Pulse articles from December 2007

Pulse archives from December 2007

Hospital follow-up burden shifts to GPs.
December 5, 2007... GPs set to take on more complex cases as national target aims to free up hospital capacity EXCLUSIVE By Nigel Praities GPs must brace themselves for an influx of more complex cases, after the NHS moved to shift the burden of hospital...

How new NHS indicators will work.(National Health Service)(Brief article)
December 5, 2007... * Better Care, Better Value indicators aim to help trusts compare their performances and increase efficiency * The first indicator will examine the new-to-follow-up outpatient appointments ratio, and highlight alternatives to hospital...

GP surgeries to carry out abortions.
December 5, 2007... The Government is planning to set up abortion services at GP practices, Pulse can reveal. The move is part of proposals to make abortion available closer to where patients live. The Department of Health confirmed it was carrying out trials...

GPs get legal alert as co-proxamol phase-out stalls.
December 5, 2007... As licence withdrawal approaches, 60,000 patients remain on drug Exclusive By Nigel Praities GPs are being warned of the huge medicolegal risks they will face from 1 January as it emerged that tens of thousands of patients across the...

Government promises Ca care boost.(cancer)(Brief article)
December 5, 2007... The Government has promised a massive improvement in the resources available to GPs to help fight cancer, claiming that current delays in diagnosis can lead to a `catastrophic' breakdown in care. As part of a #370m Cancer Strategy, revealed...

Access special: A third of GPs on Choices website.(Website overview)
December 5, 2007... GPs are turning to the web for new patients and taking on private firms as PCTs push for extended opening Exclusive By Steve Nowottny The Government's drive to encourage patients to pick and choose between GPs has been handed a major...

Choices teething problems.
December 5, 2007... Although a third of GP practices have signed up to NHS Choices, it would not be NHS Choices without teething problems. Dr David Barrett, a GP in Coventry, is among GPs who have complained about difficulties with using the site and...

PCTs splash out on GP hours.
December 5, 2007... PCTs are to spend up to 1% of their entire primary care budget on extending GP opening hours, Pulse has learned. A survey of PCTs this week found many are now budgeting to fund extended opening hours - despite the GPC warning it will be a...

GPs squaring up on APMS.
December 5, 2007... A group of 13 GP practices is to take private providers head-on in a bid for an APMS practice - in a move with far-reaching implications for the tendering process. The move is being seen as a fightback against private firms by GPs,...

InBrief: GPs must work with midwives to cut deaths.
December 5, 2007... GPs and midwives need to work closer to prevent maternal deaths, according to a report by the Confidential Enquiry into Maternal and Child Health. Only 3% of women have details about their care shared between midwives and their GPs, says...

InBrief: No GPs for asylum seekers.
December 5, 2007... Plans to deny hundreds of thousands of failed asylum seekers access to primary care are said to be being debated by the Government. The Home Office said it was pushing ahead with a review of ways to `shut down the privileges of people in...

InBrief: Anti-polyclinic fightback.(Brief article)
December 5, 2007... Londonwide LMCs has launched a resource pack to help the capital's GPs fight off the threat of polyclinics. The pack has been released to coincide with a capital-wide consultation run by London's 32 local primary care trusts to be launched...

InBrief: NHS lacks clinicians' voice.(National Health Service)(Brief article)
December 5, 2007... Failure to engage doctors and other clinical staff in managing their budgets is at the heart of the financial problems plaguing the NHS and can result in poorer services, says a new report from the Audit Commission. Steve Bundred, chief...

InBrief: New test for chlamydia.
December 5, 2007... A new 30-minute, point-of-care chlamydia test could massively improve coverage of the national screening programme, say UK researchers. The study of 1,300 women found the vaginal swab test to be cheap and effective. Researchers writing in...

InBrief: Ezetimibe no cost impact.(Brief article)
December 5, 2007... NICE guidance recommending ezetimibe as an add-on to simvastatin will have no significant impact on costs, says an analysis accompanying the final guidance. Although use of the drug as monotherapy will cost the NHS #260,000 a year, its use...

Drug switching safe over two-year period.
December 5, 2007... Key study shows switching statins and ARBs still safe in medium term By Georgie Hobbs Patients can safely and stably have their statins and ARBs switched as long as GPs are suitably supported, latest results from an influential study...

QOF drives up GPs' COPD diagnosis.
December 5, 2007... The prevalence of diagnosed COPD has jumped by almost 15% in two years since introduction of the QOF alongside significant improvements in its management, a study reveals. A combination of NICE guidelines and the GMS contract has driven...

