Pulse articles from March 2009

Pulse archives from March 2009

Sainsbury's to open 200 GP franchises.
March 4, 2009... LMC leader to take key role in rollout of national programme of in- store `polyclinics' Exclusive By Ian Quinn Supermarket giant Sainsbury's plans to roll out 200 in-store GP franchises in a move that will dramatically ramp up the...

How the sums add up.(compensation earned by general practitioners)(Brief article)
March 4, 2009... What you pay * GP franchise holders pay #100 a month to PriMed Services, which is responsible for vetting doctors * They also pay about #10 an hour rent to Sainsbury's What you get * Franchise holders will be able to earn...

OTC cold drugs `of no benefit in under-sixes'.
March 4, 2009... A review by the Medicines and Healthcare Products Regulatory Agency of over-the-counter cough and cold remedies found `no robust evidence' they work in children under six, and that they may cause side-effects. By March 2010 the packaging...

Medical bodies demand talks on records access.
March 4, 2009... The leaders of eight leading healthcare organisations have demanded a meeting with justice secretary Jack Straw to discuss new legislation that could see patient records used to target suspected terrorists. A joint letter from the eight...

RCGP wants flu vaccine offered to all GPs.
March 4, 2009... GPs and NHS managers should offer annual flu vaccinations to their staff to boost the effectiveness of the vaccine, the RCGP has claimed. The college wants it to be compulsory for employers to offer all frontline staff vaccinations in order...

PCTs fear missing 18-week target as referrals leap again.
March 4, 2009... Cuts in prospect for primary care budgets as latest referrals surge and winter pressures bite Exclusive By Nigel Praities PCTs are warning they are in danger of missing the Government's centrepiece 18-week referral-to-treatment...

PCTs in crisis.
March 4, 2009... NHS Norfolk: 18-week targets are `at risk', with particular problems with dermatology, orthopaedics, ENT and general surgery referrals. NHS Gloucester: 7% increase in GP referrals is `impacting on the trust's ability to manage the...

Four in five vacancies now salaried posts.
March 4, 2009... Exclusive By Gareth Iacobucci GP recruitment has been completely turned on its head in the space of five years, with four-fifths of advertised vacancies now salaried posts, a Pulse investigation reveals. There is also evidence...

GPs warned off glitazone use in patients at risk of fracture.
March 4, 2009... Patients with a high risk of fracture should be taken off glitazone treatment, according to NHS prescribing advisers. The warning came in the National Prescribing Centre's monthly MeReC bulletin for February, after the recent publication of...

DARZI PLANS: Darzi rollout plan to strip paediatrics from GPs.
March 4, 2009... SHA pushes ahead with proposals for specialist `children's GPs', while in London Darzi plans prompt protest By Steve Nowottny NHS managers are to push ahead with controversial plans to hive off GP care of children to a new breed of...

DARZI PLANS: NHS Yorkshire and Humber's plans.
March 4, 2009... * Children's GPs - SHA admits the plan `courted some controversy' but still intends to pilot the role as one of a number of proposals to improve paediatric primary care * Skill-mixing - call for a `team approach' to primary care to...

DARZI PLANS: `The PCT wants to move Darzi centre right on top of us'.
March 4, 2009... GPs fighting a second phase in the rollout of Lord Darzi's GP-led health centres are railing against plans to locate one right next to a host of existing surgeries. Emotions ran high last week as GPs joined forces with patients to protest...

Echo of fundholding as GPs get real budgets.
March 4, 2009... Exclusive By Lilian Anekwe GPs are to be handed control of real budgets for prescribing and referrals to secondary care under innovative new commissioning deals at a series of PCTs. Entrepreneurial practice-based commissioning...

How real budgets would work.
March 4, 2009... * The reliance on indicative budgets is regarded as one of PBC's major flaws. Giving GPs an imaginary figure to represent how much they have to spend on commissioning, with no real penalties for missing spending targets, has failed to engage...

