Pulse articles from September 2008

Pulse archives from September 2008

Pay squeeze forces GPs to expand lists.
September 3, 2008... Financial pressures compel three-quarters of GPs to take a cut in drawings as vacancies fall 60% Exclusive By Steve Nowottny Thousands of GP practices have begun moves to expand their lists as financial pressures force them to compete...

Two drugs best for treating children's fever.
September 3, 2008... Researchers have advised GPs to give 120mg ibuprofen before 150mg paracetamol, followed by the two drugs together, for fever in children. A BMJ study of 156 children found that children given both medicines for four hours experienced fever...

BMA appeals over charges for GPs over 65.
September 3, 2008... The BMA is appealing to the High Court to try to block GMC moves to charge GPs over the age of 65 to stay on the GMC register. As Pulse first reported in May, the GMC is to scrap exemption on annual GMC retention fees for almost 1,000 GPs...

Three named for regulatory commission.
September 3, 2008... The new health regulator, the Care Quality Commission, has appointed three NHS heavyweights as commissioners. Professor Deirdre Kelly, professor of paediatric hepatology at Birmingham Children's Hospital, Lord Patel of Bradford, chair of...

Dispensing GPs on the brink.(General practitioners)
September 3, 2008... As many as 700 practices could lose dispensing rights under white paper plans, DH analysis reveals By Nigel Praities More than 700 practices could face losing their dispensing rights if the Government presses ahead with plans set out...

What could happen to dispensing.
September 3, 2008... The Government has proposed four options for the dispensing practices rules: Option 1: No change. Option 2: PCTs to determine the rural localities where GP dispensing is appropriate on the basis of a pharmaceutical needs assessment....

PCT calls in fraud team over claims of leak to private firm.
September 3, 2008... Exclusive By Steve Nowottny A PCT says it has called in NHS counter-fraud investigators over claims it released financial plans to the private sector before they went public. The NHS Counter Fraud and Security Management Service said...

GPs fear flu vaccine confusion as shops ramp up stocks.
September 3, 2008... Retailers are dramatically ramping up provision of flu vaccines this winter, in a move which GPs claim will cause confusion at practices and could leave them with unused stock. Pulse has learned that Sainsbury's will be selling flu...

NHS Counter Fraud Service.
September 3, 2008... * The NHS Counter Fraud Service is part of the NHS Counter Fraud and Security Management Service, established in 1998. Its remit is to tackle all cases of fraud and corruption in all areas of NHS spending. * The service includes a `first...

NICE to review QOF on costs.
September 3, 2008... Indicators that do not deliver value for money face being scrapped under wide-ranging review by institute Exclusive By Lilian Anekwe QOF indicators that are not delivering value for money are set to be scrapped as part of a sweeping...

How NICE and QOF conflict.
September 3, 2008... Lipid modification: NICE advises GPs aim for a target of 4mmol/l for total cholesterol, whereas the QOF rewards GPs for hitting a total cholesterol of 5mmol/l or less in patients with established CVD. Blood glucose: NICE guidance says GPs...

Measuring heart rate `should be routine'.(Clinical report)
September 3, 2008... Elevated heart rate predicts cardiovascular morbidity and death in patients with coronary disease and GPs should routinely measure it, say cardiology experts. The call came following the release of data from the first prospective study to...

STATINS: Risk of death rises fourfold when statins are stopped.
September 3, 2008... Stopping statin treatment in patients following an acute coronary event more than quadruples their risk of dying, concludes new research presented at the ESC congress. Interruption in statin therapy was an independent predictor of all-...

TARGETS: Cardiologists criticise QOF secondary prevention targets.
September 3, 2008... Cardiologists have attacked secondary prevention targets in the QOF for not being strict enough and resulting in substantial under-treatment. A UK study presented at the conference looked at risk factors for all patients who had completed...

POLYCLINICS: Bidding divides the profession.
September 3, 2008... A spot poll of 100 GPs shows controversial moves by LMC leaders to bid for polyclinics have divided the profession. Pulse revealed last week that LMCs were heavily involved in the tendering process, with about a fifth putting together their...

POLYCLINICS: GPs' polyclinic bids falling at first hurdle.
September 3, 2008... GPs frozen out as PCTs appear to block them from even submitting bids By Steve Nowottny GPs are being frozen out of bidding for the new wave of polyclinics, with fears that up to half of GP-led bids are falling at the first hurdle....

POLYCLINICS: London pushes on with polyclinics.(Brief article)
September 3, 2008... NHS bosses in London have decided to push ahead with an aggressive rollout of fully-fledged polyclinics and will approve 13 new centres in this year's first wave, Pulse can reveal. NHS London is not due to announce details of the first...

