GP articles from December 2008

GP archives from December 2008

Education: Professional development - RCGP membership by performance.(Royal College of General Practitioners)(Conference news)
December 12, 2008... RCGP examiners Dr Marilyn Graham and Dr Ken Menon explain the benefits of iMAP. As RCGP examiners, we were invited to attend a new component of interim membership by assessment of performance (iMAP), which consisted of three mini...

MedEconomics: How to ... Make tax-efficient donations.
December 12, 2008... Boost the value of the charitable gifts you make and add to the feel-good factor. At Christmas many of us consider those less fortunate than ourselves. Maximising the benefit of anything we give to charities will enhance their work and...

MedEconomics: Taking photos of your patients.(Brief article)
December 12, 2008... The MDU's Dr Sally Old warns GPs to beware pitfalls with making a visual record of clinical symptoms. GPs may wish to take photographs of their patients for a number of reasons. Some may wish to record unusual presentations for case...

MedEconomics: Environmentally friendly surgery.
December 12, 2008... Dr Martin Judson explains the many green features of Sacriston Medical Centre in County Durham. Earlier this year we moved into a brand new surgery designed to harmonise with the environment and encourage others to adopt green...

Dispensing: Dispenser of the year - Valuing excellent dispensing staff.
December 12, 2008... The Limekilns Surgery has helped nurture its award-winning dispenser, writes Dr Yuk Chan. The Limekilns Surgery in Fife has been a dispensing practice since 1910 It is currently a two-partner, semi-rural practice serving a population of...

Clinical: Journals Watch - Down's syndrome, TB and CFS.(chorionic villus samplings)(tuberculosis)(Clinical report)
December 12, 2008... Too busy to catch up on the research? Let Dr Lizzie Croton guide you through some recent papers. National screening for Down's syndrome BMJ 2008; 337: a2,547 This Danish population-based cohort study evaluated the impact of a...

Clinical: Clinical Review - Sexually transmitted infections.(Disease/Disorder overview)(Reprint)
December 12, 2008... Section 1: Dysuria and discharge. Chlamydia Chlamydia is responsible for 50 per cent of pelvic inflammatory disease (PID), and is the main preventable cause of infertility. Nearly half of all ectopic pregnancies are thought to be...

Clinical: Clinical Q & A - Testicular pain and gliclazides.
December 12, 2008... Our panel of experts answer questions posted on our website. Q: Testicular pain An 18-year-old boy presented with right testicular pain, which he had experienced for 72 hours. The right testicle was quite enlarged and very tender -...

Education: Pictorial case study.(Case study)
December 12, 2008... The case. A 69-year-old woman presented in the surgery with a five-day history of noticing black floaters in her right eye with occasional flashes of light. Her vision was otherwise unaffected and she had no other symptoms. She had not...

Education: A registrar survival guide ... writing a referral letter.
December 12, 2008... The amount of information required in a letter of referral depends on the problem being referred. In the case of a simple complaint such as a skin lesion, less information is required by the consultant than in the case of a more serious...

Plain Tales from the Surgery.
December 12, 2008... Toilet humour. I was taking a history from a patient regarding his bowels. He was accompanied by his wife. I asked 'did you ever suffer from irritable bowel syndrome?' His wife replied 'No I don't think so, but he is usually...

Opinion: Christmas home visits in a winter of discontent.
December 12, 2008... The Dickensian Christmas is a thing of the past, so to speak; global warming may be bad news for polar bears, but it's no picnic for GPs either. Christmas-time home visits have long been an integral and much-cherished weave in the great...

Opinion: Jingle bells, Darzi smells, promises fly away.
December 12, 2008... Midnight on Christmas Eve, and Scrooge had sent Cratchett home - he could do without the guilt trips that ghost took him on every Christmas. It was 90 years since the GP pay freeze and he couldn't afford more staff. The clock struck, and...

