Pulse articles from November 2008

Pulse archives from November 2008

Half QOF targets to be scrapped.
November 5, 2008... Ten new indicators a year to replace those deemed poor value for money By Lilian Anekwe The QOF is to be torn up and rewritten, with plans to scrap almost half of clinical indicators within the next four years and replace them with...

Vulnerable indicators.
November 5, 2008... Statins for CHD Earns the average practice #2,760 but saves far fewer lives than use of warfarin or ACE inhibitors. Diabetic retinopathy screening The benefits of screening and treatment do not outweigh the costs. Retinopathy...

GMC suspends homophobic letter GP.
November 5, 2008... A Muslim GP who wrote a letter setting out his homophobic views has been suspended for 12 months by a GMC fitness-to-practise panel. Dr Muhammad Siddiq sent the letter to Pulse in his role as president of the Islamic Medical Association,...

No more than two coffees a day in pregnancy.
November 5, 2008... Pregnant women should reduce their caffeine intake to no more than two cups of coffee a day, the Food Standards Agency warned this week. The agency cut its daily recommended levels of caffeine by a third, from 300mg to 200mg, after an...

Figures reveal extent of data security lapses.
November 5, 2008... The Information Commissioner's Office has received 75 reports of data security breaches by the NHS and healthcare sector since last November, new figures show. The reported breaches include 27 lost computers, 18 losses of removable media...

DH holds secret list of major losers under QOF changes.
November 5, 2008... Department of Health says it cannot pass information on to practices or guarantee financial support Exclusive By Gareth Iacobucci The Government has drawn up a secret list of GP practices most under threat from the changes to the...

CONTRACT OVERHAUL: How the furore has unfolded.
November 5, 2008... * Many practices with high disease prevalence will gain from the ending of the controversial square root formula, but Pulse has revealed some will lose up to #100,000 a year in funding. * Estimates show a total of 140 practices across the...

CONTRACT OVERHAUL: MPIG phase-out details not set in stone.(minimum practice income guarantee)(Brief article)
November 5, 2008... Negotiations over the scrapping of the MPIG are far from a done deal, even though ministers have drawn up detailed financial modelling for a five-year phase-out, the GPC is warning. GP negotiators say the Government's theoretical modelling...

Civil war at NICE over osteoporosis advice.
November 5, 2008... NICE has been plunged into civil war over osteoporosis guidance after its own advisers branded two new appraisals of drug treatment `unworkable'. The institute's technology appraisals - on primary and secondary prevention of osteoporosis...

EXPANSION: PCTs plan rise in referral schemes.
November 5, 2008... GPs fear expansion of referral management will mean more patients being bounced back or diverted Exclusive By Nigel Praities PCTs are planning a big expansion in referral management schemes, prompting fears that GPs will see...

INCENTIVES: Trust seeks GMC advice on payments for cutting referrals.
November 5, 2008... A PCT is seeking GMC guidance on its referral incentive LES, following a wave of outrage from GPs and patients over controversial schemes rewarding practices for cutting referrals. Devon PCT's decision to write to the GMC, which it said...

Partners look to fixed-share deals.
November 5, 2008... Disenchantment with salaried GP contract driving practices to consider alternative options, Pulse survey reveals By Nigel Praities GP partners are losing faith in the BMA model contract for salaried GPs and are looking to alternative...

IN BRIEF: Warning on measles and rubella single vaccines.
November 5, 2008... Single vaccines for measles and rubella may be associated with anaphylactic shock, suggests a spate of cases in the south-west of England. Researchers found the estimated rate of potentially fatal anaphylaxis after use of the single...

IN BRIEF: Exception reporting falls.
November 5, 2008... The exception reporting rate in England has fallento its lowest ever level, according to new figures. Statistics compiled by the NHS Information Centre show the national rate of exception reporting in England in 2007/8 was 5.26% across all...

IN BRIEF: Scottish GPs win battle over health visitors.
November 5, 2008... GPs have scored a victory in their battle against plans to remove health visitors from their practices. A delegation of GPs last week delivered petitions including more than 20,000 signatures to the Scottish Parliament in protest at the...

Confusion over HPV vaccine rules.
November 5, 2008... GPs put in `impossible situation' with conflicting guidance over girls not covered and use of Gardasil Exclusive By Lilian Anekwe GPs are being put in an `impossible situation' by the release of conflicting guidance from PCTs on...

