Pulse articles from March 2007

Pulse archives from March 2007

An era of scrutiny and suspicion.
March 1, 2007... Huge overhaul of medical regulation puts GPs on the defensive - or threatening to quit By Helen Crump The most dramatic overhaul of medical regulation in more than a century is set to prompt a surge in the practice of defensive...

We'll practise defensively - or retire.(Brief article)
March 1, 2007... `It would make me practise more defensively and it actually has already. I'm always worried about patients complaining' Dr Shan Whitear, Hadleigh, Essex `I don't think anyone will want to settle the bill for the Chief Medical Officer's...

Army of GP nurses and receptionists to run CVD screening.(General Practitioners)(Cardiovascular Disease)
March 1, 2007... PCTs to receive implementation guidance on programme as early as April Exclusive by Eleanor Goodman The starting gun has been fired on a huge programme of cardiovascular screening in general practice, with PCTs to receive guidance on...

How screening will work.(Brief article)
March 1, 2007... * Report proposes screening at or shortly after 40th, 50th and 60th birthdays * Patients may be called in with `birthday cards' or screened opportunistically * Healthcare assistants, nurses and even receptionists set to be trained to...

Long MPIG wait.(Minimum Practice Income Guarantee)(Brief article)
March 1, 2007... GPs are unlikely to be told the future of MPIG until after the consultation on the GMS global sum formula ends on 11 May. But it seems increasingly likely the outcome will keep practices at current MPIG levels rather than creating a safety...

Postnatal screens.(Brief article)
March 1, 2007... GPs should screen women to pick up early signs of antenatal and postnatal depression, new NICE guidelines propose. The institute's ambitious proposals also recommend GPs offer women psychological therapies within three months of diagnosis,...

Half of drug switching schemes `pose threat to patient safety'.
March 1, 2007... Almost half of GPs are coming under such pressure to switch patients to cheaper drugs that they believe safety is being put at risk, a Pulse investigation reveals. More than 90 per cent of GPs are coming under pressure from their primary...

`My patient nearly died'.(Brief article)
March 1, 2007... Dr Simon Cooke has `definite concerns about patient safety' after one of his patients suffered renal failure following switching of statins. The patient, who had a kidney transplant and was on cyclosporin, `effectively went into renal...

InBrief: 94% signed up to PBC.(practice based commissioning)(Brief article)
March 1, 2007... More than nine in 10 practices in England have signed up to practice- based commissioning. Statistics from 10 strategic health authorities show that 94 per cent of practices have received an incentive payment - either the first part of the...

InBrief: Referral choice increases.(Brief article)
March 1, 2007... The proportion of patients who recalled being offered a choice of referrals by their GP increased from 35 to 38 per cent between July and September. At least 60 per cent of patients must recall being offered choice by April for practices to...

InBrief: Varenicline `beats NRT'.(nicotine replacement therapy)
March 1, 2007... A new study suggests smokers treated with varenicline are nearly twice as likely to stop smoking as patients on nicotine replacement therapy. Pfizer launched varenicline in December but the study, funded by the company and the Canadian...

InBrief: Workforce policy group.(Brief article)
March 1, 2007... The BMA, other unions, the Government and NHS Employers have signed an agreement to work together on the workforce implications of policy. A BMA spokesperson said: `We have a lot of issues in common with other staff groups in the NHS and it...

InBrief: GP wronged by GMC.(Brian Peacock )(Brief article)
March 1, 2007... The GMC was wrong to bring disciplinary proceedings against a Bedfordshire GP almost 10 years after one of his patients suffered a heart attack because of the drugs she was taking, the High Court has ruled. Mr Justice Gibbs said there were `no...

InBrief: Flu cases continue to rise.(Brief article)
March 1, 2007... The number of cases of flu in England and Wales continues to rise, with rates above baseline levels in all regions. Figures from the RCGP show the rate has increased in the last week from 38.4 to 44.8 per 100,000. Rates in Northern Ireland...