Schools and nurses join PBC.
September 3, 2008... Launch of first US-style Integrated Care Organisation in make-or-break PBC initiative PBC in numbers 18% of practices agree PBC has improved patient care 48% rate their PCTs managerial support as poor 59% of practices given an...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.
September 3, 2008... `iPod ear' may be on the rise, but blasting your cochlea with loud music may not be such a problem in a few years if you believe The Independent, Telegraph and Times. US researchers have shown for the first time that it is possible to regrow...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
September 3, 2008... Heated car seats have become the latest modern device to pose a threat to male fertility. German researchers found that 30 men who sat in the seats for 90 minutes were made to feel all warm and comfy down below. But the rise in testicle...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.
September 3, 2008... Little doubt about the findings of this research after the summer we've had. Experts have found the weather really is worse on a weekend, with the build-up of soot and particles from car exhausts, chimneys and power stations during the week...

Consultants ready for new turf war.
September 3, 2008... Specialists feel threatened by moves to provide care in polyclinics and other community settings By Lilian Anekwe Moves to shift work from hospitals into the community as part of the Government's drive for care closer to home are...

IN BRIEF: Out-of-hours row.(Brief article)
September 3, 2008... A row has broken out over out-of-hours provision amid claims that a private provider has reduced payments for GPs. GPs in Worcestershire warned the move would be a `major disincentive' for local GPs to continue with out-of-hours work. The...

IN BRIEF: Conflict of interest fears.(Brief article)
September 3, 2008... Health bosses in London have identified potentially serious conflict of interests through PCTs holding both provider and commissioner functions. In a report on the plans, Caroline Mitchell, head of commissioning development at NHS London,...

IN BRIEF: CVD screening `should not be top priority'.(cardiovascular diseases)(Brief article)
September 3, 2008... Priority should be given to treating people with established cardiovascular disease before rolling out cardiovascular screening, says an internationally respected epidemiologist. The comments came in a debate published in the BMJ on the...

Trusts rapped for C&B manipulation.(choose and book system)
September 3, 2008... `Significant numbers' of hospitals are restricting appointment slots in order to meet 18-week target By Steve Nowottny The Department of Health has issued a stern reprimand to hospital trusts for manipulating the Choose and Book system...

JOURNAL WATCH: MI sex bias in diabetes.
September 3, 2008... Type 2 diabetes puts women at much greater risk of myocardial infarction than men, say UK researchers. Their cohort study looked at MI rates in data from 235,640 patients with type 2 diabetes and age- and sex-matched controls on the UK...

JOURNAL WATCH: Ezetimibe no cancer risk.
September 3, 2008... Treatment with ezetimibe does not increase a patient's risk of cancer, according to a major study of its use when prescribed in combination with a statin. A previous study - the SEAS trial - had found ezetimibe was associated with an...

JOURNAL WATCH: Young struggle to quit.
September 3, 2008... Recruitment for smoking cessation services for young people is difficult and quit rates are `disappointing', conclude the authors of a Scottish study. The results came from an independent evaluation of 470 participants in a three-year...

Psychosis drugs raise stroke risk.
September 3, 2008... All antipsychotics increase risk of stroke, especially in dementia By Lilian Anekwe All antipsychotic drugs increase the risk of stroke, with the risk particularly high in patients with dementia, a new primary care study shows. ...

PbR inaccuracies revealed.(Report)(Brief article)
September 3, 2008... Almost one in 10 episodes of acute hospital care is incorrectly coded under Payment by Results, according to a new Audit Commission study. The commission warned the poor data quality and inaccurate payments would adversely affect NHS...

FOCUS ON... The rising influence of NICE.(United Kingdom. National Institute for Clinical Excellence)
September 3, 2008... The institute strengthens its influence over GPs with a review of the QOF and tough implementation powers By Nigel Praities NICE has always been a controversial animal. The nature of the beast means it grabs national headlines...

EDITORIAL: Clinical becomes political.(Editorial)
September 3, 2008... It's a good job that only sticks and stones break bones, or NICE would be lying in bed covered in bandages by now. Few health organisations seem so regularly to crash the front pages of our national newspapers, and fewer still manage to attract...

VOX POP: What is your verdict on NICE?
September 3, 2008... Dr Bill Beeby chair of the GPC clinical and prescribing subcommittee `NICE is always going to be political and it is inevitable that when a body like NICE makes decisions they are going to be controversial. But is it equipped to extend its...

