Pulse articles from March 2008

Pulse archives from March 2008

GPs face crackdown over QOF gaming.
March 5, 2008... Government-funded study alleges manipulation of prevalence and exception reporting EXCLUSIVE By Lilian Anekwe GPs face a crackdown on exception reporting and tough scrutiny of disease registers, amid accusations that some have...

The accusations.(practices of General practitioners)(Brief article)
March 5, 2008... * Practices above the upper threshold for an indicator in 2004/5 artificially increased their prevalence in 2005/6to increase revenue * Practices below the upper threshold deliberately took patients off registers to maximise chance of...

Antifungal stripped of indications.
March 5, 2008... Antifungal treatment ketoconazole has been stripped of a number of its indications after a UK drugs regulator review found evidence of serious hepatotoxicity. The Medicines and Healthcare Products Regulatory Agency found oral ketoconazole...

GP2GP record transfers rise by three times.(electronic health record system)(Brief article)
March 5, 2008... Patient record transfers using the GP2GP system have more than tripled in the last three months, with more than 80,000 since last July, according to Connecting for Health. More than 3,500 practices with EMIS and INPS are now using the...

Report says QOF should shrink in size.
March 5, 2008... The QOF should be reduced as a proportion of GP income, one of the framework's architects has said, after a report found only `mixed' evidence to support a beneficial effect on patient care. In an analysis of 36 published academic articles...

Everington says some GPs don't invest in practice.
March 5, 2008... Dr Sam Everington, former deputy chair and current council member of the BMA, has provoked controversy after recommending PCTs clamp down on GPs who don't invest in their practices. Dr Everington told Radio 4's You and Yours programme that...

DARZI PROPOSALS: #1.5bn black hole in Darzi's polyclinic plan.
March 5, 2008... EXCLUSIVE By Steve Nowottny Plans to restructure general practice around a network of polyclinics lack any evidence of benefit and `seriously threaten' patient care, concludes an independent evaluation commissioned by LMCs. The report,...

NORTH LONDON PCTS: Trusts jump gun with polyclinic blueprint.(Camden Primary Care Trust)(University College London Hospital)(Brief article)
March 5, 2008... Two north London trusts have already drawn up and presented plans for the capital's first polyclinic, even though public consultation on the controversial programme does not end until later this week, Pulse has learned. University College...

ARBs backed in heart failure.
March 5, 2008... ARBs have been given a place in the routine treatment of heart failure under new guidance issued by the National Prescribing Centre. Recent trial data supports use of the drugs in patients with severe heart failure, the centre's MeRec...

GP judgment beats BNP.
March 5, 2008... GPs would do better relying on their clinical judgment than B-type natriuretic peptide testing in patients with suspected heart failure, a new study suggests. The study found BNP testing - which is recommended by NICE for ruling out heart...

US giant in talks on spending NHS cash.(UnitedHealth Group Inc. negiotating with United Kingdom. National Health Service for private health care finance )
March 5, 2008... Conflict of interest fears as UnitedHealth, BUPA and Humana lead charge to offer private commissioning support EXCLUSIVE By Gareth Iacobucci US giant UnitedHealth is among a clutch of companies in talks with NHS bodies that are set to...

FESC pilot areas.
March 5, 2008... Ashton, Leigh and Wigan PCT Deal with one of the following could commence in May 2008: UnitedHealth, BUPA, Humana, McKinsey, Tribal East of England SHA Currently discussing with: Axa, UnitedHealth, BUPA, Humana North East...

GPs fight back over hours criticism.
March 5, 2008... Grassroots GPs are fighting back after weeks of negative headlines over their hours and pay with a concerted campaign to state their case to patients. As GPs across the country cast their votes in the poll on the Government's contract...

GPs facing new scrutiny over PBC.
March 5, 2008... GPs are set to face central scrutiny of the quality and scope of their commissioning under the Government's plans for a new healthcare regulator. The Department of Health has set out its intention to regulate commissioning by GPs and PCTs...

