GP articles from November 2002

GP archives from November 2002

YOUR NEW GP CONTRACT: No data to price new contract.
November 25, 2002... The new GMS contract is facing major delays because data vital for pricing the deal has not yet been collated. No information on practices' current funding, including gross fees and allowances and direct staff reimbursement, is currently...

No pension agreement until contract is priced.
November 25, 2002... Negotiations over a pensions' deal for GPs have been shelved until the new GMS contract can be priced properly. GPC joint deputy chairman Dr Simon Fradd said pensions was becoming a central issue within the contract negotiations and could...

Daily folic acid for heart disease.
November 25, 2002... All patients with heart disease, stroke or DVT should be taking folic acid on a daily basis, a UK study has concluded. The study found high homocysteine levels in all patients with these conditions. After discounting smoking,...

An apple a day keeps the doctor at play.
November 25, 2002... Dr Claire Rushton is pictured as the evil queen in a local performance of Snow White and the Seven Dwarfs. Dr Rushton, a GP in Blackburn, Lancashire, combines general practice with her love of acting and her role as the Small Practices...

Vacancies double in one year.
November 25, 2002... DoH statistics show the number of unfilled GP vacancies more than doubled last year and over 100 have remained empty for more than 12 months. At the same time, the numbers of applicants per vacancy almost halved and more GPs said they...

Top of the class.
November 25, 2002... GPs in the north of England spent an evening in 'detention' preparing for annual appraisal. Fifty 'students' from small practices descended on Bury, near Manchester, for an hour's preparation led by (left to right) Dr Chayan Datta, Dr Kumar...

Vaccine to fight cervical cancer available by 2008.
November 25, 2002... A vaccine against human papilloma virus (HPV) infection could be available by 2008. The vaccine was 100 per cent effective in a US study involving 2,400 women aged 16 to 23 years (New England Journal of Medicine 2002; 347: 1645-51). ...

Slow growth in Scottish GP principal numbers.
November 25, 2002... Scottish GP workforce figures reveal the number of principals rose by only 48 last year. The number of unrestricted principals in Scotland rose from 3,707 in 2000 to 3,755 in 2001. The figures cover GP numbers up to October 2001 and...

High-speed internet for all GPs.
November 25, 2002... GP computer experts have welcomed a prime-ministerial promise to give all the profession high-speed broadband connections to the internet. But they have condemned the suggestion that it would allow GPs to conduct 'video consultations'...

Alliance leader hits out at new contract.
November 25, 2002... A leading GP representative has criticised the new GMS contract as an attack on personal care and the doctor-patient relationship. Chairman of the NHS Alliance, Dr Michael Dixon, made his views known as the alliance prepared to launch a...

Running out of time.
November 25, 2002... TV GP Dr Mark Porter is looking for keen colleagues to run next year's London marathon with him as part of 'Team Flora'. The team members will all have guaranteed entry into the event (which is already oversubscribed), pre-race training help,...

'Give statins to the elderly'.
November 25, 2002... GPs have been urged to prescribe statins more widely for older people. The advice follows a trial which discovered that the drugs reduce heart disease deaths by nearly a quarter in those aged over 70. The Prospective Study of...

Clinical image of the week.
November 25, 2002... Blood pressure can be continually monitored with this device, pictured here on a match head. It measures blood pressure in long-term intensive care patients when implanted under the skin. The device can be programmed and read from outside the...

Research briefs: Increase in child peanut allergy.
November 25, 2002... Peanut allergy in children has increased, according to researchers at the David Hide asthma and allergy research centre, St Mary's Hospital, on the Isle of Wight. Peanut sensitisation increased three-fold, from 1 per cent in 1989 to 3 per...

Research briefs: Depression and teenage cannabis use.
November 25, 2002... Teenagers who use cannabis frequently are more at risk of developing depression and schizophrenia in later life. An Australian study involving 1,600 students found that two thirds had used cannabis by the age of 20 years, with 7 per cent...

Research briefs: Criticism of statins is rebuffed.
November 25, 2002... Statins may contribute to patients developing heart failure a US scientist has claimed. Dr Peter Langsjoen, from East Texas Medical Center, who carried out the research, found statins deplete the supply of coenzyme Q10 which prevents heart...

