GP articles from March 2009

GP archives from March 2009

Opinion: The uselessness of general knowledge.
March 27, 2009... Noblesse oblige being what it is, I took part in a table quiz a few weeks ago, in aid of a popular and worthy Irish charity, The Royal College of Village idiots - we have a few locals studying for the fellowship and enjoy sniggering at them...

Opinion: The joys of not always being good.
March 27, 2009... Tonight my husband, hard-hearted champion of the Serious Rules regarding the Dieting Dog, is caught out when she throws up all over the kitchen and thus reveals that he fed her my cassoulet. Initially this must have seemed a good plan. My...

Clinical: At a Glance - Plaque-type morphea vs Becker naevus.(Disease/Disorder overview)
March 27, 2009... PLAQUE-TYPE MORPHEA (LOCALISED SCLERODERMA). Aetiology - Cause unknown but occasionally follows injury, pregnancy, viral infections or autoimmune disease. - Results from excessive deposition of collagen that leads to thickening...

Clinical: Clinical Review - Hay fever.(Disease/Disorder overview)
March 27, 2009... Contributed by Dr Anthony Crockett, GP and hospital practitioner, Great Western Foundation Hospital, Swindon. Section 1: Epidemiology and aetiology Hay fever is a symptom complex caused by allergic inflammation of the nasal mucosa....

Education: Professional development - Skills for successful negotiation.
March 27, 2009... Dr Tillmann Jacobi explains some basic and effective negotiation skills of value to all GP trainees. GPs are perceived as being empathetic, pragmatic and aiming for ethical correctness. It might appear that these qualities do not sit...

Education: Pictorial case study.(Case study)
March 27, 2009... The case. A 58-year-old man presented urgently in the surgery one morning. He had been alarmed by the appearance of his left eye that morning. His left eye was bright red but painless. There was no history of trauma and no discharge...

Education: A registrar survival guide ... surviving study groups.
March 27, 2009... - Choose a good mix of people. Studying with the right group of people can seriously cut down on your exam workload. Choosing the wrong group could be yet another source of anxiety and frustration. Do not be tempted to join a group...

MedEconomics: How to ... Understand practice nurse roles.
March 27, 2009... Sue Cross explains the qualifications and skills needed by different practice nursing team members. Fully understanding the roles, skills and qualifications of practice nurses and healthcare assistants (HCAs) will help GPs deliver...

MedEconomics: Ask the experts - Tenancy and maternity rights.
March 27, 2009... Q: TENANTS' DUTIES. I am the sole owner of a surgery built in 1991. About 18 months ago I retired and effectively took on the role of a private landlord. Since then I have been trying to organise a formal lease with my ex-partner...

MedEconomics: How much locums are charging.(Survey)
March 27, 2009... Our annual survey shows it is still possible to achieve high earnings as a locum. Locum work suits some GPs, but the Medeconomics February 2009 survey of locum pay rates reveals that a large minority of respondents were locums because of...

Dispensing: Pharmacy competition - Pharmacy applications update.(Law overview)
March 27, 2009... Progress has been made on the petition to the Scottish parliament, writes Alan Kennedy. In October 2008, following the application for a commercial pharmacy in the Leuchars and Balmullo area of East Fife (later refused but now under...

Plain Tales from the Surgery.
March 27, 2009... Corporal symptoms. This ex-army patient had developed symptoms of nerve compression at his wrist. He came to see me after the nerve conduction studies had confirmed my provisional diagnosis. Before even sitting down, he started: 'The...

Vascular benefit of metformin shown.
March 27, 2009... Event risk cut by continuing metformin treatment after insulin initiation. Metformin treatment should be continued in type-2 diabetes patients started on insulin, research suggests. Continuing treatment reduces risk of macrovascular...

High vitamin D dose is 'better'.
March 27, 2009... Larger doses of vitamin D lead to greater reductions in bone fracture risk, an analysis of trials involving over 80,000 patients has revealed. Researchers from the University of Zurich examined 20 trials studying fracture rates in...

