GP articles from October 2009

GP archives from October 2009

Tory funding shift to target elderly population.
October 30, 2009... NHS Funding - Economists say Conservatives 'misunderstand' funding formula, but plans win some GP support. Experts have questioned the viability of Conservative plans to rewrite the NHS funding formula to redirect cash to areas with large...

Diabetes drug can cut obesity in non-diabetics.
October 30, 2009... The diabetes drug liraglutide could be used to treat obesity in non-diabetics and could also cut the risk of prediabetes, Danish research suggests. The latest findings come as Diabetes UK warns that seven million people in the UK could be...

GP offers tips on handling conflict.
October 30, 2009... Kent GP Dr David Marshall, a martial arts expert, has written a book providing practical advice on how to avoid conflict. The book and an accompanying DVD extol the virtues of martial arts as a way to keep fit and relaxed, but he stresses its...

COPD combination benefits questioned.
October 30, 2009... Respiratory disease - Research suggests combination therapy does not offer additional benefits in lung disease. Adding long-acting beta- agonists (LABAs) to corticosteroid therapy for COPD does not appear to offer additional benefits, Dutch...

Paternal link to childhood disease.
October 30, 2009... Several serious conditions of childhood may be the result of testicular tumours affecting older fathers, an Oxford University study suggests. Previous research has suggested that some disorders are the result of mutations accumulating with...

Antipsychotics linked to weight gain.
October 30, 2009... Young patients treated with antipsychotic medicines should be given twice-yearly metabolic health checks, US researchers have suggested. The researchers found that second-generation antipsychotic medicines were associated with weight gain and...

Research briefs.(Report)(Brief article)
October 30, 2009... Alzheimer's in diabetes patients - Patients who have diabetes and Alzheimer's disease have a slower rate of memory loss than people who only have Alzheimer's, a US study suggests. The results are surprising given that diabetes can also impair...

Locums may face extra charge for revalidation.(General Medical Council)(Brief article)
October 30, 2009... Revalidation GMC says it may charge a fee for directly revalidating doctors unable to find a responsible officer. The GMC could have to charge doctors who are unable to find a responsible officer (RO) to link with for revalidation. The...

DoH in consultant crackdown in NHS.
October 30, 2009... Health minister Mike O'Brien has pledged to investigate the use of management consultants in the NHS. At the NHS Alliance annual conference in Manchester last week, Mr O'Brien said more openness and transparency was required when private...

GMC wants right to check EU doctors' English.
October 30, 2009... Registration - Regulators urge employers to carry out language tests and maintain fight to overturn EU directive. The GMC has said it will continue to lobby the EU for a change in the law to allow it to language-test doctors, even as another...

The 'Goody effect' boosts screening.(Brief article)
October 30, 2009... The number of eligible women aged 25 to 64 who attended cervical screening in England rose by almost 12 per cent in the last year, NHS Information Centre data reveal. A total of 3.6 million women were screened in 2008/9, up from 3.2 million...

GPs 'can cut pounds 4.5m from asthma bill'.
October 30, 2009... PCTs could save up to pounds 4.5 million in unnecessary hospital admissions if they commissioned more effective preventive care from GPs, data from Asthma UK suggest. The charity examined emergency hospital admissions, comparing PCT...

Behind the headlines: Are fertility test results misleading?
October 30, 2009... Home fertility tests give women false hope that they can delay starting a family and still conceive successfully, newspapers have warned. Tests to detect hormones linked to women's remaining stock of eggs are given to women who are planning...

Can DoH review fix dementia care?(Department of Health)
October 30, 2009... Charities are hopeful a much-delayed review will end reliance on drugs to treat dementia. Sanjay Tanday reports. Last month, Alzheimer's charities called on the government to release its long-awaited review into the use of antipsychotics in...

Healthcarerepublic.com: A round-up of the best from GP's website this week.
October 30, 2009... The Travelling Doctor blog Meet Healthcare Republic's new blogger Dr Peter Reeves and read about his adventure spending a year out of medical training and volunteering in developing world primary healthcare settings at...

