the NHS Alliance, commented it was `unfair to threaten zero- star trusts when CHI based ratings on anachronistic quality indicators' and `ousting senior managers...

Letter: GPC lives in a world apart as cracks show in new contract.(Letter to the Editor)
August 4, 2003... Already the cracks are beginning to appear in the new contract. We have our trade union blithely telling GPs it has no intention of producing the vital ready-reckoner until next year. Dr Simon Fradd, GPC joint- deputy chair, is quoted (July 28)...

Letter: Neglect obesity problem and prescribing budgets will escalate.(Letter to the Editor)
August 4, 2003... You reported `GPs urge ban on ``plug'' for obesity drug' (June 23). Obesity is a disease, with an ICD code (ICD-10 E.66) for more than 40 years and has been a priority for health care for over a decade, largely because of its huge impact on...

Letter: It's not HPA's job to urge MMR catch-up campaign.(Letter to the Editor)
August 4, 2003... With reference to the story about a possible MMR catch-up campaign for five- to 15-year-olds (July 14), the Health Protection Agency would like to make clear it isn't urging such a campaign on ministers. The remit of the agency is to...

Letter: Battling to highlight Asperger syndrome.(Letter to the Editor)
August 4, 2003... I felt I had to write after reading Dr Lorna Gold's account of her battles with the prejudice and stigma associated with Asperger syndrome (`How I felt labelled as a bad parent', July 28). Our son, now aged 13, also has Asperger syndrome...

Letter: Of course you must be able to talk to patients.(Letter to the Editor)
August 4, 2003... You reported `GMC may scrap English language test' (July 14). What on earth is the world coming to? Coming from east Africa I feel it absolutely normal that I underwent some form of language test to ascertain I could communicate with my...

Letter: Achieving star ratings.(Letter to the Editor)
August 4, 2003... The assertion that star ratings are `biased towards rural and leafy areas' is almost certainly overstated (July 21). While there may be some correlation between low star ratings and urban areas it is certainly not always the case. Be careful...

Should you call the police for disturbed patient?
August 4, 2003... Case history You are called to the waiting room during evening surgery as two patients are having a loud argument. You ask the louder one into your room, away from the interested audience of other patients. He is well known to you and has...

Achieving optimum diabetic care under the new contract.
August 4, 2003... Dr Rina Davison gives GP Dr Tonia Myers practical advice on diagnosis monitoring in part 2 of our focus on diabetes Should we identify and screen patients at risk of developing diabetes? It is unclear which groups to screen. Women with...

LEARNING FROM ILLNESS: How skin problems shaped my career.
August 4, 2003... Dr Nigel Stollery explains why fear of social ridicule and continual embarrassment over his skin condition affected his life and medical career A major influence on my becoming a GP and the special interests I have pursued can be traced to...

10 TOP TIPS: Actinic keratoses.
August 4, 2003... Bite-sized practical advice for busy GPs 1 Actinic keratoses are otherwise known as solar keratoses. They are usually multiple, although can be solitary. They are found in older patients in areas of solar damage, with yellow, wrinkled and...

Avoiding pitfalls in diagnosis of vulval problems.
August 4, 2003... Resist the temptation to assume most vulval symptoms are `thrush', writes Dr Karen Gibbon A patient with vulval symptoms in a busy surgery can be a bit of a heartsink. It can be tempting to assume it's thrush and prescribe anti- fungals,...

CLINICAL CASEBOOK: Testicular pain raises fears for young man.
August 4, 2003... Case history A 22-year-old man attends looking embarrassed. `I'm worried,' he said. `I've seen those programmes on the telly, so I thought I ought to see you. I hope I'm not wasting your time but one of my testicles is very tender.' Dr...

ANSWER BACK: Does this rash always signal coeliac disease?(Brief Article)
August 4, 2003... Q: Do patients with dermatitis herpetiformis inevitably get coeliac disease and how is dapsone used? A: The vast majority of patients with dermatitis herpetiformis have a gluten sensitive enteropathy. This is usually mild and rarely gives...

ANSWER BACK: Do I give varicella jab to non-immune?(Brief Article)
August 4, 2003... Q: A mother who is not varicella immune has requested immunisation. Is this reasonable and what are the side-effects? A: Vaccination might be appropriate if she is planning to become pregnant again. Maternal chicken pox in the first 20...

PCTs admit to false pledges on spending.(primary care trusts)
August 11, 2003... Government spending promises for enhanced services are a sham. Primary care trusts have admitted they made up figures submitted to ministers. PCTs told Pulse they had given the Department of Health false breakdowns of their planned...

Angry GP in snub for insurer.(Brief Article)
August 11, 2003... Dr Shelagh McCormick has accused an insurance company of threatening the doctor-patient relationship after it asked her to tell a patient why it had refused him life cover. Dr McCormick, a GP in Gunnislake, Cornwall, refused the request...

`Suicide' GP had nowhere to turn.(Brief Article)
August 11, 2003... A confidential occupational therapy service to help stressed GPs was recently withdrawn from the region where Dr Dawn Harris was found hanged last week. Depression due to stress and a belief she was unable to do enough to help patients...

