Pulse articles from March 2004

Pulse archives from March 2004

GMC faces new crisis.
March 1, 2004... Exclusive By Ian Cameron The Shipman Inquiry's final report could end self-regulation for doctors. A leaked letter obtained by Pulse which indicates the inquiry's potential conclusions delivers a damning indictment of the GMC's...

Q&O set for last-gasp change.
March 1, 2004... The Department of Health is considering 11th-hour changes to GP quality and outcomes indicators for chronic obstructive pulmonary disease following a report from the National Institute for Clinical Excellence. The changes - which would...

GPC defends GPs over absenteeism attack.
March 1, 2004... The GPC has rebutted criticism of GPs in a new report that blames the profession for its part in the growing problem of long-term employee absenteeism. The report from the Engineering Employers Federation (EEF) said GPs manage two-thirds...

Market days boost GPs' quality pay.
March 1, 2004... Dr Philip Cox and Dr Peter Williams say they are helping Derbyshire GPs earn more quality pay by running a nurse-led clinic for the county's farmers. The drop-in clinic at the livestock market in Bakewell allows farmers to see a nurse to...

`Practice profits set to rise 20% in next financial year'.
March 1, 2004... GPs' practice profits will rise by up to 20 per cent in the next financial year, medical accountants predict. The early calculations are a boost to GPs who had feared - after getting their indicative budgets for next year - that their...

GPs warned to budget for new pension rates.
March 1, 2004... Medical accountants are warning GPs they could face cash-flow problems next year if they over-estimate profits by failing to account for changes to pension contributions. Employers' contributions for GPs' pensions will be included in...

Wanless backs compulsory data mining of GP records.
March 1, 2004... GPs will be ordered to take part in a massive primary care `experiment' that will mine confidential patient records for data on health inequalities, if radical Treasury recommendations are accepted by the Government. The initiative -...

Violent patients' GPs go mobile.
March 1, 2004... Dr John Jenkins and Dr Miland Tadpatrakar will work in the first mobile surgery for treating violent patients, which was unveiled last week. The specially-adapted van will cover eight PCTs in Nottinghamshire. Patients removed from a GP's...

GPs back new database plan for vaccines.
March 1, 2004... GPs - and an influential backbench MP - are backing pioneering plans for an independent database on vaccine safety in the wake of the latest controversy over MMR. The international vaccine safety library would collate data from clinical...

GPs could quit LMCs over contract work.
March 1, 2004... GPs working for LMCs are considering quitting their posts because of excessive workload brought on by the new contract. LMC secretaries said they were having to cut back on sessions at their practice so they could read contract documents,...

Consultations longer in GP practices with nurse triage.
March 1, 2004... Running a nurse triage system to divert patients with minor illness away from GPs leads to a significant increase in consultation lengths, research finds. The study into the use of nurses to handle lesser cases found patients who...

GP's computer still snarled in red tape.
March 1, 2004... Dr Ravinder Sahota's practice still has not received its first computer system because NHS red tape has delayed the order for more than a year. He now has less than a month to install the system before the new contract starts. The practice...

Default deal not an option for most GPs.
March 1, 2004... GP negotiators reiterated their warning to GPs not to use the default contract as an alternative option to the new GMS deal after it was finally published last week. GPC joint-deputy chair Dr Hamish Meldrum stressed the default contract...

Primecare to withdraw from another city.
March 1, 2004... Primecare is to withdraw its service from GPs in Plymouth after a co- operative was chosen as a single provider of out-of-hours services. The deputising service said it would quit its contracts with 48 GPs from May 1 because the decision by...

Drug company's `radical' care scheme sparks GP controversy.
March 1, 2004... A drug company has sparked controversy over a scheme to help manage patients with heart disease and diabetes by funding a dedicated management team in a PCT to `re-inforce' GP prescribing. The pilot scheme will allow GPs to refer patients...

Test can distinguish viral from bacterial infections.
March 1, 2004... A blood test that can distinguish whether a suspected lower respiratory tract infection is caused by bacteria or a virus may help GPs prescribe antibiotics to those who really need them. Researchers in Switzerland have developed a sensitive...

Fewer children have acute asthma.
March 1, 2004... Acute asthma episodes in children are at their lowest since the mid- 1980s, according to new RCGP statistics. Data from the college's weekly returns service - based on a practice population of around 600,000 - showed acute episodes rose...

