Pulse articles from February 2008

Pulse archives from February 2008

GPs face penalties for in-hours closure.
February 6, 2008... Practices that close for lunchtimes or a half-day set to miss out on extended hours cash EXCLUSIVE By Steve Nowottny Ministers plan to crack down on lunchtime and half-day closing in practices by attaching stringent conditions to the...

March of the private sector.(Alternative Provider Medical Services )(Brief article)
February 6, 2008... Privately run primary care centres will be in every town by the end of this year and suck funds from existing GP practices, the BMA warned this week. GPC deputy chair Dr Richard Vautrey said he expected all of the 150 APMS health centre...

Campaign to curb antibiotics.
February 6, 2008... The Government has launched a publicity campaign to discourage GPs from prescribing antibiotics for colds, and to dissuade patients from asking for them. Chief medical officer Sir Liam Donaldson has stressed that antibiotic resistance is...

E-discharge system trialled.(Brief article)
February 6, 2008... A hospital in Suffolk has become the first in the country to trial a new electronic patient discharge system that `will improve the delivery of patient discharge information to GPs'. The West Suffolk Hospital in Bury St Edmund's claims the...

Choice agenda is stalling.(Survey)
February 6, 2008... New figures suggest the Government is failing to make progress in its choice agenda. Provisional figures from November 2007 show 44% of patients recalled being offered a choice of hospital by their GP for their first outpatient appointment,...

APMS TENDERS: GPs lose out on APMS over cost despite better services.
February 6, 2008... Private companies undercut GPs by up to 25%, raising fears that PCTs are prioritising cash over quality By Gareth Iacobucci GPs have lost out to private companies in the APMS bidding process after being undercut by up to 25% - and...

PROTEST TAKES TO STREETS: `We believe patients are at risk'.
February 6, 2008... Emotions ran high as dozens of GPs and patients took to the streets to protest at what they claim is a bias towards private companies under the Government APMS initiative. The demonstration in Tower Hamlets, east London, was sparked by the...

Security fears on missing NHS smartcards.
February 6, 2008... EXCLUSIVE By Steve Nowottny Thousands of NHS smartcards have already gone missing, raising fresh fears over the security of patient data held online, a Pulse investigation reveals. After requests to hundreds of NHS bodies under the...

LEGAL CHALLENGE: Legal threat to drug switch `bribes'.
February 6, 2008... Future of drug switching schemes is uncertain as ABPI legal challenge goes straight to the European Court EXCLUSIVE By Nigel Praities The UK pharmaceutical industry is to take its legal challenge over GP prescribing incentives straight...

FORMULARIES: Trusts are asking GPs to adhere to strict drug formularies.
February 6, 2008... PCTs across the country are asking GPs to work to strict drug formularies as the push continues to control prescribing costs. Moves to limit the range of drugs GPs can use are revealed just weeks after a parliamentary report called for...

Boost for computer CVD screening.
February 6, 2008... A computer program that trawls GPs' lists can pick out patients who are more than 90% likely to be at high risk of cardiovascular disease. The software, which has been successfully validated in a new study, could form the first step of the...

GPs face chlamydia demands.
February 6, 2008... Ministers plan concerted pressure on practices to force screening uptake up to 70% By Lilian Anekwe GPs are to face increasing pressure to participate in the flagging National Chlamydia Screening Programme over the coming year with...

Suicidality reports with varenicline.
February 6, 2008... Smoking cessation drug varenicline has been associated with 36 reports of patients developing suicidal thoughts since its launch in the UK, according to a bulletin by drug regulators. A further 33 cases of depression have been reported,...

BMA brands mental health law `unethical'.
February 6, 2008... Criticism comes as Pulse survey shows widespread GP doubts By Nigel Praities and Lilian Anekwe The BMA launched a fierce attack this week on the Government's planned mental health legislation, as a Pulse survey revealed that GPs feel...

GPs doubt security of the care record.
February 6, 2008... Nine in 10 doctors believe patient records will be at risk if put on a national NHS database. A BMA poll of 219 doctors found 93% had no confidence in the Government's ability to safeguard patient data, and 90% did not feel able to assure...

Thousands petition against polyclinics.
February 6, 2008... More than 2,000 GPs, practice managers and patients have signed a petition opposing Government plans for polyclinics and extended opening hours. But Healthcare for London this week continued to lay the foundations for polyclinics,...

GP heart failure burden to rise.
February 6, 2008... New strategy document urges trusts to get complex heart failure patients out of hospital sooner By Nigel Praities GPs will be expected to take on an increasing number of potentially complex heart failure cases as the NHS steps up its...