Clinical: Paediatric medicine - Vomiting in infancy and childhood.(Disease/Disorder overview)
December 12, 2008... Vomiting has many possible causes so a systematic approach is vital to diagnosis, writes Dr Keith Lindley. Both vomiting and gastro-oesophageal reflux result in the ejection of gastric contents through the mouth, but the pathophysiology...

Debt-free PCTs to bail out hospitals.
December 12, 2008... Move will ensure trusts can start implementing polyclinic plans, says NHS London. Plans to take up to pounds 275 million from London PCTs' budgets to pay off hospital debts have been criticised as unfair. The 26 PCTs in London...

England's pounds 2.1bn NHS underspend.
December 12, 2008... The NHS surplus for England in 2007/8 was pounds 2.1 billion - four times the figure for the previous financial year. The underspend is revealed by the Health Committee as part of its annual inquiry into expenditure on health and social...

Behind the Headlines: Can caesareans raise asthma risk?
December 12, 2008... Children born by caesarean section are more likely to develop childhood asthma, according to media reports. Researchers in the Netherlands followed children up to the age of eight and found that those born by caesarean section were almost...

Life after the spending boom.
December 12, 2008... Jonn Elledge reports on the implications for GPs of any health funding revision. It may not have felt like it, but the past few years have been a boom for the health service. For half a decade the government raced to raise health...

Your say online ... community.healthcarerepublic.com.
December 12, 2008... What GPs are saying online about pharmacists raising safety concerns about dispensing doctors. - Have there been specific incidents reported? Unless there really is some solid evidence of poor practice, then please, just leave GPs to get...

Opinion: Ballot box.
December 12, 2008... 79% of GPs think GPs should not issue electronic fit notes. Source: Healthcare Republic. -------------------- Did you find this article useful? Why not subscribe to the magazine? Please call 08451 55 73 55 for more information or...

Editorial: The value of GP trainers must be reflected in pay.(Editorial)
December 12, 2008... Training practices have had a busy year or so. Along with introducing the new curriculum, trainers are now required to become educational supervisors for trainees while they undertake the hospital component of their training. This,...

Opinion: Dress codes and the battle against infection.
December 12, 2008... I was distinctly unimpressed with the consultants at a recent hospital meeting: they all came jacketless and in open-necked, short-sleeved shirts that wouldn't go amiss on a beach. Did they look like authoritative, highly trained doctors? Did...

Exclusive: PCTs choose GPs for vascular checks.
December 12, 2008... GPs will be solely responsible for delivering vascular screening in half of PCTs. GPs are winning the race to deliver the DoH's vascular screening programme, despite almost two-thirds of PCTs being approached by private companies...

Exclusive: DoH to scrap and replace GP training grant.
December 12, 2008... The training grant is to be scrapped and replaced with a new tariff-based system for funding GP trainers. At present, the UK's 2,000 training practices receive an annual grant for taking on a trainee. This is currently valued at pounds...

Merry Christmas.
December 12, 2008... Your next issue of GP will be with you on 9 January. The GP team would like to wish all of our readers a merry Christmas and a happy new year. You can keep up to date with all the news between now and January by signing up for our...

GPs face prosecution threat over NICE.
December 12, 2008... New regulator warns legal action will be used as a last resort for ignoring NICE guidance. 'Draconian' legal powers to prosecute GPs who do not follow NICE guidelines, or fail other measures of care quality, will be a last resort,...

Need for holistic view from NICE.
December 12, 2008... NICE guidance will need to move beyond a topic-based approach if it is to have an impact on public health inequalities, according to a public health expert. Speaking at the NICE annual conference last week, Professor David Hunter,...

NICE to improve guideline presentation.
December 12, 2008... NICE needs to improve the way it presents its guidelines to GPs, its chairman has said. Speaking to GP at the NICE annual conference last week, Professor Sir Michael Rawlins said that NICE's greatest impact on the quality of patient care...

No pay rise for five years, King's Fund warns.
December 12, 2008... GPC says the NHS will not be able to retain practitioners if GP income is frozen year after year. GPs will not see a real pay increase for at least five years, according to King's Fund's chief economist John Appleby. Public spending...

