Pulse articles from December 2003

Pulse archives from December 2003

`Immature' trusts threaten contract.
December 1, 2003... The head of the Department of Health's strategy unit has admitted there are `real issues' over the capacity of PCTs to implement the new contract. Professor Chris Ham called on GPs to be `realistic' over how long it will take trusts to...

GP locked out by former partners.
December 1, 2003... A GP has been barred from his practice after his former partners took out a court injunction and changed the locks in a dispute over his retirement plans. Dr Ronnie Cook was served with an interim interdict after he returned from a...

GP hits back over sicknote claims.
December 1, 2003... Dr Peter Meade has denied a Sunday Times allegation that he `coached' an undercover journalist on how to get time off sick from her employer. Dr Meade was one of 14 GPs criticised in an investigation for giving patients - who said they were...

GPC defends GPs in no-win situation over sicknotes.
December 1, 2003... The GPC has said the profession is in a no-win dilemma over sicknotes after a national newspaper claimed doctors were prepared to issue post- dated certificates to healthy patients. A report in the The Sunday Times alleged 14 out of 38 GPs...

Placements aim to tempt students to become GPs.
December 1, 2003... Dr Neil Smith is running a scheme to aid GP recruitment by giving medical students more hands-on experience. Twelve practices in the Blackburn area are taking students in the final year of medical school on two-month placements. Dr...

No anonymity for GPs in GMC cases.
December 1, 2003... The GMC will notify primary care organisations of a complaint against a GP as soon as it decides it merits investigation, the council has decided. The decision ends any chance of doctors involved in cases remaining anonymous. It comes...

GPs face legal risk in rush to computerised records.
December 1, 2003... The drive towards computerised record-keeping - set to gather pace under the new contract - is leaving GPs more vulnerable to legal action, warn leaders of a major study. The switch from paper to IT-based records `encourages minimalist...

`PMS GPs getting #5k quality pay'.
December 1, 2003... The average PMS GP already earns around #5,000 for work included in the quality framework, accountants estimate. Mark Wilson, from Silverthorne Consulting, told a PMS conference last week that PMS baseline funding averaged #1,000 for...

`No GP will need default contract'.
December 1, 2003... GP negotiators are predicting `not a single practice in the land' will have to use a `default contract' drawn up in case primary care organisations fail to implement the GMS deal. Negotiators insisted there was enough time before April for...

`Flu vaccination for all would be cost-effective'.
December 1, 2003... Mass influenza immunisation of healthy adults and children is cost- effective and a change in vaccination policy should be urgently considered, concludes a Government-commissioned assessment. The findings were published as it emerged that...

Flu levels drop.
December 1, 2003... Flu levels across the UK have dropped from the peak rates seen last week. But while the Health Protection Agency says flu may have reached an early peak it warns it is too early to say whether levels of illness will go on declining or will...

Spotting signs of abuse.
December 1, 2003... Over-protective fathers and single parents who blame problems on their child are potential indicators of child abuse, according to Dr Anna Wilson. Dr Wilson, a GP specialist in child protection in Winchester, said rough handling of...

Onus on GPs for child protection.
December 1, 2003... GPs are `at the forefront' of child protection but are not receiving adequate training, according to the author of the report into the abuse and murder of Victoria Climbie. Lord Laming told Pulse GPs were `the lead people' in spotting...

GPs need resources to reduce obesity.
December 1, 2003... The Chief Medical Officer has warned GPs one in three adults could be obese by 2020 if current trends continue and cases of type-2 diabetes could rise by more than 50 per cent, according to unpublished Government data. Addressing the...

GPs split over proposals to even out quality pay.
December 1, 2003... GPC and NHS Confederation plans to use a complex formula to narrow the gap in quality pay between practices with high and low disease prevalence are set to split the profession. The proposals, exclusively revealed by Pulse last week, will...

For those who stand and wait.
December 1, 2003... Dr David Lawrence's practice has replaced old copies of Reader's Digest in its waiting room with books of poems. The practice in Kew, Surrey, has joined the Arts Council's free Poems in the Waiting Room scheme. `As with the Tube poems...

GP appraisal checks before revalidation.
December 1, 2003... Primary care organisations' clinical governance leads will have to confirm GPs have had an appraisal for it to count towards their revalidation, the GMC has ruled. The decision comes after growing concern from the Shipman Inquiry that...