Opinion: Ballot box.
October 30, 2009... 80% of GPs think practice-based commissioning is a 'corpse not for resuscitation'. 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.
October 30, 2009... RCGP chairman calls for GPs to take back 24-hour care - I agree with most of Professor Steve Field's advice, but I wonder if he has considered carefully the following points: 1) Most of the GPs voted 'yes' for the new contract for freedom to...

Opinion: Bringing a touch of glamour to the URTI.
October 30, 2009... Treat a charlady like a duchess and a duchess like a charlady, goes the old medical epithet; unfortunately we don't have any royalty in rural Ireland, though I did once play football with a chap whose nickname was 'the Duchess'. However, this...

Opinion: Defeat at the hands of the inner professional.
October 30, 2009... Sometimes it's not the patients, but the inner professional, that defeats us. It started well. I prepared my best active listening posture as he entered the room, and he wasn't crying. I was in with a chance. 'I'm feeling crap,' he said,...

Editorial: Do GPs want a return of 24-hour responsibility?(Editorial)
October 30, 2009... Have you ever tasted 'a cup of cold vomit'? That was the memorable comparison made at last year's Welsh LMCs conference to describe the prospect of the return of 24-hour responsibility. It may not feel as though the ink has long dried on...

Opinion: A testament to chronic exhaustion.
October 30, 2009... Isn't it fascinating how we can analyse the behaviour of a group of people as though they were a single individual? A group whose members are all talking agitatedly may be considered anxious; one where everyone is reluctant to speak may be...

Clinical: Journals Watch - Raynaud's and dementia.(Report)
October 30, 2009... Too busy to read all the journals? Let Dr Jane Barnard keep you up to date with the latest research. Laser Doppler perfusion in Raynaud's phenomenon - J Rheumatol 2009; 36: 2257-63 Nailfold videocapillaroscopy (NVC) and laser Doppler...

Clinical: The basics - Hyperthyroidism.
October 30, 2009... There are a number of causes for excess secretion of thyroid hormones. Hyperthyroidism is defined as the excess secretion of thyroid hormones (T4 and T3) due to thyroid overactivity. Thyrotoxicosis is the term used for the resulting...

Clinical: Therapeutic options to treat acne scarring.(Disease/Disorder overview)
October 30, 2009... Treatment for acne scarring can be effective, but several techniques are sometimes required. Scarring as a result of acne can cause significant psychological distress. However, not all acne scars are true scars. Pseudo-scars are non-permanent...

Clinical: Red Flag Symptoms - Scrotal problems.
October 30, 2009... Dr Lizzie Croton explains the symptoms that may give cause for alarm. Many patients with testicular problems tend to delay presentation because of embarrassment and may not seek medical attention until the symptoms become unbearable. A good...

Clinical: Clinical Review - Chlamydia.(Disease/Disorder overview)
October 30, 2009... Contributed by Dr Gary Brook, clinical lead in GUM/HIV services, North West London Hospitals Trust, Central Middlesex Hospital Section 1 Genital chlamydia infection Genital chlamydia infection is caused by the sexually transmitted...

Clinical: Case Study - A ruptured Achilles tendon.
October 30, 2009... Could cholesterol-lowering therapy be the cause of a tendon rupture, asks Dr Louise Newson. Mr R, a 42-year-old financial analyst came to see me one morning for a medication review. He had been taking statins for several years for primary...

Clinical: Malignant disease.(Case study)(Brief article)
October 30, 2009... Carcinoma of the ovary This woman presented with an ovarian mass. It was adherent to the bladder, but had not spread further. She underwent major surgery to remove the ovary and bladder and, two years later, is doing well. Liposarcoma...

Clinical: Clinical Solutions - Anaphylaxis.(Case study)
October 30, 2009... THE CASE A 20-year-old man presents explaining that he had reacted to something he had eaten and attended the A&E department where he was given adrenaline. - What is an anaphylaxis reaction? Anaphylaxis describes a life-threatening...

