Pulse articles from September 2006

Pulse archives from September 2006

Fight on as Warner renews bid to cap GPs' pensions.(increased pensions of General Practitioners)
September 7, 2006... Strike action on the agenda as GPC negotiators vow to use `every weapon' to fight plan Exclusive By Helen Crump The Government has renewed its bid to cap GPs' new contract pension rises. Health minister Lord Warner has written to...

New asthma phone review battle.(consultations for treatment of asthma)(Brief article)
September 7, 2006... The debate over use of telephone reviews in asthma is set to be reopened in the coming QOF review after a new study strongly refuted claims they compromised patient care. GP researchers found telephone reviews were not only as effective as...

Obesity care crisis threatens new GP management role.(general practitioners)
September 7, 2006... Secondary care services unable to cope as referrals are bounced back EXCLUSIVE By Daniel Cressey The Government's attempts to force GPs to shoulder the management of obesity are likely to fail because of a crisis in secondary care...

What specialists told Pulse.(beliefs of general practitioners)(Brief article)
September 7, 2006... We are struggling. We only provide surgery. Often this is not appropriate, but there is very little alternative. Dr Paul Leeder, consultant in upper GI and bariatric surgery at Derbyshire Royal Infirmary, Derby The advice to eat less...

Stand firm on extra work `blackmail'.(Practice Laws)(Brief article)
September 7, 2006... GPs should not feel `morally blackmailed' or contractually threatened to provide services beyond their level of competence, the BMA is advising. New guidance states GPs should not be asked to accept clinical responsibility for patients in...

When is a GP responsible?(list)(General Practitioner)(List)
September 7, 2006... GPs are unlikely to be responsible for patient care if: * a consultant or other hospital doctor has responsibility * hospital documentation or medication is used * a home is secure and staffed by psychiatric nurses * patients have...

Battle in store as GPC fights to relax CKD quality targets.(General Practitioners Council)(Chronic Kidney disease)(treatment - Quality and Outcomes Framework)
September 7, 2006... GPC negotiators are to attempt to modify the chronic kidney disease indicators in the upcoming QOF review to relieve pressure on overstretched practices, writes Daniel Cressey. The GPC admitted the new indicators had `raised problems that...

New breed of expert pharmacists to ease GP burden.(General Practitioners)(Brief article)
September 7, 2006... The Government has announced plans for a new breed of expert pharmacist who will take on part of the burden of chronic disease management from GPs. The plans envisage `pharmacists with a special interest' running diabetes clinics,...

Homoeopathy in mainstream move.(licensing regulations)(Brief article)
September 7, 2006... Homoeopathy has taken a big step towards the mainstream following changes to licensing regulations. In a move that has prompted derision from GPs, new homoeopathic medicines will receive specific licensed indications for the first time...

Complaints to escalate as patients get longer to object.(National Health Services)(Primary care trusts)(Brief article)
September 7, 2006... Patients will have six months to escalate a complaint about NHS services to the Healthcare Commission under changes introduced this month. The limit has been raised from two months in a move medico-legal experts predict will increase the...

InBrief: Good Medical Practice.(guidelines approval)(Brief article)
September 7, 2006... The GMC has given its formal seal of approval to new Good Medical Practice guidelines. Significant changes include new guidance on substance abuse, relations with patients and accepting gifts. Doctors found to have impaired fitness to...

InBrief: Meningococcal advice.(penicillin administration guidelines)(Brief article)
September 7, 2006... GPs should still aim to give penicillin injections to patients with suspected meningococcal disease but rapid referral is now `highest priority', new guidance recommends. The Health Protection Agency document says GPs should carry...

InBrief: Confidentiality risks.(primary care nursing - risks)(Brief article)
September 7, 2006... Potential breaches of patient confidentiality are the most common risk in GP practices, research by MPS Risk Consulting has concluded. Some 95 per cent of practices put confidentiality at risk through poor positioning of computer screens,...

InBrief: Relenza for prevention.(drug licensing)(Brief article)
September 7, 2006... GlaxoSmithKline has received a Europe-wide licence for its antiviral Relenza for prevention of influenza A and B in adults and children aged over five. GSK claimed the licence would increase the options for controlling seasonal flu and...

