GP articles from July 2008

GP archives from July 2008

Opinion: Trust me, antibiotics are very necessary.
July 25, 2008... The lay reader of this column might conclude that (a) GPs are cold-hearted cynical bastards and, (b) that I am unreasonably obsessed with antibiotics; that's lay people for you, it shows how much they know. The eternal struggle to avoid...

Opinion: We are all merely lambs in mint sauce.
July 25, 2008... Last week I found myself in Edinburgh airport for rather longer than I intended. I had the company of a fellow examiner who had actually read one of my books, and could even quote bits of it at me, which filled me with such enormous pride...

Clinical: Journals Watch - Malaria, muscles and insomnia.(briefs)
July 25, 2008... Too busy to catch up on the latest research? Let Dr Simon Hunter update you on recent papers. Importing malaria BMJ 2008; doi:10.1136/bmj.a120 With the increase in availability and the decrease in cost of long-haul flights, more...

Clinical: Clinical Review - Stable angina pectoris.(Disease/Disorder overview)
July 25, 2008... Section 1 Definition and pathophysiology Angina pectoris results from the failure of myocardial oxygen supply to keep up with demand. When symptoms (usually chest discomfort) occur in proportion to exertion in a predictable and...

Clinical: Benign vascular tumours and naevi.
July 25, 2008... Pyogenic granuloma. The cause of this relatively common problem is unknown, but in some cases the patient will recall previous minor injury. This patient had pricked her finger when pruning a berberis bush in her garden. About a...

Clinical: Sports medicine - Dope testing and prohibited medications.
July 25, 2008... Dr Chris Jarvis looks at the drugs included on the prohibited list and the reasons athletes use them. There are often media reports of athletes misusing drugs in the pursuit to enhance their performance in sport. With the 2008 Beijing...

Clinical: Treating anxiety and depression using NLP.
July 25, 2008... Neuro-linguistic programming is ideal for the treatment of depression. Depression is overtaking back pain as the chief cause of absence from work. One in four consultations is now related to depression. GPs are at the front line of...

Clinical: Viewpoint - Assessment of HPV vaccination.(Human papillomavirus)(Viewpoint essay)
July 25, 2008... Dr Anne Szarewski assesses the role of HPV vaccines in preventing cervical cancer and genital warts. Since infection with HPV is the main cause of most cervical cancer, the obvious solution is to vaccinate children against it.1 ...

Clinical: The basics - Polycystic ovary syndrome.(Disease/Disorder overview)
July 25, 2008... Dr Louise Newson explains how to diagnose and treat this common condition. Polycystic ovary syndrome (PCOS, formerly known as Stein-Leventhal syndrome) is the most common hormonal disturbance in women. PCOS is characterised by...

Education: Professional development - Membership of the RCGP.(Royal College of General Practitioners)
July 25, 2008... Dr Sathya Naidoo explains the criteria that are required for completing iMAP. Interim membership by assessment of performance (iMAP) is a portfolio-based assessment to allow established GPs to become members of the RCGP; iMAP is about...

MedEconomics: How to ... Talk to your patients about medication.
July 25, 2008... Dr Sally Barnard from the MDU advises on the best ways to avoid errors when issuing prescriptions to patients. According to the National Patient Safety Agency (NPSA), the most common adverse incidents in general practice reported to its...

MedEconomics: Digital time-saving.
July 25, 2008... Dr Andrew Whiteley developed software that eases referrals and reports work flow for GP practices. Ten years ago, I was struck by how much time was wasted by GPs and their staff in dictating and typing referral letters and reports: time...

MedEconomics: Ask the experts - NHS pension value and profits.
July 25, 2008... Q: NHS Pension value Will my NHS pension be calculated at 1.4 per cent of all my NHS GP earnings or has that changed under the revised arrangements? Also, how will my NHS hospital service of three years be taken into account? For GPs...