Education: MRCGP - A registrar's guide to the CSA.(Royal College of General Practitioners)
October 30, 2009... Videos, home visits and a decent diagnostic set are all part of the thorough preparation that will leave you confident and relaxed on the day of the CSA examination, writes Dr Leke Asong. The mere thought of the clinical skills assessment...

Education: Monitor your prescribing.
October 30, 2009... Reflecting on personal prescribing habits is a useful learning exercise for appraisal, explains Dr Tillmann Jacobi. Have you ever wondered how much money you spend on prescribing in a month? Would you like a detailed summary of the medicines...

MedEconomics: Salaried GPs and the future.(Survey)
October 30, 2009... Fiona Barr asks whether employee status will predominate in general practice in the years to come. Figures presented in 2008 to the Doctors' and Dentists' Review Body (DDRB) for the UK show a 65.6 per cent increase in salaried GP numbers from...

MedEconomics: GPs' swine flu pandemic dilemmas.(general practitioners)
October 30, 2009... Sarah Whitehouse and Dr Roger Palmer provide the answers to some common ethical questions for GPs. Q. I am concerned with the safety aspects of the swine flu vaccine and may refuse the vaccination. Should I deter my patients from having it?...

MedEconomics: Book Review - Cultural perceptions of obesity.
October 30, 2009... Dr Jeremy Phipps finds that a book about grossly overweight people through the ages is still relevant to GPs practising today. In March this year, a study co-ordinated through Oxford University and published in The Lancet showed moderate...

Dispensing: DDA Campaign - Pricing changes threaten the future of dispensing practices.(Dispensing Doctor's Association)
October 30, 2009... Dr David Baker explains why the DDA is launching a national campaign to highlight pricing issues. Dispensing doctors face a growing financial threat which could undermine the viability of many practices. This is why the Dispensing Doctor's...

Plain Tales from the Surgery.
October 30, 2009... Ring your own bell I recently visited a warden-controlled home. I went looking for one of the healthcare assistants who usually accompany the residents to the lounge after their lunch. When got to the lounge and asked about the whereabouts...

Exclusive - Tories will draw up new GP contract.
October 30, 2009... Lansley says contract will put commissioning responsibility 'in hands of GPs'. Shadow health secretary Andrew Lansley has confirmed there will be a new GP contract if the Conservatives take office. After his speech to the NHS Alliance...

Exclusive - PCTs ignore advice on antipsychotics.
October 30, 2009... PCT inaction leaves dementia patients on drugs despite safety concerns. Over half of PCTs in England are failing to commission services to reduce antipsychotic prescribing among dementia patients, despite well-known safety risks, GP can...

CQC wants better discharge data.
October 30, 2009... Nearly half of PCTs report that GPs do not receive hospital discharge summaries in time for them to be of any use, a Care Quality Commission (CQC) report reveals. The report calls on PCTs to assess whether hospitals send the right data to GPs...

Experts to decide if all children should receive swine flu jabs.
October 30, 2009... The Joint Committee on Vaccination and Immunisation (JCVI) is considering whether all children should receive the swine flu jab, as the DoH warns that almost one in three children could catch the virus this winter. Currently, only children...

BMA chairman hits out at GP commissioning plans.
October 30, 2009... GPs should not be handed full responsibility for commissioning, the head of the BMA has told MPs. At a health select committee evidence session on commissioning last week, BMA chairman Dr Hamish Meldrum appeared to reject Conservative plans...

Balanced scorecards 'to replace GP contract'.
October 30, 2009... NHS Alliance conference Rise of scorecard use predicted l Call for GP reorganisation l Czar backs down. Balanced scorecards could eventually replace the GP contract, the project director of the King's Fund inquiry into general practice has...

