Collapse all descriptions
Medical- Euthanasia and Physician Assisted Suicide- Do GP's support it ?
Updated: 23 May 2013
GPs to be consulted on support for legalisation of assisted dying
21 May 2013 | By Alisdair Stirling
Exclusive The RCGP is to consult its members on whether the college should support a parliamentary bill that
would change the law on assisted dying for terminally ill patients.
The move could lead to the college becoming the first medical college or body to support assisted dying.
The consultation, to be announced tomorrow, follows a letter to The Times newspaper today from a dozen senior
doctors supporting a change in the law over the issue.
The letter, from 12 former leaders of medical royal colleges was prompted by the Assisted Dying Bill tabled in the
House of Lords by Lord Falconer of Thoroton, the former Lord Chancellor.
The bill aims to give a small group of very advanced terminally ill patients whose suffering is not adequately
alleviated by palliative care the choice to legally end their lives if they wish to.
Although no medical royal colleges or bodies currently support assisted dying - with many opposed to it - the
RCGP says it will now ask its members whether it should support a change in the law and that it will release full
The RCGP last consulted members on assisted dying in 2005 and the move comes after an article discussing
Professor Gerada said that doctors had a right to hold a view on whether they should help someone to die but
argued that medical royal colleges should adopt a neutral stance on the issue and let society decide.
The letter published today from doctors including Sir Terence English, past president of the Royal College of
Surgeons, Dame Margaret Turner Warwick, former president of the Royal College of Physicians and Dame Fiona
Caldicott, past president of the Royal College of Psychiatrists says: ‘We believe that there is a strong case for the
legalisation of assisted dying for terminally ill mentally competent adults’.
’We hope that the debate among legislators and the public will focus on the central issue. This is whether a small
group of very advanced terminally ill patients should be allowed this degree of control over the end of their life.’
Medical-Angela Jolie & The Faulty BRCA2 Gene - Now a 53 yr old Man has his Prostate removed
Updated: 21 May 2013
After the actress Angelina Jolie’s double masectomy dominated the headlines last week, a British man has
become the first in the world to undergo a preventative prostatectomy on finding he has the ‘faulty’ BRCA2
gene, the Sunday Times has reported.
The 53-year-old man, married with children, wanted to avoid the fate of relatives who developed breast or
prostate cancer after discovering he had the gene when taking part in an Institute of Cancer Research trial.
Doctors were reportedly persuaded to operate when tissue samples showed signs of malignant changes, but
on removal it was found the prostate had a considerable level of undetected cancer.
Surgeon Professor Roger Kirby told the paper: ‘The relatively low level of cancerous cells we found in this
man’s prostate before the operation would these days not normally prompt immediate surgery to remove the
gland, but given what we now know about the nature of BRCA2, it was definitely the right thing to do for this
‘A number of these BRCA families have now been identified, and knowing you are a carrier is like having the
sword of Damocles hanging over you. You are living in a state of constant fear. I am sure more male BRCA
carriers will now follow suit.’
Medical- Syphilis,Sex and Fear
Updated: 19 May 2013
Syphilis, sex and fear: How the French disease conquered the world
Researching the Borgias, Sarah Dunant learnt how syphilis took Europe by storm during the 1490s, and the far
reaching effects it's had ever since
Cesare Borgia, who contracted syphilis in 1497 when he was 22. Photograph: De Agostini/Getty Images
History doesn't recount who gave Cesare Borgia syphilis, but we do know when and where he got it. In the
summer of 1497, he was a 22-year-old cardinal, sent as papal legate by his father, Pope Alexander VI, to crown
the king of Naples and broker a royal marriage for his sister, Lucrezia.
Naples was a city rich in convents and brothels (a fertile juxtaposition in the male Renaissance imagination),
but it was also ripe with disease.
Two years earlier, a French invasion force including mercenary troops back from the new world, had dallied a
while to enjoy their victory, and when they left, carried something unexpected and deadly back home with them.
His work accomplished, Cesare took to the streets.
