GP articles from April 2008

GP archives from April 2008

Education: Medicolegal - When you may break patient confidentiality.
April 25, 2008... Dr John Holden of the MDU, explains some circumstances of when a GP may need to disclose patient information. Most doctors recognise that they have an ethical and legal obligation to protect patient information from improper disclosure...

MedEconomics: How to... Understand the rules on incapacity.
April 25, 2008... The wishes, however illogical, of a patient with capacity should be followed, says Dr Tom Lloyd. The Mental Capacity Act 2005, fully effective from October 2007, is good news for GPs. It provides a framework that will assist doctors...

MedEconomics: Ask the experts - GP succession and pensions.
April 25, 2008... Q: GP Succession I am planning to take over a single-handed GP's practice and I am aware that primary care organisations (PCOs) want to get rid of these. However if I become the GP's partner initially and then she gives the PCO notice of...

MedEconomics: Must a partner retire?
April 25, 2008... GP partners may be protected from being forced to retire at a certain age under age discrimination laws, says Jean Sapeta. Despite their title, the Employment (Equality) Age Regulations 2006 affect professional partnerships as well as...

MedEconomics: Revamp your CV via the internet.
April 25, 2008... If you are looking for a new practice help is at hand. By Dr Emma Lackey. Decisions about short-listing job applicants may be made in less than a minute, so if you are applying for a salaried or a partnership post a well-presented...

MedEconomics: Pounds 400,000 drug budget savings.
April 25, 2008... Dr Mark Spencer explains how new approaches and procedures at his surgery radically cut prescribing costs. Last December in GP I related how my practice saved pounds 500,000 from its practice based commissioning (PBC) budget by reducing...

MedEconomics: Practice finance - Deciphering the Drug Tariff.
April 25, 2008... Dr Lisa Silver offers her tips on how a little regular reading can save money. The Drug Tariff should be seen as a vital part of the running of your dispensing practice. Unfortunately, this weighty tome, delivered every month to the...

Plain Tales from the Surgery.
April 25, 2008... - Please believe me I recently met a patient who, from her notes, had been seen by my colleague on numerous occasions with various minor aches, pains and complaints. 'Dr K thinks I'm a hypochondriac,' she complained, before telling...

Clinical: Medical Antiques - The practise of phisick - Wax anatomy.
April 25, 2008... The work of anatomists like Galen and Vesalius formed the building blocks on which we have developed our current understanding of anatomy, physiology and medicine. Arguably, nowhere in the history of art has the anatomy of the human body...

Clinical: Test yourself - MIMS prescribing quiz.
April 25, 2008... MIMS is the perfect place to refresh your prescribing knowledge, and we have devised this monthly quiz to help you keep up to date, with the added incentive of a prize draw for pounds 50 of John Lewis vouchers. Each monthly edition of...

Clinical: Clinical Review - Acute kidney injury.
April 25, 2008... Section 1: Epidemiology and aetiology Acute kidney failure, or more accurately, acute kidney injury (AKI), is characterised by a rapid fall in glomerular filtration rate resulting in an abrupt rise in urea and creatinine, usually...

Clinical: Case Study - Unusual abdominal symptoms.
April 25, 2008... An otherwise healthy man presented with abdominal cramps and diarrhoea. Mr Davidson was a 57-year-old man who was a little overweight but generally in good health, and not taking any regular medication. When he came to see me recently he...

Clinical: The basics - Erectile dysfunction.
April 25, 2008... Erectile dysfunction may be a side-effect of many conditions, says Dr Julian Spinks. Erectile dysfunction (ED) is the persistent inability to attain and/or maintain an effective erection. The prevalence of ED is high, with one UK study...

Cancer referrals are 'downgraded'.
April 25, 2008... Welsh consultants veto 'urgent' cases. The lives of patients in Wales are being put at risk, because consultants can downgrade cancer referrals without discussion with GPs. Following an urgent suspected cancer referral, a patient is...