Postcode lottery fear on scaled down GP enhanced services.
March 1, 2004... LMCs are warning a postcode lottery will develop if GPs bow to primary care organisation pressure to agree scaled-down national enhanced services paying less money. PCOs in some areas are looking to strike deals for GPs to provide services...

Dementia risk prompts targeted screening call.
March 1, 2004... Diabetes experts have reiterated calls for targeted diabetes screening in the wake of a major study showing women with diabetes are at a higher risk of mental decline than those without the condition. The US authors of the prospective...

Weight clue to diabetes.
March 1, 2004... Monitoring weight gain in childhood and intervening to prevent obesity could halt the boom in cases of diabetes, a major new study suggests. Researchers from the University of Southampton and colleagues in India evaluated glucose tolerance...

GPs could face 3m diabetics by 2010.
March 1, 2004... GPs could be treating three million diabetics by 2010, according to a new report for GPs from the BMA's board of science. The disease currently affects 1.3 million patients in the UK, accounting for at least 5 per cent of NHS costs. ...

GP prescribing curbs lifted by NICE U-turn on osteoporosis.
March 1, 2004... Stringent limits on the drugs GPs can use to prevent and treat osteoporosis may be relaxed after the National Institute for Clinical Excellence bowed to pressure to re-evaluate its draft appraisal of the condition. NICE recommended curbs...

Guidance clarifies GPs' referral options over dyspepsia.
March 1, 2004... The National Institute for Clinical Excellence has told GPs to cut urgent endoscopy referrals for dyspepsia patients. The second draft of NICE's primary care dyspepsia guidelines, released last week, said patients under the age of 55...

Shipman Inquiry criticisms that could sink GMC.
March 1, 2004... The Shipman Inquiry is set to find serious fault with the GMC's past performance and future arrangements - we reveal the potential criticisms that could end self-regulation The Shipman Inquiry has identified 17 areas where it may wish to...

GPC `deplores' NHS managers' behaviour.
March 1, 2004... The GPC has stoked the row between GPs and NHS managers by passing a motion `deploring' the way the contract is being in implemented in some areas. The move comes after GPs accused primary care organisations of gloating at meetings that...

GP computing firm back on IT bandwagon.
March 1, 2004... GP software supplier EMIS has reopened negotiations over linking up with the Government's #5 billion national NHS IT programme. The company, which supplies well over half of GP practices, had pulled out of talks with the five local service...

GPs agree to train for child protection.
March 1, 2004... A group of GPs has agreed to attend training on child protection issues and passing information to social workers after an 11-week-old baby was killed by its father. Alexander Ness, who suffers from brain damage, was convicted of culpable...

GMC cuts costs for refugee doctors.
March 1, 2004... The GMC has cut the cost for refugee doctors to join the medical register by #200. The move brings the total cost of joining the register for a refugee doctor to #865. The cost of the Professional Linguistic Assessment Board part 2...

Journal watch: Aspirin-induced asthma wider spread.
March 1, 2004... Aspirin-induced asthma in adults is much more prevalent than previously suggested, according to a joint British and Australian review reassessing existing evidence which found it was present in 21 per cent of adults and 5 per cent of children....

Journal watch: Home monitoring cuts `white coat' effect.
March 1, 2004... Researchers from Belgium have found adjustment of hypertensive treatments based on home blood pressure measurements can avoid the `white coat' effect. They said patients could be on less-intensive and therefore less-costly treatment based...

Journal watch: Chickenpox vaccine efficacy falls quickly.
March 1, 2004... The effectiveness of the varicella zoster vaccine declines significantly after the first year post-vaccination, according to an investigation in the US. A study looked at 339 children over 13 months old who had been diagnosed with...

Take GP job satisfaction into account in costing.
March 1, 2004... Dr David Kernick has criticised the NHS for not considering benefits such as increased GP job satisfaction when deciding whether new projects are cost-effective. In an article published by the National Primary and Care Trust Development...

GP negotiators knew the Carr-Hill formula would cause crisis.
March 1, 2004... GP negotiators knew weeks in advance of the `Black Wednesday' crisis that Government interference with the Carr-Hill formula could scupper the contract. Their admission came after a BMA report into the troubled negotiations for the GP,...

`Help pharmacists with GP work'.
March 1, 2004... Pharmacists need `a huge injection of resources' from their new contract to enable them to take on more work from GPs, according to the GPC. Speaking at a meeting of the All-Party Pharmacy Group, GPC chair Dr John Chisholm reiterated the...