MedEconomics: Push opportunistic care and create a success story.
July 25, 2008... My small practice has a high quality score and a low GP consultation rate, writes Dr Andrew Demetriou. I have always considered opportunistic screening and prevention to be central to every clinician's role in primary care. By...

Dispensing: Pharmacy White Paper - Defending practice dispensing.
July 25, 2008... Raising awareness about the impact of dispensing proposals is vital, writes Dr Jeremy Phipps. The Pharmacy White Paper, published in April, is the biggest threat to dispensing and rural general practice that current doctors have...

Plain tales from the surgery.(Brief article)
July 25, 2008... Quality of life. An elderly couple came to see me in the surgery. 'Doctor,' said the wife, 'would you tell my husband to go for a walk every morning. I read in a ladies' magazine that if he does this he will live 10 years more.' ...

Opening hours 'not linked to patient satisfaction'.
July 25, 2008... Practices maintained high levels of patient satisfaction despite anti-GP spin, the GP Patient Survey 2008 shows. The slide in patient satisfaction with practice opening times in the GP Patient Survey 2008, occurred regardless of changes...

Statins to receive safety guidance.
July 25, 2008... Safety warnings will be added to statin packaging and to information sent to GPs from this autumn, says the MHRA. Warnings about depression, sleep disturbances, memory loss and sexual problems will be published, although no exact date has...

Choice will weed out the poor practices, say Conservatives.(Brief article)
July 25, 2008... Conservatives plan outcomes-based QOF and greater choice. Greater patient choice means that poor practices will close, a Conservative health spokesman has said. Shadow health minister Mark Simmonds told GP that the party wanted a...

GP's film shows new arrivals to UK how the NHS works.
July 25, 2008... A Huddersfield GP has produced a 10-minute film to show people newly arrived in the UK how the NHS works. The film, being launched at Manchester Museum on 30 July, covers how to register with a GP, making appointments, interpreters,...

Behind the headlines: Can eating nuts in pregnancy lead to childhood asthma?
July 25, 2008... Expectant mothers who consume nuts or nut products every day could increase their child's risk of developing asthma by over 50 per cent, according to media reports. In an eight-year study, children diagnosed with asthma or other...

Behind the Headlines: Cancer care from GP of an 'incomparable standard'.
July 25, 2008... After losing his wife to ovarian cancer, Leslie Wright contacted GP to highlight the outstanding care she had received from their local GP, Dr David Pouncey. Dr Pouncey has worked at the Minchinhampton surgery in Gloucester for over 15...

Is the teenage health message sinking in?(Survey)
July 25, 2008... The chief medical officer used a report last week to highlight deficiencies in services for adolescents. Rachel Liddle reports. Recent headlines about teenagers have been dominated by knife crime and zero tolerance on drink driving, but...

Your say online: community.healthcarerepublic.com.(Website overview)(Brief article)
July 25, 2008... New website 'iwantgreatcare.org' allows patients to rate GPs. - Let's also name patients who hop from one practice to another, those who are high demand, aggressive tendencies, frequent attenders, don't keep appointments... -...

NICE to overhaul QOF under Darzi plan.
July 25, 2008... Quality framework GPs warn QOF is 'not a public health tool' as review threatens UK split. Plans for NICE to overhaul quality framework indicators could end the UK-wide GMS contract, GPs fear. Last week, health minister Lord Ara...

Pounds 105 million DES cash freed but correction factors cut.(Direct Educational Services )(Brief article)
July 25, 2008... Correction factor cuts proposed by the Doctors' and Dentists' Review Body (DDRB) this year are almost certain to go ahead, the GPC has admitted. GP leaders said they had successfully argued the cuts were illegal, but the DoH had begun a...

Extended hours DES 'redundant'.
July 25, 2008... Exclusive - Local deals between GPs and PCTs override national extended hours deal. The extended hours directed enhanced service (DES) may be redundant when it is published because most PCTs have developed more flexible local agreements,...