InBrief: Call for GP action on STIs.(Brief article)
March 1, 2007... NICE guidance calls for GPs to do more to halt the rise of STIs and prevent conception in under 18s. It recommends GPs identify those at high risk and offer them one-to-one structured discussions, ideally lasting at least 15 to 20...

Regulation white paper: Sliding scale standard of proof `unworkable'.
March 1, 2007... Pulse campaign forces CMO to backtrack over fitness-to-practise cases By Helen Crump A `sliding scale' standard of proof for judging fitness-to-practise cases will be unfair and unworkable, medicolegal experts are warning. Their...

Regulation white paper: GPs' threat over appraisals.(Brief article)
March 1, 2007... The Government's revalidation proposals could spark an exodus of GP appraisers. GPs who have carried out the role are warning that they may pull out if appraisal becomes a summative performance assessment, as proposed in the regulation...

Regulation white paper: N Ireland and Wales to adopt reforms.(Brief article)
March 1, 2007... All the devolved governments apart from Scotland look set to take up the reforms outlined in the regulation white paper in full. Although the white paper, which is based on a report by the CMO for England, asks devolved administrations to...

Regulation white paper: GMC reform to end self-regulation.
March 1, 2007... Regulation white paper lays out changes to council structure, performers list and professional standards By Helen Crump Sweeping reforms to the GMC will end self-regulation. The GMC will be stripped of its adjudication role, which...

Regulation white paper: Plans leave GPs `exposed to stalkers'.(Brief article)
March 1, 2007... GP information GPs could be vulnerable to identity theft and revenge attacks from stalkers under Government plans to make more information publicly available. This is the view of GPC negotiator Dr Peter Holden, who argues that GPs'...

Regulation white paper: Conduct in contract.(Brief article)
March 1, 2007... GP contracts will be amended to include the professional standards outlined in the GMC's Good Medical Practice. The changes announced in the white paper on regulation will make GPs contractually responsible for any breaches in professional...

Regulation white paper: Ministers climb down on affiliates.
March 1, 2007... Government waters down proposals on GMC affiliates, agreeing to introduce them on a small scale By Helen Crump The Government has bowed to pressure over GMC affiliates, which will now be introduced on a smaller scale. Ministers...

Regulation white paper: NCAS to spearhead rehab of below-par doctors.(National Clinical Assessment Service )(Brief article)
March 1, 2007... The National Clinical Assessment Service is to spearhead the rehabilitation of doctors who fall short of expected standards. NCAS will work with the GMC and employers to set out specific rehabilitation packages and conditions on practices...

Specialists `dumping' risky scripts on GPs.
March 1, 2007... GPC warns cash-strapped hospitals are shifting over `unsafe' work By Daniel Cressey Hospital doctors are `dumping' prescriptions on GPs as pressure grows to stay within drug budgets, the GPC is warning. The committee has received...

Traffic light system for shared care.(Brief article)
March 1, 2007... * Red - drugs suitable for secondary care only * Amber - suitable for shared care - GP must agree via proforma to accept clinical responsibility for patient - Agreements should clarify what monitoring is required and when further...

Drug combination speeds up Alzheimer's.(Brief article)
March 1, 2007... Use of a combination of sedatives and antipsychotics seems to strongly accelerate the progression of Alzheimer's disease, writes Daniel Cressey. Researchers from the UK and Greece found the drug classes raised the risk of deterioration...

ECG referrals vary.(echocardiography)(Brief article)
March 1, 2007... GPs vary `widely' in their interpretation of ECGs and referral of patients for echocardiography, a study reports. The researchers insisted most GP were capable of conducting initial heart failure screening with ECGs, but that the variation...

Oxygen `waste'.(Brief article)
March 1, 2007... The NHS is spending #18m a year on oxygen therapy for which there is no evidence of benefits, doctors are warning. They called for further scrutiny of the potential benefits of the treatment after finding most COPD patients who claimed it...