Journal watch: Is the polypill a step closer?
March 1, 2004... US researchers have added evidence in favour of a polypill by looking at the combined effect on coronary mortality of a cocktail of drugs for acute coronary syndromes. A study of 1,358 patients, followed up over three years, found patients...

Journal watch: Women under-report medication use.
March 1, 2004... An American study has shown women's use of all medication, including herbal supplements, is higher than anticipated and that they are unlikely to report this to their GP. Of the 570 non-pregnant gynaecology patients involved, 92 per cent...

Journal watch: Dust as bad as passive smoking to infants.
March 1, 2004... Household dust and surfaces are equivalent to `several hours of active adult smoking' for infants, according to researchers who compared 49 homes of children aged two to 12 months, some where parents smoked, some where parents smoked out of the...

EDITORIAL COMMENT: Crunch time approaches for self-regulation.
March 1, 2004... Doctors hold self-regulation as an essential facet of their professionalism. The alternative, state regulation, rightly sends shivers down medical spines. Yet the GMC's existence is likely to be under enormous threat when the Shipman Inquiry...

Letter: Why the prevalence formula is so unfair.(Letter to the Editor)
March 1, 2004... I wonder if I might help my colleagues to understand the unfairness of the prevalence formula with the following worked examples. Prevalence payment calculation 5,891 = average practice size NP = national prevalence P =...

Letter: Contract does not work on temporary residents.(Letter to the Editor)
March 1, 2004... Yet again there is a mistake in the formulae of a contract spreadsheet - this time it is in the indicative contractor budget spreadsheet. The temporary resident adjustment does not work because, while the figures have been shown separately...

Letter: Cheaper than GP assistant.(Letter to the Editor)
March 1, 2004... At present many practice nurses do the job of a proposed GP assistant - some can also prescribe if they have undertaken the nurse prescribing course. Many are trained midwives who could update to take on the monitoring of low-risk...

Letter: Why contract has me thinking of emigration.(Letter to the Editor)
March 1, 2004... As an experienced 37-year-old GP who is currently completing a period of mutual assessment for a partnership in semi-rural Nantwich, Cheshire, the new contract fills me with dismay. I voted against an unpriced contract and I am now coming to...

Letter: Primecare's not abandoning you on out-of-hours.(Letter to the Editor)
March 1, 2004... I read with great interest the story on Dr Anne Lawson indicating her concern about Primecare withdrawing services from Portsmouth (`Don't leave us in the lurch, GP tells Primecare' (News, February 16). Primecare announced its decision to...

Letter: Missed chances over the rules on controlled drugs.(Letter to the Editor)
March 1, 2004... Professor Richard Baker is quoted in your news report `Demand for overhaul of rules on controlled drugs' as saying that confusion about these rules could be traced to the end of regular inspections in 1991 (Pulse, February 9). Actually the...

Letter: How to diagnose low back pain.(Letter to the Editor)
March 1, 2004... I refer to Professor Charles Greenough's article `Can surgery end low back pain?' (February 16). In my experience between 25 and 50 per cent of cases of low back pain presenting in general practice can be attributed to sacroiliac problems. ...

Letter: Where's evidence for menopause stance?(Letter to the Editor)
March 1, 2004... Dr Ellen Grant (Letters, February 16) states that `menopausal symptoms signal nutritional deficiencies and adverse reactions to food and chemicals, often caused by previous use of hormones, smoking or alcohol'. Perhaps she'd be kind enough to...

QUALITY AND OUTCOMES FRAMEWORK: Asthma.
March 1, 2004... Dr John Couch on the money available and what is required toearn points from asthma POINTS ACHIEVED WITH COMPLETE EASE Asthma 1 Practice can produce register excluding patients with asthma who have been prescribed no asthma-related...

Q&As: What about confidentiality when 16-year-old may be `runaway'?
March 1, 2004... Q: Recently a 16-year-old girl and a 40-year-old man who are living together registered with our practice. We are worried she is a runaway and are not sure what, if anything, we must do. Can you advise us? A: The first concern is whether...

Q&As: Police are demanding records for a patient held in custody.
March 1, 2004... A: One of our patients has been taken into police custody on suspicion of committing a serious offence and the police are demanding the medical records. Should I give them the original records or a copy? A: Unless your patient has given...

Q&As: Make sure the father is indeed the legal guardian.
March 1, 2004... Q: I have had a request from the father of an adult patient for information relating to his son's visit to the surgery and his subsequent management. The patient is severely mentally disabled and the father claims he is the legal guardian. How...