Private companies could take over PBC.
July 25, 2008... If GPs fail to make practice-based commissioning (PBC) work, the private sector will take over commissioning, according to the NHS Alliance. Dr David Jenner, PBC lead for the organisation, believes the Framework for External Support for...

GPs 'are not gaming QOF'.(Clinical report)
July 25, 2008... GPs in England exception report only 5 per cent of their patients and there is little evidence that widespread gaming of the quality framework occurs, UK research suggests. Concerns had been raised that some GPs would exclude large...

GP bash-o-meter.(Website overview)
July 25, 2008... Libel lawyers have confirmed that a new website is hosting potentially defamatory comments about doctors. iWantGreatCare.org allows anyone to post and read reviews about named doctors in the UK. Magnus Boyd, from Carter-Ruck solicitors,...

GPs face 'impossible' HPV task.
July 25, 2008... Workload warning after DoH extends HPV jabs to 300,000 girls aged 17 to 18 years. GPs will be under 'impossible pressure' after the DoH announced that it will extend the HPV vaccination programme to 300,000 girls aged 17 to 18 from...

NICE to back stroke referral.(National Institute for Health and Clinical Excellence)(Brief article)
July 25, 2008... GPs should refer patients with suspected stroke to specialist stroke units within 24 hours, according to latest guidance. NICE has issued guidance on the acute stage of a stroke or TIA, while the Royal College of Physicians (RCP) has...

News in brief.(Brief article)
July 25, 2008... Tickets to the Fringe Amateur Transplants, a comedy double act starring junior doctors Adam Kay and Suman Biswas, is on at the Edinburgh Fringe next month. Send your name and address to GPletters@haymarket.com to enter a prize draw for...

Women who oversleep may have high stroke risk.
July 25, 2008... Sleeping for nine or more hours a night could increase the risk of ischaemic stroke by 70 per cent among postmenopausal women, US research suggests. But sleeping less than six hours a night was also linked to a modest increase in stroke...

Apolipoprotein test best predictor of heart attack.(Clinical report)
July 25, 2008... Doubt cast on cholesterol ratios for estimating risk of MI. Doctors have been urged to ditch cholesterol ratios when estimating MI risk and look at apolipoproteins instead. Apolipoprotein B100 (ApoB)/apolipoprotein A1 (ApoA1) is...

Research briefs.(Brief article)
July 25, 2008... Antihistamine hope for Alzheimer's A hay fever drug could help improve symptoms in patients with Alzheimer's disease, according to US research. In a placebo-controlled trial of 183 patients with Alzheimer's, taking 20mg of Dimebon three...

GPC negotiator reveals gender change.(Brief article)
July 25, 2008... Sunday paper forces GP to reveal new gender ahead of planned announcement. Londonwide LMCs chief executive Dr Stewart Drage has called for 'respect' after being forced to announce last week that he had changed gender. Dr Drage, who...

GPC goes for youth with negotiators.
July 25, 2008... The GPC elected its youngest-ever negotiator this week, with 35-year-old Dr Beth McCarron-Nash chosen to replace Dr Michelle Drage. Dr McCarron-Nash, a GP in Honiton, Devon, who becomes the only current female negotiator, said her...

Editorial: Quality should always come before cost.(Editorial)
July 25, 2008... When the quality framework was first conceived it was intended to improve outcomes for patients, particularly those with long-term conditions, by providing incentives to drive up standards of care. There was no mention of cost- effectiveness....

Opinion: When it comes to IT, the NHS is in the Stone Age.
July 25, 2008... The National Programme for IT (NPfIT) is now four years behind schedule and will cost pounds 300 million more than planned, according to the National Audit Office. The electronic care records service, allowing doctors to access patients'...

How the Darzi review will affect general practice.(general practices effect on General practitioners Compensation)
July 11, 2008... In the wake of the much anticipated review, Jonn Elledge looks at the changes that will occur and how they affect GPs. Polyclinics, it seems, were a red herring. For months now, practices have been bracing themselves for the Darzi review...

