GP articles from September 2011

GP archives from September 2011

MedEconomics: How to ... Improve customer care in practice.
September 23, 2011... Fiona Dalziel says delivering good care when people are unwell, and perhaps scared, is challenging. The people we look after in the surgery acquire different labels from time to time: service users, clients, customers, consumers, even...

MedEconomics: Ask the Experts - Maximising QOF and extending surgery size.
September 23, 2011... Q: EXTENDING SURGERY I own surgery premises with cramped conditions. I have planning permission to extend, which would cost approximately pounds 70,000. As PCTs are cash-strapped, I have little hope of getting an improvement grant. However, I...

Commissioning: Seven steps to success for CCGs.(clinical commissioning group)
September 23, 2011... CCGs' biggest challenge will be acute trusts' behaviour and cost base, say Georgina Craig and Ray Carter. Proving competence in procurement is going to be core business for clinical commissioning group (CCGs). Using quality as the main...

Commissioning: Viewpoint - Practice-based examples of integrated services are key.
September 23, 2011... NHS Future Forum chairman Professor Steve Field writes about the body's new projects and objectives. The second phase of the NHS Future Forum has begun with energy and optimism and a real sense of purpose. The membership has been refreshed...

Plain Tales from the Surgery.
September 23, 2011... - Lucozade and chips An overweight patient with uncontrolled diabetes regularly comes to see me and I always ask him about his diet. He recently told me he often drank three bottles of Lucozade as a tonic. I advised him to stop this behaviour...

Opinion: Homoeopathy flies in the face of medical wonder.
September 23, 2011... The older I get the more respect I have for the achievements of scientific medicine. Today I saw a seven-year-old girl, who had her atrial septal defect (ASD) corrected some years ago. Go back a few decades and she would have required major...

Opinion: Don't say it out loud, but I am trying to be nice.
September 23, 2011... There's the odd moment when I have to poke myself with a silver nitrate stick in order to remain fully attentive to the tragedy of Mrs Constipated's bowels ('it were an explosion, doctor, I can't tell you how grateful we all were for Toilet...

Education: How to ... Succeed in out-of-hours training.
September 23, 2011... It is up to individual GP registrars to ensure they achieve competency says Dr Donald Law. All GP registrars are required to undertake 108 hours of out-of-hours training, spread over the 18 months that they are attached to a training...

Education: Medico-legal - Who's the daddy? Patient requests for paternity tests.
September 23, 2011... GPs should bear in mind that paternity testing is not a routine investigation, says the MDU's Dr Jacqui Phillips. Members of the public are now able to buy paternity testing kits OTC from a high street chemist. A helpline is available for...

MedEconomics: Reducing missed appointments.
September 23, 2011... Steve Martin explains how small changes with zero costs can change patients' behaviour and reduce DNAs. Reducing 'did not attends' (DNAs) is something every practice strives for - often with mixed success. Recently we have been trying several...

MedEconomics: New opportunities in buy-to-let homes.
September 23, 2011... This could be the right time to take another look at investing in buy-to-let property, says Liz Willis. The boom in the buy-to-let property market came to a halt in 2007 when house prices began to fall. Things are now improving and with help...

Clinical: Journals Watch - Organisms and osteoporosis.
September 23, 2011... Not had time to read the journals? Let Dr Bryan Palmer bring you up to date on the latest research. - Hospital transmission of multiresistant organisms Med J Aust 2011; 195: 276-9 Microbiologists at a tertiary hospital in Sydney...

Clinical: Clinical Review - Atopic eczema.
September 23, 2011... Section 1: Epidemiology and aetiology Atopic eczema (AE) is a chronic relapsing disease of the skin characterised by dry itchy eczematous lesions. The lifetime prevalence of AE is estimated to be between 15 and 30 per cent in children and 2...

Clinical: Case Study - Diagnosing an itchy rash.
September 23, 2011... Growth in foreign travel means this condition is presenting more, say Dr John Carey and Dr Sidhu Gada. Recently, our surgery has seen two similar cases of a dermatological condition that is unusual in UK general practice. An itchy rash ...