Conflicting advice on HPV.
November 5, 2008... * Wessex LMCs - GPs obliged to provide vaccination to those who need it * Yorkshire LMC - GPs not obliged to provide vaccination but could be criticised for not doing so if clinically appropriate * Leeds LMC - GPs may prescribe...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.
November 5, 2008... Getting your oats could reduce the risk of having a heart attack, claim researchers quoted in the Daily Mail this week. Although not completely unbiased - the study was funded by Weetabix - the researchers found an impressive 17% decrease...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
November 5, 2008... If you're an older man feeling tired and irritable, you could be suffering from the latest health epidemic to be warned of in the Daily Mail: the male menopause. Experts say a fifth of all men over 65 are tired, moody and losing their...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.
November 5, 2008... Apologising to patients who complain makes them feel better, say the startling findings of a study of 700 medical professionals. Elton John may have felt sorry was the hardest word, but GPs obviously think it does the trick in the event of a...

Under-fire GPs hit out over alcohol services.
November 5, 2008... GPs urged to do more for drinkers but only a quarter have proper services By Tony Lithgow Three-quarters of GPs are reporting a significant shortage of specialist services for alcohol misuse in their area. The scale of the problem...

Half-dose orlistat is set to go OTC.
November 5, 2008... A lower-dose version of the weight-loss drug orlistat is set to become available over the counter after a decision by European medicines regulators. The Committee for Medicinal Products for Human Use (CHMP), part of the European Medicines...

New row over patient records for research.
November 5, 2008... A fresh row has broken out over the use of patient records in research, after it emerged that 500 million records have been shared with researchers funded by Dr Foster Intelligence. Pulse first revealed details of the release of data to the...

JOURNAL WATCH: Benefits of combination.
November 5, 2008... Adding ezetimibe to existing atorvastatin treatment achieves greater reduction in LDL cholesterol than simply increasing the dose of atorvastatin alone, according to Canadian researchers. In a double-blind study, 579 adult patients with...

JOURNAL WATCH: Fewer metformin deaths.
November 5, 2008... Metformin may be associated with a lower risk of death from cardiovascular disease than other oral diabetic treatments, suggests a US meta-analysis of data from 40 studies. It showed treatment with metformin was associated with a 26%...

JOURNAL WATCH: NRT not a stillbirth risk.
November 5, 2008... The use of nicotine replacement therapy (NRT) during pregnancy does not appear to increase the risk of stillbirth, according to Danish study. Data collected from 87,032 pregnancies found a total of 495 pregnancies - 5.7 of every 1,000...

FOCUS ON... The salaried contract row.
November 5, 2008... As the divide between partners and salaried GPs widens, the BMA faces a struggle to keep the model contract alive By Nigel Praities A storm has been brewing for some time over salaried GPs' contractual terms and conditions - but the...

EDITORIAL: Choppy ride ahead on the QOF.(Editorial)
November 5, 2008... The QOF was always supposed to evolve over time to reflect advances in the evidence base and the GPC claims, not entirely convincingly, that a quarter of the framework has changed since its inception. Ministers might reasonably retort that...

VOX POP: Should the BMA model contract be revised?
November 5, 2008... Should the BMA model contract be revised to be more favourable to practices? Dr Fay Wilson GPC member and former medical director of Londonwide LMCs `It is a model contract - it is not the contract. It doesn't say that you have to...

DEBATE: Should pharmacists sell antibiotics OTC?
November 5, 2008... YES The decision to supply an OTC antibiotic for a particular indication will be made in exactly the same way a GP would, with the same clinical information, claims pharmacist Colette McCreedy Before I consider the suitability of...

PULSE: YOUR GUIDE TO... EXTENDED HOURS.
November 5, 2008... Half of practices are now offering extended hours but grassroots opposition continues. This guide offers advice on how you can make the policy work for you The Government was quick to celebrate last month when it hit its target of 50% of...

PULSE: YOUR GUIDE TO... CONDITIONS FOR DESs AND LESs ACROSS THE UK.
November 5, 2008... The incentives for offering extended hours in England, Scotland and Wales vary wildly. Gareth Iacobucci outlines the differences The wide variation in uptake of extended hours across the UK is matched by an equal diversity in the conditions...

EXTENDED HOURS LESs IN THE UK.
November 5, 2008... Walsall PCT (87.3% uptake) * Funding: A level 1 service at #2.95 per patient per annum and a level 2 service at #4.95, with extra funding to enable the practice to employ nurses and to provide a range of services, including the...

PULSE: HOW I MADE LONGER HOURS WORK FOR OUR PRACTICE.
November 5, 2008... Dr Michael Loverock explains how he offered extended hours cost- effectively and to the satisfaction of his patients Like most GPs, my first reaction to the Government's proposals for extended hours was one of anger. I felt we were being...

