Pulse articles from October 2003

Pulse archives from October 2003

Alliance forged to halt league tables.(general practitioner rating tables)(Brief Article)
October 6, 2003... GPs and Government advisers have formed an unlikely alliance in a campaign to head off practice league tables. Architects of the quality framework and supporters of the Department of Health's quality agenda joined condemnation of...

Very demoralising.(publishing general practitioner rating scores would affect employee morale)(Brief Article)
October 6, 2003... Dr Helen Parry believes publishing GP quality framework scores would be `very demoralising' for the profession. The Sunderland GP, whose sister is a teacher in the city, said she had seen the morale-sapping effect league tables had on schools...

DoH considers scrapping GPs.(plan to make all doctors specialists)(Brief Article)
October 6, 2003... The Government is considering the long-term option of making all doctors specialists and ending the principle of general practice. Patient choice tsar Harry Cayton told Pulse a move to a `French model' where patients saw a `different GP for...

Government adviser urges caution on HRT.(asks general practitioners to exhibit caution when prescribing horome replacement therapy)(Brief Article)
October 6, 2003... A member of the expert Government group investigating the risks and benefits of HRT has urged GPs to be more cautious in their prescribing of the therapy. The warning was prompted by latest results from a landmark US study that conclude...

Study clears flu vaccine use in asthma and COPD patients.(chronic obstructive pulmonary disease)(Brief Article)
October 6, 2003... Influenza vaccination does not increase the risk of acute exacerbations in patients with asthma and COPD, a major study of GP records has shown. The study also found the vaccination visit gave GPs the opportunity to improve their...

Alert over mammography backlog.(increase in number of mammographies to be analyzed causes backlog)(Brief Article)
October 6, 2003... GPs have been warned to prepare themselves for a surge of worried patients after leaders of the NHS breast cancer screening programme conceded that workload pressures were causing backlogs. They blamed `pressures on the service' for the...

GPs warned not to base disease registers on Read codes alone.(general practitioner )(registration of coronary heart disease based on Read codes)
October 6, 2003... Basing practice heart disease registers purely on Read codes is inaccurate and misses one patient in three with the condition, Government-funded research reveals The additional checks needed to set up an accurate CHD register in...

GP study shows deprivation link to epilepsy.(general practitioner survey on epilepsy demographics)(Brief Article)
October 6, 2003... Patients in deprived areas are five times more likely to have epilepsy than the national average, Dr George Barlow's research has revealed. Dr Barlow, a GP in Glasgow and lead clinician on the study funded by the charity Epilepsy Scotland,...

Angry GPs in despair over league tables.(general practitioner rating tables)(Brief Article)
October 6, 2003... Government plans to allow crude league tables of practices' performance will deliver a crushing blow to the profession's morale, say GPs. In a unanimous condemnation of the proposals, GPs also predicted practices in deprived areas would be...

Seniority pay put on hold until December.(general practitioner seniority pay)(Brief Article)
October 6, 2003... GPs face being drip fed their pay rise into next year after it was revealed seniority payments will not be made until December at the earliest because of Government delays. GPC joint-deputy chair Dr Simon Fradd said the Department of Health...

Antibiotic use in babies raises the risk of childhood asthma.(Brief Article)
October 6, 2003... Babies prescribed antibiotics in their first six months of life are more likely to develop asthma and other allergies in childhood, a US study suggests. The study followed 448 children from birth to age seven to determine whether their...

High-risk elderly left out of Ca screening.(colorectal cancer screening )(Brief Article)
October 6, 2003... The Government's planned national screening programme for colorectal cancer is set to exclude the age group at highest risk of the disease. Leaders of the pilot screening trials say the failure to check whether it is cost-effective to include...

GPC condemns `perverse' PMS proposals.(Brief Article)
October 6, 2003... The GPC has accused the Government of being `perverse' after its proposals for PMS appeared to extinguish its NHS Plan goal for a single contractual framework for GPs. GPC joint-deputy chair Dr Hamish Meldrum attacked the measures for...