Win a Sony Vaio worth pounds 600.
April 25, 2008... The Sony Vaio NR is a stylish and practical notebook loaded with easy-to-use software and connections galore. And coming from the Sony stable of classy, well-built Vaios, it should be on every laptop wish list. Available in sleek silver,...

Self-monitoring kits could cause 'harm' to diabetics.
April 25, 2008... Pounds 100 million spent on type-2 diabetes could increase depression. Experts have condemned the pounds 100 million in NHS funds spent each year on self-monitoring kits for type-2 diabetics, which have no apparent benefit and could even...

No confidence in Darzi vote planned by Scottish LMCs.(Brief article)
April 25, 2008... Scottish LMCs may call for the immediate resignation of health minister Lord Darzi. Ayrshire and Arran LMC proposed the motion, which will be debated at the Scottish LMCs conference in Clydebank this week. The LMC says that Darzi's...

A&E charging plan is 'unworkable'.(Brief article)
April 25, 2008... Charging practices every time their patients make inappropriate trips to A&E is unworkable, according to GPC chairman Dr Laurence Buckman. As revealed exclusively by GP last September, the government is considering charging practices...

Patients hit by faults with Choose and Book.(Brief article)
April 25, 2008... Outpatient booking software glitch provides hundreds of patients with appointments at the wrong time. Hundreds of patients have been referred to the wrong consultant at the wrong time, because of a glitch in the Choose and Book system....

Abdomen screen plan questioned.(Brief article)
April 25, 2008... DoH plans to screen all men over 65 for abdominal aortic aneurysm (AAA) could leave many knowing they are a ticking time bomb, with no option of surgery, says a top surgeon. In January, prime minister Gordon Brown said he wanted AAA...

A polyclinic by any other name.
April 25, 2008... Tom Ireland looks at the latest visions and proposals for England's polyclinic roll-out. The NHS Confederation's latest report attempts to calm the polyclinic debate - but could actually provide more reason for GPs to worry. ...

Behind the headlines: Can vitamin tablets lead to premature death?
April 25, 2008... Taking vitamin supplements does not improve health and may increase the risk of premature death, according to media reports. A review of 67 randomised trials found that taking the supplements vitamin A, vitamin E and beta-carotene could...

GPs overturn scheme to cut out-of-hours visits.
April 25, 2008... UK out-of-hours providers monitor the number of GP home visits and the success of telephone consultations. A scheme to reduce out-of-hours home visits by GPs has been withdrawn amid complaints from GPs. Many out-of-hours providers...

PBC blocked by hospital IT glitch.
April 25, 2008... Practices in North Somerset have been unable to commission new services, because of IT problems at the local hospital. DoH guidance dating from 2006 requires PCTs to provide practices with data on areas including elective activity and...

Opinion: One foot in and one foot out in home visit hell.
April 25, 2008... Her innate truculence had morphed with age into outright aggression. The request for a house call, inevitably, came from yet another brow-beaten home help who just couldn't take it any more and who felt it only fair that the GP should share...

Opinion: Mystic Mary and her diagnostic crystal ball.
April 25, 2008... I arrive home after a long day to be surrounded by hopeful and adoring chickens. It doesn't matter that I have nothing for them, the fact that on a previous occasion I appeared with a giant trifle that nobody liked but me sustains them in...

Editorial: Age discrimination squeezes GP partnerships.(Editorial)
April 25, 2008... Most young professionals setting out on their career path see a structure of steps that will take them through some years of development towards an ultimate goal. This is much less so for the average young GP who has three options:...

Opinion: My plea for evidence-based management.
April 25, 2008... This government is undeniably underhand. Nothing is ever done for the reasons given; hidden agendas are everywhere. The quality framework was originally introduced as 'entirely voluntary': now, low-scoring practices are threatened by their...