Q&As: Can a mother have her dead son's records as keepsake?
March 1, 2004... Q: One of our young patients was killed in a road traffic accident three years ago. His mother has asked if she can have his records as a keepsake as they are no longer of use to the NHS and may help her resolve her grief. Is this permissible?...

March contract calendar.
March 1, 2004... March will be another busy month as practices complete preparations for the new contract - things have not been helped by the Department of Health constantly missing its deadlines while insisting GPs always meet theirs MARCH 7 You...

Lesson I learned from my trainer's tragic example.
March 1, 2004... Dr Stephen Farley, who was found hanged in January, was described by colleagues as `the most caring GP you can imagine' - here his former trainee, Dr Ian Stuart, says first-hand experience of such commitment caused warning bells to ring In...

So how do we keep happy and sane in my practice?
March 1, 2004... We have agreed that while income is important we are not prepared to risk stress-related illness in its pursuit. We also agree that high clinical standards are a major priority. So the rules are: * There are an agreed minimum number of...

Will you register `private' patient?
March 1, 2004... Case history Your partner has inherited George, a charming, elderly patient who was looked after by your charismatic, now deceased senior partner `privately' and paid a small fee for six-monthly visits. George lives some way from your...

Drug and alcohol addiction among GPs.
March 1, 2004... Dr Stefan Cembrowicz speaks to Dr Alasdair Young of the Sick Doctors Trust about the causes of addiction and its consequences for physicians How big is the problem? Is there anything about us that makes doctors vulnerable to...

10 TOP TIPS.
March 1, 2004... Bite-sized advice for busy GPs 1. Pain in the hip may herald loosening and impending failure of a total hip replacement, with the need for revision. 2. If this is needed, NICE recommends metal-on-metal resurfacing (MoM), a new...

Quick wins for the new contract.
March 1, 2004... GPs are working hard to make the most of the quality points available under the new contract. Rather than every GP reinventing the wheel, Pulse invites readers to send in their thoughts on aspects of the new contract they think would be of...

Understanding anti-HIV drugs side-effects.
March 1, 2004... The introduction of highly active antiretroviral therapy (HAART) has caused a sustained decline in HIV-associated deaths. This, with a rise in the number of new diagnoses, has meant a steep increase in the number of people requiring complex,...

How good are you at estimating time of patient's death?
March 1, 2004... Simple external body changes can help a GP estimate how long a body has been dead, says Dr Anthony Busuttil Whenever a doctor is asked to confirm that death has supervened, quite frequently he or she will also be asked their opinion about...

Dealing with patients who miss hospital appointments.
March 1, 2004... Case history Steven Rees presented with an odd pigmented lesion 10 weeks ago. He was referred urgently but failed to attend. A further appointment was sent, with a second non-attendance. The dermatologist wrote explaining the situation and...

ANSWER BACK: Do moles continue changing in adults?
March 1, 2004... Q: It is often said moles stop changing in young adults, but in my experience they don't. The contraceptive pill and pregnancy change them, but they still seem to evolve beyond that. It causes many adults to attend. What is the truth? A:...

ANSWER BACK: Can paracetamol use in pregnancy cause child asthma?
March 1, 2004... Q: Should pregnant women avoid paracetamol, in view of the proposed link with asthma in their offspring? A: The Avon longitudinal study followed 14,000 pregnancies through to birth and beyond, and their offspring are now aged 10 years1.....

GPs face double jeopardy.
March 8, 2004... A GP is at the centre of a land-mark High Court legal battle that could effectively end self-regulation for doctors even before the Shipman Inquiry's final report. The case will determine whether a new super-regulator, the Council for the...

Colleague's hell over case review.
March 8, 2004... Dr John Orchard has described how a GP colleague endured `24 hours of hell' after the Council for the Regulation of Healthcare Professionals told him it was reviewing his case. The GP, who has asked for anonymity, had been reprimanded by...

Extra cash if GPs open until 10pm.
March 8, 2004... GPs will be offered extra cash to hold evening surgeries if Labour wins a third term. The incentives for practices to offer slots between 6pm and 10pm will be part of the party's election manifesto, a `senior MP' has told a national...

CSM set to strengthen warnings on GI bleeding risk from SSRIs.
March 8, 2004... The Committee on Safety of Medicines is considering stronger warnings on the risk of gastrointestinal bleeding on product information for selective serotonin re-uptake inhibitors. The move follows a Drug and Therapeutics Bulletin report...