High Court battle off as MMR parents lose aid.(funding for case claiming a connection between measles-mumps-rubella vaccine and autism is dropped)(Brief Article)
October 6, 2003... More than 1,000 parents who claim their children suffered autism and other brain disorders caused by MMR vaccine have lost funding for their case. Their appeal against a decision by the Legal Services Commission to end funding was thrown...

Government rows hold up GPs' IT cash.(general practitioner information technology systems)(Brief Article)
October 6, 2003... Internal Government rows over the direction of NHS IT policy are holding up new money for GPs' IT systems, according to the GPC. GPC negotiator Dr Laurence Buckman said it was in agreement with the NHS Confederation that as much as #50...

#5,000 bill stops nurses going on prescribing course.(nurses will not be trained to prescribe drugs)(Brief Article)
October 6, 2003... Dr Dean Marshall's practice cannot send its nurses on extended independent prescribing training courses because it would cost nearly #5,000 to cover them. Dr Marshall, a GP in Edinburgh, attacked the Scottish Executive after it set aside...

Specialist PMS to start bidding war among GPs.(general practitioners)(Brief Article)
October 6, 2003... PMS GPs have warned Government plans for Specialist PMS practices will pitch GPs into a bidding war with hospitals and each other to secure money from cash-strapped PCTs. The alert comes after the Department of Health confirmed there would...

Anger at PMS powers.( )(Brief Article)
October 6, 2003... The GPC is demanding PMS practices are only allowed to add markers to the quality framework if they try to negotiate a local variation of it with their primary care trust. GPC joint-deputy chair Dr Hamish Meldrum said it would `make a...

GPs angry over lack of detail on next year's contract earnings.(general practitioners)(Brief Article)
October 6, 2003... GPs' faith in the new contract is being severely stretched by doubts over funding for enhanced services and IT systems, Pulse's contract survey reveals. Many GPs also complained lack of information on the detail of the contract means they...

GPs planning to maximise profits by taking on extra staff.(general practitioners)(Brief Article)
October 6, 2003... GPs are planning to take on staff rather than make cuts in order to maximise profits. Forty-five per cent said they would need to hire extra employees compared with only 5 per cent planning to make cuts. Some GPs had forecast practices...

Aiming high but with scepticism.(general practitioners surveyed on estimated ratings scores)(Brief Article)
October 6, 2003... GPs expect to aim for high marks in the quality framework even though many remain sceptical whether it is the right mechanism to improve quality of care. Some 37 per cent of GPs plan to aspire to more than 700 points next year and a...

Brush-off for 48-hour GP access.(general practitioner patient access hours)(Brief Article)
October 6, 2003... One-third of GPs will shun the Government's 48-hour access target by opting out of the access to GMS directed enhanced service. GPs can earn 50 `bonus' quality points by offering 48-hour access after ministers insisted the target was...

Shortage of cover after out-of-hours opt-out.(Brief Article)
October 6, 2003... Out-of-hours providers will be struggling to find cover for shifts when GPs are able to give up 24-hour responsibility. As expected, more than 90 per cent of GPs said they planned to ditch out-of-hours under the contract. But only 47 per...

Quality of relationship is key for GPs to win the trust of patients.(general practitioners)(Brief Article)
October 6, 2003... Patients' trust in GPs is unrelated to how long they have been registered with a practice or how often they consult with their usual GP, new research has found. Overall, three-quarters of patients had a high level of trust in their regular...

Diabetes targets "too hard".(high-risk diabetes patients may not recieve care under new contract)(Brief Article)
October 6, 2003... Dr Clare Davison fears GPs will avoid tackling high-risk type 2 diabetes patients under the new contract because they are the hardest to bring within `extremely difficult' quality targets. Dr Davison, clinical lead for diabetes at Newham...

`Use MMR instead of single rubella'.(measles, mumps, rubella)(Brief Article)
October 6, 2003... The Chief Medical Officer has told GPs to use MMR rather than single rubella vaccine in women of child-bearing age. In a letter to all GPs last month, Professor Sir Liam Donaldson said supplies of licensed single vaccine were about to run...

