Pulse articles from October 2004

Pulse archives from October 2004

Measles epidemic this winter.
October 4, 2004... Exclusive By Emma Wilkinson and Brian Kelly A measles epidemic on a scale last seen in the 1960s will hit the UK this winter as a direct consequence of the collapse in MMR uptake, Government officials warn. Computer models predict an...

Vioxx withdrawal warning.(Brief Article)
October 4, 2004... Medical defence bodies are warning GPs to act urgently to contact 400,000 patients on rofecoxib (Vioxx) in the wake of the worldwide withdrawal of the drug. Manufacturer MSD took rofecoxib off the market after data from its own trials...

Out-of-hours services face collapse as GPs quit shifts.(Brief Article)
October 4, 2004... GPs are warning out-of-hours services could collapse in the new year because thousands of doctors will stop working shifts for new providers. The alarm came after GPs accused PCTs of `blackmailing' doctors to fill on-call slots before...

Delays in flu vaccine supplies.(Brief Article)
October 4, 2004... Dr Raymond Given says delays in flu vaccine supplies will hold back his practice by a month and leave it unlikely to meet the Government's 70 per cent uptake target in the over-65s. The Northern Ireland GP said: `We sent out a lot of...

Double whammy hits start of flu vaccine programme.
October 4, 2004... GPs are facing a chaotic opening to the influenza vaccination programme with a furious row over which patients should be immunised following hot on the heels of nationwide delays in vaccine supply. The GPC threw the programme into confusion...

Quality checks in chaos as GPs face two PCT visits.
October 4, 2004... Quality framework reviews are descending into chaos after the GPC warned GPs to refuse primary care trusts access to patient records or face breaking the law. Negotiators said GPs in the first wave of visits starting this month would now...

PMS contract `has gone pear-shaped'.(Brief Article)
October 4, 2004... PMS is set to `wither away' because primary care trusts are imposing block contracts on practices which stifle all local innovation, according to a GP pioneer of the scheme Dr James Kingsland, chair of the GPC PMS sub-committee and a former...

French GPs prefer London.(Brief Article)
October 4, 2004... French GPs are being enticed to work in London by shorter hours, no on- call and greater part-time working opportunities, a study has found. The qualitative research, published in this month's British Journal of General Practice, concluded...

GPs get disability discrimination alert.(Disability Discrimination Act)(Brief Article)
October 4, 2004... GPs have been warned to check their premises comply with the Disability Discrimination Act, which came into force on October 1. Practices risk legal action from patients or staff if they have not taken `reasonable' steps to improve physical...

Reid renews his walk-in centre pledge.(Brief Article)
October 4, 2004... Health Secretary John Reid has reiterated the Government's pledge to introduce walk-in centres for commuters in major transport hubs. He told the Labour Party conference centres in London, Newcastle, Manchester and Leeds would open by...

GP uses spirometry to boost quit rate.(Brief Article)
October 4, 2004... Dr Gary Parkes is persuading smokers to give up by using spirometry to demonstrate the damage they are doing to their lungs. Dr Parkes, a GP in Hoddesdon, Hertfordshire, achieved a 10 per cent quitting rate in a pilot study and has now been...

NICE hypertension advice `fails younger patients'.
October 4, 2004... NICE guidance on hypertension has come under fire for failing the needs of younger patients. Patients under the age of 55 should be treated according to the British Hypertension Society's AB/CD guidance and not initiated with a diuretic as...

Most needy miss out on Beta-blockers.(Brief Article)
October 4, 2004... Patients who would benefit most from Beta-blockers are least often receiving them, according to new research. Less than half of patients recovering from a heart attack and only 12 per cent of those over the age of 80 were receiving the...

Repeat prescription scheme `unrealistic'.(Brief Article)
October 4, 2004... A new system to ease GPs' repeat prescriptions workload has been branded `unrealistic' by the authors of a new study. Instalment dispensing systems being piloted across 57 pathfinder PCTs cannot cope with the changing demands of elderly...