Clinical: Journals Watch - Dermatitis, incontinence and vital signs.
April 25, 2008... Too busy to catch up on the latest research? Let Dr Alison Glenesk update you on recent papers. Relapses in atopic dermatitis Br J Dermatol 2008; 158: 801-7 We often seem to be 'fire-fighting' with eczema - treating relapses...

GPC legal challenge halts pay talks.
April 25, 2008... GPC tells PMS practices that they are entitled to a 2.7 per cent funding increase. Talks on the promised 1.5 per cent practice income increase have collapsed while the BMA challenges the legality of the Doctors' and Dentists' Review Body...

No meningitis C deaths recorded in under-19s.
April 25, 2008... No meningitis C deaths were recorded in under-19s in the UK in 2007, according to the DoH. This is the first year without deaths since records began in the late 19th century. Previously, meningitis C killed up to 78 under-19s a year,...

NICE skin cancer surgery guidance 'too restrictive'.
April 25, 2008... The implementation of NICE guidance is preventing GPs from treating basal cell carcinomas (BCCs) in primary care. Instead, the guidance is forcing GPs in England to refer patients unnecessarily on to secondary care services. A number...

Young GPs facing fewer partnership opportunities.
April 25, 2008... Next generation of GPs may be thwarted by age law. Age discrimination legislation could be blocking partnership opportunities for younger GPs, say lawyers. Recent changes to the Employment (Equality) Age Regulations 2006 means...

Extended hours consults limited.(Brief article)
April 25, 2008... Small practices in Scotland will only have to deliver extended hours clinics once a month. Under the new extended hours directed enhanced service (DES), practices with list sizes of less than 1,000 will only have to open for an extra 30...

Appeals to patients over extended opening.
April 25, 2008... Single-handed GP Dr Tony Hall-Jones, from Tring, Hertfordshire, has written to his 3,700 patients about the possible closure of his practice. After 22 years at the New Surgery, Dr Hall-Jones says he, and other single-handers, are being...

Managers share polyclinic fears.(Report)(Brief article)
April 25, 2008... The BMA is 'almost certainly correct' that polyclinics are inappropriate for rural areas, according to an NHS Confederation report. The BMA believes polyclinics would waste money, duplicate services and increase the distance patients had...

Genetics GPSI needed in every PCO.(Clinical report)
April 25, 2008... DoH adviser demands more back up for GPs over predictive tests. A GPSI in genetics in every primary care organisation (PCO) is needed to help advise GPs on how best to deal with insurance companies, according to the chairman of the DoH's...

PCTs must fund practice IT security upgrades.
April 25, 2008... PCTs are set to shell out for IT upgrades, because the DoH thinks GP computer systems are not secure. Connecting for Health's Kemi Adenubi, the programme director for GP Systems of Choice (GPSoC), recently wrote to all of England's PCTs...

Heightened male CVD risk is evident from teenage years.(cardiovascular disease )
April 25, 2008... Gender difference suggests CVD linked to other factors than body fat. The increased risk of cardiovascular disease (CVD) seen in healthy men starts as early as the age of 19, say US scientists. They also showed that the innate...

Nasal surgery improves quality of life in apnoea.
April 25, 2008... Nasal surgery can help to remove airway obstructions and improve quality of life in patients with obstructive sleep apnoea (OSA), suggest Taiwanese research findings. Blockage of the nasal passage is common in OSA patients and...

Hereditary link found for COPD.
April 25, 2008... COPD may be hereditary, claim researchers from Germany and Sweden. It follows findings that siblings of COPD patients have a much greater risk of developing the disease than spouses. Although smoking is known to be the most common...

Research briefs.
April 25, 2008... Skin problems add to headache Migraine sufferers are also more likely to have sensitive skin, say US researchers. A survey of over 16,000 headache patients showed that 68 per cent of those with chronic migraine and 63 per cent of those...

Conservative plan to give practices real budgets.
April 25, 2008... A fifth of practices in England at risk of closure due to polyclinics, according to Tory Party. Plans for polyclinics would mean the closure of as many as 1,700 surgeries in England, the Conservative Party has claimed. But the party...