Patient advocate predicts end to GP 'small business'.
October 30, 2009... The 'small business model' of general practice should be ditched to help primary care focus on wider public health benefits, a patient involvement expert says. Dr Brian Fisher, NHS Alliance patient and public involvement lead, said the small...

Czar defends 'corpse' remark.(United Kingdom. National Health Service)(Conference news)(Brief article)
October 30, 2009... Primary care czar Dr David Colin-Thome has said his recent description of practice-based commissioning (PBC) as a 'corpse' was misunderstood. England's clinical director of primary care made the remarks earlier this month, adding that the...

Warning on antidepressants as NICE updates its advice.
October 30, 2009... Sharp rise in scrips suggests long-term drug use GPs should not prescribe antidepressants routinely for long periods, or to treat mild depression, NICE has warned. Updated guidance published this week says GPs should only consider the...

GP Diary.
October 30, 2009... Size matters The GPC has rarely afforded this magazine's polls the kind of respect that serious works deserve. 'Go on,' it says, when we ask for its views on a survey showing that 86 per cent of GPs want Dr Laurence Buckman put in the stocks,...

Opinion: Thanks for nothing, science.(Viewpoint essay)
October 23, 2009... The Society of Medical Writers meets every year, and it is not like other medical gatherings. No one is trying to get ahead (because, let's face it, it's a dead-end job and no-one is going anywhere anyway) and no one is trying to suck up to...

Opinion: In search of an admiring crowd.
October 23, 2009... Impressing one's children becomes a raison d'etre when they are teenagers. When I was elected to the RCGP council I told mine I was now an MP. I thought they would be impressed, and at last regard me as one who had attained Interesting...

Clinical: Paediatric medicine - Viral skin infections in children.(Reprint)(Report)
October 23, 2009... Specific areas of the history and examination will help in the diagnosis. When considering common causes of rash in children, a detailed history of the rash, associated symptoms and a careful examination will help to narrow the differential...

Clinical: Clinical Review - Cardiac rehabilitation.
October 23, 2009... Contributed by Professor Bob Lewin, professor of rehabilitation, British Heart Foundation Care and Education Research Group, University of York, and Professor Patrick Doherty, professor of rehabilitation, York St John University. Section 1:...

Clinical: Urticarial rashes.
October 23, 2009... Acute ordinary urticaria Weals appear spontaneously anywhere on the body as the result of a stimulus that causes degranulation of mast cells and the release of histamine. The rash may persist for a few minutes or some hours. There may or...

Education: Careers - Consider a position with the RCGP.(Royal College of General Practitioners)
October 23, 2009... Promote the profession and educate GPs on a wider scale, suggests Professor Ruth Chambers. As a GP, you will be aware that the RCGP is the foundation of quality, setting standards in GP training and everyday practice. This includes deciding...

Education: Pictorial case study.(Case study)
October 23, 2009... The case For 20 years this 59-year-old man had been aware of peeling of his right hand. Apart from a slight soreness and itch, and the nuisance of flaking skin, it did not trouble him unduly. Assuming it to be dermatitis he avoided contact...

Education: A registrar survival guide - Surviving the RCGP curriculum.
October 23, 2009... Know your enemy The Condensed Curriculum Guide published by the RCGP is about as readable as the curriculum is going to be. The book covers each of the different statements and is subdivided to detail the domains covered in each. The GP...

MedEconomics: Guide to ... GP premises under the LIFT scheme.(local improvement finance trust)(United Kingdom. National Health Service)
October 23, 2009... NHS Local Improvement Finance Trust schemes have pros and cons, writes James Atkins. Searching for 'LIFT' on www.healthcarerepublic.com swiftly reveals that the private-public partnership scheme in England has attracted a lot of criticism. ...

MedEconomics: Moving to a Darzi centre pays off.(Occupation overview)
October 23, 2009... Taking a salaried job at a new GP-led health centre has revitalised my career, says Dr Sally Johnson. Earlier this year I left the perceived safety of traditional general practice and became GP lead at a Darzi centre in Ashford, Surrey that...