InBrief: Practice policy on mobiles.(laws, rules and regulations)(Brief article)
September 7, 2006... GP surgeries should develop a written policy on use of mobile phones on site and display information posters to inform patients, new Department of Health guidance advises. Telling patients to switch mobiles off on entering the premises and...

InBrief: GPs handle diabetes well.(General Practitioners - Practice)(Brief article)
September 7, 2006... Diabetes was managed more effectively in the UK than the US even before the advent of the new GP contract, a new study reports. The research, published in the Journal of the Royal Society of Medicine, found care of diabetes up to 2003 was...

InBrief: Dementia priorities upset.(clinical priorities)(Brief article)
September 7, 2006... Memory clinics for providing drug treatment to patients with dementia have distorted clinical priorities, consultants warn in the BMJ. Their editorial argues that the resources spent on cholinesterase inhibitors should be diverted to...

#1m consultation had no impact on policy.(evaluation of Primary care nursing)
September 7, 2006... Patients say Government ignored their views on future of primary care By Helen Crump GP complaints that the Government's high-profile public consultation on the future of primary care was a sham have been supported by an official...

Consult patients on change.(medical practice)(Brief article)
September 7, 2006... A Court of Appeal ruling that North Derbyshire PCT failed to properly consult patients over a tender to run two practices will have a major impact on GPs, the chief executive of the trust has warned. Dr Martin McShane said GPs who sought to...

Alternatives `no better than HRT'.(Hormone Replacement Therapy)(Brief article)
September 7, 2006... Complementary therapies are less effective than HRT for reducing symptoms and may not be any safer, a new report warns. The Royal College of Obstetricians and Gynaecologists said its review suggested alternative medicines had an efficacy of...

GP's yoga class makes a difference.(General Practitioners)(Brief article)
September 7, 2006... The visit a month ago of a 20-stone diabetic patient unable to walk unaided gave Dr Raja Dandapat an idea of how he could do a little extra to help his chronically ill patients. Dr Dandapat, pictured foreground with his wife, has set up a...

Trusts force cost cuts on PMS GPs.(Personal Medical Services)(General Practitioners)
September 7, 2006... PMS practices are being given new targets and extra work as Government seeks greater value for money By Helen Crump PCTs are turning the screws on PMS practices as part of a Government- inspired attempt to wring greater value for money...

GPs attack `meet and greet' plan.(General Practitioners - Services)(Brief article)
September 7, 2006... GPs in Scotland have attacked proposals demanding they provide a `welcome' consultation for all new children registering with practices. NHS Lothian, which has put forward the plans, believes the initial consultations will act as an added...

High patient expectations.(appointment with General Practitioner)(Brief article)
September 7, 2006... Patients increasingly expect to be able to see a GP within 24 hours rather than the Government's target of 48 hours, a poll has found. An Ipsos MORI survey of more than 1,000 people showed 65 per cent would expect to get a GP appointment...

MediaWatch: `Sex causes cancer spread'.(research study)(Brief article)
September 7, 2006... The Story Unprotected sex causes cancer to spread and should be avoided by all women, claims the Sun. The story is also covered by BBC Online, the Independent and the Mirror. The Source A new study, published in the Journal of Endocrinology...

MediaWatch: `Elixir of eternal youth'.(hormone for eternal youth)(Brief article)
September 7, 2006... The story Injections of human growth hormone are `the secret of eternal youth', the Daily Mail and the Sun claim. The Source Dr Jeya Prakash, a Harley Street plastic surgeon, claims he and his wife have benefited from injections over the...

MediaWatch: `Juice delays Alzheimer's'.(prevention of Dementia)(Brief article)
September 7, 2006... The Story Dementia can be prevented by eating a healthy diet, according to the Guardian, Daily Express, Daily Mail, Times and BBC Online. The Source The Kame study, published in The American Journal of Medicine, found people who drank...

Vitamin D script plea.(general practitioners prescription )
September 7, 2006... Study urges GPs to combat rising vitamin D deficiency in Asian children GPs should prescribe vitamin D supplements to all Asian children in the first two years of life to curb dramatic increases in vitamin D deficiency, researchers advise....