Prescribing of antibiotics decreases `in spite of GPs'.(general practitioners)
October 6, 2003... Copyright: CMP Information Ltd. Much-lauded falls in GP antibiotic prescribing seen since landmark Government guidelines are due more to lower disease rates than better prescribing practice, major new research shows. GPs were last...

White coat effect `surprisingly high'.(Brief Article)
October 6, 2003... Copyright: CMP Information Ltd. GPs have been urged to confirm hypertension with ambulatory blood pressure tests before starting drug therapy after a study suggested the `white coat effect' on raising blood pressure was surprisingly...

New IT network for NI practices.(information technology, Northern Ireland)(Brief Article)
October 6, 2003... Practices in Northern Ireland will be connected to a new secure IT network linked to other health and social care organisations from January next year. The move is part of a #26.7 million investment in IT recently announced by Angela...

GPs sceptical of offering counselling to smokers.(general practitioners)
October 6, 2003... Most GPs are reluctant to offer smoking cessation counselling and treatments recommended in NHS guidelines because of time pressure and doubts about effectiveness, an international study has shown. The findings suggest GPs may struggle to...

NICE's depression guidance doomed.(National Institute for Clinical Excellence)(Brief Article)
October 6, 2003... Just 13 per cent of GPs are likely to follow National Institute for Clinical Excellence guidance on depression because patients often fail to take medication and attend follow-up appointments, Government- funded research suggests. The...

Legal warning to conform to new records guidance.
October 6, 2003... GPs using electronic patient records could put themselves at risk of legal action unless they follow extensive new guidance on the issue, medicolegal experts have advised. The guidance, released by Joint Computing Group of the GPC and the...

Report castigates GPs for COPD care.(general practitioners, chronic obstructive pulmonary disease )(Brief Article)
October 6, 2003... A damning report by the British Lung Foundation has revealed patients with chronic obstructive pulmonary disease spend much of their time in hospital or recuperating at home because they are not identified early enough by their GP. The...

GPs in protest at allocations.(general practitioners)(Brief Article)
October 6, 2003... GPs in four PCTs have called on managers to publish how many patients are being allocated to practices amid fears that some GPs are bearing the brunt. North Staffordshire LMC said it had received a large number of complaints from GPs about...

Say no to new work or it's back to Red Book days.(Brief Article)
October 6, 2003... Dr Russell Walshaw has warned the new GMS contract will be no different from the Red Book unless GPs learn to say No to new work. Dr Walshaw, medical secretary of Northern Lincolnshire and East Yorkshire LMCs, told a seminar of local GPs it...

Just three GPs tempted to join up for #50,000.(general practitioners)(Brief Article)
October 6, 2003... Only three GPs have been enticed by the armed forces' #50,000 golden hello to join up. The Ministry of Defence had declared it had `hundreds of expressions of interest' after the scheme opened last year. A spokesman said a further 14...

Talking POINTS.
October 6, 2003... Dr James Cave practises in Chievely, Berkshire. He has been a GP for 13 years. Jo Carlowe spoke to him about hot topics in his practice. League tables What would be the impact of publishing details of practice performance? A...

We are chasing an illusory BP target.(Letter to the Editor)
October 6, 2003... Many of the performance indicators in the new contract relating to blood pressure specify a reading of 150/90mmHg obtained from patients within the last nine months. Blood pressure is a variable, fluctuating within a fairly wide range of values...

Professionalism not league tables raises standards.(Brief Article)(Editorial)
October 6, 2003... The only surprise about the Government's plans to publish the quality points scored by practices is that the GPC didn't see it coming. But when the league tables inevitably arrive in 2005 will they matter to GPs? Probably not as much as...

48-hour target will turn us into `spin doctors'.(Letter to the Editor)
October 6, 2003... I read with interest the article on advanced access (September 29). I believe the 48-hour target to have been introduced purely for political gain, without thought to the practicalities of running a safe and efficient service for patients. ...

Why our walk-in service is a hit.(Letter to the Editor)
October 6, 2003... Our town does not have a walk-in centre so presumably will not benefit from the threatened extra #40 million to be invested in this service. Yet we, the local GPs, pharmacists and nurses, provide a total of five regular walk-in service...

