Pulse articles from December 2006

Pulse archives from December 2006

QOF care distortion prompts pay fears.(quality and outcomes framework )
December 7, 2006... GPs' pay and pensions come under pressure as new research questions value of the QOF EXCLUSIVE By Daniel Cressey The GP contract is systematically distorting care by driving neglect of conditions that do not carry incentives,...

The QOF effect.
December 7, 2006... * Diabetes - consultations up 11.3 per cent in men and 5.9 per cent in women * Asthma - up 7.6 per cent in men and 7.9 per cent in women * Depression - consultations fell 10.9 per cent in men and 11.9 per cent in women * Anxiety -...

As Warner moves to cap GP pensions.(General Practitioners)(Brief article)
December 7, 2006... Health minister Lord Warner is to impose a cap on GPs' pensions, citing `unintended' rises in GP pay from the new contract to justify the move. As Pulse went to press, sources indicated the Department of Health was clearing the way to...

Astounded by minister's pay jibe.(Brief article)
December 7, 2006... Dr Gillian Rice is `astounded' at Lord Warner's accusation that GPs have failed to invest enough money from the new contract in their practices. Dr Rice said her practice in Bristol had taken on a salaried GP to cope with the demands of...

Furore over Care Records opt-out.
December 7, 2006... Connecting for Health to issue guidance after another week of controversy By Ingrid Torjesen Patients will not be able to opt out of having their data uploaded on to the NHS Care Records Service, guidance from Connecting for Health...

The opt-out saga.(Chronology)(Brief article)
December 7, 2006... May 2006 Connecting for Health publishes policy that patients cannot opt out of initial Care Record upload, but can stop their record being shared 1 November Guardian prints letter for patients to use to opt out of initial upload...

Training row over nurse prescribing.(Brief article)
December 7, 2006... Nurse prescribers may be left to mentor their own colleagues amid a fierce row over who should be responsible for training and supervision. GPs are refusing to support training up of nurses because of lack of resources for the `onerous'...

Why I've had to give up family planning.(Brief article)
December 7, 2006... Dr Margaret Safranek has had to give up her work in a family planning clinic because she has found it impossible to access compulsory update training. Dr Safranek, a GP in Muswell Hill, north-west London, has tried and failed to enrol on a...

GP obesity role to be stepped up.(General Practitioners)
December 7, 2006... GPs are to be expected to hand out physical activity questionnaires to all their overweight patients under a Government initiative to step up management of obesity. Under the new plans, GPs will be asked to refer sedentary patients to a...

Smoking drug set to be a key option.(Brief article)
December 7, 2006... Trials suggest new smoking cessation drug varenicline is effective and likely to become a key treatment option, the National Prescribing Centre has advised. Pfizer launched the drug last week as the first non-nicotine medicine specifically...

GPs hampered by PBC `roadblock'.(practice-based commissioning)(General Practitioners)(Brief article)
December 7, 2006... Hospital trusts are acting as a roadblock to practice-based commissioning by threatening consultants with disciplinary action if they set up services in the community. The trusts are trying to protect their income because a growing number...

InBrief: Few trained in spirometry.(Brief article)
December 7, 2006... Only 30 per cent of GPs have received training on how to use spirometry, a survey of Scottish practices reports. The research, published in the Scottish Medical Journal, also found only around 20 per cent of GPs had access to a community...

InBrief: Faecal incontinence query.(Brief article)
December 7, 2006... GPs should `actively yet sensitively' inquire about faecal incontinence in groups including the frail elderly, new mothers and those with diarrhoea, new guidance advises. The NICE draft document recommends a `focused baseline assessment'...

InBrief: Competition consultation.
December 7, 2006... The RCGP is seeking the views of patients and doctors on the Government's choice and competition policies. It wants to shift the spotlight to the impact of the private sector on primary care, rather than hospitals. The consultation paper is...

InBrief: Primary care spending up.(Brief article)
December 7, 2006... Spending on primary care in Scotland rose by 11.5 per cent to #701m last year, figures from the Scottish Executive show. Separate statistics from the executive also revealed complaints relating to primary care services in Scotland dropped by 8...

