GP articles from November 2008

GP archives from November 2008

Clinical: Case Study - An unusual rash associated with rheumatoid arthritis.(Case study)
November 28, 2008... Fever and a rash gave Dr Louise Newson cause for concern. Laura, a 36-year-old air hostess, presented one morning with flu-like symptoms. Her symptoms had started a few days earlier with a mild sore throat, myalgia, headache and a high...

Education: nMRCGP - An insider's guide to the CSA cases.(clinical skills assessment)
November 28, 2008... The cases of the clinical skills assessment (CSA) are considered realistic and representative of UK general practice. Although registrars worry that they cannot be completed within 10 minutes, observers have agreed that this is feasible,...

Education: Golden rules for registrars.
November 28, 2008... Medico-legal adviser Dr Jim Rodger offers some expert advice on how to excel as a GP registrar. Do remember that you've joined the best and most rewarding profession in the world, and celebrate that you are about to embark on a career...

MedEconomics: How to ... Make your regular savings grow.
November 28, 2008... Now might not appear the right time but GPs can still make money by investing wisely. Despite the gloomy economic situation, many GPs still need to make savings decisions. Alas, this month's 1.5 per cent base rate cut and the...

MedEconomics: Taking over an existing staff team.
November 28, 2008... GPs must be aware of employment legislation if they inherit staff after a tender, says Andrew Firman. Your tender for an NHS contract may mean that you will be providing a service that replaces an existing one provided by a predecessor GP...

MedEconomics: Our consortium's experience of PBC.(practice-based commissioning)
November 28, 2008... Our group of 16 small practices has encountered numerous obstacles to its plans, says Dr Krishna Chaturvedi. My single-handed practice is a member of the Small Practices Academy of Clinical Excellence (SPACE) in Southend on Sea. ...

MedEconomics: Ask the experts - Pension contributions and negative equity concerns.
November 28, 2008... Q: SUPERANNUATION I am considering 24-hour retirement to access my NHS pension lump sum, but I am getting conflicting information regarding whether the funding for my employer's 14 per cent contribution will still be paid to the practice...

Dispensing: Practice Finance - More about personally administered items.
November 28, 2008... Dr Jeremy Phipps answers readers' questions about PAs. Following my earlier article on maximising income from dispensing personally administered (PA) items and dressings (GP, 10 October), a number of dispensing doctors have written to GP,...

Plain tales from the surgery.
November 28, 2008... Marital allergen I visited an elderly couple at their home to give the flu jab. They were in their late seventies but coping quite well. As a matter of routine I asked the wife if she was allergic to anything Promptly her husband...

Opinion: Fat chance of any of us changing.
November 28, 2008... 'My daughter's pregnant,' she said accusingly, as if somehow I was personally responsible, hauling the aforesaid young woman behind her into the surgery. 'Hey, don't blame me,' I should have said, but instead I conducted a sober and...

Opinion: Luck and stubbornness works for me.
November 28, 2008... Sometimes we roll our eyes doctorishly and sigh. Take Mr Barmy. He has terrible bronchiectasis, quiescent lymphoma and a central disc prolapse the size of Coventry which was discovered in the chest ward. The chest physio said she didn't...

Clinical: Journals Watch - Adiposity and sexual health.
November 28, 2008... Too busy to catch up on the latest research? Let Dr Gwen Lewis update you on the leading articles. Abdominal adiposity and risk of death N Engl J Med 2008; 359: 2,105-20 BMI is used to assess the association of adiposity with...

Clinical: Oral problems.
November 28, 2008... Polyp. This girl developed an annoying lesion on the inside of her cheek after wearing a brace for some time. Given her young age, it was very unlikely to be anything sinister, but it was excised and proved to be a benign fibroepithelial...

Clinical: Medical Antiques - The practise of phisick - Early devices for measuring blood pressure.
November 28, 2008... Early assessment of BP was limited to crude estimates based on palpating the nature of the pulse, or assessing manually how much pressure was required to arrest a peripheral pulse. The Rev Stephen Hales in 1733 first attempted to measure...

Clinical: The basics - The causes of heartburn.
November 28, 2008... A variety of GI disorders present with heartburn. Dr Taqi Hashmi explains the common diagnoses. Heartburn is a substernal pain or burning sensation usually associated with the regurgitation of gastric juice into the oesophagus. ...

Clinical: Clinical Review - Malaria.
November 28, 2008... Section 1: Epidemiology and aetiology Malaria parasites are single-celled hermaphrodites that can reproduce both asexually and sexually. Ten types are known to infect humans but only four are of practical importance: Plasmodium...