Clinical: The Basics - The management of head lice.
September 23, 2011... Head lice and their eggs can be dealt with by physical or medical means, says Dr Tillmann Jacobi. 1. Aetiology Head lice (pediculus capitis) are blood-feeding insects of 1-4mm in length that can look like sesame seeds. They exclusively...

Clinical: Burns.
September 23, 2011... Sunburn - epidermal (superficial partial thickness) burn This woman had fallen asleep on the beach and was now complaining of painful burns. On examination, the skin was grossly inflamed and painful, and there was brisk capillary refill after...

MPs slate CQC's GP focus as inspections drop 70%.
September 23, 2011... Report by MPs warns regulator not to lose sight of other priorities as it prepares to register GPs. The Care Quality Commission (CQC) focused on preparing to register GP practices to the detriment of its inspection and review activities, a...

GP Diary.
September 23, 2011... BARROW STORIES Bemused looks all around at a commissioning conference in London last week, owing to a strange turn by NHS Alliance chairman Dr Michael Dixon Introducing NHS chief executive Sir David Nicholson, he remarked: 'I had a dream...

GP Online.com: A round-up of the best from GP's website this week.
September 23, 2011... Win a laptop worth pounds 450 To celebrate the new school year, GPonline.com is offering one lucky GP the chance to win a Dell Inspiron Duo, the latest innovative laptop/tablet hybrid, worth pounds 450. GPonline.com/offduty - Follow GP...

CCG populations must exceed 100,000.(Clinical commissioning groups)
September 23, 2011... Unavoidable fixed costs may leave small CCGs with almost no funding to pay for patient care. Clinical commissioning groups (CCGs) should not have populations of less than 100,000, according to an NHS London director. Hannah Farrar, NHS...

CCGs fear they will inherit PCT debts.(clinical commissioning groups)(pregnancy, child tracking & health services)
September 23, 2011... Two-thirds of pathfinder clinical commissioning groups (CCGs) believe that they will inherit PCT debts, according to a joint survey by the NHS Alliance and the National Association of Primary Care. Participants in the poll included...

Depression increases the risk of fatal stroke by half.
September 23, 2011... Depression has similar impact to smoking on stroke risk. People with depression are at much greater risk of having a stroke, findings from a large meta-analysis suggest. Depression was found to increase the risk of developing the condition...

Flu 'storm' data could save lives.
September 23, 2011... Research that shines light on how flu causes an immune 'storm' that damages the lungs could lead to new treatments. A severe immune reaction to flu infection known as a 'cytokine storm' excessively fills alveoli sacs in the lungs with immune...

Research Brief: Drop in flu cases.
September 23, 2011... Giving the seasonal flu jab to twoto four-year-olds cuts emergency hospital visits for flu-like illness, according to a US study. The research found vaccinating pre-schoolers led to a 34 per cent drop in flu-like illness (CMAJ Online 2011). ...

Research Brief: Ha! I laugh at pain.(Brief article)
September 23, 2011... Laughter may indeed be the best medicine - for pain at least Oxford University researchers found that volunteers who laughed watching comedy shows had higher pain thresholds than normal (Proceedings of the Royal Society B Online 2011). ...

Overall quality of memory services remains variable.(Brief article)
September 23, 2011... GP expert warns focus of strategy must shift to encouraging self-diagnosis and the better use of GPSIs. The number of memory services in England has increased under the national dementia strategy (NDS) but their quality is variable, a survey...

Competition Dell's latest innovative laptop/tablet hybrid could be yours.
September 23, 2011... Win a Dell Inspiron Duo, worth pounds 450. To celebrate the new school year, GPonline.com - the website for GP newspaper - is offering one lucky GP the chance to win a Dell Inspiron Duo, the latest innovative laptop/tablet hybrid, worth...

Should GPs fear rise of private firms?
September 23, 2011... Private companies are now a fixture as providers of NHS primary care. Susie Sell looks at what this means for GPs. When UnitedHealth backed out of the primary care market in the UK this year, there was speculation that private companies had...