Medicines regulator `carefully monitoring' varenicline.
December 5, 2007... The smoking cessation drug varenicline is being `carefully monitored' by the UK medicines regulator, amid fears over possible links to depression and suicidal thoughts. The move follows a request by the US Food and Drug Administration to...

Out-of-hours care `fragmented'.(home care services)
December 5, 2007... Reports condemn reporting of abnormal test results and reluctance to provide home visits By Steve Nowottny The fragmentation of out-of-hours services is severely disrupting the reporting of abnormal test results, causing a number of...

98% get fast access.(patient care)(Brief article)
December 5, 2007... GPs are offering 98% of patients an appointment within two working days, according to official Government figures released this week. Practices also offered the same proportion of patients an appointment with a primary care professional...

ACE inhibitor pregnancy alert.
December 5, 2007... GPs should not use ACE inhibitors or ARBs at all in pregnant women, warns a new bulletin from the medicines regulator. Use in women who are planning pregnancy should also be avoided unless absolutely necessary, according to the new alert....

End of co-ops a `national disaster'.(National Association of GP Co-operatives)(Brief article)
December 5, 2007... Dr Krishna Korlipara, CMEDS chief executive and founder of the now- defunct National Association of GP Co-operatives, warned the collapse of the co-operative system was a `national disaster'. He said it had caused `public concern for the...

GP scrutiny conflict of interest row.
December 5, 2007... Conservatives warn responsible officers may be too close to GPs to report on them effectively CAMPAIGN - JUSTICE FOR GPS By Gareth Iacobucci GPs are forming such close relationships with PCT boards that it may compromise...

GP data a fraction of true flu figures.
December 5, 2007... GP surveillance statistics used as the trigger for the Government's flu antiviral programme massively underestimate the prevalence of influenza infection, a report said this week. Patients' reluctance to consult with GPs over flu creates a...

Soap and water better than drugs to stop spread of flu.
December 5, 2007... Soap, water and a mask may be more effective weapons against the spread of flu than vaccines or antiviral drugs, a systematic review concludes. Cochrane reviewers found the combined intervention of hand-washing and wearing masks, gloves...

MediaWatch: `Life-altering asthma drug'.
December 5, 2007... The story NICE approval for asthma `wonder drug' omalizumab will transform the lives of patients, say the Daily Mail, Daily Telegraph and Express. The source The drug, a subcutaneous anti-IgE monoclonal antibody therapy for allergic...

MediaWatch: `More men need Viagra'.
December 5, 2007... The story Many more men would benefit from sildenafil than are currently getting the drug on the NHS, report the Daily Mail, Independent and Daily Telegraph. The source The BMA has asked the Department of Health to review the decision to...

MediaWatch: `MRSA-proof pyjamas'.
December 5, 2007... The story Pyjamas made with silver thread will protect patients from MRSA infection, according to the Sun, Daily Telegraph, Mirror and Daily Mail. The source `Sleepsafe' pyjamas containing silver thread have gone on sale at Marks & Spencer...

NICE on fence over combined inhalers.
December 5, 2007... NICE has stopped short of fully endorsing combination inhalers in children with chronic asthma. Concerns were raised about the preliminary draft of the NICE guidance, which did not explicitly endorse the use of combination inhalers. ...

MPs consider QOF overhaul.
December 5, 2007... Local QOFs backed as health select committee examines contract's impact on inequalities By Gareth Iacobucci The chair of the health select committee is calling for local variants of the QOF to tackle deprivation, as MPs prepare to...

Job advisers for GP surgeries.
December 5, 2007... The number of employment advisers based in GP surgeries is to be trebled, the Department of Health has announced. The Government is to plough #5m into expanding existing pilots, which place Jobcentre Plus advisers in practices, with a...

Bowel Ca screening reduces mortality.
December 5, 2007... The bowel cancer screening programme has had a dramatic impact on emergency diagnoses of colorectal cancer, findings from a key pilot site have revealed. The reduction, accompanied by a sharp fall in 30-day mortality, was partly due to a...

NHS backs patient budgets.
December 5, 2007... The chief executive of the NHS has backed controversial plans to offer personal healthcare budgets to patients. Speaking at a King's Fund event, David Nicholson said the NHS should `encourage and develop' individual patient budgets, and...

JournalWatch: Low testosterone CVD risk.
December 5, 2007... Low testosterone in men is a significant marker for cardiovascular disease, suggests a UK study. Researchers prospectively studied the relationship between endogenous testosterone and all-cause mortality in 11,606 Norfolk men aged between...