Research briefs: Monday morning blues.
November 25, 2002... Research has shown that people do not like Mondays. Employees in Britain are more satisfied with their jobs when interviewed on Friday or Saturday than other days of the week. The research was conducted at the Institute for Social and...

Heart disease costs pounds 7 billion every year.
November 25, 2002... Heart disease costs the UK more than pounds 7 billion each year, making it the most expensive disease in the country. Researchers in Oxford looked at direct and indirect costs for all UK residents in 1999 with CHD (Heart 2002; 88:...

Cardiac risks rise at home.
November 25, 2002... Patients who suffer a cardiac arrest at home have a less than 2 per cent chance of survival, according to a study in Sweden (Heart 2002; 88: 579-582). The researchers studied patients who had a cardiac arrest out of hospital and found...

Half the public 'is unaware of CHD risks'.
November 25, 2002... Less than half the public recognises that CHD is the greatest cause of death in Europe. More than 5,000 people across the UK, France, Germany, Italy and Sweden were interviewed in the Reassessing European Attitudes about Cardiovascular...

PMS GPs already making plans for a return to GMS.
November 25, 2002... Some PMS GPs are already planning to switch back to GMS if the new contract shows that this is the better option. Essex GP Dr Rupert Halliday moved to PMS only last month, but said he would have no qualms about returning to GMS. 'I...

Only a call away.
November 25, 2002... NHS 24 launched the UK's largest health-related call centre last week in Glasgow. Dr Brian Robson, medical director of NHS 24 and a former Paisley GP, said the advice line was now answering GP out-of-hours' calls for a third of the...

Shipman Inquiry to quiz RCGP on whistle-blowing.
November 25, 2002... The Shipman Inquiry has asked the RCGP to submit evidence this week on whistle-blowing, monitoring disciplinary procedures and single-handed practice, dating back to 1977. The RCGP has also been asked to respond to the independent review...

Malaria tablet for children launched.
November 25, 2002... The UK's first anti-malarial tablet for children has been launched. Malarone Paediatric tablets are a combination of atvaquone and proguanil, and inhibit plasmodium falciparum reproduction in the liver and blood cells. They are for...

'DoH recruitment attempts will fail in primary care'.
November 25, 2002... General practice is becoming a no-go area of medicine because it is so unappealing, according to shadow health secretary and former GP Liam Fox. He warned MPs in the House of Commons that the crisis in primary care looked certain to...

Most PCOs fail to meet GPs' needs.
November 25, 2002... A survey of GP representatives has reported that Primary Care Organisations (PCOs) are failing the profession on most levels. The survey of 34 LMCs comes five years after the Labour government came to power promising to give more say to...

Walking back to healthiness.
November 25, 2002... Retired GP Dr Malcolm Rigler has a special interest in cardiology and gives guidance to the Wyre Forest 'Health Walks' programme. It is part of Wyre District Council's 'Stride and Stroll' scheme. Thirty cardiac patients have two sessions...

GPs facing pressure on privacy changes.
November 25, 2002... The DoH has called on GPs to help shape patient privacy standards by participating directly in a consultation on the use of confidential information. The NHS Information Authority's (NHSIA) director of stakeholder relations Dr Anthony...

Knee pain breakthrough.
November 25, 2002... The food supplement glucosamine is as effective as NSAIDs in relieving knee pain caused by osteoarthritis, a review of published trials has confirmed. The review, published in the Drug and Therapeutics Bulletin (2002; 40: 81-2), found...

Rapid rise in reports of serious food poisoning.
November 25, 2002... GPs in England and Wales have been warned that serious cases of food poisoning are on the increase, following research by the Public Health Laboratory Service (PHLS). The increase in serious cases comes in spite of the overall number of...

GP NEWS FOCUS: Is end to limited lists a step too far? - GP negotiators want to abolish the cap on list sizes but small practices are wary. Neil Durham reports.
November 25, 2002... According to the Red Book, the maximum list size for a GP is 3,500 patients. The figure is 4,500 for GPs in partnership, as long as the average number of patients per GP across the partnership does not exceed 3,500. Last week, it was...