InBrief: Methadone warning.
December 7, 2006... The US Food and Drug Administration has warned of reports of deaths and life-threatening side-effects with use of methadone. The FDA said doctors should be aware of signs of overdose including shallow breathing and extreme tiredness, and that...

InBrief: GPs' handwriting `duty'.(General Practitioners)(Brief article)
December 7, 2006... Doctors' handwriting is no worse than that of health service managers or other workers, US researchers say. But the University of Kansas study, published in Quality and Safety in Healthcare, concluded doctors had a duty to either have...

InBrief: Anti-violence campaign.(Brief article)
December 7, 2006... A campaign to combat violence against GPs and practice staff has been launched in Scotland. Posters and leaflets are being sent to practices and a simpler system to report unacceptable behaviour introduced. Copyright: CMP Information Ltd.

InBrief: SearchMedica a winner.(Brief article)
December 7, 2006... SearchMedica is a better source of medical information than generic search engines such as Google, an independent survey of 200 GPs has found. A majority of GPs surveyed by Medix-UK praised SearchMedica's option of allowing them to...

PCTs too poor to bring in GP private providers.
December 7, 2006... Government scheme to recruit private firms to run GP services hits buffers EXCLUSIVE By Christian Duffin At least half of the PCTs corralled by the Government into a scheme aimed at bringing in private firms to run GP services may...

PCT asks GPs to take pay cut.(primary care trusts)(general practitioners)(Brief article)
December 7, 2006... A PCT has taken the unprecedented step of asking its GPs to take a voluntary 5 per cent pay cut to help lift it out of a financial crisis. GPs in Havering, north-east London, received letters this week asking if they could `agree to this...

OOH firm missing most of its targets.(out-of- hours services )(Brief article)
December 7, 2006... A private firm controversially awarded a contract to provide out-of- hours services in Cornwall is missing almost all of its targets. The Kernow Urgent Care Service, run by Serco, is missing targets for emergency, urgent and non-urgent home...

PCTs told to mend fences with GPs.(primary care trusts)(general practitioners)(Brief article)
December 7, 2006... New PCTs must mend their `fractured' relationships with GPs, the chief executive of the NHS has warned. David Nicholson said personal trust was key to the relationship developing. Good relations were essential for the success of PCTs and...

MediaWatch: `Abortion pill beats cancer'.(Brief article)
December 7, 2006... The story An abortion pill could prevent the growth of breast cancer in high-risk women, report the Daily Telegraph, Daily Express, Sun and BBC News Online. The source A team from the University of California Irvine in the US found that in...

MediaWatch: `Fridge magnet heart risk'.(Brief article)
December 7, 2006... The story Fridge magnets can be a killer for patients who have weak hearts, reports BBC News Online. The source Heart Rhythm journal reports that Swiss researchers at the University Hospital of Zurich tested the effect of neodymium magnets...

MediaWatch: `Fruit cuts miscarriage risk'.(Brief article)
December 7, 2006... The story Regular fruit and vegetable consumption can halve the risk of a miscarriage in the first three months of pregnancy, according to the Daily Mail. The source A new study in the BJOG of 603 women whose most recent pregnancy ended in...

Vaccines for care staff.
December 7, 2006... Flu vaccines for care home staff would cut risks for elderly, says study By Lilian Anekwe Vaccinating care home staff against flu would cut complications and deaths from the disease among elderly residents, a new analysis concludes....

GP pay: GPs' earnings soar in first year of contract.
December 7, 2006... EARNINGS GPs' average earnings rocketed by more than 30 per cent in the first full year of the new contract, writes Christian Duffin. New figures based on tax returns for 17,897 GPs showed net income for all GPs in 2004/5, including...

GP pay: Staff costs the fastest rising expense as GPs invest for QOF.(quality and outcomes framework )(Brief article)
December 7, 2006... EXPENSES Practices spent 17 per cent more on staff costs in 2004/5 as they took on the demands of the quality and outcomes framework for the first time. The rise - from #62,700 to #73,500 for an average practice - was the biggest out...

