Pulse articles from October 2008

Pulse archives from October 2008

Follow-up cuts leave GPs to pick up pieces.
October 1, 2008... Emergency readmissions leap as hospitals cut follow-up appointments and shift work to GPs Exclusive By Nigel Praities GPs are having to deal with a rising tide of complex cases as hospitals cut follow-up care to meet new NHS...

NAPC appoints new chair in reshuffle.(National Association of Primary Care appointed Dr Johnny Marshall as president and Peter Smith as vice-president)(Brief article)
October 1, 2008... The National Association of Primary Care has announced a reshuffle of its executive committee, with Dr James Kingsland stepping down as chair to take on a new role as the association's president. Former treasurer Dr Johnny Marshall has been...

Call to abolish retainers for care home services.
October 1, 2008... A report has called on the Government to abolish retainer fees charged by GPs for providing standard health services to patients in care homes. The report, by the English Community Care Association, said there was a lack of clarity about...

Trust pays GPs #3.50 for each C&B referral.
October 1, 2008... A PCT in south London desperate to increase use of Choose and Book has begun offering GPs flat-rate payments for referrals made through the controversial system. Incentives for using Choose and Book have tended to reward the percentage of...

POLYCLINICS: Trusts told to offer firms bulk deals on Darzi centres.
October 1, 2008... Move to seek discounts from firms awarded multiple contracts threatens to undercut GP bidders Exclusive By Gareth Iacobucci Ministers have told PCTs to get best value for money by setting up bulk deals with private providers to run...

POLYCLINICS: How bulk deals could work.
October 1, 2008... * The Department of Heath advice has urged PCTs to consider awarding a single provider multiple contracts for GP-led health centres to achieve savings * Multiple deals would require bidders to offer discounts in return for being awarded...

POLYCLINICS: Polyclinics forced into temporary buildings.
October 1, 2008... Exclusive At least a third of Lord Darzi's polyclinics are set to be housed in temporary buildings because PCTs have run out of time to find premises, Pulse can reveal. One trust even plans to situate its GP-led health centre in a car...

POLYCLINICS: Foundation trusts get go-ahead to bid for Darzi centres.(Survey)(Brief article)
October 1, 2008... The Government has paved the way for foundation trusts to run Lord Darzi's polyclinics, despite serious concerns over conflicts of interest. It has issued advice to SHAs on how PCTs can avoid conflicts of interest that may arise even if...

GPs beat PCTs on out-of-hours.
October 1, 2008... Pulse analysis of Healthcare Commission data finds not-for-profit providers lead way in quality of care Exclusive By Steve Nowottny Not-for-profit GP providers are providing better out-of-hours cover on average than their privately...

NICE pushes for QOF inequality indicators.
October 1, 2008... The QOF has failed to tackle health inequalities and should be reshaped to include specific indicators for narrowing the gap between rich and poor, NICE has said. The institute will begin work next year on a large-scale review of the...

Long-term patients to get free scripts.
October 1, 2008... The Government plans to abolish prescription charges for all patients with long-term conditions in `the next few years'. Prime Minister Gordon Brown announced all patients with cancer would be exempt from prescription charges at the Labour...

No more enforcement of polyclinics, pledge Tories.
October 1, 2008... The Tories this week vowed to scrap the `top down' enforcement of polyclinics on GPs. Speaking at the annual Conservative Party Conference, shadow health secretary Andrew Lansley pledged to improve patients' access to their GP while...

CARE RECORDS: Patient data breaches at four in five trusts.
October 1, 2008... Loss, theft and misuse of information fuels fears over electronic records Exclusive By Steve Nowottny Four PCTs and hospitals in five have lost patient data or suffered a data security breach since the beginning of last year, Pulse can...

CARE RECORDS: Data breach dossier.
October 1, 2008... Devon PCT A staff member at a GP surgery accessed a patient's medical record to obtain his telephone number, then used it to contact the patient for `personal reasons not related to health'. Mid Essex PCT Reported a number of...