Managers join GPs in Choose and Book attack.(Brief Article)
October 4, 2004... NHS managers have criticised the Government for leaving them in the dark over the Choose and Book initiative and raised serious questions over whether the scheme can work. PCT directors responsible for implementing the controversial...

Contract means I earn less than hired help.(Brief Article)
October 4, 2004... Dr Baljit Bhullar says she earns 30 per cent less than the salaried and locum GPs she employs to help her cope with demand as a result of the new contract. Dr Bhullar, a singlehanded GP in Feltham, Middlesex, said she had no spare time to...

Don't worry, QMAS will pay off in time.(Quality Management and Analysis System )(Brief Article)
October 4, 2004... Practices should not worry if they see their expected quality achievement plummet when they start using Quality Management and Analysis System (QMAS), according to GPs using the software. Surgeries have reported up to 50 per cent falls when...

LMC defies GPs' demand to stand down.(Brief Article)
October 4, 2004... GPs in Sunderland are demanding their LMC members stand down immediately following a bitter row over allegations of `undemocratic' committee elections. In a poll of GPs in the city, staged by 13 GPs protesting at the LMC's decision to...

Shipman's hospital years to be probed.(Brief Article)
October 4, 2004... The Shipman Inquiry is to publish an extra report detailing its investigations into the killer's four-year spell working at a hospital in Yorkshire. The report will cover Shipman's time as a pre-registration house officer and senior house...

Six months in, how is it going?
October 4, 2004... Pulse returns to five typical GPs to see how they are dealing with the demands of the new contract RURAL GP DR GORDON BAIRD, Sandhead, Wigtownshire Practice profile: Rural, GMS * 2 partners * 1 nurse * 3...

GPs warned to monitor CVD risk in cox-2 patients.(cardiovascular risk )
October 4, 2004... GPs should assess and modify cardiovascular risk factors in patients beginning treatment with cox-2 inhibitors because of the additional dangers, warn UK researchers. Cox-2 inhibitors can raise blood pressure and substantially increase the...

Sexual health strategy at risk.(Brief Article)
October 4, 2004... The Government's national sexual health strategy risks floundering because GPs lack the time or the training to take on work from GUM clinics. Plans for general practice to manage a greater proportion of sexual health patients were `highly...

Weight management success in practices.(Brief Article)
October 4, 2004... Weight management programmes in general practice can have significant and sustained effects, new research suggests. Over a third of patients enrolled maintained 5 per cent weight loss at 12 months, the study found. Patients completing the...

JOURNAL WATCH: Mediterranean diet benefits explained.(Brief Article)
October 4, 2004... A Mediterranean diet reduces levels of systemic inflammation and can suppress features of the metabolic syndrome, an Italian study shows. Researchers randomly assigned 90 patients with the metabolic syndrome to a traditional...

JOURNAL WATCH: Coeliac disease raises cancer risk.(Brief Article)
October 4, 2004... Patients with coeliac disease are at significantly increased risk of cancer in the year after diagnosis but the excess risk then subsides, according to an analysis of the general practice research database. The study included 4,732 patients...

JOURNAL WATCH: Teenagers' children prone to suicide.(Brief Article)
October 4, 2004... Children who were born to teenage mothers are twice as likely to commit suicide as those of older mothers, a new study finds. Swedish researchers monitored 713,370 people born between 1973 and 1980 until 1999, in an attempt to relate suicide...

JOURNAL WATCH: Cardiac rehabilitation better for women.(Brief Article)
October 4, 2004... Cardiac rehabilitation benefits women more than men, according to a new study. US researchers assessed 340 patients with coronary heart disease who enrolled in an outpatient exercise programme and completed 36 sessions over a 12-week period....