JournalWatch: Alcohol protects post-MI.(myocardial infarction)(Brief article)(Clinical report)
December 5, 2007... Moderate drinking is more effective than intense cholesterol-lowering in protecting patients who have had a myocardial infarction, according to an analysis of the Stockholm Heart Epidemiology Programme, which studied 1,346 patients eight years...

JournalWatch: COPD rehab backed.
December 5, 2007... Endurance and resistance training are equally effective in community- based pulmonary rehabilitation programmes, say Norwegian researchers. Forty patients with COPD were randomised to receive 12 weeks of pulmonary rehab - either by...

JournalWatch: HPV test improves screen.
December 5, 2007... Adding human papillomavirus DNA testing to the current cervical screening programme could extend the testing interval, say Dutch researchers. Their study randomised 8,575 women to two screening groups - one with the test and the other...

GPs warned of rise in virulent MRSA strains.
December 5, 2007... PVL strains of MRSA soaring in community, with children most at risk By Emma Wilkinson GPs have been warned of a sharp rise in cases of new virulent strains of community-acquired MRSA that particularly affect children. Cases of...

Hospital referral puts patients at risk.(Brief article)
December 5, 2007... GPs' patients run a significant risk when referred on to hospital, with almost one in 10 suffering harm during their hospital stay, a large- scale study has revealed. At least a third of those adverse events were avoidable, the review of...

Analysis: Debate hots up over nurses' pay.
December 5, 2007... Tensions emerge between general practice staff after nurses call for a bigger slice of the QOF cake By Georgie Hobbs The traditional image of the harmonious general practice team has received something of a battering in recent weeks....

Analysis: Do GPs exploit practice nurses?
December 5, 2007... In its written evidence to the Doctors and Dentists' Review Body, the Department of Health made great capital of the fact that although the number of surgery consultations had risen in general, those taken by GPs had fallen by 30% between...

Letter: A rethink is needed on drug switching.(Letter to the editor)(Brief article)
December 5, 2007... Dr John O'Malley, Moreton, Wirral Regarding drug switching (Debate, 21 November), I would like to raise another concern. I am a GP who also works as a hospital practitioner in gastroenterology and we commonly find some exacerbations of...

Letter: These regulation plans smack of socialist control.(Letter to the editor)
December 5, 2007... Name and address supplied So, these are the Government's new plans (`New regulator to be unleashed on GPs', News, 14 November)? More regulation, giving power to a new body to enter all premises and vehicles (presumably without...

Letter: We will pay nurses what we like.(Letter to the editor)
December 5, 2007... From Dr Robert Koefman, Bracknell, Berkshire Re- your article `GPs told to raise practice nurse pay', News, 28 November), what they have to realise is that we run small businesses and they are employed by us to do a job of work. We...

Letter: Alternative medicine needs equal status to drug therapy.(Letter to the editor)
December 5, 2007... From a GP in London, name and address supplied It is rather surprising that the NHS is controlled by allopathic practitioners, as GPs and hospital doctors are. In the 21st century this control in every sphere of the NHS is narrow...

Letter: Positive action is needed now over extended hours.(Letter to the editor)
December 5, 2007... From Dr Turabali Maimoon, Birmingham I think the opinion of GPs has been quite clearly established regarding extended hours from your survey of 163 GPs (News, 31 October). So do I take it that Dr Mubarik is the only brave GP to speak...

Letter: Traditional out-of-hours care no myth.(Letter to the editor)
December 5, 2007... From Dr David Church, Machynlleth, Mid Wales I would like to challenge the claim that it is a myth that surgeries provided good out-of-hours care before the contract (Letters, 14 November). In common with my colleagues, I provided...

Letter: Acne advice needs revision.(Letter to the editor)
December 5, 2007... From Dr R Dawood, GPSI in dermatology, Harrow, Middlesex The Government and PCTs always recommend oxytetracycline as first choice for treating acne vulgaris - but it should not be first choice. Compliance is the major issue in acne and...

Opinion: Patients must take purse-strings.(health care payment system)
December 5, 2007... Direct payments and individual budgets have worked in social care - it's time to try them in the NHS, says Professor Jon Glasby Imagine an alternative future for healthcare. What if women could choose not only where they gave birth, but...

A spine waiting to snap.(electronic medical records)
December 5, 2007... Phil's brush with the HMRC debacle has reinforced his fears over electronic health records Today I've had a letter from Her Majesty's Revenue and Customs, somewhat apologetic in nature, although not apologetic enough for my liking. It's...

Dinah'sDiary: Dinah Roy.
December 5, 2007... Dinah's troubled by a fluffy friend and a not-so-fluffy MH worker Monday Preview my week's diary: * London `world-class commissioning' meeting (nice idea but no time, will cancel). * Clear backlog of 250 emails. * See...

