GP articles from September 2008

GP archives from September 2008

Clinical: Review - Ankylosing spondylitis.
September 26, 2008... Section 1: Epidemiology and aetiology Ankylosing spondylitis is a chronic inflammatory condition that primarily affects the axial skeleton.1 Sacroilitis is its hallmark, accompanied by inflammation of the entheses (points of union...

MedEconomics: Telecardiology speeds referrals.
September 26, 2008... Dr Amol Kelshiker and Dee Hannah describe a community-based service that delivers rapid diagnostics. Harrow PCT serves a population of nearly 250,000 in a busy commuter-belt, suburban area of north-west London. In 2005, an audit of...

MedEconomics: Health promotion in a male setting.
September 26, 2008... Our practice held a successful clinic targeting men at a builders' merchant, says Dr Jeremy Phipps. Persuading men to consider a healthier lifestyle can prove difficult. My Lincolnshire practice recently tried a novel approach and set up...

Dispensing: Practice finance - Costs cut to ease hit on dispensing profits.
September 26, 2008... Profits from dispensing are falling, reports Paul Kendall. Three or four years ago my advice to young doctors who were looking for a practice to join was to opt for a dispensing practice in a provincial town. The lower list size of these...

Plain tales from the surgery.
September 26, 2008... - When I grow up... Sometimes I ask the students attached to our practice what made them decide to become doctors. I've received the following good answers: 'The voices told me to.' 'It was when I saw my GP's Porsche.' ...

Clinical: Journals Watch - Stomach cancer and autism.(Clinical report)
September 26, 2008... Too busy to catch up on the latest research? Let Dr Alison Glenesk update you on recent papers Gastrectomies for gastric cancer - Arch Surg 2008; 143: 769-75 Like most GPs, I have always thought of gastric cancer as having a very poor...

Clinical: Book review - Primary care prescribing.
September 26, 2008... Dr Barney Tinsley reviews a book that aims to provide an insight into the wider issues of prescribing in primary care. Formal pharmacological teaching can be a bit 'hit and miss', and much is obtained from self- directed learning and...

Clinical: Clinical dilemma - When social services are necessary.
September 26, 2008... The dilemma My health visitor came to see me recently and he was very upset. He described a difficult case he was currently involved with where a family's home situation clearly put two young children at risk However, he did not want to refer...

Clinical: At a Glance - Plantar warts vs corns.(Disease/Disorder overview)
September 26, 2008... Clinical features - Extremely common, especially in children, teenagers and the immunocompromised. - Caused by infection of epidermis by HPV, usually types 1, 2 or 4. - Occur most commonly in pressure areas such as ball of foot...

Clinical: The basics - How to treat cases of head lice.(Disease/Disorder overview)
September 26, 2008... Now the new school term has started, GPs are more likely to encounter this problem. Head lice are a common problem - as many as 3 million people a year in the UK catch head lice. Each year in the UK, the NHS and the general public...

Clinical: Expert opinion - Issues linked to pleural effusions.
September 26, 2008... Dr Nick Maskell and Dr Andrew Medford answer questions about causes, investigations and prescribing. Pleural effusions are accumulations of fluid within the pleural space They are usually discovered incidentally on examination or X-ray....

Clinical: At a Glance - Blue naevus vs venous lake.(Disease/Disorder overview)(Brief article)
September 26, 2008... Blue naevus Presentation - Smooth, round, slightly raised, blue papules. Less than 0.5mm in diameter. - May occur anywhere on the body. Common on the face, and backs of hands and feet. - Dermoscopy - homogenous steely-blue...

Medeconomics: How to... Put a price tag on your tender.(general principles for contract cost )
September 26, 2008... Jenny Stone explains the tricky task of working out an acceptable contract cost for you and the PCT. Costing out the contract price is arguably the most difficult aspect of bidding to provide NHS services. Set too high a price tag and...

