Pulse articles from November 2004

Pulse archives from November 2004

GPs told to spend 40% of quality pay on patient care.
November 1, 2004... The Government expects GPs to plough at least 40 per cent of their quality pay back into their practices to improve patient services, writes Rob Finch. GPs reacted with outrage to the demand, retorting that it was `none of the Government's...

Practices with low quality scores could lose to private firms.
November 1, 2004... GPs could have their contracts ended and practices taken over by private firms if they do not score well on the quality framework, writes Ian Cameron. A leading Department of Health official said last week that PCTs should use quality...

GPC fights back as MPs claim GPs cannot spot cancer signs.
November 1, 2004... Furious GPC negotiators have defended GPs against `insulting and unfair' allegations by MPs that they don't have the skills to detect cancer. The All-Party Parliamentary Group on Cancer report released last week claimed GPs had difficulty...

Go-ahead for bowel cancer screening.(Brief Article)
November 1, 2004... Bowel cancer screening will be rolled out nationally starting in 18 months' time, Health Secretary John Reid announced last week. Home testing kits for faecal occult blood testing will be sent to all men and women over 60 from April 2006....

GP quits over allocations.(Brief Article)
November 1, 2004... Dr Ann Bolitho-Jones is resigning from her practice after 14 years in protest at her PCT's decision to allocate 26 nursing home patients. The allocations came as a result of a dispute between Watford and Three Rivers and Hillingdon PCTs...

GSK cancels flu jab orders.(Brief Article)
November 1, 2004... GPs have been left reeling after drug company GSK admitted it was unable to fulfil orders for flu vaccines, just a month after Chiron withdrew two million doses. GSK last week cancelled orders promised to some GPs who had turned to the...

PCTs underfund enhanced services.(Primary Care Trust (UK National Health Service))(Brief Article)
November 1, 2004... Many PCTs will fail to meet their minimum spending targets for enhanced services. GPs said trusts have either not commissioned enough services or capped activity at too low a level. Trusts that fail to meet their spending floor could lose...

Government wants to cut registrar pay supplement.(Brief Article)
November 1, 2004... The Government is pushing the pay Review Body to cut the income supplement for GP registrars in order to boost recruitment of hospital doctors. Department of Health evidence to the 2005 review said `careful consideration' should be given...

Personal health plans may cause rebellion against GPs.
November 1, 2004... Government plans to force GPs to `nanny' and `guilt-trip' patients into better health could backfire and cause patients to rebel, public health experts warn. Under a scheme due to be unveiled in next week's public health white paper, GPs...

GP's `no compromise' stance over #5bn regeneration plan.(Brief Article)
November 1, 2004... Dr Jonathan Fluxman's practice is resisting a compulsory purchase order served by Westminster city council so it can start work on a #5 billion regeneration project. The practice has objected that plans for a new health centre built as...

GPs are warned over epilepsy prescribing.(Brief Article)
November 1, 2004... GPs should not prescribe drugs to patients with suspected epilepsy until a specialist confirms the diagnosis - despite long neurology waiting lists, according to new NICE guidelines. The guidelines on the diagnosis and treatment of epilepsy...

Antidepressant `exaggerated'.(Brief Article)
November 1, 2004... Pharmaceutical company Wyeth exaggerated the benefits of Efexor (venlafaxine), regulatory authorities have ruled. A Medicines and Healthcare Products Regulatory Agency investigation found `insufficient data' to prove Efexor offered better...

Scotland will be short of 500 GPs.(Brief Article)
November 1, 2004... Scotland will suffer a shortfall of 500 GPs by 2012, RCGP Scotland has warned. In evidence to a Scottish Parliament health committee inquiry, the college said it expected a `rapid deterioration' in GP numbers over the next eight years. A...

Never enough slots for patients.(Brief Article)
November 1, 2004... Dr Howard Freeman says his south London practice leaves one-third of appointments open for advance booking, but patients still complain there are not enough. `What the Government wants is for people to have greater access on the day but that is...