I think this may be an antibiotic record.(Letter to the Editor)
October 6, 2003... A young patient of mine recently went to France. While there he developed a chest infection and was sent home on the following plethora of medications which includes four different types of antibiotics, an anti-inflammatory, an acetylcysteine...

Partner's Christian attitude is to be welcomed.(Letter to the Editor)
October 6, 2003... Re-`3 GPs Views' (September 22), I am more dismayed by the bigoted views of the doctors than the case history of the `diligent, cheerful, computer-literate, well-informed' new partner who so willingly `does the most irksome visits'. Could...

Is there a subtle plan to make us withdraw cytology services?(Letter to the Editor)
October 6, 2003... I am concerned about the financial rewards for providing a cytology service under the new contract. Adding the 1.1 per cent of the global sum and the reward for achieving a maximum of 22 points, an average GP will still only get around #1,650 a...

Advanced access and pre-booking can work.(Letter to the Editor)
October 6, 2003... Concerning your article on advanced access and pre-booked appointments (September 29): in my five-partner, two-site practice we offer full advanced access but to achieve this we identified there were 1,100 appointments that produced our - and...

Still worried by dog's breakfast of a contract.(Letter to the Editor)
October 6, 2003... Most GPs are very worried about the new contract. It is of labyrinthine complexity. The Yes vote was secured on the promise of a huge pay rise, but that is becoming uncertain as we endeavour to plan our income. The PCTs have no money and...

Why ban Kava when it works?(Letter to the Editor)
October 6, 2003... I was pleased to see the article `Complementary therapies: what works, what doesn't' (Features, September 15). It says there is good evidence to show Kava is effective for reducing anxiety. This is true, however the Government passed...

Very safe record for chiropractic.(Letter to the Editor)
October 6, 2003... The General Chiropractic Council is not a little perturbed by Professor Edzard Ernst's opinion (Features, September 15) that `there is insufficient evidence to show chiropractic is safe'. How safe does it have to be compared with, for example,...

Don't criticise GPs for sticking to older hypertension drugs.(general practitioners)(Letter to the Editor)
October 6, 2003... Re-your article `GPs stick to older hypertension drugs' (September 8): the World Heart Federation, rather than criticising UK GPs for prescribing `older' drugs for hypertension when compared with their European counterparts, I think they should...

Trying to survive the IT payments confusion.
October 6, 2003... IT payments under the new contract are confused to say the least - Dr Paul Cundy tries to clarify an unsatisfactory situation When GPs voted a massive Yes to the new contract the situation regarding IT seemed encouraging. ...

TEN POINTS TO QUALITY: COPD.(chronic obstructive pulmonary disease)
October 6, 2003... Dr Lorna Gold continues her series on achieving the necessary standards to meet the quality framework by looking at COPD care ONE: Complete your asthma register before attempting to create a COPD register There is a practical reason...

Q&As: How can we make sure faxes sent out-of-hours remain confidential?(Brief Article)
October 6, 2003... Q: Our practice manager has suggested we leave the fax machine switched off at night as she believes we could be liable for any urgent fax not acted upon or for any breach of confidentiality if it is seen by the wrong people. A: Patients...

I'm worried my partner is taking practice cash.
October 6, 2003... The problem To cut a long story short, for some time now I have suspected that one of my partners is not playing fair with cash that comes in from private certificates, medicals and so on. This is practice income but doesn't appear to be...

Has vasectomy patient made teenager pregnant?
October 6, 2003... Case history By 19 Angela has already had three first-trimester terminations but this time she is delighted to be pregnant. She has only just missed a period and has not yet broken the news to her parents or her partner. `I'm with a really...

Q&As: Is a six-month GP sabbatical every five years reasonable?(general practitioner)(Brief Article)
October 6, 2003... Q: I would like to have a six-month sabbatical every five years. Would this be an unreasonable request? A: Taking time off to pursue an educational goal, travel or spend time with family and friends is an excellent way of recharging your...

Q&As Where can I find an outside mentor in general practice?
October 6, 2003... Q: I would like an outside mentor to discuss personal and tricky practice issues with. How do I find one? A: The idea of a mentor sounds excellent. Throughout the years as a junior hospital doctor and as a GP registrar there is support. By...