MPIG phase-out on horizon.(Brief article)
March 5, 2008... A phase-out of the MPIG could begin within a year, and `preliminary discussions' with GPC negotiators are already under way, it emerged this week. In a letter sent last month and obtained by Pulse, Welsh health minister Edwina Hart argued...

ANTIDEPRESSANTS: NICE takes fresh look at depression.
March 5, 2008... Under-fire institute will examine unpublished figures on antidepressant efficacy before issuing new guidance EXCLUSIVE By Lilian Anekwe NICE will consider unpublished data on the efficacy of antidepressants before new guidance on the...

Any better than placebo?(Brief article)
March 5, 2008... * Data on all clinical trials submitted to the FDA were obtained under the US Freedom of Information Act * The effect of initial severity on improvement was assessed for both active and placebo arms * No differences found between drug...

PSYCHOLOGICAL THERAPIES: More therapists pledged.
March 5, 2008... Ministers have promised a major expansion in the number of psychological therapists available to people with depression and anxiety disorders, in a further success for Pulse's Action on Depression campaign. The Department of Health has...

Quitting guidance criticised.
March 5, 2008... GPs have criticised new smoking cessation guidance from NICE, after the institute reversed its decision to recommend NRT for people wanting to cut down rather than immediately quit. NICE signalled support for the use of NRT in smokers...

Media Watch: This week's top... Miracle cure.
March 5, 2008... Less a miracle cure and more the holy grail of preventive medicine on offer this week, as the Daily Mail and Daily Telegraph predict we will soon have a vaccine against cancer. We're not talking HPV immunisation here, but a new vaccine...

Media Watch: This week's top... Scare story.(australians with mcular degeneration have greater chance of heart attacks and stroke)(Brief article)
March 5, 2008... This week's story has a firm basis in the truth. It happens. People living with age-related macular degeneration are twice as likely to die from a heart attack or stroke, say researchers whose study was reported in the Daily Telegraph and Daily...

Media Watch: This week's top... most pointless research.(hrry Potter books are influencing readers psychology)(Brief article)
March 5, 2008... Harry Potter has more than the Deathly Hallows to be worried about, according to the Journal of General Psychology. In an online survey of 4,000 fans, 30% were characterised as addicted or on the edge of addiction to Harry Potter. Author of the...

Audit office report - GPC refutes claim GPs are paid more to do less.
March 5, 2008... GP leaders warn National Audit Office claims will fuel anti-GP prejudice By Lilian Anekwe GP leaders have refuted claims in a controversial report that the GMS contract has been poor value for patients, as they seek to fight back...

Audit office report - New row over growing partner-salaried pay gulf.
March 5, 2008... GP partner earnings have increased far more dramatically than those of salaried GPs or practice nurses since the GMS contract, the National Audit Office report concluded. The report's findings were rejected by the GPC, but have prompted...

Audit office report - Praise for private contracts.
March 5, 2008... The drive to introduce private competition into general practice by use of APMS contracts can improve access and help tailor services to local health needs, the National Audit Office report said. It praised the `entrepreneurial culture'...

Audit office report - GMS contract `entrenching health inequalities'.(Brief article)
March 5, 2008... The GMS contract has allowed health inequalities to persist, and may have crowded out conditions left out of the QOF, the National Audit Office report warned. Its authors made a series of recommendations for reforms of the contract...

Setback for plan to overhaul GP training.
March 5, 2008... Ministers have drawn criticism from the GPC after blocking recommendations designed to transform GP training and raise the status of the profession. The Department of Health has decided to delay any changes to GP training `on whatever...

IN BRIEF: Sexual health QOF calls.
March 5, 2008... Sexual health provision in GP surgeries is `often limited and variable' and should be included in the QOF, a group of researchers commissioned by the Department of Health has concluded. The experts from University College London and the...