Northern Ireland GPs face delay on pay arrears.
December 1, 2003... GPs in Northern Ireland are almost certain to have to wait a month longer than their peers in the rest of the UK to receive their pay arrears. Chair of GPC Northern Ireland Dr Brian Dunn said the committee was pressing the Department of...

New security at scene of GP's ordeal.
December 1, 2003... Security at an out-of-hours centre in Northern Ireland where a GP was attacked by thugs wielding baseball bats has been drastically improved. The Moylinn Medical Centre in Craigavon, Co. Armagh, has had fencing improved and alarms and CCTV...

GPs call halt to `slow-track' waiting list.
December 1, 2003... An LMC has acted to stop patients referred from a musculoskeletal triage service being put in a slow queue to see a consultant. Dr Richard Vautrey, Leeds LMC member and a GP, said the scheme was launched to speed up access to hospital and...

Call for temporary ban on paroxetine.
December 1, 2003... The Government's expert inquiry into the safety of selective serotonin reuptake inhibitors has been urged to issue a temporary ban on prescribing paroxetine (Seroxat) to all patients amid new claims that even small dose changes can `precipitate...

GPs urged to spot hidden MS problems.
December 1, 2003... GPs will be expected to play a key role in spotting `hidden problems' associated with multiple sclerosis, such as depression and impotence, under guidelines from the National Institute for Clinical Excellence. But a national shortage of...

Antiretroviral therapy increases risk of heart attack.
December 1, 2003... Use of anti-HIV drugs increases the relative risk of a myocardial infarction per year of exposure by 26 per cent for the first four to six years of use, according to a US study of 23,468 patients. However the absolute risk remains low and must...

Low-dose oestrogen therapy no safer than traditional dosage.
December 1, 2003... Lower dose oestrogen therapy (0.3mg) does not avert serious adverse events associated with HRT and should not be promoted as safer than standard preparations (0.625mg), US researchers say. Decreases in hot flushes were lower with...

Need for more paediatric IBD specialists.
December 1, 2003... More specialists are needed to treat children with inflammatory bowel disease, according to a study that found wide regional variations in investigation and treatment. A third of 739 under-16s studied received care from an adult service and a...

New breast cancer risk model the most accurate.
December 1, 2003... A new model for assessing individual breast cancer risk is more accurate than existing mathematical models, which underestimate risk. Researchers in Manchester who tested the models on women from a hospital-based family history clinic say the...

Efficacy of ear drops at treating acute otitis in primary care.
December 1, 2003... Ear drops containing steroids are more effective than acetic acid at treating acute otitis externa. But combined steroid and acetic acid or steroid and antibiotic ear drops are equally effective, according to a study involving 79 practices in...

Effect of eradicating H. pylori on dyspeptic symptoms.
December 1, 2003... Eradicating Helicobacter pylori prevents the development of dyspeptic symptoms and peptic ulcer disease in healthy asymptomatic blood donors and is not associated with an increase in the incidence of symptomatic gastro-oesophageal reflux...

Call for GPs to act as GUM `safety valve'.
December 1, 2003... The Government has come under pressure to abandon its `softly softly' approach to chlamydia screening in the UK and speed up the roll-out of its national programme with GPs fully involved. The recommendation came in the Health Protection...

Aspirin best policy to reduce CHD risk.
December 1, 2003... Aspirin is the most cost effective way to prevent heart disease and should be given to most men and women over the age of 55. A study in last week's BMJ concluded aspirin and blood pressure- lowering drugs could prevent heart disease at a...

NHS Direct triage dropped.
December 1, 2003... The Government has further backtracked from its plans for NHS Direct to handle all out-of-hours calls after admitting the service could not cope with future demand. Department of Health guidance to PCTs on implementing the out-of-hours...

GP's `day off work' for Bush visit.
December 1, 2003... Dr Peter Jones was caught up in the massive security operation surrounding the visit of American president George Bush to Prime Minister Tony Blair's constituency. The village of Sedgefield, County Durham, where Dr Jones's practice is...

Software problems jeopardise plans for repeat dispensing.
December 1, 2003... Government plans to roll out repeat dispensing to all practices by next year are being threatened by problems with GPs' software. Practices in the first wave of 30 repeat dispensing pilots which are using the EMIS system have found it will...

RCGP warning over national patient record.
December 1, 2003... Patient records must not be `copied and pasted' into a new electronic system allowing notes to be shared across the NHS, the RCGP has warned. In its response to a consultation on the Integrated Care Records Service, the college said only...

