Pulse articles from June 2004

Pulse archives from June 2004

Drive to curb emergency GP referrals.
June 7, 2004... Ministers are poised to pile the pressure on GPs over emergency referrals with a tough target to cut `inappropriate' hospital admissions for chronic diseases by 15 per cent. Department of Health officials will this week hammer out details...

Government interference led me to quit PCT post.
June 7, 2004... Dr Phillip Ambler says he quit his post as a PCT professional executive committee chair because its decisions were overridden by Government. Dr Ambler was chair of the committee at South West Oxfordshire PCT, the trust ordered by a...

Statins diabetes hope.
June 7, 2004... Prescribing bills are set to soar after a landmark trial showed `highly significant' benefits for statins in diabetic patients with normal cholesterol levels. The collaborative atorvastatin diabetes study has been stopped two years early...

More scrutiny of appraisals as revalidation is tightened.
June 7, 2004... GPs will have their appraisal evidence scrutinised by a panel of doctors and lay people to test whether it is suitable for revalidation under further plans to tighten the process. If the panel finds gaps in the appraisal file, GPs will be...

Spanish GP registrars prefer UK.
June 7, 2004... Dr Jordi Sabate has helped set up a scheme that gives Spanish GP registrars the chance to join their countrymen in the UK during training. So far 15 registrars have spent between one and two months in County Durham and Tees Valley, where...

Praise for GPs who made a difference.
June 7, 2004... Nine GPs have been singled out by the BMA and the Prime Minister for introducing innovative schemes to improve care, reduce waiting times and target hard-to-reach groups. The BMA's `A to Z of doctors making a difference', endorsed by Tony...

GPs demand Euro court challenge on `restraint of trade'.
June 7, 2004... GPs are calling on the GPC to launch a European Court challenge to overturn a clause in the contract that stops them charging their patients for non-NHS work. The demand comes in a series of motions to the annual LMCs conference arguing...

Man banned from every surgery.
June 7, 2004... A man has been barred from entering every GP surgery in England and Wales after NHS security services applied the first-ever antisocial behaviour order against a patient. The order prevents 53-year-old Norman Hutchins from attending...

Contract comes under fire.
June 7, 2004... GPs will deliver an attack on almost every aspect of the new contract at this month's annual LMCs conference. Debate is dominated by motions criticising lack of enhanced services funding, global sum allocations, premises cash and seniority....

Fears raised by surge in antibiotic scripts.
June 7, 2004... A new surge in antibiotic prescriptions has sparked fears that the impact of high-profile warnings about resistance is fading. Figures released by the Prescription Pricing Authority last week showed antibiotic prescriptions rose by half a...

Warning on legal threats.
June 7, 2004... Inadequate investigations, poor communication and misfiled reports are among the lapses leaving GPs open to legal action, the Medical Defence Union warns. And latest MDU data shows delayed diagnosis is the focus of half of all claims against...

Pioneering GP fights inequality.
June 7, 2004... Professor Peter Campion's pioneering practice has been hailed by the Department of Health for its drive to tackle health inequalities. The Quays practice was set up three years ago to tackle Hull's growing populations of asylum seekers and...

`Flawed evidence backs US-style care'.
June 7, 2004... Ministers are using `flawed' evidence to support their crusade to bring American health care systems to the NHS, academics claim. The attack came in a study that criticises research cited by the Department of Health as evidence for using US...

Warning over lure of `policy tourism'.
June 7, 2004... The Government risks falling for the lure of `policy tourism' by buying in health care initiatives without properly considering whether they can work in the UK, according to a leading academic. Professor Trevor Sheldon, professor of health...

DoH brushes the worries aside.
June 7, 2004... Despite serious concerns over evidence, the Government is pressing ahead with its nationwide rollout of active case management. Gary Belfield, the Department of Health's head of primary care, insisted the time for talking and analysing was...

BP self-monitoring helps GPs to cut workload and hit pay targets.
June 7, 2004... The British Cardiac Society conference heard research on hypertension and heart failure - by Rob Finch A novel blood pressure monitoring scheme could help to cut GP workload and boost pay, according to new research. The scheme, in...

GPs `undertreat heart failure'.
June 7, 2004... GPs are undertreating patients with heart failure, new research suggests. A study conducted by researchers from the University of Nottingham found patients were less likely to receive the drugs needed to treat heart failure from their GP...

Conference round-up: NSF advice on CHD falls short.
June 7, 2004... Current national service framework advice for CHD is falling short of the potential for preventing major cardiac events. In an evaluation of the risk treatment thresholds, researchers with the British Regional Heart Study found the current...