GPs urged to take 'proactive approach' to stop TB.
September 23, 2011... Rising rates of TB prompt NICE to recommend mobile teams as GPs demand better services. GPs have welcomed efforts to tackle an 'insidious' rise in TB, but LMCs warned that 'patchy' provision of services to treat cases needed to improve. A...

Researchers want wider drug tests.
September 23, 2011... New drugs should be compared with existing ones before approval by regulators to ensure they are safe, effective and good value, experts have argued. They warned the lack of a formal requirement for this can result in 'the widespread use of...

Opinion: Ballot box.
September 23, 2011... 73% of GPs think GPs should take industrial action over the government's NHS pension plans. Source: GP. -------------------- Did you find this article useful? Why not subscribe to the magazine? Please call 08451 55 73 55 for more...

Opinion: Your say online.
September 23, 2011... Reaction to Commons 'Yes' vote for Health Bill It is hard to find anyone to support this Bill other than those who hope to make money out of it. GPs who are enthusiastic about commissioning will be disappointed when they realise what the...

Editorial: GPs have the tools to protect general practice.(Editorial)
September 23, 2011... This week's exclusive GP investigation and splash finds 4 per cent of NHS practices in England are now run by private companies. GP leaders believe that this could more than double to 10 per cent by 2014 because PCT-run practices are becoming...

Opinion: Why have we forgotten Bevan's core NHS vision?
September 23, 2011... I am irritated by the way some opponents of the Health Bill are using sloppy, emotional arguments rather than rational ones. Increasingly the rhetoric is that 'the government wants to destroy the NHS' and that any attempt to change it is 'a...

Firms will run 10% of practices by 2014.
September 23, 2011... GPs predict sharp rise in privately run practices after GP investigation. Private companies will run one in 10 GP practices by 2014, more than doubling their current share of the market, GP leaders believe. The warning came after a GP...

Bid to scrap GP added pension years.
September 23, 2011... Plans to scrap added years scheme may not be legal, BMA experts believe. The BMA is seeking legal advice to prevent the government from withdrawing GPs' right to top up their pensions by purchasing added years, BMA pensions committee chairman...

Meldrum criticised over response to Bill.(Hamish Meldrum)(Brief article)
September 23, 2011... BMA London council members backed a 'vote of censure' against BMA chairman Dr Hamish Meldrum last week over his handling of calls for the Health Bill to be withdrawn. The near-unanimous vote came as GPs hit out at the Liberal Democrats for...

GP leaders fear impact of PROMs.(Clinical report)
September 23, 2011... GP leaders are 'very concerned' about plans to judge GPs' performance on patient surveys, after hospital pilots gave inconsistent results. Latest results from the patient reported outcome measures (PROMs) scheme released last week by the NHS...

BMA fights on over women's pensions.
September 23, 2011... The BMA has vowed to continue to fight pension rules that discriminate against women. Despite losing at a judicial review earlier this year, BMA pensions committee chairman Dr Andrew Dearden said the BMA would continue to fight rules that...

GPC warning over funding for NHS 111.(general practitinors)
September 23, 2011... Funding could be raided to pay for costly and variable NHS 111 services. GP leaders fear out-of-hours primary care budgets could be raided to pay for NHS 111 once pilots for the service are completed. Speaking after the monthly GPC meeting...

New AF drug for GPs in Scotland.
September 23, 2011... GPs in Scotland can now prescribe a new alternative to warfarin for AF patients following approval by the country's drugs watchdog. The Scottish Medicines Consortium (SMC) accepted dabigatran etexilate for the prevention of stroke and...

Lansley blocks blanket bans on GP scan referrals.
September 23, 2011... Investigation by GP prompts warning from health secretary to trusts that block GP use of scans. Health secretary Andrew Lansley has ordered PCTs not to enforce blanket bans on GP use of diagnostic scans, after a GP investigation revealed...