Low-carb benefits for diabetes.
December 7, 2006... A new study's insistence that low-carbohydrate diets are a `real option adds to the diabetes controversy By Cato Pedder A new study has fuelled the debate over dietary advice in diabetes after finding long-term benefits for a...

Options for bowel screening.(Brief article)
December 7, 2006... Switching to alternative bowel cancer screening strategies would be more cost-effective than using faecal occult blood testing as planned. New research published online in Gut suggests screening with flexible sigmoidoscopy would have...

GPs' fatigue causing errors.(Brief article)
December 7, 2006... Excessive GP workload and fragmentation of patient care are the key causes of medical errors in general practice, warns a new study. Researchers found `excessive demands' on time and workload were causing human errors, while fragmented...

Failing GPASS is on its way out.(General Practice Administration System Scotland)
December 7, 2006... Scottish GPs to get new practice software as damning report backs long- standing complaints about GPASS By Ingrid Torjesen GPs in Scotland are to get new practice software over the next three years after a damning report signalled the...

NHS network blamed for lack of speed.(National Health Service)(Brief article)
December 7, 2006... Connecting for Health has admitted the new national N3 network is one cause of slow broadband speeds in some practices. When GPs first raised the issue last week (News, 30 November), the agency blamed the way PCTs were prioritising services...

GPs told: prepare for stampede of quitters.(General Practitioners)
December 7, 2006... 1 July date looms as Scotland sees surge in demand for smoking services By Daniel Cressey GPs have been warned to gear themselves up for a huge influx of quitters in the run up to the ban on smoking in public places in England. ...

ACE drugs economic for artery disease.(Angiotensin converting enzyme)(Brief article)
December 7, 2006... Treating patients with stable coronary artery disease with ACE inhibitors would be cost-effective in the UK, an analysis of a major European trial reveals. Use of the drugs in these patients would not only reduce cardiovascular events but...

Osteoarthritis patients `lost'.
December 7, 2006... Patients with osteoarthritis are being left to deteriorate on waiting lists without proper treatment because of communication breakdowns, an NHS study warns. Management of pain was `inadequate, with few referrals to appropriate services',...

Warning as drug firms target nurses.(Brief article)
December 7, 2006... Targeting of nurses by pharmaceutical companies must be addressed following extension of nurse prescribing rights, experts are warning. The Association of the British Pharmaceutical Industry is reacting to the expansion of nurse prescribing...

Arthritis next for shared care shift.(Brief article)
December 7, 2006... An NHS study suggests rheumatoid arthritis could be next in the shift of care into the community, after finding GP management has significant benefits. A shared-care model, with GPs taking on the bulk of responsibility for reviewing...

Riddle as paracetamol pack changes fail to cut suicides.(Brief article)
December 7, 2006... Suicide rates have surprisingly been unaffected by regulations on paracetamol pack sizes. The new research also finds marked inequalities remain in paracetamol- related deaths, with deprived people having higher overdose and death rates....

`Fundholding lessons not learned'.
December 7, 2006... Study says practice-based commissioning policy makers are repeating the mistakes of fundholding By Helen Crump The Government has failed to learn lessons from fundholding in developing practice-based commissioning, research has...

End in sight for partnerships.(Brief article)
December 7, 2006... The days of GP partnerships are numbered, a leading healthcare consultant is predicting. Kingsley Manning, founder of Newchurch, which advises the NHS and private providers, told the recent NHS Alliance annual conference in Bournemouth...

`Shared records risk prejudice'.(Brief article)
December 7, 2006... Doctors risk being prejudiced by information in the shared Care Record and not treating patients appropriately as a result, a GP is warning. Dr Gerard Bulger, a GP in Bovingdon, Hertfordshire, told the Care Record Development Board's...

GPs feel hopeless about NHS.(General Practitioners)(National Health Service)(Brief article)
December 7, 2006... GPs feel a sense of `hopelessness' about the NHS because of constant changes in the service, its former director of clinical governance claims. Professor Aidan Halligan told the NHS Alliance's annual conference the change agenda had not...