Annual breast screens for over-50s ruled out.
April 25, 2008... Breast screening mammograms in women over 50 should continue to be carried out at three-year intervals, say UK researchers. The UK Breast Screening Frequency Trial has shown that annual screening is no better at reducing breast cancer...

News in brief.(Brief article)
April 25, 2008... Blood clot buster available A new blood-thinning drug could help to prevent tens of thousands of deaths due to blood clots. The drug, known as Pradaza, received its licence this week and will become available to hospitals within weeks...

Independent Nurse: DoH accused of bullying unions into accepting three-year deal.
April 21, 2008... Unions have accused the DoH of using 'bully-boy' tactics to force them to back the three-year pay deal worth almost 8 per cent. In a letter, NHS chief executive David Nicholson said: 'If the proposals are is not accepted by union members,...

Independent Nurse: GP pay freeze could hit practice nurse salaries.
April 21, 2008... Nurse leaders fear a freeze on GP income means many practice nurses will not see a salary rise in 2008/9. Despite the DoH announcing a 2.7 per cent increase in global sum funding this month, the majority of practices will see no rise....

Independent Nurse: Statins could help lower high BP.
April 21, 2008... Statins may help to lower blood pressure (BP) levels independently of their cholesterol-lowering ability, US research suggests. Previous studies have indirectly shown that statins could reduce BP in patients with hypertension. But this...

Independent Nurse: Pneumonia is still possible after jab.
April 21, 2008... Nurses should be alert to potential cases of pneumonia in children, even if they have received the pneumococcal jab, according to UK research. The call comes after researchers identified a rise in serotype one pneumococcal bacteria,...

Independent Nurse: Flu vaccination cuts COPD exacerbations.
April 21, 2008... Flu jabs prevent COPD exacerbations, can prevent decline in lung function and lead to reduced hospital admissions, Indian research suggests. Researchers from the University of Delhi monitored 87 male patients with COPD for acute...

Independent Nurse: News in brief.
April 21, 2008... Obesity - The Scottish government has announced pounds 6 million of funding to tackle childhood obesity. Health boards have been told to use the cash to set up family-focused programmes aimed at children aged five to 15 that will promote...

Independent Nurse: 18% of nurses using NP title do not have the qualification.
April 21, 2008... Almost 18 per cent of nurses who call themselves nurse practitioners do not have the nurse practitioner qualification, according to figures from the Working in Partnership Programme (WiPP). WiPP's Supporting Nurse and Practice survey of...

Independent Nurse: Vital Statistics - Continuing care in England.
April 21, 2008... 29,092 the number of people receiving continuing care in England in 2007/8. 5.65 people per 50,000 receive continuing care in Gloucestershire PCT, the lowest level area 88.07 people per 50,000 receive continuing care in Coventry...

Independent Nurse: Journals Watch.
April 21, 2008... - Lung cancer gene risk for smokers Two gene variants that boost the risk of smokers developing lung cancer have been discovered by UK scientists. Carrying both variants increases the risk of cancer by 80 per cent, and carrying one...

Independent Nurse: PBC only being used by 41% of practices.
April 21, 2008... The majority of practices have still never commissioned a service using practice-based commissioning (PBC), a DoH survey has revealed. Figures from the first quarter of 2008 show that 51 per cent of practices have still never commissioned...

Independent Nurse: Tool kit to help nurses justify training costs.
April 21, 2008... A new tool kit to help nurses make their case for funding for training has been launched by charity Education for Health. The tool kit contains disease specific proposals, which show nurses how to link their chosen training course to DoH...

Independent Nurse: World Outbreak Information - Week beginning 21 April.
April 21, 2008... Vietnam There are reports of an outbreak of cholera in northern Vietnam. The highest incidence is in Hanoi, Hai Phong city and Ha Tay. Travellers are advised to take extra care with food and water hygiene. A vaccine is available for...