Action is urged on open-but-full lists.
December 12, 2008... GPs must tackle open-but-full lists if general practice is to reach its full potential, the RCGP chairman has said. Professor Steve Field praised the proposed NHS constitution for clarifying that patients have the responsibility to keep...

Sleep disturbances linked to type-2 diabetes.
December 12, 2008... A breakthrough offers the potential to treat the condition by addressing problems in sleeping patterns. Type-2 diabetes may be linked to abnormalities in a person's body clock and sleep patterns, according to an international study. ...

Research briefs.(Brief article)(Clinical report)
December 12, 2008... Supplements fail to cut cancer. Taking vitamin E or selenium supplements, alone or in combination, does not lower the risk of developing cancers, US research suggests (JAMA Online 2008). Sexing up the credit crunch People in...

Single men likely to miss prostate checks.(prostate cancer)(Brief article)(Clinical report)
December 12, 2008... Efforts to improve early detection of prostate cancer need to focus on single men and those with a family history of the disease, the results of a decade-long study suggest. Researchers from the University of Michigan examined the...

DoH looks at impact of axing QOF indicators.
December 12, 2008... Evidence of the impact on patient care will be needed before indicators are removed from the quality framework (QOF), a DoH adviser has warned. Speaking at the NICE annual conference in Manchester last week, GP Professor Helen Lester...

Win a fabulous Christmas hamper worth pounds 250.
December 12, 2008... Celebrate Christmas in style with a fantastic John Lewis hamper packed in a beautiful lidded and lined wicker basket, filled with specially selected food and wine to delight the gourmet. The hamper includes a bottle of Fleuron de France...

Independent Nurse: Incoming NMC chair casts doubt on introduction of revalidation.
December 12, 2008... The incoming chair of the NMC has cast doubt on whether revalidation will ever be introduced for nurses. Professor Tony Hazell, who takes up his three-days-a-week, pounds 48,000-a-year post in the new year, said that the revalidation...

Independent Nurse: Advanced nurse register is 'on hold' says NMC.
December 12, 2008... The development of a separate register for nurses in advanced roles has been put on hold indefinitely, the NMC says. The advanced nurse register has been held up by changes in regulation and uncertainty whether revalidation will come in...

Independent Nurse: DoH rejected plan to pay for nurses in extended hours.
December 12, 2008... The DoH costed a deal that would have provided funding for practice nurses in negotiations over extended opening in GP practices, documents released under the Freedom of Information Act reveal. The deal, which was never made available to...

Independent Nurse: NMC 'no worse' than other regulators.
December 12, 2008... The incoming chair of the Nursing and Midwifery Council believes that the NMC's communication with its stakeholders is no worse than that of any other health regulator. In June, the Commission for Healthcare Regulatory Excellence (CHRE)...

Independent Nurse: Registration changes under fire in report.
December 12, 2008... A report has heavily criticised the 2005 decision by the NMC to allow health professionals to remain on the specialist community public health nursing (SCPHN) register without maintaining their basic registration as a nurse or midwife. ...

Independent Nurse: News in brief.
December 12, 2008... Workload More than 22 per cent of community nursing work in Scotland involves wound care, a census shows. Long-term conditions account for 11 per cent of contacts, child development 10 per cent and bladder or bowel care 9 per cent. An...

Independent Nurse: DoH crushes nurses' hopes of a generalist career pathway.
December 12, 2008... Nurses will not be offered a generalist career pathway under the Modernising Nursing Careers (MNC) framework, the DoH's new deputy chief nursing officer (CNO) has confirmed. Training will be based around the five patient pathways outlined...

Independent Nurse: Vital statistics - HIV prevalence.
December 12, 2008... 77,400 people were living with HIV in the UK in 2007 28% were unaware of their infection 7,334 new diagnoses were made in 2007 Nearly a third - 31 per cent - of people with HIV are diagnosed after the point at which therapy...