IN BRIEF: C. difficile deaths soar.
March 5, 2008... Reported deaths involving C. difficile rose by 72% from 2005 to 2006, according to latest data from the Office for National Statistics. In 2005, 3,757 death certificates in England and Wales mentioned C. difficile but this rose to 6,480 in...

IN BRIEF: Chest pain referrals cut.(cardiac patients avoid using telemedicine services)(Brief article)
March 5, 2008... Nearly 60% of referrals for non-acute chest pain are avoided by using a cardiac telemedicine service, according to a 12-month trial in 48 surgeries in Greater Manchester. The service allows ECG readings to be carried out in the surgery and...

IN BRIEF: Practice managers' voice.(professional associations uses opinion of practice managers )(Brief article)
March 5, 2008... Practice managers are being invited to join a new professional body that aims to develop a code of practice and raise the profile of the profession. Before the new, as yet unnamed, body is created the organisers are asking managers whether...

JournalWatch: Home BP testing benefit.
March 5, 2008... Patients with hypertension who measure their blood pressure at home are up to 50% more likely to achieve control than those who do not, according to a Japanese study. Researchers studied 2,363 patients taking anti-hypertensive drugs, 77%...

JournalWatch: Diabetes ups fracture risk.
March 5, 2008... Elderly women with type 2 diabetes have a reduced ability to perceive vibration because of peripheral neuropathy, putting them at increased risk of a fracture, suggest UK researchers. Diabetes is associated with an increased risk of hip...

JournalWatch: Aspirin doesn't cut Ca risk.
March 5, 2008... Taking low-dose aspirin does not reduce a woman's risk of breast cancer, suggests a new study contradicting previous findings. It has been suggested that regular aspirin use could reduce future risk of cancer by decreasing endogenous...

JournalWatch: Organic diet aids Crohn's.
March 5, 2008... Patients with Crohn's disease who follow a strict organic diet see a significant improvement in their intestinal symptoms, suggests preliminary research. Austrian researchers randomised 18 patients with mild to moderate Crohn's to receive...

THERAPY GUIDELINES: Topical NSAIDs first line in osteoarthritis.
March 5, 2008... NICE overturns previous NSAID advice and widens use of PPIs By Nigel Praities NICE has overturned traditional advice on osteoarthritis by recommending topical NSAIDs as first-line therapy and the use of proton pump inhibitors for...

EVIDENCE DOUBTS: Role for glucosamine is ruled out.
March 5, 2008... NICE has dismissed claims that the controversial supplement glucosamine has a role in treating osteoarthritis. In draft guidance released last July, NICE recommended a trial of glucosamine sulphate alongside oral NSAIDs or cox-2 inhibitors....

Digoxin drives up death risk.(Clinical report)
March 5, 2008... Study finds patients with atrial fibrillation on digoxin have a 58% increased risk of mortality By Emma Wilkinson Digoxin substantially increases the risk of death in patients with atrial fibrillation, and NICE was right when it...

Doubts over mass use of statins in CKD.
March 5, 2008... Statins are only beneficial for patients with chronic kidney disease if they are at a very high cardiovascular risk, according to Cochrane researchers. A meta-analysis of 50 trials found a 20% reduction in cardiovascular mortality and...

Focus on... The Darzi vision for GPs.
March 5, 2008... GPs have their final say on polyclinic proposals, but there are fears the plans now have unstoppable momentum By Steve Nowottny This week sees the close of a consultation on what just might be the blueprint for the future of general...

Debate - Can private franchises work for general practice?
March 5, 2008... Private companies can enhance patient care by treating the customer as king, argues GP Dr James Heath, managing director of primary care provider Aston Healthcare Even Heart of Birmingham Teaching PCT - for all its reputation as a maverick...

Letter - Give patients choice of access or continuity.(patient care services provided by gneral practitioners)(Editorial)(Brief article)
March 5, 2008... From Dr Bruno Capone Tunbridge Wells, Kent Open letter to Alan Johnson I have carefully read your letter in which you explain how the Government wishes to improve access to GP services. I would like to share my view with you. A...