GP NEWS FOCUS: Central approach tackles ill health - Neil Durham discovers how GPs are using healthy living centres to improve lives across the UK.
November 25, 2002... One of the themes running through the new GMS contract appears to be 'bigger is better'. Last week GP reported that negotiators wanted to end the cap on list sizes in a move that could lead to the merger of practices and the development...

LETTERS.
November 25, 2002... WHY PATIENTS MUST SEE THEIR REFERRALS. Dear Editor I read with interest that routine copying of referral letters could cost the NHS pounds 50 million (GP, 4 November). I do not think so. Even before everyone talked about this, I...

GP OPINION: It's time to stop wasting my time.
November 25, 2002... I've just spring-cleaned my filing cabinet at the surgery - I know it's autumn, but that's what overload does to you. Out went all sorts of things: old agendas, copious documents from the old PCG, and minutes from LMC meetings of six...

GP OPINION: No more risks - or home visits.
November 25, 2002... The increased incidence of violent attacks in general practice has given me serious cause for reflection. Something has to be done about it, so I've made a decent start - I don't hit my patients anymore. I'm willing to go that extra...

GP OPINION: LEADER - GP recruitment facing its greatest challenge.
November 25, 2002... If anyone still doubts that general practice is facing its worst recruitment crisis in the history of medicine, then take a look at the latest figures from no less an authority than the DoH. DoH researchers investigated 1,000 GP vacancies...

GP OPINION: LEADER - Hewitt blew it on broadband.
November 25, 2002... It is difficult enough finding health ministers who understand the workings of the NHS, but it is a whole new world of incomprehension when a secretary of state for trade and industry decides to dabble. This week the listeners of Radio...

GP BUSINESS: IN PRACTICE WITH .... Dr Felicity Marsh, Northumberland - Every week we travel the UK to profile GPs and their practices. This week Debbie Andalo visits Ashington.
November 25, 2002... Q: How did you start in general practice? A: When I did my biology degree I went into molecular research, but realised I was more interested in medicine so I studied medicine as my second degree. I wanted to be a GP to do something...

GP BUSINESS: GPs' wish list for ENT care - An Audit Commission report finds wide variations in waiting times across ENT, says Jane Laughton.
November 25, 2002... Waits for outpatients' elective surgery and audiology are a long-standing problem in ENT. The report 'Access to care: ear, nose and throat and audiology services', published by the Audit Commission last month, examines the impact of...

GP BUSINESS: MIMS Handbook of Pain Management.
November 25, 2002... The MIMS Handbook of Pain Management 2003 will be published at the end of this month and is available free to all general practitioners. You can order your copy now. A recent Pain Society study showed that more than one in five...

GP BUSINESS: ASK THE EXPERTS - Stop underperformance before it starts. Keeping an eye on how staff perform early on will help prevent problems at a later stage, says Ray Wilcox.
November 25, 2002... It is the sort of thing that begins as a small irritation and then, if not tackled early enough, presents itself some time later as a major problem. It is called 'underperformance'. I am referring to paid employees, although the...

GP BUSINESS: Trust tackles recruitment head on - A teaching trust in Sunderland is successfully dealing with the GP employment situation, says Jennifer Taylor.
November 25, 2002... Sunderland Teaching Primary Care Trust (TPCT) is successfully recruiting GPs. There are now 50 GPs per 100,000 people and average list sizes have fallen below 2,000 patients per GP for the first time. The trust's success is due to a...

GP BUSINESS: Time for advice on generic medication - Offer incentives to pharmacists to find cheap sources of drugs, says Dr Stuart Handysides.
November 25, 2002... It must be nice to be one of the believers. Just slap a patch on and make things better. One patient recently assured me that lansoprazole had helped the pains in his legs as well as his abdomen. He had just had a flu jab. 'That should...

GP BUSINESS: Repeat prescribing made fun - Too often repeat prescriptions are handled by staff rather than GPs. Dr Nigel Higson says it is time GPs took control.
November 25, 2002... For most of us, repeat prescribing is a bore. It is seen by GPs as a way to let patients avoid having to attend for a face-to-face consultation. It is surrounded by warnings, such as 'do not order your prescription by phone' or 'we need...

