Pulse articles from October 2007

Pulse archives from October 2007

GPs face sweeping QOF pay overhaul.(general practitioners)(quality and outcomes framework)
October 3, 2007... * Shocking figures undermine square root formula * Exception reporting crackdown looms By Lilian Anekwe GPs face a huge shake-up of QOF payments after new figures revealed massive variations in pounds-per-point earned and in levels...

Formula is `an outrage'.(Brief article)
October 3, 2007... Dr Alan Keith says it's a `complete outrage' how the square root formula starves small practices in deprived areas of money. `I'm appalled the Government went along with this. It's not in their interests to put money in rich GPs' pockets,'...

Thiazides blamed for diabetes risk.(Brief article)
October 3, 2007... Thiazides are the dominant cause of the increase in new cases of diabetes associated with a combination of Beta-blockers and diuretics, according to findings from a major hypertension trial. The new findings pose a challenge to the NICE...

GPs lead way in cutting resistance to antibiotics.(general practitioners)
October 3, 2007... Patients in practices with low prescribing rates show least resistance EXCLUSIVE By Cato Pedder GPs are leading the way in cutting antimicrobial resistance, a groundbreaking new study has shown. In a world first, Professor...

GPs carry as much nasal MRSA as hospital staff.(general practitioners)(methicillin-resistant Staphylococcus aureus)(Brief article)(Clinical report)
October 3, 2007... GPs have similar rates of nasal MRSA carriage as hospital staff, research reveals. One in 13 GPs was found to be an MRSA carrier in a study of 80 GPs in the West of Ireland - comparable with the 8% rate found recently among hospital staff...

Forcing GPs into polyclinics is `not the way forward'.(general practitioners)(Brief article)
October 3, 2007... Coercing GPs into polyclinics is `not the way forward', the BMA has warned in a hard-hitting response to the controversial Government plans. Lord Darzi's proposals for polyclinics could result in `damaging fragmentation', and may not...

BMA in clash with GMC over ethical rules.(British Medical Association and)
October 3, 2007... The BMA has clashed with the GMC over its proposed ethics advice for GPs, accusing the regulation body of giving doctors a `licence to discriminate' against patients on issues such as abortion, writes Georgie Hobbs. The BMA this week...

NICE: Self-monitor in type 2 diabetes.(National Institute for Clinical Excellence)(Brief article)
October 3, 2007... All patients with newly diagnosed type 2 diabetes should be offered self-monitoring of blood glucose according to draft NICE diabetes guidance. As exclusively reported by Pulse last month, GPs will be expected to implement a raft of weight...

Flu vaccine delays strike again.(Brief article)
October 3, 2007... This year's flu vaccination campaign looks set to begin once more against a backdrop of delays to deliveries. The Department of Health has begun its annual publicity drive urging over-65s and those in at-risk groups to visit their GP to get...

InBrief: Pulse a bigger favourite.(Brief article)
October 3, 2007... Pulse's place as the best-read medical weekly has been strengthened by new figures showing our readership lead increasing. In the six months to August, 79% of GPs read Pulse - five percentage points higher than GP and 10 points ahead of Doctor...

InBrief: BT blows trumpet over IT.(Brief article)
October 3, 2007... BT has launched a national advertising campaign to publicise its role in the rollout of the NHS' embattled IT programme. In the national newspaper print adverts, the telecoms giant, which has attracted controversy for its suggestion that...

InBrief: MMR uptake increases.(measles-mumps-rubella vaccines)(Brief article)
October 3, 2007... Two English regions - the North East and East Midlands - have hit 90% uptake for MMR in two-year-olds for the first time since 2001, the Health Protection Agency reports. The figures come as statistics from the NHS Information Centre show yet...

InBrief: New move on colorectal Ca.(Brief article)
October 3, 2007... The NHS Bowel Cancer Screening programme is piloting new faecal immunochemical tests (FITs) to screen for colorectal cancer, as a study published in the Journal of the National Cancer Institute suggested newer FITs may be more accurate than...

InBrief: Backing for Beta-blockers.(Brief article)
October 3, 2007... Beta-blockers have a greater effect on heart rate than other blood pressure-lowering drugs, and have more of an effect on central than brachial blood pressure. Professor Bryan Williams, professor of medicine at the University of Leicester,...