'GPs are prized asset' say the Lib Dems.
July 11, 2008... Liberal Democrat shadow health secretary Norman Lamb says that, a year into the post, the 'fog is beginning to clear'. It's good timing, because he has plenty to digest with the release of the final report of Lord Darzi's NHS Next Stage...

Behind the headlines: Can a gene test predict breast cancer risk?
July 11, 2008... A new genetic test could identify women most at risk of breast cancer, according to reports. A genetic test would mean women could be screened for breast cancer based on their level of risk rather than according to age. Women could...

Ballot box.
July 11, 2008... GPs who think nurses should be rated on their compassion: 63% Source: www.healthcarerepublic.com

Opinion: Dramatic rescues are all in a day's work.(Personal account)
July 11, 2008... The fire was already out of control, the mandatory crowd assembled; the polyclinic was 60 miles away and was shut for the night anyway, so they had called me. A fireman came dashing up, the traditional grizzled veteran. 'There are...

Opinion: Insomnia can be an occupational hazard.
July 11, 2008... The tortured ramblings of my GP mind are keeping me awake. We need online chat rooms for insomniac doctors. It's 3am, and there's nobody out there - even my editor at GP has unaccountably gone to bed. For once it's not the travails of Mrs...

Editorial: Darzi review must not destabilise practices.(Editorial)
July 11, 2008... Lord Darzi's 'Next Stage Review' was broadly welcomed when it was published at the start of last week. With its focus on quality, driving up standards and improving patients' experiences it was hard to find fault. But, as with all...

Opinion: GPs are the glue holding the NHS together.
July 11, 2008... When does a dive become a dive? Standing on the diving board? In the air? Entering the water? In truth, each part is integral to the whole and cannot be taken out of context. Yet I suspect the government doesn't realise that primary care...

Clinical: Journals Watch - Prostate cancer, MS and asthma.
July 11, 2008... Too busy to catch up on the latest research? Let Dr Raj Thakkar update you on recent papers. Prostate-cancer specific survival following salvage radiotherapy JAMA 2008; 299: 2,760-9 Recent studies have indicated radical...

Clinical: Clinical Review - Endometriosis.(Clinical report)
July 11, 2008... Contributed by Mr Michael Booker, consultant obstetrician & gynaecologist, and fertility specialist at Mayday University Hospital, Croydon. Section 1 Epidemiology and aetiology Endometriosis is one of the most common gynaecological...

Clinical: Equipment review - Bags you can be proud of Dr Gwen Lewis compares two bags for doctors.(Chiswick bag )(Viewpoint essay)
July 11, 2008... The Chiswick I like the colour of the Chiswick bag and it made a welcome change from my old briefcase-style bag. Although the Chiswick bag weighs only 0.8kg, it does feel fairly robust, yet neat and compact measuring 31 x 22 x 15cm. It...

Clinical: At a Glance - Urticaria pigmentosa in children vs adults.
July 11, 2008... Children Clinical features - Mastocytosis with increased mast cells, usually in the skin. - Usually presents within the first few months of life and resolves spontaneously by teenage years. - Widespread itchy, brown or reddish...

Clinical: The diagnosis and treatment of iritis.(Clinical report)
July 11, 2008... Iritis is common at all ages but it does respond well to topical steroids and cycloplegics, writes Ms Gilli Vafidis. Iritis means inflammation of the iris. The term is synonymous with anterior uveitis, when used to encompass inflammation...

Clinical: Red flag symptoms - Alcoholism.
July 11, 2008... - Evidence of current intoxication - Tremor - Malnutrition - Memory loss - Stigmata of liver disease - Depressed mood - Irritability - Capillarisation of facial skin and conjunctivae A large number of alcoholics go...

Education: MRCGP - How to apply for your certificate.(Membership of the Royal College of General Practitioners)
July 11, 2008... Applying to the RCGP for your CCT recommendation now takes three clicks, writes Fiona Erasmus. If you are one of the 1,700 ST3 trainees who are completing the new MRCGP assessment this summer it is likely that you will, by now, have got...

