GP articles from August 2010

GP archives from August 2010

Opinion: The inescapable truth of becoming a doctor.(Column)
August 20, 2010... We are never naked, we wear the silken cloak of our esoteric knowledge wherever we go. 'Dr Livingstone, I presume,' said Henry Morton Stanley; his indomitable will had driven him headlong across jungle, desert, mountain and river, and he...

Opinion: Let's all make the world a brighter place to live.(Column)
August 20, 2010... Mrs Glum is miserable - she's nearly 50, she's going grey, the children are leaving home and there's a recession. I draw on my inner reserves. What can I say? It's all true. I should be in the same boat, yet I find life full of small joys....

Clinical: Journals Watch - Depression and vitamin D deficiency.
August 20, 2010... Not had time to catch up on the latest research? Dr Sally Hope brings you up to date on the journals. Recurrent depression and cardiovascular risk in women Psychosom Med 2010 doi:10.1097/PSY.0b013e3181eeeb17 Depressive symptoms are risk...

Clinical - At a Glance - Granulomatous cheilitis vs angioedema.
August 20, 2010... Granulomatous cheilitis (Miescher-Melkersson-Rosenthal syndrome) Aetiology - Rare condition that occurs at any age, in any sex or race. Cause unknown. - May be associated with allergy, Crohn's disease or sarcoidosis. Presentation ...

Clinical: Emergency medicine - Acute coronary syndromes.
August 20, 2010... Identifying the 'true positive' ACS patient can be life saving, while identifying the 'true negative' can save patient distress, explains Professor Tom Quinn. Despite recent impressive reductions in premature mortality from cardiovascular...

Clinical: Clinical solutions - Morton's neuroma.(Neuralgia)(Disease/Disorder overview)(Case study)
August 20, 2010... THE CASE A 49-year-old woman complains that when she walks she experiences sharp pain in her foot and a sensation of having a pebble under the metatarsal region. The pain is relieved by taking off her shoes and massaging her toes. You suspect...

Clinical Review: Septic arthritis.(Disease/Disorder overview)
August 20, 2010... Contributed by Mr DS Chauhan, orthopaedic registrar, and Miss Carol Brignall, consultant orthopaedic surgeon, Cumberland Infirmary, Carlisle, Cumbria. Section 1: Epidemiology and aetiology Septic arthritis, also known as 'acute suppurative...

Clinical: Red flag symptoms - Epigastric pain.
August 20, 2010... It is vital to ensure the patient is haemodynamically stable, says Dr Mehul Mathukia. - Altered bowel sounds - Marked involuntary guarding - Tenderness to percussion - Haematemesis/melaena - Hypovolaemia or shock - Impaired...

Education: MRCGP: CSA practice case - Patient requests specific medication.(clinical skills assessment)(Member of the Royal College of General Practitioners)
August 20, 2010... To be used individually or in a study group with someone playing the doctor, patient and assessor. Dr Prashini Naidoo provides this CSA practice case. When preparing for the clinical skills assessment (CSA), mock cases with your tutor or...

MedEconomics: Taxation - Self assessment basic rules.
August 20, 2010... Simon Gray outlines how the tax assessment and payment system works if you are a self-employed GP. I have written this with GP partners in mind but the same basic rules apply to freelance GPs, such as self-employed locums. Self employment...

MedEconomics: Ask the experts - Pensions and inheritance tax.
August 20, 2010... Q: ENHANCED PENSION ANNUITIES I am retiring soon and have heard about being able to increase my pension income if I am in bad health. Is this true? If you have a personal pension, you are likely to end up buying an annuity when you retire...

MedEconomics: We pursued our PCT for debt and won.(United Kingdom. National Health Service. Primary Care Trusts)
August 20, 2010... Dr Jeremy Phipps says the way his practice managed to get its money may encourage GPs to chase debtors. We initiated legal action against our PCT and won just under pounds 5,000. This is on top of more than pounds 18,000 we were previously...

