Pulse articles from July 2003

Pulse archives from July 2003

MMR crisis hits GPs' pockets.(measles, mumps, rubella vaccine, general practitioners)
July 7, 2003... The MMR crisis is hitting GPs in the pocket, with a plunge in the number qualifying for vaccine target pay over the last year, new Government figures reveal. The first hard evidence that GPs are paying the financial penalty for parents'...

NHS Direct `kept me in the dark'.(UK National Health Service)(Brief Article)
July 7, 2003... Dr Joe Neary has criticised NHS Direct's policy on patient confidentiality after he was refused details of advice given to a patient taking a controlled drug. Dr Neary, head of the RCGP's clinical network, was visited by a patient with a...

Most `poor' GPs are men over 50.(general practitioners)(Brief Article)
July 7, 2003... Four in five GPs referred to the Government watchdog for poorly- performing doctors are over the age of 50, new figures reveal. And 80 per cent of cases sent to the National Clinical Assessment Authority relate to male GPs, writes Rob Finch....

GPs fear pay delay as PCOs face up to contract struggle.(general practitioners, primary care organizations)(Brief Article)
July 7, 2003... Grave doubts have emerged over primary care organisations' ability to implement the new contract on time after Government guidance gave them a near-impossible timetable. In a letter to PCOs last week, the Department of Health said it...

NICE tells GPs how to wash their hands.(National Institute for Clinical Excellence )(Brief Article)
July 7, 2003... The Government's latest guidance to GPs sets out step-by-step instructions on how to wash their hands. New advice from the National Institute for Clinical Excellence says GPs need to reserve enough time at the end of every seven-minute...

GPs stop advance bookings to achieve 48-hour access.(Brief Article)
July 7, 2003... GPs are refusing to let patients book appointments in advance because of intense Government pressure to hit the 48-hour access target. A leaked memo from the National Primary Care Development Team says at least three practices using the...

GP wins award for defibrillator campaign.(Brief Article)
July 7, 2003... Dr Peter Randall's determination to get defibrillators installed in all GP surgeries has won his PCT a Government award. Dr Randall led an initiative to improve coronary heart disease services after an audit of resuscitation facilities by...

More doctors become GPs in mid career.(Brief Article)
July 7, 2003... Doctors are increasingly switching mid-career to become GPs, the BMA's study of 1995 graduates has revealed. The cohort study found 30 per cent of the 545 doctors are GPs, but only one-third are full-time principals. Overall, doctors...

GP charged on morphine injection.(Brief Article)
July 7, 2003... A GP will appear before a crown court on manslaughter charges next week after he allegedly killed a patient with a morphine injection. Dr Narendra Sinha of Liverpool is alleged to have killed the elderly patient while working as a locum in...

GP sees gene test potential.(Brief Article)
July 7, 2003... Dr Rhydian Hapgood believes controversial Government plans to increase genetic testing will `open up new opportunities' for GPs. Dr Hapgood, a part-time GP in Nottingham, is conducting research into pharmacogenetics. `Genetics doesn't...

GPs set to drop smears in under-25s.
July 7, 2003... The national cervical cancer screening programme is set for an overhaul with GPs likely to be told to abandon smear tests for women under 25. Under the planned changes, GPs would have to offer screening every three years to women aged...

NHS Direct ignores its own GP policy.(Brief Article)
July 7, 2003... A Which? report has condemned NHS Direct for failing to follow its own policy of asking callers for GPs' details. GP details were requested in under half the 33 calls made to the helpline by Consumers Association researchers posing as...

Scots row over future of PMS.(Brief Article)
July 7, 2003... Dr Gavin Brydone has accused GPC Scotland of `cynically representing' a letter from the Scottish Executive to PMS GPs over the contract's future. The letter states the 100 PMS practices in Scotland will either become permanent or switch...

Government target for GP recruitment is in tatters.
July 7, 2003... The number of whole-time equivalent GPs in England rose by just 29 last year, leaving the Government's NHS Plan target to increase GP numbers by 2,000 by next year in shreds. Department of Health figures revealed growth in GP recruits was...