InBrief: Threat to Scots dispensers.(Brief article)
October 3, 2007... Scottish `dispensing doctors', GPs who offer pharmacy-type services in some of Scotland's most isolated communities, are under threat from a revamped national pharmacy contract. Until now, rural GPs had used the extra income from dispensing...

GPs are `frozen out' of Darzi's NHS review.(general practitioners)(Lord Ara Darzi)(National Health Service)
October 3, 2007... Angry GPs claim Lord Darzi's consultation is being `stage-managed' By Steve Nowottny GPs are being frozen out of a `stage-managed' consultation on the future of the NHS, it was claimed this week. The claims surfaced as two GPs...

Relaunch for NHS Choices website.(National Health Service)(Brief article)
October 3, 2007... A relaunch of the NHS Choices website will help patients rate and choose between GP surgeries, a leading Department of Health official said this week. The relaunch, to take place at the end of this month, will allow patients to see the...

How choice `can increase health inequalities'.(Brief article)
October 3, 2007... Offering patients `choice' does little to improve patient care or health service efficiency - and may actually increase health inequalities - a new report has warned. In a review of literature, researchers from the National Primary Care...

UK health inequalities.(Brief article)
October 3, 2007... The problem * Children from poor backgrounds are one-and-a-half times as likely to die during infancy as those from better-off families * Babies in the West Midlands are 70% more likely to die than those born in the south-east of...

GP funding shake-up urged.(general practice)(Brief article)
October 3, 2007... NHS Confederation demands major overhaul of MPIG and QOF payments to fight inequality By Steve Nowottny The scrapping of MPIG and an overhaul of the square root formula for adjusting QOF payments are being demanded by the NHS...

CBT plus fluoxetine backed.(cognitive behavioral therapy)(Brief article)
October 3, 2007... A fluoxetine and CBT combination is the most effective treatment for depressed adolescents, a study has found - backing up controversial NICE guidance. But the US study involving 439 adolescents with depression found that patients treated...

Tories would scrap contract and hand OOH back to GPs.(out-of-hours)(Brief article)
October 3, 2007... The Conservative Party will renegotiate the GP contract and hand responsibility for out-of-hours cover back to GPs if they win the next election. The Tory plans, revealed at the party's conference in Blackpool this week, would put GPs in...

Findings on depression in adolescents.(Brief article)
October 3, 2007... * Use of fluoxetine should be made widely available, not discouraged * CBT or other evidence-based psychosocial treatment should be used alongside fluoxetine * If psychosocial treatment is not available, monotherapy with fluoxetine...

GPs refute blame for allergy failings.
October 3, 2007... Department of Health faces fury over `disingenuous' attempt to pass the buck on allergy services By Lilian Anekwe GPs and allergy specialists have responded furiously to Department of Health attempts to shift the blame for the poor...

Exercise poses no risk to knee joint.(Clinical report)
October 3, 2007... GPs can reassure healthy patients that running and other forms of vigorous physical activity do not usually damage the knee joints - and may do some good. In adults with no history of knee injury, vigorous physical activity has beneficial...

Regulation fight stepped up.
October 3, 2007... BMA intensifies opposition to the Government plans that it calls an `assault on profession' By Steve Nowottny The BMA is stepping up its campaign to halt the Government's shake-up of medical regulation, condemning the plans as an...

BMA concerns on regulation plans.(British Medical Association)(Brief article)
October 3, 2007... * Standard of proof: `A change in the standard of proof is unacceptable to the profession.If a doctor stands to lose his or her livelihood, nothing less than the current criminal standard will do.' * Independent adjudicator: `We do not...

GPs set to be issued with personal attack alarms.(general practitioners)(Brief article)
October 3, 2007... GPs in England may be issued with personal attack alarms after NHS trusts were promised #97m to protect front-line workers from violent patients. Health secretary Alan Johnson announced the funds at last week's Labour Party conference. ...