Machiavelli, his contemporary and a man with a wit as unflinching as his politics, has left a chilling account of
his coupling with a prostitute who, when he lights a lamp afterwards, is revealed as a bald, toothless hag so
hideous that he promptly throws up over her.
Given Cesare's elevated status, his chosen women no doubt were more enticing, but the sickness they gave
him (and suffered themselves) was to prove vicious.
First a chancre appeared on his penis, then crippling pains throughout his body and a rash of itching, weeping
pustules covering his face and torso.
Fortunately for him and for history, his personal doctor, Gaspar Torella, was a medical scholar with a keen
interest in this startling new disease and used his patient (under the pseudonym of "Niccolo the young") to
record symptoms and attempted cures. Over the next few years, Torella and others charted the unstoppable
rise of a disease that had grown men screaming in agony as their flesh was eaten away, in some cases down to
I still remember the moment, sitting in the British Library, when I came across details of Torella's treatise in a
book of essays on syphilis.
There is nothing more thrilling in writing historical fiction than when research opens a window on to a whole
new landscape, and the story of how this sexual plague swept through Europe during the 1490s was one of the
turning points in Blood and Beauty, the novel I was writing on the rise and fall of the Borgia dynasty.
By the time that Cesare felt that first itch, the French disease, as it was then known, had already spread deep
That same year, Edinburgh town council issued an edict closing brothels, while at the Italian university of
Ferrara scholars convened an emergency debate to try to work out what had hit them.
By then the method of the contagion was pretty obvious.
"Men get it from doing it with women in their vulvas," wrote the Ferrarese court doctor baldly (there is no
mention of homosexual transmission, but then "sodomy", as it was known then, was not the stuff of open
The theories surrounding the disease were are as dramatic as the symptoms: an astrological conjunction of the
planets, the boils of Job, a punishment of a wrathful God disgusted by fornication or, as some suggested even
then, an entirely new plague brought from the new world by the soldiers of Columbus and fermented in the
loins of Neapolitan prostitutes.
Whatever the cause, the horror and the agony were indisputable.
"So cruel, so distressing, so appalling that until now nothing more terrible or disgusting has ever been known
on this earth," says the German humanist Joseph Grunpeck, who, when he fell victim, bemoaned how "the
wound on my priapic gland became so swollen, that both hands could scarcely encircle it."
Meanwhile, the artist Albrecht Dürer, later to use images of sufferers in propaganda woodcuts against the
Catholic church, wrote "God save me from the French disease.
I know of nothing of which I am so afraid … Nearly every man has it and it eats up so many that they die."
It got its name in the mid 16th century from a poem by a Renaissance scholar: its eponymous hero Syphilus, a
shepherd, enrages the Sun God and is infected as punishment.
Outside poetry, prostitution bears the brunt of the blame, though the real culprit was testosterone.
Men infected prostitutes who then passed it on to the next client who gave it back to a new woman in a deadly
Erring husbands gave it to wives who sometimes passed it on to children, though they might also get it from
suckling infected wet-nurses.
Amid all this horror there were elements of poetic justice. In a manifestly corrupt church, the give-away "purple
flowers" (as the repeated attacks were euphemistically known) that decorated the faces of priests, cardinals,
even a pope, were indisputable evidence that celibacy was unenforceable.
When Luther, a monk, married a nun, forcing the hand of the Catholic church to resist similar reform in itself,
syphilis became one of the reasons the Catholic church is still in such trouble today.
Though there has been dispute in recent years over pre-15th-century European bones found with what
resemble syphilitic symptoms, medical science is largely agreed that it was indeed a new disease brought back
with the men who accompanied Columbus on his 1492 voyage to the Americas. In terms of germ warfare, it was
a fitting weapon to match the devastation that measles and smallpox inflicted travelling the other way.
It was not until 1905 that the cause of all this suffering was finally identified under the microscope – Treponema
pallidum, a spirochete bacterium that enters the bloodstream and, if left untreated, attacks the nervous system,
the heart, internal organs and the brain; and it was not until the 1940s and the arrival of penicillin that there was
an effective cure.
Much of the extraordinary detail we now have about syphilis is a result of the Aids crisis.