MPs warn over Monitor role in regulation of competition.(Brief article)
September 23, 2011... How the health watchdog Monitor will regulate competition in the NHS remains unclear, MPs have warned. The House of Commons health select committee has said that many parts of Monitor's future role remain 'uncertain or unclear'. Following...

Dumfries GP takes silver in 100k run.
September 23, 2011... A Scottish GP won a silver medal for Great Britain after finishing second in a 100km running race. Dumfries GP Dr Joanna Zakrzewski (pictured, centre), of the Charlotte Street Surgery, ran in the World 100K Championships in the Netherlands...

Overseas GPs 'ill-prepared' for UK work.
September 23, 2011... GMC launches induction scheme to raise standards of doctors new to NHS. The GMC is to introduce an induction programme for overseas doctors, after it found some doctors were practising with 'little or no preparation' for working in the UK. ...

Clot-busting drug backed by NICE.
September 23, 2011... Anti-clot drug ticagrelor is likely to be accepted for use in the NHS in England and Wales after it gained NICE approval in draft guidance. NICE recommended anti-platelet drug ticagrelor plus aspirin for use in patients with acute coronary...

Out-of-hours tariff plan may undermine NHS integration.
September 23, 2011... Expert fears tariff could drive out-of-hours into a silo, but top GP backs it to improve service. Fixing a tariff price for primary care out-of-hours services could undermine their integration with other NHS services, an expert has warned. ...

GPC slams DoH over handling of NHS reforms.
September 23, 2011... Pressure on CCGs and failure to scrap quality premium could alienate profession, warns GPC. GP leaders have hit out at the DoH over the implementation of the NHS reforms, warning that enthusiastic GPs were now being driven away. GPC...

Opinion: Letting down the profession, sexually speaking.(Viewpoint essay)
September 16, 2011... Readers of this column will know of my distaste for vulgarity. Stephen Fry, Oscar Wilde, Noel Coward, these great men were my chief influences; the droll spoof, the dry wit, the little bon mot, the biting satire. But I was not always so...

Opinion: The complete angler's guide to avoiding a chat.(Viewpoint essay)
September 16, 2011... I am running late when Mrs Gossip appears with her fishing rod. Her previous 10 consultations all begin with the Read code 'had a chat to patient'. I resolve not to chat. Only the twitch of one eyebrow hints at my state of inner turmoil. Mrs...

Clinical: Journals Watch - Heart failure and contraception.(briefs)
September 16, 2011... Not had the time to read the journals? Let Dr Gwen Lewis bring you up to date on the latest research. Weight issues for heart failure in type-2 diabetics Am J Med 2011; 124: 834-40 It is already known that type-2 diabetes is an...

Clinical Review: Huntington's disease.(Disease/Disorder overview)
September 16, 2011... Contributed by Rachel Taylor, nurse consultant, The National Hospital for Neurology and Neurosurgery, and Professor Sarah Tabrizi, professor of neurology, UCL Institute of Neurology. Section 1: Epidemiology and aetiology Huntington's...

Clinical: The basics - Diagnosis of lymphoedema.(Disease/Disorder overview)
September 16, 2011... It is important to differentiate lymphoedema from other causes of oedema, says Dr Simon Auty. Lymphoedema can be inherited or acquired. The acquired form can be due to cancer directly invading the lymphatics, or more commonly associated with...

Clinical: Haematology - Reversal of warfarin treatment.
September 16, 2011... Management depends on the clinical circumstances, say Dr Shruthi Patel and Dr John Hanley. In recent years, there has been a dramatic increase in the number of patients receiving long-term anticoagulation with warfarin. It is possible that...

Clinical: Red Flag Symptoms - Chest pain.
September 16, 2011... There is a wide differential diagnosis for this symptom, says Dr Asim Safdar. - Central pain - Crushing pain - Radiation to left jaw, neck or arm - Exertion-related - Dyspnoea - Clamminess - Nausea Chest pain has a large...