MediaWatch: `Down's drug trialled'.(Brief article)
March 1, 2007... The story A drug that could improve learning and memory difficulties in people with Down's syndrome is set for clinical trials, report The Times and Daily Telegraph. The source In a study published in Nature Neuroscience, mice genetically...

MediaWatch: `Soya beans curb obesity'.(Brief article)
March 1, 2007... The story A diet rich in soya beans could help fight obesity and prevent diabetes, according to the Daily Mail and Independent. The source Researchers in Korea fed rats a fatty diet, supplemented with various levels of black soya. In rats...

MediaWatch: `Breath test to spot cancer'.(Brief article)
March 1, 2007... The story A new breath test can pick up the early stages of lung cancer, say the Daily Mail and The Times. The source The breath test uses a small array of 36 spots of chemically sensitive compounds, which change colour when they come into...

Fears over e-referrals.
March 1, 2007... Choose and Book concerns after electronic referrals found to lack detail By Lynn Eaton Electronic patient referrals contain less detailed information about a patient's condition than paper referrals, a study has found. This...

Not a pay cap - just an incentive to invest.
March 1, 2007... Ministers believe GPs should be `incentivised' to invest a larger share of their income in their practices, rather than face pay caps, Pulse has learned. Sources close to ministers say Health Secretary Patricia Hewitt's comments to the...

`Iron out NHS's variations'.(Brief article)
March 1, 2007... The NHS is going to have to tackle wide variations in GP referral and prescribing rates and differences in PCTs' spending decisions to ensure a viable future. That is the view of a King's Fund report published last week, which warned that...

PCT is stuck with OOH firm.(Brief article)
March 1, 2007... Cornwall and Isles of Scilly PCT looks likely to have little choice but to continue with its out-of-hours contract with private provider SERCO, despite undertaking a 20-day review. The PCT is reviewing the contract, which still has two...

Shipman and Ayling responses: PCTs may get power to fine poor GPs.
March 1, 2007... Government responds to inquiries on Shipman and Ayling with raft of proposals to toughen scrutiny of GPs By Christian Duffin PCTs could be handed greater powers for monitoring and disciplining GPs. The Government will consult on...

Shipman and Ayling responses: Whistleblowing to be made easier.(Brief article)
March 1, 2007... Reporting Colleagues Whistleblowers are to be given more outlets for reporting concerns about the conduct of GPs and other practice staff. The Government wants all NHS organisations, including practices, to draw up a written policy on...

Shipman and Ayling responses: Inquiry into sex with patients.(Brief article)
March 1, 2007... Sexual attraction and `boundary transgressions' between doctors and patients will be the subject of a major Government-sponsored investigation. It will consider whether GPs should be exempt from disciplinary action if they disclose...

GPs face death form probes.
March 1, 2007... Death Certificates All death certificates for burials and cremations will be scrutinised for suspicious circumstances by an independent `medical examiner', the Government has announced. The medical examiner, who will be attached to a...

PCTs to get records with GP complaints.(Brief article)
March 1, 2007... GPs may be forced to hand over patient records to their PCT if complaints against them are investigated. The Government supports the idea in principle and will consult stakeholders to thrash out the details. But GPC deputy chair Dr Laurence...

Talks over training in psychiatry.(Brief article)
March 1, 2007... All GPs could be trained in psychiatry. The Department of Health will hold talks with the RCGP about introducing elements of psychiatry into the GP training programme and continuing professional development models for qualified GPs. The...

Patients will not get say over recruits.(Brief article)
March 1, 2007... Health Secretary Patricia Hewitt has rejected calls for practices preparing to recruit a new GP to canvass patients on what sort of doctor they would like. Dame Janet Smith suggested in the Shipman Inquiry that patients' views should be...