Independent Nurse: Journals watch.
December 12, 2008... - Fast food linked to risk of developing Alzheimer's Fast food could increase the risk of developing Alzheimer's disease, according to Swedish researchers from the Karolinska Institute. Mice fed a diet rich in fat, sugar and cholesterol...

Independent Nurse: Unite/CPHVA conference - Health visiting 'must change', DoH admits.(Conference news)
December 12, 2008... Health visitor workload is so high and morale so low that no change is 'not an option', deputy chief nursing officer Viv Bennett has said. The Child Workforce Strategy, due to be published this month, could help strategic health...

Independent Nurse: Unite/CPHVA conference - Expert urges 2 for 1 recruitment drive.(Conference news)
December 12, 2008... Two health visitors will be required for every one that retires, due to the vast workloads and experience of the current workforce, a childcare expert has warned. Merja-Maaria Turunen, a leading child physician from Finland studying UK...

Independent Nurse: Social enterprises - Nurses urged to be entrepreneurs.
December 12, 2008... A nurse practitioner who developed a social enterprise that works for PCTs and out-of-hours providers has urged colleagues to follow her lead. Amanda Mayo, clinical director of the 14-month-old Urgent Care Ltd, received pounds 400,000...

Independent Nurse: World outbreak information - Week beginning 8 December.
December 12, 2008... - Germany At least 40 people on a UK-based cruiser on the Rhine last month became ill with gastroenteritis, caused by the highly infectious norovirus. - Pakistan More than 1,000 cases of dengue fever were recorded in Lahore last...

Independent Nurse: Health visitors slam minister's remarks.
December 12, 2008... Health visitors have hit out at claims by health secretary Alan Johnson that they can be replaced by community nurses. At last month's health select committee meeting, Charlotte Atkins, Labour MP for Staffordshire Moorlands, warned that...

Independent Nurse: GP bodies offer help for nurses' training.
December 12, 2008... Nurse practitioners have been urged to liaise with local medical committees (LMCs) over training rather than primary care organisations. Dr Michelle Drage, chief executive of Londonwide LMCs and a London GP, told delegates at last month's...

Independent Nurse: MMR warning as cases of measles rise further.
December 12, 2008... Nurses must continue to remind parents about the importance of ensuring that their children receive both doses of the MMR vaccination, the Health Protection Agency (HPA) has warned. This year, by the end of October, there had been 1,049...

Independent Nurse: News focus - PCTs are failing on end-of-life care.(United Kingdom. National Health Service. Primary Care Trusts)(Report)
December 12, 2008... A National Audit Office report says cost-cutting in community nursing is harming palliative care. Tom Ireland reports. A damning report on the state of palliative care in England has highlighted that a lack of co-ordination in community...

Independent Nurse: Opinion - Online.
December 12, 2008... See who's saying what at www.healthcarerepublic.com 'A nurse who supervises doctors is under fire from GPs': I learned more (medicine) in my first year as a house officer from the main ward sister than from many of my clinical tutors. ...

Independent Nurse: Editorial - A generalist career pathway is needed.(Editorial)
December 12, 2008... When the DoH launched its Modernising Nursing Careers consultation last year, nurses in primary care had grave concerns about the five career pathways proposed: children, family and public health; first contact, access and urgent care;...

Independent Nurse: Opinion - A positive future for our proud profession.
December 12, 2008... The countdown has begun to 2009 and also to the celebrations for the 150th anniversary of the beginnings of district nursing. This is a milestone that should make everyone involved in primary care nursing feel proud. It was in 1859 that...

Independent Nurse: Opinion - In my view - We must encourage patient self-referral.
December 12, 2008... I was pleased to hear health secretary Alan Johnson endorsing the need to open up patient self-referral to allied health professionals (GP, 24 October). We have been expanding self-referral for musculoskeletal patients in Huntingdonshire...

Independent Nurse: Clinical - Influenza - Fighting seasonal infections.
December 12, 2008... Good hygiene in addition to vaccination is vital in the fight against flu, says Dr Rosalind Stanwell-Smith. Nurses are the front line defence against influenza in the UK, administering flu jabs to at-risk groups and healthcare workers...