MediaWatch: `Paracetamol-coffee alert'.(Brief article)
October 3, 2007... The story Drinking 20-30 cups of coffee while taking paracetamol triples the effect of the toxic enzyme produced when the liver breaks down `the world's most popular painkiller', reports the Daily Mail. The source A study published in the...

MediaWatch: `Lack of sleep can kill'.(Brief article)(Clinical report)
October 3, 2007... The story Not getting enough sleep doubles the risk of dying from cardiovascular disease, report the Daily Mail and Daily Telegraph. The source A study of 10,000 British civil servants published in Sleep found that cutting sleep from seven...

MediaWatch: `Long-haul triples DVT risk'.(deep vein thrombosis)(Brief article)(Clinical report)
October 3, 2007... The story Taking a long-haul flight nearly triples the risk of developing deep vein thrombosis, report the Daily Telegraph and Guardian. The source A study of 8,755 people conducted at the Leiden University Medical Centre, Holland,...

Teenagers `have legal right to GP confidentiality too'.(general practitioner)(Brief article)
October 3, 2007... Teenagers have the same legal right as adults to confidentiality from their GP, new GMC guidance stresses. The booklet, 0-18 years: guidance for all doctors, reminds GPs that parents cannot override the competent consent of a young person...

GPs meet tougher QOF challenge.(general practitioners)(quality and outcomes framework)
October 3, 2007... GP efforts lead to maintained QOF scores - but with a slight wobble in mental health By Lilian Anekwe GPs across the UK have maintained their QOF performance this year, slipping only slightly in the face of a more challenging set of...

`We told them that GPs would overperform'.(general practitioners)(Brief article)
October 3, 2007... The Department of Health was repeatedly warned the new GP contract could cost more than expected - and promised `the NHS would bankroll it', the GPC said this week. The revelation followed a report showing the Government has spent #1.8bn...

TGs and waist measure `predict heart disease'.(triglycerides)
October 3, 2007... Simple tool could be used to screen primary care patients, say UK researchers By Emma Wilkinson Dual measurement of waist circumference and triglyceride level can be used by GPs as a quick and accurate predictor of heart disease risk...

Antibiotic use `for rational reasons'.(Brief article)
October 3, 2007... GPs prescribe broad-spectrum antibiotics for rational well-intentioned reasons - and despite guidance that discourages their use. A questionnaire designed to investigate the considerable variation in drugs such as fluoroquinolones found...

JournalWatch: Lung disease-fracture link.(Brief article)(Clinical report)
October 3, 2007... Patients with chronic lung disease such as COPD or emphysema have a small but significant increased risk of fracture of between 19% and 31%, according to a Danish case-control study. The study of 124,655 patients who had a fracture and...

JournalWatch: HDL always poses risk.(high-density lipoproteins)(Brief article)(Clinical report)
October 3, 2007... HDL cholesterol levels are predictive of major heart events even in patients with low LDL cholesterol levels. When LDL cholesterol levels achieved in patients receiving statins were factored in, the role of HDL cholesterol was less marked,...

JournalWatch: OSA-atherosclerosis hope.(obstructive sleep apnoea)(Brief article)(Clinical report)
October 3, 2007... Treating severe obstructive sleep apnoea with continuous positive airway pressure has an impact on atherosclerosis in a matter of months, suggests a new study. This is the first study to demonstrate a causal direct relationship between the...

JournalWatch: Low BP no problem in old.(blood pressure)(Brief article)(Clinical report)
October 3, 2007... Taking diastolic pressure down to 55mmHg when treating isolated systolic hypertension is probably not a problem for older people, suggests data from the Systolic Hypertension in Europe (Syst-Eur) trial. But the researchers stress that in...

Tide turns against glitazones.(Brief article)
October 3, 2007... The tide appears to have turned against glitazone drugs with GPs being advised to prescribe them to only a few patients because of the mounting evidence against them, writes Cato Pedder. The advice follows new research published in The...

Interview: Champion of PBC battles on.(practice-based commissioning)(James Kingsland)(Interview)
October 3, 2007... NAPC chair Dr James Kingsland on leadership, funding and `frightening' health ministers By Gareth Iacobucci Practice-based commissioning, supposedly one of the Department of Heath's flagship health policies, has been suffering a...