Conference round-up: Angina strongly predicts CVD.
June 7, 2004... Positive Rose angina scores are highly predictive of cardiovascular events and death, according to a large UK study. Researchers at the University of Glasgow screened 15,406 people aged 45- 64 and followed up 1,468 found to have angina over...

Conference round-up: Heart failure screening hope.
June 7, 2004... The N-BNP test, used to rule out left ventricular systolic dysfunction (LVSD), has been criticised for its poor positive predictive value in the past, but researchers at the University of Leicester have devised a way to make the test more...

Journal watch: GPs' beliefs hamper CFS management.
June 7, 2004... GPs' beliefs about chronic fatigue syndrome (CFS) are putting up barriers to effective management, researchers suggest. A study of 135 GPs found many did not refer patients with symptoms of CFS because they believed mental health...

Journal watch: Exercise programmes prevent bone loss.
June 7, 2004... Exercise programmes with an emphasis on bone strength can significantly reduce bone loss and back pain in early postmenopausal women with osteopaenia, German researchers have found. In a trial of 50 participants, the exercise arm took part...

Journal watch: Heart risk lower with celecoxib in elderly.
June 7, 2004... Older people's increased risk of congestive heart failure with the Cox- 2 inhibitor celecoxib is smaller than with other NSAIDs, according to a major Canadian study. The study looked at the use of NSAIDs in more than 130,000 people over the age...

GP condemns waste on `overpriced' generics.
June 7, 2004... Dr John Ashcroft believes the NHS is wasting millions on overpriced generic simvastatin, while details of the delayed pharmacists' contract are thrashed out. He claims the money could have been spent on saving lives by treating patients at...

GPs struggling with diabetes BP targets.
June 7, 2004... BP and CVD risk were spotlighted at the American Diabetes Association conference - Cato Pedder reports GPs are failing to use optimum doses of hypertension drugs and struggling to reach blood pressure targets in patients with type 2...

Framingham underestimates the risk of CHD in diabetics.
June 7, 2004... The established method of assessing cardiovascular risk in people with type 2 diabetes is seriously underestimating both risk and costs to the NHS, two new studies suggest. UK research presented to the conference found the Framingham method...

Inhaled insulin effective long-term.
June 7, 2004... Inhaled insulin maintains glycaemic control and pulmonary function in patients with diabetes even over four years of continuous therapy, according to new research. A University of Miami study found the rate of overall hypoglycaemia...

Journal watch: Fibre reduces cholesterol levels.
June 7, 2004... A moderate increase in soluble fibre in the diet can significantly reduce both LDL-cholesterol and glucose levels in healthy people, a new study concludes. The Spanish study randomised 53 participants to a control diet or a diet enriched...

Journal watch: Echinacea ineffective in URTIs.
June 7, 2004... The herbal remedy echinacea purpua is ineffective for treating upper respiratory tract infections in children, according to a new US study. The trial of 66 children aged two to 11 found that both duration and severity of infection were the...

Journal watch: Further doubts on PSA as screening tool.
June 7, 2004... Further doubts have been cast on the validity of the PSA test as a screening tool by a US trial of 18,882 older men. The trial found that in men with no abnormal digital rectal examination and a `normal' PSA of less than 4.0ng/ml, 15.2 per...

`Royal colleges should take revalidation from the GMC'.
June 7, 2004... Medical royal colleges should decide whether doctors are revalidated, not the GMC, a former president of the council has told the Shipman Inquiry. Sir Donald Irvine attacked the use of GP appraisal backed by clinical governance reviews as...

Row erupts over #500 deduction from GP pay.
June 7, 2004... GPC negotiators are warning GPs to add a caveat to agreements over their final income for this year because of a Government move that could knock #500 from their pay. The advice came after negotiators became embroiled in a row with the...

Complaint system put on hold.
June 7, 2004... The Government has delayed implementation of controversial changes to the NHS complaints system after a request from the Shipman Inquiry. The inquiry asked for the delay to allow its report on the issue later this summer to be considered....

Trust finds it has `spare' #270,000.
June 7, 2004... A primary care trust has found #270,000 for enhanced services after carrying out an audit of `redundant budgets'. The cash, found by Southend on Sea PCT, would have been spent under the Red Book but effectively becomes redundant under the...

Catto rejects GMC `cosy club' image.
June 7, 2004... GMC president Sir Graeme Catto has defended the council against accusations that it is still a `cosy club' for doctors. In a debate with the Consumers Association, Sir Graeme was accused of heading a body that is failing to protect the...