Combination cuts COPD death rate.(Chronic Obstructive Pulmonary Disease)
September 7, 2006... A round-up of research presented at the European Respiratory Society conference in Munich this week By Daniel Cressey A major new study has questioned the view of COPD as an inevitable death sentence after finding combination treatment...

Adherence to long-acting Beta-agonists.(lists)(List)
September 7, 2006... Predictors of low adherence * Initiation without steroids * No respiratory visits to GP * Nebuliser use * Asthma history * Poor adherence to hypertension therapy Predictors of high adherence * More than five respiratory visits...

Test reveals COPD patient compliance.(Chronic Obstructive Pulmonary Disease)(Brief article)
September 7, 2006... Evaluating COPD patients for a series of key indicators can pick out those whose compliance is poorest, a new study concludes. Patients who rarely saw their GP, had few prescriptions for short- acting Beta-agonists and were poorly adherent...

Beta-agonist warning.(general practitioners prescriptions)(Brief article)
September 7, 2006... Doctors are introducing long-acting beta-agonists too early in asthma and often without inhaled steroids, a European-wide survey reveals. A study of 602 doctors from six countries, including the UK, found 22 per cent would consider...

Asthma assessments.(evaluation)(Brief article)
September 7, 2006... GPs need to conduct systematic assessments of children's persistence with asthma medication, researchers warn. A study of 220 UK children with persistent asthma found as many as 54 per cent discontinued inhaled steroids during 12 months'...

Immunisation cuts wheezing in infants.(asthma - care and treatment)(Brief article)
September 7, 2006... Childhood immunisation appears to reduce the incidence of asthma, a study shows. Researchers found wheezing in children aged one to four years was increased by 41 per cent in those with delayed, partial or no immunisation. The...

Singlehander quits over workload.(General Practitioners practice)
September 7, 2006... GP says inadequate funding is leaving her on the verge of burnout because she can't afford any new staff By Ian Cameron A GP has spoken of her anguished decision to quit her singlehanded practice because spiralling workload is putting...

PCT withdraws from APMS pilot.(primary care trust)(Alternative Provider Medical Services )(Brief article)
September 7, 2006... One of the six PCTs involved in the Government's pilot for Alternative Provider Medical Services contracts has withdrawn from the scheme. Plymouth Teaching PCT had tendered for a service for 2,000 patients living in nursing and residential...

GP's fringe benefits.(General Practitioners)(Brief article)
September 7, 2006... Dr Paul Sinha's comedy career is set to take off after he was shortlisted for one of the most prestigious awards at the Edinburgh festival. Dr Sinha, a locum GP, was one of five nominees for this year's if.comeddies award, formerly the...

JournalWatch: Inhaled steroids in infants.(treatment of respiratory tract diseases)(Brief article)
September 7, 2006... Inhaled steroids are ineffective for halting the progression of respiratory symptoms in wheezy infants, a UK study reports. Researchers randomised 175 infants and young children to 100 g fluticasone twice daily or placebo and followed them...

JournalWatch: Bad sleep for diabetic men.(health aspects)(Brief article)
September 7, 2006... Men with diabetes are much more likely than those in the population generally to suffer from obstructive sleep apnoea, a UK study concludes. The researchers selected men with type 2 diabetes from local hospital and GP databases and assessed...

JournalWatch: Same VTE risk in all travel.(venous thromboembolism )(Brief article)
September 7, 2006... The risk of venous thromboembolism is similar with all modes of transport, Dutch researchers conclude. A case-control study examined 1,906 patients attending an anticoagulation clinic with a first VTE, 233 of whom had travelled for more...

JournalWatch: Statin interaction.(care and treatment for high cholesterol)(Brief article)
September 7, 2006... Atorvastatin may reduce the effectiveness of clopidogrel, a Canadian study reports. Researchers used administrative databases from the province of Quebec to assess 2,927 patients who were prescribed clopidogrel, 727 of whom also received...

JournalWatch: Pre-diabetes targeted.(statin therapy)(Brief article)
September 7, 2006... Intensive statin therapy has incremental benefits for patients with coronary heart disease and the metabolic syndrome, whether or not they have diabetes. The international Treating to New Targets study enrolled 10,001 patients aged 35 to...