Letter: GPs being stripped of ability to do their jobs.(general practitioners)(Letter to the editor)(Brief article)
October 3, 2007... From Dr Philip Gibson, Loughborough I am not in the habit of commenting on what is going on in the NHS, partly because of a certain resigned feeling that it makes no difference. But I am totally fed up with constantly reading examples of...

Letter: Officials should ban ghee.(Letter to the editor)
October 3, 2007... From Dr Narendra Singh, Burnley Regarding the recommendations in forthcoming NICE guidance on diabetes (News, 6 September), I agree that weight reduction is beneficial to patients with diabetes and GPs do a good job in putting this across...

Letter: No need to fear care record.(Letter to the editor)
October 3, 2007... From Marlene Winfield, National patient lead, NHS Connecting for Health Regarding your article `Patients nervous over care records' (News, 6 September), the results of any survey depend on how questions are asked and the background...

Letter: `GP2GP makes new consultations safer'.(Letter to the editor)
October 3, 2007... From Dr Pete Horsfield, Clinical adviser to NHS CfH national clinical leads It was encouraging to see your article `Electronic records transfer explained' (Finance, 20 September). NHS Connecting for Health believes GP2GP is now delivering...

Letter: Surely shome mistake?(Letter to the editor)
October 3, 2007... From Caroline Charles Practice manager, Swindon A medical representative recently gave me a book about practice-based commissioning. On looking through, I found it referred to 2005/6 so was a little out of date. However, we were...

Letter: What people really think on GP access.(Letter to the editor)
October 3, 2007... From Dr David Church, Machynlleth, Powys I was on the Downing Street e-petition website recently and noticed that fewer people had signed an e-petition asking for Saturday morning and evening GP opening than had signed openly racist...

Letter: Appraisals should be beneficial.(Letter to the editor)
October 3, 2007... From Dr William Murdoch, clinical director of teaching, Heart of Birmingham Teaching PCT I was disappointed to hear of the unnamed reader's experience of appraisal (Letters, 12 July). Appraisal serves many functions and when done...

Letter: Enhancing script safety for kidney patients.(Letter to the editor)
October 3, 2007... From Dr Donal O'Donoghue, National clinical director, Kidney Care Thank you for highlighting the important issues around estimated glomerular filtration rate (eGFR) reporting and drug prescribing. However, your news item (News, 6...

Letter - Supermarket sweep: how to avoid storing up trouble.(Letter to the editor)
October 3, 2007... From Dr Mark Shenton, Stowmarket, Suffolk In response to the suggestion that GPs provide a service to the patient in supermarkets (News, 20 September), I have a proposal. Create confidential lanes where GPs can provide the patient with...

Letter: How consultation with terminally ill made me feel privileged.(Letter to the editor)
October 3, 2007... From Dr Chris Jones, Poole Yvonne is 55 and she came to say goodbye to me today. I am not going away myself, but she doesn't think she will see me again. She reminded me that I wanted to see her if her condition worsened and before she...

Letter: Smartcard process insane.(Letter to the editor)
October 3, 2007... From Dr Anita Sharma, Oldham One of the requirements of the IM&T DES is that every staff member with access to the clinical computer system is authenticated and registered with a smartcard. They must know how to use it, and that includes...

Opinion: Shift to primary care going too far.
October 3, 2007... Professor Roger Jones believes the unchecked expansion of GPSIs could prove costly - both in financial terms and in threatening the core values of general practice I never fully understood the thinking behind the secondary to primary care...

More Government hot air.
October 3, 2007... The NHS heatwave plan is enough to make anyone lose their cool, complains Phil I think I know what happened to our summer. It didn't arrive, obviously, and that's not unusual in Great Britain. But on this occasion I think we can blame...

Dinah'sDiary: Dinah fears the NHS could learn a lot from Tesco.(National Health Service)(Column)
October 3, 2007... Monday Early meeting with practice manager; review of staff roles and time/motion study. She wants to cut down - needs more time to travel with husband... (sounds attractive but I'll pass on the husband), so I have to decide new team...