`GPs' morale hit by patient choice drive'.
June 7, 2004... Ministers are guilty of `empty moral abstraction' by pushing for patients to be more involved in GPs' decisions about their care, Government-funded research concludes. The qualitative study found GP morale was undermined by the Department...

Loss of confidence in HRT sees scripts plummet by a million.
June 7, 2004... Shattered confidence in hormone replacement therapy has seen the number of prescriptions fall by a million, according to new figures. The Prescription Pricing Authority found just 6.4 million HRT prescriptions were written in 2003, down...

`Struggling' GPs demand enhanced service for Ritalin.
June 7, 2004... GPs are calling for the prescription of methylphenidate (Ritalin) to follow other shared-care drugs like warfarin in becoming an enhanced service, following evidence of increasing confusion over the split of responsibilities. Continuing to...

Chlamydia testing varies with GPs' patchy knowledge.
June 7, 2004... Patchy knowledge of chlamydia and its image as an urban problem are leading to dramatic variations in the frequency of testing across different practices, a Health Protection Agency study has revealed. Levels of knowledge about the...

`Promote abstinence to misusers'.
June 7, 2004... Abstinence from drugs and alcohol should be back on the agenda for misusers, according to Dr Gordon Morse, RCGP regional lead in substance misuse. He told a recent RCGP sex, drugs and HIV task group conference that abstinence programmes...

Government study backs GPs' criticism of NHS 24's IT failings.
June 7, 2004... A Government-commissioned evaluation of NHS 24 has backed GP criticisms that the nurse helpline is plagued by IT problems and is failing to integrate with existing out-of-hours services. The report commissioned by the Scottish Executive...

Urban GPs are short-changed on out-of-hours.
June 7, 2004... GPs in urban areas are warning out-of-hours care could suffer after they were given a smaller share of #28 million Government funding for new services. One GP co-operative said the allocation for its region amounted to just 18p per patient...

Primecare seeks seat on PCT committees.
June 7, 2004... Primecare has written to four primary care trusts to request a place on their professional executive committee. The move comes ahead of a decision by the trusts in Essex over contracts to provide out-of-hours services. Primecare is the...

`Substandard housing costs extra #10m in visits to GPs'.
June 7, 2004... Using substandard temporary accommodation to house homeless people costs #10 million a year in extra visits to GPs because of increased health problems, a report by the charity Shelter claims. The `Living in Limbo' report found more than...

GPs face new spotchecks on their controlled drugs.
June 7, 2004... More practices will be subject to random checks on how they manage controlled drugs under guidelines aimed at tightening inspection of GPs. The guidance from the National Prescribing Centre also calls for more `routine and co-ordinated'...

COMMENT: Upcoming Q&O review visits must not be confrontational.
June 7, 2004... Surprisingly, the new contract's introduction has caused little friction between primary care organisation managers and most GPs. They have had a common enemy in the Department of Health with its shifting deadlines, changing budget formulae and...

Letter: Anyone else lost heart with the new contract?(Letter to the Editor)
June 7, 2004... Am I the only one feeling very disillusioned with the new contract? I assumed that if we signed the contract it was fixed and binding, but obviously that premise is wrong. Sutton and Merton PCT wishes to change IUCD fittings from a...

Letter: Reason for resignations at LMC.(Letter to the Editor)
June 7, 2004... Regarding the article about Sunderland LMC (News, May 17), I would like to clarify that members of the LMC did not resign because the committee did not support Dr Ford and Dr Glass. They actually resigned during May and June 2003 on an...

Letter: Sorting out errors with Read codes.(Letter to the Editor)
June 7, 2004... There are a number of errors in the preferred Read codes aide-memoire (May 10) which do not comply with those listed in the latest version of the Department of Health's Logical Query Specification, February 2004. * In the `testing'...

Letter: Don't get into dispute about partner pulling their weight.(Letter to the Editor)
June 7, 2004... I wonder if those obsessed by the imminence of major partnership disputes as a result of the pressures of nGMS (News, May 24) have lost sight of the principles underlying partnerships. A partnership exists so its members may benefit from...

Minimise risk of medical lawsuits.
June 7, 2004... GPs need to be more aware than ever of the risk of missing or delaying a diagnosis, says Dr Mayur Lakhani With the new contract and other reforms bringing in additional providers and multi-points of access to primary care, GPs are becoming...