MedEconomics: Ask the experts - Premises and out-of-hours.
October 23, 2009... Q: QOF and retirement I am a GP with one partner who will be retiring on 30 November 2009. My question is about QOF pay. Is there a quality points 'finalisation' and payout at the end of November? What I mean is, could my partner and I get...

MedEconomics: Put some zing into IT training.
October 23, 2009... Dr Neil Paul discovers free software for instant computer screen video and image capture. Do you want to improve the IT training in your practice? Do you find yourself showing the same things over and over to different people? Do you want to...

Dispensing: Prescribing - Avoiding mistakes while dispensing.
October 23, 2009... The MDU's Dr Michael Devlin explains safe dispensing. At a recent Old Bailey trial a pharmacist received a suspended jail sentence for dispensing beta-blockers instead of steroids to an elderly patient who died three days after taking the...

Plain Tales From the Surgery.
October 23, 2009... Tea and sympathy In these times of hi-tech medicine it is nice to know there is still a place for simple treatments. A recent hospital discharge letter contained the phrase 'progress monitored by critical care outreach tea'. Dr Raj...

Behind the headlines: Is ME triggered by a viral infection?
October 23, 2009... A virus linked to prostate cancer could account for two thirds of the cases of myalgic encephalomyelitis (ME), media reports suggest. The potential breakthrough offers fresh hope for ME patients. There is currently no cure for the condition,...

Conservatives make a pledge to 'liberate GPs'.
October 23, 2009... Tories will offer GPs freedom in their 'age of austerity', Mark Simmonds tells Jonn Elledge. The Tories are holding their cards close to their chest. Partly this seems to be a desire not to frighten the horses; partly it is because, with the...

Opinion: Ballot box.
October 23, 2009... 50% of GPs think a pay freeze for GPs in 2010/11 is unnecessary 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: www.healthcarerepublic.com/forums.
October 23, 2009... CQC plans annual fee for practices - The whole Care Quality Commission thing is a New Labour waste of money. GPs should boycott it until the next election, when no doubt it will be abolished. DoH says no pay rise for GP partners but 1% for...

Clinical: Journals Watch - Colon cancer and miscarriage.(Report)
October 23, 2009... Too busy to read all the journals? Let Dr Gwen Lewis keep you up to date with the latest research. Bowel screening programme in Australia - Med J Aust 2009; 191: 378-81 The National Bowel Cancer Screening Programme (NBCSP) was launched in...

Clinical: Practice dilemma - A colleague's refusal to treat.
October 23, 2009... The Dilemma - A 40-year-old woman complains after seeing your practice nurse. She has attended your surgery four times over the past six weeks complaining of cough and breathlessness. Despite stating she was very keen to stop smoking and having...

Clinical: Book Review - Delivering mental health care.
October 23, 2009... Dr Brian Marien explains why this book is a timely and essential addition to any general practice library.[QQ]Delivering Mental Health in Primary Care is a useful resource for GPs. It provides up-to-date, straightforward information on the...

Clinical: The basics - Ectopic pregnancy.(Disease/Disorder overview)
October 23, 2009... Prompt diagnosis is key in saving women's lives and future fertility, writes Dr Louise Newson. An ectopic pregnancy describes implantation of the products of conception outside of the endometrial cavity, most commonly in the fallopian tube...

Clinical: Oral lichen planus.
October 23, 2009... Mr Anish Shah describes the diagnosis, management and treatment of this inflammatory oral disease. Lichen planus is a mucocutaneous inflammatory disease of unknown aetiology. It is a common condition that mainly affects patients of middle age...

Online GP ratings are 'acceptable' says GPC.
October 23, 2009... NHS CHOICES - Bulk of comments on GP ratings website offer support by recommending practices to other patients. The GPC dropped its opposition to NHS Choices after the website agreed to strengthen its moderation policies, GP leaders have...