Interim GMC knife-attack guidance 'unclear'.
September 26, 2008... Scottish defence union says that guidelines on knife wounds could lead to a breach of confidentiality. GPs faced with a patient wounded in a knife attack could risk breaching confidentiality because GMC guidance is 'unclear', legal...

GMC urges GPs to report any ASBOs.
September 26, 2008... Doctors who receive antisocial behaviour orders (ASBOs) must report them immediately, the GMC has warned. The warning comes as the GMC publishes revised guidance to clarify the rules on reporting convictions. The old guidance said...

Behind the Headlines: Antibiotics in pregnancy linked to disabilities.
September 26, 2008... Giving antibiotics to pregnant women in premature labour could increase their chance of having a child with functional impairment and cerebral palsy, media reports suggest. Previous research has suggested that taking antibiotics could...

Opinion: Your say online... community.healthcarerepublic.com.
September 26, 2008... What GPs are saying about health minister Ben Bradshaw criticising anti-private dogma: - In view of the most recent collapse within the financial institutions, why are we still so keen to privatise services within the NHS? It has become...

Opinion: Ballot box.
September 26, 2008... 77% of GPs think practices should not be barred from providing non-NHS services in extended hours Source: healthcarerepublic.com

Opinion: Three cheers for no gain from pain.
September 26, 2008... One of the great strengths of the NHS is that GPs have little financial interest in our patients. Apart from holding them upside down and shaking them for points (maybe leave 'em hanging for a while 'til they're nice and gamey), we can be...

Opinion: My fat dog taught me about obesity.
September 26, 2008... I had to take my dog to the vet this week. I have avoided the vet for three years because my dog is fat. She's a retriever and she eats EVERYTHING. Dried food, wet food, our food, chicken food, next door's cat's food, the contents of the...

Clinical: Before and after treatment.
September 26, 2008... Pilonidal sinus Most of these occur in the region of the natal cleft. They may be single or multiple and are more common in men. Recent studies have suggested that it occurs as the result of hormonal (androgen) stimulation of a sweat...

Education: nMRcgp - Prepare for the CSA experience.(clinical skills assessment )
September 26, 2008... Dr Zohra Jafri describes how her consultations helped her prepare for the clinical skills assessment. The clinical skills assessment (CSA) is structured to reflect the practical working experiences of an authentic surgery list, so it...

Editorial: GPs best placed to survive economic turmoil.(Editorial)
September 26, 2008... With the financial markets teetering on the brink of meltdown, the general consensus seems to be that Gordon Brown will hold onto his job... for now, at least. The irony is that the very same economic crisis that temporarily saves his...

Opinion: Save the money for the important things.
September 26, 2008... 'There's always time enough for the important things,' wrote Alan Lakein. And since in a viable enterprise time and money are interchangeable, it follows that there is money enough for the important things, too. It all depends upon...

MedEconomics: Weighing up private provider services.(Assura is a health provider organisation contract with General practitioners and United Kingdom. National Health Service. Primary Care Trusts)
September 26, 2008... In the coming weeks we will look at all the major players. This week Fiona Barr considers Assura's track record. Assura started life in 2003 as the Medical Property Fund, set up to invest in GP and primary care property. It was renamed...

MedEconomics: Ask the experts - Staff pension and inheritance tax.
September 26, 2008... Q: STAFF PENSION I am a practice manager due to retire in 2010. Before I was able to contribute to the NHS Pension Scheme I took out a private pension. I heard that it is possible to have this pension paid through another provider and...

Credit crunch thwarts private bids.
September 26, 2008... Exclusive - Private-led GP roll-out falters as healthcare firms hit by global economic crisis. The global economic crisis is making primary care investment impossible for the private sector, businesses have warned. The global...

Out-of-hours providers criticised on response times.
September 26, 2008... One in three out-of-hours providers fail to respond fast enough to calls, according to a Healthcare Commission report. Out-of-hours GP services should start assessments within 20 minutes for patients classified as urgent and within 60...