Colon Ca referral chaos.
March 1, 2007... Study reveals `marked' variation in GPs' use of two-week rule By Lilian Anekwe A study has uncovered `marked variability' in GPs' use of referral guidelines for colorectal cancer, with many apparently unaware of the two-week rule. ...

When to refer for colorectal Ca.(Brief article)
March 1, 2007... * Bleeding with a change of bowel habit towards looser stools and/or increased stool frequency persisting six weeks or more * Aged 60 years and older, with rectal bleeding persisting for six weeks or more without a change in bowel habit and...

Screening cuts colonoscopies.(Brief article)
March 1, 2007... Offering immunochemical tests to patients who test positive for faecal occult blood can streamline colorectal screening and cut the demand for endoscopy, a study concludes. Use of faecal immunochemical tests has already been incorporated...

Most drug errors arise from mix-ups.(Brief article)
March 1, 2007... The vast majority of medication errors in general practice occur when one drug or vaccine is mixed up with another, an analysis has revealed. Two-thirds of all calls to an advice line run by the Medical Defence Union over a six-month...

JournalWatch: Pulse pressure predicts AF.(atrial fibrillation)(Brief article)
March 1, 2007... Pulse pressure strongly predicts the risk of atrial fibrillation, an analysis of the Framingham heart study reports. The prospective study followed 5,331 residents of the US town of Framingham, 698 of whom developed atrial fibrillation, a...

JournalWatch: Montelukast doubts.(Brief article)
March 1, 2007... A leukotriene receptor antagonist is inferior to an inhaled steroid when used in combination asthma treatment, US researchers report. Their randomised, placebo-controlled crossover trial compared treatment with montelukast plus salmeterol...

JournalWatch: Eradication benefits.(Brief article)
March 1, 2007... H. pylori eradication in long-term users of proton pump inhibitors can reduce the severity of symptoms and use of healthcare, a UK study reveals. Researchers randomised 184 patients who were users of PPIs and positive for H. pylori to...

JournalWatch: Beta-blockers and fracture risk.(Brief article)
March 1, 2007... Use of Beta-blockers reduces the risk of fractures, but the relationship appears unlikely to be causal, Dutch research concludes. The researchers conducted two case-control studies using the UK general practice research database and a Dutch...

JournalWatch: Tadalafil no coronary risk.(Brief article)
March 1, 2007... Tadalafil does not appear to raise the risk of coronary events, a UK analysis concludes. The observational cohort study included data on patients' demographics and outcomes obtained from their GPs. It examined clinical information on 6,229...

Mental health setback.(Brief article)
March 1, 2007... Primary care workers improve satisfaction but not outcomes By Lilian Anekwe Primary care mental health workers deliver patient satisfaction but do not improve outcomes, a Government-funded trial reveals. The study found no...

Analysis: Asian culture a diabetes challenge.
March 1, 2007... As cultural factors fuel soaring rates of diabetes among south Asians, GPs are urged to step up treatment By Eleanor Goodman When Dr Shirine Boardman was asked to educate the local south Asian community about diabetes, she was well...

Letter: Perverse incentives.(Letter to the editor)
March 1, 2007... From Dr Bern Bedford, Southampton You seem surprised that drug use has changed towards ACE inhibitors from diuretics (News, 22 February). Consider: a) diuretics are off-patent so nobody advertises them - hence ASCOT was advertised...

Letter: How do I ask staff to take a pay cut?(Letter to the editor)
March 1, 2007... From Dr David Starritt, Tarland, Aberdeenshire I am really very concerned about what might happen to my income at this unusual small practice in the light of the continuing review of MPIG. I have a list of 800 - rural, predominantly...

Letter: `Practice-based decommissioning' could save us money.(Letter to the editor)
March 1, 2007... From Dr Bernard Newgrosh, Bolton, Lancashire Pity the poor community matron who, as described by Phil Peverley, was asked to check on an asthmatic with normal blood pressure (Columnists, 15 February). She was made an offer she could not...