Compulsory MMR rejected by BMA.(measles-mumps-rubella vaccine)(Brief Article)
July 7, 2003... The BMA has rejected calls from some of its members for mandatory MMR vaccination but condemned the Government's `lamentable failure' to persuade parents the vaccine is safe. A policy of compulsory childhood vaccination would harm the...

Study backs CSM on HRT and heart disease.(hormone replacement therapy)
July 7, 2003... Government-funded research has confirmed that HRT does not cut women's heart disease risk. Only women who had used HRT for more than five years had a reduced risk of a cardiovascular event (odds ratio 0.42), according to the unpublished...

Ministers look at US model to cut GP work.(Brief Article)
July 7, 2003... The Government has commissioned research into whether US-style physician assistants can help ease the GP shortage. The study will examine a pilot scheme in the West Midlands where a physician assistant has been recruited from Chicago to...

BNF underestimates diabetics' CHD risk.(coronary heart disease)
July 7, 2003... Many diabetics at high risk of coronary heart disease are missing out on statins because the risk prediction charts in the BNF are inaccurate, research suggests. More than a quarter (28 per cent) of diabetics whose 10-year risk falls...

Immunotherapy call as hay fever surges.(Brief Article)
July 7, 2003... Allergy specialists are calling on the Government to bolster specialist services as GPs are swamped with consultations for hay fever. GPs have seven to 10 times more consultations for hay fever than asthma, and immunotherapy administered by...

GP in `bitch' case takes her trust to ombudsman.(general practitioners)(Brief Article)
July 7, 2003... A GP forced to attend an independent review panel after telling a patient not to call her practice nurse a `bitch' has taken her case to the Health Service Ombudsman. Dr Gerri McKeever condemned Medway PCT for making her appear before the...

GPs get one in five Read codes wrong.(Brief Article)
July 7, 2003... GPs are entering the wrong Read code in up to one in five consultations, RCGP research has revealed. A follow-up of 191 diagnoses of vaccine-preventable diseases found 35 had been coded incorrectly, according to the annual report of the...

Ministers aim to extend `no-fault' negligence scheme to cover GPs.(Brief Article)
July 7, 2003... Sweeping reforms of clinical negligence processes will be extended to cover GPs as soon as the Government's new `no-fault' compensation scheme has been piloted in hospitals. Chief Medical Officer Professor Sir Liam Donaldson said last week...

GP childcare scheme `a waste of money'.
July 7, 2003... A #6 million Government scheme to help GPs with childcare arrangements has had no impact since it was set up in February and has been a waste of money, GPs have claimed. The initiative has paid for 174 co-ordinators to help health...

BMA demands rise in GPs' global sum.(Brief Article)
July 7, 2003... The GPC has been ordered to negotiate an annual increase to the global sum to cover inflation and rises in staff costs. The BMA's annual representatives meeting agreed last week that the proposed increase of #1 per patient for 2005/6 was...

Ministers get autumn date for PMS answers.(Brief Article)
July 7, 2003... The BMA has set the Government a deadline of September to clarify the arrangements for PMS GPs who want to return to GMS. The association also called for the Department of Health to inform the GPC by the same date whether PMS practices put...

Income guarantee protects low-quality GP practices.(Brief Article)
July 7, 2003... One of the negotiators of the GMS contract has attacked the minimum practice income guarantee, claiming it `heavily diminishes' the original intention to shift resources to poorer practices. Dr Tony Snell, a member of the NHS Confederation...

Talking POINTS.(Interview)
July 7, 2003... Dr Pravin Shah, a PMS GP, practises in Stoke on Trent, Staffordshire. He has been a GP for 25 years. Jo Carlowe asked him about the hot topics in his practice. Enhanced services Do LMCs have the `teeth' to force PCOs to fund enhanced...

Letter: Let's counter-sue frivolous complainers.(Letter to the Editor)
July 7, 2003... When I was a newly-qualified houseman I asked the MDU why it was they never counter-sued over vexatious or libellous complaints. I was rather patronisingly told doctors did not want to be seen by the public to be suing their patients - that...