Clinical: Paediatric medicine - Management of acute cough in children.(Report)
November 28, 2008... Dr Atul Gupta and Professor Andrew Bush offer their insights on this common presenting symptom. Cough is an important protective reflex, enabling airway secretions to be cleared. Cough is one of the most common presenting symptoms in...

Clinical: Learning disabilities - Assessing capacity.(Report)
November 28, 2008... It may be necessary to assess capacity to consent in patients with learning disabilities. When people with learning disability present with health problems, it is often necessary to assess their capacity to consent to medical...

Exclusive - Half of PCTs have 28-day scrip limits.
November 28, 2008... PCTs are limiting scrips but have failed to assess impact on GPs or patients. More than four out of 10 PCTs have introduced 28-day prescribing limits without any assessment of their impact on patient care, GP can reveal. But patient...

Chancellor promises pounds 100m for premises in budget report.
November 28, 2008... Up to 600 GP practices could be given funding to expand their premises, the government has announced. The pre-budget report, released on Monday, pledges 'pounds 100 million to advance the upgrading of up to 600 GP surgeries to training...

Bid to lift 40% of practices off MPIG.(minimum practice income guarantee)
November 28, 2008... GPC demands 4% rise to counter soaring expenses; DoH wants 1.6% uplift. The GPC has called for an increase in net income of 4 per cent this year, which would mean more than 40 per cent of practices no longer need MPIG. Those still...

GPs to issue 'fit notes' from 2010.
November 28, 2008... GPs will be issuing electronic 'fit notes' to patients instead of sick notes from 2010, as part of a radical overhaul of the current sickness scheme in Britain. The overhaul is designed to stop people drifting into extended sick leave...

GPC wants LES help for prevalence losers.
November 28, 2008... The GPC hopes LMCs can negotiate payments from PCTs for practices suffering heavy losses under the new prevalence formula. GPC chairman Dr Laurence Buckman said PCTs should set up enhanced services to help practices that face five-figure...

Exclusive - Expected retirement 'time bomb' fails to go off.
November 28, 2008... 20 per cent of GPs now over 55, as GP investigation reveals huge numbers delaying retirement plans. Fears of a retirement time bomb have not materialised, a GP survey of PCTs can reveal. The numbers staying in work mean fears of a GP...

Chemists swap GP scrips to generics.
November 28, 2008... Pharmacists will be able to substitute drugs prescribed by brand with generic equivalents under a DoH deal with the pharmaceutical industry. The drug pricing agreement takes effect next February, and generic substitution is to be...

Exclusive - Czar backs local incentive for GP cancer checks.
November 28, 2008... Professor Mike Richards says local enhanced services for cancer audits could boost survival rates. GPs should be incentivised to take part in the primary care cancer audit, in an attempt to boost poor survival rates, according to...

GPC admits 'pay cuts' are correct.
November 28, 2008... The GPC has said that pay cuts affecting practices across the UK in October were not incorrect, as it previously thought. After practices on MPIG reported that their correction factors had been cut inexplicably, the GPC said an error had...

Hairspray doubles rates of male genital birth defects.
November 28, 2008... Being exposed to hairspray during pregnancy appears to double the risk of having a son with genital birth defects, say UK researchers. The findings suggest that hairspray and hypospadias, one of the most common genital birth defects in...

Hormone could stop eye disease.
November 28, 2008... Melatonin, a hormone that regulates sleep, could help to treat the eye disease uveitis, Argentine research suggests. Currently, there is no cure for uveitis. If left untreated the inflammatory disease can lead to permanent loss of vision....

Antibiotics cut COPD risk.
November 28, 2008... Long-term antibiotic use could reduce exacerbations. Long-term use of antibiotics could reduce COPD exacerbations by 35 per cent, according to UK research. But the benefits of long-term antibiotic use may have to be weighed up...

Darzi review has 'failed to move the NHS forwards'.(united kingdom. national health service)(Brief article)
November 28, 2008... The Darzi review 'hasn't moved the NHS on an inch', a leading NHS commentator has said. 'There was nothing in Darzi we did not know already,' said Roy Lilley, who was chairing the NAPC conference. 'If we had not had it I do not think it...

Trust surpluses safe from Treasury.(Brief article)
November 28, 2008... The NHS chief executive has pledged that the pounds 3 billion surplus built up over the last two years will not be clawed back by the Treasury. 'I spent the last two years arguing that surpluses are good, surpluses are what make you...

NHS Choices could publish details of practice profits.
November 28, 2008... Details of practice profits could be posted online for patients to see, NHS website developers have hinted. NHS Choices is a website which provides details of all NHS services. Each practice has its own page listing opening hours and...