Independent Nurse: Clinical - Gastroenterology - Diagnosing abdominal pain - Case study.(Case study)
December 12, 2008... Independent Nurse: A man presents with abdominal cramps and diarrhoea. Dr Harry Brown outlines his diagnosis and treatment. Mr Davidson was a 57-year-old man who was a little overweight but generally in good health, and not taking any...

Independent Nurse: Clinical focus - Paget's disease.(Disease/Disorder overview)
December 12, 2008... Overall key points - Paget's disease is a condition of increased but uncontrolled bone turnover. - It leads to excessive but weak bone formation, but only 5 per cent of patients are symptomatic. - Diagnosis is based on clinical...

Independent Nurse: Clinical - Obesity - Update on obesity management - Public health.
December 12, 2008... Independent Nurse: Obesity is a physical sign of underlying pathology and should be managed accordingly, writes Dr David Haslam. There are two schools of thought regarding obesity: one is that it is a societal problem, and that...

Independent Nurse: Clinical - Prescribing - Using antipsychotics in primary care - Mental health.
December 12, 2008... Antipsychotic dose should be kept to the minimum required for efficacy to reduce risk of side-effects, writes Dr David Morris. Antipsychotics are most commonly employed in primary care for non-psychiatric problems. Thus, prochlorperazine...

Independent Nurse: Clinical - Prescribing - Achieving best practice in tonsillitis - Infection.
December 12, 2008... Is a PIL more appropriate for throat infection than a pill? Penny Lovatt assesses the evidence. Sore throat and tonsillitis are among the commonest presentations in outpatient care.1 The only bacteria in the throat that respond to...

Independent Nurse: Professional - Running super-efficient flu clinics.
December 12, 2008... A 'super flu clinic' has enabled my practice to vaccinate 1,700 patients in five hours, writes Rosemary Burrows. Every winter, general practices throughout the UK face the challenge of providing influenza immunisations for their patients....

Independent Nurse: Professional - Health promotion - Encouraging children to take more exercise.
December 12, 2008... Collaboration between health and sports organisations is helping to engage young people, writes Crispin Andrews. Despite national campaigns and persuasive endorsements from high-profile sporting celebrities, significant numbers of...

Independent Nurse: Professional - Resources - Worth a look.
December 12, 2008... Migraine action plan Interactive tool An interactive tool at www.migraineaction plan.co.uk can help migraine sufferers create management strategies based on a review of their physical symptoms and the impact they have on their time...

Independent Nurse: Professional - Recommended patient resource.
December 12, 2008... What is it? The final book by humorist, musician and broadcaster Miles Kington, who died of cancer in January 2008, drafted a few months before he died. It is written with Kington's characteristic humour and comprises a series of letters to...

Independent Nurse: Professional - Workplace - Career profile - Mike Paynter, Bridgwater, Somerset.
December 12, 2008... - Why did you become a nurse? I vividly recall coming out of school and witnessing an elderly lady getting hit by a car as she crossed the road. I felt helpless and subsequently enrolled on a first aid course, which sparked my interest....

Independent Nurse: Professional - Practical prescribing.
December 12, 2008... Molly Courtenay helps resolve everyday issues for nurse prescribers. Q: I am a nurse independent/supplementary prescriber and am moving to a blood transfusion service. Would I be able to use my prescribing qualification in this area? ...

Education: Consultation skills - Consultations with anxious patients.
December 5, 2008... Empathy and reassurance can help in consultations with anxious patients, explains Dr Mona Kular. GPs are frequently faced with anxious patients. This anxiety may manifest itself in numerous different ways, all of which have the...

Education: DVD Review - CSA revision DVD.
December 5, 2008... A useful resource that can trigger discussion if watched in a revision group tutorial, writes Dr Anna Cumisky. The DVD to the clinical skills assessment (CSA) contains nine clinical scenarios, each designed to reflect cases that might be...