NICE issues final guidance on CKD.
September 26, 2008... NICE has published final guidelines on the treatment of chronic kidney disease (CKD). The guidelines, released in draft in March, recommend that patients with diabetes, hypertension or cardiovascular disease be offered testing for CKD....

ADHD care should 'start in hospital'.
September 26, 2008... Attention-deficit hyperactivity disorder (ADHD) should only be diagnosed in secondary care, according to new guidelines from NICE. The guidelines stress that GPs should not make initial diagnoses of ADHD or start drug treatment for...

Flu jabs extended to pregnant women.
September 26, 2008... Exclusive - Vaccination programme will offer immunity to newborns and their mothers. All pregnant women are set to receive flu jabs from next year in an extension to the influenza vaccination programme, according to a DoH vaccine...

24-hour opt-out 'let down the GMS contract'.(Labour Party Conference )(General Medical Services)(Conference news)(Brief article)
September 26, 2008... Labour Party Conference 2008 - Ben Bradshaw laments out-of-hours deal; fitness-to-practise rethink urged. Allowing the opt-out from out-of-hours care was the biggest problem with the GMS contract, Ben Bradshaw has said. During a...

GMC hearings 'too punitive'.
September 26, 2008... The punitive nature of fitness- to-practise hearings could be making it more likely bad doctors are going unchecked, the chair of the health select committee has warned. Speaking at a fringe event at the Labour Party conference, MP Kevin...

A quarter of PCTs have no need to build polyclinics.(Primary Care Trusts)
September 26, 2008... Researchers say polyclinics are being located in wrong areas. Nearly a quarter of PCTs are building a polyclinic that is unnecessary or badly needed elsewhere, say researchers. A demographic analysis of the location of GP-led health...

News in brief.
September 26, 2008... Dispensing practices warned on White Paper Some practices would have to cut services if the pharmacy White Paper plans proceed, GPC chairman Dr Laurence Buckman said. However, he added practices should resist the urge to 'either minimise...

Extra pounds 50m to improve service access.
September 26, 2008... PCTs are to increase investment in local enhanced services (LESs) by 20 per cent - although the money is likely to be directed at improving access. The increase in LES budgets will be funded by pounds 50 million of the pounds 105 million...

Security of electronic patient records in doubt.
September 26, 2008... An emergency override facility for consent could allow healthcare staff inappropriate access to care records. Healthcare staff will be able to inappropriately access patient care records simply by claiming to have their consent, it has...

PCT leaves GPC chair speechless.
September 26, 2008... GPC chairman Dr Laurence Buckman described himself as 'lost for words', after a north London PCT denied it had unlawfully threatened to remove GPs' contracts. Twenty-five of Barnet's 128 practices had been told that their contract could...

Anticholinergic inhalers 'raise risk of CVD by 58%'.
September 26, 2008... Concern following a study into the risk of CVD in COPD patients. Patients with COPD who are talking anticholinergic inhalers to control their symptoms are at an increased risk of cardiovascular disease (CVD), a joint US and UK study has...

Research briefs.(Society for General Microbiology conference )(Brief article)
September 26, 2008... Statins linked to delirium Taking statins could increase the risk of postoperative delirium in elderly patients by 28 per cent, Canadian research suggests. (CMAJ Online 2008). Clean teeth cut MI risk Keeping your teeth clean...

PBC groups may lead out of hours.
September 26, 2008... The DoH believes out-of-hours responsibility could kick-start commissioning, writes Tom Ireland. Although GP leaders say they haven't discussed 'even peripherally' the profession taking back 24-hour responsibility for patients, the DoH...

Independent Nurse: NHS London to double proportion of nurses in community settings.
September 22, 2008... Nurses and educators have backed plans to double the proportion of London nurses working in community settings over the next decade. The plans could become a national blueprint for building a workforce to deliver DoH plans to move care...

