Pulse articles from December 2004

Pulse archives from December 2004

New contract blow as GPs work harder.
December 6, 2004... Eight months after the GPC hailed the contract as a new era, GPs say it is failing them - Joe Lepper reports The new contract is failing to deliver on almost every promise to improve GPs' working lives. A landmark Pulse survey of 1,110...

Dr Tony Stellon - I quit.(Brief Article)
December 6, 2004... Singlehander Dr Tony Stellon is quitting his Dover practice in January over the new contract. He said: `It is harder work with the new contract but for me the question is, is it improving patient care? I don't think it is. The contract is...

Chiron `should pay GPs for flu losses'.(Brief Article)
December 6, 2004... GPs hold vaccine manufacturer Chiron responsible for providing compensation for disruption to the flu campaign, according to a new survey. A Pulse/doctors.net.uk poll of 200 GPs found a third had been affected by vaccine shortages, with...

Howard Griffiths retires after 31 years at Pulse.(Brief Article)
December 6, 2004... Pulse's editor-in-chief, Howard Griffiths, has retired after 31 years on the newspaper. Howard joined as a features writer in 1973, writing his first article on complaints by smaller LMCs that they were under-represented on the BMA's GP...

Inquiry links asthma deaths with poor care from GPs.
December 6, 2004... A confidential inquiry into deaths from asthma has identified poor- quality GP care as a key factor. Failures to follow-up patients, to monitor peak flows and to prescribe inhaled steroids were all implicated by the inquiry, which examined...

How will the Government's patient choice plans affect primary care?
December 6, 2004... GPs gave their scathing assessment at a BMA conference last week Empowered patients are useless unless you have empowered clinicians. We could end up with doctors that don't care and say `You choose, because I can't be fecked.' Dr Paul...

Chancellor wants job advisers in surgeries.(Brief Article)
December 6, 2004... Chancellor Gordon Brown has unveiled plans to base employment advisers in GP surgeries to help patients on incapacity benefit return to work. In his pre-Budget statement last week, Mr Brown said the move would build on successful pilot...

Call for a 50 per cent cut in antibiotic prescribing.(Brief Article)
December 6, 2004... Senior Government advisers are calling for antibiotic prescribing to be cut by half as new evidence suggests a surprising proportion of respiratory infections are viral in origin. Members of the Specialist Advisory Committee on...

GPs massively opposed to OTC switch.(Brief Article)
December 6, 2004... GPs are overwhelmingly opposed to Government plans to move antibiotics over the counter. Three-quarters of GPs told a Dr Foster-Norwich Union Healthcare survey they opposed moves for antibiotics to become available without a prescription....

`Wheelie bin forms are not GPs' job'.(Brief Article)
December 6, 2004... Dr Peter Holden has won a local fight to stop GPs being bombarded with requests from patients to sign consent forms so they can get help moving their wheelie bins. Derbyshire Dales district council originally told residents who are unable...

GPs do not have time or staff for chaperones.(Brief Article)
December 6, 2004... GPs do not have the resources or the time to make trained chaperones available to patients for intimate examinations, research has found. The GP-led study concluded that lack of availability, time constraints and threats to confidentiality...

MI-link drug licensed for heart failure.(Brief Article)
December 6, 2004... An angiotensin receptor blocker (ARB) has been controversially licensed for use in heart failure, despite warnings that it may increase the risk of myocardial infarction. Candesartan (Amias) received approval for use in chronic heart...

GMC must await its fate over Shipman.(General Medical Council)(Brief Article)
December 6, 2004... Ministers will wait until February before responding to the Shipman Inquiry's fifth report, on regulation of doctors, Pulse has learned. The report, due to be released this Thursday, is expected to be scathing of the GMC for allowing...

Report casts doubt on case management.
December 6, 2004... The Government's active case management drive has suffered a serious blow, with a leading public health think-tank concluding it is unlikely to provide a `golden bullet' for cutting hospital admissions. A new report from the King's Fund...

The Evercare model.(Brief Article)
December 6, 2004... Active case management aims to target the 3 per cent of over-65s who have multiple morbidities and are at highest risk of unplanned hospital admissions. The Evercare model, in which advanced practitioner nurses manage the care of...

US health models `wrong for the NHS'.(Brief Article)
December 6, 2004... Government plans to use US models of health care to cut emergency bed days will be expensive and wrong for the UK, leading health academics are warning. Speaking at a BMA conference on the NHS Improvement Plan, Professor Allyson Pollock...

`Contract is failing to deliver on its promises'.
December 6, 2004... The first major post-contract survey suggests GPs are working harder and longer under GMS2 - Joe Lepper reports GPs say the new contract is forcing them to work longer and harder and is failing to deliver on its promise of greater control...