JOURNAL WATCH: Low-carb diet benefits severely obese.(Brief Article)
October 4, 2004... Severely obese patients may benefit from a low-carbohydrate diet, research suggests. A US study compared lipoprotein subfractions and C-reactive protein levels in 78 severely obese patients, 86 per cent of whom were diabetic or had the...

JOURNAL WATCH: Psychotic women risk postnatal blues.(Brief Article)
October 4, 2004... Women with a history of psychotic disorders are at high risk of postnatal depression even if they have not been in contact with psychiatric services during their pregnancy, new research shows. The study analysed data from 199 cases and 787...

New contract `neglects' CHD primary prevention.(Coronary heart disease)
October 4, 2004... Primary prevention is by far the most effective way of cutting deaths from heart disease but has been largely ignored by Government policy and the new GMS contract, researchers conclude. Three times as many lives have been saved by reducing...

Physician assistants prescribing plea.
October 4, 2004... American-style physician assistants need to have the same prescribing rights as GPs if they are to function properly, a Government- commissioned study concludes. The research into a pilot in the West Midlands found physician assistants...

Share a joke and men will open up.(Brief Article)
October 4, 2004... GPs should joke more with their male patients to get them to open up about their problems, new research concludes. The study by the Welsh School of Pharmacy found men were more comfortable using humour to discuss their illnesses. Dr...

Statins under-prescribed in high-risk diabetics.
October 4, 2004... New research on diabetes suggests guidelines are not universally applied and highlights the importance of HbA1c - Brian Kelly reports The vast majority of patients with diabetes are not receiving the lipid- lowering therapy they need,...

HbA1c is linked to heart deaths in non-diabetics.(Brief Article)
October 4, 2004... Lowering levels of HbA1c in non-diabetic patients could become an important way of preventing deaths from cardiovascular disease, according to a new large-scale study. Blood glucose levels continued to be related to cardiovascular risk...

Guidance on liver testing with glitazones is often ignored.(Brief Article)
October 4, 2004... NICE guidelines on the use of glitazones are often ignored with wide variation in the use of liver function tests before prescribing, new primary care research suggests. Liver testing is a key requirement under NICE, but the rate of...

Asthma alert: be proactive over occupational causes.(Brief Article)
October 4, 2004... GPs have been issued with new guidance urging a proactive approach to identifying occupational causes of asthma. The British Occupational Health Research Foundation has called for GPs to quiz all new asthma patients about possible...

`Strip GPs of any right to a choice over computers'.
October 4, 2004... As GPs suffer a setback on computer choice, a pledge there will be no `Hoovering' of notes - by Ian Cameron GPs' fight to retain choice over practice computer systems has been dealt a blow after an influential primary care IT organisation...

Bid to calm GPs' fears over electronic patient record.(Brief Article)
October 4, 2004... A leading GP involved with the National Programme for IT has sought to calm doctors' fears over the content and security of the planned national electronic patient record. Dr Mike Bainbridge, senior clinical architect for the national...

EDITORIAL COMMENT: Row over contract flu rules a sign of worse to come.(Brief Article)
October 4, 2004... With the flu season now upon us GPs are faced with conflicting guidance over vaccination of asthma patients. The new GMS contract insists everyone with asthma should get the vaccine, but updated Government advice is to vaccinate only those with...

Letter: NICE will listen to anyone on its guidance.(Letter to the Editor)
October 4, 2004... Dr Chaand Nagpaul - `NICE in talks over drug firm link-ups' (News, September 6) - is right to point out the importance of NICE maintaining its independence from the pharmaceutical industry. We maintain our independence from all those who take...

Letter: Guiding GPs' skin cancer operations.(Letter to the Editor)
October 4, 2004... I read with interest your article `NICE to snub GPs' success on skin cancer operations' (News, September 27). I think we need to get a few things into perspective. The vast majority of GPs are only too willing to refer suspected melanoma into...