MedEconomics: Review - Putting the iPad through its apps.
August 20, 2010... Dr Neil Paul loves his iPad. He suggests buying each of the partners at your practice one to use for work. 'It's just a big iPod.' 'Don't you look silly holding it up to your ear to make a phone call?' I have heard all the jokes but people...

Commissioning: GP Consortia - How White Paper model can work.
August 20, 2010... How six GP consortia in Cumbria commissioning care collectively has impressed. I am an enthusiast for health services management married to clinical leadership. That does not sound very glamorous, but for me it underscores what the new NHS is...

Commissioning: Viewpoint - White Paper offers new opportunities.
August 20, 2010... Dr Michael Dixon explains why GPs should take an interest in the coalition's health White Paper. The White Paper is the biggest change for general practice since the NHS was created in 1948. It offers GPs a unique chance to lead the NHS as...

Commissioning: How GPs should take on commissioning.
August 20, 2010... Dr Johnny Marshall and David Stout outline the first steps that GPs and PCTs should be taking now. While we still require more detail about how the changes envisaged by the health White Paper will happen, it is clear the foundations need to...

Plain Tales from the Surgery.
August 20, 2010... - A holiday identity crisis A message for triage read: 'patient returned from Spain yesterday - not himself'. Perhaps passport control should be made aware. Dr David Carvel, Biggar, Lanarkshire - Egged on to test hearing A third...

GPC 'in the driving seat' over White Paper plans.
August 20, 2010... Former Tony Blair adviser says GP consortia will mirror PCTs but GP leaders can force change. The GPC is 'in the driving seat' to make demands in this year's contract negotiations, according to a former health adviser to Tony Blair. Paul...

GP DIARY.
August 20, 2010... EMERGENCY GUINEA PIGS We've all been there. You settle down for a quiet night in and the guinea pig goes into labour. But what do you do? A list of daft calls compiled by Sussex police reveals one lady decided to dial 999. How stupid. That's...

Darzi centre GPs warn of APMS contract pitfalls.
August 20, 2010... GPs powerless to prevent closure of health centre in six months despite strong evidence of success. A GP in charge of the first Darzi centre facing closure has warned the profession of the dire implications of APMS contracts. The Alma Road...

Charity warns on change to patient oxygen supply.
August 20, 2010... Oxygen suppliers must learn from the problems of 2006 and ensure all patients are contacted before supply arrangements change, the British Lung Foundation has said. Next year, management of home oxygen supply contracts in England and Wales...

Calls for health impact studies.(Brief article)
August 20, 2010... More must be done to meet demand for health services in growing communities in Scotland, says a leading GP. Last week, estimates forecast Scotland's population would rise by 7 per cent to 5.54 million by 2033, according to the General...

Climbing hobby saves GP.
August 20, 2010... A GP who has conquered Mount Everest says his love of climbing saved his life. Dr Alistair Sutcliffe suffered a potentially fatal brain haemorrhage in February. Fortunately, his hobby reopened a foetal circulatory system in his brain,...

Repeat UTI 'is due to immune fault'.
August 20, 2010... Recurring infections might be prevented by development of human vaccine. Recurrent UTI may be caused by an immune system overreaction to previous infections and could be prevented by a vaccine, researchers believe. Severe acute...

RA reclassification to help in prevention of the disease.
August 20, 2010... Redefining the classification for rheumatoid arthritis (RA) could help prevent thousands of people developing the disease, researchers say. The new criteria focus on early diagnosis and treatment of initial symptoms to prevent more serious...

Research Brief: Wrap up warm.(Myocardial Infarction)(Brief article)
August 20, 2010... Cold weather is associated with a higher risk of MI. A drop of 1 degsC on a single day may be associated with an extra 200 cases of MI. Researchers from the London School of Hygiene and Tropical Medicine studied 84,010 hospital admissions for...

Research Brief: Adolescent asthma.
August 20, 2010... Paracetamol is linked to an increased risk of asthma in adolescents, a study of 300,000 14-year-olds in 50 countries suggests. The chances of having asthma are 2.5 times greater for those who took paracetamol at least once a month compared...