Independent Nurse: DoH rates nurses' contribution equal to GPs'.
September 22, 2008... The DoH now rates nurses' contribution to primary care as equal to that of GPs, Independent Nurse can reveal. Academics had complained that the government's definition of under-doctored areas was producing misleading results by ignoring...

Independent Nurse: 70% of health visitors feel unable to meet needs of at-risk children.
September 22, 2008... A quarter of England's health visitors have been left so over-stretched by budget cuts that they fear a repeat of the Victoria Climbie case in their own PCT, a survey has found. The survey, conducted by Unite/CPHVA, also found that 70 per...

Independent Nurse: DES will not improve osteoporosis care.
September 22, 2008... The clinical directed enhanced service (DES) for osteoporosis will not incentivise practices to improve care of the disease, experts have warned. Final details of the five clinical DESs for England, covering osteoporosis, heart failure,...

Independent Nurse: DoH working on plans for local QOFs.
September 22, 2008... The DoH is working on plans to let PCTs develop local QOFs from a 'national menu' of options, but experts warned the move could create a postcode lottery. An NHS Next Stage Review newsletter, published this month, shows that the DoH and...

Independent Nurse: NICE guidance.
September 22, 2008... NICE guidance recommending the generic drug alendronate for osteoporosis may not be cost-effective, an expert says. Dr Tarun Solanki, a consultant physician in geriatric medicine, said patients suffered side-effects that required hospital...

Independent Nurse: Diabetes and CVD.
September 22, 2008... Exposure to a chemical commonly used in food packaging is associated with an increased risk of metabolic disease, a UK study has found. Patients with a high urinary level of bisphenol A, a compound used in plastic food packaging, were 2.9...

Independent Nurse: MRSA.
September 22, 2008... Cases of MRSA bloodstream infections (above) have fallen 14 per cent in the last quarter, data from the Health Protection Agency show There were 836 cases reported in England during April to June of 2008, compared with 969 between January and...

Independent Nurse: Miscarriage risk.
September 22, 2008... Obesity significantly increases the risk of a subsequent pregnancy loss in women with recurrent miscarriages, a UK study shows. Researchers at St Mary's hospital in London made the link after investigating the effect of BMI on unexplained...

Independent Nurse: Flu.
September 22, 2008... Newborns can be protected from seasonal flu if their mothers are vaccinated during pregnancy, according to US research. The researchers observed a 63 per cent reduction in influenza among infants born to vaccinated mothers. NEJM Online 2008

Independent Nurse: Call for QOF to have greater focus on lifestyle interventions.
September 22, 2008... Experts have called for the QOF to place a greater emphasis on lifestyle interventions following research showing that lifestyle factors are responsible for more than half of premature deaths in women. Smoking cessation and effective...

Independent Nurse: Vital statistics - Bowel screening.
September 22, 2008... 1.5% of men tested positive in faecal occult blood tests in Scotland's screening programme 0.9% of women tested positive 40% of the most deprived fifth of the population came for screening, compared with 62 per cent of the least...

Independent Nurse: Journals Watch.
September 22, 2008... - Lung cancer kills more men Lung cancer mortality in people who have never smoked is higher in men than women, according to an analysis of cohort data including over 1.8 million people. It showed that rates of death from lung cancer in...

Independent Nurse: Antibiotics could harm unborn babies.
September 22, 2008... Prescribing antibiotics to women at risk of giving birth prematurely could increase the risk of functional impairment and cerebral palsy in their children, according to UK research. For the study, the researchers looked at whether...

Independent Nurse: Immigration plans to hit nursing staff.
September 22, 2008... The nursing profession is facing staffing shortfalls because of government plans to limit immigration, the RCN has warned. Previously, nursing was included on the list of 'shortage professions', making it easier to bring in workers from...

Independent Nurse: World Outbreak Information - Week beginning 22 September.
September 22, 2008... Indonesia The WHO has confirmed 137 human cases of avian influenza (112 deaths) in Indonesia to date. The most recent cases have reportedly come from Banten Province. Philippines Health officials have reported almost 20,000...