Media Watch: This week's top...Miracle cure.(Brief article)
February 6, 2008... Passing electric currents through the brain may sound more like something from the pages of One Flew Over the Cuckoo's Nest than a way of retrieving forgotten memories, but The Independent claims the technique offers hope as a treatment for...

Media Watch: This week's top...Scare story.(Brief article)
February 6, 2008... Killer yoghurts are on the loose, according to the Telegraph and Daily Mail. Researchers at the University Medical Centre in Utrecht have admitted that 24 people have died during their study of whether probiotics affect inflammation of the...

Media Watch: This week's top...and most pointless research.(Brief article)
February 6, 2008... By using functional magnetic resonance imaging technologyto monitor the brains of 13 volunteers while they were scratched on the lower leg with a small brush, US scientists have revealed something any eczema sufferer could tell you. `This...

JournalWatch: Obesity surgery benefits.
February 6, 2008... Obesity surgery can lead to long-term remission of type 2 diabetes in almost four out of five cases, suggests US research. The study randomised 60 obese patients with diabetes to receive weight loss advice with a focus on lifestyle changes or...

JournalWatch: Five-day antibiotics backed.
February 6, 2008... A short, five-day course of antibiotics is as effective as longer courses for acute exacerbations of COPD and chronic bronchitis, say Dutch researchers. In their analysis of 21 studies, involving 10,698 patients, clinical cure rates were...

JournalWatch: Glitazones curb psoriasis.
February 6, 2008... Glitazones reduce the risk of developing psoriasis by almost 70%, suggests a study of data from the UK general practice research database. Swiss researchers compared information on 36,702 patients with a first- time diagnosis of psoriasis...

JournalWatch: Limits to anti-TNF drugs.
February 6, 2008... Anti-TNF drugs - effective in established rheumatoid arthritis - have no long-term impact on undifferentiated arthritis, a UK study reports. In the first placebo-controlled trial of anti-TNF therapy for undifferentiated arthritis, 17...

JournalWatch: Statin benefit a class effect.
February 6, 2008... The effectiveness of statins in older patients with heart failure is a class effect, with low doses of simvastatin as effective as more potent drugs like atorvastatin, say Canadian researchers. Researchers looked at prescribing in 15,368...

Matrons struggling on as few as 10 patients.
February 6, 2008... Doubts raised over ability of community matrons to relieve GP workload By Lilian Anekwe Community matrons are failing to hit caseload targets set by the Department of Health, with some struggling to manage caseloads of just 10...

GPs `interrogated' during QOF visits.
February 6, 2008... GPs are finding themselves under increasing pressure during QOF visits as the Government presses PCTs to scrutinise practices more closely. LMCs have raised concerns over what they claim is a heavy-handed and interrogative approach by...

Thiazides `best for BP' even with metabolic syndrome.
February 6, 2008... Thiazide diuretics are as good as calcium channel blockers, ACE inhibitors or alpha blockers even in hypertensive patients with the metabolic syndrome, whose risk of diabetes is particularly high, US researchers claim. The findings, from...

IN BRIEF: GP2GP gathers pace.
February 6, 2008... More than 3,000 GP practices have now gone live with GP2GP electronic records transfer, NHS Connecting for Health announced this week. The system - which enables patient details to be transferred between surgeries in minutes, rather than months...

IN BRIEF: Antibiotics caution.
February 6, 2008... GPs should not prescribe antibiotics to prevent serious complications in patients with upper respiratory tract infections, new guidance from the National Prescribing Centre advises. The centre's MeReC extra bulletin said that although...

IN BRIEF: Glitazones update.
February 6, 2008... Glitazones have kept their place as a second-line therapy in joint US and European guidance on type 2 diabetes, but with new warnings on their use. The American Diabetes Association and the European Association for the Study of Diabetes have...

IN BRIEF: Obesity drug milestone.
February 6, 2008... The number of prescriptions for obesity drugs in England has hit one million a year for the first time - according to figures released by the NHS Information Centre. In 2006, 1.06 million prescriptions were written for the treatment of obesity...

Gaps in colon Ca advice.
February 6, 2008... NICE guidance allows patients with anaemia to slip through net, researchers warn By Emma Wilkinson NICE is under renewed pressure to rewrite the rulebook on referral for colorectal cancer after publication of a study showing its...

Two-week pathway under fire.(Calendar)
February 6, 2008... * February 2007 - two studies show the rule is `overwhelming' hospitals with inappropriate referrals and failing to identify colorectal cancers effectively * March 2007 - study reveals `marked variability' in GPs' use of referral...