Letter: Advice on air travel.(Letter to the Editor)
October 4, 2004... I found some interesting advice on the Aviation Health Institute website which was one of the sources for further information concerning medical contraindications to air travel (September 20). It specifically recommends transcendental...

Letter: Be as wary of overtreating as undertreating with asthma.(Letter to the Editor)
October 4, 2004... I read with interest your article `What's new in asthma and allergic rhinitis' (Clinical, September 20), in particular the review of guideline-based asthma control. Dr Glenis Scadding makes a valid point that the Gaining Optimal Asthma...

Letter: Trial new drug for comparison.(Letter to the Editor)
October 4, 2004... Dr Scadding describes research on the use of allergen taken by buccal absorption for treatment of allergy (Clinical, September 20). This treatment is well established in the form of isopathy, which utilises serial succusion and dilution to...

Letter: GMC is arrogant to charge GPs over Shipman.(Letter to the Editor)
October 4, 2004... The extraordinary arrogance of the GMC in charging colleagues of Harold Shipman with serious professional misconduct because they signed some cremation forms raises far more serious concerns about the conduct of the council itself. I have...

Letter: Why I am no longer thinking of quitting.(Letter to the Editor)
October 4, 2004... Recently I had the pleasure of listening to Simon Weston, the Falklands War veteran. His courage, strength, willpower and self-belief have inspired me. The sour taste of the contract has suddenly disappeared. `Do it the way you feel right'...

Don't lose out in bidding wars for enhanced services.
October 4, 2004... With enhanced services going to tender soon, Dr John Couch shows how to have all your elements in place to make a success of your bid Whether practices were quick off the mark and commenced enhanced services from April or started later, it...

Stressed teacher keeps asking for a sicknote.
October 4, 2004... Case history Mrs Peters is a teacher. She was signed off work by your partner two months ago for work-related stress. A locum gave her another sicknote last month. She has come to ask you for a further note, saying she can't face going...

Co-ordinate your disease clinics.
October 4, 2004... Dr Peter Stott describes how his practice has dovetailed several clinics together to ease workload So, you've developed your skill mix. You've got your doctors, your nurse practitioners, your nurses and your health care assistants. You...

October contract calendar.(Calendar)
October 4, 2004... Dr Bob Button advises practices on what they need to be doing this month OCT 4 Many of you will now be facing your first quality visit. The PCT is likely to want to inspect 50 notes selected at random. Sort out how you will maintain...

Public private partnership - could it work for you?
October 4, 2004... Three individuals in the primary care sector discuss the issues surrounding procurement of new premises, the benefits and pitfalls of public private partnership, and the dramatic benefits a new primary care centre can bring to a population ...

Flu: the winter ahead.
October 4, 2004... With the flu vaccination campaign beginning this week, Professor John Oxford makes a personal plea for tougher action against this global threat Influenza is a sinister two-faced virus with a pandemic face and an epidemic side. There is no...

Flu vaccination: who next?
October 4, 2004... With concern surrounding uptake of vaccine in at-risk under-65s, Dr Douglas Fleming looks at the arguments for extending the programme Influenza vaccination policy is based on targeting groups at increased risk. We vaccinate about 70 per...

Allaying parents' fears over MMR.(Measles, Mumps, Rubella )
October 4, 2004... With MMR uptake plummeting further, parents will more than ever want reassurance over the vaccine's safety - GP Dr Michael Fitzpatrick, whose 12-year-old son is autistic, suggests answers to the most common questions Is there a link...

Treating glue ear.
October 4, 2004... In the second of a two-part update on glue ear, Professor Mark Haggard and Mary Gannon detail the latest thinking on surgery and the alternatives Surgery in otitis media with effusion (OME) has been the subject of much controversy, but...

LEGAL LESSONS: A missed case of TB.
October 4, 2004... Although GPs are once again seeing cases of TB, presentations can vary and failure to diagnose can prove costly - Dr Sean Kavanagh details the pitfalls We sought advice from a GP expert about this legal case. He commented that the most...