`Ridiculous' access targets force GPs to restrict bookings.
November 1, 2004... Unrepentant GPs insist they have no spare capacity to offer advance slots to meet 48-hour targets - by Nerys Hairon Practices are adamant they have no alternative other than to restrict advance appointments as long as the Government...

PCTs `will not be decimated'.(Primary Care Trust )(Brief Article)
November 1, 2004... Health minister John Hutton has strenuously denied reports the Government plans to slash the number of primary care trusts. He said the NHS needed more reorganisation `like a hole in the head' and there were no plans to cut the number of...

Poor data on cash to accruals.(Brief Article)
November 1, 2004... The Government has admitted the data it used to work out the controversial cash to accruals factor is `of poor quality' but is refusing to change the calculation. GPs stand to lose #500 each as a result of applying the factor of 0.9956 to...

GPs condemn plan to transfer core work.
November 1, 2004... As GPs attack a skill mix plan as `the thin end of the wedge', a new pharmacy contract has reignited pay fears - by Emma Wilkinson GPs have condemned a Government plan to shift large chunks of their core work to other health care workers as...

Alert as PCOs shortchange GPs over childhood immunisations.(Brief Article)
November 1, 2004... PCOs could be shortchanging GPs on childhood immunisations by refusing to pay retrospective payments on top of advance sums, warns Dr Lisa Silver. The contract changeover from retrospective reimbursement to payments up front has caused...

Pharmacy contract sparks GP pay fear.(Brief Article)
November 1, 2004... The launch of the new pharmacy contract has reignited fears that it could undermine continuity of care and cut into GPs' enhanced service pay. Under the new deal, due to go to a vote this month, pharmacists could be paid for providing...

Acid suppression `raises the risk of pneumonia'.
November 1, 2004... Patients on acid suppressant therapy are four times more likely to catch pneumonia, according to new research. GPs should prescribe the minimum dose of acid suppressant therapies to patients at risk of acquiring pneumonia, and only when...

More acute RTIs as GPs cut scripts.
November 1, 2004... Fears have resurfaced that GPs' success in cutting antibiotic use may have caused a big rise in serious respiratory tract infections as new research shows rising hospital admissions. The news came as it emerged that a Government advisory...

Hep B vaccine hope.(Brief Article)
November 1, 2004... Universal hepatitis B immunisation in adolescents would be highly successful, especially if only two doses were used, a Scottish pilot has shown. The Government's immunisation advisory body, the Joint Committee on Vaccination and...

JOURNAL WATCH: BP not controlled in high-risk patients.(Brief Article)
November 1, 2004... Hypertension is least likely to be controlled in patients at highest risk of heart attack and stroke despite them being on more medication, according to US research. A chart review and survey of 613 patients found that patients with...

JOURNAL WATCH: Traffic exposure triggers heart attack.(Brief Article)
November 1, 2004... People who spend a lot of time in the car or on public transport may be increasing their risk of a heart attack, warn German researchers. An analysis of the records of 691 patients found exposure to traffic was associated with three times...

JOURNAL WATCH: Understanding diabetes information.(Brief Article)
November 1, 2004... Diabetic patients with poor literacy skills benefit more from individual management programmes than those who can read and write, according to a large randomised controlled trial. Patients with literacy problems who received individualised...

JOURNAL WATCH: High-flow oxygen helps COPD exercise.(Chronic Obstructive Pulmonary Disease )(Brief Article)
November 1, 2004... High flows of humidified oxygen improve exercise performance in patients with COPD, a US study has found. The study of 10 patients with COPD found patients could exercise for nearly two minutes longer on high flows with less dyspnoea, better...

JOURNAL WATCH: Risk factors for near-fatal asthma.(Brief Article)
November 1, 2004... The loss of lung elastic recoil and hyperinflation are risk factors for near-fatal asthma, according to a new study. The Toronto study of 43 asthmatic patients, aged 16 to 49, found a persistent reduction in FEV1 of The loss of lung...