Call for GPs to boycott referral management centre.(General Practitioners)(Brief article)
December 7, 2006... GPs in Kent are being urged to ignore a clinical assessment service being introduced in selected practices to help cut referrals. Bexley Care Trust has introduced the assessment service after claiming some GPs are overspending on practice...

Welsh GPs' working misery.(General Practitioners)(Brief article)
December 7, 2006... Box-ticking and mountains of paperwork are making the working lives of GPs in Wales miserable. A survey of practices by the Welsh Liberal Democrats also found many GPs were struggling in substandard or small premises. Of the 53...

Hewitt: DoH right on patient survey.(Department of Health)(Survey)(Brief article)
December 7, 2006... Health Secretary Patricia Hewitt has defended the Department of Health's decision to quiz patients for their views on surgery opening hours. GPs have hit out at the questions in the national patient experience survey for raising patient...

Welsh GPs' complaints.(general practitioners)(Brief article)
December 7, 2006... `There is less contact with patients, more with papers. Until two years ago we had one shredder in our practice. Now we have eight.' (urban practice) `There is a lot of temptation to cheat with the QOF.' (large practice near...

RCGP warns of sex talk `fiasco'.(Royal College of General Practitioners)(National Institute for Clinical Excellence )
December 7, 2006... College response warns NICE proposals for GPs to counsel young people on sex would be counter-productive By Lilian Anekwe Plans for GPs to counsel young people about sex would be counter- productive and deeply unpopular with doctors,...

RCGP reservations.(Royal College of General Practitioners)(Brief article)
December 7, 2006... * Recommendations on identifying at-risk groups and taking full sexual histories `need to be more explicit' * One-to-one interventions may worsen sexual health * Content of counselling sessions is unclear * Provision of emergency...

Dying lose on mental health.(Brief article)
December 7, 2006... Hospice patients have woefully inadequate access to mental health services, a new survey shows. GPs were urged to intervene to ensure patients receive suitable care, after 41 per cent of hospices admitted to difficulties in accessing...

JournalWatch: Fish oil's heart benefits.(treating atherosclerosis)
December 7, 2006... Eating fish oils can protect against progression of atherosclerosis, a Finnish study reports. The researchers followed up 228 women from a trial examining the effect of oestrogen replacement therapy on atherosclerosis. Atherosclerosis...

JournalWatch: Warfarin bleeding signals.(Brief article)
December 7, 2006... A combination of eight risk factors can predict the likelihood of major bleeding in patients taking warfarin, a US study reports. Researchers analysed data from 26,345 patients on warfarin for atrial fibrillation, along with statistics on...

JournalWatch: Beta-blocker risks queried.(risk of developing depression in beta blockers usage)(Brief article)
December 7, 2006... Patients who take beta-blockers in the year after a myocardial infarction are not at increased risk of depression, a Dutch team report. The study used the Beck Depression Inventory to assess mental health in 381 patients discharged from...

JournalWatch: Low vitamin disability risk.(helath of elderly women)(Brief article)
December 7, 2006... Low levels of micronutrients predict future disability in elderly women, a US study concludes. The longitudinal study assessed serum concentrations in 643 women who were followed at six-monthly intervals between 1992 and 1995. Risk of...

JournalWatch: Duloxetine a urinary aid.(treating stress urinary incontinence)(Brief article)
December 7, 2006... Duloxetine can improve quality of life in patients with stress urinary incontinence, but side-effects are common, a systematic review concludes. The UK research evaluated nine trials assessing duloxetine against placebo in 3,063 women with...

Oral steroids diabetes risk.(Brief article)
December 7, 2006... As many as 2 per cent of all cases of diabetes are caused by oral steroids, researchers estimate. Their report warned the true figure could be higher because of errors misclassifying exposure, although inhaled, injected or topical steroids...