Research Brief: GPs urged to prepare as asthma in children soars.
August 20, 2010... GPs must ensure all children with asthma have action plans explaining how to manage their condition when returning to school, Asthma UK has said. The charity said GPs must ensure they spend 'adequate time' going through personal action plans...

Research Brief: Practice income in NI slashed.
August 20, 2010... Practices in Northern Ireland face a pounds 10,000 drop in income this year following a pounds 3.6 million cut in GMS budgets, the BMA has said. Northern Ireland GPC chairman Dr Brian Dunn said that local GPs were 'dismayed' by the income...

GMC may keep adjudication role under DoH plan.(General Medical Council)(Department of Health)
August 20, 2010... 'Fundamental' changes to the GMC convince DoH that new super-regulator is unnecessary expense. A key plank of reforms to the GMC prompted by the Shipman inquiry could be scrapped, the DoH has revealed. The department wants to cut NHS costs by...

Stop drugs being wasted to make savings, NHS told.
August 20, 2010... Cutting drug waste and improving adherence will save more money than changing prescribing practice, a leading pharmacy group has argued. The National Pharmacy Association (NPA) said 'big wins' in NHS savings could only be achieved by changing...

GP trainees head for South Africa.
August 20, 2010... Seven GP trainees set off last week to work for a year in rural hospitals in South Africa as part of a ground-breaking training scheme. The group will work in KwaZulu-Natal for the same rates of pay local doctors receive. The experience will...

Baby boomers 'set to boost death rate'.
August 20, 2010... GPs should prepare for a 'huge increase' in deaths over the next decade, a leading public health expert has warned. Deaths among people aged 85 and over have risen 7 per cent in the past 10 years and are expected to climb further, according...

GPs voice White Paper concerns.
August 20, 2010... Commissioning is an inevitable part of the future for GPs. Nick Bostock reports on why the profession is worried. The avalanche of policy and consultation papers emerging from the DoH in recent weeks paint a picture of GPs as the axis around...

Sessionals 'need commissioning role'.
August 20, 2010... GPs GPs demand sessionals have chance to engage with White Paper plans. The health White Paper should offer sessional GPs a chance to become involved with consortia, according to the leader of their representative body. Dr Vicky Weeks,...

Pharmacists granted the power to hand out the Pill.
August 20, 2010... Pharmacists are to initiate long-term contraception for girls and women aged 13-25 under a scheme on the Isle of Wight. Anyone given emergency hormonal contraception (EHC) will be offered a 28-day supply of the progesterone-only pill...

Personal health budget warning.
August 20, 2010... Pilot sites for personal health budgets have raised concerns that the scheme might only benefit 'more able groups' that are able to navigate the system, an evaluation report reveals. The report, written for the DoH by the University of Kent,...

Healthcarerepublic.com.
August 20, 2010... A round-up of the best from GP's website this week Exclusive videos Watch Dr Vicky Weeks, the chairman of the GPC's sessional GPs subcommittee, explain how the BMA plans to improve the representation of sessional GPs in the organisation....

Exclusive: Consortia 'will inherit PCT deficits'.(Primary Care Trusts)
August 20, 2010... Leading GPs warn starting with deficits will doom GP commissioning to failure. PCT debts are likely to transfer to GP consortia when the profession takes on commissioning, senior GPs have warned. Starting off with millions of pounds worth...

PCT plans to cut referrals failing.
August 20, 2010... PCT schemes to cut referrals do not work, but there is no reason GP commissioners cannot develop systems that do, a leading think tank has said. A King's Fund report on referral management published last week says the success of many PCT...

RCGP urges GPs to freeze firms out of commissioning.
August 20, 2010... RCGP chairman Professor Steve Field has warned the profession must do 'everything it can to resist private companies taking over GP consortia'. The college chairman, who steps down in November, said there was 'clear evidence' that if...

Exclusive - GPC 'must resist hijacking of GP pay'.(general practitioners committee)
August 20, 2010... GP survey reveals profession's deep misgivings over health White Paper commissioning plans. Three quarters of GPs want the GPC to reject any bid to plunder existing practice income to fund 'quality premiums' for successful commissioners, a GP...