Independent Nurse: Nurse referral centre saves pounds 2m.
September 22, 2008... A team of nurse practitioners in Shropshire is saving the NHS almost pounds 2 million a year, by diverting hospital referrals to community services. The Shropdoc Care Co-ordination Centre (CCC) is staffed by 15 nurse practitioners, who...

Independent Nurse: Dispensing practice staff facing the axe.
September 22, 2008... Dispensing practices are axing staff as drug profits fall, say accountants. The average profit made on drugs dropped by nearly a third from pounds 45,949 in 2006/7 to pounds 32,948 in 2007/8, according to Paul Kendall, from Dodd & Co...

Independent Nurse: Unions issue strike warning over pay.
September 22, 2008... Unions have warned that strike action is inevitable as the three-year pay deal is increasingly dwarfed by rising inflation. The three-year deal incorporates annual rises of 2.75 per cent, 2.4 per cent and 2.25 per cent for 2008/9 to...

Independent Nurse: Paracetamol use linked to asthma.
September 22, 2008... Adults who take paracetamol weekly are nearly three times more likely to have asthma than those who do not take the drug, UK research suggests. Previous studies have shown that the prevalence of asthma is higher in children and adults in...

Independent Nurse: Debt forces health students to quit.(Clinical report)
September 22, 2008... More than half of all health students may quit their studies due to debt, according to a Unison survey. The union found that almost a quarter owe at least pounds 10,000, and called for a review of student funding to avoid a recruitment...

Independent Nurse: Research proves MMR vaccine efficacy.
September 22, 2008... Nurses have been handed a strong tool to encourage patients to accept MMR vaccination after a study confirmed it provides almost 100 per cent protection against measles. A Health Protection Agency (HPA) analysis of 1,794...

Independent Nurse: NI practices achieve 99% of QOF points.
September 22, 2008... The first QOF scores released for 2007/8 show that practices in Northern Ireland are achieving 99 per cent of points on average. The average practice score was 987 out of a possible 1,000 points, which is up on last year's average of 978....

Independent Nurse: News focus - Will social enterprises take off?
September 22, 2008... With success stories thin on the ground, unions remain wary of nurse-led social enterprises. Jonn Elledge reports. Talk to anyone in the NHS about social enterprises, and it won't be long before Central Surrey Health (CSH) comes up....

Independent Nurse: Opinion - Online ... see who's saying what at www.healthcarerepublic.com.
September 22, 2008... Regarding calls for schools to tackle obesity, the best 'role model' is the parent. Teachers are becoming 'extended' parents... where will it end? The responsibility should be at home. In banning private firms from running practices,...

Independent Nurse: Online competition www.healthcarerepublic.com/competitions.
September 22, 2008... Win a Sony Bravia TV worth over pounds 500. Nothing delivers a visual and audio experience quite as stylishly as Sony's new high definition (HD) 32-inch L4000 Bravia TV, with its chic flat-panel design. Whether you want to watch...

Independent Nurse: Editorial - London leads the way in funding nurse CPD.(Editorial)
September 22, 2008... NHS staff are used to upheaval and change. Some times this change brings problems and difficulties, at others it is change for change's sake to satisfy the latest political whim. But, every once in a while, the NHS embarks on an...

Independent Nurse: Opinion - Bursaries are available for driven nurses.
September 22, 2008... At a time when banks are needing to be rescued and mortgages are increasingly hard to come by, it is unusual to be in a position to say to people 'we have some money, please come and take it'. But happily for those of us at the QNI,...

Independent Nurse: In my view - Sign Unite's petition for a fair pay deal.
September 22, 2008... At the end of August, Unite launched a national petition to reverse the government's hard-line stance on below-inflation pay awards for NHS staff. We are now calling on the general public to lend their passionate support. The aim is to...

Independent Nurse: Clinical - Combating the threat of West Nile virus.(Clinical report)
September 22, 2008... West Nile virus can prove fatal. Barry Hill examines its potential threat to the UK. West Nile virus (WNV) is an arthropod borne virus first isolated in Uganda in 1937. WNV can be transmitted to humans and animals via the bite of an...