Tories would scupper plans for ICOs, promises Lansley.
November 28, 2008... NAPC Conference 2008 Integrated care organisations - Darzi review failures - NHS surplus - GP profits. A Conservative government would block development of integrated care organisations (ICOs), Andrew Lansley has said. Speaking to...

Call for GPs to re-test for asthma and COPD.
November 28, 2008... GPs could face a huge increase in workload after the British Lung Foundation called for all patients over the age of 35 diagnosed with asthma or COPD to be re-tested. This comes after the results of a survey by the charity revealed that...

Asthma link to flu season babies.
November 28, 2008... Children born four months before peak flu season have a greater risk of developing asthma than those born at any other time of the year, US research suggests. Researchers from Vanderbilt University analysed data from 95,000 children in...

Practices subsidise extended hours services.
November 28, 2008... GPs say official costings for extended hours DES are based on out-of-date information. GP leaders say detailed costings released by the DoH show that practices are subsidising extended opening hours. The calculations behind the...

Behind the headlines: Can peppermint oil treat IBS?
November 28, 2008... Peppermint oil is the most effective treatment for irritable bowel syndrome (IBS), media reports suggest. Canadian research found that the oil, which is cheap and readily available without a prescription, was more effective at treating...

Johnson backs extra QOF smoking targets.
November 28, 2008... GPs' pay could be linked to their success in getting patients to quit smoking. Health secretary Alan Johnson told the health select committee that adding smoking cessation rates to the quality framework was 'certainly something we are...

'Drug-driving' scrips review.(Brief article)
November 28, 2008... Prescription medicines that affect people's fitness to drive could be included in a new drug-driving offence being considered by the Department for Transport (DfT). A new law on drug-driving is being proposed, as well as legislation...

Opinion: Ballot box.
November 28, 2008... 67% of GPs think that health visitors should not launch industrial action over the three-year NHS pay deal. Source: Healthcare Republic. -------------------- Did you find this article useful? Why not subscribe to the magazine?...

Editorial: Where is the value in limiting prescriptions?(Editorial)
November 28, 2008... Science prides itself on being evidence-based. Can you imagine introducing a new drug without rigorous testing? Last month GP reported that PCTs were introducing 28-day time limits on GP prescriptions to save money (31 October). In...

Opinion: Social services need to trust instinct not data.
November 28, 2008... Why do social services seem to get it so wrong, so frequently? We all know cases of child abuse that have been missed despite frequent contact with social workers. Equally, on other occasions social workers have made 'connections' that...

Clinical: Journals Watch - MI, asthma and placebos.(Survey)(Statistical data)
November 21, 2008... Too busy to read the journals? Let Dr Raj Thakkar ease the load. Sudden death after MI - JAMA 2008; 300: 2,022-9 Coronary artery disease remains the number one killer in the UK. The risk of sudden cardiac death after an acute cardiac...

Clinical: Clinical Review - Renal colic.
November 21, 2008... Contributed by Mr Ranan DasGupta, specialist registrar and Mr Jonathon Olsburgh, consultant urological surgeon, Guy's & St Thomas' Hospital, London Section 1: Epidemiology and aetiology The lifetime risk of kidney stones is 1-15 per...

Clinical: Associated clinical problems with learning disabilities.
November 21, 2008... Dr Afia Ali and Dr Ian Hall assess the treatment of the learning disabled. Studies have shown that people with learning disability have high levels of undetected health problems.1 Genetic syndromes A number of genetic syndromes...

Clinical: Causes of nail changes.
November 21, 2008... Leukonychia Leukonychia presents as transverse white streaks or spots on the nail The cause of these changes are unknown but they are thought to be related to trauma or enthusiastic manicuring of the nails and are not normally of any...

Education: Career paths - Working abroad in a rural practice.(Personal account)
November 21, 2008... Dr Kingsley Poole describes the differences he experienced working at a remote practice in New Zealand. The on-call phone woke me after midnight. I was wanted at the police station - a gang member high on methylamphetamine had multiple...

Education: Professional development - Honing your presentation skills.
November 21, 2008... Most people feel nervous facing an audience, but practice will make it easier, says Dr Kevin Brown. Whatever the circumstance, when asked to make a speech, most people stand in front of a group of people with some trepidation. However,...

Medeconomics: How to ... Prepare for quality scheme changes.
November 21, 2008... Dr Jeremy Phipps suggests practices use the coming months to gear up for the 2009/10 points. Changes to the quality framework for 2009/10 were announced last month, giving GPs an opportunity to prepare in advance for the new clinical...