The MDU advice.
June 7, 2004... Helen Goodwin, clinical risk manager at the MDU, advises that if you face litigation for missed diagnosis it is possible to mount a successful defence provided the clinical management can be shown to be competent and reasonable, as judged by a...

Manager threatens shock resignation.
June 7, 2004... Case history Your three-partner practice appointed a manager two years ago. She settled in well, the staff like her and the partners feel she is effective. Profits are adequate, if not stunning. During her appraisal she blurts out that...

Q&As: Will we continue to be paid for seeing non-registered patients?
June 7, 2004... Q: Under the old contract we have over the years provided contraceptive services to some patients who are not registered with us and we have been paid by the PCO for doing so. Some practices have also provided maternity services and child...

The global sum - how to check that it is right.
June 7, 2004... The first batch of payments under new GMS have shown inconsistencies and miscalculations of the global sum, says accountant Richard Vickery During February and March this year my company checked many practices' global sum equivalents...

CASE HISTORY: DR CORNEL FLEMING.
June 7, 2004... A little while ago I received an impressive looking spreadsheet which I was told in a covering letter would give me a breakdown of my prospective earnings. Everything looked fine until I started checking the figures carefully. The spreadsheet...

Get ready to be a pension millionaire.
June 7, 2004... With many GPs bound to be nearing the maximum #1.5 million pension pot in 2006, Dr John Couch shows what you should do if you want to increase your retirement funds When Gordon Brown's pension cap comes in to force in April 2006 many GPs...

A patient-centred approach to osteoarthritis care.
June 7, 2004... Health Secretary John Reid announced in April that he wants to see patient-centred integrated care for arthritis sufferers - Dr Steve Longworth looks at what GPs can do KEY POINTS * OA is common and causes a lot of pain and disability...

PRACTICAL OPHTHALMOLOGY FOR GPS: Eyes that go `ouch' in the night.
June 7, 2004... In the last of his series on common eye problems, Dr Scott Fraser looks at conditions that result in loss of epithelium during the night There are three eye conditions that are little known outside ophthalmology which can result in patients...

The latest evidence on COCs and POPs.
June 7, 2004... In the first of a two-part series, Professor John Guillebaud details the latest advice on prescribing oral contraceptives Combined oral contraceptives (COCs) Current scientific evidence suggests only two prerequisites for the safe...

CLINICAL CASEBOOK: Fever in a returning traveller.
June 7, 2004... Case history P.F. is a 38-year-old who returned from a visit to her relatives in India four weeks ago. Soon after her return she was admitted to hospital by a partner at the practice with a febrile illness, in view of the risk of malaria,...

How to sail through the MRCGP orals without stress.
June 7, 2004... MRCGP orals are looming, to test your decision-making skills and professional values. In two 20-minute exams you will be asked to talk about five topics, spending about four minutes on each. Pulse has spoken to GP tutors and registrars who...

ANSWER BACK: First trimester screening accuracy.
June 7, 2004... Q: What is the sensitivity of the first trimester antenatal screening test? At what range of gestation can it be done? A: First trimester screening has moved forward hugely in recent years. It is now usual to assess the risks of conditions...

ANSWER BACK: Measuring zinc and magnesium levels.
June 7, 2004... Q: Alternative therapists often tell patients to ask their GPs for zinc and/or magnesium levels to be measured. Why? A: Mineral analyses are usually requested by therapists for clients with chronic fatigue, irritable bowel, osteoporosis,...

Plan raises spectre of GP fundholding.
June 14, 2004... GPs are demanding safeguards to ensure Government plans for practices to be offered financial incentives to commission care will not signal a return to fundholding. The warning comes after sources close to the Department of Health revealed...

GPs set up bonus schemes for staff.(general practitioner)(Brief Article)
June 14, 2004... GPs are setting up performance-related bonus schemes for staff to reward their work in achieving quality points but also keep a lid on pay rises. Medical accountants said practices were making the move because they could not afford big...

Despairing GP pioneers own cognitive clinics.(general practitioner Steven Harris )(Brief Article)
June 14, 2004... Dr Steven Harris believes he is one of the first GPs in the country to set up a cognitive behaviour therapy clinic in his practice, after despairing at the lack of NHS provision for the treatment. Dr Harris, who is studying for an MA in...

GP turning tide on energy.(general practitioner Stuart Anderson's campaign for tidal energy scheme)(Brief Article)
June 14, 2004... Dr Stuart Anderson is leading a campaign for a tidal energy scheme to be built near his practice in Kinmel Bay, north Wales. He said the scheme would benefit the struggling local economy as well as help the environment. `Wind power is...