Letter - BMA pursuing QOF square root solution.
March 5, 2008... From Dr Laurence Buckman Chair, GPC Your claim that the BMA has abandoned discussions with NHS Employers over the QOF square root formula is untrue (`Talks on scrapping QOF square root suspended', pulsetoday.co.uk/news). The BMA has...

Letter - Be shot or hung? Call that a choice?(working of British Medical Association)(Brief article)
March 5, 2008... From Dr G J Saunders Northwich, Cheshire The ballot paper gives us no reasonable choice. It is like asking: do you want to be shot, or hung? Or, when did you stop beating your wife? The BMA should be ashamed for doing the Government's...

Letter - Good job my appraisal's out of the way.(Letter to the editor)
March 5, 2008... From Dr John Chalmers Rosyth, Fife Thankfully, I have not long completed my appraisal for this year. But I am being plagued by a guilty secret. I am associating, professionally, with liars, conmen and cheats. In my defence, I only had...

Letter - GPs' pension anomaly needs sorting out.
March 5, 2008... From Dr Paul Stewart Kidderminster, Worcestershire I'm writing regarding GMS pensions contributions. I read annex B to TN6/2008 dated 29 January 2008 and would point out an apparent anomaly under which the contribution rate is applied to...

Letter - Remember - our notes are our copyright.
March 5, 2008... From Dr Gary Rogers Fleggburgh, Norfolk Dr Rick Freeman suggests our GP records should have commercial value (`Care records are a company boss's dream', pulsetoday.co.uk/ letters). They should and I believe they do. It is a well-known fact...

60-second interview - Dr Anouska Hari.
March 5, 2008... Dr Anouska Hari is vice-chair of Westminster LMC in London has been involved in the response to Lord Darzi's polyclinic proposals. She practises as a sessional GP in Kensington and Chelsea and has also appeared on a number of TV documentaries....

Editorial - Punished for crimes of others.(Editorial)
March 5, 2008... Ouch. It's been a tough few weeks to be a GP, but last week's National Audit Office report marked a new low. Financial audits are usually moderate, temperate, dull even, whereas this one was an exercise in mischief. From its provocative...

PulseClinical - POISONING.(toxic effects of paracetamol, plants and the contraceptive pill)
March 5, 2008... Clinical toxicologist Professor Nick Bateman answers GP Dr Mandy Fry's questions on the toxic effects of paracetamol, plants and the contraceptive pill Take-home points * Paracetamol ingestion below 150mg/kg body weight, more than 24...

PulseClinical - SEMEN ANALYSIS.
March 5, 2008... Urologist Mr Suks Minhas offers pointers on interpreting often confusing results from andrology labs 1 It's important to ask the patient to produce two samples for analysis, the second a month or two after the first. Semen analysis can...

PulseClinical - PURPLE RASH ON BABY.(childhood pneumonia causes skin rash)(Brief article)
March 5, 2008... Dr Mike Wyndham shares another unexpected diagnosis The patient This eight-month-old baby had had a difficult start to her life. She had suffered from two bouts of pneumonia but responded well to antibiotics. However, she had developed...

PulseClinical - CHILDHOOD ALLERGIES.
March 5, 2008... Consultant immunologist Dr Andrew Clark's guide to current and upcoming causes of allergy Peanut allergy The prevalence of this condition has risen over the past decade and it now affects 1.5% of five-year-olds. The most frequent...

PulseWorking Life - USING AN AWAYDAY AS A BUSINESS PLANNING TOOL.(consultants provide financial services to general practitioners)
March 5, 2008... This month is the end of the financial year for many practices and a good time to formulate business strategy. An awayday can be very helpful in doing this, says accountant Mike Gilbert Practice finance Many GPs find it difficult to...

PulseWorking Life - ON THE JOB: PRISON MEDICAL OFFICER.
March 5, 2008... Dr Marcus Bicknell describes his work as a prison doctor - challenging and frustrating but highly rewarding Working in a prison is one of the less usual careers for a GP. Traditionally, prison medical officers came from diverse backgrounds....