Practices invest in extra staff.(Brief Article)
December 6, 2004... Practices plan to expand staffing levels in the next two to three years to cope with the new contract and possibly earn extra income. Some 85 per cent of GPs say they will increase staff numbers or working hours to tackle the extra...

Forced allocation problem persists.(Brief Article)
December 6, 2004... More than one in five GPs is still having a problem with forced allocations to their practice, but the problem has improved marginally since April. A total of 22 per cent of GPs have been affected by allocations since the contract was...

Plea to ministers as jobs crisis drags on.
December 6, 2004... Practices beset by recruitment problems are urging the Government to do more to attract GPs - by Nerys Hairon Practices are still mired in a recruitment crisis with vacancies taking longer to fill and a chronic shortage of candidates,...

`My recruitment nightmare'.(Brief Article)
December 6, 2004... Dr Tim Dowling says the stress of recruiting a GP to his two-partner practice has been `just a nightmare'. Despite advertising, joining a PCT-wide recruitment campaign, and cold-calling friends of friends, he still could not find a new partner....

Positives and negatives in figures from 2003 and 2004.(Brief Article)
December 6, 2004... The positives * Vacancies fell from 3,435 to 3,240 * Average number of applicants per post rose from 3.3 to 3.7 GPs * 42 per cent of GPs said the recruitment process was more difficult than five years ago, down from 57 per cent ...

Contract fails over adherence.(Brief Article)
December 6, 2004... More than half of women taking drugs for osteoporosis place themselves at risk of fractures by stopping treatment within a year, according to a new report by the National Osteoporosis Society. The report criticised the new GMS contract for...

`Guidelines could hit osteoporosis care'.
December 6, 2004... NICE draft guidelines on secondary prevention of osteoporosis are `not relevant' to most patients seen by GPs and may actively damage the standard of care, researchers claim. The guidelines would deny treatment to over a quarter of younger...

Five key risks to target DEXA scan.(Brief Article)
December 6, 2004... Identifying five risk factors could allow targeted use of DEXA scans to find young women with very low bone mineral density who are liable for preventive treatment, researchers claim. Women who are very underweight, have anorexia, a family...

HRT consensus issued.(Hormone Replacement Therapy )(Brief Article)
December 6, 2004... The Royal College of Obstetricians and Gynaecologists has issued a consensus statement it hopes will end confusion over HRT among doctors and patients. The college's advice (see box) follows on from last month's update of the risk-benefit...

Support for celecoxib.(Brief Article)
December 6, 2004... The safety profile of celecoxib is at least as good as that of paracetamol and conventional NSAIDs, a new large-scale study suggests. The Pfizer-funded meta-analysis of 40,000 patients found celecoxib had fewer gastrointestinal events than...

New symptom analysis to boost colorectal Ca referral accuracy.
December 6, 2004... Combining 10 different symptoms for colorectal cancer using a new diagnostic tool can dramatically improve accuracy of GP referral, concludes the largest ever study of patients presenting in primary care. The statistical tool - based on...

Chlamydia yearly reinfection tests.
December 6, 2004... Patients who test positive for chlamydia should be rescreened at yearly intervals, according to a new study finding high levels of reinfection. Even those who tested negative should be followed up every 20 months, concluded the research...

BMA promises `big fights' to stop pensions threat to GPs.
December 6, 2004... The BMA is promising to give the Government `two big fights' if it tries to raise the NHS retirement age to 65 and move all health service staff to a career-average pension scheme similar to GPs. The plans are set to be outlined in a...

GBS `rare effect of flu vaccination'.(Brief Article)
December 6, 2004... Guillain-Barre Syndrome appears to be a rare adverse effect of flu vaccination, a new study concludes. The syndrome was the most common neurological effect reported after flu vaccination, researchers reported, after analysing data from the...

Computer loses #55k for practice.(Brief Article)
December 6, 2004... A PMS practice was underpaid by #55,000 in its latest quarterly payment because of errors in the software used to pay GPs. The Leigh View Medical Practice in Leeds was hit after the regional payments agency failed to add in the 14 per cent...

JOURNAL WATCH: Trial finds best option for back pain.(Brief Article)
December 6, 2004... A combination of spinal manipulation and exercise has markedly greater benefits than current `best care' in general practice for reducing back pain, UK researchers suggest. They studied 1,334 patients who had consulted GPs about lower back...

JOURNAL WATCH: Aneurysm screening of limited value.(Brief Article)
December 6, 2004... Population screening for abdominal aortic aneurysms in men aged 65-83 does not reduce overall mortality, although it can cut deaths in men aged 65 to 75. Australian and Canadian researchers conducted a population-based randomised...