PulseFinance: ASK THE EXPERT.
October 3, 2007... More of your professional and financial queries are answered by our panel. To pose a question, log on to pulsetoday.co.uk/asktheexpert MEDICOLEGAL Dr Emma Cuzner Explains the possible pitfalls of a website discussion Q I have...

LEGAL LESSONS: WHAT TO DO WITH A STAFF MEMBER WHO IS ALWAYS LATE.
October 3, 2007... In the first of a new series, barristers Michael Salter and Chris Bryden offer legal advice on a tricky employment issue THE SITUATION I run a small practice along with one other partner. We employ two staff - a practice manager and a...

PulseFinance - IT Q&AS: LOGGING ON FROM HOME.(information technology questions and answers)(Brief article)
October 3, 2007... A simple way to set up remote access from home to your surgery computer Q Can I log into my surgery computer from home? And if so, how? A Now that most practices are using electronic notes successfully there should not be any reason...

HOW TO... SET UP A MINOR SURGERY SERVICE.(Brief article)
October 3, 2007... PCTs across the country are either putting out to new tender, or else renegotiating, the minor surgery offering in primary care as part of cost-cutting measures for 2007/8. How can you respond to this challenge without extending resources or...

HOW TO DO A NEUROLOGICAL EXAMINATION IN FIVE MINUTES OR LESS.
October 3, 2007... What kind of neuro exam can GPs be expected to do in a brief consultation? A useful exam can be done in very little time, argues neurologist Dr Giles Elrington Neurology and the neurological examination is traditionally considered to be...

PulseClinical: FOOT AND ANKLE PROBLEMS.
October 3, 2007... In the first of two articles rheumatologist Dr Phillip Helliwell and colleagues look at common problems of the forefoot before giving tips on footwear advice The most common problems encountered in primary care in the forefoot are:...

PulseClinical - NEED TO KNOW: ACNE.(Disease/Disorder overview)
October 3, 2007... In the first of two articles on acne and rosacea, GP Dr Tonia Myers has her questions answered by dermatologists Dr Tom Oliphant, Dr Lyndsey Paul and Dr Shernaz Walton Take-home points * Propionibacterium acnes flourishes in a greasy...

PulseClinical: STUDIES GIVE LIMITED SUPPORT TO PROBIOTICS IN DIARRHOEA.(Brief article)
October 3, 2007... Q Do probiotics prevent antibiotic-associated diarrhoea in children? Synopsis These authors searched multiple databases to find randomised controlled trials of probiotics (live microbial food ingredients) for the prevention of...

PulseClinical: WHERE ARE WE NOW? - HDL AFTER THE UNEXPECTED.(high density lipoproteins)
October 3, 2007... When a promising treatment failed, hopes that HDL-C-raising therapy would rival statins fell with it. Chemical pathologist Dr Anthony Wierzbicki on why increasing HDL-C should be a good thing - but isn't necessarily The controversy It...

PulseClinical: MOUTH ULCERS.(Disease/Disorder overview)
October 3, 2007... Oral medicine consultant Professor Crispian Scully's hints on deciding which mouth ulcers are worrying 1 Before treating a patient with mouth ulcers, try to make a diagnosis. Ulcers can arise from causes ranging from trivial to the...

WHEN IT'S HARD TO KEEP MUM ABOUT ANOTHER GP'S STANDARD OF CARE.(general practitioners)
October 3, 2007... Three GPs share their approach to a practice problem CASE HISTORY You have worked as a GP in your home town for some time. Your parents are still registered with the family practice, although your family GP has been replaced by a...

GEOFF TIPPER'S - REGISTRAR DIARY: Speaking of headaches.
October 3, 2007... Our diarist, now working as a locum, experiences the pain and gain of his newly flexible role Fortunately the dried blood washed out of my hair quite easily this morning. I was in the park yesterday with my son and heir. My somewhat...

PulseRegistrar: HASLAM'S HINTS - 10 tips for making referrals.(David Haslam)(Brief article)
October 3, 2007... 1 Before you refer anyone, be absolutely certain they want to be referred. 2 Ask your practice secretary about how letters should be dictated or written. 3 Before referring, think if there is any alternative. If in doubt, ask your...