Independent Nurse: GPs 'should control out-of-hours'.
April 21, 2008... The current out-of-hours system is confusing, unpopular and could put more pressure on A&E departments, according to the NHS Alliance. The alliance's report, 'In sickness and in health', published this month, suggests practices should...

Independent Nurse: NICE reverses decision on osteoporosis drugs.
April 21, 2008... NICE has reversed its decision to recommend alendronate as the only treatment option for osteoporosis in post-menopausal women. A draft appraisal document issued this month recommends second-line use of risedronate and etidronite in...

Independent Nurse: Six food colourings face UK phase-out.
April 21, 2008... The Food Standards Agency (FSA) is to advise ministers to phase out six commonly used food colourings by 2009. The move follows research linking them to hyperactivity in children. The FSA proposed that food manufacturers phase out use of...

Independent Nurse: RCN questions HPV programme funds.
April 21, 2008... The RCN has raised concerns about whether the Scottish government has allocated enough resources to roll out its HPV immunisation programme. From 1 September girls in S5 and S6 will be offered the HPV vaccine in Scottish schools. The...

Independent Nurse: Research casts doubt on depression scale.
April 21, 2008... Nurses and health visitors should diagnose postnatal depression using face-to-face interviews instead of the Edinburgh Postnatal Depression Scale (EPDS), UK research findings suggest. The study found that the EPDS method, recommended by...

Independent Nurse: ARBs 'as effective' as ACE inhibitors.
April 21, 2008... Angiotensin receptor blockers (ARBs) are as effective as ACE inhibitors at lowering the risk of cardiovascular disease (CVD), Canadian research suggests. The ARB telmisartan was found to be as effective as the gold standard ACE inhibitor...

Independent Nurse: Win a Sony Vaio laptop worth pounds 700.
April 21, 2008... Online competition - www.healthcarerepublic.com/competitions. The Sony Vaio NR is a stylish and practical laptop loaded with easy-to-use software and connections galore. And coming from the Sony stable of classy, well-built Vaios, it...

Independent Nurse: News focus - Employment standards vary greatly.
April 21, 2008... A survey of more than 1,000 practice nurses has exposed huge variation in training access. Emma Bower reports. While one practice nurse might thoroughly enjoy her role and feel supported, valued and a key part of the practice team,...

Independent Nurse: Opinion - Online ... see who's saying what at www.healthcarerepublic.com.
April 21, 2008... Why on earth are nurses putting themselves and their patients at risk by working in areas in which they are not competent? They are doing a great disservice to their patients and themselves and they should put this right immediately. I...

Independent Nurse: Editorial - GPs must match any pay deal for nurses.(Editorial)
April 21, 2008... The proposed three-year pay deal for NHS staff may (in RCN general secretary Peter Carter's words) go 'some way towards bridging the gap between nurses' pay and other public sector workers'. In an uncertain economic climate, a guaranteed rise...

Independent Nurse: Opinion - Quality of care is important in all settings.
April 21, 2008... Quality of care matters to patients, and their family or carers, wherever the patient is. But after looking at most of the current writings, policies and initiatives in this area, you would be forgiven for thinking that the only place where...

Independent Nurse: In My View - Asthma patients should have free scrips.
April 21, 2008... While people with asthma in Scotland and Wales can be assured that the burden of prescription charges will not affect them (Scotland plans to remove the charge completely by 2011), those in England and Northern Ireland are unclear as to how...

Independent Nurse: Clinical - Diabetes - Children and young people have differing insulin requirements.
April 21, 2008... Dr Surendran Chandrasekaran and Dr Jo Blair explain. Managing diabetes in children and young people is challenging, due to the changes occurring during physical, psychological and emotional development. The choice of insulin and treatment...

Independent Nurse: Clinical - Respiratory - Treating asthma exacerbations in children.
April 21, 2008... The onset of an acute asthma exacerbation can be spotted early, enabling appropriate and timely treatment, writes Sarah Latham. Childhood asthma has been defined as 'a condition in which episodic wheeze and/or cough occur in a clinical...