Tax plans could hit GPs' pension rise.
December 1, 2003... GPs could find their predicted pension increase from the new contract swallowed by a 60 per cent tax levy, medical accountants are warning. The Treasury has proposed the tax on pension funds in excess of #1.4 million. Although GPs do...

Inland Revenue targeting GPs for tax investigation.
December 1, 2003... Medical accountants believe GPs are the focus of an Inland Revenue crackdown on tax compliance. Accountants said a record number of their GP clients were the focus of tax investigations and cases had been increasing throughout the year. ...

Society to revise advice on `homely remedies'.
December 1, 2003... The Royal Pharmaceutical Society is promising to review controversial guidance that asks GPs to authorise `homely remedies' for individual patients in care and residential homes. The move comes after a row broke out between the GPC and the...

EU calls for stronger warnings on Cox-2 inhibitor prescribing.
December 1, 2003... The EU drug safety watchdog has recommended new and stronger warnings on the use of Cox-2 inhibitors in patients with gastrointestinal and cardiovascular risks after reports of safety problems. But primary care gastrointestinal experts...

GPs urged not to use PPIs long term.
December 1, 2003... GPs could save their practices thousands of pounds a year by following NICE guidelines on the use of proton-pump inhibitors (PPIs) and lowering doses or offering patients alternative therapies. GPs attending a King's Fund symposium on...

GPs lack advice on shoulder pain tests.
December 1, 2003... GPs may struggle to make an accurate diagnosis of shoulder pain because of a lack of guidance on the best test for use in primary care, a Government-commissioned study reveals. The Government's flagship Health Technology Assessment (HTA)...

Talking POINTS.
December 1, 2003... Dr Adrian Pierry practises in Cardiff. He has been a GP for 20 years. Jo Carlowe spoke to him about the hot topics in his practice. Quality pay Is the quality pay correction formula fair? Anything that strays away from rewarding...

Letter: Attack on statin was completely unjustified.(Letter to the Editor)
December 1, 2003... Your news item `Row over Lancet alert on Crestor' (November 3) prompted me to read the original leading article. The Lancet piece is an unjustified attack on an ethical pharmaceutical company, and was unprecedented in its viciousness. It...

EDITORIAL COMMENT: Why are GPs still being kept guessing?
December 1, 2003... In comedy, so they say, timing is everything. But few GPs will have been amused that in the same week as a BMA review heaped criticism on negotiators for not keeping GPs informed, it was left to this newspaper to reveal a detailed proposal to...

Letter: Polypill may cause chaos.(Letter to the Editor)
December 1, 2003... The concept of the polypill (News, November 17) is attractive but I can see considerable practical problems. The combination of drugs will result in a patient advice leaflet the size of a tea towel, offering those prescribed it a wide range...

Letter: Kaiser Permanente has much to teach on models of care.(Letter to the Editor)
December 1, 2003... Like many others, Dr Kailash Chand has totally missed the point in his critisism of attempts to learn from Kaiser Permanente (Letters, November 24). In the UK the NHS has a responsibility to provide comprehensive health care to all its...

Letter: Advice must be pulling my leg.(Letter to the Editor)
December 1, 2003... The editorial board of the Drug and Therapeutics Bulletin (November issue) must have gone for April Fool's Day early with their recommendations on restless legs. The normally conservative journal is recommending the referral of patients in...

Letter: Wild mumps infection carries low risk of serious complications.(Letter to the Editor)
December 1, 2003... Regarding the quick quiz on mumps (Clinical, November 17), what is Dr Stollery's source for meningitis incidence of 5 per cent? Certainly in the 1960s meningoencephalitis occurred in less than 2.5 per cent of clinical cases under the age of...

Letter: Entire notes are necessary for whiplash claims.(Letter to the Editor)
December 1, 2003... With regard to solicitors' requests for access to medical records (Letters, November 10) a very common reason to request these records is a claim resulting from symptoms following rear-end collisions. The increasingly accepted...

Letter: GPs need to be free spirits.(Letter to the Editor)
December 1, 2003... As a GP for nearly 25 years I have adapted to many and varied community health administrations - from the old family practitioner committee to the PCT. This latest body is certainly leaving no stone unturned in its Orwellian zeal to...

Letters: On quality points - locums - and fat.
December 1, 2003... Readers may be interested to know that our quality and outcomes points estimator for CHD (News, October 20) has now been extended to cover the other clinical areas in the contract. The software, which is only available for EMIS users at the...