DEBATE: Do patients want polyclinics?
September 3, 2008... YES Not only do patients like the concept of polyclinics, they also like them in practice and are already rushing to sign up, says Dr Tom Coffey This debate is about what patients want and deserve and - as I practice in London with...

PULSECLINICAL: COULD AGGRESSIVE BLOOD GLUCOSE LOWERING BE HARMFUL?
September 3, 2008... NEW SERIES: To kick off his new fortnightly clinical column, Dr Malcolm Kendrick asks whether the orthodox view in diabetes - the more aggressive the treatment the better - could be doing more harm than good As part of an article I wrote a...

SNAPSHOT DIAGNOSIS: RECURRENT MOUTH ULCERS.(Case study)
September 3, 2008... Dr Hercules Robinson describes a case where a patient's fifth visit with mouth ulcers prompted him to dig deeper The patient This young woman presented with a large mouth ulcer. Looking back through her recent attendances, there had...

WHEN TO TEST FOR HIV.
September 3, 2008... Too many early HIV infections are being missed in primary care, according to recent studies. Dr William Ford-Young gives his hints 1 Primary HIV infection - or seroconversion - is commonly missed by both healthcare professionals and...

PULSECLINICAL: CARDIAC ARRHYTHMIAS.
September 3, 2008... Cardiologists Professor John Camm and Dr Malini Govindan answer GP Dr Mandy Fry's questions on rate versus rhythm control and `pill in the pocket' regimes 1 What factors influence whether we should be aiming for rate or rhythm control in...

PULSECLINICAL: HOW I... TARGETED PERSISTENT FREQUENT ATTENDERS.
September 3, 2008... Dr John Havard explains how he and his colleagues tackled the problem of patients who attend too often The problem Every practice has a group of frequent attenders who never seem to get better. This relatively small cohort of patients...

Should we retest for trichomonas?(Brief article)
September 3, 2008... Q We occasionally get Trichomonas vaginalis reported as an unexpected finding on a cervical smear result in asymptomatic women, who might be considered low risk. I believe these can be `false positives', but don't understand the mechanism for...

Are GI diets a healthy way to lose weight?
September 3, 2008... Q Is the glycaemic index (GI) of foods a useful basis for eating healthily or losing weight? A GI describes the rise in blood glucose after eating the amount of a food that provides 50g of carbohydrate. The index was first developed to...

ASK THE EXPERT: BEDSIDE MANNER.
September 3, 2008... Dr John Holden considers what to do if a partner's attitude to patients seems somewhat short on tact One of our GPs has developed a rather blunt approach with patients who are overweight or who smoke. A nurse confided in me that he told a...

BUSINESS BRIEFING: TAX CHANGES FOR YOUR STAFF.
September 3, 2008... As an employer you need to ensure your practice is fully prepared for the upcoming changes in the tax rates, says Rosemary Smith It is crucial that you are alert to the changes about to take place in tax rates and that you keep in regular...

PULSE SERVICES: Locum cover that won't let you down.
September 3, 2008... Does your locum insurance offer everything you need? Ensure you have total peace of mind, says Stuart Smith A good quality locum insurance policy is an essential part of the insurance portfolio for any GP who would have financial...

A case of post-jolly blues.
September 3, 2008... Phil finds returning to work hard enough without being pounced upon for vicarious details I resist the impulse to slap myself soundly on the forehead. I also resist the impulse to shout: `What the hell has that got to do with you?' because...

Women GPs locked out of leading jobs.
September 10, 2008... Representative bodies are failing to reflect the influx of women into general practice Exclusive By Lilian Anekwe Women GPs are unable to break into the top jobs in general practice, with the profession's representative bodies...

New BNF urges caution over cephalosporins.
September 10, 2008... Cephalosporin antibiotics should be avoided in patients who have a history of immediate hypersensitivity to penicillin, the latest BNF advises. Cefaclor, cefadroxil, cefalexin and cefradine should definitely be avoided. But BNF 56...

Variations in spending create postcode lottery.
September 10, 2008... A King's Fund report has claimed there is a postcode lottery in NHS spending, with huge variations in funding between PCTs, including for life-prolonging cancer drugs. It warns the situation applies across the board, with some of the...

Weekly dose of exenatide shows benefits.
September 10, 2008... A once-weekly formulation of the drug exenatide in patients with type 2 diabetes provides better glycaemic control than the current twice-daily regimen, research has found. In a trial of 259 patients given either a subcutaneous 2mg dose...