CARE RECORDS: Religious groups seek to opt out of electronic records.
October 1, 2008... Exclusive Millions of Catholic and Muslim patients could opt out of having electronic care records because their data may be used without explicit consent for research purposes contrary to their faiths, Pulse has learned. The Catholic...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.
October 1, 2008... Parents looking for an easy supper for their babies now need look no further than the trusty fish finger, after the Daily Mail and Daily Telegraph reported that fish can protect infants from eczema. A study published in Archives of Disease...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
October 1, 2008... Potential 2012 Olympic swimming champions should beware, according to reports in the Telegraph and Daily Mail that chlorine in outdoor swimming pools raises asthma risk five times. Belgian researchers found secondary school swimmers using...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.
October 1, 2008... In a study that has set back the feminist cause by a few decades, US researchers have found that men who think the best place for women is in the home earn an average of #4,722 more than more `modern-thinking' men. Next up, a series of...

Gentlemen's deals revealed.
October 1, 2008... BMA admits practice agreements not to take on each other's patients do exist in places By Steve Nowottny A number of GP practices are operating `unacceptable' gentlemen's agreement's not to take on each others patients, the BMA has...

The practices with no patients.(Minimum Practice Income Guarantee)(Brief article)
October 1, 2008... The existence of `gentlemen's agreements' between practices was one justification cited by ministers in July for abolishing the MPIG. The other headline-grabbing argument was the existence of a number of practices with very limited patient...

IN BRIEF: MMR uptake stalls.
October 1, 2008... Uptake figures for the MMR vaccination have stalled, with only 82% of two-year-olds receiving the vaccine last year - fuelling fears of a measles epidemic. The Government has issued a #5.5m rescue package to PCTs to help them raise their...

IN BRIEF: Graphic smoking warning.(Brief article)
October 1, 2008... The UK this week becomes the first country in the EU to use graphic pictures of cancer victims as warnings on cigarette packets. The pictures will illustrate the destructive quality of tobacco on health through 15 images, including those of...

DH rules out better deal for extended hours in England.
October 1, 2008... The Department of Health has ruled out bringing in more flexible arrangements in England to increase GP take-up of extended hours. It comes despite GPs in Wales receiving a #16m funding boost for extended opening and a string of other...

Cash incentive for advance appointments.(Brief article)
October 1, 2008... Ministers plan to plough up to #50m into incentives for GPs to offer appointments in advance, the Department of Health has announced. The new money - the balance of the #105m additional investment agreed as part of this year's contract deal...

Row over safety of anticholinergic drugs.
October 1, 2008... Controversial study suggests COPD drugs raise risk of cardiovascular events By Nigel Praities A controversial study suggests inhaled anticholinergics could substantially increase the risk of heart attacks and strokes in patients with...

Combined inhaler gets thumbs-up.
October 1, 2008... A combined inhaler is `an effective option' for both maintenance and rescue therapy in adults with poorly controlled asthma, according to new recommendations from the National Prescribing Centre. The endorsement follows the inclusion of the...

JOURNAL WATCH: Intensive control better.(Brief article)
October 1, 2008... Intensive glycaemic control reduces the risk of long-term hypertension compared with conventional control, long-term follow-up of a six-year trial shows. Analysis of 20 years of data from 1,375 participants showed the 2% difference in...

JOURNAL WATCH: Chronic fatigue clue.
October 1, 2008... Postural orthostatic tachycardia syndrome is common in patients with chronic fatigue syndrome and response to standing should be added into the clinical evaluation of the condition, UK research suggests. A study of 59 patients with CFS and...

JOURNAL WATCH: Poor lacking vitamin C.
October 1, 2008... Poor vitamin C status is relatively common among UK adults living on a low income, a study suggests. A total of 433 men and 876 women aged over 19 had a plasma vitamin C measurement as part of the Low Income Diet and Nutrition Survey. About...