Boosting intake of omega-3 'could ward off' Alzheimer's.
March 27, 2009... Alzheimer's disease Call for at-risk people to eat more oily fish. GPs should encourage patients to consume a diet rich in omega-3 to lower their risk of developing Alzheimer's disease, findings of new UK research suggest. Speaking...

Research briefs.(Report)(Brief article)
March 27, 2009... Blushing and alcohol: People who blush after drinking alcohol are at increased risk of oesophageal cancer, US research suggests. The ALDH2 gene is linked with alcohol-related blushing and oesophageal cancer risk, researchers found (PloS...

Pre-eclampsia test 'unreliable'.
March 27, 2009... Measuring protein levels in the urine of women with pre-eclampsia fails to predict fetal or maternal outcomes, research suggests. The findings question current practice, which relies heavily on proteinuria as a test for diagnosing and...

Report hands QOF top marks on effectiveness.
March 27, 2009... The QOF is among the most effective tools for improving health, according to Health England. QOF is one of the most effective ways of incentivising changes in health behaviour, according to a report published last week. Health...

Complaints move will 'cut red tape'.
March 27, 2009... Complaints that GP practices can handle within a working day will no longer have to be formally reported to PCTs from April, the GPC has reminded practices. GP leaders urged practices to take advantage of the new system, which they...

DoH reviews case for PSA screening.
March 27, 2009... Study shows PSA tests cut deaths by 20% as case for screening grows. The DoH is to examine latest research which found that PSA-based screening can cut the number of deaths from prostate cancer by 20 per cent, in a move that could pave...

Online tool helps find depression.
March 27, 2009... An online interactive programme to help GPs in the detection and treatment of depression in older people has been developed by the charity Age Concern. The programme, called Take the Challenge, is designed to help GPs identify the...

Internet is transforming GPs into expert advisers.
March 27, 2009... Internet access to medical information is creating a 'reformation', changing doctors into expert advisers in the same way priests' roles developed in the 1500s, a BMJ editorial argued. Joanne Shaw, chairwoman of NHS Direct, said that as...

MPs say LESs can tackle health inequalities.
March 27, 2009... All-Party Parliamentary Group report calls for more powers for GPs to set local priorities. Local enhanced services (LESs) should be used to tackle health inequalities and improve the health of disadvantaged communities, say MPs. ...

GPs' preventive care data a 'benchmark' for the NHS.
March 27, 2009... GP practice data about preventive care and patient safety is being held up by the Healthcare Commission as a benchmark for the rest of the NHS to follow. Such data is lacking across most of the NHS, except in GP practices, where...

Win a Nintendo Wii Fit.
March 27, 2009... The Wii Fit is divided into four categories aerobic exercise, muscle conditioning, yoga poses and balance games. You can set your own personal goals and compare fitness levels with other players. How to enter: For your chance to win,...

GPs in community hospitals urged to check legal cover.
March 27, 2009... Indemnity GPs' work in hospitals may not be covered by insurance. GPs working in community hospitals are being forced into delivering care that may not be covered by their insurance from medical defence organisations (MDOs). Dr Jean...

PCTs must improve access for traveller communities.
March 27, 2009... The BMA is calling on PCTs to improve gypsy and traveller communities' access to GP services. These communities are among the most discriminated against in the NHS, according to a DoH consultation launched as part of its Pacesetters...

Research units to 'change GP role'.
March 27, 2009... Head of Darzi 'centre of excellence' says GPs will be forced to specialise more. Sanday Tanday reports. When Lord Ara Darzi set out his vision for the future of the NHS last summer, heads were turned by controversial plans to herd GPs...