Just when we thought antibiotics, the pill and more liberal attitudes had taken the danger and shame out of
sexual behaviour, the arrival out of nowhere of an incurable, fatal, highly contagious sexual disease challenged
medical science, triggered a public-health crisis and re-awoke a moral panic.
Not surprisingly, it also made the history of syphilis extremely relevant again.
The timing was powerful in another way too, as by the 1980s history itself was refocusing; from the long march
of the political and the powerful, to the more intimate cultural stories of everyman/woman.
The growth of areas such as history of medicine and madness through the work of historians such as Roy
Porter and Michel Foucault was making the body a rich topic for academics.
Suddenly, the study of syphilis became, well, there is no other word for it, sexy.
Historians mining the archives of prisons, hospitals and asylums now estimate that a fifth of the population
might have been infected at any one time. London hospitals during the 18th century treated barely a fraction of
the poor, and on discharge sufferers were publicly whipped to ram home the moral lesson.
Those who could buy care also bought silence – the confidentiality of the modern doctor/patient relationship
has it roots in the treatment of syphilis.
Not that it always helped. The old adage "a night with Venus; a lifetime with Mercury" reveals all manner of
horrors, from men suffocating in overheated steam baths to quacks who peddled chocolate drinks laced with
mercury so that infected husbands could treat their wives and families without them knowing.
Even court fashion is part of the story, with pancake makeup and beauty spots as much a response to
recurrent attacks of syphilis as survivors of smallpox.
And then there are the artists; poets, painters, philosophers, composers.
Some wore their infection almost as a badge of pride: The Earl of Rochester, Casanova, Flaubert in his letters.
In Voltaire's Candide, Pangloss can trace his chain of infection right back to a Jesuit novice who caught it from
a woman who caught it from a sailor in the new world.
Others were more secretive.
Shame is a powerful censor in history, and in its later stages syphilis, known as the "great imitator", mimics so
many other diseases that it's easy to hide the truth.
Detective work by writers such as Deborah Hayden (The Pox: Genius, Madness, and the Mysteries of Syphilis)
count Schubert, Schumann, Baudelaire, Maupassant, Flaubert, Van Gogh, Nietzsche, Wilde and Joyce with
contentious evidence around Beethoven and Hitler.
Her larger question – how might the disease itself have affected their creative process – is a tricky one.
Van Gogh paints skulls and Schubert's sublime last works are clearly suffused with the awareness of death.
But in 1888, when Nietzsche, tumbling into insanity, wrote work such as Ecce Homo is his intellectual
grandiosity genius or possibly the disease talking?
There is a further layer of complexity to this.
By the time Nietzsche lost his wits, tertiary syphilis had undergone a transmutation, infecting the brain and
causing paralysis alongside mental disintegration.
But many of its sufferers didn't know that then.
Guy de Maupassant, who started triumphant ("I can screw street whores now and say to them 'I've got the pox.'
They are afraid and I just laugh"), died 15 years later in an asylum howling like a dog and planting twigs as baby
Maupassants in the garden.
Late 19th-century French culture was a particularly rich stew of sexual desire and fear.
Upmarket Paris restaurants had private rooms where the clientele could enjoy more than food, and in opera
foyers patrons could view and "reserve" young girls for later.
At the same time, the authorities were rounding up, testing and treating prostitutes, often too late for
themselves or the wives.
As the fear grew, so did the interest in disturbed women.
Charcot's clinic exhibited examples of hysteria, prompting the question now as to how far that diagnosis might
have been covering up the workings of syphilis.
Freud noted the impact of the disease inside the family when analysing his early female patients.
"It's just as I thought. I've got it for life," says the novelist Alphonse Daudet after a meeting with Charcot in
In his book In the Land of Pain, translated and edited by Julian Barnes in 2002, the writer's eye is unflinching as
he faces "the torment of the Cross: violent wrenching of the hands, feet, knees, nerves stretched and pulled to
breaking point," dimmed only by the blunt relief of increasing amounts of morphine: "Each injection [helps] for
three or four hours.
Then come 'the wasps' stinging, stabbing here, there, everywhere followed by Pain, that cruel guest … My
anguish is great and I weep as I write."