QOF fails to iron out CHD inequalities.
February 6, 2008... The GP contract has failed to iron out inequalities in heart disease care, despite a steep rise in the number of people on registers, researchers suggest. Prescribing for coronary heart disease increased by 17% after the introduction of...

Focus on...Drug switching incentives.
February 6, 2008... Payments for drug switching face a legal challenge - but in an era of tightening costs, are they a necessary evil? By Nigel Praities Fast forward to 2012. The London Olympics opens billions over-budget, Northern Rock makes its first...

Should GPs be offered financial incentives to switch patients?
February 6, 2008... YES Dr George Rae, a GP in Whitley Bay, Tyneside `There are times when cost-effectiveness will be to the overall benefit of all your patients. I am quite relaxed about incentives and as long as there is no coercion and there is no detriment...

Debate: Will polyclinics benefit patients?
February 6, 2008... Where GPs agree to work in polyclinics, they can provide a wide variety of services to patients, without losing the personal touch, argues Dr Charles Alessi YES The concept of the polyclinic has attracted mainly adverse publicity...

Letter: Let's think the unthinkable and resign from the NHS.(Letter to the editor)
February 6, 2008... Name and address supplied The Government tactic of offering a change of contract, which if not accepted would be replaced by the imposition of a more punitive one, is the beginning of a campaign to remove GPs from their present role within...

Letter: BMA does not want to lead NHS departure.(Letter to the editor)
February 6, 2008... From Dr Laurence Buckman Chair, BMA GPs committee I wish to correct your reporting of a slide-show presentation prepared by the GPC to assist speakers with forthcoming LMC meetings, which will discuss the Government's plans to extend...

Letter: I'm willing to fight for GPs by leading split from BMA.(Letter to the editor)
February 6, 2008... Name and address supplied Last Thursday I attended a meeting of local GPs regarding the extended hours blackmail threat and when the question `Who is prepared to take significant industrial action?' was asked, well over half the hands in...

Letter: GP poll must include option of action.(Letter to the editor)
February 6, 2008... From Dr Alistair Cameron Pudsey, West Yorkshire Last night I attended a meeting of Leeds doctors working in general practice called by the LMC. For the first time in my GP life I even wore a suit. At some subconscious level, I think I was...

Letter: Prescribing cost is hardly spiralling.(Letter to the editor)
February 6, 2008... From Dr Ric Naish Ealing, west London Why do you use the emotive word `spiralling' when describing the 60% increase in the cost of GP prescribing since 1996? (`GPs could be limited to strict drug formularies', pulsetoday.co.uk/news). ...

Letter: Mum's not the word on birthing choices.(Letter to the editor)
February 6, 2008... From Dr John Havard Saxmundham, Suffolk Health secretary Alan Johnson has just announced #112m per year for three years for the best possible care and to guarantee a full range of birthing choices. We have a dedicated group of...

Letter: Patients should be allowed to pay for top-ups.(Letter to the editor)
February 6, 2008... From Dr Paul Charlson Brough, Cumbria The Department of Health ruled two cancer patients are not able to pay for a private cancer drug, Avastin, on top of their NHS care. But as the doctors' group Doctors for Reform pointed out in a paper...

60-second interview: Dr Richard Halvorsen.
February 6, 2008... Dr Richard Halvorsen is a GP in Holborn, central London. He had been running the Brunswick Medical Centre in Camden, but recently lost out in the APMS tendering process to US giant UnitedHealth. * What made you want to bid for the Brunswick...

Editorial: Where's focus on patient care?(Editorial)
February 6, 2008... Cast your mind back to 2003 and the debate over the merits of the QOF - which, in the days before extended hours, was then the Government's pet health policy. Some saw the QOF as a bold and ambitious attempt to drive up GP performance, others a...

Why you have to vote No.
February 6, 2008... Phil is fuming over Government gunboat diplomacy and fearful for the future of general practice We stand at a crossroads. The future of British general practice lies in our hands. Shortly, the GPC will ask us to vote on what is laughingly...

PulseClinical: TRAVEL MEDICINE.
February 6, 2008... Travel medicine consultant Dr Ron Behrens answers questions from Dr Kathryn Griffith Take-home points * Adults may need the hepatitis A vaccine but children under 10 rarely develop hepatitis A. * DTP vaccine is safe during...

PulseClinical: ELDERLY PATIENTS WITH ITCH.
February 6, 2008... Dr Elizabeth Ogden offers some practical advice gained from her experience as both an associate specialist and a GP with a special interest in dermatology 1 Bear in mind the many different causes of itch. The causes of itch fall into six...