PulseWorking Life - GP SMELLS ALCOHOL ON PARTNER'S BREATH.
March 5, 2008... Continuing our series on medicolegal situations your practice could face A GP noticed one of her partners was regularly late starting surgery, had forgotten to sign prescriptions on a couple of occasions and had become irritable and...

Turkeys voting for Christmas.
March 5, 2008... The contract ballot has left Phil feeling more depressed than ever about GPs' future Well, I feel pretty stupid. Just two columns ago I was urging, nay, begging you all to vote to reject our Government's shameful contract `offer' - and...

A future of `blood, sweat and tears'.
March 12, 2008... Negotiators predict further contract impositions as GPs are forced to accept extended hours By Steve Nowottny GP leaders fear a series of future contractual impositions from the Government in the wake of the reluctant decision by GPs...

BMA pushes on with boycott of hours audit.
March 12, 2008... The BMA is continuing to advise practices to boycott the nationwide PCT audit of surgery appointments and opening times - despite Department of Health warnings that practices who fail to respond will not be eligible for the extended access DES....

Call to increase ethnic minority Ca screening.(cancer)(Brief article)
March 12, 2008... Cancer screening must increasingly focus on encouraging uptake among ethnic minorities, NHS bosses warned this week. The call follows the publication of a wide-ranging Government-funded study, which found that because of `cultural...

Travel plan to help patients to polyclinics.
March 12, 2008... Every polyclinic in London must have its own `travel plan' to ensure patients are still able to easily access their GP, an official report urged this week. An interim impact assessment into the Healthcare for London project warned that...

NICE set for early access to data on unlicensed drugs.(Brief article)
March 12, 2008... The Government is to consider allowing NICE to look at data on unlicensed drugs in order to ensure guidance is ready as soon as treatments are launched. The move comes after a parliamentary committee claimed patients in England were...

Government screening plans to put huge pressure on GPs.
March 12, 2008... Evaluation finds just one component of screening will put extra 120 patients a practice on CVD drugs By Nigel Praities Government plans to screen for heart disease and diabetes will put `huge' pressure on GPs and place more than 100...

Framingham replacement not `adequately validated'.(Brief article)
March 12, 2008... The move by NICE to abandon the Framingham risk score will deprive large numbers of patients at risk of cardiovascular disease of preventive treatment, an official consultation response has warned. The British Heart Foundation told NICE...

Pregnant women set for chickenpox screen and vaccine.
March 12, 2008... Government advisers are considering an interim screening and vaccination programme to protect pregnant women from varicella, Pulse can reveal. The Joint Committee on Vaccination and Immunisation is weighing up the possibility of a...

GPs face exclusion league tables.
March 12, 2008... Practices with high exception reporting rates to be named and shamed after new gaming accusations By Lilian Anekwe GPs face being placed into exception reporting league tables under plans to clamp down on practices with inappropriately...

Polyclinics could be #1m `white elephants'.
March 12, 2008... Lord Darzi's polyclinics are at risk of becoming #1m white elephants because PCTs lack the time or expertise to properly assess demand, writes Gareth Iacobucci. The GPC raised serious concerns over the quality of modelling carried out by...

GPs criticise infection control checks.
March 12, 2008... GPs across the country are being rigorously audited on their quality of infection control, as PCTs act on the Government's drive to reduce community-acquired infections. Pulse has learned at least 16 PCTs have entered into agreements with...

GPs won round by franchise plans?
March 12, 2008... A PCT behind plans to convert GP practices into McDonald's-style franchises has claimed it is winning the battle for GPs' hearts and minds. Last November, Heart of Birmingham PCT attracted national headlines for its `corporate franchise...