Practice-based commissioning back on track, according to department.(General practitioners compensations)(Brief article)
September 7, 2006... The Department of Health claims take-up of practice-based commissioning is back on track. The number of PCTs meeting four criteria set by the department to determine involvement in commissioning was 57 per cent at the end of July against a...

Drug cuts strokes.(drug use)(Brief article)
September 7, 2006... Treatment with a glitazone can substantially cut the risk of recurrent stroke in patients with diabetes, a study has concluded. Researchers claimed the findings - from a sub-study of the major Proactive trial - would help push an expansion...

Telephone CBT effective.(Cognitive behavioural therapy )(Brief article)
September 7, 2006... Cognitive behavioural therapy by telephone is just as effective as face to face for treating obsessive compulsive disorder, researchers report. Their study found telephone sessions were only about half as long as face-to-face sessions,...

Steroid sinusitis boost.(care and treatment)
September 7, 2006... Cochrane review finds steroids are an effective alternative to antibiotics By Daniel Cressey Topical steroids speed the recovery of acute sinusitis and could replace antibiotics for treating milder forms of the disease, a new gold...

GPs unite against private sector.(General Practitioners services)
September 7, 2006... GPs band together to set up social enterprise to manage PBC and help win contracts to provide services By Helen Crump Around 100 GPs in east London have banded together to form a social enterprise to help fight off the threat from...

Certification claim.(licensed profession)(Brief article)
September 7, 2006... Evidence from the US suggests certification of doctors will help to improve quality of care, researchers claim. An analysis by the Universities of Cambridge and North Carolina concludes that more than half of studies on the issue between...

DNA figures up following start of advance booking.(prebooking for general practitioner appointment survey )(Brief article)
September 7, 2006... The Government's drive to improve access to GP services by allowing patients to pre-book has driven up the number of people missing their appointment. Developing Patient Partnership's annual survey found patients missed 11 million GP...

Diabetes self-care scheme works.
September 7, 2006... National X-pert programme to train patients in self-management has significant benefits for disease control By Danusia Osiowy A major primary care programme to educate diabetes patients on self- management substantially improves...

ACE inhibitor cuts risk of diabetes.(Angiotensin-Converting Enzyme)(Brief article)
September 7, 2006... The benefits of an ACE inhibitor and calcium channel blocker for diabetes risk are slightly greater than originally calculated, a sub- study of ASCOT has concluded. The combination cut diabetes risk 34 per cent compared with a beta-...

Reviews cut elderly falls.(pharmacists recommendation of medication to nursing home patients)(Brief article)
September 7, 2006... Pharmacist reviews of GP patients in care homes produce substantial changes to medication and sharp reductions in falls, according to new research. The GP study revealed problems with the way medication is reviewed, adding to concerns over...

DVT screens: be selective.(deep vein thrombosis a risk for cancer)(Brief article)
September 7, 2006... GPs should investigate unexplained deep vein thrombosis for cancer but screening all thromboses is not necessary, a new study concludes. Dutch researchers found patients with idiopathic DVT were 3.6 times more likely to have an undiagnosed...

Analysis: Patient power sees off US giant.(North Eastern Derbyshire PCT tender case report)
September 7, 2006... Pensioner's Court of Appeal victory stops US health giant in its tracks and should help GPs win more contracts By Ian Cameron It is a story worthy of being the next Billy Elliot-style blockbuster. Set against the backdrop of a...

`Trust didn't knowingly do anything wrong on tender'.(North Eastern Derbyshire PCT public involvement in tender )(Brief article)
September 7, 2006... Dr Martin McShane, chief executive of North Eastern Derbyshire PCT, maintains the trust `at no stage did anything knowingly wrong' in its handling of the tender process. `We worked in good faith and with complete integrity, and when we...

How to...Find and keep a good locum.(methods)
September 7, 2006... Have you had locum problems this summer? If so, the following should help you find a good locum in future - and keep that locum coming back. 1 Try online matching services. Websites such as locum123.com and gpmatch.com have thousands of GP...

Raise your game now or lose out on QOF and DES points.(Quality and Outcomes Framework)(Department of Education and Science)
September 7, 2006... Top scores will be harder to get this year. Dr John Couch offers advice It is likely that the rosy glow of achievement felt by most practices at the end of each of the first two nGMS years will be missing this year. While it was clear from...