PulseCareers: JUST THE JOB - SKY'S THE LIMIT AS AN RAF MEDICAL OFFICER.(Royal Air Force)
October 3, 2007... Fast jets and celebrity medicals are all in a day's work for RAF GP Wing Commander Dr Jon Griffiths Life in a light blue uniform is never dull. I am senior medical officer at RAF Cottesmore, home to the joint force Harrier fleet of fast...

CareerCoach: Writing tips.
October 3, 2007... Dr Pam Brown offers advice on how to write clearly and concisely for everyday purposes or for publication * Writing is a daily necessity, from academic papers to patient records. * Learning to write well improves communication, saves...

CareerTaster: GP appraiser.(general practitioner)
October 3, 2007... Looking for other career options? Being a GP appraiser might be for you, says Dr Ruth Chapman Why it's on my job menu Appraisers visit but once a year. We are all familiar with their role, and we all go through the process of fattening up...

PulseComment: Can't have it both ways.(general practitioners' role in allergy care)(Brief article)
October 3, 2007... It is perhaps too much to expect consistency from our political leaders, but their ability to face two ways at once in their behaviour towards GPs has rarely been so blatant. There is the apparent belief that GPs can - indeed, should - save the...

LAST WORD: Dr George Moncrieff.
October 3, 2007... Dr George Moncrieff... on global warming, sick notes and Enya The best thing about my practice is the fabulous partners I have to work with. And the worst is the limitations of the NHS. My greatest fear is not keeping up to date....

Trusts begin moves to extend GP hours.
October 10, 2007... Plans to be driven by carrot-and-stick approach in line with Lord Darzi's recommendations By Steve Nowottny PCTs have made the first moves in a campaign to dramatically extend GP opening hours in line with recommendations in last...

Darzi calls for massive GP pay overhaul.
October 10, 2007... A wide-ranging shake-up of core GP funding is looming after Lord Darzi's report called for major changes in the way practice income is determined. The MPIG faces being scrapped, and the global sum formula fundamentally altered, as...

Trusts jump gun on polyclinics despite Darzi's cold feet.(Ara Darzi)
October 10, 2007... Polyclinics are being pushed by PCTs - but fail to feature in Darzi report By Steve Nowottny PCTs across the country are pressing ahead with local plans for polyclinics - despite indications that Lord Darzi has gone cold on the idea....

When is a polyclinic not a polyclinic?(Brief article)
October 10, 2007... Undoubtedly this year's big idea, there is confusion over exactly what does and does not constitute a polyclinic. The original model, proposed in Lord Darzi's Healthcare for London review, would hold up to 25 GPs serving about 50,000...

Outspoken GP to aid Darzi.
October 10, 2007... A GP who only recently accused ministers of `shameful' treatment of the profession has been handed the job of overseeing Lord Darzi's shake-up of access. Dr Sam Everington, former BMA deputy chair and recently defeated BMA leadership...

100 new surgeries for poor areas.
October 10, 2007... The Government is to fund 100 new GP surgeries in the poorest areas of the UK in an attempt to tackle health inequalities in `underdoctored' areas. Speaking at the launch of the Darzi report, health secretary Alan Johnson pledged to have...

LORD DARZI'S VISION FOR THE NHS.
October 10, 2007... * All GP practices to be earmarked for extended opening hours, with at least half to open on Saturday or one or more evenings each week within three years * About 100 new GP practices, including up to 900 staff, in the 25% of PCTs with the...

DH hands private firms role in PCT commissioning.(Department of Health, Primary Care Trust)
October 10, 2007... The Department of Health this week attempted to shoot down suggestions that it has backtracked over the role of the private sector in primary care commissioning, amid fears of potential conflicts of interest. The move came after it...

Case study: Hillingdon PCT.(Primary Care Trust)(Case study)(Brief article)
October 10, 2007... Financial necessity rather than political vision has been the main factor driving Hillingdon PCT's decision to tender commissioning services under the new framework. The PCT, which recorded debts of #52m in 2006/7, has tendered a range of...

NHS review backs calls for local QOF.
October 10, 2007... Lord Darzi has added his voice to the growing calls for a locally- negotiated quality and outcomes framework. In his interim report, he reveals that his review will look at `whether there should be an independent process for setting and...