Clinical: At a Glance - Erysipelas versus contact dermatitis.(Disease/Disorder overview)
September 16, 2011... Erysipelas Aetiology - Streptococcal infection of the skin, usually group A streptococcus if the face is affected. - Usually follows skin trauma or ulceration. - Infection often stems from nasal carriage of the bacteria. - More...

Clinical: Book Review - The Hands-on Guide to Data Interpretation.(Book review)
September 16, 2011... This book provides a succinct synopsis of the vast amount of data clinicians encounter, says Dr Mehul Mathukia. This book has been written by a group of junior doctors who chose to address interpretation of the vast amounts of clinical data...

Clinical: Managing obesity in pregnancy.(Report)
September 16, 2011... It is vital that professionals know the risks associated with obesity in pregnancy, says Dr Polly Weston. There is an obesity epidemic in the UK today. The latest Health Survey for England data showed that in 2009, 61 per cent of adults were...

Education: Out-of-hours training Part 1 - Train for out-of-hours work.
September 16, 2011... Registrars responsible for organising out-of-hours training. When the GP contract was renegotiated in 2004, out-of-hours medical services were transferred to PCTs and so was the responsibility for training GP registrars. This training was...

Education: Pictorial Case Study.(Disease/Disorder overview)
September 16, 2011... The case Brenda looked the picture of health after two weeks' holiday on a Greek island. Sun, good food, friends and fun had made the holiday a great success and she was delighted with her new tan. However, she came to the surgery because the...

A registrar survival guide: Devising shared management plans.(Brief article)
September 16, 2011... Devising a shared management plan is a vital skill for all GPs. The key is to be 'patient-centred' rather than 'doctor-centred'. - Ideas, concerns and expectations (ICE) All registrars will be familiar with the importance of ICE. Once you...

MedEconomics: Medico-legal - No decisions about me without me.
September 16, 2011... Dr Stephanie Bown explores what greater patient choice might mean for GPs and how they can prepare. While the government's health reforms continue to cause controversy, one principle that remains at the forefront is patient choice. This is...

MedEconomics: GPs' mid-career move to Australia.(general practitioners)
September 16, 2011... Pressing the 'refresh' button led us overseas to a new practice. Having left the comfort and cold of a rural Scottish town 11 months ago, we have settled well into the Australian way of life and work. Making this long journey involved us...

MedEconomics: Ask the experts - Apportioning profits and pension freezes.
September 16, 2011... Q: FORMER PARTNER I retired from partnership part-way through the last practice accounting year. I was replaced by a salaried doctor but cannot work out if my profit share is based on anything other than my departure date, with no account...

MedEconomics: NHS 111 and GPs' on-call services.
September 16, 2011... It is important for NHS 111 to integrate with existing urgent care services, says Dr Brian Gaffney. The aim of the NHS 111 service is to help local people across England get a quick and effective response to their urgent, non-emergency...

Commissioning: Urgent care - How to commission urgent care.
September 16, 2011... Neil Durham reports on essential tips for commissioners contained in guidance from the RCGP. Commissioning provides an 'ideal opportunity' to look differently at urgent care provision, according to the RCGP. Dr James Kingsland, England's...

Commissioning: Patient Populations - Don't force PCT size on commissioners.
September 16, 2011... We might be going insane delivering the current NHS reform agenda, says Scott McKenzie. Insanity: doing the same thing over and over again and expecting different results. Does this appear to be exactly what is happening with the NHS reform...

GP Online.com: A round-up of the best from GP's website this week.(general practitioners)
September 16, 2011... - Health Bill interactive timeline View our new interactive NHS reform timeline to see the progress of the Health Bill since it was published last July. GPonline.com/healthbill - Follow GP on Twitter Get all the latest primary care...

Best CCGs focused on improving care.(clinical commissioning groups)(Brief article)
September 16, 2011... Commissioning - DoH adviser warns CCGs not to get bogged down in structural reform. The best-performing clinical commissioning groups (CCGs) have focused on improving care for specific diseases, not the shape of their organisation, according...