Numbness of the senses.(patient care)(Column)
March 1, 2007... Phil is incensed by an unnecessary house call to a shameless time- waster of a patient It was the patient's neighbour who phoned up. That's what put our receptionist off the scent; they are supposed to get a contact number so we can phone...

Dinah'sDiary: Dinah Roy.(Column)
March 1, 2007... This week Dinah tears her hair out over IT and misses one meeting too many Monday Stressful morning. Early start - mission to pick up papers from PCT then rush back home just in time to prevent IT man being poisoned with suspect...

Opinion: GPs perfectly fit for post-op checks.(postoperative care)
March 1, 2007... Professor Martin Roland says the dismay sparked by the primary care tsar's proposals for GPs to take on up to three-quarters of a million post-operative checks a year is misplaced. He insists GPs have nothing to fear So David Colin-Thome...

PulseFinance: WHY THE NHS PENSION SCHEME IS SO GOOD.
March 1, 2007... Shane Stack of Medical Money Management explains why GPs enjoy a very good pension scheme indeed, and one most certainly to be cherished First let us explore how much the NHS pension scheme costs you and what you get for your money. ...

PulseFinance: Pooling your practice computer skills.
March 1, 2007... Most practices fail to use their computer capacity to the full, so if staff members work together and pool their knowledge a much greater use of resources can be achieved, says Dr John Couch I like to think that I can use our computer...

How to get the best from your IT system.
March 1, 2007... By now, most doctors will have overcome their `early adopters' prejudice regarding computers and will have embraced the benefits of IT. But they will still be harnessing less than 10 per cent of their system's capabilities. A greater...

PulseClinical: Need to know heart failure diagnosis and investigations.(Disease/Disorder overview)
March 1, 2007... Take-home points * A third of patients with IHD have hibernating myocardium or silent ischaemia, and present with breathlessness on exertion rather than angina * Left ventricular ejection fraction (LVEF) is not a direct indicator of...

PulseClinical: Pain control.
March 1, 2007... GP Dr Martin Johnson specialises in chronic pain management. Here he offers lessons from experience Useful website britishpainsociety.org 1 Pain is common It is estimated that 7.8 million people live with chronic pain in the UK....

PulseClinical: Essential guide to...Raynaud's phenomenon and fatigue.(Disease/Disorder overview)
March 1, 2007... Concluding our series on musculoskeletal conditions, consultant rheumatologist Dr Colin Tench provides a fresh perspective on these key features of connective tissue disease Connective tissue diseases (CTDs) are a group of multisystem...

PulseClinical: A practical guide to...vision fitness to drive.
March 1, 2007... Tim Carter, chief medical adviser to the Department for Transport, outlines the most common primary care eye problems that can impair vision and fitness to drive When driving, people use foveal (central) vision as a directed gaze for...

PulseClinical: Cancer in Primary Care - Metastatic Disease.
March 1, 2007... Dr William Hamilton and Professor Deborah Sharp identify the warning signs Most disseminated cancers spread locally first, and produce local symptoms. However, there are two relatively common presentations of metastatic cancer that...

PulseClinical: Duct tape ineffective for warts in children.(Brief article)
March 1, 2007... Q Is duct tape effective in treating warts in children? Synopsis In this study, 103 children aged four to 12 with warts were randomly assigned to apply duct tape or a placebo (corn pads). The duct tape was applied and left on for...

PulseRegistrar: Woman with abdominal pain demands to see male partner.
March 1, 2007... CASE HISTORY You, a male GP partner, are in the middle of an overbooked surgery when the receptionist tells you 25-year-old Miss Smith is asking to see a doctor urgently about a `confidential' problem. When you suggest Miss Smith should...

PulseComment: A new era of suspicion.(Brief article)
March 1, 2007... It represents the most fundamental overhaul of medical regulation for 100 years - the culmination of a six-part inquiry into the activities of Harold Shipman, six months of wrangling over the Chief Medical Officer's half-baked ideas and...