JOURNAL WATCH: Four drugs for H pylori.
October 1, 2008... Using a four-drug regime eradicates Helicobacter pylori in more patients who complete the course than triple therapy, but compliance is lower. In a study of 100 patients, the one-week quadruple regimen - lansoprazole, metronidazole,...

Undercover survey finds pharmacy advice unsafe.
October 1, 2008... Many community pharmacies are providing unsuitable and potentially dangerous advice to patients, an undercover survey reveals. The investigation by consumer body Which? raises questions over the Government's plans to extend the clinical...

FOCUS ON... The rise in GP referrals.
October 1, 2008... As the DH investigates a 16% rise in GP referrals, Pulse examines a number of theories for the worrying increase By Lilian Anekwe Dr Ann Bowman's patient has a worrying skin lesion that may be a melanoma, but that is no guarantee of a...

FOCUS ON... How PCTs plan to cut referrals.
October 1, 2008... Northamptonshire PCT Has plans to rethink its investment in primary care services to fund the increasing hospital workload. `Our plans to invest resources in community and primary care-based services and prevention will need to be...

EDITORIAL: The bouncing patient effect.(Editorial)
October 1, 2008... The law of unintended consequences dictates that any given action has effects that are both unpredictable and unspecific. It is a rule that fits health policy particularly well - and the unforeseen consequences usually turn out to be nasty...

VOX POP: Why do you think GP referrals have jumped?
October 1, 2008... Dr Michael Dixon GP in Cullompton, Devon, and chair of the NHS Alliance `The reasons are threefold. If you get your waiting times low enough demand goes up. The second issue is the increasing pressure on referrals to reduce clinical risk....

LETTER: The real reason for rocketing referral rates.(Letter to the editor)
October 1, 2008... From Dr David Chesover Maidstone, Kent Last week's article `PCTs to slash spending after rocketing GP referrals' (pulsetoday.co.uk/news) stated there was `no clear reason identified for the rapid rise of referrals'. In my area there...

LETTER: Clear case of sexism in the profession.(Letter to the editor)
October 1, 2008... Dr Anita Sharma Oldham, Lancashire Your front page article `Women GPs locked out of leading jobs' (pulsetoday.co.uk/news) provides clear evidence of sexism. When the Medical Women's Federation was founded in 1971, the members fought...

LETTER: Few nurses want GP-level responsibility.(Letter to the editor)
October 1, 2008... From Dr John Orchard Alfreston, Derbyshire I refer to your Focus on article `Are nurses the new GPs?' (pulsetoday.co.uk/news). There are very few nurses who want the responsibility of a GP. If they were all clamouring to take our roles...

LETTER: Back to the old days of 24-hour slavery.(Letter to the editor)
October 1, 2008... From Dr FM Hirji Hemel Hempstead, Hertfordshire I don't believe GPs should take back out-of-hours responsibility. It would be back to the bad old days of slavery and derisory pay. The service would never be adequately funded and GPs...

LETTER: Obesity remark just takes the biscuit.(Letter to the editor)
October 1, 2008... From Dr Mark Bancroft-Livingston, Gloucester I read `Ratings website to scrutinise practices' (pulsetoday.co.uk/news) with interest. A London Health Observatory spokesperson queried: `If there is a high level of obesity (in a specific...

LETTER: Virgin shyness speaks volumes.(Letter to the editor)
October 1, 2008... From Dr Kulwant Singh Pandher Adlington, Oxfordshire Virgin withdrawing its plans to enter primary care is evidence that all private ventures are in it for the money, not patient care. The Government still seems to be blind to this when it...

LETTER: GP hours not at fault for rise in strokes.(Letter to the editor)
October 1, 2008... Dr Rupen Kulkarni Redditch, Worcestershire I refer to your news story `Recurrent strokes blamed on surgery opening hours' (pulsetoday.co.uk/news). It is possible to relate almost anything to extended GP hours. Patient education on...

