Pulse articles from November 2003

Pulse archives from November 2003

Out-of-hours mess delays GPs' opt-out.(primary care organizations lack cash)
November 3, 2003... Many GPs will be forced to wait until the December 2004 deadline to ditch out-of-hours work because primary care organisations are struggling to find the cash for the services. The delays mean PCOs going to the wire before letting GPs opt...

GP attacked by baseball bat thugs.(general practitioner Sandra Elliott)(Brief Article)
November 3, 2003... Dr Sandra Elliott has been attacked by thugs wielding a baseball bat as she ended an out-of-hours shift. The assault took place as she left the out-of-hours centre in Craigavon, County Armagh, at midnight. `I was driving when they ran...

Confusion over contract informed dissent rules.(reporting women who refuse cervical screening)(Brief Article)
November 3, 2003... Confusion has emerged on what steps GPs will have to take before they can report women as informed dissenters for cervical screening under the new contract target pay system. The disagreement between the GPC and NHS Confederation blew up...

Top-scoring GP loses #2k bonus for prescribing.(general practitioner meets prescibing quality guidelines)(Brief Article)
November 3, 2003... Dr Adrian Pierry has missed out on a #2,000 prescribing incentive bonus despite scoring top marks for prescribing quality. Dr Pierry, a singlehanded GP in Cardiff, got 31 out of 32 prescribing indicator points - the highest score in South...

PCOs in the dark on budgets as GP prescribing costs soar.(Brief Article)
November 3, 2003... Primary care organisations may have to set crucial budgets without key Government commissioned estimates of how much cash to set aside to fund the quality framework. Researchers charged with predicting the impact of the framework on GP...

Teenagers worst hit by surge in mumps.(Brief Article)
November 3, 2003... The number of mumps cases in Wales has soared more than five-fold in a year, official figures reveal. There have been 323 laboratory-confirmed cases so far this year compared with 64 in the whole of last year and just two in 1999. England...

GPs are put at legal risk as solicitors fish for records.
November 3, 2003... GPs are being put at risk of legal action for breaches of patient confidentiality because they are so overwhelmed by a deluge of solicitors' demands for medical records. Government research has found GPs often do not have time to screen...

Two options for PMS GPs' quality payments.(medical clinic quality management)(Brief Article)
November 3, 2003... PMS practices will either get less money per quality point or have a threshold imposed before they can start earning under proposals to implement the framework for PMS GPs. The two options are the leading contenders in GPC and Department of...

Fasting risk in Muslim diabetics.(Brief Article)
November 3, 2003... Dr Yohannes Bahru has urged GPs to ensure Muslims with type 2 diabetes protect their health during Ramadan. Under Islamic law people with diabetes or any other illness do not have to fast during Ramadan, which began on October 26. But many...

NICE steroids advice for COPD thrown into doubt.(National Institute for Clinical Excellence studies chronic obstructive pulmonary disease treatment)
November 3, 2003... Inhaled steroids can slow lung function decline in all patients with chronic obstructive pulmonary disease, reveals a US Government-funded study. The finding challenges the traditional view that the drugs only benefit the most severe COPD...

Accountants allay GP pension fears.(general practitioners' expense for profit calculation)(Brief Article)
November 3, 2003... Medical accountants are dismissing reports practices will face #2,000 bills for calculating their profits in order to work out GPs' pensions. GP negotiators also predicted practices will save money under the pension arrangements for the...

Rural GPs help to pay for bus for patients.(Brief Article)
November 3, 2003... Dr Iain Mungall's rural practice is helping fund a bus service to bring patients to the village where the surgery is based. Patients can use the weekly bus, even if they just want to go shopping or meet friends. Dr Mungall, a GP in...

Fresh doubts over staffing at NHS Direct.(United Kingdom's National Health Services)(Brief Article)
November 3, 2003... NHS Direct is battling to overcome staff shortages at most of its sites, Government figures reveal. The statistics have cast fresh doubt on Department of Health plans to expand the nurse triage service to become a single point of contact...