Education: MRCGP exam update - Prehypertension.(Membership of the Royal College of General Practitioners)(Clinical report)
July 11, 2008... Current situation Research has shown the benefits of patients with 'prehypertension' being treated with medication to lower their BP. Individuals with prehypertension or high normal BP - BP 130 to 139/85 to 89mmHg - are at increased...

MedEconomics: How to ... Fund and set up a gym at your practice.
July 11, 2008... Ask patients to help with fundraising activities if grant finance is not available, says Tom Ireland. A practice gym is a valuable addition to the services GPs offer and is appreciated by patients. Assuming there is a suitable room at...

MedEconomics: Ask the experts - Gazundering and seniority payments.(Gazundering is the practice of demanding a reduction in price to secure the sale of a property)(General practitioners seniority payment)
July 11, 2008... Q: Gazundering We have found a house that we wish to purchase but, for some reason, the owners do not want to complete for another six months. However, they do want us to exchange contracts on the sale as soon as possible. Does this...

MedEconomics: Practice motoring - Go to work in a new Audi saloon.
July 11, 2008... Dr Tony Rimmer test drives the new Audi A4 2.0 TDI, an executive saloon with good fuel economy. Are you a professionally successful GP who enjoys hobbies such as walking, reading or travel? Say 'yes' and you fit into the UK demographic...

MedEconomics: Doing voluntary work on holiday.
July 11, 2008... Ensure you have defence cover if you use your medical skills to help an overseas project. If you will be volunteering as a doctor for an overseas charity instead of taking the usual beach holiday this summer, you need to think about the...

MedEconomics: Life-changing work in Canada.(Canada is recruiting UK health professionals)(Occupation overview)
July 11, 2008... Canada is recruiting UK health professionals. Adele Waters talks to a GP who made the big step. In 1991, Dr Robert Halse was set to join a GP partnership in Stroud Originally from Bridgend, south Wales, he'd completed his medical...

MedEconomics: Go for a multi-function printer.
July 11, 2008... Dr Paul Bromley reviews the Brother DCP-9045CDN printer, scanner and copier. I am a fan of the multifunction devices produced by Brother, as they are excellent value for money. Over the past four years, my practice has used two of their...

MedEconomics: Dispensing - Practice Finance - The principles of endorsement.(Endorsing: once electronic scanning of prescriptions )
July 11, 2008... Efficient endorsing helps to protect your dispensing income, writes Annette Arthur. Endorsing is the process by which dispensers tell the Prescription Pricing Division (PPD) what they have used to fulfil a prescription. It details...

Plain tales from the surgery.
July 11, 2008... Put the squeeze on Mr Smith, a pleasant 82-year-old man, came to see me about his urinary symptoms. His concerned sister had already written a letter to us regarding the same problem and requested that we see him as he was not too keen...

Liver protein test for diabetes.
July 11, 2008... Scientists find protein that could predict type-2 diabetes risk. Measuring levels of a liver protein could offer a new approach to screening for patients with type-2 diabetes, US research suggests. Patients who had high levels of the...

Fertility hope for cancer patients.
July 11, 2008... Women having cancer treatment could have the chance to preserve their fertility, say German researchers. They have stimulated ovaries to produce eggs in the final or luteal phase of the menstrual cycle. Until now, ovarian stimulation has...

Research brief.
July 11, 2008... Sprinters turn to Viagra: The World Anti-Doping Agency says traces of Viagra are being found in tests of sports competitors who believe the drug can help by improving heart function

GPs warned to delay child jabs after supply shortage.
July 11, 2008... DoH writes to all practices in England revealing allocation 'error'. GPs have been warned to delay second doses of scheduled childhood vaccines, following shortages across England. Every GP practice in England was sent a letter from...

News in brief.
July 11, 2008... GP anger over health visitors North Glasgow GPs are petitioning MPs to stop plans to relocate NHS Greater Glasgow and Clyde health visitors with social workers, saying it will undermine the health of deprived populations. Continuity...