PULSE: EXPERT PANEL - TIPS ON RUNNING EXTENDED HOURS.
November 5, 2008... SMALL PRACTICES MUST LOOK AT BIGGER PICTURE Singlehanders and small practices should take a long-term view and not be daunted by costs and workload, advises Dr Michael Taylor I felt pressured over extended hours because as sole...

PULSECLINICAL: AUTISTIC SPECTRUM CONDITIONS.
November 5, 2008... Autism researcher Professor Simon Baron-Cohen answers GP Dr Mandy Fry's questions on screening, treatment and the prognosis in autism 1 When should GPs suspect an autistic spectrum condition? How can these children be distinguished from...

PULSECLINICAL: FIBROMYALGIA.
November 5, 2008... Further information www.UKFibromyalgia .com provides accurate patient information and links to valuable patient resources Dr Alex Allinson's advice on what GPs can do to diagnose fibromyalgia and manage the chronic pain 1 Although...

PULSECLINICAL: ACUTELY PAINFUL, SWOLLEN ANKLE.(Case study)
November 5, 2008... A normally healthy 65-year-old woman has a warm, red, swollen ankle. Is it an infection, gout or an arthropathy? Dr Hercules Robinson describes how he came to the diagnosis The patient A 65-year-old woman asked for a home visit. She...

CARDIAC TESTS: ECHOCARDIOGRAPHY.
November 5, 2008... Cardiologists Dr Clive Handler and Dr Gerry Coghlan continue their series on commonly used tests in primary care with a look at echocardiography This is the most powerful diagnostic non-invasive cardiac imaging test for assessing valve...

PULSECLINICAL: HOW NOT TO MISS... PULMONARY TUBERCULOSIS.
November 5, 2008... Essential reading NICE guidelines. Tuberculosis. www.nice.org.uk/nicemedia/pdf/CG33quickreffguide.pdf Consultant physician and TB specialist Professor Peter Davies explains the signs, symptoms and key questions to ask if you suspect TB...

COPPERFIELD: Now really, would I lie to you?
November 5, 2008... Patients tell such glaring whoppers, Copperfield wonders why he can't reciprocate with a few choice fibs The soft-in-the-head brigade try to foist the idea on us that doctors and patients are best-buddy partners and play an equally...

Patients to be given email access to GPs.
November 12, 2008... Ministers to launch e-consultations in latest stage of drive to improve access to general practice Exclusive By Steve Nowottny The Government is to offer patients email consultations with GPs in the next stage of its drive to improve...

GPs urged to throw out children's toys.
November 12, 2008... GPs have been ordered to remove children's toys from surgeries after NHS officials claimed they posed a health risk. Trafford PCT has advised practices to get rid of all wooden and soft toys due to fears they spread infections among...

GP warns of `miracle cures' exploitation.
November 12, 2008... Vulnerable patients with incurable conditions are being increasingly exploited by the online advertising of `miracle cures', according to the charity Sense about Science. A new guide published this week aims to help patients distinguish...

#30m obesity investment for nine areas.
November 12, 2008... Health secretary Alan Johnson has announced a #30m investment package to improve the health of people in nine cities and towns across England. The investment is the latest scheme in a #372m strategy to tackle obesity, announced by the DH...

Cash-strapped PCTs to delay referrals if waits `too short'.
November 12, 2008... GPs under pressure to hold back referrals in specialties that are `overperforming' against 18-week target Exclusive By Nigel Praities GPs are being pressed to delay referrals in specialties that have beaten the Government's...

HOSPITAL ACTIVITY PRESSURES: No guidance on GP financial incentives.
November 12, 2008... The GMC is refusing to issue new guidance on the ethics of GPs taking up financial incentives as part of referral management schemes. The NHS Alliance and some PCTs and GPs have called for fresh guidance to give greater clarity. But GMC...

Leap in patients readmitted within one day of discharge.
November 12, 2008... The proportion of emergency readmissions within a day of discharge has leapt by one-third in less than a decade, a Department of Health report reveals. The increase will fuel fears that patients are being put at risk by being moved out of...

Ministers look to PCTs to help spend way out of trouble.(primary care trusts)(Brief article)
November 12, 2008... Ministers are set to order NHS officials to help kickstart economic recovery by spending their financial surpluses, Pulse can reveal. Sources in the Department of Health expect Chancellor Alastair Darling to announce trusts will be told to...

Statins trial prompts NICE guidance review.
November 12, 2008... Landmark study shows statins cut CV risk in people without raised cholesterol By Nigel Praities NICE is set to review its guidance on primary prevention of cardiovascular disease after a major trial showed statins substantially reduce...