Nurses to outnumber GPs three to one in Darzi centres.
September 10, 2008... Exclusive By Gareth Iacobucci Nurses will outnumber GPs by as much as three to one in Lord Darzi's national network of polyclinics, amid moves to radically reshape the skill mix of primary care. The Department of Health has...

DH puts dramatic global sum shake-up back on table.(United States. Department of Health and Human Services)(Brief article)
September 10, 2008... A controversial shake-up of the global sum formula that could see big increases in funding for some practices and swingeing cuts for others will be considered in the next round of contract negotiations. The Formula Review Group's...

Being a GP is who we are, not just what we do.
September 10, 2008... Guest Editorial Dr Fay Wilson takes the reins this week as guest editor of Pulse, helping shape the news agenda and select features. Here she offers her take on this week's top stories In general practice some things never change,...

Patient power?(Brief article)
September 10, 2008... PCTs in London insist their polyclinic plans are subject to board approval and public consultation, but fresh signs have emerged that they may be jumping the gun. Camden PCT last month began advertising for a new head of integrated service...

NHS makes polyclinic U-turn.
September 10, 2008... London PCTs universally reject single-site polyclinics in favour of hub- and-spoke model PULSE: SOS - Save Our Surgeries By Steve Nowottny PCT bosses in London have universally rejected Lord Darzi's proposals for a series of...

New clinical DES payments get lukewarm reception.
September 10, 2008... Many GPs are likely to snub the Government's new clinical enhanced services, LMC leaders warned, as financial details were released of DES payments. GPs will be paid only #2.33 per patient for screening new registrants for harmful drinking...

What the DESs are worth.
September 10, 2008... Heart failure: cases due to LV dysfunction treated with a Beta-blocker - #35 per patient Alcohol: newly registered adults screened using FAST or AUDIT-C - #2.33 per patient Learning disabilities: annual checks for people on learning...

How patients miss their slot.(Brief article)
September 10, 2008... * If a patient does not book a date, time and hospital at the GP surgery, they are given an appointment request letter and told to phone the national appointments line or book online. * When the patient calls to book, 20% of the time they...

Patients' C&B slots vanish.(Brief article)
September 10, 2008... As many as 5,000 patients a day left unable to book appointments over the phone By Steve Nowottny As many as 5,000 patients a day are left unable to book an appointment through Choose and Book because their slot has disappeared, Pulse...

IN BRIEF: Pandemic plans patchy.
September 10, 2008... GPs are still unprepared for a flu pandemic with more than a third of practices having no contingency plans in place, according to a new survey. A Management in Practice poll of 419 practices found only 62% had specific plans in place,...

IN BRIEF: Pharmacists in CVD push.
September 10, 2008... Pharmacists have stepped up their campaign to take on a major new role in tackling cardiovascular disease, with claims that high-risk patients are missing out on treatment from their GP. Research presented at the British Pharmaceutical...

IN BRIEF: Polyclinic petition row.(Brief article)
September 10, 2008... An MP is in hot water after allegedly hijacking a GP's polyclinic petition for political purposes. Tom Brake, MP for Carshalton and Wallington and the Liberal Democrats' authority on data protection, was reprimanded by the Information...

How POMs are going OTC.(Perscription Only Medicine)(over the counter)(Brief article)
September 10, 2008... August 2008: Azithromycin 500mg tablets for the treatment of confirmed asymptomatic Chlamydia trachomatis genital infection in those aged 16 and over, and their sexual partners September 2008: Naproxen 250mg tablets may now be supplied...

Pharmacists to sell diclofenac.
September 10, 2008... GPs express worries over decision to make yet another NSAID available without prescription By Lilian Anekwe Diclofenac is to become the latest high-profile drug to be made available over the counter in a move that has raised...

Scottish health bill to ban private bids for GP services.
September 10, 2008... Private companies will be blocked from bidding for GP services in Scotland as part of new legislation. Scotland's first minister Alex Salmond, setting out his plans for the coming year, said a new health bill would `help ensure the future...

Salaried GPs set to flock to private firms.
September 10, 2008... Almost 70% considering working for private sector as partnerships dry up By Nigel Praities Salaried GPs are so frustrated by the lack of opportunities within general practice that almost 70% are now considering turning to the private...

MEDIA WATCH: THIS WEEK'S TOP... Miracle cure.(Brief article)
September 10, 2008... Placing a small sponge the size of a postage stamp in your abdomen may not seem appealing, but it could be a future way of banishing post- operative pain, according to the Daily Mail. The magic sponge - which is currently in clinical trials...