Behind the headlines: Does a 'fat controller' manage fat metabolism?
March 27, 2009... A 'fat controller' enzyme determines whether dietary fat is stored in the body or used to produce energy, newspapers reported last week. US researchers found that mice missing the gene for the enzyme MGAT2 were able to feast on a...

Opinion: Ballot box.
March 27, 2009... 65% of GPs believe prescription charges should be abolished in England Source: Healthcare Republic. -------------------- Did you find this article useful? Why not subscribe to the magazine? Please call 08451 55 73 55 for more...

Opinion: Your say online ... www.healthcarerepublic.com/forums.(Chronic kidney disease)(Brief article)
March 27, 2009... Individual kidney care plans launched for patients - Another care card that the patient will forget to bring to consultations and that will eventually be abandoned. - Having a folder about your CKD is not the issue. Getting access to...

Editorial: DoH must close the door on local QOF funds.(Editorial)
March 27, 2009... If ever there were any doubts about the value of the quality framework, they should have been dispelled by recent events. The QOF is one of the most effective ways of incentivising changes in health behaviour, according to a DoH report....

Opinion: The DoH continues to patronise us all.(Department of Health)
March 27, 2009... Why is the DoH so incompetent at PR? It seems completely incapable of responding to true public interest. Take health promotion. The publicity surrounding Jade Goody's cervical cancer has deeply impressed upon many women the importance of...

Clinical: Journals Watch - Wheeze, flu, vitamin K and PTSD.(Report)
March 27, 2009... Too busy to catch up on the latest research? Let Dr Jonathan Holliday update you on recent papers. - Inhaled steroids in infants Arch Dis Child 1 March 2009.doi: 10.1136/adc.2007.132100 Inhaled corticosteroids (ICS) are commonly...

Examining the eye.
March 27, 2009... Confidence in eye examination comes with practice and Ms Gilli Vafidis says it is well worth learning the skills. While few ophthalmologists would trust fully their diagnosis if prevented from using magnifying wide angle devices,...

Clinical: Practice dilemma.(Case study)
March 27, 2009... Should you withhold clinical information? An 80-year-old man was admitted to a nursing home after suffering a mild stroke. He has made a good recovery and is mobile with the help of a walking frame. He has developed renal failure. It has...

Clinical: Red flag symtoms - Jaundice in an adult.
March 27, 2009... Dr Tillmann Jacobi explains when this worrying symptom should be seen as a cause for alarm. - Painless - Slow onset - Recent or frequent travel abroad - Weight loss - Systemically unwell - History of alcohol or drug misuse ...

Clinical: The basics - Chickenpox in adults and pregnancy.(Disease/Disorder overview)
March 27, 2009... Varicella zoster may require intensive management. The varicella zoster (VZ) virus has two clinical manifestations: chickenpox and shingles. Although chickenpox tends to be more common in children it can also affect the adult population...

Prevalence losers face merger.(National Health Service. Primary Care Trusts)(Law overview)
March 27, 2009... GMS contract Losers under 2009/10 contract could be merged or switched to APMS. National guidance for PCTs suggests merging practices that are no longer financially viable because of changes to the prevalence formula in 2009/10. ...

Practices score highly in new accreditation scheme.(Royal College of General Practitioners)
March 27, 2009... Half of practices piloting an RCGP practice accreditation system that could be adopted by NHS regulator the Care Quality Commission (CQC) scored 90 per cent or above. Nearly one in three (30 per cent) passed 100 per cent of the core...

QOF changes to be made every year.
March 27, 2009... QOF Government backtracks on local QOFs but leaves door open for their introduction. QOF will be subject to annual changes when NICE takes over the review of indicators next week. Responding to the consultation on changes to how...

Dual CVD risk tools 'confusing'.(Brief article)
March 27, 2009... GPs have warned that including both the QRISK2 and Framingham risk scores in guidelines for the vascular checks programme will create confusion. Professor Roger Boyle, England's national director for heart disease and stroke, told GP...