GP opposes bid to gag his family.
August 20, 2010... Dr Stuart Gray, the GP whose father was killed by German locum Dr Daniel Ubani, has pledged to 'vigorously defend himself' against a bid to gag his family. Dr Gray's father David died after Dr Ubani gave him an overdose of diamorphine on his...

GPs must be allowed to innovate to meet local patients' needs, argues think tank.
August 20, 2010... GPs must remain free to innovate or the NHS will be unable to meet local needs, a right-wing think tank has argued. A report by the Bow Group this week argues that the new framework on which GP commissioners will be assessed must not be too...

PCT managers' consultancy role.
August 20, 2010... A DoH scheme that encourages PCT staff to set up social enterprises will be open to PCT managers hoping to offer commissioning support to GPs, the DoH has confirmed. The DoH says its 'Right to Request' scheme aims to put PCT staff 'in the...

NICE reveals commissioning blueprint.
August 20, 2010... Nine new best practice standards for GPs to base commissioning decisions on. NICE has unveiled nine best practice standards on which GPs will have to base commissioning decisions. The standards will also be used to assess GPs' and other...

Your say online ... www.healthcarerepublic.com/forums.
August 20, 2010... Commissioning to put GP income at risk - Why should GPs be punished for accepting to 'do commissioning'? Revealed: Health White Paper 2010 - We will be replacing a relatively small number of PCTs with a much larger number of...

Ballot box.
August 20, 2010... 53% of GPs think the DoH is right to overrule NICE and set up a pounds 50m cancer drugs fund Source: Healthcare Republic. -------------------- Did you find this article useful? Why not subscribe to the magazine? Please call 08451 55 73...

Editorial: GPs need more detail on commissioning plans.(Editorial)
August 20, 2010... GPs are highly concerned about the plans for the future of the NHS.[QQ]This week's joint GP/Family Doctor Association poll found that half of respondents were worried about the vision set out in the White Paper - a further 22 per cent were...

Opinion: Practising medicine perfectly is impossible.(Column)
August 20, 2010... August is the killing month, when many newly-qualified doctors become house officers for the first time - and hospital death rates rise slightly. The daughter of one of our partners has just begun her first house job and her father is...

Clinical: The basics - Secondary amenorrhoea.(Disease/Disorder overview)
August 20, 2010... It is essential to exclude pregnancy in patients with amenorrhoea, explains Dr Louise Newson. Amenorrhoea is the absence or cessation of menstruation. It can be physiological (before the menarche, after the menopause or in pregnancy),...

Healthcarerepublic.com: A round-up of the best from GP's website this week.
August 6, 2010... CPD organiser Healthcare Republic has launched an improved version of its Storage Folder facility called a CPD organiser. This free tool will help you streamline your learning. You can save pages from the internet into your organiser, add...

Opinion: Put a beggar on horseback and he'll ride to hell.(Viewpoint essay)
August 6, 2010... I was called recently to a patient who had collapsed in the car park after church. I can recommend this as a good place to collapse, implying as it does a previous life of probity and devotion. For a start, the bystanders are likely to be...

Opinion: We will be judged on what is expected of us.
August 6, 2010... That England's World Cup collapse was followed by a chaos of well-rehearsed criticism was no surprise to those of us looking at our MORI survey. Once again 30 per cent of our patients state that they have to wait more than 48 hours for...

Clinical: Journals Watch - Cruciate tears and suicide.(Clinical report)
August 6, 2010... Missed this week's journals? Let Dr Bryan Palmer bring you up to date on the latest research. Treatment of anterior cruciate ligament tears - N Engl J Med 2010; 363: 331-42 The optimal management of a torn anterior cruciate ligament (ACL)...

Clinical: At a Glance - Swan neck deformity vs boutonniere deformity.(Report)
August 6, 2010... Swan neck deformity Presentation - Occurs in about 50 per cent of rheumatoid arthritis (RA) cases, but may also occur as a congenital phenomenon or following trauma. - Develops with hyperextension of the proximal interphalangeal (PIP)...