EDITORIAL COMMENT: Protect GPs from trivial complaints.(general practitioners)(Brief Article)
July 7, 2003... Last week a GP was hauled before an independent review panel hearing after she had reprimanded a patient for calling her practice nurse a `bitch'. The patient was allowed to pursue her complaint against the GP who was not even her doctor. ...

Letter: My years of stress over a complaint.(Letter to the Editor)
July 7, 2003... A young male patient under my care for depression died following an overdose of the tricyclic antidepressant I had prescribed. I had clearly recorded that he was not suicidal when I saw him. His friends and workmates had not noticed he was...

Letter: Students may need litigation classes.(Letter to the Editor)
July 7, 2003... Your June 30 issue took me through a rollercoaster of emotions, almost needing a counsellor to maintain my sanity. On the front page I saw Dr Gerri McKeever is to face an independent review panel for the silliest of complaints. Diabolical,...

Letter: Demoralised by all this browbeating.(Letter to the Editor)
July 7, 2003... While on weekend duty at our emergency service co-operative two years ago, one of our more feckless patients rang in for the umpteenth time with a trivial problem. I have known her since she was a baby, so after dealing with her `emergency' I...

Letter: How GPs can fight back over complaints.(general practitioners)(Letter to the Editor)
July 7, 2003... I think we have all experienced the mindless process of the complaints procedure. It is worth remembering that without a long-winded and bureaucratic process, the complaints staff would not have jobs, so it is not in their interests to consider...

Letter: Coping with contradictory advice from the experts.(Letter to the Editor)
July 7, 2003... Dr G O'Neill of Belfast was concerned about `conflicting cholesterol advice' (Letter, June 30). He highlighted the effect on workload, contradictory advice from experts, the cost of drugs, and patient compliance. Increasingly it seems GPs...

Letter: My nightmare over false complaint.(Letter to the Editor)
July 7, 2003... Three years ago three doctors formulated complaints against me involving supplying methadone to a child who died and fraud, among others. Despite being factually inaccurate, the complaint was accepted by the Fitness to Practise Directorate and...

Letter: `Freeloaders' achieve care at expense of resident patients.(Letter to the Editor)
July 7, 2003... One cannot help but be sympathetic to the dilemma facing Dr P Critchley of Camberwell, south London, when confronted by migrants demanding care and attention. Doctors do not enter the profession to become rich, otherwise they would opt to be...

Letter: When it's OK to check their passports.(Letter to the Editor)
July 7, 2003... I was astonished to read the letter from Dr P Critchley (June 23 ) headlined `Patients expect care - not to be interrogated'. There are those who might think that to adopt such a position is an unfair burden on the NHS. Some time ago I...

Letter: How to handle life medicals.(Letter to the Editor)
July 7, 2003... I refer to the item headlined `Fairer rate for life medicals' (March 10). Just to stir the `pot', GPs should note that most often: * A medical takes 15 minutes and not 30 minutes as stated. * An ECG can be reported as `within normal...

Letter: Death certificates myth exploded.(Letter to the Editor)
July 7, 2003... The problem with myths is that if they are repeated often enough people believe they are true. The article on dealing with your first death (Pulse Registrar, June 9) stated they `must be reported if the doctor has not seen the patient within...

You need to keep working to gain that pension boost.
July 7, 2003... Working on for three more years may be very valuable - Andy Blake explains GPs' pensions will be greatly improved under the new contract, but the way the calculations are done need to be understood if expensive mistakes are not to be made....

Where do I start on quality points?
July 7, 2003... Dr Rob Barnett recaps what the quality framework is all about, what money is involved and what issues practices must address as soon as possible For many years GPs have complained they have not been rewarded for providing a quality...

Practice Q&As: Should we take part in fly-on-the-wall TV documentary?
July 7, 2003... Q: We have been asked to take part in a televised documentary about primary care. This will involve observing some consultations in the planning stage and then filming daily life in the practice. Can you advise on the issue of data protection,...