CARE RECORD: Care records rollout causes chaos in A&E.
March 4, 2009... First hospital to access patient data held by GPs reports big problems By Steve Nowottny The rollout of the Summary Care Record has caused such chaos at A&E that the first hospital to gain access has had to abandon plans for routine...

CARE RECORD: Warning on restricted access.
March 4, 2009... Moves to restrict access by researchers to medical records will deny UK patients access to new treatments through clinical trials, leading research organisations are warning. The claims came in response to the Government's decision to...

GPs warned of C. difficile risk in PPI use.
March 4, 2009... GPs have been urged to review PPI use in all patients, after a study found the drugs could raise the risk of Clostridium difficile by as much as threefold. Researchers warned there was growing concern over the complications from PPI use,...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.(Ctip2 gene controls growth of tooth enamel)(Brief article)
March 4, 2009... Those of us with less than perfect smiles won't have to grin and bear it any longer as scientists at Oregon State University have found a gene in mice, called Ctip2, that they say controls the growth of tooth enamel. The Guardian and Daily Mail...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
March 4, 2009... Thousands of baby vaccines have been infected with poison, reports the Daily Mirror in typically restrained style. The article comes from a warning from the UK medicines regulator that 20,000 doses of the meningitis C vaccine - sold under the...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.(Brief article)
March 4, 2009... Researchers studying the link between the `television-to-exercise ratio' and BMI took two years and 1,200 Belgian teenagers to work out that those who watched the most TV and did the least exercise were the same teens who had the highest BMIs....

GPs face new pressure on LARCs.
March 4, 2009... Ministers to publish league tables of prescribing rates in new push to drive down rates of teenage pregnancy By Lilian Anekwe Ministers are drawing up plans to launch league tables scrutinising GP prescribing of contraception in an...

More cash for contraception.
March 4, 2009... * #7m for a new `contraceptive choices' media campaign to raise awareness of LARCs and other contraceptive measures * #10m for local health services to ensure contraception is available in the right places at the right time * #1m to...

NICE pushes rapid arthritis referral.
March 4, 2009... GPs urged to refer patients with suspected rheumatoid arthritis even when blood tests are inconclusive By Nigel Praities NICE is urging GPs to refer patients with suspected rheumatoid arthritis rapidly to specialists even when blood...

Referral guidance for rheumatoid arthritis.
March 4, 2009... * Refer for specialist opinion any person with suspected persistent synovitis of undetermined cause * Refer urgently if there has been a delay of three months or longer between the onset of symptoms and seeking medical advice * Also...

JOURNAL WATCH: Muscular link to statins.
March 4, 2009... Muscle problems with statins could be more common than previously assumed, say German researchers. This cross-sectional study looked at the reporting of muscular symptoms in more than 1,030 patients over 50 years of age in primary care,...

JOURNAL WATCH: PPI risk with clopidogrel.
March 4, 2009... Prescribing PPIs along with clopidogrel and aspirin in patients who have suffered a heart attack or have unstable angina may put them at increased risk of heart attack or death. A retrospective study of 8,205 patients in the US with acute...

JOURNAL WATCH: New risk score for AF.(atrial fibrillation )(Brief article)
March 4, 2009... A new risk score could help identify people at most risk of atrial fibrillation in primary care, according to a US study. Using data from the Framingham Heart Study, the researchers selected 4,800 individuals aged 45 to 95 without signs of...

GP child protection crackdown.
March 4, 2009... PCTs scrutinise GP attendance at case conferences and plan to enforce training By Nigel Praities GPs face a crackdown over their child protection role in the wake of the Baby P case, with PCTs targeting poor GP attendance at child case...

GPs leading reform is `nonsense'.
March 4, 2009... Lord Darzi's drive towards a clinician-led NHS is misguided and fails to recognise fundamental deficiencies in doctors' managerial skills, a leading health economist claims. GP leaders recently warned the profession was being frozen out of...