Clinical: The basics - Tennis elbow.
August 6, 2010... Sometimes a 'wait and see' policy is best for this common and painful condition. This is a common and painful condition, with an incidence of 4-7 per 1,000 people per year, meaning a full-time GP will see about one new patient per month. ...

Clinical Review: Stroke.
August 6, 2010... By Dr Jonathan Birns, consultant in stroke medicine, geriatrics and general medicine, Guy's and St Thomas' NHS Foundation Trust and honorary senior lecturer, King's College London. Section 1: Epidemiology and aetiology Stroke is defined as...

Clinical: Practice dilemma - Patient requests a second MRI scan.
August 6, 2010... The Dilemma - Mr Jones has a history of anxiety and depression. He has visited the surgery three times in the past two weeks with minor illnesses and has been complaining of headaches for the past two years Last year, a neurologist organised an...

Clinical: Spirometry in primary care.
August 6, 2010... A good reading requires co-operation from the patient. By Jane Scullion and Dr Steve Holmes. Over the past 10 years, more GP practices have started to perform spirometry. With an emphasis on early and accurate diagnosis of asthma and COPD,...

Clinical: Paediatric medicine - Tourette's syndrome.(Disease/Disorder overview)
August 6, 2010... This condition has a wide variation in severity. Tourette's syndrome (TS) was named after Dr Georges Gilles de la Tourette in 1885 who described the condition. It is the most common cause of tics and is sometimes known as multiple tic...

Clinical: Case Study - Family history.
August 6, 2010... It is important to use routine check ups to ask about a family history. Caroline was a 31-year-old who came to the surgery for a routine pill check. She was nulliparous though was considering pregnancy in the next two years. She was a...

Education: GP Training - Starting at a practice as a GP registrar.
August 6, 2010... It can be a daunting experience, but Dr Linda Miller offers advice on how to start life as GP registrar. Starting as a GP registrar in a practice can be daunting but most training practices have a well-planned induction programme, which makes...

Education: Book Review - Adventures in CSA land.(Brief article)
August 6, 2010... When preparing for the CSA examinations, this book would prove a helpful tool, writes Dr Meena Nathan. Dr Rhona Wright, a CSA examiner and GP training programme director, has been creative in her writing by comparing the journey of the CSA to...

Education: A Registrar survival guide ... Identifying underlying psychosocial problems.(Brief article)
August 6, 2010... It is Friday afternoon. In walks Mr Smith who has returned to discuss his epigastric pain that he has had since 2006. There are a number of ways to tackle the consultation: 1. Biomedical model: focus is on the physical cause of disease. 2....

MedEconomics: White paper - Countdown to new NHS starts.(United Kingdom. National Health Service)
August 6, 2010... Daniel Brookbank says GPs must plan ahead for hard budgets and the other reforms. Last month's White Paper, Equity and Excellence: Liberating the NHS, has been billed as the most ambitious shake-up of the NHS since its inception. The main...

MedEconomics: How best to investigate complaints of bullying.
August 6, 2010... A firm stance on bullying behaviour is vital if practices are to avoid tribunal claims. There is a culture of relaxed banter at work, plenty of in-jokes and harmless teasing. Then one of the junior members of staff makes a complaint of sexual...

MedEconomics: Ask the experts - Extended hours pay and rents.
August 6, 2010... Q: EXTENDED HOURS PAY - Can you advise on payment for the surgery sessions we do outside normal NHS hours? We get an enhanced service payment for providing two surgeries after 6.30pm. Only two of the partners are prepared to do these...

MedEconomics: The NHS IT revolution soldiers on.(National Health Service information technology)
August 6, 2010... Despite flaws with SCRs and Choose and Book, the National Progamme for IT will grow. There is little doubt that information technology is destined to play an even bigger role in the reformed NHS. Except for snippets such as elective patients...