MedEconomics: Gather data via freedom of information requests.
November 21, 2008... David Craik explains how to apply for information from PCTs and to increase the chance of it being supplied. Getting hold of detailed information about tenders from PCTs will help you make a stronger bid. A good way to do this is to make...

MedEconomics: Ask the experts - 24-hour retirement and pensions.
November 21, 2008... Q: Practice continuation. I am a full-time GP and have run our practice with a part-time locum for several years. I have a GP assistant starting in the new year (when the locum leaves) who will become my partner in April. Will I be...

MedEconomics: CVD scheme combats low life expectancy.
November 21, 2008... How difficult is changing people's lifestyles? Professor Ruth Chambers describes an initiative in Stoke-on-Trent. The gap between the life expectancy of the local population in Stoke-on-Trent and the rest of England is so great that the...

Dispensing: Pharmacy White Paper - Adding a pharmacy: the drawbacks.
November 21, 2008... Dr Paul Williams offers a cautionary tale on the drawbacks and benefits of choosing a pharmacy. The pharmacy White Paper may result in many dispensing practices losing all or part of their dispensing income. This will not only hit...

Plain Tales from the Surgery.
November 21, 2008... Self medication. While summarising a new patient's medical record, I came across an entry made by the previous surgery. It read: 'Patient enquiry about Med 3, advised to self satisfy for one week.' Needless to say, when I shared this...

Opinion: The wicked temptations of Crossmaglen.
November 21, 2008... When I started practice in Crossmaglen, the Troubles were at their height, and one helpful consequence of this was the absence of road signs, these having been removed by enthusiastic locals to confuse the army and other officers of the...

Opinion: 264 miles of wobbly jelly protection.
November 21, 2008... You can learn so much from patients. I have learned about jelly. I thought jelly was the coloured stuff that I keep in my car for desperate moments between visits, but they meant the stuff they put in clothes. Did you know that they put jelly...

Clinical: Viewpoint - ED acts as a window to the heart.(Erectile dysfunction)(Clinical report)
November 21, 2008... ED should always be considered a risk factor for cardiovascular disease, says Dr Graham Jackson. Erectile dysfunction (ED) is common. It affects over 50 per cent of men aged 40-70 years. As its incidence increases with age, men over 70...

Confidential clinic to provide support services for GPs.
November 21, 2008... Support London clinic launched to boost practitioners' health. GPs in London will have the chance to discuss their physical or mental health problems at a confidential clinic launched this week by the DoH. The Practitioner Health...

DES pay claim angers GPC.(General Practioners Committee)(directed enhanced service)(Brief article)
November 21, 2008... A national newspaper has declined to publish a letter from GPC chairman Dr Laurence Buckman accusing it of inaccurately reporting that GPs were demanding more cash to save the lives of patients with learning disabilities. On 4 November...

Editorial: Bargain basement NHS not the best idea.(United Kingdom. National Health Service)(Editorial)
November 21, 2008... In these credit crunch times it seems everyone, including the NHS, is looking for a bargain. The health service is guaranteed funding increases until 2010/11, but what happens then? Niall Dickson, chief executive of The King's Fund...

Opinion: Double-edged sword of a salaried GP service.
November 21, 2008... Last month was notable for three events: the launch of Change4Life, the DoH's project to tackle childhood obesity; the release of the new quality framework rules; and the suggestion by Welsh health minister Edwina Hart that GPs in Wales could...

Clinical: Medical Antiques - The practise of phisick - Early hearing aids.
November 21, 2008... Hearing loss has been around since the dawn of time, and so have measures to help the hard of hearing. In 1551, an Italian physician, Girolamo Cardano, noted that sound could be conducted through bone using a shaft of spear held between...

Job crisis is 'bigger threat' than private firms.
November 21, 2008... GPs' failure to create jobs for younger doctors could undermine general practice, GPC chairman warns. GPs' failure to make room for their younger colleagues is a bigger threat to general practice than polyclinics or privatisation, Dr...

American heart association conference.(Conference news)
November 21, 2008... ARB fails to reduce heart failure deaths, trial shows. Use of the angiotensin receptor blocker (ARB) irbesartan does not appear to reduce mortality rates in patients with heart failure (HF), US research suggests. The findings,...

Jab hope to treat blocked arteries.
November 21, 2008... Hydrogen sulphide could be used to treat heart failure, US researchers have claimed. The researchers, led by Professor David Lefer from Emory University School of Medicine in Atlanta, developed a model for inducing heart failure in mice...