GP BUSINESS: Misery to happiness a matter of seconds - A memorable Dickensian maxim can save GPs a great deal of stress, says Dr John Lockley.
November 25, 2002... Everyone knows about Mr Micawber and the cogent words Charles Dickens put in his mouth: 'Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds...

GP BUSINESS: GPs need to work at managing risk - GPs should not under-estimate the importance of risk assessment and should have a more hands-on approach, says Dr Joe Wilson.
November 25, 2002... Every day we make risk assessments without a lot of thought - putting on a seat belt or locking our car when we go in to pay for petrol at a garage. The latter comes to mind because a friend of mine had her car stolen recently as she...

GP REGISTRAR: The practice of a practice - Understanding the duties of a practice manager is vital to a GP's role, says Dr Linda Miller.
November 25, 2002... During your training year, you will have to learn most of the intricacies of general practice. These are not confined to working with the other GPs or medical personnel but also with the practice manager. It is difficult to recognise the...

GP REGISTRAR: PASS NOTES - Hyperlipidaemia part two.
November 25, 2002... There is overwhelming evidence that statins are highly beneficial in the secondary prevention of CHD. The 'Simvastatin Survival Study' (4S), published in The Lancet (1994; 44: 383-89), was the first landmark trial of LDL-cholesterol...

GP REGISTRAR: WHAT THEY FORGOT TO TELL YOU ... CARPAL TUNNEL SYNDROME.
November 25, 2002... Carpal tunnel syndrome is caused by compression of the median nerve at the wrist as it passes through the flexor retinaculum, and is a common cause of pain in the hand and arm, particularly in women. Steroid injection can help in cases...

GP NET: GP/NHS NET ACCOLADES - Go online to win pounds 1,000 of training. An online aid to the cancer referral directive is Dr John Redmond's entry to our IT awards.
November 25, 2002... One of the most exciting developments to come from our connection to NHS net is the ability to organise electronic referrals. When the government announced the directive requiring suspected career patients to be referred within two weeks, the...

GP NET: The GP/NHS net Accolades.
November 25, 2002... GP has teamed up with the NHS Information Authority to celebrate excellence in the use of IT and computing in practices. Three prizes, each consisting of pounds 1,000 worth of computer training with Computacenter, will be awarded to surgeries...

GP NET: What the judges are looking for.
November 25, 2002... Accolade 1: Integration of technology For practices that use technology as a supportive tool in everyday work. - For example: using an online best practice database during consultations. Accolade 2: Innovation For practices using a...

GP NET: Scan to save space - The latest optical character recognition software turns documents into more than just pictures, says Dr John Lockley.
November 25, 2002... Scan a page of a journal into your computer and you simply get a picture of the page. As it stands, there is nothing you can do with the text in that picture. You can neither edit it nor search it for words - it might as well be a picture of...

GP NET: MEDICINE ON THE WEB - Atopic eczema and sensitive skin.
November 25, 2002... This week's Clinical Review on page 61 looks at sensitive skin, atopic eczema and itchy rashes. Here Dr Keith Barnard looks at relevant websites ATOPIC ECZEMA www.countrydoctor.co.uk/ education/education%20-%20Eczema%20best%20...

GP LIFE: FOOD - Making the most of langoustine. A tasty dish of langoustine with herbed couscous will go down a treat, says Dr Chris Duckham.
November 25, 2002... When I am thinking up dishes for the restaurant menu the greatest difficulty I sometimes have is finding the right vegetable or starch accompaniment. With main courses it is easy because most main course dishes feature a small selection...

GP LIFE: DRINK - Matching food and wine is an art. Forget about the old rules and go with your tastebuds, says Dr Idango Adoki.
November 25, 2002... It is not often that I resort to collusion and subterfuge but circumstances compel me to do so. It is my children, you see. They want Sky TV and I seem to be losing the battle. I need you to write to me stating how time-wasting,...