Q&As: How can I avoid becoming practice `gynaecologist'?(Brief Article)
October 6, 2003... Q: I am replacing the only female partner in a practice of four male GPs. How can I avoid adopting her role as the `gynaecologist'? A: This issue should have been discussed when you agreed to the partnership. Start as you mean to go...

GP role in handling psychological problems of asylum seekers.(general practitioner)
October 6, 2003... Dr Stefan Cembrowicz and Dr Angela Burnett discuss the resources for GPs to help this challenging group of patients GPs who see asylum seekers are often faced with complicated scenarios that may seem far beyond the brief of the traditional...

What to do with a returning traveller who develops fever.
October 6, 2003... Tropical medicine specialist Dr Tom Doherty explains when to reassure, when to test, when to treat and when to refer Case scenario A 32-year-old Caucasian woman spent four weeks on holiday in Tanzania, two weeks on the coast and two...

Treating Buddhist patients.
October 6, 2003... Enlightenment, the preservation of life and the need for blessings at crucial times are key to treating Buddhists, writes Dr Upali Abeysiri Buddhism is more a way of life than a religion. There is no belief in a creator god or a permanent...

10 TOP TIPS: Sunburn.
October 6, 2003... Bite-sized practical advice for busy GPs 1. UVB is the cause of sunburn in 85 per cent of cases and is stopped by glass. UVA though isn't stopped by glass and is the main cause of UV- induced malignant change. 2. Some 65 per cent of UV...

When you're asked to assess if a patient should be sectioned.
October 6, 2003... Case history Adrian is a chronic schizophrenic you have seen in surgery twice. He is on the psychiatric ward where you are being asked to assess for Section 3 of the Mental Health Act. He is a bit fed up, is able to tell you the...

MRCGP ESSENTIALS: Political developments affecting primary care.
October 6, 2003... Our handy revision notes to simplify your exam preparation OVERVIEW The NHS Plan1 has driven the biggest shake-up of primary care for 50 years, acting as a blueprint for changes in GPs' professional and personal lives. It is too early...

ANSWER BACK: CA125 in ovarian cancer screening.
October 6, 2003... Q: A patient with long-standing abdominal pain has been given a diagnosis of ovarian cancer. Is there any role for CA125 as a screening test? A: Although often referred to as `the silent killer', recent publications have indicated 95 per...

ANSWER BACK: What are overseas visitors entitled to?(Brief Article)
October 6, 2003... Q: If GPs can register any overseas visitors, what are the limitations on the services those visitors can receive? Can visitors be given an FP10 or be referred to community-based services such as district nurses or for secondary care? Could...

GPs in tough fight for CHD quality pay.(general practitioners, coronary heart disease)
October 13, 2003... GPs face a much tougher task than they realise to earn CHD quality pay under the new contract. A major study of 14,500 CHD patients has revealed only half of those on statins are achieving the 5mmol/l cholesterol target in the quality...

How I help singlehanded practices to offer female GP option.(general practitioner)(Brief Article)
October 13, 2003... Dr Samina Bashir is helping four singlehanded practices offer patients access to a female doctor and longer appointments. She is one of three salaried GPs employed by Bradford City PCT. Around 30 per cent of its practices are singlehanded,...

GPs told not to prescribe tricyclics.(general practitioners)(Brief Article)
October 13, 2003... GPs have been urged to stop prescribing tricyclic antidepressants to new patients after Government data revealed they are responsible for more than 90 per cent of all deaths from antidepressant overdose. Unpublished research by the Office...

Global sum set to drop to 51p per patient.(Brief Article)
October 13, 2003... Practices will get `roughly' 51p per patient in their global sum rather than the expected 53p, according to the GPC. The exact figure will be revealed in March, leaving many practices unsure whether they will qualify for MPIG. GPC...

GPs will shun out-of-hours.(general practitioners)
October 13, 2003... Only one GP in five in some areas is willing to work out-of-hours shifts due to fears working conditions will nosedive when primary care organisations take over. The warning came as PCOs said they will not be able to afford out-of- hours...