LETTERS: GPs responsible for obesity? That's a joke.(Letter to the editor)
September 7, 2006... Success claims of Counterweight Project provoke a strong response From Dr Alan Davis London W13 When I read your story regarding rolling out a programme of obesity management into overstressed general practice (News, 24 August) I...

Letter: Obesity is our bread 'n' low-fat spread.(Letter to the editor)
September 7, 2006... From Dr Induja Bandara South-west London I was bemused to read about the `new' GP role in obesity care as I feel this work has been the `rice cakes and low-fat spread' (ie bread and butter) of my work as a GP for some time now. Obesity...

Letter: How Not To Miss - unmissable stuff.(Letter to the editor)
September 7, 2006... From Dr Peter Hill Birmingham Re your How Not To Miss series (Clinical) - it's excellent. I believe there should be more emphasis on diagnosis. It can be tricky. I have given up full-time GP work but look back with profound sadness on...

Letter: Old-school system works for us.(Letter to the editor)
September 7, 2006... From Dr Suresh Sanders Livingston We are a practice that is quite out of fashion. We have individual lists, a 10-minute appointment system and urgent on-the-day slots for any doctor. In view of the endless, poorly thought out...

Letter: New system is double the trouble.(Letter to the editor)
September 7, 2006... From Dr Arnold Zermansky Leeds Am I alone in seeing another financial crisis looming for the NHS? Since the advent of Choose and Book in our patch two months ago I have not referred a single patient to our local teaching hospital because...

Letter: NHS Direct - a waste of time and money.(Letter to the editor)
September 7, 2006... From Dr John Fitton Kettering Your story `Where did NHS Direct go wrong?' (News, 24 August) was excellent. I've lost count of the number of complaints I've sent into NHS Direct about their [non] service while working at our local co-op (we...

Letter: Kendrick's spot on on overuse of statins.(Letter to the editor)
September 7, 2006... From Dr Michael Green Manchester Thank you for Dr Malcolm Kendrick's article on statins (Clinical, 3 August), which I fully support. A summary of the evidence on statin use by leading epidemiologists in Germany (drugs bulletin...

SecondOpinion - Andy Jones: The importance of clinical governance.(organization structure of primary care trusts)(Column)
September 7, 2006... The issue of clinical governance is foremost in my mind. I think it needs to be central to new organisational structures in healthcare and not just bolted on. Indeed, a better name for it would be `excellence across healthcare'. The remit of...

Letter: Let's cure negativity over homoeopathic remedies.(Letter to the editor)
September 7, 2006... From Dr Noel Thomas Maesteg, Mid Glamorgan Perhaps Professor Edzard Ernst will gain more first-hand knowledge of homoeopathic practice in future. Until then his message (Clinical, 3 August) will remain a source of amusement and sadness. ...

PulseClinical: Need to know travel medicine.(Travelers diarrhea prevention)
September 7, 2006... Take-home points * A single dose of 500mg of ciprofloxacin is a proven effective treatment for travellers' diarrhoea; azithromycin 1g is an alternative * High-risk groups for travellers' diarrhoea include British honeymooners and...

PulseClinical: practical lowdown on...HRT.(Hormone Replacement Therapy)
September 7, 2006... Benefits * Symptom relief Improvement in vasomotor symptoms occurs in a few weeks, and in vaginal symptoms in three months. Improvement in mental function is less certain. The mental health of women with vasomotor symptoms seems to improve...

Kendrick on...Idiotic dietary advice we give to diabetes patients.(Malcolm Kendrick)
September 7, 2006... Our clinical columnist, Dr Malcolm Kendrick, challenges another sacred cow - this week he argues the nutritional advice GPs give to patients with diabetes is nonsensical Type 2 diabetes is primarily a problem of insulin resistance. Insulin...

PulseClinical: Lowering homocysteine does not cut CVD risk.
September 7, 2006... Q Is supplementation to lower homocysteine levels effective for preventing or treating cardiovascular disease? Synopsis An elevated level of homocysteine is an independent predictor of the risk of developing CVD. The leap that many...

PulseClinical: Tramadol for neurophathic pain and osteoarthritis?(drug review)(Drug overview)
September 7, 2006... Summaries of two Cochrane reviews that could be relevant to your next consultation How effective is tramadol for neuropathic pain? Peripheral neuropathic pains often include symptoms such as burning or shooting sensations, abnormal...