Science centres 'a threat' to GPs' role.
March 27, 2009... GPs' generalist role may come under threat as a wave of Darzi-inspired academic centres take root across the UK, experts believe. Academic health science centres (AHSCs) combine clinical expertise with university research to speed the...

GPs will make rationing decisions under Tories.
March 27, 2009... The Conservatives plan to strip NICE of its power to ration medicines and make GPs decide which treatments their patients have access to. Shadow Conservative health secretary Andrew Lansley said GPs should be responsible for the cost of...

Exclusive: Glut of locums is undermining rates of pay.
March 27, 2009... Medeconomics' annual survey of GP locums finds many searching for partnership opportunities. Locum pay across the UK has stagnated, and those working in London can receive as little as pounds 150 a day, the 2009 Medeconomics survey...

GP Diary.
March 27, 2009... Hangover by proxy The CMO's annual report on public health contained intriguing references to 'passive drinking', which sounds considerably cheaper than 'active' drinking. Closer scrutiny revealed it involves the 'consequences of one...

'Perverse incentives' for PCTs to use private firms.(primary care trust)(Brief article)
March 27, 2009... Private providers PCTs may be forced to introduce competition PCTs are under pressure to use the private sector unnecessarily, according to a leading NHS chief executive. Mike Farrar, chief executive of NHS North West, said the DoH's...

Legal warning on DoH claims plan.
March 27, 2009... GPs could be forced to report clinical negligence claims and PCTs may be handed powers to suspend practitioners with immediate effect. A DoH document published last week, Tackling Concerns Locally: the Performers List System, set out...

Opinion: On the road to Damascus.
March 20, 2009... When I was a medical student in Dublin, I had a four-week attachment to the vascular surgery team. It was in a stark contrast to my general practice rotation, which consisted of one grimy morning surgery in a cruddy inner-city health centre....

Opinion: Not a lot of people have one of those.
March 20, 2009... My owl bit me the other day, which is a sentence not many people get to say a lot. He has been rather bad tempered lately - there's a lot of feather pulling and flouncing about going on. He's the same every spring, and we are trying to...

Education: nMRCGP - Preparing registrars for the CSA.(Royal College of General Practitioners)(clinical skills assessment)
March 20, 2009... The role of the trainer is crucial in helping registrars pass the CSA, writes Dr Kamila Hawthorne. The clinical skills assessment (CSA) is an examination of clinical consulting skills. Many GP trainers have not had experience of preparing...

Education: Consultation skills - How should we address our patients?
March 20, 2009... Dr Rodger Charlton asks whether there is a loss of respect or professionalism if we use first names. There is a debate as to whether we should address patients by their surname, or whether first names are more patient-centred, and as to...

Education: A Registrar Survival Guide: Home visits.
March 20, 2009... Preparation Before setting out, gather information about the patient from their notes and from colleagues at the practice. Check recent blood tests and clinic letters, and see if there are any QOF points that need chasing. Remember...

MedEconomics: How to ... Deal with an NHS fraud probe.(National Health Service. Primary Care Trusts)
March 20, 2009... Dr Jeremy Phipps explains what practices can expect if the NHS Counter Fraud Service comes calling. Picking up the phone and hearing: 'Hello, I am from the NHS Counter Fraud Service' could be a heart-stopping moment. Fortunately, in my...

MedEconomics: Consider practising in Ireland.
March 20, 2009... There is a shortage of GP jobs in some UK areas but the opposite applies in Ireland. Practising in Ireland does not often spring to mind when UK GPs are looking for employment. Yet Ireland has an acute shortage of GPs while, in parts of...

MedEconomics: Ask the experts - Lease renewals and pension limits.
March 20, 2009... Q: LEASE NEGOTIATION The 15-year lease on our surgery has recently expired and we are negotiating renewal with the landlords - both former partners Associated costs are over pounds 11,000: legal costs, pounds 3,500; dilapidation survey,...