GP LIFE: A patient advocate with political clout - GP and mayor Dr Vivienne Manheim did not plan on a political career. But, she tells Emma Baines, she loves her dual role.
November 25, 2002... Many GPs have patients who insist on coming to them with problems ranging wildly beyond the scope of general practice. In the case of Dr Vivienne Manheim there is rather more reason for the confusion. After 10 years as a councillor in...

GP LIFE: The New Knee Golf Society.
November 25, 2002... A replacement knee need not be the end of a GP's sporting life, discovers Nick Baxter. You can soon get back in the swing If you are a GP facing knee replacement surgery, you have probably resigned yourself to a lifetime of restricted...

GP RESOURCES: Equipment Review - Advanced ultrasonic technology.
November 25, 2002... Dr Bryan Palmer thinks that it may be time for GPs to update their ultrasonic Doppler I would think that there are few GPs who are not familiar with the hand-held ultrasonic Doppler. Perhaps the most common use for GPs is to detect the...

PLAIN TALES FROM THE SURGERY.
November 25, 2002... Feeling a bit blue First in the queue at Friday morning's emergency clinic was an extremely anxious 50-year-old woman. She looked well but rather flustered. 'How are you?' I asked. 'I've gone blue,' she stated. 'My husband...

Give me my job, any day..
November 25, 2002... There can be few professions that involve the juggling of responsibility, worry, exhaustion and customer expectation of absolute knowledge of everything to the extent that general practice does. But there is one job more exhausting than a...

BEHIND THE HEADLINES: Alcohol intake affects cancer risk - Worldwide data has revealed a positive link between alcohol intake and raised risk of breast cancer. Emma Baines reports.
November 25, 2002... Government guidelines on safe drinking were amended in 1995, raising the recommended limits to between three and four units of alcohol a day for men, and between two and three for women. Recent reports in the media, however, suggest that...

Various vascular lesion problems.
November 25, 2002... SPIDER VEIN ON FACE This child developed a spider vein (spider naevus) at a site where a superficial pustule had healed. It was treated by diathermy to the central feeding vessel, after application of EMLA cream and a small injection of...

CASE HISTORY: Painful hand points to recurrent illness - Dr Laurence Knott was posed a challenge by a patient who could not swallow tablets.
November 25, 2002... Vince, aged 60, was one of those people who could not swallow tablets. He insisted on having any medication that he needed in soluble, liquid or crushable form. Three years ago he appeared in my surgery with severe pain and swelling...

10 TIPS ON SCRIPS: Look at the options for asthma control - When is it best to use long-acting beta-2 agonists for asthma control? Dr David Morris explains.
November 25, 2002... 1. Salmeterol and formoterol (eformoterol) are the two long-acting beta-2 agonist bronchodilators currently marketed in this country. They relax the bronchial smooth muscle and decrease bronchial hyperreactivity. 2. Long-acting beta-2...

JOURNALS WATCH: Febrile episodes, fat and exercise for older people - If time is limited, and your intray is piling up, let Dr Lorna Gold be your guide to the latest crop of medical journals.
November 25, 2002... REASONS TO BE CHEERFUL Lancet 2002; 360:1,552-6 Winter has arrived, children are coming home from school bearing offerings of respiratory viruses, and many mothers will be worrying whether their partaking of these pyrexial illnesses...

CLINICAL REVIEW: Itchy rashes and sensitive skin.
November 25, 2002... THE ESSENTIALS - The incidence of skin conditions such as atopic eczema is increasing. - Clinical diagnosis is important as biopsies are often non-diagnostic. - Skin conditions may have an impact psychosocially as well as medically. -...

AT A GLANCE: Migraine.
November 25, 2002... Epidemiology - Onset of migraine may be at any age, but symptoms most commonly begin between the ages of 10 and 40. - Women are more commonly affected by migraine than men. - About half of migraine sufferers have a positive family...

MIMS UPDATE.
November 25, 2002... Additional hepatitis vaccine presentation Aventis Pasteur MSD has announced that Vaqta Paediatric (a purified inactivated hepatitis A vaccine for paediatric and adolescent use) is available in a new vial presentation. Each dose contains...