Do you bow to patient demand for longer opening hours?
September 7, 2006... Three GPs share their approach to a practice problem Case history Your patient satisfaction survey shows although the patients seem to like the doctors, think they listen and provide good care, they definitely do not like the surgery's...

PulseRegistrar: My perfect reading list.(general practitioners recommended books)(Recommended readings)
September 7, 2006... As new registrars, you will be faced with a daunting choice of books to help you through the exams. Dr Sue Ford, who recently sat the MRCGP, reveals the reading list she found most useful Don't take this reading list as chapter and verse....

PulseRegistrar: Red flags - Abdominal pain.(diagnosis of abdominal pain)
September 7, 2006... In the first of a new series to help you avoid missing a major diagnosis early on in the registrar year, GP tutor Dr Des Spence looks at danger signs to look out for in abdominal pain Good judgment comes from experience - experience comes...

PulseRegistrar: Your first patient who wants to go private.(medical referral management)
September 7, 2006... A private referral can be a rubber-stamping exercise - or a minefield, warns Dr Melanie Wynne-Jones Depending on where you work, private referrals may be the exception, or account for a large proportion of your referrals. The usual...

PulseRegistrar: Little gems - How hot are you on...CVd risk?(general practitioners tips on cardiovascular disease risk calculation)
September 7, 2006... Test your knowledge for the nMRCGP with this little GEM from GPnotebook Q What is the relationship between cardiovascular risk and coronary heart disease risk? A Previous primary risk charts examined coronary heart disease (CHD) risk...

PulseComment: No surrender on pensions.(pension contract not affordable)(Brief article)
September 7, 2006... Back in January, when the Government first said GPs' new contract pension rises were `unaffordable' and it wanted to cap them, we said there should be no compromises in fighting any such plans. The Government agreed the new contract. ...

GP premises: a national disgrace.(general practitioners)(no practice palces for general practitioners in United kingdom)
September 14, 2006... Shocking Pulse figures reveal that over 1,000 UK practice buildings are not fit for purpose EXCLUSIVE By Anna Hodgekiss A Pulse investigation has uncovered the shocking and deepening scale of the GP premises crisis. At least...

Cramped, stuffy, leaking... just a typical GP surgery.(general practitioner)(Brief article)
September 14, 2006... Dr Phil Speakman is typical of the thousands of GPs blighted by having to work in unfit premises. The flat roof on his 1970s-built practice in Buckley, Flintshire, leaks. The waiting room is tiny. Freezing in winter and boiling in...

GP income under scrutiny in review of new contract.(general practitioners income)
September 14, 2006... Pensions, MPIG and the QOF are all on the Government's agenda By Ian Cameron Ministers have launched a three-pronged assault on GPs' incomes with a wholesale review of whether primary care is providing value for money. GP...

Major changes due for 2008 QOF.(Quality and Outcomes Framework )(changes in medical practice)(Brief article)
September 14, 2006... GPs face `major changes' to the QOF in 2008 with new disease areas and tougher thresholds, a leading expert has claimed. Professor Martin Roland, one of the architects of the QOF, has warned a complete overhaul is planned for the review...

NHS review questions evidence for computerised CBT.(National Health Service )(cognitive behavioural therapy)(care and treatment of mental disorders)(Brief article)
September 14, 2006... Using computers as a substitute for human therapists in treating depression and anxiety may not be feasible after all, a new analysis warns. The NHS Health Technology Assessment questions the evidence that led NICE to recommend funding of...

GMC breaks its silence on overhaul of regulation.(General Medical Council)(Medical Practice laws)
September 14, 2006... EXCLUSIVE Sir Liam Donaldson's plans to overhaul medical regulation would damage doctors' professionalism and harm patients if implemented wholesale, the GMC is warning. Finlay Scott, chief executive of the GMC, broke the council's...

BMA stands firm on pensions cap.(British Medical Association )(Brief article)
September 14, 2006... The BMA has vowed there will be no compromise in negotiations with the Government over a potential cap on GPs' pensions. Speaking a week after Pulse revealed a cap was back on the agenda, Dr Andrew Dearden, chair of the BMA pensions...