JOURNAL WATCH: Multiple drug therapy cuts heart risk.(Brief Article)
November 1, 2004... Patients prescribed both a statin and an ACE inhibitor are less likely to have a cardiovascular event than patients prescribed either drug alone, new Greek research shows. The study of 1,600 patients with coronary heart disease found that...

NHS plan hits GPs' place at heart of primary care.
November 1, 2004... The Government's NHS Improvement Plan is set to damage GPs' place at the heart of primary care and further weaken small practices, the GPC is warning. In an official response to the plan, the committee said a pledge to increase the number...

Data advice for quality visits.(Brief Article)
November 1, 2004... Practices must either get patients' express consent before revealing information to PCTs during quality visits or anonymise all data, the Medical Defence Union is advising. Dr Matthew Lee, medico-legal adviser for the defence body, said if...

#13m super-surgery lift-off.(Brief Article)
November 1, 2004... Building work on a new #13 million super-surgery housing more than 30 GPs and catering for 60,000 patients began last week. All six existing practices in Macclesfield, Cheshire, will move into the Waters Green surgery which is due to open...

GPs stop PMS cash going to GMS practices.(Brief Article)
November 1, 2004... GPs in Devon have stopped their PCT allocating some of its PMS growth money to GMS practices. Exeter PCT had wanted to reallocate #90,500 out of #602,000 PMS growth funds to help two GMS practices in financial trouble. It also wanted to...

GPs left guessing over exception reporting rules.
November 1, 2004... The GPC believes the guidance on exception reporting is clear, but GPs are telling Pulse a different story - Rob Finch analyses the results of our latest survey GPs are crying out for advice over how to exception report after a Pulse...

GP will report over flu vaccine refusals.(Brief Article)
November 1, 2004... There is no evidence base to support immunising mild asthmatics against flu, according to Dr Mike Thomas - who is determined to exception report anyone who refuses. He is part of a minority of GPs planning to exception report against flu...

GPs to join NHS fraudbusters on visits to protect confidentiality.
November 1, 2004... Copyright: CMP Information Ltd. Clinical `experts' including GPs will accompany NHS fraudbusters on visits to practices suspected of wrongdoing in order to protect patient confidentiality. In a move intended to allay GPs' fears over a...

GP steps in to keep solo practice open.(Brief Article)
November 1, 2004... Dr Brian Balmer is acting as `caretaker' GP at the beleaguered Hoppit singlehanded practice, which has been saved from closure by a vociferous patient campaign. Patients had accused Maldon and South Chelmsford PCT of trying to close the...

EC orders safety inquiry into all cox-2 inhibitors.(European Commission )
November 1, 2004... The European Commission has stepped in to order a root-and-branch review of the safety of cox-2 inhibitors after a preliminary inquiry failed to give the drugs a clean bill of health. But GPs are to be left without clear guidance...

More cox-2 inhibitor news.(Brief Article)
November 1, 2004... * MSD has moved to quell concerns by offering to reimburse patients for the cost of their final prescription of Vioxx or Vioxxacute. Patients should call 0800 106024 for details of how to receive the #6.40 refund. * Pfizer announced last...

Pill could prevent heart disease.(Brief Article)
November 1, 2004... Oral contraceptives could be used to prevent cardiovascular disease and some types of cancer, US researchers claim. According to the latest analysis of the Women's Health Initiative trial, women taking the Pill had significantly lower odds...

Hospital data may prompt varicella vaccine rethink.(Brief Article)
November 1, 2004... Government immunisation experts considering universal varicella vaccination across the UK are examining new evidence on hospitalisation rates for chicken pox. The first ever detailed report on the burden of severe complications from...

New RCGP chair promises to make college `relevant'.(Royal College of General Practitioners )
November 1, 2004... As Dr Mayur Lakhani prepares to take the reins at the RCGP, he aims to focus its role and woo back grassroots GPs - Ian Cameron hears his plans While on a recent holiday in New York, Dr Mayur Lakhani queued for an hour to meet Pamela...