Letter: GMC unfair to attacked doctors.(Letter to the Editor)
December 1, 2003... I disagree with Sir Michael Buckley (Letters, November 10). I think it is very unfair for my name, age and home address to be given when the patient remains as patient X. The doctor's anonymity should be maintained even in an ordinary court....

The increasing use of chronic care clinics.
December 1, 2003... Under the new contract GPs must ensure that chronic illnesses are managed as effectively as possible, and dedicated clinics are the ideal way of doing this says Dr Stephen Gardiner The quality framework element of the new GP contract offers...

Summarising notes will be vital under the new contract.
December 1, 2003... Under new GMS, practices will need really accurate notes, well summarised and on the computer, writes Dr Rob Barnett In order to make the most of the new contract, having well-ordered notes suitably summarised and available on the practice...

Salaried GPs and partners: a fair division of workload.
December 1, 2003... Successfully integrating salaried GPs into practices will be vital for success under the new contract writes Dr John Couch Salaried GPs are not a new phenomenon but numbers are increasing rapidly as new GMS approaches on April 1, 2004. The...

Addiction surgeries backlash.
December 1, 2003... The problem As part of a locally enhanced service, our PCT offered GPs #200 per patient per year to provide a service for drug addicts. Two of our four partners were keen to become involved and, with the support of the rest of us, now do...

New patient demands monthly home visits.
December 1, 2003... Case history A 46-year-old woman who is a new patient requests a visit. But she refuses to tell the receptionist the reason why, only saying that it is personal. When you visit she requests antibiotics for a urinary tract infection...

Explaining the unexplained to patients.
December 1, 2003... Medically unexplained syndromes have their own assessment and management implications - Dr Christopher Bass offers advice Somatic symptoms unexplained by an identifiable disease form a substantial proportion of all doctors' work. An...

10 TOP TIPS: Onychomycosis.
December 1, 2003... Bite-sized practical advice for busy GPs 1. Onycholysis may also be caused by trauma. Mycological diagnosis from nail clippings is important as treatment may involve up to three months of oral therapy. 2. For non-matrix infections...

FACE TO FACE: Interventional cardiology.
December 1, 2003... GP Dr John Couch interviews Dr David Fluck about latest thinking in intervention cardiology Practical points * Catheterisation can give detailed anatomy * Emergency angioplasty certain to be used more in UK * More and more...

CLINICAL CASEBOOK: Patient with Down's syndrome speaks out.
December 1, 2003... Case history Thirty-year-old James is a new patient; you are surprised he has come to consult you unaccompanied as he clearly has Down's syndrome. When you ask if there is anyone he would like to bring in with him, he tells you he is quite...

ANSWER BACK: Can folic acid help prevent stroke?
December 1, 2003... Q: Is folic acid a worthwhile preventive treatment following a stroke? A: The role of supplementary intake of folate in reducing the risk of stroke has been under investigation following the emergence of evidence linking homocysteine in...

ANSWER BACK: Can acid in bulimia cause neoplasia?
December 1, 2003... Q: Does exposure of the oesophagus, throat and oral cavity to gastric acid increase the risk of neoplastic change with bulimia ? A: Patients with bulimia nervosa expose their oesophagus, pharynx and oral cavity to gastric acid on a regular...

Rawlins attacks GP script mistakes.
December 8, 2003... Most GPs lack basic prescribing skills and a pharmacist should be drafted into every practice to cut hospital admissions caused by GP mistakes, claims the head of the Government's National Institute for Clinical Excellence Professor Sir...

GPs praised as referrals drop.
December 8, 2003... NHS chief executive Nigel Crisp has praised GPs after his six-monthly report showed a dramatic fall in the growth of outpatient referrals. The rise in the growth of GP referrals to hospitals slowed from an annual average of 1.4 per cent...

Quality payments `could destroy general practice'.
December 8, 2003... The quality and outcomes framework could lead to `the death of general practice as we know it', a leading Government-funded primary care academic claims. Professor Martin Marshall said there was a serious risk the framework could destroy...

Primecare's price for out-of-hours to rise 20%.
December 8, 2003... GPs using Primecare will pay between 10 and 33 per cent more for their out-of-hours cover next year, the deputising service has admitted. Price increases will average 20 per cent across the country in 2004, adding #1,600 to a typical GP's...

Urban GPs buck trend and opt-in.
December 8, 2003... GPs in the UK's two biggest cities are bucking the national trend by keeping their out-of-hours responsibility. A survey by the Harmoni co- operative in west London found 86 per cent of its GPs, including Dr Tom Davies (pictured), would opt in....