Patients lose cover as GPs forced to shrink boundaries.(Brief Article)
August 11, 2003... Parts of the UK are set to become `black holes' with no GP services because practices are shrinking their boundaries to avoid housing developments. The warning comes after NHS managers uncovered GP-free zones in Berkshire covering several...

Quality pay hold-up will make GPs `bloody furious'.(Brief Article)
August 11, 2003... GPs may not receive quality preparation payments until late September at the earliest because of GPC and NHS Confederation delays in giving evidence to the Review Body. The GPC said it expected GPs to be `bloody furious' over the hold-up...

PCOs worry they can't afford to meet soaring out-of-hours rates.(primary care organizations)(Brief Article)
August 11, 2003... Primary care organisations are warning they may not be able to afford rocketing pay rates for out-of-hours GPs. Several co-ops have recently increased their rates, with Surrey co-op Thamesdoc paying the equivalent of #140,000 a year. ...

GPC reveals pay deal for pneumococcal campaign.
August 11, 2003... The GPC has thrashed out a pay deal for GPs in England to immunise millions of elderly patients with polysaccharide pneumococcal vaccine this year but warned it may be too late to order supplies. GPs will receive a #6.80 item-of-service B...

GPs attack trusts over zero tolerance.
August 11, 2003... Two GPs have accused their primary care trusts of making a nonsense of the Government's zero-tolerance policy after they were censured for striking abusive patients from their list. Both GPs were dragged through the complaints process by...

General practice better for doctor in family way.(Brief Article)
August 11, 2003... Women doctors are choosing general practice over hospitals to enable them to pursue a career and raise a family. Research has shown 81 per cent of female GPs have had children compared with only 49 per cent of female hospital doctors. The study...

Locums go after check on status.(Brief Article)
August 11, 2003... Nine locum GPs have been removed from supplementary lists after the Department of Health forced primary care trusts to make urgent checks for unqualified GPs. The GPs had been put on lists by trusts even though they did not hold a JCPTGP...

GP who made obscene videos is still on register.(Brief Article)
August 11, 2003... A GP who has pleaded guilty to making obscene videos of children in the toilet of his home has still not been suspended by the GMC. Dr Peter Finklestone, a GP in Gosport, Newcastle, pleaded guilty at Newcastle magistrates court last week to...

New vaccines proposed in five-year plan.
August 11, 2003... Pneumococcal, chicken pox and hepatitis vaccines are to come under scrutiny - Brian Kelly reports Three new vaccines with the potential to significantly reduce infectious disease have been highlighted by Government public health advisers....

PMS practice pioneers exclusive care of elderly.(Brief Article)
August 11, 2003... Dr Jordi Sabate has joined the first nurse-led PMS practice specialising in care of elderly patients in nursing and residential homes. The practice in Willington, County Durham, has taken on 250 residential care home patients from practices in...

Pertussis oral swab set to replace blood tests.(Brief Article)
August 11, 2003... The Health Protection Agency is developing an oral swab test for whooping cough in children. It said they would eventually replace more invasive and time-consuming blood tests and would provide a better national picture of how common the...

Practice halves A&E admissions.(Brief Article)
August 11, 2003... An immediate response team set up by a practice to handle emergency and urgent cases for its patients has cut A&E admissions by half. Dr Paul Everden said the `Appropriate Care at Point of Need' project had also reduced the number of 999...

GP chlamydia screening is the last straw.(Brief Article)
August 11, 2003... Government plans to involve GPs in opportunistic screening for chlamydia would be the `straw that breaks the camel's back', according to a Health Protection Agency survey. The Department of Health last month invited GPs to bid for...

Inadequate smears raise cancer risk.(Brief Article)
August 11, 2003... Women whose Pap smears are inadequate could have as much as double the risk of developing cervical cancer as the general screening population, new research suggests. Researchers at West Midlands hospitals looked at 1,972 inadequate...

`Switch vaccine for diphtheria'.(Brief Article)
August 11, 2003... The Government has told GPs to switch from using the current diphtheria vaccine for adults to the combined tetanus and low-dose diphtheria (Td) vaccine for all routine uses. The Department of Health ordered the switch because supplies of...

`Better-off' locums join battle to wreck BMA fees campaign.(Brief Article)
August 11, 2003... Locums have backed attempts to derail a three-year BMA campaign to publish suggested fee scales, arguing they can earn more under the current free market. The support comes after the National Association of Non-Principals claimed the BMA...

Non-principals get appraisal pledge.(Brief Article)
August 11, 2003... Non-principals have been assured they will be treated the same as principals when they are appraised. Government-commissioned guidance released last week recommends non- principals are appraised by trained appraisers familiar with the work...

Most GPs would act as a good Samaritan.(Brief Article)
August 11, 2003... More than 90 per cent of GPs would act as a good Samaritan and help an injured person in the street, a survey has found. Overall, just 30 out of 458 doctors questioned said they would not help an elderly person who had collapsed. GPs,...