Last word: Dr Phil Brookes.
March 1, 2007... Dr Phil Brookes... on Hewitt, drug addiction and the Bible The best thing about my practice is coffee time at 10.30am. We all stop every morning to shoot the breeze, make decisions, moan or whatever is needed. Helps relationships no end....

Pay freeze to cut practice profits 13%.
March 8, 2007... GPC won't rule out Choose and Book boycott as anger grows over zero per cent award By Helen Crump Average practice profits will plunge by 13 per cent over two years as a result of GPs' zero per cent pay award, predicts an accountant's...

Meldrum: `No I will not resign'.(Hamish Meldrum )(Brief article)
March 8, 2007... GPC chair Dr Hamish Meldrum has said he will not be resigning, despite staking his reputation on delivering at least an inflationary pay rise for GPs this year, writes Helen Crump. Dr Meldrum told the LMCs conference in June 2006: `I and...

NICE U-turn throws open access to osteoporosis drugs.
March 8, 2007... Draft guidance backtracks over age restrictions and need for DXA scans By Daniel Cressey NICE has flung open the door to treatment for many thousands more patients with osteoporosis under dramatically revised proposals. Its new...

Revised NICE draft guidance.(dual energy X-ray absorptiometry)(Brief article)
March 8, 2007... Primary prevention * Alendronate for initiation of primary prevention * Women aged 70 years or older with one or more clinical risk factors and T-score of 2.5 SD or below are recommended for treatment * Women 75 years or older with...

CVD screening faces `major barriers'.(cardiovascular diseases)(Brief article)
March 8, 2007... A national cardiovascular screening programme is set to go ahead even though the diabetes pilots it is modelled on fell short of expectations. Diabetes screening was hampered by gaps in patient records that made it more difficult than...

GPs to offer air-conditioning and anger management.(Brief article)
March 8, 2007... GPs are to be expected to commission an eclectic range of new services including air-conditioning for patients with lung disease and anger management for unruly children. The Government has set aside #8.9m for commissioners to spend on...

GP pay award: Row over `cynical' workload stats.
March 8, 2007... Government claims GPs' working week has dropped five-and-a-half hours but GPC condemns data manipulation HOURS WORKED The GPC has attacked the Department of Health for `cynically manipulating' research in its evidence to the Doctors'...

GP pay award: Who got what pay rise.(Brief article)
March 8, 2007... * Independent GMS contractors 0 per cent pay increase * Salaried GPs #1,000 increase to top and bottom of the scale for those employed by PCOs. No recommendation on annual uplift * GP registrars Supplement for new...

GP pay award: `A threat to future GP recruitment'.(Brief article)
March 8, 2007... TRAINING Disappointing pay increases for GP trainers and educators and a cut to the registrars' supplement could threaten future recruitment, GP leaders warn. Last week's report from the Doctors' and Dentists' Review Body recommended...

GP pay award: GPs left to haggle over community hospital pay.(Brief article)
March 8, 2007... OTHER GROUPS The GPC has described the Doctors' and Dentists' Review Body's failure to recommend on pay for GPs working in community hospitals as `completely unacceptable'. Dr Peter Holden, GPC negotiator, said: `This is the seventh...

InBrief: GP research network.(Brief article)
March 8, 2007... A new primary care research network has been launched to raise awareness of clinical studies among GPs and encourage patient recruitment. Eight regional teams of specialists, academics and nurses will work with GP practices on studies of...

InBrief: Script charges going up.(Brief article)
March 8, 2007... Prescription charges are to rise by 20 pence in England from April this year, the Department of Health has announced. The department's review of prescription charging is set to report back in July 2007, with any changes set to be cost-neutral...

InBrief: Care initiative failures.(Brief article)
March 8, 2007... More than half of consultants have examples of Government initiatives that have adversely affected patient care. The BMA survey found only 11 per cent of 265 leading consultants thought the Choice and Booking initiative would improve care and...