DEBATE: Can GPs carry out minor surgery safely?
October 1, 2008... YES The fastest way to treat almost any lesion is GP excision followed by histology and referral if necessary, says Dr John Adams The answer to this question is a very simple Yes. GPs have been doing minor surgery for many years, very...

YOUR GUIDE TO... PENSIONS.
October 1, 2008... Pensions are complex, important and a regular source of contention. Here we provide a potted history of the ever-changing NHS pension scheme and six pages of advice on how to plan for the future GP pensions have been the centre of a fierce...

YOUR GUIDE TO... MAXIMISING YOUR PENSION FUND.
October 1, 2008... Financial consultant Justine Roberts offers a 10-step guide to planning, assessing and managing your pension 1 Start your pension planning early. For every five years of delay in funding for a pension, future premiums will be doubled....

YOUR GUIDE TO... PENSIONS: CASE STUDIES.
October 1, 2008... A married 30-year-old full-time GP, in his first practice as a partner, wishing to retire at 60. He has no career breaks planned. The purchase of additional pension benefits from the NHS is significantly cheaper at this stage as payments...

YOUR GUIDE TO... HOW I BUILT MY RETIREMENT NEST EGG.
October 1, 2008... Dr John Couch shares his experience of creating a portfolio of investments to top up his GP pension If I'm honest, I didn't give retirement a thought until I was 34. What prompted me was attending the retirement party for one of my...

YOUR GUIDE TO... PENSIONS: YOUR QUESTIONS ANSWERED.
October 1, 2008... Financial adviser Ric Belcher addresses some of the questions he is most often asked by GPs Q I used to pay 6% of my income to the NHS pension scheme but now pay 22.5%. Is the scheme really that good? A Yes, the NHS pension scheme...

PULSECLINICAL: PRESCRIBING AFTER A STROKE.
October 1, 2008... New evidence on dipyridamole, clopidogrel and aspirin is changing practice for the secondary prevention of stroke. Stroke physicians Dr Anthony Rudd and Dr Nigel Smyth review the data It's been a busy couple of years in terms of research on...

PULSECLINICAL: SUDDEN ONSET OF SWOLLEN ANKLES.(Case study)
October 1, 2008... Ankle oedema in an older patient on amlodipine suggested the drug could be the cause - but was it? Dr Mike Wyndham describes another case from his files The patient This patient is a 62-year-old lady who is a regular visitor to the...

PULSE CLINICAL: LAB TEST UPDATE - MCV.(mean corpuscular volume)(Case study)
October 1, 2008... The case A 42-year-old woman attends with a history of persistent tiredness for about the past six months. She is otherwise well, with steady weight and reasonable appetite, is on no medication, and has no relevant past medical history....

PULSE CLINICAL: NEED TO KNOW - SCHIZOPHRENIA.
October 1, 2008... Psychiatrist Dr Mark Salter answers GP Dr Mandy Fry's questions on using depots, changes to the benefit system, the effects of cannabis and emergency sedation Take-home points * Only one of the newer antipsychotics - risperidone - is...

Prognosis for abdominal migraine.
October 1, 2008... Q What can I tell parents about the likely prognosis in a child who appears to have abdominal migraine? A Migraine in children may initially present with atypical symptoms, sometimes known as `migraine equivalents', including brief...

Diagnosing intolerance to lactose.
October 1, 2008... Q I'm slightly confused about current thinking on lactose intolerance. I recently read up to 200ml of milk is tolerable even for people with confirmed lactose intolerance. Is this true? And what about diagnosis? Testing for reducing sugars in...

PULSECLINICAL: HOW NOT TO MISS... A LEAKING ABDOMINAL AORTIC ANEURYSM.
October 1, 2008... Vascular surgeon Professor Roger Greenhalgh outlines the key clinical features and pitfalls in diagnosing a ruptured aortic aneurysm Worst outcomes if missed This is a lethal condition, which few patients survive. Survival is only...