Row over Lancet alert on Crestor.(efficacy of statin drug challenged)(Brief Article)
November 3, 2003... GPs have been urged by The Lancet to think twice before prescribing the statin Crestor (rosuvastatin). The accusation that manufacturer Astra- Zeneca `forced' Crestor into the market despite there being `no reliable data about efficacy and...

Practices meet CHD targets - but at a price.(coronary heart disease )(Brief Article)
November 3, 2003... Dr Stewart Findlay's PCT has managed to meet nearly all the targets for coronary heart disease in the new contract - but at a cost to the prescribing budget and other services. Dr Findlay, a GP in Bishop Auckland, and chair of Durham Dales...

Advisers say PSA policy is `bad medicine'.(prostate specific antigen )
November 3, 2003... GP advisers have accused the Government of putting GPs in an impossible position by jumping the gun on prostate specific antigen testing. They say the policy that requires GPs to provide PSA tests on demand should be abandoned until full...

Osteoporosis drug launch.(high price of teriparatide may limit use)(Brief Article)
November 3, 2003... The first in a new class of osteoporosis drugs that stimulate the growth of new bone has been flagged up by a Government research body as having a `significant clinical impact' on treatment of the disease. But the cost of teriparatide...

GPs protest at call to take on care of high-risk patients.(high-risk mental health patients )(Brief Article)
November 3, 2003... GPs in Manchester have accused psychiatrists of trying to saddle them with high-risk mental health patients to cover for a consultant vacancy. Manchester Mental Health and Social Care Trust wrote to the LMC saying consultant teams would...

Records policy vital to avoid complaints.(medical records policies)(Brief Article)
November 3, 2003... GPs are risking patient complaints unless they establish policies for record keeping, adverse incidents and monitoring patients who fail to attend for follow-ups. A survey of 200 doctors by the Medical Defence Union found 70 per cent of...

Delayed scripts cut antibiotic use by half.
November 3, 2003... GPs can halve the number of patients taking antibiotics for upper respiratory tract infections by writing deferred prescriptions, a study reveals. The vast majority of patients in the study were confident about making choices about their...

New breast cancer scares spark stampede from HRT.(hormone replacement therapy)
November 3, 2003... GPs and patients have been scared off HRT in the wake of two high- profile studies linking the therapy to breast cancer, experts claim. Prescribing rates have dropped by almost a fifth in England and 15 per cent in Scotland since the US-led...

GP takes action over `shoddy' orthopaedics.(general practitioner Sarah Schofield)(Brief Article)
November 3, 2003... Dr Sarah Schofield was so appalled by the `shoddy care' provided by orthopaedics in her area that she joined the board of her local acute trust to make a difference. Dr Schofield, a GP in Southampton, helped set up a Government-funded...

CSM stands by HRT advice.(Committee on Safety of Medicines on hormone replacement therapy )(Brief Article)
November 3, 2003... The Committee on Safety of Medicines has refuted calls to withdraw `unsound' advice on hormone replacement therapy based on the Million Women Study. In August the CSM issued warnings over combined HRT after the study suggested it caused a...

Truant reports `will drive wedge in doctor-patient relationships'.
November 3, 2003... GPs have accused education authorities of threatening the doctor- patient relationship in their efforts to crack down on school truants. The row broke out after GPs in South Yorkshire were asked by councils to provide medical reports on...

Drug trial GPs are set to lose #30k.(finance of clinical research contracts )(Brief Article)
November 3, 2003... Dr Barry Silvert is warning many GPs could lose #30,000 a year in clinical research contracts because primary care organisations are `muscling in' on approval for drug trials. Dr Silvert, chair of the British Association of Clinical...

League tables lead to `climate of fear'.(public rankings of physician performance indicators)(Brief Article)
November 3, 2003... League tables of GPs could be counter-productive and lead to a `climate of fear and disaffection', statisticians are warning. A report from the Royal Statistical Society criticised the `design, analysis and reporting' of many performance...