GP Clinical: Hip resurfacing helps retain mobility in younger patients - An alternative technique to hip replacement allows patients to enjoy a higher quality of life for longer, as Emma Baines discovers.
November 25, 2002... Hip replacement surgery has been widely available since the 1960s. Over the years, new materials have been developed which have greatly improved the durability and comfort of artificial hips. However, even though a hip replacement can...

THE GOOD OLD DAYS.
November 25, 2002... PRESCRIBING THE IDEAL CLIMATE The Canary Islands, off West Africa, have long had a reputation as a climatic resort for the winter and spring months. Tenerife is the largest. Fogs are almost unknown here, and from the end of April to...

GUIDE TO MINOR SURGERY: Part 7 - Sebaceous cyst excision.
November 25, 2002... 1. EXCISION TECHNIQUE AND SUTURES After injecting local anaesthetic, a simple incision over the dome of a small cyst often enables it to be quickly delivered by applying pressure with the fingers on either side of the wound, or with blunt...

YOUR NEW GP CONTRACT: No limit on patient list size.
November 18, 2002... Negotiators want to end the cap on list sizes under the new GMS contract in a move which could lead to giant practices or mergers. Speaking at an NHS Confederation conference in London last week, the body's lead contract negotiator Mike...

And data entry to add 30 minutes to surgeries.
November 18, 2002... Consultations could become up to a minute and a half longer because GPs will have to input specific data under the requirements of the new GMS contract. That was the stark warning from GP Dr Colin Hunter, special advisor to the quality...

Violence could close branch surgery.
November 18, 2002... GPs want to close a branch surgery in Brighton because the premises have been vandalised and the staff intimidated by patients. Senior partner Dr Jane Eadie (pictured) said incidents at the Moulsecoomb surgery had included a GP's tyres being...

YOUR NEW GP CONTRACT: Negotiators to analyse GPs' retirement plans.
November 18, 2002... The GPC and NHS Confederation are surveying GPs about their retirement plans as part of efforts to include incentives in the new GMS contract to encourage GPs not to retire early. The 11-page questionnaire asks GPs for views on a range of...

More flu than last year.
November 18, 2002... The Met Office has predicted that GPs will see an increase in the number of people with flu this year. However, there is no sign of the virus mutating and causing a major flu outbreak. Dr William Bird, from the Met Office, told GP that...

No pay demand before contract.
November 18, 2002... The BMA has postponed its pay demand to the Doctors and Dentists Review Body - thus pinning its hopes on the continuing contract negotiations. This summer, GP revealed ministers wanted to offer GPs the same pay deal as consultants (GP, 5...

YOUR NEW GP CONTRACT: PMS to keep out-of-hours.
November 18, 2002... PMS GPs could be forced to keep 24-hour responsibility when colleagues are allowed to opt out under the new GMS contract. GPC negotiator Dr Mary Church said there was uncertainty about whether PMS doctors would have the same opportunity...

Government stands by mental health bill.
November 18, 2002... Health secretary Alan Milburn insists mental health legislation will go ahead despite the controversial draft Bill being left out of the Queen's Speech last week. The Bill's absence prompted speculation that it would be shelved. However,...

Complaints over delays result in 'speedier' scans.
November 18, 2002... GPs in Hertfordshire who complained about ultrasound delays received quicker scans for their patients, regardless of clinical priority, CHI has revealed. A backlog of 2,700 unprocessed ultrasound requests at Chase Farm Hospital was...

Better standard of living.
November 18, 2002... East London GP Dr Sam Everington is pictured outside the former hospital he hopes to convert into a healthy living centre. If it goes ahead, the project, which would cost up to pounds 11 million, would see Hackney's former Queen Elizabeth...

Heavy drinking linked to breast cancer risk.
November 18, 2002... GPs have welcomed a study that spells out the risks of drinking alcohol and smoking tobacco in relation to breast cancer. The world's largest study into the link was carried out by Cancer Research UK and published in the British Journal...

Clinical image of the week.
November 18, 2002... Obesity is the major cause of type-2 diabetes in the UK. The condition was highlighted last Thursday on World Diabetes Day as becoming a major health issue. This is an electron micrograph of the oval adipocytes that make up adipose connective...