MedEconomics: In a nutshell ... critical illness cover.
August 6, 2010... Why it makes sense for GPs to take out this insurance and choose a suitable policy. In a nutshell A quick guide to issues affecting GPs A critical illness policy is cover that will pay out a tax-free lump sum if you are diagnosed with a...

Good Practice: Rapid access - In-hours acute visiting scheme.
August 6, 2010... Dr Shikha Pitalia describes how a PBC scheme dramatically reduced emergency admissions. Our Acute Visiting Scheme (AVS) is an in-hours, rapid access home visiting scheme, seeing patients within 30-60 minutes of a request and giving...

Plain Tales from the Surgery.
August 6, 2010... - Template for disaster A recent out-of-hours communication read: 'Patient has passed away Expected death. Ring back if any worse.' Oh, the joy of using set templates. Dr Kamal Sidhu, Hartlepool, Cleveland - Farmer Giles is to blame ...

Commissioning to put GP income at risk.
August 6, 2010... Funding will come from existing pay and cause 'friction' between GPs. Existing GP funding streams such as QOF are likely to be top-sliced to fund a 'quality premium' for GP consortia, according to senior GPs. Reform of the GP contract will...

QOF changes to slow transition to outcomes.
August 6, 2010... NICE has released its menu of indicators for the 2011/12 QOF, covering BP, dementia, diabetes and mental illness. The 10 new indicators will be considered by NHS Employers and GPC negotiators this winter and those accepted will be added to...

Private firms will bid for consortia if GPs fail.
August 6, 2010... Opportunities for private sector open up as top GP predicts consortia 'odds-on' to struggle. GP consortia are 'odds-on' to fall into deficit and be taken over by private firms when they take on commissioning, according to one leading GP. ...

GPs want 'time to think' as DoH hands out immediate veto on spending plans.
August 6, 2010... GPs 'need more time' to think about how to develop consortia, says the former GP charged with transferring commissioning out of PCTs. The remarks came as a letter from NHS chief executive Sir David Nicholson last week ordered PCTs to get...

Early end for UnitedHealth commissioning contract.
August 6, 2010... One of the first deals for a private company to commission NHS services on behalf of a PCT has ended, a year early. UnitedHealth UK signed a three-year deal to help NHS Northamptonshire commission NHS services in 2008. But a spokesman for...

Opportunity for GPs.
August 6, 2010... Commissioning will only be successful if GPs engage secondary care and the public, the chairman of the BMA has said. BMA chairman Dr Hamish Meldrum says the White Paper offers doctors a chance to 'take more control over their working lives...

NHS Reform criticism.
August 6, 2010... Former health secretary Andy Burnham has launched a 'Save our NHS' campaign against the 'unnecessary reorganisations' planned by the government. Mr Burnham criticised the government's plans for NHS reform, arguing its priority instead should...

Coalition investigation.
August 6, 2010... How the new coalition government intends to resolve the issues undermining the effectiveness of NHS commissioning is to be the subject of an investigation. The deadline for written evidence is noon on 6 October. The DoH's White Paper...

Cost-cutting PCTs to slash GP funds.
August 6, 2010... GP investigation reveals plans to cut enhanced services and slash primary care. PCTs are set to slash GP services, slim down urgent care and put pressure on referral and prescribing rates to cut costs, GP can reveal. PCTs across England...

Watchdog warning over care records.
August 6, 2010... A data watchdog has warned GPs not to block uploads to the summary care record (SCR) without asking patients. Former GPC IT subcommittee chairman Dr Paul Cundy has called for GPs to enter a '93C3 Read code' into the notes of patients who have...

Extended public health role for GPs will not be funded, minister warns.
August 6, 2010... GPs should be prepared to offer public health services for free, a health minister has said. Public health minister Anne Milton told a King's Fund event that GPs should offer public health interventions without additional incentives. She...

DoH cuts funding for appraisal tool.
August 6, 2010... GPs could be forced to pay for access to the NHS Appraisal Toolkit website after the DoH withdrew funding. The department will not renew its contract with the site's supplier when it expires on 31 October, meaning GPs will have to apply to...