PULSESERVICES: Beat the crunch with a secure investment.
October 1, 2008... In these troubled times, where can you safely invest your hard-earned savings? Stuart Smith has the answer Global financial markets are in a bit of a mess at the moment, to put it mildly. In the US, Lehman Brothers filed for...

C&B ad is lipstick on a pig.(Viewpoint essay)
October 1, 2008... It's cheap-looking, inaccurate and patronising - and worst of all Phil's taxes are paying for it I don't watch a lot of television. Never Mind The Buzzcocks and Have I Got News For You tends to be about my limit, and I spend most evenings...

Tories to tear up registration rules.
October 8, 2008... Plans for commuter lists, funding shake-up and outsourced home visits Exclusive By Lilian Anekwe The Conservative Party will tear up the GP contract if it comes to power and implement radical plans that would allow patients to register...

What the Tory plans might mean.(Brief article)
October 8, 2008... Allowing everyone to register with the GP practice they want Pros: * Offers patients choice and flexibility * Market forces could help drive up standards Cons: * Risks destabilising practices in commuter belts * May overwhelm...

SHAs urged to talk to GPs.
October 8, 2008... The RCGP has called on SHAs to communicate better with GPs in order to improve on piecemeal local engagement with Lord Darzi's NHS reforms. Professor Steve Field, chair of the RCGP, which held its annual conference last week, said the...

Oxygen advised for GP surgeries.
October 8, 2008... GPs surgeries should have emergency oxygen so they can treat acutely ill patients while waiting for an ambulance, says the British Thoracic Society. In its first guideline for emergency oxygen, the BTS says GPs should aim to achieve a...

London health gap sidelined.(Brief article)
October 8, 2008... NHS London is scaling back efforts to tackle health inequalities, to focus on commissioning and the polyclinic rollout. A board paper on the review of NHS London's strategic plan for 2008/9 included health inequalities in a list of schemes...

New-style GP entrepreneurs mop up Darzi centre contracts.
October 8, 2008... Exclusive By Gareth Iacobucci GPs are dominating the tender process for Lord Darzi's polyclinics and new practices, Pulse can reveal. But an emerging breed of entrepreneurial GP has sparked a row in the profession, with some bidding...

A second wave?
October 8, 2008... Primary care tsar Dr David Colin-Thome has revealed there could be a new rollout of Darzi centres if the first wave is successful. Dr Colin- Thome told the Primary Care Live conference last week: `There might be more GP-led health centres if...

New osteoporosis advice challenges NICE.
October 8, 2008... GPs are caught in a dramatic showdown over the treatment of osteoporosis, with the launch of a major new national guideline that directly contradicts NICE. Clinical bodies from across musculoskeletal medicine have joined forces on the...

Adding in tiotropium cuts mortality in patients with COPD.
October 8, 2008... The anticholinergic tiotropium significantly cuts mortality, admission rates and exacerbations in patients with COPD, a major new trial reports. UPLIFT found significant benefits for the treatment compared with placebo plus usual care, but...

NICE `forcing GPs to quit minor ops'.
October 8, 2008... GPC letter to the institute warns skin cancer guidance is proving unworkable and should be scrapped Exclusive By Lilian Anekwe The GPC has demanded NICE withdraw its guidance on skin cancer, which it says is forcing GPs out of...

GPs over 65 must pay retention fee, High Court rules.
October 8, 2008... More than 1,000 practising GPs will be forced to pay hundreds of pounds a year to the GMC after the BMA lost its legal battle to protect GPs over 65 from the annual payment. The High Court turned down the BMA's application for a judicial...

Back pain advice sparks safety row.
October 8, 2008... NICE guidance on back pain controversially recommends spinal manipulation, despite doubts over evidence By Nigel Praities NICE has controversially promoted spinal manipulation to a first-line treatment for low back pain despite doubts...