Would you expose depressed patient's neglect of her child?
July 7, 2003... Case history You have often felt your patient Susan has had a raw deal in life. Her 12-year-old daughter Joanne is severely physically and intellectually disabled, cannot speak, is prone to fits and is becoming increasingly violent. Susan...

Moving practices the painless way.
July 7, 2003... Swapping urban sprawl for rural practice needs careful planning, says Dr Patrick Wills When I first met my wife, we talked of travelling the world. We would practise barefoot medicine in the sun, maybe on a tropical island. So after six...

Q&As: How do I check on practice accounts?(Brief Article)
July 7, 2003... Questions from GPs in the early stages of their career Q: I am considering joining a partnership. What are the pitfalls when examining a prospective practice's accounts? A: This is not a task to undertake without professional help. You...

Latest advice on diagnosing and managing fibromyalgia.
July 7, 2003... Easing patient fears of serious pathology is a first step to managing this controversial condition, writes Dr Selwyn Richards Tired all the time and `pain all over' are common complaints in primary care. Fibromyalgia is a common explanation...

Life-threatening cardiac problems I tried to ignore.
July 7, 2003... An infected pacemaker wire proved to be just the beginning of Dr Peter Tate's ordeal as a patient I was too fat at 17 stone, and was concerned about my nagging angina- like pain, previously but dubiously diagnosed as oesophagitis. I...

TEST YOURSELF ON: Guttate psoriasis and varicose veins.
July 7, 2003... Use our quick quiz to check your clinical knowledge Questions: Guttate psoriasis 1. Where does the word guttate come from? 2. It can be distinguished from psoriasis vulgaris by its location. True or false? 3. What usually...

Infrequent attender worried by swelling at side of face.
July 7, 2003... Case history 35-year-old Mrs Graham, who rarely attends surgery, presents to the registrar with a swelling at the side of her face. This appeared over the last few days. `It doesn't hurt,' she says, `but I was worried about what it might...

ANSWER BACK: Why the gap between live vaccines?(Brief Article)
July 7, 2003... Q: What is the rationale and evidence for the three-week gap between administering live viral vaccines? A: There are two reasons. First, a simultaneous challenge to the immune system may result in reduced immune response to both vaccines....

ANSWER BACK: Can thiomersal be linked to autism?(Brief Article)
July 7, 2003... Q: A patient recently came to see me bearing an article from the Daily Telegraph suggesting mercury in the DTP vaccine could be a trigger for autism. Could it? A: Concern over thiomersal in childhood vaccines relates to the fact that it...

GPs face a postcode pay lottery.
July 14, 2003... GPs face a postcode lottery for enhanced service pay rates, with some strategic health authorities planning to spend #1.5 million less than ministers demanded but others predicting a massive overspend. Wild variations in the spending...

GP suffers anti-Semitic attack at his surgery.(Brief Article)
July 14, 2003... Dr Nicholas Vites had to be rescued by patients when he was the victim of an anti-Semitic attack in his surgery reception. Dr Vites said a neo-Nazi who had left his list the year before returned to attack him after learning he was Jewish....

Ministers urged to launch MMR catch-up campaign.(measles, mumps, rubella vaccine)(Brief Article)
July 14, 2003... The Government's Health Protection Agency has urged ministers to consider an MMR catch-up campaign in children aged five to 15 because the continuing decline in vaccine uptake has put them at high risk of measles, writes Brian Kelly. Dr...

Government advisers warn MMR errors hit GP morale.(measles, mumps, rubella vaccines)
July 14, 2003... MMR vaccine uptake is more than 3 per cent higher than national figures suggest because of flaws in official reporting systems, Government scientists have revealed. Some areas under-report uptake rates by as much as 9 per cent, the Health...

GPs may get more quality pay upfront.(Brief Article)
July 14, 2003... GPs may see a higher proportion of their quality and outcomes money paid upfront after the NHS Confederation indicated it was prepared to be flexible over how payments are structured. GPC joint-deputy chair Dr Simon Fradd said he would be...