JOURNAL WATCH: Steroid link to bisphosphonate scripts.(Brief Article)
December 6, 2004... Patients using inhaled steroids may be more likely than normal to be prescribed drugs for osteoporosis, suggesting the recognised effect on bone mineral density is clinically relevant. Irish researchers studied records of 32,081 patients...

JOURNAL WATCH: CVD falls faster in diabetes patients.(cardiovascular disease )(Brief Article)
December 6, 2004... The incidence of cardiovascular disease has decreased significantly faster in patients with diabetes than in those without the disease, according to US research. The study analysed the records of 8,181 patients, 430 of whom had diabetes,...

JOURNAL WATCH: No benefit of starting steroids high.
December 6, 2004... Starting patients who require inhaled steroids on high doses has no significant benefit compared with starting them on a moderate dose, according to Australian researchers. The meta-analysis of 13 randomised controlled trials compared the...

GPs' confusion over aspirin means diabetics miss out.
December 6, 2004... More than a third of diabetes patients at high risk of cardiovascular disease are not being treated according to current guidance as GPs admit to confusion over who should receive low-dose aspirin. GP diabetes experts claimed there was...

MP steps into hypnotics controversy.(Brief Article)
December 6, 2004... A leading MP has called for doctors to be held accountable for continuing to prescribe benzodiazepines despite the known risks. The demand came as GPs were issued with a new warning on the use of hypnotic drugs, with experts claiming they...

Systematic diabetes screening backed.(Brief Article)
December 6, 2004... Systematic screening for diabetes could be highly effective at picking up undiagnosed cases, according to a US study. Testing for any two of a range of risk factors, including dyslipidaemia, BMI, family history, hypertension or high HDL...

Act quickly to avoid being the victim of a stalker.
December 6, 2004... As one GP wins his legal battle over harassment by a patient and defence bodies report increasing problems, Nerys Hairon looks at why GPs attract stalkers The doctor-patient relationship is the cornerstone of general practice. But the...

EDITORIAL COMMENT: Contract failing to live up to the promises.(Brief Article)(Editorial)
December 6, 2004... In June 2003, after nearly 80 per cent of GPs had voted in favour, the then GPC chair Dr John Chisholm said the new contract `will be a turning point'. He added: `It allows GPs to control their workload, receive better and fairer pay, and...

Letter: Consultation lengths: do we really despise ourselves?(Letter to the Editor)
December 6, 2004... Thank you for your very interesting article about consultation length (Clinical, November 15). It certainly gave us some ideas, which may affect both our practices. A good mix of consultation lengths may be the most satisfying way forward;...

Letter: We have got to get practice based commissioning right.(Letter to the Editor)
December 6, 2004... `Commissioning plan in tatters' (News, November 22) highlighted some of the NHS Confederation's concerns about the draft guidance on practice- based commissioning It is important to emphasise that feedback from our members suggests that...

Letter: Reid runs scared on smoking ban.(Letter to the Editor)
December 6, 2004... Successive governments have totally neglected public health issues and prevention. The biggest threats to health - alcohol, tobacco, inadequate exercise, poor diet, unsafe sex - have been known for years. The white paper rightly includes...

Letter: Diagnosis the essence of practice.(Letter to the Editor)
December 6, 2004... I was delighted to read Sally Whittet's Jobhunter article `Bring back diagnosis and cure' (November 22). I felt she could easily have written diagnosis and care. It has always seemed to me that the essence of general practice is diagnosis and,...

Letter: Study shows pharmacists operate statin protocol well.(Letter to the Editor)
December 6, 2004... Your report (News, November 15) of our paper1 misrepresents the nature, purpose and results of the study. The report implies the study is a recent post-launch assessment of pharmacist performance with simvastatin OTC. This is not correct....

Letter: GPs' help needed for major CFS/ME project.(Letter to the Editor)
December 6, 2004... There are probably about a quarter of a million people in the UK with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), of whom some 25 per cent are so severely incapacitated as to be housebound or bedbound. But these are...

Letter: How egg donation will make my Christmas.(Letter to the Editor)
December 6, 2004... I would like to highlight, through your publication, the severe shortage of donated eggs for fertility treatment in this country. As a doctor I am involved in helping couples who have difficulty in conceiving, but have only recently become...

Letter: Does Primary Care Physician fit the title bill?(Letter to the Editor)
December 6, 2004... For a few years I have been working part-time as a GP in St Thomas's A&E department. My badge reads: Primary Care Physician, which in my opinion fits the bill. It will be a long time, if ever, before patients adapt to the change (few...