Letter: Surgery visits turn us all into circus animals.(Letter to the Editor)
November 1, 2004... Yesterday at the practice we had the visit from the local infection supremo. Nice lady, very thorough. We all complied with the directive not to wear nail varnish that day, although I had an irresistible urge to pick my nose while admiring...

EDITORIAL COMMENT: Why generalists must never be replaced.(Brief Article)(Editorial)
November 1, 2004... The skills mix `shopping list' produced this week by NatPaCT, the Government's faceless modernisation arm, could be dismissed as just another piece of bureaucratic lunacy but it is more sinister than that. Its underlying logic - that almost...

Letter: Why these multiple clinics must drive our patients mad.(Letter to the Editor)
November 1, 2004... Is Dr Quilliam pulling our legs by suggesting he would consider referring 100 patients to the chest clinic (News, October 25)? Why on earth should the PCT replace a nurse trained in spirometry? The practice claims to be left unable to carry out...

Letter: Do not let OOH work devalue us.(Letter to the Editor)
November 1, 2004... Dr Dirk de Cocq complains about low pay for out-of-hours work (News, October 25). He calls the #30 an hour he is being paid `a rip off and scandalous'. I agree, but he only has himself to blame. Out-of-hours work will now be dependent on...

Letter: A better deal from `new fundholding'?(Letter to the Editor)
November 1, 2004... As a former fundholding GP, I found it to be better for my patients. When they needed a CT or ultrasound they would get an appointment within a few days rather than waiting for several months; operation waiting lists were also shorter. I did...

SOAPBOX: Why we must fight concept of carer as killer.
November 1, 2004... Physician-assisted suicide could change the GP's role beyond belief, argues Dr Rhona Knight Doctors in the UK are facing the greatest threat for many years. Close in the wake of Shipman, where the public were appalled by even the idea that...

Letter: I will never do terminations in my surgery at any price.(Letter to the Editor)
November 1, 2004... When I first read your article about terminations (News, October 18) I was speechless for 10 minutes, something my staff will tell you is very unusual! It wasn't April 1 so my conclusion is that the Department of Health has finally...

Letter: The GP's responsibility and motivation would be shifted.(Letter to the Editor)
November 1, 2004... A GP is often in the privileged position of knowing something about a woman and her background. As such, he or she is in an ideal position to counsel her about termination, or to refer her to a local pregnancy crisis centre where she will be...

Letter: Distressing, unacceptable - this plan mustn't go forward.(Letter to the Editor)
November 1, 2004... Patients who are opposed to terminations would find it extremely distressing if they found out they were being performed in GP premises. Likewise, GPs like myself would find it totally unacceptable to know that terminations were being...

Letter: Get ready for high-impact change.(Letter to the Editor)
November 1, 2004... I received the October edition of the GP Bulletin, published by the Department of Health, and distributed to all GPs, this week. The top headline is `10 high-impact changes' and the article states: `If implemented across the whole NHS [the...

Letter: Allocations are the final straw - I quit.(Letter to the Editor)
November 1, 2004... After 14 years as a principal, I have decided to resign. The reason is that, contrary to what our negotiators would have us believe, we no longer have any control over our workload. We have been told that closing our practice list...

Letter: Surveillance schemes vital.(Letter to the Editor)
November 1, 2004... Further to Professor Pirmohamed's excellent and informative article on adverse drug reactions (Clinical, October 18) it may be of interest that to observe an ADR with an incidence of one in 100, the medicine must be tested in an average of 300...

Letter: Cremation form help is at hand.(Letter to the Editor)
November 1, 2004... As a retired cremation referee I find it both worrying and disgraceful that some GPs in Berkshire and Buckinghamshire are unwilling to sign part two cremation forms. There is no risk to any doctor who fills in these forms correctly, which...