10 TOP TIPS: HIRSUTISM.
October 4, 2004... Dr Nigel Stollery passes on his tips gained from many years' experience as a GP with a special interest in dermatology - he practises in Kibworth, Leicestershire ONE Though hirsutism is common it is always worth checking a serum total...

CLINICAL CASEBOOK: Domestic violence.
October 4, 2004... Case history Marie is 25 and in her third pregnancy. She is 20 weeks pregnant and presents as an extra on Monday morning with a front tooth missing and bruising on her face. She `tripped and fell down the stairs'. She is worried about the...

CAREERS: How I secured a dream sabbatical as an island GP.
October 4, 2004... A long-cherished dream to practise on a Scottish island came true for a Worcestershire GP when she spotted a job advert for work in Shetland - a sabbatical took over a year to arrange but will benefit both practices, says Dr Kathryn Shore ...

CAREERS: WHY I LOVE BEING A COURSE ORGANISER.
October 4, 2004... * The GP trainees Whether GP SHOs on our vocational training scheme or GP registrars, they are a delight to be with and teach. It's great to see such enthusiastic, highly-motivated young doctors. * My course organiser colleagues ...

CV: Dr Laurence Buckman answers the Pulse careers questionnaire.(Brief Article)(Interview)
October 4, 2004... What/who made you decide to go into general practice? My trainer John Marks. I had always liked general practice after my student days with Mike (now Professor) Carmi in Enfield but John confirmed what I already thought - that I might be OK...

DEAR CAREER COACH.
October 4, 2004... I have been locuming as a GP for some time and though I love the freedom aspects I also feel a sense of not belonging. What should I do - join a practice? Even though I have shied away from this for seven years so far! Dear Doctor, Freedom...

LET'S PRACTISE IN: PENZANCE.(Brief Article)
October 4, 2004... Where? Penzance is the capital of the far west of Cornwall, 10 miles from Land's End. Far flung? You could say that. The town is at the centre of some of the UK's most beautiful coastline which attracts tens of thousands of tourists, many...

CAREERS: Lies, damned lies and medical CVs.
October 4, 2004... Jobhunter's search for work continues this week with some practical and pithy advice on standing out from the crowd Writing a CV isn't just about putting down the facts. This guide will help you produce a creative account that will make you...

GP plans to sue over anticonvulsants.
October 11, 2004... Dr Clare Scarlett is planning to sue the makers of anti-convulsants because she says she was not warned of the effects they could have on her unborn children. All three of her children have squints and her youngest also has learning...

GPs seek pay-out over flu chaos.
October 11, 2004... The GPC is demanding the Government steps in to compensate GPs who face losing thousands of pounds in income and administration costs after the first month of the flu vaccination campaign was wiped out in many areas. GPs were forced to...

GPs threatening legal action over OOH `blackmail'.(Brief Article)
October 11, 2004... GPs are threatening legal action against a primary care organisation over plans to force them to carry on doing out-of-hours next year. The furious row broke out after NHS Highland pledged to use the `exceptional circumstances' clause in...

Government closes loopholes to stop `fundholding' windfalls.
October 11, 2004... There will be no Saabs or plasma TVs for GPs if they sign up to practice-based commissioning - Ian Cameron reports GPs are highly unlikely to repeat fundholding windfalls if they sign up to the Government's practice-based commissioning...

How commissioning will affect your practice.
October 11, 2004... What is practice-based commissioning? GPs are given indicative budgets by their PCT to commission elective surgery, outpatient care and diagnostics. The budget will initially be based on practices' past spending but the intention is to...

Why commissioning works for us.
October 11, 2004... North Bradford PCT has been operating practice-based commissioning for four years. All of its 12 practices are involved and the scheme covers outpatients, elective surgery, locality services and acute care. Some 6,000 appointments a year...