What NICE says on back pain.(United Kingdom. National Institute for Clinical Excellence)(Brief article)
October 8, 2008... * Advise all patients to maintain a physically active lifestyle. * Paracetamol is the first medication option - consider NSAIDs for short-term use if ineffective. If using NSAIDs or COX-2 inhibitors then also co-prescribe a PPI. * Also...

Doubts over child flu vaccination.
October 8, 2008... New research has questioned the benefits of expanding the flu vaccine campaign to include children. The Government's Joint Committee on Vaccination and Immunisation has looked at the evidence for vaccination of children several times, but...

Patients to be paid for seeing GP.
October 8, 2008... PCT leads way in offering cash incentives to patients at risk of ill health in return for attending health checks By Lilian Anekwe Patients are to be paid to see their GP as an incentive to stay healthy and avoid costly long-term...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.
October 8, 2008... Most miracle cures come with the downside of not being available for another 10 years, but this week's could be available next month - and in the UK to boot. Some 600 British volunteers will `get a jab to beat deadly superbug C. difficile',...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
October 8, 2008... Extra-marital nooky endangers not only your marriage, but also your life. The Daily Telegraph and Daily Mail report that Italian researchers say the stress of concealing an affair can result in severe migraines, which in some cases can lead to...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.
October 8, 2008... In what may be an unexpected boost to the Government's drive to get the long-term sick back to work, research from University College London reveals that if you take long spells off sick you are more likely to die. It found the almost 30%...

Nurses to shun extra work.
October 8, 2008... Practice nurses may refuse expanded role as research finds them dissatisfied over pay Row escalates over practice nurse role N0V 07 Nurse leaders accuse GPs of `raking it in' after a NHS Working in Partnership Programme survey...

IN BRIEF: Call to publish GP data.
October 8, 2008... GPs should have a legal obligation to publish performance data, according to Tim Kelsey, co-founder of Dr Foster Intelligence. Speaking at the Conservative party conference, he called for a radical overhaul and expansion of the way the NHS...

IN BRIEF: Undercover patients row.
October 8, 2008... The row over PCTs sending undercover patients to check up on GPs has escalated. Derbyshire County PCT, which is one of those sending so-called mystery shoppers to surgeries, has told GPs the scheme `will give us the information we need to...

IN BRIEF: Safety audits `variable'.
October 8, 2008... GPs must improve their recording of events that impact on patient safety in their practices, says the National Patient Safety Agency. The NPSA warned the quality of significant events audits was `variable and could be improved' and...

When should you consider a grommet?
October 8, 2008... * Children with three or more acute infections of the middle ear cleft in a six-month period * Children and adults with glue ear * Patients with speech and language problems or behavioural problems related to hearing loss *...

Grommets effective for OM.(otitis media)
October 8, 2008... Experts advise referring children with recurrent otitis media for surgery in light of review By Lilian Anekwe GPs have been urged to consider referring children with recurrent otitis media for insertion of grommets, after a gold...

JOURNAL WATCH: Heart rate just a marker.(Brief article)
October 8, 2008... Raised heart rate in middle age may be a marker of cardiovascular disease but it is not an independent risk factor, a large Norwegian study has concluded. The 14-year study included 180,353 men and 199,490 women aged 40 to 45 with no...

JOURNAL WATCH: Prostate drug risk.(Brief article)
October 8, 2008... The risk of vascular events is increased with many alpha-blockers used for the treatment of benign prostatic hyperplasia, a large meta- analysis has shown. Canadian researchers found alpha-blocker use was associated with an overall...

JOURNAL WATCH: Glucosamine fails OA trial.
October 8, 2008... Glucosamine and chondroitin sulphate are no better than placebo in slowing the rate of cartilage loss in osteoarthritic knees, according to US research. The study compared 357 patients taking 500mg glucosamine three times a day, 400mg...