PulseFinance: PERSONAL FINANCE - PENSIONS AND RETIREMENT.
December 5, 2007... In the last of our series on personal finance, Dr John Couch stresses the importance of your pension and retirement planning Statistically, we can expect to live an extra 20 years once we reach the age of 60, and many younger GPs'...

PulseFinance: WASTE OF EXPENSIVE TRAINING.
December 5, 2007... Advice on a tricky practice problem from barristers Michael Salter and Chris Bryden THE SITUATION I have just paid for my junior receptionist to attend a course to improve her skills. This is over and above the usual training we offer...

PulseClinical: NEED TO KNOW - FITNESS TO FLY.(aviation medicine)
December 5, 2007... Professor Anthony Nicholson and colleagues answer GP Dr Graham Archard's questions on aviation medicine Take-home points * Pulse oximetry provides some guidance about the need for supplemental oxygen in flight. * Ten days should...

PulseClinical: NON-OA HIP PAIN.(osteoarthritis)(Clinical report)
December 5, 2007... Dr Louise Warburton's key hints on hip pain that is unrelated to osteoarthritis 1 The most important part of the consultation is the history. Never assume that pain described as coming from the hip will actually be originating in the hip...

PulseClinical: PRIMARY CARE EMERGENCIES - EYE TRAUMA.(Clinical report)
December 5, 2007... Dr Chantal Simon, Dr Karen O'Reilly, Dr Robin Proctor and Dr John Buckmaster advise on eye trauma presentations Corneal abrasions * Take a careful history to exclude high-speed particles (for example, from a strimmer) that could cause...

PulseClinical: MANAGING ALLERGIC DISEASE IN PRIMARY CARE.
December 5, 2007... Asthma UK described last week's Department of Health report on secondary care allergy service reform as `disappointing' - Dr Harry Morrow-Brown advises what can be done for allergy sufferers in primary care A recent report by the House of...

CLINICAL CASEBOOK - FOUR-YEAR-OLD WHO IS FAILING TO THRIVE.(Case study)(Clinical report)
December 5, 2007... Dr Tanvir Jamil looks at the case of a child brought to surgery by his mother who is worried about his small size and fussy eating - how would you investigate and manage the patient? CASE HISTORY Four-year-old Archie is brought in by...

GEOFF TIPPER'S REGISTRAR DIARY - Try a bit of gamesmanship.(general practitioner exam)(Brief article)
December 5, 2007... Geoff thinks the registrar's lot seems to be on the slide, but he will rise to the challenge The lot of the registrar does seem to be on the slide. The study budget has been axed in the face of a new exam that nobody knows much about. ...

PulseCareers: BALANCING OUTSIDE WORK WITH PRACTICE NEEDS.
December 5, 2007... Extending your range of skills is one thing, but make sure you don't get bogged down in excessive or inappropriate work, says Dr Peter Saul Many young GPs are aware of the need to keep their range of skills as wide as possible and this may...

CareerCoach: Decision-making.
December 5, 2007... Dr Pam Brown gives advice on how to take decisions with speed and confidence Everyone makes hundreds of decisions daily, and doctors need to make frequent and important clinical decisions - career decisions too. Many of us become...

CareerTaster: Academic GP.
December 5, 2007... This week, as she continues to look into options for non-principals, Dr Ruth Chapman talks to an academic GP Why it's on my job menu I'd heard about academic general practice but wasn't really sure what the work entailed. Engaging in...

PulseComment: Withdrawal symptoms.(co-proxamol)(Brief article)
December 5, 2007... In less than a month, co-proxamol - for so long a mainstay of pain control - will lose its status as a licensed drug. From January onwards, those GPs who choose to prescribe it will be doing so off their own back - with the legal risk placed...

LAST WORD: Dr Dennis Cox.(Interview)
December 5, 2007... Dr Dennis Cox... on playing the sax and reaching the patients The best thing about my practice is the way the staff always put our patients first. And the worst is that we are still suffering from the follies of 1960s architecture....

Top GP's APMS bid loses to private firm.
December 12, 2007... Dr Sam Everington, Government access adviser and European GP of the Year, is outbid EXCLUSIVE By Gareth Iacobucci Claims that GPs are given a fair crack at tenders for APMS practices have suffered a huge blow, after the Government's...

GPs fight off new attack on staff pay.
December 12, 2007... GP partners have angrily rejected claims they are exploiting staff, after coming under attack from both their salaried colleagues and practice nurses. A survey of nurses fomented the row over staff pay after finding just one in three had...