Reid not for turning on appointment booking.(Brief Article)
October 13, 2003... Dr John Reid has used his first speech on primary care to ram home that GPs must offer pre-booked appointments. The Health Secretary said practices were able to hit the 48-hour access target and provide advance slots. `One does not...

Risks of HRT outweigh osteoporosis benefit.(hormone replacement therapy)(Brief Article)
October 13, 2003... GPs should not prescribe HRT to asymptomatic women even if they are at high risk of osteoporosis, according to a consensus group chaired by a Government adviser. For most women the raised risks of breast cancer and vascular disease...

Overdose data highlight scale of tricyclics risk.
October 13, 2003... Exclusive By Brian Kelly SSRIs are responsible for just 7 per cent of all deaths caused by antidepressant overdose, unpublished Government statistics show. Antidepressant overdose was the cause of 3,959 deaths in England and Wales over...

`We've had league tables since 1980s'.(Brief Article)
October 13, 2003... Performance league tables of GPs in Northumberland have been published since the 1980s with no complaints, says LMC chair Dr Alan Dove. He said the process started with immunisation figures and now GPs' performance against clinical...

GPs condemn #64m spend on e-booking.(general practitioners)
October 13, 2003... GPs have condemned the Government for spending #64.5 million on a new system for practices to book outpatient appointments electronically, while they continue to wait for GMS contract IT cash. Under the National Electronic Booking System to...

Don't worry about IT money, GPs are told.(information technology, general practitioners)(Brief Article)
October 13, 2003... GPs will get 100 per cent reimbursement for IT and `should not worry where the money is coming from', the NHS Confederation says. Mike Farrar, chair of the confederation negotiating team, said the commitment for PCTs to cover maintenance...

Pay weighted by country.(Brief Article)
October 13, 2003... GPs' quality pay will be weighted according to whether they are in England, Scotland, Wales or Northern Ireland. GPC and NHS Confederation negotiators have agreed achievement payments to practices in March 2005, the end of the first year of...

DoH admits to flaws in GP workforce data.(Department of Health, general practitioner)(Brief Article)
October 13, 2003... The Department of Health has admitted its own data on GP numbers is `so poor' it does not form a reliable picture of the workforce crisis. The extraordinary admission has shredded the credibility of Government claims to have recruited more...

Ditch GPs? `It's unworkable'.(general practitioners)(Brief Article)
October 13, 2003... Government proposals to end general practice in favour of community- based specialists are unworkable and too expensive, according to GPs. Patient choice tsar Harry Cayton has said the idea of patients seeing `a different GP for every...

Time-saver allows GPs to delegate.(general practitioners)(Brief Article)
October 13, 2003... Receptionists at Dr Stephen Gardiner's practice have been trained to take patients' blood pressures after a computerised appointment check- in system saved them two hours a day. Patients confirm their arrival using the check-in system...

U-turn over increased GP role in drug misuser care.(general practitioner)
October 13, 2003... The Government spent #1.3 million to get an extra 4 per cent of GPs involved in treating drug misusers last year. But ministers are now admitting they have scrapped their target to involve one in three practices in shared care programmes. ...

GPs cut waiting list from 2 years to 9 weeks.(general practitioners)(Brief Article)
October 13, 2003... Dr Steve Brinksman is part of a 160-strong team of GPs that has cut treatment waits for drug misusers from two years to nine weeks. Dr Brinksman, who practises in Quinton, Birmingham, is a GP lead for the largest of England's drug action...

Key role for GPs in childhood obesity.(general practitioners)(Brief Article)
October 13, 2003... Family-based interventions by GPs are the most cost-effective way to tackle the growing epidemic of childhood obesity, an NHS evidence review suggests. One in 10 six-year-olds is now obese and the figure rises to 15 per cent at age 15,...

BMA throws in the towel in battle to recommend locum fee rates.(British Medical Association)
October 13, 2003... The BMA has bowed to pressure from non-principals and is abandoning its three-year battle for the right to recommend locum pay rates. The surprise decision will mean the free market for cover, which has led locum rates to rocket to as much...