Letter: Why I have reservations on electronic sphygmos.(Letter to the Editor)
November 1, 2004... I would urge caution in following Professor Francesco Capuccio's advice to `go electronic' (News, October 18). In my experience electronic sphygmomanometers, especially the fully automatic type, are unsuitable for surgery use. The readings...

Lessons we've learned in moving to new premises.
November 1, 2004... An eight-GP practice in Somerset has just moved into new premises - Dr Stephen Gardiner and managing partner Deb Farnworth-Wood give some insight into the lessons learned Lesson 1 Be prepared to be flexible Having agreed the need for...

November contract calendar.
November 1, 2004... Dr Bob Button advises practices on what they need to be doing this month November 7 Those of you that are PMS should by now have completed your negotiations with the PCT for the new contract. Do give this top priority if you have not...

Is there a future for GP premises ownership?
November 1, 2004... Dr John Couch looks at the thorny issue of buying your surgery in today's changing practice climate Historically around 50 per cent of practices have owned their own premises at any given time. However, over the last 10 years many...

How nurse practitioners can ease GP workload.
November 1, 2004... Dr Peter Stott outlines the benefits for practices in the development of the role of the nurse practitioner Until recently, one of the major stumbling blocks to the development of the role of the nurse practitioner (NP) was that NPs could...

Practice Q&As: Are our fears over patient confidentiality justified?(Brief Article)
November 1, 2004... Q: I have been asked to provide confidential medical data to the probity officer of the local patient services agency to check my patient's exemption from ophthalmic testing charges. I have been sent a form signed by the patient giving consent...

Practice Q&As: How `free' must we be with our information?(Brief Article)
November 1, 2004... Q: Our PCT has informed us we must minute all our practice meetings as we may be required to provide all of the details if these are sought under the Freedom of Information Act. Much of our discussion is about the financial and business affairs...

Why Beta-blockers are vital cardiovascular tools.
November 1, 2004... Although the most widely indicated medication for cardiovascular disease, Beta-blockers are significantly underused by GPs - Dr Rubin Minhas makes an evidence-based case for their use While there are many general concerns about...

The shifting ground on Beta-blockers.(Brief Article)
November 1, 2004... When the Nobel Prize in Medicine was awarded to Sir James Black in 1988 for his role in the development of Beta-blockers, his discovery was heralded as `the greatest breakthrough against heart illness since the discovery of digitalis 200 years...

Hyperventilation: an under-recognised condition.
November 1, 2004... Research indicates that overbreathing may contribute to 40 per cent of symptoms presenting to GPs - Anne Pitman advises on diagnosis and management Almost every GP in the country has several patients who regularly attend with a list of...

Managing primary care patients with personality disorder.
November 1, 2004... Dr Philip Sugarman and Dr Antony Walters advise how to assess personality disorders and who to refer Psychiatrists make an important distinction between personality disorder and mental illness. Disorders of personality are `deeply...

TRAUMA CLINIC: Elbow pain.
November 1, 2004... In the last of our trauma clinics, Mr Fares Haddad details a case of tennis elbow Case history A 37-year-old right-handed healthy man presented with a three-month history of increasing lateral elbow discomfort. He had vague pain...

Don't overstep the mark when dealing with drug companies.
November 1, 2004... With more GPs forming links with drug companies to meet new contract targets, Dr Nicholas Norwell of the MDU offers advice on the legal pitfalls to bear in mind A number of GPs have contacted the MDU recently for advice about their...

The GMC's Good Medical Practic guidance for doctors.
November 1, 2004... The GMC's Good Medical Practice guidance for doctors in their financial dealings "You must be honest in financial and commercial dealings with employers, insurers and other organisations or individuals." Paragraph 54 "You must act...

CLINICAL CASEBOOK: Assessing a patient with depression.
November 1, 2004... Case history Liam is 23 and lives in a bedsit having fallen out with his parents and his girlfriend. He abandoned his university course as a `waste of time' and works shifts in a factory. He has come in for a signing off note following a...