Of course, we have not seen the end of syphilis – worldwide millions of people still contract it, and there are
reports, especially within the sex industry, that it is on the increase in recent years.
But the vast majority will be cured by antibiotics before it takes hold.
They will never reach the point, as Cesare Borgia did in the early 16th century, of having to wear a mask to
cover the ruin of what everyone agreed was once a most handsome face.
What he lost in vanity he gained in sinister mystery.
How far his behaviour, oscillating between lethargy and manic energy, was also the impact of the disease we
will never know.
He survived it long enough to be cut to pieces escaping from a Spanish prison.
Meanwhile, in the city of Ferrara,his beloved sister Lucrezia, then married to a duke famed for extramarital
philandering, suffered repeated miscarriages – a powerful sign of infection in female sufferers.
For those of us wedded to turning history into fiction, the story of syphilis proves the cliche: truth is stranger
than anyone could make up.
• A Cultural History of Syphilis will be broadcast on Radio 3 on 26 May
Medical- Umbilical Hernia
Updated: 16 May 2013
I have a hernia around my navel. I am overweight and I know that surgery is out of question until I lose pounds.
However my hernia is very uncomfortable and it moves.
What are the warning signs and how can I treat the discomfort?
When should I see my GP?
‘Umbilical hernia’ – rarely causes a problem in an adult.
If it becomes acutely sore and tender to touch in an unusual way for you or if it changes colour then you should see your GP.
Otherwise leave well alone – there is no treatment other than surgical.
Special supports, etc are pretty useless for this kind of hernia.
The NetDoctor Medical Team
Read more: http://www.netdoctor.co.uk/ate/digestiveandurinary/201864.html#ixzz2TPck5Bas
Medical- Nurse Staffing Levels and those who "Bury their Mistakes"
Updated: 13 May 2013
Nurse Staffing Levels
Optimum staffing levels have never been set in stone since the concept of the NHS.
And as now Doctors are as much to blame as Administrators.
Dr Dan Poulter Health Minister is the latest.
This Doctor working in Surgery, has experience of staffing levels in Operating Theatres , Wards and Emergency
Departments, yet he washes his hands of the problem, by saying it is for hospitals to decide on their Nurse
So we have those who have no patient care qualifications telling day and night nursing staff how many patients
each they must care for in acute and non acute hospital and community situations.
These administrators are not fit for purpose and Dr Poulter is not fit to be in a position of authority.
We need a root and branch review of safe Nursing staffing levels.
The ratio of Qualified Nurses to Nurses in Training to Technicians to Untrained and to Domestic Staff in any given
Unit situation, needs much more examination.
For example a patient being admitted to any acute or non acute situation needs to be sure that the person in
charge is sufficiently qualified.
An inexperienced Staff Nurse is as useless as an “unqualified” Doctor in an acute admission ward.
Yet there could be 12 hours of day time, 7 days a week to cover and 84 hours a week is more time than one
experienced Ward Sister works.
Even two would not cover holidays and sickness levels.
As a Nurse Manager I employed Four Ward Sisters between two 36 bedded wards and soon found my boss and
her finance Officer on my back, yet for an Acute Orthopaedic admission ward in a hospital with a busy A&E Dept
that was a safe situation when trauma and cold surgery admissions were admitted.
Then there is the work load. Nurses now accept duties previously only undertaken by the Medical profession.
On Night Duty nurses often work a 12 hour shift under extreme staff shortages as most administrators knock off at
5pm and arrive at 9am knowing little of what happens in between on their busy wards.
Then there is the competence of the Junior Medical Staff, who are required to carry out ward procedures to the
whims of their Consultant bosses, to be watched and led by the nose. Many a Doctor owes his or her career to
an experienced Ward Sister.
Finally and most importantly are the interests of the patient, who were treated little better than cattle 50 years ago.
Ward and Dept design and organisational facilities constantly need up dating and patient and their relations needs
At Lincoln Hospital, orthopaedic outpatients are expected to queue to get "admitted" by a receptionist.
This brings a whole new meaning to a "stress fracture".