MedEconomics: Agreeing an informal dismissal.
March 20, 2009... 'Without prejudice' discussion with employees can ease the termination process, says Rayner Jones. GPs may have come across the term 'without prejudice' in legal correspondence at some stage. When these words appear on a document, they...

Dispensing: Licensing - Opening a pharmacy: your questions answered.(Surelines Limited)(Interview)
March 20, 2009... There are a host of practicalities involved in obtaining a pharmacy licence, as Nigel Morley and Joseph Forshaw explain. The biggest growth in the development of community pharmacies has been in those that are GP-owned, led and co-located...

Dispensing: Obituary: Dr Iain McLean.(Obituary)
March 20, 2009... Valued contributor to GP, dispensing doctor and long-standing member of the Dispensing Doctors' Association Dr Iain McLean, died suddenly on 21 February 2009. GP wanted to publish this short tribute to Dr McLean from his friend and colleague...

Plain Tales From The Surgery.
March 20, 2009... - Air of depression A middle-aged man came into my surgery recently, with symptoms suggestive of a mild depression. What particularly struck me was his dishevelled and grubby appearance, and an especially unpleasant aroma that had...

GPSI accreditation delays spark two-tier service fear.
March 20, 2009... Patchy implementation of accreditation for GPSIs could lead to the emergence of a two-tier service, GPs have warned. England's guidelines for accreditation are only available for a limited range of GPSI services. Where nationally agreed...

MPs warn Darzi centres 'favour rich'.(members of parliament)(Brief article)
March 20, 2009... Darzi centres could make it harder for people from lower socio-economic backgrounds to see their GP, MPs fear. In a report on health inequalities, the House of Commons health select committee voiced concerns that GP-led health centres...

Practices to have named 'safeguarding GPs'.(Report)
March 20, 2009... Lord Laming report in wake of Baby P calls for increased GP role in protecting children. GPs must take more responsibility for child protection in the wake of the Baby P tragedy, a report has concluded. In The Protection of Children...

Practice reviews 'could defame'.
March 20, 2009... Allowing patients to anonymously review practices as if they were books or pop music could result in misleading and defamatory comments, the Medical Protection Society (MPS) has warned. A Cabinet Office paper, Working Together - Public...

Fifth of GPs say QOF checks by PCOs are 'heavy handed'.
March 20, 2009... GP survey shows assessors lack 'light touch'. More than one in five practices describe their PCO's approach to QOF assessments as 'heavy-handed', a GP survey shows. GPs responding to the survey described their PCO's attitude as...

RCGP to revive named consultant referral.(Royal College of General Practitioners)(Royal College of Surgeons of England)(Brief article)
March 20, 2009... The RCGP is joining forces with the Royal College of Surgeons (RCS) to propose reforms to Choose and Book. GPs say the referrals system limits choice by preventing them from referring to named consultants. Surgeons have accused hospital...

Bids made to assess indicators as part of QOF review.
March 20, 2009... The RCGP has submitted a joint bid with the National Primary Care Research and Development Centre (NPCRDC) to assess quality indicators as part of the new QOF review process. If successful, the RCGP and NPCRDC will review the evidence...

A&E doctors target out-of-hours.
March 20, 2009... Out of hours - Negotiator says GPs should commission out-of-hours to prevent 'land grab'. GPs should take back responsibility for commissioning out-of-hours services to prevent a 'land grab' by emergency doctors, a GPC negotiator has...

Bid to pay practices to take on partners.
March 20, 2009... Scottish LMCs conference - Encouraging partnership - Extended hours - Locums - Call to scrap revalidation. GPC Scotland should renegotiate the GP contract to provide incentives for practices to take on partners, according to GPs at the...

Locums demand a say on LMCs.(Local Medical Committees)(Survey)(Brief article)
March 20, 2009... LMCs in Scotland must aim to have locum and salaried representatives, said Scottish GPs. Dr Ian Thompson, a sessional GP from Aberdeen, said that LMCs should do more to engage these doctors. He said that 22 per cent of Scottish GPs...