MEDIA WATCH: THIS WEEK'S TOP... Scare story.
September 10, 2008... Salad munchers beware. It may be washed in spring water, but poisonous bugs are clinging to the underside of your lettuce, warn scientists at Imperial College London. According to reports from the Daily Mail and Telegraph, prewashed salads may...

MEDIA WATCH: THIS WEEK'S TOP... most pointless research.
September 10, 2008... New research commissioned by margarine manufacturer Flora pro.activ says although statins may be the front line of attack, diet can also help to tackle that nasty cholesterol. The study says saturated fat should be replaced with monounsaturated...

GPs handed HPV vaccine role.
September 10, 2008... Shortage of school nurses forces PCTs to commission practices to deliver #100m vaccination programme By Steve Nowottny The HPV vaccination programme is to be run entirely by GPs in some parts of the country, amid warnings that some...

Vaccination could eradicate varicella.
September 10, 2008... A two-dose vaccination programme could eliminate the varicella virus in the UK, but may also mean the elderly need to be vaccinated to prevent them contracting shingles, according to new research. Modelling data from Health Protection...

Chlamydia drive falls short.
September 10, 2008... The number of people being tested as part of the national chlamydia screening programme is falling far short of the target required to make the programme a success, a new analysis shows. The report by Health Protection Agency researchers...

MRSA often from community.
September 10, 2008... As many as a third of patients diagnosed with MRSA in hospital contracted the infection in the community, a new analysis concludes. The study reveals the stark reality of the rise in community-acquired MRSA infections, writes Lilian Anekwe....

JOURNAL WATCH: MI in COPD patients.
September 10, 2008... Many patients with COPD suffer heart attacks that are never recognised by their doctors, say Norwegian researchers. They looked at 897 COPD patients discharged after treatment for an exacerbation in hospital, and analysed the ECG records...

JOURNAL WATCH: Flu vaccine found to cut deaths 19% - not 50%.
September 10, 2008... Claims than the influenza vaccine can cut mortality by 50% are not supported by the evidence, according to Canadian researchers. Their study estimated the reduction in mortality in 700 patients hospitalised for community-acquired pneumonia...

JOURNAL WATCH: Diabetes self-care alert.
September 10, 2008... Continuous glucose self-monitoring is associated with improved glycaemic control in adults with type 1 diabetes but is more difficult in children and adolescents, say US researchers. Their study looked at 322 adults and children who were...

Clinicians sidelined by Darzi.
September 10, 2008... Senior adviser says doctors aren't getting look-in during implementation By Gareth Iacobucci A senior adviser to Lord Darzi claims the Government has frozen clinicians out of implementing the health minister's NHS review. Dr...

DH saves cash on GP pay award.
September 10, 2008... This year's pay award will cost taxpayers just #5m, with nine in 10 GPs due to receive no increase at all, the Department of Health has confirmed. The DH finally published the Statement of Financial Entitlements for 2008/9 last week, after...

FOCUS ON... The careers of women GPs.
September 10, 2008... Nearly half of GPs are women, yet few reach the top jobs. Here, three female GPs describe their own experiences By Lilian Anekwe Getting on for half the GPs in the country are now women, so you might think a debate over sexism and male...

TWO VOICES: Are too many women coming into general practice?
September 10, 2008... Two leading GPs consider the claim that an influx of women has unbalanced the workforce 1 Dr Peter Holden GP in Matlock, Derbyshire, and GPC negotiator Why ask the archetypical white Anglo-Saxon Protestant ex-public schoolboy - a...

VOX POP: Is there a glass ceiling for women in general practice?
September 10, 2008... Dr Richard Fieldhouse vice-chair of the National Association of Sessional GPs `Partnerships are more male-orientated and have more to do with the organisational aspects of the practice, while more female GPs are employed as salaried GPs to...

PULSEGUEST EDITOR: REPLACING A PARTNER.
September 10, 2008... Pulse invited Dr Fay Wilson - GPC member and chair of the last LMCs conference - to be guest editor for the week. She has planned a special features section looking at some of the areas that interest her most in general practice - including the...

PULSEGUEST EDITOR: HOW TO EXPAND YOUR PRACTICE LIST.(Editorial)
September 10, 2008... Dr Talac Mahmud advises how practices can attract new patients and compete with private providers The idea of actively marketing services to win more patients is uncomfortable for many GPs. However, our patients are now fair game for...

PULSEGUEST EDITOR: SAFEGUARD YOUR PATIENT DATA.(www.ico.gov.uk/)
September 10, 2008... Useful website Information Commissioner's Office www.ico.gov.uk/ For information on the Data Protection Act and special situations Patient data falling into the wrong hands can be disastrous - Dr Roy Sharma advises how to...