`Target high-flying GPs for performance assessment'.
July 14, 2003... A Government watchdog is aiming to persuade primary care organisations to step up scrutiny of more poorly performing GPs, suggesting one in 20 should be considered for referral. `High-flying' GPs who are difficult to manage should also be...

System to detect poor GPs not working.(Brief Article)
July 14, 2003... Dr Has Joshi, an adviser to the National Clinical Assessment Authority, says `a fair number of PCTs are in a bit of a pickle' about their procedures for detecting poorly performing GPs. Dr Joshi has already visited around half the PCTs in...

Lib Dems demand overhaul of GP vaccine target payments.(Brief Article)
July 14, 2003... GP vaccine target pay is unethical, unfair and undermines the doctor- patient relationship, the Liberal Democrats have claimed. In a heated Commons debate, Lib Dem health spokesman Dr Evan Harris rounded on the Government for its...

All three GPs in partnership battle are reported to GMC.(Brief Article)
July 14, 2003... All three GPs embroiled in a long-running partnership dispute that transformed their surgery into a `cauldron' of resentment have now been reported to the GMC. Two of the three GPs from the Belfast practice have been found guilty of...

GMC may scrap English language test.(Brief Article)
July 14, 2003... The GMC is considering abandoning English language tests for GPs who qualified outside the European Union but want to work in the UK. It has been forced to consider the move - one of a range of options - because of fears it could be accused...

IT alert aims to cut methotrexate errors.(Brief Article)
July 14, 2003... GP software will have a warning system as part of a Government drive to flag up the danger of methotrexate prescribing errors. The National Patient Safety Agency hopes to have the system running by the end of the year after its review of...

Legal fear eased over addict care.(Brief Article)
July 14, 2003... GPs will be able to provide sterilised equipment to hardcore drug misusers on the NHS as part of a Government drive to reduce infection. The Home Office has announced that from August 1 it will no longer be an offence for GPs, pharmacists...

Campaign launch on script charges.(Brief Article)
July 14, 2003... GPC chair Dr John Chisholm and RCGP chair Professor David Haslam are leading a campaign for an urgent review of NHS charges, including prescription fees. In a letter to The Independent, they said the system was `riddled with unfairness and...

Review `makes mockery' of zero tolerance.
July 14, 2003... A GP with an unblemished 40-year career has denounced the complaints process after he was told he would face an independent review panel for removing an abusive patient from his list. Dr Peter Ashby said he may quit as a result of the...

GP faces GMC over practice nurse error.(Brief Article)
July 14, 2003... A GP has been reported to the GMC after unsafe sterilisation of specula led to the recall of 500 patients for chlamydia and hepatitis B and C tests. An audit at Dr Ibrahim Derar's practice in Darwen, Lancashire, revealed a practice nurse...

Child BNF will give GPs legal protection.
July 14, 2003... The Government's Committee on Safety of Medicines is planning to produce a BNF for children in a bid to ensure GPs are prescribing appropriate drugs in safe doses. Medicolegal experts have welcomed the idea, saying such a guide would be...

Many do not benefit from aspirin post MI.(myocardial infarction)(Brief Article)
July 14, 2003... Aspirin is ineffective at reducing cardiovascular risk in over a quarter of heart attack patients, latest research suggests. The national service framework for coronary heart disease says identifying, advising and treating patients with a...

Complacency makes over-65s refuse flu jab.(Brief Article)
July 14, 2003... Tens of thousands of elderly patients are shunning the flu vaccine because they have become `complacent' about the low levels of flu activity over the last three years, according to official data, writes Brian Kelly. The Health Protection...

GPs will lack facilities to meet heart failure targets.(Brief Article)
July 14, 2003... GPs will struggle to meet Government demands on heart failure until at least next year because of problems accessing echocardiogram services, an NHS-funded researcher has warned. As revealed by Pulse in April, final guidance from the...

GPs quitting earlier to escape burnout.
July 14, 2003... The workload crisis is driving more GPs to retire early or quit the profession in their mid-40s, Government statistics have revealed. Figures published by the Department of Health showed a sharp increase in the number of GPs in England aged...