Practices hit at PCO threats over referral.(Brief Article)
October 11, 2004... GPs have condemned `invasive' and `threatening' efforts by primary care organisations to scrutinise outpatient referral rates and target high- referring practices. The criticism came as doctors predicted a surge in PCO monitoring of GP...

Victory over `too harsh' GMC cost me #80k.(Brief Article)
October 11, 2004... Dr Mrigendra Kumar Nandi has won a High Court appeal to overturn a GMC serious professional misconduct verdict. In the first such ruling by the High Court, Mr Justice Collins said the GMC had `taken too harsh a view' in finding against Dr...

Chaos over Vioxx as GPs left with conflicting advice.(Brief Article)
October 11, 2004... GPs have been thrown into confusion by the chaotic withdrawal of rofecoxib (Vioxx) with conflicting advice about how to manage patients who were on the drug. The Department of Health has said only that the most appropriate alternative...

Correction.
October 11, 2004... Correction In last week's issue we erroneously reported findings suggesting users of celecoxib were 1.7 times more likely than non-users to suffer a cardiovascular event. The increased risk in question was associated with use of rofecoxib...

What should patients be switched to?(Brief Article)
October 11, 2004... Dr Graham Davenport Primary Care Rheumatology Society `I would advise patients to change to the one with the best safety profile and the most data and that's celecoxib' Dr Chaand Nagpaul GPC prescribing sub-committee `Some GPs,...

GPs defying visits guidance as quality confusion reigns.
October 11, 2004... GPs are still mired in confusion over quality and outcomes visits, with practices ignoring GPC guidance to stop assessors seeing patient- identifiable data. Many practices receiving visits last week said they had let assessors see records....

Police drug swoops `putting GPs at risk'.(Brief Article)
October 11, 2004... Dr Phil Fielding says a drugs clampdown by his local police force is likely to put GPs and practice staff at greater risk from violent drug misusers. His practice in Cheltenham has hired a security guard and installed panic buttons to cope with...

GPs outraged by PCT access ploy.(Primary Care Trust (UK National Health Service) )(Brief Article)
October 11, 2004... GPs have condemned a PCT's plans to bar practices that fail to hit the 48-hour access target from taking on local enhanced services. East Staffordshire PCT made the threat after it commissioned an audit by financial services giant KPMG...

Drug firm censured over nurse's bogus diabetes guidelines.
October 11, 2004... A drug company has fallen foul of the pharmaceutical industry watchdog after a nurse it sponsored produced `bogus' diabetes guidelines masquer- ading as official local policy. The Prescription Medicines Code of Practice Authority found...

GP to advise on central records.(Care Record Development Board)(Brief Article)
October 11, 2004... Dr Richard Fitton is the only GP to be appointed to Care Record Development Board, which will advise on the implementation of the national electronic patient record. GPs have raised concerns over the confidentiality of information stored...

BP targets threat to GP workload.(General practitioners)(Brief Article)
October 11, 2004... British Hypertension Society guidelines on blood pressure will greatly increase GP workload, a study concludes. Hitting the stringent targets in the guidance would be cost-effective but GPs would need extra financial incentives to persuade...

Chickenpox vaccine plan may be put on hold.(Brief Article)
October 11, 2004... Discussions over the introduction of routine vaccination for chickenpox may be put on hold after new evidence suggested rates of the disease are declining sharply. Consultation rates for chickenpox fell from around 1,000 cases per 100,000...

GP mental health care inadequate.(Brief Article)
October 11, 2004... GPs are not meeting the needs of many patients with mental illness, new research finds. The study found more than one in four patients who consulted GPs had mental health problems but only 40 per cent were adequately treated. Only 28...

`Stay open all day or lose pay' GPs told.(Brief Article)
October 11, 2004... GPs are embroiled in a row with PCOs over demands to keep their practices open all day and not take a lunch break. Three local health boards in Wales have insisted GPs keep their doors open for the entire in-hours period between 8am and...