`Local' QOF could see workload surge.
November 12, 2008... GPs in the same PCT could be working under different QOF indicators under Government plans for a locally flexible quality framework. The plans could sharply increase workload for GPs by allowing PCTs to pick targets their local practices...

Physios may get prescribing rights.
November 12, 2008... Ministers consider handing powers to allied health professionals ranging from paramedics to music therapists Exclusive By Lilian Anekwe Ministers are considering handing prescribing rights to physiotherapists, paramedics and even...

Reform lowdown.(Brief article)
November 12, 2008... Health secretary Alan Johnson last week announced a reform to allow all patients to refer themselves for physiotherapy and treatment by all other allied health professionals (AHPs). To further empower AHPs and allow speedy treatment, the DH has...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.
November 12, 2008... Women will soon be able to find out exactly how long their biological clock will tick, thanks to a new test to predict when a woman will experience the menopause. The Observer reports scientists have developed a `roadmap' of fertility for...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
November 12, 2008... Teenagers watching saucy television are at a raised risk of experiencing pregnancy, claim researchers in the Daily Mail this week. The US study found both male and female teenagers watching TV shows with sexual content were more likely to...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.
November 12, 2008... Researchers have been keen to get to the nub of the obesity epidemic, and the 13,188-child Millennium Cohort Study may just have done it. Its conclusions - fat children tend to have fat parents. Also, children who are overweight now were often...

Self-referral plan for dementia tests.
November 12, 2008... Ministers plan expansion in memory clinics as dementia testing becomes latest area set to sidestep GPs By Lilian Anekwe Ministers are planning a dramatic expansion in memory clinics across the UK as part of proposals to allow patients...

IN BRIEF: Patient survey expanded.
November 12, 2008... The Department of Health has revealed further details about the new GP patient survey, which will run quarterly from next April. The DH has commissioned Ipsos MORI to update and conduct the expanded survey, which will ask patients a wider...

IN BRIEF: Head injury link to ADHD.
November 12, 2008... Head injuries early in life are associated with subsequent diagnoses of attention-deficit hyperactivity disorder (ADHD), according to a study published in the BMJ. The study, of more than 62,000 children from 308 general practices in the...

IN BRIEF: Confidentiality guidance.
November 12, 2008... The GMC is urging doctors to submit their views on the council's revised guidance on confidentiality before the deadline closes later this month. The council is consulting on its revised core guidance, Confidentiality: A draft for...

`Worst over' for GPs under threat from private firms.
November 12, 2008... A meeting of GP leaders was told practices were `out of the eye of the storm' when it comes to the threat posed by the rise of private providers. The gathering of LMC secretaries in London heard a bullish assessment by the GPC, which has...

One in six trusts will fail to hit polyclinic deadline.(Brief article)
November 12, 2008... PCTs are falling behind in their attempts to meet the Government's deadline for opening Lord Darzi's polyclinics, Pulse can reveal. Department of Health statistics released to Pulse show more than one in six trusts will not have their...

How GPs may lose dementia gatekeeper role.
November 12, 2008... * Self-referral by patients to memory clinics * Funding for each PCT to have a memory clinic * A newly-created role, similar to that of primary care mental health worker, to co-ordinate the care of people who have dementia * A...

JOURNAL WATCH: B vitamins don't stop Ca.
November 12, 2008... A supplement of folic acid, vitamin B6 and vitamin B12 does not appear to protect against cancer in women at high risk of cardiovascular disease. A total of 5,442 US women aged 42 years or older, with pre-existing cardiovascular disease or...

JOURNAL WATCH: Tamoxifen stopped early.
November 12, 2008... Half of breast cancer patients fail to finish their prescribed five- year tamoxifen treatment, Scottish research suggests. An analysis of prescription records of more than 2,000 women showed one in five regularly forgot to take a tablet -...

JOURNAL WATCH: Folic acid and epilepsy.
November 12, 2008... UK researchers have questioned the recommended high doses (5mg) of folic acid in women taking anti-epileptic drugs who are planning to conceive or who are in the early stages of pregnancy. In a study of 1,935 women who reported receiving...

PCTs failing GPs on violent patients.
November 12, 2008... Trusts not even recording incidents and failing to provide attack alarms amid rise in attacks on NHS staff By Gareth Iacobucci Violent attacks on GPs are being grossly under-recorded, with some PCTs admitting they have no idea of how...