Cash-flow shortage may hit GP premises improvements.(physician's office and clinic improvements)
November 3, 2003... GPs are raising concerns that cash-strapped primary care organisations will not have enough money to pay for premises improvements under the new contract. A poll of GPs in Gloucestershire has shown 60 per cent of GPs want to make...

EDITORIAL COMMENT: Out-of-hours care must have GPs on board.(Brief Article)(Editorial)
November 3, 2003... With varying degrees of enthusiasm, PCOs are bracing themselves for the full weight of out-of-hours responsibility that is headed their way. As they consider their options, they should pay particular attention to new figures that raise major...

Talking POINT.(Interview)
November 3, 2003... Dr Raj Dhumale practises in Norfolk. A GP for nine years, he is also a qualified general surgeon. Jo Carlowe asked him about the hot topics in his practice. Information technology Does your practice have a modern IT system capable of...

Letter: Time to lay animosity to rest between locums and principals.(Letter to the Editor)
November 3, 2003... In my short time as a GP registrar I have noticed an increasingly fractured workforce. We now have GMS, PMS, GPs with special interests, locums, retainers - the list goes on. As this fracturing continues we are in danger of misunderstanding...

Letter: No more home visits except for the severely debilitated.(Letter to the Editor)
November 3, 2003... Regarding Dr Nick Luscombe's letter (October 20), I have a few examples of home visit requests of my own. * During evening surgery I was asked by a woman to visit her 18-year- old son who had a cough. I offered to see him in surgery but...

Letter: Why Muslims opt for circumcision.(Letter to the Editor)
November 3, 2003... Copyright: CMP Information Ltd. In his condemnation of routine infant male circumcision (Letters, October 27) Dr Simon Fisher says those of the Muslim and Jewish faith are beginning to question the wisdom of the procedure. I perform...

Letter: Be sensitive to the beliefs of Christians.(Letter to the Editor)
November 3, 2003... `Treating Christian patients' (October 20) aimed `to outline Christian belief systems impacting on care' but left the impression that members of the various protestant and independent churches, who together make up 90 per cent of the Christian...

Letter: Taking issue with Dr Simon Fisher.(Letter to the Editor)
November 3, 2003... I must take issue with Dr Simon Fisher when he states that many Muslim authorities are questioning circumcision. As a member of a Mosque committee who attends national meetings, I am not aware of any such questions. To be a Muslim a...

Letter: Atkins deficient only in stodge.(Letter to the Editor)
November 3, 2003... Susan Jebb (Answer Back, September 22) either has not read Atkins or is wilfully misrepresenting his work. The evidence for the effectiveness of the reduced carbohydrate diet is quite clear, and evident on a daily basis to any diabetic...

Letter: Why be so un-complementary?(Letter to the Editor)
November 3, 2003... I find myself reading the answers to Answer Back provided by Professor Edzard Ernst with an uneasy feeling - how can a professor of complementary medicine be so negative about his own specialty? In his discussion of aloe vera (October 27)...

Letter: Grant GPs anonymity in GMC proceedings.(Letter to the Editor)
November 3, 2003... I entirely agree with the Medical Protection Society that doctors facing proceedings before the GMC should at least be granted anonymity (News, October 27). There is a glaring irony in your article that might be funny were not the matters...

Use computer templates to hit top quality scores.(quality management for medical practice)
November 3, 2003... Do not underestimate the importance of templates and care pathways in getting the best from the quality framework, says Dr John Couch You would have to have been on a desert island for the last 12 months to be unaware of the new GMS quality...

How automated check-in saves us two hours a day.(medical office uses Savience system)
November 3, 2003... A computerised appointment check-in system for patients is saving receptionists at Dr Stephen Gardiner's practice two hours a day - he explains how it works Most practices are on the lookout for ways to manage their ever- increasing...

Minor surgery under the new contract.(general practitioners' contract)
November 3, 2003... There is money to be made performing minor surgery but your practices will have to prioritise, says Dr Nigel Stollery Since 1990, simple monthly cryotherapy clinics and occasional steroid joint injections have resulted in maximum minor...