Public back private practices, says CBI.
July 11, 2008... The public supports plans to bring private health providers into under-doctored areas by a ratio of three to two, a CBI survey has found. Plans for private companies such as UnitedHealth to take over inner city GP practices under APMS...

Public thumbs-up.
July 11, 2008... 48% of the public accept private practices. Source: CBI

GPs to be trained 'on the cheap' by nurses.
July 11, 2008... Yorkshire deanery says nurses can be 'appropriate' trainers, but GPs fear erosion of quality. Yorkshire deanery is to train nurses as associate GP trainers. The nurses will support existing GP trainers and teach parts of the...

Virgin amends its profit plans.
July 11, 2008... Virgin Healthcare has abandoned a plan under which GPs could be paid for referring NHS patients to private Virgin services. GPs who sign up with Virgin will remain independent contractors, but will work within a Virgin-branded health...

DoH reveals alternative to MPIG.
July 11, 2008... Funding Revised system will pay GPs for rurality, patient turnover and geographical costs. Higher payments for rural practices and those with high patient turnover could offset the end of the MPIG, the government has revealed. The...

Patients may be denied HPV vaccinations.
July 11, 2008... GPs fear PCTs could prevent them from giving girls the HPV jab when clinically appropriate if they fall outside of the vaccination programme due to begin later this year. From September, girls aged 12-13 years in England will receive the...

Push for abortions in GPs' surgeries.
July 11, 2008... Abortions could be carried out in GP surgeries and polyclinics if amendments put forward to modernise the 1967 Abortion Act are passed. The need for two doctors' signatures could be scrapped and early medical abortions may be allowed to...

DoH model 'underestimates cost of vascular screening.
July 11, 2008... Economic report on screening plans branded as 'nonsense'. The DoH's first model of national cardiovascular disease (CVD) screening hugely underestimates the workload and cost of the scheme, say experts. The report, 'Economic...

DoH backing for QRISK sets up a potential clash with NICE guidance.
July 11, 2008... GPs could be left confused over which cardiovascular risk tool to use after the DoH indicated support for QRISK in the vascular screening programme. The economic evaluation of a vascular screening programme for England was based on the...

GPs are being 'forced into polyclinics'.
July 11, 2008... Birmingham GPs are being forced into polyclinic-style premises amid fears that their contracts will be otherwise terminated, LMC leaders say. Over half of practices in the Heart of Birmingham PCT have now signed up to move into new...

GP Bash-o-meter.
July 11, 2008... Health minister Ben Bradshaw has let fly with a series of anti-GP remarks in recent weeks. GP's new bash-o-meter will aim to track anti-GP spin in the media, whether from the self-appointed minister for GP-bashing himself, or others. Here is...

Exclusive - Strike-off risk over dementia drugs.
July 11, 2008... Legal experts confirm GPs risk being struck off over antipsychotic prescribing. GPs could be struck off for prescribing antipsychotic drugs to dementia patients, a medico-legal expert has warned. Dr Mike Devlin, an adviser at the...

QOF should target outcomes, MPs say.
July 11, 2008... Reports by patients on how their health has improved should be included in the quality framework, MPs have said. The All Party Parliamentary Group on Primary Care says patient-reported outcome measures (PROMs) should be added to the...

GPs condemn NHS privatisation.
July 11, 2008... GPC chairman Dr Laurence Buckman won a standing ovation at the BMA's Annual Representative Meeting (ARM) in Edinburgh this week after he condemned the 'distorted market' that GPs are being forced to compete in. He said some PCTs were...

Independent Nurse: Nurses could be struck off for mixing drugs in syringe drivers.
July 7, 2008... Nurses could be struck off for unwittingly breaching prescribing rules after an NHS watchdog said they were not qualified to mix drugs in syringe drivers, a practice that is common in palliative care. Independent Nurse has learned that a...