Independent Nurse: Clinical - Wound care - Providing access to topical negative pressure therapy.
September 22, 2008... Patients in primary care may not have access to topical negative pressure therapy. Maureen Benbow explains. The ageing population, coupled with unhealthy lifestyles and the obesity epidemic, will inevitably lead to more people being...

Independent Nurse: Clinical - Pictures in practice - Axillary problems.
September 22, 2008... - Skin tags Whereas in other parts of the body skin tags (acrochordons) may be nothing more than an unsightly nuisance, in the axillae they might cause problems if they rub and become sore or infected. These common benign lesions are...

Independent Nurse: Clinical - Musculoskeletal - A swollen wrist and confusion.
September 22, 2008... Case Study: A hot, swollen and tender joint may indicate septic arthritis, writes Dr Louise Warburton. Mr Williams is a 75-year-old man who lives with his wife in a tidy semi-detached house. He suffered a small cerebrovascular accident...

Independent Nurse: Clinical - Delivering best practice in urinary incontinence.
September 22, 2008... Women's health - Effective treatment for urinary incontinence can be provided in primary care, writes Joanne Townsend. The delivery of continence care is becoming increasingly complex as the issue is pushed down the government's agenda...

Independent Nurse: Clinical - Optimising blood pressure control.
September 22, 2008... In hypertension, blood pressure control is generally sub-optimal Alison Turner explains how lifestyle modification and medication can help. Treatment of hypertension reduces cardiovascular morbidity and mortality,1 but many patients...

Independent Nurse: Clinical Focus - Multiple sclerosis.
September 22, 2008... Overall key points - MS is the most common disabling neurological condition affecting young adults in the UK. - MS should be considered when young adults present with episodes of focal neurological dysfunction. - Patients...

Independent Nurse: Clinical - Investigating anaphylaxis.
September 22, 2008... Case study: 'Idiopathic' anaphylaxis may be due to a less common allergen, writes Dr Michael Radcliffe. Janice, a 35-year-old veterinary nurse, attends for the results of her allergy blood tests. These had been arranged last week on the...

Independent Nurse: Professional - Caring for carers.
September 22, 2008... Unpaid carers save taxpayers pounds 87 billion per year, so how can they be better supported? Julie Griffiths investigates. In June, the DoH launched a new national strategy for unpaid carers, the first in nearly 10 years. It followed the...

Independent Nurse: Professional - Encouraging new mothers to stop smoking.
September 22, 2008... Peer support from a stop smoking support worker can help new mothers to give up smoking, writes Heather Stringer. Smoking has been recognised by the DoH as 'the single biggest preventable cause of poor health',1 yet large sections of the...

Independent Nurse: Professional Resources - Worth a look.
September 22, 2008... - Rural Health Week - Institute of Rural Health This year's Rural Health Week takes place from 28 September to 4 October and aims to highlight the links between health and the environment. Organised by UK charity the Institute of...

Independent Nurse: Professional Resources - Recommended patient resource.
September 22, 2008... What is this? Published in August, this book describes a groundbreaking method of managing dementia developed by Alzheimer's charity SPECAL (Specialized Early Care for Alzheimer's). It has been drawn up from a combined wealth of personal...

Independent Nurse: Professional Resources - Consultation on a regime for unsustainable NHS providers.
September 22, 2008... What is this document? 'Developing the NHS performance regime', published 4 June 2008, announced the government's intention to 'establish a failure regime for state-owned providers that reflects the government's obligations to ensure service...

Independent Nurse: Professional Resources - In numbers - Antipsychotic scrips rise.
September 22, 2008... Figures from the NHS Prescription Pricing Division show that the prescribing of antipsychotic drugs olanzapine and risperidone by GPs in England will rise for the second year running, despite safety concerns. In 2006, GPs signed off...