When I complained the authorities just ignored my concerns and the same situation continues today as far as I am
To put it bluntly Dr Poulter the patient often needs protecting from those who “bury their mistakes”.
Staffing levels need to reflect the patient workload at its heaviest. The problem is that some can't stand seeing
Nurses having periods of a quieter time, time for re - training or tution. A&E staff are expected to work flat out for
the whole shift and then give some more.
Medical-Nurse staffing levels- Health Minister Dr Poulter walks past on the other side
Updated: 13 May 2013
Nurse shortages put lives at risk
Sunday 12 May 2013
by Paddy McGuffin Home Affairs Reporter
Health professionals and unions issued a stark warning today that NHS cuts are leading to dangerously unsafe hospital staffing levels.
The Safe Staffing Alliance, which includes the Royal College of Nursing, Unison and the Patients Association, said some wards have so few nurses that an extra 20 patients a year could die as a result.
The alliance fears that this ratio could be seen as the acceptable minimum - despite it putting patients' lives at risk.
It quoted a survey of almost 3,000 nurses at 31 English hospitals which found that wards were run with one nurse per eight patients about 40 per cent of the time.
The report, entitled Safe and Sound, was launched to coincide with International Nurses Day and is based on research by Southampton University.
The research showed that hospitals with more than eight patients per registered nurse would expect to see around 20 extra deaths a year more than those that were better staffed.
Royal College of Nursing policy head Howard Catton said: "This is the profession coming together with one united voice to say under no circumstances should a nurse have more than eight patients to look after.
"If they do, the risks increase significantly - risks like medication errors, trips and falls, infection rates.
"In a lot of circumstances it should be a ratio of one nurse to five or six patients."
Unison head of nursing Gail Adams said: "The evidence is mounting that there is safety in numbers when it comes to caring for patients. The government must face facts, or face more tragedies like Mid Staffs.
"In survey after survey nurses say that the most satisfying aspect of their job is day to day, face to face, caring for patients. What they want is to be given the time to do that safely and well."
Health Minister Dr Dan Poulter said: "It is for hospitals themselves to decide how many nurses they employ.
"Nursing leaders have been clear that hospitals should publish staffing details and the evidence to show that staff numbers are right for the care needs of the patients."
He said: "The number of clinical staff in the NHS has risen and the number of admin staff has fallen by 18,000."
Medical- Advances in the Eradication of Malaria and Prevention of Dengue Fever
Updated: 11 May 2013
Could the discovery of a new mosquito-infecting bacteria strain hold the key to preventing malaria?
The BBC reports that temporary infection of malaria-carrying Anopheles mosquitoes with the bacteria made
them immune to the malaria parasite.
The Wolbachia bacteria strain more commonly infects other insects, in which it often causes changes that
boost the female population. Research in Australia has shown that Wolbachia can prevent the spread of
Dengue fever by mosquitoes, but the malaria research is at a much earlier stage – for one thing, it has not yet
been shown to work in the particular Anopheles mosquito strain that carries malaria in Africa.
Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the US, said the study
was ‘a proof of concept’ though. He said: ‘If you can get it to survive and proliferate in the environment of
mosquitoes in malaria-stricken areas, this could conceivably have an important impact on the control of
malaria. I think the potential for this is very important. The implementation will be the challenge.
Medical- NHS Urgent and Emergency Care is "Out of Control"
Updated: 10 May 2013
NHS emergency care is ‘out of control’ across large swathes of the country, reports The Telegraph this morning.
Too many patients — especially the elderly — are arriving in hospital as an emergency, when they should have
received help much earlier, said David Prior, head of the CQC.
As a result, he added, the healthcare system is on the brink of collapse and regulators cannot promise to prevent
further scandals like Mid-Staffordshire.
In his first major speech since being appointed to lead the regulator earlier this year, Mr Prior called for large-
scale closures of hospital beds and investment in community care.
He said that almost half of hospitals are providing care which was either poor, or ‘not terribly’ good. The CQC
has identified 45 hospitals which have had problems which date back five years. And he criticised the decision
to allow GPs to opt out of out-of-hours care, saying that they should be available to patients around the clock.