Child porn links found on registrar's computer.
November 3, 2003... The problem The practice registrar has been with us for almost six months. He is a pleasant, rather quiet young man who is unforthcoming about his social life but works hard and seemed certain to complete his training successfully. But a...

Practice Q&As: Overseas visitor demands hospital investigation.(Brief Article)
November 3, 2003... Q: The mother of one of our patients has just arrived from her home in Libya for a holiday. She has a number of pre-existing medical conditions and is insisting I accept her on my GMS list and I refer her to hospital for investigations and...

Wife wants you to conspire against `alcoholic' husband.
November 3, 2003... Case history Dennis, 70, has psoriasis with mild arthropathy. Symptoms are well controlled on methotrexate, diclofenac and topical emollients, and he normally consults your partner. Today, in your partner's absence, he has come to see you...

Is the polypill realistic?(combination drug of cardiac disease medications)
November 3, 2003... Dr Irene Chung and Professor Gregory Lip review the available evidence and ask... Coronary heart disease and stroke are major problems in the UK. CHD is the biggest killer, accounting for 124,000 deaths each year2. Its prevalence is 3-7...

What GPs need to know about self-testing.(patient use of diagnostic kits)
November 3, 2003... Sue Jones and Dr Lisa Argent look at whether over-the-counter monitoring kits can be useful An increasing number of people are taking a positive approach to their health and a personal approach to monitoring it. This has led to a market...

CLINICAL: Osteoporosis.
November 3, 2003... GP Dr Stefan Cembrowicz in conversation with consultant geriatrician Dr Theresa Allain Practical points * PTH could be a very effective treatment * Bisphosphonates only work if patient is calcium and vitamin D replete *...

TEST YOURSELF ON: Polymorphous light eruption.
November 3, 2003... Use our quick quiz to check your clinical knowledge 1 How common is polymorphous light eruption (PMLE)? US 10 per cent, UK 20 per cent. 2 Women are more commonly affected than men. True or false? True. The ratio is 3:1,...

Should you see a drug rep calling on spec?
November 3, 2003... Case history After a busy morning surgery the receptionist rang through while you were trying to drink coffee and sign prescriptions. `There's a rep just come in. She's brought some doughnuts. Could you see her for five minutes?' Dr Peter...

YOUR FIRST: MISTAKE.(missing penicillin allergies)
November 3, 2003... Thirty seconds after Mrs Jones left with her prescription for penicillin you realise you forgot to ask about allergies. You check the computer to discover that she is, in fact, allergic to penicillin. Our first reaction when we discover we...

ANSWER BACK: Clearing up the confusion over HRT.
November 3, 2003... Q: Do the WHI data mean we should change what we say about HRT? A: The Women's Health Initiative (WHI) study has raised important clinical issues and we have to re-evaluate the way we prescribe HRT. It must be emphasised this relates...

ANSWER BACK: When should we use metformin in PCOS?
November 3, 2003... Q: Which women with PCOS should receive metformin? A: There are now many studies supporting the view that metformin is useful treatment for improving the rate of ovulation and for hirsutism in polycystic ovary syndrome (PCOS). But there has...

GPs on alert over deadly flu strain.
November 10, 2003... The Government has put GPs on alert over a new variant strain of influenza that has caused the deaths of several children in the UK. GPs are being urged by the Health Protection Agency to step up their flu immunisation efforts, focusing...

PCTs may help choose partners.
November 10, 2003... Patients and primary care trusts could be given a say in who GPs take on as their partners under an idea floated by the Shipman inquiry team. The suggestion - in a consultation document that sets out the issues to be considered by the...

Quality scheme had to crack down on exception reporting.
November 10, 2003... GPs working in a prototype of the quality framework have seen their levels of exception reporting cut to a `bare minimum' after a crackdown by assessors, Pulse has learned. Leaders of the Primary Care Clinical Effectiveness - or PRICCE -...