PCTs told to set GPs admission targets and consult firms.
December 12, 2007... New Government drive on PCT commissioning to put GPs in spotlight EXCLUSIVE By Gareth Iacobucci GPs are to be set targets for keeping patients out of hospital as part of a Government drive to improve PCT commissioning. Ministers...

`Where will it all lead?'.(Brief article)
December 12, 2007... Dr Sabby Kant, a GP in Northwood, Hillingdon - where a firm is to aid PCT commissioning for the first time - said GPs had a `psychological anxiety about where the plans could lead'. He said: `In principal, there's nothing wrong with a...

Private sector influence grows.
December 12, 2007... * Department of Health to launch World Class Commissioning initiative, including new targets covering areas such as admissions, mortality rates and obesity. * The department reveals six areas lined up to follow Hillingdon in bringing in...

GPs face scrutiny on Ca pick-up rate.
December 12, 2007... GPs are to face close scrutiny of how long they take before deciding to refer patients to hospital with suspected cancer, under the Department of Health's new cancer strategy. Part of the scope of the strategy, published last week, will be...

Antibiotics are of no benefit in sinusitis, GPs warned.
December 12, 2007... GPs are being urged to stop prescribing antibiotics in sinusitis, after new evidence suggested they have little if any effect on the course of illness. Amoxicillin has no benefit for acute sinusitis used either alone or in combination with...

A blow for amoxicillin use.
December 12, 2007... * Researchers studied 240 patients with acute sinusitis * Patients were randomised to 500mg of amoxicillin three times a day for seven days, 200 g of budesonide in each nostril once a day for 10 days, placebo versions of both and all...

Pneumococcal doubts grow.(Brief article)
December 12, 2007... The pneumococcal vaccination campaign in the elderly could be scrapped immediately, after a preliminary review concluded it had little impact on disease rates. Government advisers found that although the vaccination campaign had been...

GPs left in dark over HPV.
December 12, 2007... Lack of national guidance on HPV vaccination is leaving GPs confused over the advice to give to women and facing a lottery over funding for one-off vaccination requests. Fewer than a quarter of PCTs approached by Pulse had agreed to fully...

InBrief: PCTs miss matrons targets.
December 12, 2007... PCTs have failed to hit Government recruitment targets for the much- criticised community matrons scheme, it was revealed this week. Only 1,600 community matrons have been recruited since 2004, leaving GPs and district nurses struggling to...

InBrief: Blow for anti-obesity drug.
December 12, 2007... NICE has ruled against the use of the anti-obesity drug rimonabant in a preliminary appraisal. The institute has asked the manufacturer Sanofi Aventis for more data on cardiovascular risk outcomes in patients who have successfully lost weight...

InBrief: Script charge phase-out.(Brief article)
December 12, 2007... Scotland's plans to scrap prescription charges for patients with chronic illness have been delayed. Instead the charge will be gradually reduced before a planned abolition in 2011. The cost of a prescription will drop from #6.85 to #5.00 next...

InBrief: #10m GP patient survey.
December 12, 2007... The forthcoming GP patient survey will cost the NHS at least #10m, the Government admitted this week. The figure includes mailing surveys first-class to patients, which the Department of Health argues is `the most cost effective method' due to...

InBrief: IT budget underspend.
December 12, 2007... Connecting for Health has underspent its budget for the past three years by #828m because of huge delays in implementing the National Programme for IT. Most of the underspend occurred over the past financial year when the rollout of care record...

InBrief: Be a Pulse book reviewer.
December 12, 2007... Pulse is offering free books on general practice and health-related issues to any GPs willing to review them for our website. If you're interested, contact deputy editor Richard Hoey on rhoey@cmpmedica.com for a list of current titles. ...

GPs to take on stroke follow-up workload.
December 12, 2007... National stroke strategy announced and QOF indicator may follow By Nigel Praities GP are to become responsible for systematic follow-up of patients who have suffered a transient ischaemic attack or stroke, as part of a Government...

Trust slashes TIA referral waits.
December 12, 2007... Nottingham University Hospitals NHS Trust has slashed its waiting time for TIA referral from an average of more than four weeks to a matter of hours. GPs have a hotline to fast-track high-risk patients with a suspected TIA or stroke. The...

Trusts phasing out singlehanders.
December 12, 2007... PCTs are implementing policies aimed at cutting the number of singlehanded practices, as a new Healthcare Commission report questioned their performance in the QOF. A Pulse investigation has found at least three PCTs across London -...

GPs rise to challenge with record uptake for flu vaccine.
December 12, 2007... GPs have achieved record flu vaccine uptake for October in this year's campaign as practices demonstrated what they are capable of in the absence of delivery delays. Figures for the first month of this year's campaign show 54.7% of over...