Complaints caseload is set to surge.(Brief Article)
June 14, 2004... Changes to the NHS complaints system starting next month will lead to a 40 per cent rise in cases going to independent review, according to the body taking over the process. Minutes released by the Healthcare Commission reveal it is `geared...

Workload fears as drug ad ban ends.(Brief Article)
June 14, 2004... Restrictions on advertising medicines sold over the counter in pharmacies are to be swept away, the Government's drug watchdog has announced. The shock move means pharmaceutical companies will be able to market simvastatin and other...

PCTs curb pay rumours.(primary care trusts)(Brief Article)
June 14, 2004... PCTs in Avon have moved to calm GPs' fears that they will be asked to forgo part of their quality achievement pay next year to help pay off the trusts' massive debts. Avon LMC reported in its June newsletter that GPs feared they would be...

Confusion over statins for diabetes.
June 14, 2004... The Department of Health is refusing to issue new advice on prescribing statins to diabetes patients until an economic analysis is completed, plunging GPs into fresh confusion over statin prescribing. Experts are united in calling for...

Politicians know better than GPs? We think not.(general practitioner)(Brief Article)
June 14, 2004... Dr Richard Frood and four GP colleagues have hit back at their neighbour, Dr David Colin-Thome, over his comments that politicians know better than clinicians what patients want. The GPs in Runcorn, Cheshire, accused the primary care tsar...

Practice `barcodes' in new vaccine tracking initiative.(Brief Article)
June 14, 2004... The Department of Health is launching a major new `vaccine-tracking' initiative which could put barcode scanners and new IT software in every practice in the country. The high-tech proposals aim to link vaccine barcodes with birth and...

Framework prevents CVD events.
June 14, 2004... Two new studies predict sweeping benefits to public health from the quality and outcomes framework, with just five indicators alone capable of preventing thousands of CVD events each year. Ten CVD events could be prevented each year in a...

New safety alert over rosuvastatin.(Brief Article)
June 14, 2004... Concern is growing over the safety of lipid-lowering drug rosuvastatin (Crestor) after manufacturer AstraZeneca issuing its second warning to GPs in less than a month. In a letter to all practices, it cautioned that the maximum 40mg dose...

BP home monitoring `is best'.
June 14, 2004... Patients on the 40mg dose who have not seen a specialist should have the dose decreas-ed at their next appointment or get a specialist referral. Patients with hypertension can control their blood pressure best by monitoring it at home, a...

Government target for GP e-booking `bound to slip'.(general practitioner)(Brief Article)
June 14, 2004... The Government is almost certain to miss its target for GPs to make all hospital referrals electronically by the end of next year, Pulse has learned. A GP close to the #6 billion National Programme for NHS IT said the high-profile target...

London nearly 300 GPs short of quota.(general practioner)(Brief Article)
June 14, 2004... London is 294 full-time GPs short of its quota of doctors, a survey has revealed. The study of primary care trust vacancy rates by the London Evening Standard found an average of 7 per cent of posts were unfilled. Hounslow PCT had the...

GPC concerned over LMC election process.(General Physicians Council, local medical center)(Brief Article)
June 14, 2004... The GPC has expressed concerns over the way Sunderland LMC conducted its election process earlier this year. GPC chair Dr John Chis-holm has written to the LMC after a group of 13 GPs complained the ballot had been `manifestly unfair'...

GP time pressures threaten expert patients programme.
June 14, 2004... The Government's expert patient scheme will flounder unless funding is provided to relieve the time pressures on GPs, researchers conclude. GPs lack the time to listen to the views of patient advocates and cash is urgently needed for...

GPs reassured over treatment of hip arthritis.
June 14, 2004... Standard practice in the treatment of arthritis of the hip has received the backing of new Europe-wide guidelines. GPs should use opioids if NSAID therapy fails to control symptoms, the European League Against Rheumatism has advised. ...

Surge in depression sees antidepressant scripts soar.
June 14, 2004... The number of antidepressant prescriptions written each year has doubled since the mid-1990s as GPs face a surge in depressive illnesses, new Government figures show. According to the Prescription Pricing Authority there were 27.7 million...

GPs in dispute as cash for new staff is cut off.(General practitioners)
June 14, 2004... GPs in Northern Ireland stand to lose thousands of pounds after all four local health boards refused to continue paying for new staff. The health boards have told GPs they cannot afford to reimburse them for clerical staff and nurses taken...