IN BRIEF: GPs hit by Men C recall.
March 4, 2009... GPs will have to trace and recall all babies who may have been vaccinated with a contaminated batch of the meningitis C vaccine. The MHRA recalled the vaccine as a precautionary measure last week after it emerged 17,000 doses delivered to...

IN BRIEF: Locum insurance warning.
March 4, 2009... The Financial Services Authority has issued a warning to GPs after it emerged a company called Aquote, which had been selling locum insurance to practices, had not been passing premiums on to insurance providers, leaving GPs without cover. The...

IN BRIEF: BMA defends 084 use.(British Medical Association)(telephone numbers)(Brief article)
March 4, 2009... The BMA has defended GP surgeries' use of 084 numbers and warned practices must be allowed to see out existing contracts if the numbers are banned. Responding to the Government consultation, the BMA said in the GPC newsletter: `People...

Warning on Framingham in diabetes.
March 4, 2009... GPs using the Framingham score to assess cardiovascular risk in patients with diabetes may be inadvertently denying statins to those who need them. Researchers are urging GPs to use a diabetes-specific tool after finding use of Framingham...

PULSEIN FOCUS: Can the GPC avert a contract crisis?(General Practitioners Committee )
March 4, 2009... Negotiators are seeking talks to stop the contract changes they agreed last October. So where did it all go wrong? By Steve Nowottny Even set against a backdrop of general economic discontent, it has been a bleak winter for the GPC...

An idiot's guide to the contract crisis.(Quality and Outcomes Framework)(contract between General Practitioner Committee and United Kingdom. National Health Service)(Brief article)
March 4, 2009... Why has the deal proved so controversial? The GPC and NHS Employers thrashed out a wide-ranging contract deal last October, which included changing the formula linking QOF pay with disease prevalence, and a differential uplift to kick off...

EDITORIAL: Job crisis requires deeds not words.(Editorial)
March 4, 2009... The GPC warns it is the biggest threat to the future of general practice. Chair Dr Laurence Buckman claims an entire generation of GPs has been failed. He even suggests handing over control of GP job vacancies lock, stock and barrel to the...

LETTER: LES schemes are the answer, not local QOFs.(Letter to the editor)
March 4, 2009... From Dr Brian Dunn, GPC negotiator and chair of GPC Northern Ireland It cannot be the case that local QOFs are already in place as your article suggests (`One GP in seven working under a local QOF', pulsetoday.co.uk/news) for the simple...

LETTER: Alternative medicine has its place.(Letter to the editor)
March 4, 2009... From Dr Andrew Sikorski Wadhurst, East Sussex Complementary medicine is useful when conventional approaches have failed or do not fit a patient's requirements (`Should the NHS Alliance be endorsing alternative medicine?', pulsetoday.co.uk/...

LETTER: Homeopathy is not for me.(Letter to the editor)
March 4, 2009... From Dr Shaba Nabi, Bristol It is interesting that a model has been proposed for GPs to be the gatekeepers for alternative therapies on the NHS (`Homeopathy and acupuncture backed for NHS funding', pulsetoday.co.uk/news). When I was...

LETTER: Is closure on Lord Darzi's agenda?(Letter to the editor)
March 4, 2009... From Dr John Orchard Alfreston, Derbyshire So Lord Darzi wants general practice to follow the example of Starbucks (`Darzi: patients should be offered a Starbucks experience', pulsetoday.co.uk/ news). Presumably since its chief executive...

LETTER: Flexible approach can allow practices to offer extended hours.(Letter to the editor)
March 4, 2009... From Dr Patrick Craig-McFeely Salisbury, Wiltshire I am writing to give my own experience of running extended hours at a small practice (`Extended hours stripping cash from poor practices', pulsetoday.co.uk/news). We have very good...

FOR THE RECORD.
March 4, 2009... * Last week, we reported 44% of singlehanders and 60% of practices with one or two partners were offering extended hours, but in fact the latter figure was for practices with two or three partners. It compares with 83% of practices with eight...