Analysis: NHS Care Records: What's all the controversy about?
December 7, 2006... Cut through the confusion over confidentiality and consent. Ingrid Torjesen reports So, remind me again, what is the NHS Care Records Service? The NHS Care Records Service is meant to provide an individual electronic health record for...

The plan for implementation.(records management)(Brief article)
December 7, 2006... SPRING 2007 * Six PCTs to pilot a basic summary record - including major diagnoses, procedures, current and regular prescriptions, allergies, adverse reactions, drug interactions and recent investigation results - using data extracted...

Letter: GPs' no-win situation on benefits.(Letter to the editor)
December 7, 2006... Incapacity benefit forms are the bane of GPs' lives - but how can the current system be improved? From Dr JS Caithness, Florencecourt, Co Fermanagh As a GP who has been doing incapacity benefit medicals for 13 years, I entirely agree...

Letter: Patient Experience? Don't pander to open-all-hours whim.(Letter to the editor)
December 7, 2006... From Dr Anthony DeWeever, Manchester I would like to voice my opinion on the discredited Patient Experience survey. It is basically giving patients carte blanche to say they would like GP surgeries to open late in the evening and at...

Letter: Ambulance services merit more respect.(Letter to the editor)
December 7, 2006... Phil Peverley's views on the ambulance service and drugs misuse provoke strong reaction From Dr James Gray GP and clinical adviser to Yorkshire Ambulance Service I read with dismay the comments by Dr Peter Holden then echoed by Dr...

Letter: No place for prejudice over drugs misuse.(Letter to the editor)
December 7, 2006... From Dr Martin Weatherhead GP and clinical lead for substance misuse, Sunderland I understand Phil Peverley sets out to both entertain and stimulate controversy but feel he has overstepped the mark about drug misusers (Columnists, 16...

Letter: You're an old codger, Phil.(Letter to the editor)
December 7, 2006... From Dr Robert Duncan, Cheltenham Reading a recent Pulse, I got quite excited by the `warning: may contain satire and dark medical humour' at the top of Phil Peverley's column. Perhaps something to brighten my day. Maybe not. More...

Letter: Only GPC can stop list size problems.(Letter to the editor)
December 7, 2006... From Dr Hamish Meldrum GPC chair Dr Jonathan Munday has got it wrong (Letters, 23 November). While it may be true average list size has increased as a function of an increasing population and a smaller number of practices, what determines...

Letter: Our key primary care role in depression.(Letter to the editor)
December 7, 2006... From Dr Chris Manning Chief executive, Primhe Once again, depression is in the news. And so it will continue to be, as its prevalence and attendant issues continue to rise - diabetes included. Whether people continue to consider that...

Letter: No need for a flu vaccine scrabble.(Letter to the editor)
December 7, 2006... The rise in depression prevalence has major workload implications for GPs From Richard Stubbins Managing director, Sanofi Pasteur MSD We were surprised to read about perceived flu vaccine chaos leading to GPs across the country...

The blame culture.(Column)
December 7, 2006... Phil says life would be far less stressful if the politicians just left GPs to get on with the job Stress is a double-edged sword. Without it as a motivating force, we might never get out of bed in the morning. It's also an incentive; to...

SecondOpinion: Andy Jones - Don't sell yourself short.
December 7, 2006... The NHS is going to start advertising. GPs, among others, will be tailoring their services to suit patients' needs, and the fact will be advertised accordingly. The dream is to create an ever improving system of health care built around patient...

PulseFinance: The correct way to amend your records.
December 7, 2006... Medical records are of unique evidential value, so take care if you need to amend them, advises Dr Nicholas Norwell A medical record is a basic but essential clinical tool. It provides a clear and accurate picture of a patient's care and...

PulseFinance: Predicting disaster and planning for it.
December 7, 2006... Two misfortunes are looming on the general practice horizon, so be prepared, says Dr John Couch Within the last year many practices were asked by their PCT to produce a disaster plan for the scenario of their practice premises burning...