YOUR FIRST: Telephone consultation.
November 1, 2004... Speaking to a patient on the phone may save on appointments, but don't be too accessible, says Dr Melanie Wynne-Jones Any telephone discussion with a patient is a consultation, and should be treated with as much care as one conducted...

CAREERS: Get a grip on finance as you start on your career.
November 1, 2004... Becoming a principal usually carries a higher income and is a useful milestone to review your finances - Dr John Couch offers advice As a new GP principal you should make your personal taxation and finances a priority. You will be paying...

DEAR CAREER COACH.(Brief Article)
November 1, 2004... Following the one-year `probationary' period, my practice has decided not to take me on as a partner. I am devastated and bitter as I had started to put roots down in the area and thought I was doing OK. What should I do? Dear Colleague,...

CV: Dr Fay Wilson answers the Pulse careers questionnaire.(Interview)
November 1, 2004... What/who made you decide to go into general practice? I wanted to be a proper doctor. What would have done if you hadn't been a doctor? A manager or an accountant. Who's your career role model/guru? Hm.....no role model...

WHY I LOVE BEING A SCOTTISH GP.(Brief Article)
November 1, 2004... * No long commuting * Good schools and education system * Edinburgh Festival * Lots of great golf courses * Health is a devolved issue and in this smaller community it is easier to contact people in power - not that it...

LET'S PRACTISE IN BELFAST.(Brief Article)
November 1, 2004... Where? Capital of Northern Ireland, a `Hibernian Rio' ringed by high hills, sea lough and river valley, this robust northern metropolis was the engine-room that drove the whirring wheels of the industrial revolution in Ulster - Northern Ireland...

CAREERS: How to learn to love yourself.
November 1, 2004... Jobhunter's agony aunt advises on professional promiscuity, open partnerships and the twilight years Q: I really couldn't settle down when I was a young salaried GP and I used to drift from job to job. I'd meet a principal, fall into an...

Data puts male GPs in dock.
November 8, 2004... Male GPs are far more likely to be referred for poor performance than their female colleagues. Statistics from the National Clinical Assessment Authority reveal men accounted for 86 per cent of cases involving GPs in the past three years,...

Seven new NHS walk-in centres.(Brief Article)
November 8, 2004... Health minister John Hutton could be excused for seeing his blood pressure rise as he announces to the media a #25 million plan for seven new NHS walk-in centres in railway stations. Both the BMA and RCGP warned the centres would further...

NPfIT dubbed `a car with no steering'.(National Program for Information Technology in the NHS (National Health Service, UK))(Brief Article)
November 8, 2004... The NHS IT modernisation programme has been labelled as `like a car without a steering wheel or headlights'. The attack from Labour MP John Austin came as the Department of Health defended the project against criticism that it will cost...

BMA calls for rise in registrar pay.
November 8, 2004... The BMA is calling on the pay Review Body to raise the GP registrar supplement to 70 per cent. Its demand in evidence to the 2005 review follows the Government's appeal for a cut to aid recruitment to hospitals. It added GPs in community...

Patients promised right to book appointments ahead.(Brief Article)
November 8, 2004... The Department of Health is guaranteeing patients they will have the right to book a GP appointment in advance by next spring. Senior department officials told a committee of MPs they had given an `explicit instruction' that GPs' practice...

Bus catches patients.(Brief Article)
November 8, 2004... A diabetes awareness bus has picked up seven undetected cases of the disease in its first week, project leader Professor Mike Pringle has revealed. The bus, staffed by diabetes lead nurse Grace Vanterpool and pharmacist Jagwant Grewal...

GPs cannot charge for supplying patient data.(Brief Article)
November 8, 2004... GPs face hours of unpaid toil complying with the Freedom of Information Act after the Government said requests for data that cost less than #450 to meet must be provided free. The decision means GPs will have to spend at least a day getting...