Up to one in three practices use 0844 phone numbers.
March 12, 2008... One in three GP practices in some parts of the country now use the controversial 0844 `local rate' telephone numbers. Campaigners against 0844 numbers compiled the data from the NHS Choices website and are now using it to pile pressure on...

No benefits for depression screens.
March 12, 2008... Diabetes UK conference delegates hear of flaws in depression screening and doubts on QOF and PBC By Lilian Anekwe The two-question depression screening tool correctly identifies depression in only a fifth of the patients it picks up,...

QOF overplays diabetes care improvements.
March 12, 2008... Practice QOF scores for diabetes do not give a good measure of the quality of care delivered to patients with the disease, research has suggested. Diabetes is lauded as one of the areas in which the QOF has been a major success, but the...

Studies back screening.
March 12, 2008... A structured screening programme for type 2 diabetes would also uncover patients with untreated hypertension and dyslipidaemia, researchers have concluded. Two studies on structured screening programmes conducted in primary care were...

PBC a threat to specialist diabetes services.
March 12, 2008... The drive to expand primary care diabetes services through practice- based commissioning threatens to destabilise secondary care, and may leave GPs to deal with the fallout, delegates were warned. Dr Rifat Malik, a consultant diabetologist...

Cost savings with GPSI heart care.
March 12, 2008... Boost to proponents of controversial GPSI services By Nigel Praities A GPSI-led heart failure service can bring dramatic improvements in treatment while saving thousands of pounds compared with equivalent hospital care, an evaluation...

MEDIA WATCH THIS WEEK'S TOP...Miracle cure.
March 12, 2008... Anyone worried about the lack of obesity surgery on the NHS might have been encouraged by last week's coverage of a new `thin pill'. This alternative to gastroplasty prevents the stomach expanding, making patients feel full, say the Daily...

MEDIA WATCH THIS WEEK'S TOP...Scare story.(Brief article)
March 12, 2008... It's been a bad month for manufacturers of glucosamine. First NICE guidance on osteoarthritis ruled against its use on the NHS, and now reports in the Sun and Daily Telegraph suggest the supplement could be linked to a 64-year-old Scottish...

MEDIA WATCH THIS WEEK'S TOP...Most pointless research.(Brief article)
March 12, 2008... People planning a serious head trauma followed by a trip to A&E should really try to avoid weekends and nights, suggest researchers in this week's BMJ. They found patients were much more likely to see a junior doctor rather than a consultant if...

Homeopathy part of polyclinic plan.
March 12, 2008... Government adviser launches prototype centre featuring complementary medicine unit and spiritual healing By Gareth Iacobucci A polyclinic featuring a state-of-the-art complementary medicine centre and a spiritual healing service has...

IN BRIEF: Doctors the most trusted.
March 12, 2008... Doctors are the most trusted of all professions, for the 25th year in a row, according to a survey. The Ipsos MORI poll of more than 2,000 adults left teachers, professors, judges and priests trailing well behind - and 73% of respondents...

IN BRIEF: 300,000 scripts lost.(Brief article)
March 12, 2008... Almost 300,000 prescriptions have been lost by the NHS since 1997, the Government admitted this week. The NHS Business Services Authority's Prescriptions Pricing Division said it knew of 220 instances where batches of prescriptions, submitted...

IN BRIEF: GSK avoids legal action.
March 12, 2008... GlaxoSmithKline will not face criminal proceedings over claims it withheld information on paroxetine, the Medicines and Healthcare Products Regulatory Agency has said. But it said GSK should have been quicker to raise the alarm on the risk...

Private role stepped up.
March 12, 2008... Private firms to advise on NHS spending across the country under new plans By Steve Nowottny The Government has signalled a dramatic increase in the role of the private sector in NHS spending decisions, after deciding to expand a...

JournalWatch: Patch eases vaginal pain.
March 12, 2008... An ultra-low dose of oestrodiol relieves vaginal pain and dryness in postmenopausal women, but the patch fails to benefit other domains of sexual function, according to US researchers. The 417 women in the trial - aged 60 to 80 years - were...