Growth factor test predicts the risk of CKD progressing.
September 16, 2011... CKD Hormone levels linked to increased risk of early death, heart problems and need for dialysis, study shows. Blood tests for a growth factor hormone could help identify kidney disease patients most likely to die early or develop heart...

Health Bill forum pledges to be 'visionary and radical'.
September 16, 2011... Health bill - Former RCGP chairman says NHS Future Forum is guaranteed independence by David Cameron. The senior GP who led the Health Bill listening exercise has pledged to be 'visionary and radical' as the team behind the exercise continues...

BMA backs second chance for minimum alcohol price.(British Medical Association )(Brief article)
September 16, 2011... BMA Scotland has welcomed the Scottish government's pledge to reintroduce a Bill for minimum pricing of alcohol to help address the 'scourge of alcohol abuse' in the country. BMA Scotland chairman Dr Brian Keighley urged politicians to...

Do we need flu adverts this year?
September 16, 2011... After GPs were blamed for shortages of vaccine last year, Stephen Robinson asks if the DoH should run ads again. Last winter's flu season turned chaotic when rumours emerged that some practices were running low on vaccines. Slow early...

Long-term conditions need longer appointments.
September 16, 2011... Management - Half-hour consultations are vital to boost management of long-term conditions, RCGP warns. GPs should use 30-minute consultations to help patients with long-term conditions to manage their health better, the RCGP has said. ...

Ethnic patients less satisfied.
September 16, 2011... Minority ethnic patients report lower satisfaction with the primary care services they receive, according to a study. Researchers from Cambridge University and the Cambridge Centre for Health Services Research reassessed data from 2009 GP...

Blood test LES is designed to improve GP cancer care.
September 16, 2011... Cancer - Leeds practices respond to patient demand by offering blood tests for their chemotherapy patients. Leeds GPs can opt to provide blood tests for chemotherapy patients as part of a local enhanced service (LES) that aims to make care...

Behind the Headlines: Can blood test predict preterm birth?
September 16, 2011... A blood test to predict mothers' risk of 'premature' birth has been developed by US scientists, according to newspapers. The reports claimed the test could detect eight in 10 premature births Mothers found to be at risk could then change...

Opinion: Ballot box.
September 16, 2011... 59% of GPs think that practices should use Skype in consultations Take part in our daily polls at GPonline.com -------------------- Did you find this article useful? Why not subscribe to the magazine? Please call 08451 55 73 55 for more...

Opinion: Your say online ... gponline.com/news.
September 16, 2011... The House of Commons vote on the Health Bill - It seems the main reason for supporting the Bill is that we have passed the point of no return. So, implementation of the Bill was started before it was ever discussed or ratified and now...

QOF delays leave GPs facing losses.
September 16, 2011... PCTs missed the deadline for agreeing local QOF productivity targets. Practices are struggling to achieve payments relating to 10 per cent of the QOF, after PCTs missed deadlines for agreeing local targets, GP can reveal. A GP...

House of Lords to Demand Size Limits on CCGs
September 16, 2011... GP leaders are hopeful that Lords amendments can mitigate harmful impact of NHS reforms. The House of Lords will insist on a minimum size for clinical commissioning groups (CCGs) as part of a package of amendments to the Health Bill,...

DoH data reveals true cost of NHS reforms.
September 16, 2011... DoH data released a day after MPs voted in favour of the Health Bill showed the reforms will not deliver predicted savings and will cost the NHS pounds 600 million in redundancy pay. Thousands of PCT staff made redundant as a result of the...

GP Anger as MPs Back Health Bill
September 16, 2011... GP leaders have vowed to step up campaigns urging the House of Lords to scrap the Health Bill, after MPs ignored appeals to reject the NHS reforms. The Health Bill is one step closer to becoming law, after 316 MPs voted in favour of it in the...

UK review offers GPs menu of painkiller options.
September 16, 2011... Research on effects of oral analgesics found no one drug offered reliable pain relief in all patients. No painkilling drug is effective in all patients and their use must be carefully considered, according to a large review by UK researchers....