Education: Journals club - Management of osteoporosis in postmenopausal women.
December 5, 2008... Curriculum statement 15.9 Rheumatology and conditions of the musculoskeletal system. Key trials - One trial has shown that treatment with alendronate has greater reductions in markers of bone turnover and also greater gains in bone...

MedEconomics: Employment law - New rules for disciplining staff.(Employment Bill 2008)(Law overview)
December 5, 2008... New legislation will abolish the current bureaucratic statutory procedures. Rayner Jones explains. GP employers hoping for a quiet 2009 with few changes to employment law are going to be disappointed. The Employment Bill 2008, which...

Medeconomics: Provider organisation - Circle profile - Circle focuses on linking GPs and consultants.
December 5, 2008... Circle was set up three years ago by doctors and businessmen and started life as Centres for Clinical Excellence. Circle runs three independent sector treatment centres (ISTCs) in Bradford, Burton and Nottingham and plans to open a...

Medeconomics: Ask the experts - Global sums, relocations and pension protection.(minimum practice income guarantee)
December 5, 2008... Q: GLOBAL SUM ERROR We are a south London practice and when we received our October 2008 PCT statement we noticed our MPIG correction factor had reduced. Looking at the calculation details our annual correction factor in July was...

Medeconomics: GP commissioners must aim to please.
December 5, 2008... Dr Neil Paul offers an insider's view on how to make sure your practice-based commissioning scheme wins approval. As a member of my PCT's practice-based commissioning (PBC) approvals committee, I have seen numerous cases fail to be...

Dispensing: Consultations - Making better use of email.
December 5, 2008... Dispensing practices could benefit from providing email consultations, writes Dr Lisa Silver. In this age of IT-orientated business and ready access to the internet, I am surprised by the apparent reluctance of GPs to embrace technology...

Plain Tales from the Surgery.
December 5, 2008... Advantageous call I was doing an evening shift on a dark, drizzly night when I was asked to visit a patient suffering with acute abdominal pain. A lot of the houses had no numbers and I could not find the one I was looking for. In my...

Clinical: Journals Watch - Dementia, vertigo and anorexia.
December 5, 2008... Too busy to catch up on the latest research? Let Dr Alison Glenesk update you on recent papers. - Predictive value of the clock-drawing test Dement Geriatr Cogn Disord 2008; 26: 351-5 The authors were looking at methods for...

Clinical: Clinical Review - Pemphigus.(Disease/Disorder overview)
December 5, 2008... Contributed by Dr Sacha Goolamali, dermatology specialist registrar and Dr Rachael Morris-Jones, consultant dermatologist, King's College Hospital, London. Section 1 Aetiology and epidemiology Pemphigus vulgaris is the most common...

Clinical: Case study - A woman with unexplained bruising.(Case study)
December 5, 2008... A young woman notices bruises on her limbs and trunk. Dr Tillmann Jacobi investigates the cause. A 27-year-old woman attended the surgery with concerns about some bruising she had noticed over the past six to eight weeks. It occurred...

Clinical: Learning disabilities - Improving access to healthcare.
December 5, 2008... Patients with learning disabilities may need assistance to access care. People with learning disability and their carers often find it difficult to access appropriate healthcare. Evidence for this includes the low levels of screening...

Clinical: Managing HIV during pregnancy.
December 5, 2008... Dr Suneeta Kochhar, Dr Stephen French and Miss Prabha Sinha explain how to minimise transmission risks. HIV infection is associated with significant maternal and fetal morbidity and mortality, which may be improved by highly active...

Is the retirement time bomb still ticking?
December 5, 2008... GPs are using flexibilities in new GMS, allowing them to work for longer, reports Prisca Middlemiss. General practice has long been haunted by the prospect of a 'retirement time bomb'. Much of this concern was linked to the wave of...

Behind the headlines: Can breast cancer regress naturally?
December 5, 2008... Some breast cancers picked up by routine screening and treated with chemotherapy would have regressed naturally if left alone, media reports say. Norwegian research found that breast cancer rates were higher among women who were screened...