HOW TO FIND A NEW PARTNER.(recruitement of a General Practitioner)
December 7, 2006... Recruitment in general practice has improved over the last couple of years, undoubtedly helped by the increased financial rewards in nGMS. However, nGMS places challenging demands on GPs and practices, so finding the right person is more...

PulseClinical: TWO VIEWS - NURSE PRESCRIBING: LOGICAL OR UNSAFE?
December 7, 2006... The row over non-medical prescribing took a new twist recently with a warning from the Commission on Human Medicines over monitoring the safety of the new system. This follows a change in the law this year to allow suitably trained nurses to...

Timeline.(chronology)(Chronology)(Brief article)
December 7, 2006... Nurse prescribing Nov 2005 * Plans are announced for an extension of nurse and pharmacist prescribing powers Jan 2006 * Nurse prescribers also given access to some controlled drugs May 2006 * Independent nurse...

PulseClinical: NEED TO KNOW - ANGINA.(Disease/Disorder overview)
December 7, 2006... Cardiology experts Dr Alistair Cormack and Dr Adrian Brady tackle common primary care dilemmas from GP Dr Mike Fitzpatrick Take-home points * A negative exercise test is a reliable and robust indicator of patent coronary arteries ...

PulseClinical: Citalopram of modest benefit for IBS.(irritable bowel syndrome)(Clinical report)
December 7, 2006... Q Does citalopram improve symptoms in patients with irritable bowel syndrome? Synopsis As tricyclic antidepressants have demonstrated efficacy in IBS, and because serotonin receptors are involved in colonic motor pathways, physicians...

PulseClinical: HOW I DEAL WITH REQUESTS FOR CO-ANALGESICS.
December 7, 2006... Dr Frank Shapiro shares his techniques to avoid prescribing co- analgesics when faced with patient requests The recent furore over co-proxamol caused me to reflect on my long-term resistance to prescribing co-analgesics. Does the fact that...

PulseClinical: CANCER.(cancer diagnosis and care)
December 7, 2006... Cancer expert Dr Nick Brown looks at recent papers that have caught his eye Colorectal cancer NICE guidance advises urgent referral of patients aged over 40 with six weeks of rectal bleeding and diarrhoea, and referral of patients...

PulseClinical: DIGITAL FLOOR SCALES.
December 7, 2006... Dr Gill Jenkins gives her verdict after trying out this new piece of equipment The Seca 862 is a flatbed electronic scale with its large LCD display unit (215mm x 110mm) on a cable for remote viewing. This can be wall mounted or placed on...

PulseClinical: MY TOP FIVE WEBSITES FOR RHEUMATOLOGY.(Website list)
December 7, 2006... Dr Louise Warburton, a GPSI in musculoskeletal medicine, shares her favourite websites for patients and professionals Arthritis Research Campaign www.arc.org.uk This is my favourite and most used rheumatology website. It has a...

PulseClinical: PRACTICAL LOWDOWN ON FALLS.
December 7, 2006... Falls are serious and common for those over 75. Risk factors have been identified and specific interventions proven to reduce falls. Risk factors * Age over 80 * Cognitive impairment * History of fall and fall-related injury...

PulseClinical: SNIPPETS ON OPHTHALMOLOGY.
December 7, 2006... Dr Amar Alwitry gives advice on diagnosis and referral in cataracts Cataract What's going on? The lens has become cloudy and vision blurred. Alternatively, the vision is intact but the patient complains of `haloes' and glare,...

FIVE THINGS YOU MAY NOT KNOW ABOUT ANOGENITAL SKIN DISORDERS.
December 7, 2006... Consultant dermatologist Dr Sallie Neill gives tips on diagnosis and management 1. Examine the skin at other flexural sites on the body - to help give a clue to the diagnosis The four most common, non-neoplastic, non-infective...

PulseRegistrar: STRESSED PRACTICE NURSE QUITS BEFORE BUSY SURGERY.
December 7, 2006... CASE HISTORY When you come in on Monday the practice nurse, Jill Brown, hands you a letter. She is resigning because she feels stressed and unsupported. You are shocked, as she has been happy to accept responsibility and is a committed...