Triage delays sway choice of provider.
December 8, 2003... Primecare is set to lose out on two major out-of-hours contracts after GPs raised concerns over its triage service. Southampton City PCT is planning to use walk-in centres staffed by nurses and GPs backed up by a local triage service to...

How partner's `betrayal' destroyed our practice.
December 8, 2003... The partner of a GP jailed for defrauding their practice of #68,000 says she may quit general practice as a result of his `betrayal'. Dr Bella Shah said the three-partner practice in Hounslow, Middlesex, had been `destroyed'. Dr Shah and Dr...

Poor diabetes data means GPs face uphill quality fight.
December 8, 2003... GPs face `significant challenges' to earn quality pay for diabetes and meet deadlines set in the national service framework for the disease, warns the Government's public spending watchdog. The Audit Commission investigation of 365...

GPs face crackdown over NICE guidelines.
December 8, 2003... Ministers are planning a crackdown on GPs' adherence to National Institute for Clinical Excellence guidelines. Under the proposals, the Commission for Health Audit and Improvement will monitor primary care trusts' implementation of...

Watchdog GP advises `short HRT bursts'.
December 8, 2003... A GP member of the Government's drug safety watchdog has advised GPs to prescribe HRT in bursts of a year to women with menopausal symptoms in the wake of the latest scare. Dr Ross Taylor, a member of the Committee on Safety of Medicines,...

It's touch-and-go on over-65s flu target.
December 8, 2003... GPs' chances of meeting the Government's 70 per cent uptake target for flu vaccination among over-65s rest on a knife-edge, official figures suggest. Uptake at the beginning of November stood at 56.6 per cent - up from 55.3 per cent at the...

Flu activity may have peaked.
December 8, 2003... Flu consultation rates across the UK are continuing to fall and the Health Protection Agency says the outbreak of influenza activity appears to have levelled off. But young children still make up the biggest proportion of those affected...

How Atkins diet almost forced GP on to statins.
December 8, 2003... Dr Gill Jenkins found her cholesterol levels soared after she tried the Atkins diet for a BBC1 investigation. Dr Jenkins, a GP in Bristol with a special interest in obesity, said she would have been forced to take statins had she continued...

Justify your quality aspirations.
December 8, 2003... GPs must justify their quality points aspiration by explaining to their primary care organisation how they expect to achieve it, latest Department of Health guidance states. The decision looks certain to kill off plans by some GPs to aim...

NHS drugs bill climbs 11 per cent.
December 8, 2003... The NHS bill for GP prescribing in England has soared 11.1 per cent in a year, chief executive Nigel Crisp said last week. His six-monthly report on NHS progress said 632 million prescription items were dispensed in the community in 2002/3...

Computing confusion may threaten contract start-up.
December 8, 2003... Hundreds of GPs face not being able to implement the contract next April amid mounting confusion over funding to replace their old computer systems. Around 450 practices need to replace systems which are not equipped to deal with the...

Overseas recruits lack help to settle.
December 8, 2003... GPs recruited from overseas to fill vacancies in areas with a chronic shortage of doctors are not getting adequate support to help them settle, research concludes. A study for the RCGP's Northern deanery into the recruitment of seven...

`How I see GP future'.
December 8, 2003... The Prime Minister's chief adviser on health policy has said he still sees a future role for GPs as `specialist generalists'. Simon Stevens told a conference at the London School of Economics he did not favour making all GPs specialists....

For locum now read freelance GP.
December 8, 2003... Locums should be called `freelance GPs' and non-principals `sessional GPs', the National Association of Non-Principals has concluded. The new names have been decided by the association - which plans to change its name accordingly - to end the...

BMA concedes GPs may press parents over vaccinations.
December 8, 2003... BMA ethics guide highlights fears over target pay and other GP dilemmas - Cato Pedder reports There is a `real risk' that target payments for vaccines and cervical cytology are causing GPs to put patients under undue pressure to consent,...

`HPV best' for cervical screen.
December 8, 2003... Testing for human papilloma virus should become the main method of screening for cervical cancer with cytology only offered for women who test positive, claim leaders of a study published in The Lancet. Professor Jack Cuzick and fellow...

Practice disputes alert.
December 8, 2003... A series of acrimonious partnership disputes has sparked a BMA warning that multi-partner practices should agree rules on issues that fall outside the scope of standard partnership agreements. Practices should agree guidelines covering GPs'...