RCGP is urged to scrap revalidation.(Brief article)
March 20, 2009... Scottish GPs are calling for the RCGP revalidation plans to be scrapped. GPs agreed that the RCGP plan for revalidation to require 250 credits in five years is too complex and time consuming. They want the plan to be replaced with a...

Extended hours branded a 'PR exercise' by top GP.
March 20, 2009... GPC Scotland has called on the Scottish government to review the extended hours service. In his keynote conference speech, GPC Scotland chairman Dr Dean Marshall questioned whether the initiative had been a good use of limited NHS...

The Week's News on healthcarerepublic.com.(Website overview)(Brief article)
March 20, 2009... To receive the latest news in your inbox every day, sign up to our news alert at www.healthcarerepublic.com/dailyemail Top five stories 1. Jade Goody sparks review of cervical cancer screening A panel of experts is to carry out an...

PCOs failing to talk about diabetes.
March 20, 2009... Diabetes uk conference Call for better sharing of data l Rosuvastatin for South Asians. GPs have warned that a lack of communication between primary care organisations (PCOs) is undermining care of diabetic patients by preventing...

Statin alternative for South Asians.
March 20, 2009... Rosuvastatin can help to lower cholesterol levels and appears safe and tolerable in South Asian patients with type-2 diabetes, UK research shows. Recent data had suggested that South Asian diabetics should be advised to take lower doses...

Exclusive: Diabetes screening raises inequality.
March 20, 2009... Diabetes UK Conference - Doubts over screening l Depression link l Boost nurses' role l Memory loss. Diabetes screening may not be added to the QOF for four years although patchy local implementation could increase health inequalities, a...

Hypoglycaemia affects memory.(Report)(Brief article)
March 20, 2009... Suffering from severe hypoglycaemic episodes could lead to poorer memory and diminished brain power, research suggests. The study of 1,066 patients with type-2 diabetes showed that severe hypo-glycaemic episodes lowered memory, logic and...

Screen depressed patients for diabetes, GPs are urged.
March 20, 2009... GPs should consider screening patients with depression for signs of diabetes, research suggests. Previous studies have tended to focus on patients' risk of becoming depressed once diagnosed with diabetes. The QOF currently awards...

Specialist nurses boost diabetes care.
March 20, 2009... Practices nurses with a special interest in diabetes (PNSIs) can boost levels of diabetes care among practices struggling to deliver high-quality services, according to UK research. For the study, researchers from Birmingham East and...

Gene points to HDL drug target.
March 20, 2009... Cardiovascular disease Blocking enzyme raises HDL levels. New cholesterol drugs could be developed following the discovery of a rare gene mutation which raises high-density lipoprotein (HDL) levels. Studies in animals have suggested...

Potassium level may reveal diet quality.
March 20, 2009... Urinary potassium levels can provide a useful summary measure of the nutritional quality of patients' diets, a Canadian study suggests. Researchers from the University of Toronto measured urinary potassium levels in 220 people aged 18 to...

Research briefs.
March 20, 2009... Infections - Disease outbreaks could be identified earlier by supplementing conventional monitoring with web surveillance, a Canadian study suggests. Researchers examining a recent Listeriosis outbreak found that, ahead of official reports, a...

Practices struggling to keep patient lists open.
March 20, 2009... Workload - Ban on 'open-but-full' lists has left practices under increasing pressure as new patients register. GPs are struggling to keep their lists open in the face of rising registrations, falling incomes and fear of alienating their...

GP Diary.
March 20, 2009... Cheap thrill - Ben Bradshaw is not quite as unpopular with the medical profession as we thought. In a recent Commons debate Dr Richard Taylor, the independent MP for Wyre Forest, Worcestershire proclaimed himself thrilled to see the...