Letter: I don't need a booster.(Letter to the Editor)
December 6, 2004... Dr Lakhani is wrong to think of scrapping the title GP (News, November 22). This would be to fall in with the opinion of the late Lord Moran, who believed GPs to be doctors incapable of higher attainment. A present-day GP who knows his...

Letter: Recognition, please.(Letter to the Editor)
December 6, 2004... In reply to your article entitled `Don't call me GP, make me sound important' (News, November 22), I have always described myself as a consultant generalist. I have said I cannot do my proper job if asked to do junior doctor tasks. I...

Letter: GPs should not aid and abet insurance scams.(Letter to the Editor)
December 6, 2004... In 3 GPs' Views (November 15) Dr Des Spence seemed to suggest calling tonsillitis a pharyngitis to assist an insurance claim. Does Dr Spence teach medical ethics in his capacity as tutor in general practice, Glasgow, or does he just pass on...

Think like a PCO to succeed in your bid for enhanced services.
December 6, 2004... This has not been a good year for enhanced services. Things should improve next year - but GPs will have to think like business people to get results, says Dr Peter Stott When it comes to enhanced services, 2004 started with great...

How GPs can sell their profession to students.
December 6, 2004... GPs must sell the profession to medical students, and lecturing at medical schools is one way to do this, says Dr Beth McCarron-Nash When I decided to follow a career in general practice my consultant said: `I can't believe you're leaving...

NEW GMS - NEW ERA: DECEMBER CONTRACT CALENDAR.(Calendar)
December 6, 2004... Dr Bob Button advises practices on what they need to be doing this month DECEMBER 6 Check the direct enhanced service for violent patients is in place. Some PCOs have been dragging their heels over this and pressure may be needed. All...

Practice Q&As: Is refusing to accept new patients fair?(Brief Article)
December 6, 2004... Q: Our experience tells us that patients who are locally registered and ask to join our list without moving address are difficult to look after. Are we allowed to refuse registration on the grounds that they are already registered? At present...

Primary prevention of CHD: untapped potential or dangerous myth?(Coronary Heart Disease)
December 6, 2004... Ministers and the pharmaceutical industry are united in their drive for wider use of cholesterol-lowering drugs but others are starting to question altogether the link between high cholesterol and heart disease - Dr Malcolm Kendrick and...

Three key statin studies.
December 6, 2004... The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) was unique in its focus on hypertensive patients. It involved more than 19,000 patients with hypertension and at least three other cardiovascular risk factors who were then randomised to one...

Legal Lessons: Case study.
December 6, 2004... Dr Sean Kavanagh outlines a case where the focus on a patient's psychiatric, rather than physical, state proved fatal Mrs B, a 30-year-old teacher, saw her GP, Dr J, eight times over a period of four months. He diagnosed her headache, low...

Managing chronic kidney disease in primary care.
December 6, 2004... Dr Hugh Rayner and Dr Tony Snell outline how GPs can identify the small number of patients who need specialist care among the 10 per cent of the population suffering an under-recognised condition People commonly associate chronic kidney...

CLINICAL CASEBOOK: How to make diagnosis in scrotal pain.
December 6, 2004... Case history It is Monday morning and your receptionist asks you to see a man urgently - he has severe pain `down below' but is too embarrassed to tell her where. Stan, a 42-year-old bricklayer, hobbles into your room a few minutes later....

CAREERS: Why medicolegal work is a lucrative sideline.
December 6, 2004... Dr John Thompson explains the pros and cons of being a medical expert witness About 10 years ago when I was still doing locum GP work, I approached a GP for whom I had worked many times and who always drove a flash car. As I had always...

CV: Professor Amanda How.(Brief Article)(Interview)
December 6, 2004... Professor Amanda Howe answers the Pulse careers questionnaire What/who made you decide to go into general practice? Before I had any contact with the specialty, it was just myself I think - it seemed like the only humane specialty in...

CAREERS: WHY I LOVE: BEING A GPwSI.
December 6, 2004... * Enjoy the academic challenge * Like the challenge of setting up new services * Allows me to work as part of a team linking primary and secondary care * Adequate remuneration that you don't get being a clinical assistant *...

CAREERS: Jealousy, guilt and GPs' careers.
December 6, 2004... Q: I was looking forward to forming a two-doctor partnership with a well-established GP. However, she's started fantasising about getting another GP in and having a threesome. While I consider myself broad- minded I'm basically a one-partner...