PERSPECTIVE: Shouldn't methadone be judged on level playing field?
March 4, 2009... Why is one of the most highly researched and successful treatments ever under threat? In the first of an occasional series of short essays, Dr Meg Thomas offers her personal views on local moves to cut funding for methadone maintenance ...

PULSECLINICAL: ALLERGIC RHINITIS.
March 4, 2009... GP allergy expert Dr Dermot Ryan answers Dr Mandy Fry's questions on nasal spray technique, antihistamine choice and whether oral or injected steroids have any place in hay fever Take-home points * Patients should be told not to sniff...

PULSECLINICAL: OCD & PTSD.(obsessive-compulsive disorder )(post-traumatic stress disorder)
March 4, 2009... The second in our series on mental health in primary care, by GP and former psychiatrist Dr Mark Morris, covers obsessive-compulsive disorder and post-traumatic stress disorder OCD In this condition, there are distressing recurrent and...

PULSECLINICAL: INTOLERABLY ITCHY RASH.(Case study)
March 4, 2009... The itching on a pregnant woman's abdomen had become intense - Dr Mike Wyndham explains how he found the cause The patient This woman was 28 weeks' pregnant when she first presented with an extremely itchy rash on her abdomen, arms and...

PULSECLINICAL: HOW NOT TO MISS... TORSION OF THE TESTIS.
March 4, 2009... Mr Chris Dawson advises on the key signs and pitfalls in diagnosing torsion of the testis in primary care Worst outcomes if missed If missed, testicular torsion leads to infarction and necrosis of the affected testis, necessitating...

BUSINESSBRIEFING: Financial year planner.
March 4, 2009... Rosemary Smith guides you through the key tasks of the forthcoming financial year - covering both practice and personal finance The new financial year starting in April is likely to be another where expenses increase more than income. ...

I know I shouldn't laugh.(medical consultation)
March 4, 2009... Phil finds it's a stressful business trying to look concerned when he can't keep a straight face I had a very stressful consultation today. Probably most consultations are stressful for the patient and I think we tend to forget this - even...

Leaders rewrite the GP business model.
March 11, 2009... BMA and RCGP launch radical proposals to phase out partner-salaried system within five years By Steve Nowottny The BMA and RCGP have begun radical moves to overhaul the business model of general practice, which they warn has been...

The end of the salaried-partner divide?
March 11, 2009... * The Changing Partnerships document suggests three new roles for GPs, open to both partners and salaried GPs * `Traditional GPs' - GPs focusing on patient care, the role described as `the backbone of quality general practice' * GPs...

GPs who fail to offer choice risk losing job.
March 11, 2009... The Department of Health's plans to make offering choice a contractual obligation could see GPs who fail to comply having their contracts terminated, it emerged this week. The DH's director of primary care, Ben Dyson, said GPs who...

Extra #13m to speed up talking therapies rollout.(Brief article)
March 11, 2009... The Government has vowed to stave off a surge in people suffering from depression during the economic crisis by ploughing more cash into the provision of talking therapies. Health secretary Alan Johnson and work and pensions secretary James...

GPs jumping to diabetes drugs to hit targets.
March 11, 2009... Pressure to fulfil QOF criteria is forcing GPs to ignore NICE guidance and initiate medical treatment in patients with diabetes straight after diagnosis, instead of starting with lifestyle changes. Researchers at the University of Bristol...

NHS `guidebook to GPs' website riddled with errors.
March 11, 2009... As NHS Choices prepares to let patients rate GPs, an investigation reveals half of opening hours listed are wrong Exclusive Steve Nowottny The NHS website set to become a hotel-style guide to GP services is riddled with errors, a...

Errors on NHS Choices.
March 11, 2009... * The opening time errors littering the NHS Choices database range from the minor to the extreme. * Some entries fail to mention practices offer extended hours - or if they do, get them wrong. One north London practice, listed as offering...