Inaction leaves GPs at risk.
November 12, 2008... * A DES to allow trusts to support staff in dealing with violent patients was bought in in 2003. But medical defence experts have warned that removing violent patients from lists is `easier said than done'. * Some trusts claim they have no...

Government gives #3m to 20 alcohol hotspots.(Brief article)
November 12, 2008... The Government is investing #3m in alcohol misuse services in the 20 worst-affected areas of the country. Public health minister Dawn Primarolo said the money would be used to improve access to specialist treatment in areas including...

Studies back direct access to MRI.
November 12, 2008... Giving GPs direct access to MRI for knee problems improves quality of life at little extra cost By Emma Wilkinson Moves to provide GPs with direct access to diagnostic testing have been boosted by research finding benefits for...

FOCUS ON... The drug access lottery.
November 12, 2008... Ministers move to speed up NICE and allow NHS top-ups, but will it be enough to ease variations in access? By Nigel Praities Alan Johnson is a bit of a departure for the Department of Health - genial, easygoing and not easily ruffled...

EDITORIAL: Virtual GP plan needs reality check.(Editorial)
November 12, 2008... General practice, like pretty much every other area of life, is going electronic. IT systems are already used routinely for referrals and increasingly for prescribing, with the Summary Care Record on its way. So it's perhaps unsurprising...

VOX POP: Do you support e-consultations?
November 12, 2008... Dr Greg Place Chair of Nottingham LMC `The idea sounds good, with increased access to GPs and the facility to ask questions and make appointment requests. But we don't have time at present to reply to a lot of emails. Adequate funding...

DEBATE: Do PMS GPs get too much funding?
November 12, 2008... NO If there is evidence PMS practices get too much money, let's hear it, says Dr Jane Lothian. If not, let them get on with tailoring services to local need There have been many proponents of PMS initiatives in the decade since they...

PULSECLINICAL: NEED TO KNOW - FLU.
November 12, 2008... Take-home points * Vaccination against flu is effective in reducing deaths, hospital admissions and laboratory-confirmed illness in all age groups * Containment of flu is based on efficient delivery of vaccine early in the season to...

PULSECLINICAL: SWELLING AT THE BACK OF THE KNEE.(Case study)
November 12, 2008... A budding young tennis player has noticed a bulge on the back of his knee. It's not causing him any pain but needs a diagnosis. Dr Mike Wyndham describes how he made it The patient This nine-year-old boy is a keen tennis player and has...

KENDRICK ASKS: Should private firms offer CT scans to healthy people?
November 12, 2008... They're becoming increasingly popular, but is there any clinical justification for people to pay for body scans?Dr Malcolm Kendrick looks at the evidence Private CT scans for healthy individuals are becoming increasingly popular despite...

PULSECLINICAL: LAB TEST UPDATE - eGFR.
November 12, 2008... Clinical biochemist and GP Dr Berenice Lopez uses a primary care case history to discuss the use of the estimated glomerular filtration rate The case An otherwise well 80-year-old male presents with generalised malaise. For the last...

ASK THE EXPERT: INTERVIEW TECHNIQUE.(Personal account)
November 12, 2008... Matt Green advises a doctor who is up for a partnership job and who is nervous about how to approach the interview I have been shortlisted for a GP partnership interview. I would like an idea about what possible questions can be asked. It...

BUSINESSBRIEFING: BEWARE OF FALSE ECONOMIES.(minimum practice income guarantee )
November 12, 2008... Sensible cost-cutting in a practice is one thing - short-termism quite another, argues accountant Rosemary Smith This year has been very hard for general practice, and the tough times look likely to continue. GPs are having to work harder...

PULSESERVICES: Don't defer spouse pension payments.
November 12, 2008... Tough economic times could tempt you to put off saving for retirement - but it'll cost you, says Stuart Smith One of the unfortunate side-effects of turmoil in the financial markets is that we tend to put off starting new arrangements,...

Adding insult to injury.(Personal account)
November 12, 2008... Phil mourns the good old dangerous days before health and safety stopped our fun I burned my thumb this evening. There's a big blister on the end of it and it hurts like hell - and as it's the thumb that I usually use to hit the space bar,...

Mass GP screening for pre-diabetes.
November 19, 2008... DH ushers in new era of preventive medicine with checks to put half over-40s on medication By Nigel Praities GPs will be screening for pre-diabetes from next year after the Government flung open the remit of its vascular screening...

A new era of disease prevention.
November 19, 2008... * Some 15 million people aged 40 to 74 will be invited for a vascular check every five years when the programme is fully implemented * The total cost of the programme is #332m per year, a rise of #82m on previous estimates and a cost per...