SHIPMAN INQUIRY: Crackdown.
December 13, 2004... GPs face searching scrutiny of their day-to-day performance under far- reaching proposals in the Shipman Inquiry's `bruising' fifth report. Tougher inspection powers for PCOs, a whistleblowers' hotline for patients and practice staff, GP...

GMC survives report but further reforms demanded.(Brief Article)
December 13, 2004... The Shipman Inquiry's fifth report heavily criticises the GMC for continuing to serve the interests of the medical profession rather than patients - but stops short of calling for its abolition. The report found the GMC's fitness to...

How the GMC must change.(Brief Article)
December 13, 2004... * The investigation and adjudication procedures for fitness to practise must be separated with a new independent body set up to be responsible for adjudication * Thorough review of fitness to practise procedures to be carried out by the...

GMC warned to act in patients' interests.(Brief Article)
December 13, 2004... The GMC has been warned that if it fails to act in patients' best interests the Council for Healthcare Regulatory Excellence will be asked to step in. The council is set to play an increasingly key role in monitoring the GMC's work after...

Make it easier for patients to complain.(Brief Article)
December 13, 2004... Complaints procedures need to be amended to make it easier for patients to lodge concerns about doctors. The inquiry also called for PCOs to play a greater role in dealing with complaints and keeping track of them. Dame Janet Smith...

Empower PCOs to hit poor performing GPs with penalties.
December 13, 2004... Primary care organisations should be able to fine poor-performing GPs as part of an extensive range of new powers, the Shipman Inquiry has urged. Under the proposals, PCOs could impose financial penalties on GPs for `misconduct, poor...

Revalidation proposals `need radical overhaul'.(Brief Article)
December 13, 2004... Current plans for revalidation of doctors are not fit for purpose and do not offer adequate protection for patients, the Shipman Inquiry has concluded. It recommends a radical overhaul of the GMC's proposals, including a new level of...

Making revalidation tougher.(Brief Article)
December 13, 2004... Report conclusion on current proposals `The arrangements will not provide an evaluation of fitness to practise. It is important the public appreciate this and realise revalidation will not provide the assurance that was hoped for.' ...

`Samaritan' needed for complaints.(Brief Article)
December 13, 2004... A `single portal' as well-known as NHS Direct or the Samaritans is needed to make it easier for patients and health care staff to complain about a doctor, the inquiry found. It said an advice service - likely to be offered online and...

Controlled drug use to be curbed.(Brief Article)
December 13, 2004... The Government has come part way to meeting the Shipman Inquiry's demands for restrictions on the use of controlled drugs but has stopped short of setting up a new monitoring body. In its response to the fourth report of the inquiry,...

Give more support to solo GPs.(Brief Article)
December 13, 2004... Singlehanded practices should not be phased out but given more support and encouragement, the inquiry concluded. It said many patients preferred singlehanded practices because they provided better continuity of care. Although the...

Assist staff to blow the whistle.(Brief Article)
December 13, 2004... Every practice must introduce a `whistleblowing' policy to make it easier for staff to highlight concerns about clinical practice or professional conduct. The inquiry found practice staff faced `particular difficulty' in bringing up fears...

Hanged GP was being hounded by PCT despite concerns on his health.
December 13, 2004... A PCT has been criticised by an external inquiry into events leading to the death of a GP earlier this year - by Nerys Hairon A GP who was found hanged was pursued by his PCT over high referral rates despite concerns over his ill-health, an...

Clampdown on use of `overprescribed' antidepressants.
December 13, 2004... New guidance aims to curb antidepressant use, but GPs bemoan lack of alternatives - by Emma Wilkinson Government advisers are clamping down on the use of antidepressants in mild depression amid warnings that the drugs are being...

GPs divided over big contract pay rises.(Brief Article)
December 13, 2004... Half of the GPs who responded to our survey on the contract expect big pay rises, but many complain about extra work - Jack Shamash reports GPs are split over whether they expect the new contract to deliver a series of bumper pay rises. ...

Relations with PCO `have got worse'.(primary care organisations )(Brief Article)
December 13, 2004... Relationships between GPs and primary care organisations have worsened since the new contract began in April. Nearly one in six GPs said relations with their PCO were worse now than six months ago, compared with just 4 per who felt...

I put quality of life before the extra money.(Brief Article)
December 13, 2004... Dr Eric Ward reckons the new contract will leave him better off financially, but less happy at work. And he described the contract as `a tragedy'. Dr Ward said: `Patients are coming in with completely unrelated problems and we're asking...

Exception reporting confusion.(Brief Article)
December 13, 2004... Seven out of 10 GPs are concerned about the confusion over which patients they can exception report from quality framework targets. The concern was most acute among inner-city GPs, 77 per cent of whom said they were worried. The result...