RECENT PAPERS ON ALLERGY.
February 6, 2008... Dr Sangeeta Dhami and Professor Aziz Sheikh review recent papers that could change the way you practise Does allergen avoidance in early life work? The paper Arshad SH, Bateman B, Sadeghnejad A et al. Prevention of allergic...

PulseClinical: EMERGENCY CONTRACEPTION.(Excerpt)
February 6, 2008... GPs Dr Chantal Simon, Dr Karen O'Reilly, Dr Robin Proctor and Dr John Buckmaster give a simple guide to prescribing History Ask the woman patient: * When her last menstrual period started and usual cycle length * When she had...

PulseClinical: IRON DEFICIENCY ANAEMIA IN INFANTS.
February 6, 2008... Dr Justine Dempsey gives a guide to infants' needs for iron and when GPs should suspect anaemia The WHO definition of iron deficiency anaemia is haemoglobin of less than 110g/l for children age one to two and less than 112g/l in children...

SNAPSHOT DIAGNOSIS: STUDENT WITH RASH.(Brief article)
February 6, 2008... The patient This 18-year-old student had returned home after his first term at university. He had been unwell for 24 hours with flu-type symptoms, fever and a slight sore throat. He had taken an over-the-counter remedy twice. His...

PulseWorkingLife: Why a partnership agreement is crucial.
February 6, 2008... Practice finance Partnership agreements are crucial but are often ignored or drawn up badly - in the fourth of his series on financial management, accountant Ian Tongue urges GPs to recognise just how important they are The partnership...

How to... Ensure good stock control.
February 6, 2008... GPs and their staff order, use, and dispense a wide variety of office, clinical and pharmaceutical items. Good stock control is vital to keep costs down, to ensure good patient care and to prevent mistakes or fraud taking place. Here are the...

EX-EMPLOYEE WANTS TO SUE THE PRACTICE.
February 6, 2008... Advice on a tricky problem from barristers Michael Salter and Chris Bryden THE SITUATION An ex-employee who claims the practice unfairly dismissed her is suing me in an employment tribunal. If she is successful, what sort of sum will...

PeopleWorkingLife: A FORENSIC MEDICAL EXAMINER.
February 6, 2008... Dr Sanjeev Gaya gives an insight into his work as a forensic medical examiner, or police surgeon as they used to be called Forensic medical examiners (FMEs), formerly called police surgeons, are a group of doctors working in the field of...

CareerTaster: nMRCGP examiner.
February 6, 2008... This week Dr Ruth Chapman finds out what it takes for a salaried doctor to become an examiner for the nMRCGP Why it's on my job menu I think it is fair to say that becoming an examiner for the general practice professional exam carries...

Should HRT be tailed off and how?
February 6, 2008... Q Patients often ask whether they should `tail off' their HRT. Is there any rationale for this? And if so, how long should they take? If hot flushes recur after stopping HRT, does this mean the menopause is continuing or is this just a...

Will X-ray detect osteoporosis?
February 6, 2008... Q How sensitive are plain X-rays in detecting osteopenia and/or osteoporosis? If a plain XR is normal, but the patient still has risk factors for osteoporosis, should one proceed to request a DEXA scan? A If osteopenia is noted on an X-ray,...

GPC surrenders unwinnable fight.
February 13, 2008... Decision to favour Government's contract offer sparks backlash among grassroots GPs By Steve Nowottny GP leaders are backing the Government's contract offer because they fear extended hours has become an `unwinnable' issue that could...

GP NEGOTIATORS ON WHAT PROMPTED CHANGE OF HEART.(General Practitioners)(Brief article)
February 13, 2008... Dr Laurence Buckman `They have softened the wording and made certain things that were very prescriptive less prescriptive. GPs will still have to make up their own minds and we are not going to tell people how to vote.' Dr Stewart...

GPs accused by MPs over painkillers.
February 13, 2008... MPs have accused GPs of getting patients `hooked on pain-killers'. Labour MP Dr Bill Iddon, chair of an inquiry by the All-Party Parliamentary Group on Drug Misuse, was quoted in The Observer as saying patients were increasingly becoming...

Independent centres get fresh backing.(Brief article)
February 13, 2008... The CBI has called on the Government to breathe new life into its controversial Independent Sector Treatment Centres (ISTCs) programme. It has accused GPs of deliberately blocking patients from visiting ISTCs by not giving them enough...

UnitedHealth beats Boots to APMS contract.
February 13, 2008... US health giant UnitedHealth has beaten a combined bid by Boots and local GPs to the latest APMS contract, after being announced as the preferred bidder for a practice in Derby. The private provider was chosen ahead of other private firms...