GPs told to be alert for syphilis.(Brief Article)
August 11, 2003... The Health Protection Agency is putting GPs on alert for syphilis in heterosexuals after cases rose almost three-fold in a year in south London. Some 40 cases among heterosexuals have been reported over the five months to May in the area,...

Pressure for generics now at `silly' level.
August 11, 2003... The GPC has called on the Government and primary care organisations to stop putting `mindless pressure' on GPs to prescribe generically before the situation gets `silly'. Latest figures this month show GPs have already met the Department...

GP prescribing costs doubled in 10 years.(Brief Article)
August 11, 2003... GP prescribing costs have more than doubled in England over the last 10 years, latest Government figures show. National service frameworks accounted for much of the recent spending rise. Last year alone saw an 11.9 per cent rise in total...

Warning on expiry dates.(Brief Article)
August 11, 2003... The Medicines and Healthcare Products Regulatory Agency has issued an alert on all batches of EpiPen Auto-Injector 0.3mg (adrenaline) produced by ALK Abello. The outer pack and syringe carry matching expiry dates, which are correct, but...

GPs shun PCTs driven by obsession with targets.(primary care trusts)(Brief Article)
August 11, 2003... GPs have lost faith in primary care trusts because their judgments are being overridden by NHS managers obsessed with meeting Government targets, a report has concluded. The report from the GPC, NHS Alliance, RCGP and National Association...

TALKING POINTS.
August 11, 2003... Dr Anne Dyson practises in South Woodham Ferrers in Essex. She has been a GP for 17 years. Jo Carlowe asked her about the hot topics in her practice. Out of hours Would you do out-of-hours for #140,000? This rate is entirely...

Letter: BMA spot on over fees - solicitors would not work for pittance.(Letter to the Editor)
August 11, 2003... Thank you Dr Peter Holden, chair the BMA professional fees committee, for taking up this abuse of GPs' time by solicitors (News report, August 4). I agree that screening patient notes for material relating to third parties and so on should...

EDITORIAL COMMENT: #140k makes out-of-hours fairer all round.
August 11, 2003... GPs will be able to earn up to #140,000 a year to work out-of-hours and there will be few within the profession who will begrudge this. The majority of GPs will benefit from this new market situation. Those who plan to work out-of-hours will at...

Letter: And then there were nine.(Letter to the Editor)
August 11, 2003... Forty years ago the only form of GP was a full-time male principal/partner, but now: * Principal/partner * Salaried assistant * Retainer * Flexible career scheme GP * Locum GP * Part-timer * PMS provider * PMS performer * GP...

Letter: Stop working on the cheap to support bankrupt system.(Letter to the Editor)
August 11, 2003... Why do we devalue ourselves? Your news report says the hourly rate for one co-operative will be #50-#65 (August 4). This is a laughably small amount and reflects poorly on other professional rates (a mechanic currently charges about #50 an...

Letter: Act quickly or face out-of-hours chaos.(Letter to the Editor)
August 11, 2003... I recently had the privilege of being part of the accreditation team for two out-of-hours providers in south-east London. Both provide extremely good service to their doctors and the local population and are to be commended. But in one...

Letter: There is 48-hour access.(Letter to the Editor)
August 11, 2003... Further to your news report on 48-hour access (July 28), both the NHS Patient survey and PCT figures can be correct. I am sure most patients can be offered an appointment with a doctor within 48 hours but it may not be their doctor of choice....

Letter: GPs worth every penny of #140k.(Letter to the Editor)
August 11, 2003... It sounds a lot (`#140k for out-of-hours GPs', August 4) but based on a 40-hour week for 46 weeks a year this is an hourly rate of #76 for very unsociable hours. A four-year qualified solicitor is charged out at #250 an hour, so do I think...

Only 70% coverage gives full points for asthma.
August 11, 2003... Dr Lorna Gold continues our series on the quality framework with a look at the implications of asthma Asthma is included in the quality marker scheme because it is a common, treatable condition which is almost entirely managed in primary...

Thinking of going salaried? Get the finance sorted.
August 11, 2003... This could be the time to stop working as a locum and go for a more permanent post - Dr Stephen Shepherd helps you decide If you are one of general practice's army of locums you will have noticed the continuing increase in advertisements...

Did senior partner blunder in anger over home visit?
August 11, 2003... Three GPs discuss a tricky problem Case history Nora is 83 and quite active and independent despite troublesome osteoarthritis, angina and atrial fibrillation for which she takes warfarin. She attends several times a year for a routine...

Current strategies in the management of atrial fibrillation.
August 11, 2003... New therapeutic strategies are improving outcomes for patients with this common form of arrhythmia - Dr Anthony Chow and Dr Vias Markides explain. A trial fibrillation (AF) is one of the oldest and commonest arrhythmias known to man1....

LEARNING FROM ILLNESS: I ignored stress symptoms and my family's pleas.
August 11, 2003... Despite crippling anxiety, Dr Simon Atkins was scared to take time off work for fear of the stigma For the first 10 months 2001 shaped up pretty nicely. I had completed a year as a new GP partner and was enjoying the challenge. I had just...