#30m to ease out of hours worries.
March 8, 2004... The Government is giving PCTs a #30 million bonus to take over out-of- hours care amid growing signs ministers are worried over their ability to set up new services. The announcement by health minister John Hutton comes only four months...

GP warns diabetics on renal disease.
March 8, 2004... Dr Vasu Siva has written a leaflet for diabetes patients to stress the importance of having an annual urine test to prevent renal disease. Dr Siva, a GP in Perivale, Middlesex, made the move after her practice audit found a third of...

GPs split over COPD quality dilemma.
March 8, 2004... GP respiratory experts are divided over whether the Department of Health should make an 11th-hour change to the quality pay indicator for COPD diagnosis to bring it into line with NICE guidance. A department spokesman said the option was...

GMC `far from satisfactory' says Shipman Inquiry chair.
March 8, 2004... The chair of the Shipman Inquiry told the final day of its public hearings she was `far from satisfied' with the GMC and it `had to change'. In comments that further demonstrate the threat facing the GMC from the inquiry's final report,...

Triage nurse takes GP strain.
March 8, 2004... A triage nurse at Dr Malcolm Ridgway's practice will be able to refer patients without his approval after a training course in first contact care. Elaine Maguire is one of the first to take the MSc course, which trains experienced nurses...

GPs criticised for patchy progress on CHD targets.
March 8, 2004... Government inspectors have criticised GPs for their slow and patchy progress towards targets in the national service framework for coronary heart disease. But PCTs must share the blame because of their failure to provide enough funding and...

Singlehanders best for access says CHI.
March 8, 2004... Patients are now unable to see a GP of their choice because of Government pressure for practices to offer speedy access, a report by the Commission for Health Improvement finds. The CHI summary of 48 primary care trust clinical governance...

New HRT warnings over stroke fears.
March 8, 2004... The Department of Health is poised to issue fresh warnings over HRT after US research found `unacceptable' risks of stroke linked to oestrogen-only therapy. Concerns over the stroke risk, as well as the suggestion of an increased risk of...

Statins cut risk of stroke.
March 8, 2004... GPs have been urged to step up their prescribing of statins to patients at high risk of stroke after a landmark study found they cut the incidence of ischaemic stroke by one-third. Study leader Professor Rory Collins - whose findings from...

PCTs under fire on flu uptake.
March 8, 2004... The Liberal Democrats have named and shamed five London PCTs for failing to do enough to encourage over-65s to get vaccinated against flu. Simon Hughes, LibDem candidate for the London Mayor, said Lambeth, Southwark, Greenwich,...

CBT can help GPs curb use of benzodiazepines.
March 8, 2004... GPs could help one in three long-term users come off benzodiazepines if practice-based cognitive behaviour therapy was more widely available, a Government-commissioned study suggests. The health technology assessment on psychological...

GP spearheads diabetes network.
March 8, 2004... A GP who helped develop a clinically led diabetes network has seen the model rolled out across Scotland as part of the Scottish Diabetes Framework. Dr Alistair Emslie-Smith, a GP in Dundee and lead clinician of the Tayside Diabetes...

GPC clarifies `full' and `closed' lists.
March 8, 2004... Practices with a `full' list can refuse to take on new patients but could still receive allocations from their PCO, new GPC contract guidance states. Only if a practice has been through the list closure procedures and is `officially closed...

Overseas recruitment on increase.
March 8, 2004... More than 41,000 health professionals have joined the NHS from overseas since Labour took office in 1997, Government figures reveal. The statistics show 2,947 doctors and other medical practitioners were granted work permits in 2003...

GMC puts its case for the defence.
March 8, 2004... The under-fire GMC has reacted vigorously to the Shipman Inquiry letter with a point-by-point repudiation of the criticisms - Ian Cameron reports The GMC has vigorously defended its reform programme and predicted the Shipman Inquiry's...

Scots exodus threat over out-of-hours.
March 8, 2004... GPs in Scotland will move to other areas of the UK unless extra cash is put into out-of-hours, the Scottish GPC warns. The alert follows a parliamentary briefing paper, issued by Scotland BMA, calling on the Scottish Executive to give more...

Legal warning over supplementary lists.
March 8, 2004... Non-principals are warning GPs risk practising illegally because primary care organisations are not maintaining supplementary lists properly. Chair of the National Association of Non-Principals Dr Richard Fieldhouse said the neglect meant...