Report to look at GPs' career aims.(general practitioners)(Brief Article)
July 14, 2003... Dr Jane Harrison has been commissioned by the National Assembly for Wales to write a report on GP recruitment. The report builds on research by the National Association of Non-Principals in Wales, of which Dr Harrison is secretary, which...

National standards set for GP chest specialists.(general practitioners)(Brief Article)
July 14, 2003... Dr Kevin Gruffyd-Jones, who has been involved in drawing up a framework for GPs with a special interest in respiratory medicine, has promised they will be more than just `glorified clinical assistants'. Dr Gruffyd-Jones, a GP in Box,...

National plan for hep C may swamp GPs.(hepatitis C, general practitioners)
July 14, 2003... GPs have been warned of a `hidden epidemic' of hepatitis C that will result in patients swamping surgeries for tests and counselling. The Government's hepatitis C strategy, due out later this year, will urge GPs to conduct antibody testing...

Seroxat set for further scrutiny.(Brief Article)
July 14, 2003... The European Medicines Evaluation Agency has launched a review of Seroxat (paroxetine) following the safety alert in the UK. The Government's Medicines and Healthcare Products Regulatory Agency referred the antidepressant for Europe-wide...

Salbutamol eases COPD symptoms.(chronic obstructive pulmonary disease)(Brief Article)
July 14, 2003... Short-acting Beta2-agonists are effective and preferred by patients with chronic obstructive pulmonary disease, research shows. A meta-analysis by the Cochrane Collaboration showed patients with COPD could benefit from inhaled short-acting...

Rural GPs fear loss of out-of-hours opt-out.(general practitioners)(Brief Article)
July 14, 2003... GPs in rural areas are increasingly worried they will be stopped from opting out of out-of-hours because primary care organisations cannot afford to take over the service. PCOs will get #9,000 on average for each GP opting out, including...

TALKING POINTS.(Interview)
July 14, 2003... Dr Susan Bowie, a singlehanded PMS practitioner in rural Shetland, has been a GP for more than 20 years. Jo Carlowe asked her about the hot topics in her practice. MMR What is MMR uptake like in your area? It has fallen to a...

Letter: Why we deserve appreciation.(Letter to the Editor)
July 14, 2003... According to the Concise Oxford Dictionary, a complaint is an `utterance of grievance'. Apparently this only applies to patients within the NHS! Unfortunately, the blame and claim culture in our society is reflected in the NHS complaints...

EDITORIAL COMMENT: GPs must be protected from MMR distrust.(measles, mumps, rubella vaccine)(Brief Article)
July 14, 2003... It is imperative that something is done about the impact of the MMR crisis on GP income. The target payment system has put GPs in an impossible situation. The overwhelming majority of GPs genuinely believe in the safety of MMR. But public...

Letter: GMC was more interested in looking after its own interests.(General Medical Council)(Letter to the Editor)
July 14, 2003... When I was accused of serious professional misconduct I was aghast. The patient wrote disgusting letters about me to the GMC and I was to be struck off! Well, at least I felt the required regulatory body would have the experience to handle...

Letter: MP was my only support over complaint.(Letter to the Editor)
July 14, 2003... I was allocated a patient who was being passed from practice to practice. She was a litigious maniac, blocking most complaints systems with ongoing complaints against GPs, hospitals, consultants, psychiatrists, teachers, educationalist and...

Letter: Stop injecting known toxins into babies.(Letter to the Editor)
July 14, 2003... Dr Kassianos's reply to the question on whether the mercury (thiomersal) in childhood vaccines could be a trigger for autism epitomises the Department of Health's complacency over issues of vaccine safety. Mercury in all is forms is...

GPs' pension boost in 2006.(Correction Notice)
July 14, 2003... Last week's article `You need to keep working to gain that pension boost' said: `It is important to keep in mind that the full value on this increase will not be realised until March 31, 2003.' It should, of course, have read `March 31, 2006'....