Figures show scrapping prescription charges could drive up drugs bills.
March 11, 2009... Exclusive Implementing the BMA's demand to scrap prescription charges might push up prescribing bills as well as reducing NHS revenue, figures suggest. Prescribing rates in Wales have increased substantially more quickly than in...

GPs defy advice on referral incentives.
March 11, 2009... GPs are defying GPC guidance en masse and renewing their participation in controversial referral incentive schemes, Pulse has learned. The GPC has urged GPs not to take part in any scheme containing `an incentivised, target-based element',...

CARE RECORDS: Records opt-out must be `in person'.
March 11, 2009... BMA condemns `appalling' ruling that patients will get care record unless they explain their reasons face-to-face Exclusive By Steve Nowottny NHS managers have told thousands of patients they will only be allowed to opt out of...

CARE RECORDS: Full records access for Whitehall scrapped after backlash.
March 11, 2009... The Government has been forced to scrap a controversial clause in new legislation that would have allowed ministries far-reaching access to medical records. Justice secretary Jack Straw has removed a key clause from the Coroners and...

Benefits for post-sex HPV vaccine.
March 11, 2009... Growing pressure to widen HPV vaccine programme as study finds benefits in sexually active young women By Lilian Anekwe Pressure is building on the Department of Health to widen the school- based HPV immunisation programme, after new...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.
March 11, 2009... Physical activity is beneficial for your health, according to the Swedes, whose researchers found those who vegetate on the sofa in their 50s are likely to die sooner than those who are active. It took a study of more than 2,200 men, over more...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
March 11, 2009... Couch potato kids who spend too much time in front of the TV may be at higher risk than more active children of developing asthma, according to research reported in The Guardian. Researchers at the University of Glasgow found that children...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.
March 11, 2009... As if parents didn't have enough to worry about, researchers are now warning that catching common childhood stomach bugs could trigger the development of type 1 diabetes in young children. A study by researchers in Glasgow found signs of...

Distension is ovarian Ca red flag.
March 11, 2009... Abdominal distension with no other symptoms is enough to warrant further investigation, concludes GP study By Lilian Anekwe GPs should suspect ovarian cancer in any woman presenting with abdominal distension, researchers have warned....

JOURNAL WATCH: Statins cut pneumonia.
March 11, 2009... Statins and ACE inhibitors lower the risk of community-acquired pneumonia, UK researchers report. A case-control study of data from 3,700 patients taken from 300 practices in The Health Improvement Network found a prescription for statins was...

JOURNAL WATCH: Arthritis gene link.
March 11, 2009... Researchers have shown that a family history of rheumatoid arthritis is associated with the early appearance of joint damage. A genetic analysis of 157 Colombian patients with rheumatoid arthritis found that after adjusting for confounders,...

JOURNAL WATCH: BP drug's renal benefits.(Brief article)
March 11, 2009... Prescribing combined antihypertensives significantly reduces the risk of adverse renal events in patients with type 2 diabetes, irrespective of blood pressure. Australian researchers randomly assigned 11,410 patients to either a...

NHS REFORM: GPs to fight Darzi centres for nurses.
March 11, 2009... Practices likely to have to pay nurses more as rollout of GP-led health centres exacerbates recruitment problems By Steve Nowottny The rollout of GP-led health centres is set to swallow up large numbers of practice nurses and trigger...

NHS REFORM: GPs set for practice nurse shortage.
March 11, 2009... * A Pulse investigation found the new GP-led health centres will be dominated by nurses and salaried GPs, with some having more than three nurses for every GP. * The country's first GP-led health centre has already recruited two practice...

NHS REFORM: Winner pulls out of controversial APMS tender.
March 11, 2009... An APMS tender at the centre of a storm of protest from GPs and patients has been set back by months after the preferred bidder pulled out. Manchester PCT will now re-tender two contracts for GP practices under Lord Darzi's equitable...