Close ties mean I'll still do out-of-hours.
November 10, 2003... Rural GP Dr Michael Scott says he will need to work out-of-hours shifts to preserve his close relationship with his patients. Dr Scott and his partners in Brookborough, County Fermanagh, work eight sessions a month and will continue to do so...

`GPs don't have to publish scores'.
November 10, 2003... GPC chair Dr John Chisholm has told practices they will be under `no obligation' to publish their quality and outcomes scores. Health minister John Hutton has made clear he wants practice scores published from April 2005 under the Freedom...

Alert over BP monitor accuracy.
November 10, 2003... Fears that inaccurate automated blood pressure monitors may be missing cases of hypertension have prompted Chief Medical Officer Sir Liam Donaldson to set up a working group to advise GPs. The group is considering telling GPs they need to...

25% of practices have closed lists.
November 10, 2003... One in four of 119 practices contacted by Consumers Association researchers posing as new patients said its list was closed. The association said the results were `disturbing' but warned forced allocations put strains on overstretched GPs. ...

Over-75 checks deadline missed.
November 10, 2003... More than two-thirds of practices have still not met the April 2002 Government deadline to introduce regular medication review for over- 75s. Paul Burstow, Lib Dem health spokesman, said a reply to his parliamentary question revealed 6,208...

Plunging MMR uptake leaves UK close to endemic measles.
November 10, 2003... Crashing MMR uptake means measles is fast approaching the point where it will become endemic in the UK, warns a team that includes researchers from the Government's Health Protection Agency. But the researchers played down a highly...

Low mumps immunity in 17-20s.
November 10, 2003... More than a quarter of 17- to 20-year-olds in the UK could be at risk of catching mumps, according to researchers who studied an outbreak among trainees at an RAF base. But it is too late to start a mass immunisation campaign in this age...

Hib campaign takes a pounding.
November 10, 2003... Dr Bhupendra Patel has condemned the Government's haemophilus influenzae type b vaccine booster campaign as underfunded, bureaucratic and unfair because of unequal distribution of the #1 administration fee. The campaign was launched earlier...

Siege GP `relieved' as patient is jailed.
November 10, 2003... A GP who was held hostage at knifepoint for seven hours has spoken of his relief that he can put the ordeal behind him after the patient who held him captive was jailed for five years. Dr John Aherne was the victim of a siege by ex-soldier...

BMA acts over locum pay rates.
November 10, 2003... The BMA plans to take action to persuade non-principals who are negotiating their locum pay rates to take account of the costs faced by GP partners in running their practices. Its professional fees committee said a working group set up with...

Cannabis MS benefits `subjective'.
November 10, 2003... Long-awaited results from the first large-scale randomised trial of the use of cannabinoids in multiple sclerosis present a mixed picture. The researchers, who were funded by the Medical Research Council, found no improvement in spasticity...

No asylum seeker TB cases found.
November 10, 2003... A GP who screens newly-arrived asylum seekers for tuberculosis has revealed that the #250,000 Home Office scheme has failed to identify a single case despite screening 4,340 people in six months. Dr Peter LeFeuvre, who practises in Dover,...

Reid tells GPs to learn from US-style care.
November 10, 2003... Health Secretary John Reid has told GPs the NHS must learn five key lessons from controversial US health care provider Kaiser Permanente. Mr Reid's aggressive defence of the Department of Health's eight pilots linking primary care trusts to...

Escape hatch for threatened GPs.
November 10, 2003... GPs treating violent patients will be able to flee through an escape hatch that is being incorporated into a new mobile surgery. The mobile surgery will be used to treat violent patients from four primary care trusts across north...

Struck off for exam bribe.
November 10, 2003... GP registrar Dr Harrydath Nandoe has been struck off after starting work at a Chester practice without mentioning he faced a GMC charge of serious professional misconduct. When placed in October 2001 he was facing charges of offering #500...