Independent Nurse: Clinical - Travel medicine - Current advice on malaria prevention.
April 21, 2008... Malaria Awareness Week runs from 12-18 May. Sandra Grieve advises on bite prevention and chemoprophylaxis. Malaria is a parasitic infection transmitted by the bite of a female Anopheles mosquito. Four types of malaria affect humans -...

Independent Nurse: Clinical Focus - Hyponatraemia.
April 21, 2008... Overall key points - Hyponatraemia is usually defined as a plasma sodium concentration of less than 135mmol/l. - The syndrome of inappropriate antidiuretic hormone secretion can cause euvolaemic hyponatraemia. - The key aspect...

Independent Nurse: Clinical - Oncology - Oncological emergencies in primary care.
April 21, 2008... How to spot neutropenic sepsis and malignant spinal cord compression. A number of conditions that occur within cancer care are classed as oncological emergencies. If left untreated they can lead to morbidity and possible fatality. These...

Independent Nurse: Clinical - Prescribing - Antifungal medications in primary care.
April 21, 2008... A variety of prescription and over-the-counter preparations can be used to treat fungal infections, writes Dr David Morris. The imidazoles have become the most widely used topical antifungal agents due to their effectiveness, tolerability...

Independent Nurse: Clinical - At a glance - Differential diagnosis - Blue naevus vs Spitz naevus.
April 21, 2008... Blue naevus Discriminatory signs - Often found on the skin of older children and teenagers, but might develop at any age. - Unusual but non-cancerous mole. - Dark blue colour. - Dermoscopy reveals a characteristic...

Independent Nurse: Professional - Improving uptake of cervical smear tests.
April 21, 2008... Taking a mobile cervical screening unit to patients is improving access for marginalised women, writes Louise Logan. I took up post as the mobile cervical screening co-ordinator for Belfast Health and Social Care Trust in March 2007. The...

Independent Nurse: Professional - Management - How and why to produce a staff handbook.
April 21, 2008... Providing an effective employee handbook can prevent disputes and future claims, writes Claire Brook. There are countless benefits to having an effective employee handbook, not just for staff but also for employers and managers. It is an...

Independent Nurse: Professional - Boosting patient involvement in health care.
April 21, 2008... West Kent PCT's virtual citizen's panel will give patients a genuine say in the development and delivery of services, writes Sarah Wild. Many health care organisations pay lip service to the idea of public involvement, but few succeed in...

Independent Nurse: Professional - Resources - Worth a look.
April 21, 2008... Contact a Family Directory Patient information Details of more than 1,000 disabilities and conditions affecting children and adults are available in the new edition of the Contact a Family Directory. This UK guide provides...

Independent Nurse: Professional - Resources - In numbers - Home help/care.
April 21, 2008... Intensity of home help/home care: % of households, 1993-2007. According to the 'Community Care Statistics 2007' report on home care services for adults in England, there is a greater focus by Councils with Adult Social Services...

Independent Nurse: Professional - Resources - Recommended patient resource.
April 21, 2008... What is it? This DVD, launched in January, aims to provide information to patients diagnosed with chronic kidney disease or end stage renal failure. Who has produced it? It is charity Kidney Research UK's second DVD Participants in its...

Independent Nurse: Professional - Policy digest - NHS Winter Report 2007/8.
April 21, 2008... What is this document? Published by the DoH in April, this report for 2007/8, written by national director for emergency access, professor Sir George Alberti, and national clinical director for primary care Dr David Colin-Thome, describes how...

Independent Nurse: Professional - Workplace - Career profile - Jane Shire, East Berkshire.
April 21, 2008... - Why did you become a nurse? I wanted a job that offered me a good career path and nursing seemed to provide that. Caring for people when they are ill and helping them feel better is very worthwhile. - How has your career developed...