Should private firms commission?
November 21, 2008... A year after DoH deal to let private firms commission, their impact is limited. Tom Ireland reports. The Framework for Procuring External Support for Commissioners (FESC) published a year ago was hailed as a way for PCTs to beef up their...

Behind the headlines: Does lack of sleep raise heart risk?
November 21, 2008... Sleeping for less than seven-and-a-half hours a night can increase the risk of developing heart disease, according to media reports. Researchers in Japan found that people with hypertension who slept for less than seven-and-a-half hours...

Opinion: Ballot box.
November 21, 2008... 77% of GPs backed top-up payments for patients 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 visit...

Your say Online ... community.healthcarerepublic.com.(Website overview)(Brief article)
November 21, 2008... What GPs are saying online about the NHS being less consumer friendly than Estonia's health service. - If the system is so bad, how come we have so many health tourists to the UK? - Too much moaning on about what's not right with the...

Practices face 0.5% pay increase.
November 21, 2008... GMS contract GPs say NHS Employers' plan for 1.5% uplift will lead to real-terms pay cut. Three quarters of GMS practices will receive a core pay rise of just 0.5 per cent for 2009/10 and remain on MPIG if the DoH implements NHS...

DoH urged to give GPs real budgets as PBC 'fails'.
November 21, 2008... Practice-based commissioning (PBC) has failed and real commissioning budgets should be devolved to GPs, the King's Fund has said. A report by the think-tank this week warns that 'PBC is not operating effectively'. It calls on the...

'Cut GPs by 88%' says GMS contract architect.
November 21, 2008... Nurse triage means GPs only have to see 16% of patients. Practices could cut waits and offer same-day appointments if they use nurse practitioners to telephone triage patients, according to a former GPC negotiator. Nottingham GP Dr...

Prevalence losers may find contracts terminated.
November 21, 2008... Practices that lose out heavily from this year's revised prevalence formula could be 'let go' by their PCTs, an NHS Employers GMS negotiator warned earlier this month. Dr Adrian Jacobs told the NHS Employers annual confer- ence in...

Google can even predict flu outbreaks.
November 21, 2008... Monitoring Google searches can accurately predict influenza activity up to two weeks earlier than traditional reporting methods, a study suggests. Researchers from Google looked at the correlation between the frequency with which certain...

GPs facing up to pounds 19,200 seniority clawback.
November 21, 2008... Exclusive - Accountants warn that seniority pay estimates based on average profits may have been miscalculated. Practices could face five-figure bills when PCTs claw back four years' worth of miscalculated seniority pay, accountants have...

GPs lead bidding on new contracts.
November 21, 2008... Claims of a 'corporate takeover of primary care' are wide of the mark, according to academics led by a former director of the DoH strategy unit. Professor Chris Ham and colleagues from the University of Birmingham said in a report last...

GP reporter named best newcomer.(general practitioner)(Tom Ireland )(Brief article)
November 21, 2008... GP reporter Tom Ireland was named best newcomer at the Medical Journalism Awards last week. The judges singled out his exclusive story 'GPs face charges for patient visits to A&E' for praise, which prompted coverage by national newspapers,...

DoH pushes LARCs to cut teen pregnancy rate.
November 21, 2008... GPs warn that DoH should not force young people to choose LARCs over other contraception. GPs have welcomed plans to increase the use of long-acting reversible contraceptives (LARCs) to cut teenage pregnancies, but warned young people...

Exception data can improve care.
November 21, 2008... Exception reports in the quality framework should be used to improve patient care, the developers of a US quality reporting system believe. Categorising exceptions improves transparency and offers useful information for clinical...

Patients back under-threat dispensing GPs.
November 21, 2008... 89 per cent of patients add their weight to DDA case for no changes under pharmacy White Paper. Patients overwhelmingly oppose DoH plans to scrap dispensing practices, a survey has found. The survey, by the Dispensing Doctors...

New superbug fear as strain resists treatment.
November 21, 2008... Drug-resistant strains of the bacterium Acinetobacter baumannii represent a growing public health problem, according to research. Three strains of the bacterium are found across Europe and infection is typically encountered in hospitals....

GP caption competition winner.
November 21, 2008... On 7 November GP asked readers to send in captions to accompany a picture of health minister Ben Bradshaw dancing the night away with erstwhile top WAG Nancy Dell'Olio. Our winner was St Helens GP Dr Marion Latimer, with her entry: 'It's...

Basic diabetes tests 'still effective'.
November 21, 2008... Genetic screening fails to outperform older methods of diagnosing disease. Genetic screening is no better than assessing traditional risk factors for predicting type-2 diabetes, according to US research. The findings suggest that GPs...