PCTs struggle with finances, says CQC.(care quality commission)(United Kingdom. National Health Service. Primary Care Trusts)(Brief article)
October 23, 2009... Quality is rising but financial management is worsening in PCTs in England, according to Care Quality Commission ratings published last week. England's 152 PCTs were rated either 'excellent', 'good', 'fair' or 'weak' on these two benchmarks...

CVD diagnosis increases risk of hip fracture.
October 23, 2009... Cardiovascular disease Research in Sweden shows increased risk of fracture in patients with CVD. Patients who have been diagnosed with cardiovascular disease (CVD) are up to five times more likely to go on to develop hip fractures, a Swedish...

IBD treatment is linked to cancer.
October 23, 2009... Treatment for inflammatory bowel disease may increase patients' risk of infection-related cancer, research published in The Lancet suggests. Laurent Beaugerie and colleagues from the St Antoine Hospital in Paris studied data from 19,486...

Research briefs.(Report)(Brief article)
October 23, 2009... 'Spaghetti' scaffolding for tissue growth - Scientists at the University of Bristol have developed a 'spaghetti' scaffolding using proteins from alpha helices that could be used to grow tissues in the laboratory. The researchers hope the 3D...

Pulmonary clots not caused by DVT.
October 23, 2009... Pulmonary blood clots are primarily formed in situ, rather than being the result of dislodged peripheral clots, US research suggests. George Velmahos and colleagues from Harvard Medical School studied 247 trauma patients between 2004 and...

Nurses can free up GPs' time, says RCGP chief.
October 23, 2009... NURSE ROLES - Professor Steve Field says nurses can help GPs extend consultations and take on commissioning. The chairman of the RCGP has called for the role of practice nurses to be expanded to free up time for GPs to offer longer...

Paracetamol 'blocks jab response'.
October 23, 2009... VACCINES - Study shows post-vaccine prophylaxis may interfere with cell interactions. Children should not routinely be given paracetamol to reduce the risk of fever after vaccination, after researchers found the drug can hinder the response...

GPs warned over use of guidance.
October 23, 2009... GPs must be able to justify any deviations from NICE guidance on an individual patient basis, the Medical Defence Union (MDU) has warned. At a MIMS Dermatology conference in London last week, MDU medico-legal adviser Dr Karen Roberts said...

Melanoma screening on high street is 'unreliable'.
October 23, 2009... High street skin cancer screening services put patients at risk because they may only spot late-stage melanomas, a leading dermatologist has warned. Dr Jonathan Bowling, consultant dermatologist at Oxford Radcliffe Hospitals NHS Trust, said...

Show me the mummy.
October 23, 2009... County Tyrone GP Dr Gerry Millar's autopsy of a mummified Egyptian priestess has been filmed for a BBC documentary 'Show Me The Mummy'. Dr Millar could not find an exact cause of death, but discovered she died at about the age of 27 and never...

Healthcarerepublic.com.
October 23, 2009... GPC video interview Should salaried GPs receive a larger pay rise than partners as the DoH recommends? Watch our video interview with GPC chairman Dr Laurence Buckman to find out his opinion at healthcarerepublic.com/video. Our new video and...

Editorial: Detail is needed on Tory commissioning plans.(Editorial)
October 23, 2009... We are at last starting to see some difference in health policy from the two main political parties. Commissioning (and in particular GPs' role in this) is one area where Labour and the Tories hold different views. The Conservatives plan to...

IT competence is key to patient safety.(United Kingdom. Department of Health)
October 23, 2009... I have just heard to my horror that the DoH is planning to abandon its requirement for practices to demonstrate IT competence before being allowed to upload electronic summaries to the spine. Instead of passing the Information Management and...

GP fears over swine flu jab deliveries.
October 23, 2009... Distribution plan criticised as vaccine arrives, while post strike threatens uptake. Practices across the UK are preparing to begin the swine flu vaccination programme, with the first batches of the vaccine arriving this week. Practices in...