NHS REFORM: PCTs to ramp up drive to attract private providers.
March 11, 2009... PCTs are set to dramatically ramp up efforts to entice the private sector into primary care after failing to meet Department of Health targets to increase competition. A series of detailed SHA assessments of PCTs' commissioning skills...

IN BRIEF: Risperidone warning.
March 11, 2009... The Medicines and Healthcare Products Regulatory Agency has listed risperidone as a `black triangle' drug, in order to monitor the antipsychotic's safety profile in the wake of growing evidence of an increased risk of stroke and death in...

IN BRIEF: NICE chair gets reprieve.(National Institute for Clinical Excellence reappointed Michael Rawlins)(Brief article)
March 11, 2009... Professor Sir Michael Rawlins has been reappointed as chair of NICE - thanks to a special exemption that allowed him to extend his tenure. Chairs of bodies such as NICE are usually allowed to remain in post for a maximum of 10 years, which...

IN BRIEF: GP turns patients into art.
March 11, 2009... Damien Hirst has nothing on Dr James Pimm, a partner at the Brookside Group Practice at Winnersh, near Reading, who asked his patients to become the subjects of an art exhibition about general practice. The works include a torch shone down...

Referrals surge sparks cuts in enhanced services.
March 11, 2009... PCTs are cutting enhanced services in response to the financial crisis caused by the huge rise in GP referrals. Practices in cash-strapped trusts look set to miss out on the promised increase in enhanced service funding, which is supposed...

PULSEIN FOCUS: PBC reaches crossroads as some GPs get real budgets.
March 11, 2009... A Government relaunch of GP commissioning falls short of offering real budgets, but some PCTs are going it alone By Lilian Anekwe Should GPs seize control of portions of GP budgets, or stand aside and let the private sector take over?...

PULSEIN FOCUS: From fundholding to the future.
March 11, 2009... Fundholding: Practices with more than 5,000 patients held budgets for hospital care, drugs, staffing and community services. Accused of providing incentives to buy cheaper services or discriminate against patients needing costly care. PBC:...

EDITORIAL: These errors will distort patient choice.(Editorial)
March 11, 2009... If you were to grab a Department of Health official and ask them to describe Government primary care policy in just a couple of words, the chances are they would plump for `access' and `choice'. Both are loaded with symbolism far stronger than...

VOX POP: Is NHS Choices useful for patients?
March 11, 2009... Dr Peter Fellows GP in Lydney, Gloucestershire `It's got more to do with politics. Choice has become a byword with very little meaning. The website itself is not particularly useful and I've not come across any patients who've used it.' ...

LETTER: Attack on NHS Alliance lacking in evidence.(Letter to the editor)
March 11, 2009... From Michael Sobanja Chief executive, NHS Alliance Open letter to Professor Edzard Ernst Dear Professor Ernst, Being an academic who puts such obvious importance on evidence, it is ironic that your attack on the NHS Alliance via...

LETTER: Urgent care centres are the way forward.(Letter to the editor)
March 11, 2009... From Anne Walker Chief executive, West Hertfordshire PCT, East and North Hertfordshire PCT Your article `Urgent care centres to send thousands of cases back to GPs', pulsetoday.co.uk/news) does not tell the whole story. Since October...

LETTER: Care records improve quality and safety.(Letter to the editor)
March 11, 2009... From Dr Claire Wightman, NPfIT communication manager Royal Bolton Hospital Foundation Trust, NHS Bolton and NHS Connecting for Health are united in their confidence that the use of the Summary Care Record is progressing well in Bolton. The...

LETTER: Ivan's death is a time to reflect on the NHS.(Letter to the editor)
March 11, 2009... From Dr Andrew Cummin Farnham, Surrey We can only hope that out of the sadness of the death of David Cameron's son Ivan, ministers take a moment to reflect on how enriched we are as a country by the NHS and those who work within it. And...