QRISK to replace Framingham as heart risk tool.
February 13, 2008... NICE is this week recommending that QRISK should replace Framingham as the new cardiovascular risk scoring system. Pulse revealed NICE had delayed its guidance on lipid modification therapy to assess the evidence for the UK-based QRISK...

Contract climbdown: BMA tells GPs to boycott hours audit.
February 13, 2008... Lawyers say GPs are not obliged to co-operate with PCTs as GPs digest the latest contract developments EXCLUSIVE By Steve Nowottny The BMA has urged GPs to boycott an audit of practice opening hours ordered by the Government. ...

Contract climbdown: Mixed views on GPC cave-in.
February 13, 2008... Dr Elizabeth Barrett Shirebrook, Derbyshire `I don't like to see the negotiation process dumped but the Government has done a good job of trashing us, and it was a hard PR battle to win. We probably got the best deal we could.' Dr John...

How to refuse your PCT opening hours audit - the BMA advice.(British Medical Association)(Primary Care Trust)(Brief article)
February 13, 2008... `We have considered your request for information in relation to our obligations of disclosure under our current contract. We do not feel the PCT is entitled to demand this information from us at this stage. First, the DES has not yet been...

Care record rollout jumps gun on evaluation.
February 13, 2008... Government IT chiefs have drawn up plans to roll out electronic patient records across the country without waiting for an evaluation into the early adopter programme, Pulse has learned. The BMA - which is awaiting the results of the...

Summary Care Record - the plan.
February 13, 2008... * Aim is for one PCT and one unscheduled care setting in every SHA to go live with the Summary Care Record by the end of summer 2008 * Planning for the next wave of PCT deployments is already under way * South West Essex will be the...

PCTs neglect legal duty to offer CCBT.
February 13, 2008... More than half of PCTs are still not providing computerised cognitive behavioural therapy, despite a legal obligation By Lilian Anekwe More than half of PCTs in England are still failing to provide computerised cognitive behavioural...

New practices must offer five extra hours.
February 13, 2008... The Government has told health chiefs that the 100 new practices it plans for under-doctored areas must offer a minimum of five hours' extended opening a week. The APMS practices, many of which are earmarked for the private sector, will...

Huge deficit in PAD care revealed.
February 13, 2008... A `huge deficit' in care for patients with peripheral arterial disease is revealed by a new study, hardening criticism over the Government's decision to veto QOF points for the disease. Researchers found the management of PAD in primary...

COPD drug swap `difficult' for GPs.
February 13, 2008... GPs to be forced into potentially costly COPD treatment switch for 190,000 patients as Combivent is phased out by Nigel Praities GPs are faced with making difficult switches of treatment in thousands of patients with COPD, after the...

What can I do with patients on Combivent?(Brief article)
February 13, 2008... * Use this as an opportunity to review treatment * If the patient is well controlled, switch to separate ipratropium and salbutamol inhalers, although there may be problems with adherence in older patients * If the patient has poor...

GPs are forced to treat dental cases.
February 13, 2008... More than three-quarters of GP practices are being forced to devote consultation time to patients' dental issues because of lack of access to dental services, according to a survey by the National Association of Primary Care. In a...

Risk of death in abrupt clopidogrel cessation.
February 13, 2008... Call for review of NICE guidance as study shows high risk of adverse event By Nigel Praities Patients who are abruptly taken off clopidogrel are being left vulnerable to risk of a myocardial infarction or death in the following 90...

Media Watch: This week's top... Miracle cure.(Brief article)
February 13, 2008... Beetroot juice has joined the likes of oats, spinach and blueberries as the latest `superfood' to be feted by the newspapers. Researchers from St Bartholomew's Hospital in London claim it could `maintain cardiovascular health' after their...

Media Watch: This week's top... Scare story.(Brief article)
February 13, 2008... Pregnancy is a stressful time for expectant mums and now there is even more reason for couples to try to make their pregnancy as zen-like as possible. Children born to women who suffer significant stress, including a death or serious...

Media Watch: This week's top... most pointless research.(Brief article)
February 13, 2008... Killer heels may be murder on the dancefloor but if you are a woman under 50, it's official - they do improve your sex life. An Italian study of 66 women found that by holding their feet at a 15 degrees angle, the equivalent to a two-inch...

GP knee care could make things worse.
February 13, 2008... GP care for knee pain does not currently have any benefits for long- term outcomes and could even make things worse, research suggests. A study of 1,500 older adults found 91% of people who consulted their GP still had knee pain after three...

MRSA is killing one in five.
February 13, 2008... Patients with community-acquired MRSA have stark fourfold increase in all-cause mortality By Lilian Anekwe As many as one in five patients who contract MRSA in the community are dead within a year, concludes new research outlining the...