Three co-ops under threat in battle for out-of-hours deal.
November 10, 2003... Three GP co-operatives face closure after being forced into a head-to- head battle with commercial deputising service Primecare over who can offer the best out-of-hours service. The contract to provide the service from April next year has...

Contraception hotline comes under attack.
November 10, 2003... A GP has leapt to the defence of a new telephone hotline offering teenagers urgent GP appointments for emergency contraception after it came under fire on the eve of its launch. The Daily Mail claimed the North Tyneside PCT scheme, to be...

Aspirin break for surgery raises risk.
November 10, 2003... Patients with heart disease who stop taking their regular dose of aspirin in preparation for dental treatment or minor surgical procedures increase their risk of an acute coronary syndrome, according to new French research. Of 1,236 people...

Shipman sparks system for patients to check own notes.
November 10, 2003... A GP who experienced first hand the devastation caused by Harold Shipman is encouraging others to follow his lead in creating greater patient vigilance. Dr Richard Fitton, who works at a neighbouring practice, testified at the Shipman...

GPs told to over-egg quality aspiration to ease cash-flow.
November 10, 2003... Some LMCs are advising practices to aspire to more quality points than they think they will get in order to maximise the cash they get upfront. LMCs said practices would have more flexibility to spend the quality money and could use it to...

POLICE APPEAL: GPs asked for help to trace missing girl.
November 10, 2003... Police have asked GPs to help them find a woman who went missing in September. Shafilea Ahmed, 17, has an oesophageal stricture caused by consumption of a chemical substance and was receiving dilation treatment for the condition. She...

New study allays fear over inhaled steroids.
November 10, 2003... Long-term use of inhaled corticosteroids in patients with asthma or COPD does not lead to a significant decrease in bone mineral density, a new US study reveals. The finding, based on a meta-analysis of 14 studies, helps allay fears that...

48-hr access policy `could spread flu'.
November 10, 2003... The GPC is warning the Government's 48-hour access policy could cause flu to spread like wildfire this winter. Dr Peter Fellows, GPC prescribing chair and a GP in Gloucestershire, said his surgery had seen a glut of patients with flu-like...

GP fury as Northern Ireland delays pay.
November 10, 2003... GPs in Northern Ireland are furious after being told they will have to wait until the end of the year for their pay rise. Problems with software have delayed the uplift to fees and allowances until the next quarterly payment due at the end...

GP condemns NHS Direct advice.
November 10, 2003... Dr Patricia Critchley has condemned NHS Direct after it told a patient who wanted advice on pregnancy testing to see a GP within one hour. Dr Critchley, a GP in south London and a member of South East London Doctors on Call, said the...

Quick reckoner for quality pay.
November 10, 2003... GPs can predict how many points they will score on the quality framework in the first year of the contract using a sample of just 10 patients, according to GP negotiators. GPC joint-deputy chair Dr Hamish Meldrum said practices should...

GPs urged to record flu vaccine refusal in notes.
November 10, 2003... GPs are being urged to keep a note of patients who actively refuse the flu jab so they can defend themselves if they miss Government immunisation targets this winter. Somerset LMC has advised GPs to keep records amid concerns that a...

Talking POINTS.
November 10, 2003... Dr Helen Parry is a salaried GP in Sunderland and has practised for 15 months. Jo Carlowe asked her about the hot topics in her practice. Out-of-hours Is your PCO ready to take it over? We are still waiting to hear what the...

EDITORIAL COMMENT: A lot at stake in exception reporting row.
November 10, 2003... Enshrining the principle of exception reporting in the quality framework was one of the highlights of the new contract. GPs are rightly fed up with losing money because gullible patients have lost faith in MMR and with being accused of...

Letter: Sudden loss of vision fixed with micropore tape.(Letter to the Editor)
November 10, 2003... Dr Nick Luscombe asks for examples of abusive home visits (Letters, October 20). A couple of years ago I was working for our local out-of- hours co-operative as the visiting doctor. Our co-op functions with one doctor working at a primary care...