In a forthright speech to a conference held by health think tank the King’s Fund, Mr Prior said: ‘If we don’t start
closing acute beds, the system is going to fall over.’
Medical- Maternal & Infant Mortality - Britain is in 23rd place in Europe
Updated: 08 May 2013
The UK is becoming a worse place to be a mum relative to much of the rest of Europe, according to a global
survey of women’s health and political influence, the Independent reports today.
The Save the Children annual Mother’s Index ranked the UK in 23rd place, behind Germany, France and Ireland,
with maternal and infant mortality rates higher than in many Western nations and numbers of women in
government far lower that elsewhere in the world.
The top three countries were Finland, Sweden and Norway, while Germany was ninth, Australia tenth, France
16th and Ireland 20th.
The paper says one reason maternal mortality is so high in the UK could be the high proportion of younger and
older mothers, due to teenage and IVF pregnancies, while high rates of joblessness are another factor as
mothers whose partners are jobless are six times more likely to die prematurely than those with partners in work
Medical- Social Isolation - Britain's No 1 disease -Exacerbated by Tory Policies
Updated: 09 May 2013
How to cope with loneliness
Explains loneliness, giving practical suggestions for what you can do and where you can go for support.
- About loneliness
- Loneliness and mental health
- Overcoming loneliness
- Getting support
- Friends and Family
- Useful contacts
What is loneliness?
As social beings, most of us feel the need for rewarding social contact and relationships. One common definition of loneliness is that it is the feeling we get when our need for this type of contact is not met.However, loneliness is not the same as being alone. You might choose to be alone and live happily without much contact with other people. Or you may have lots of social contact, or be in a relationship or part of a family and still feel lonely.Loneliness is not feeling part of the world. You might be surrounded by loads of people but... you are [still] lonely. Loneliness can have a significant impact on your mental health. It can contribute to mental health problems, such as anxiety and depression.Having a mental health problem can also make you feel lonely. For example, your condition may mean that you find social contact difficult or that you find it hard to maintain friendships, or you may feel isolated because of stigma and discrimination.
What makes people lonely?
Loneliness has many different causes and affects people differently. Often people feel lonely because of their personal circumstances. But sometimes loneliness is a deeper, more constant feeling that comes from within.
Certain lifestyles and the stresses of daily life can make some people socially isolated and vulnerable to loneliness. There are many situations that might make you feel isolated or lonely.
For example, if you:
- lose a partner or someone close to you
- go through a relationship break-up
- are a single parent or caring for someone else – you may find it hard to maintain a social life
- retire and lose the social contact you had at work
- are older and find it difficult to go out alone
- move to a new area without family, friends or community networks
- belong to a minority ethnic group and live in an area without others from a similar background
- are excluded from social activities – for example, because of mobility problems or a shortage of money
- experience discrimination and stigma – for example, because of a disability or long-term health condition, or your gender, race or sexuality
- have experienced sexual or physical abuse – you may find it hard to form close relationships with other people.
Internal feelings of loneliness
Some people experience deep and constant feelings of loneliness that come from within and do not disappear, regardless of their social situation or how many friends they have.There are many reasons people experience this kind of loneliness. You might feel unable to like yourself or to be liked by others, or you may lack self-confidence. This may come from having been unloved as a child so that, as an adult, you continue to feel unlovable in all relationships. Or sometimes, consciously or unconsciously, people isolate themselves within their relationships because they are afraid of being hurt.Loneliness, for me, is a side effect of the barriers I've put up over the years to protect myself from the world, and the world from me.
If you experience this deeper type of loneliness, you may try to avoid being on your own and spend a lot of time socialising. Or you may react in the opposite way, hiding away on your own so you don't have to face a world of people you feel unconnected to. You may also develop unhelpful habits, such as using alcohol or drugs, to escape your feelings of loneliness or to face social situations that you can’t avoid.
How can being lonely affect your mental health?
Loneliness and social isolation can have a significant impact on your mental health. Studies have shown that people who are socially isolated experience more stress, have lower self-esteem and are more likely to have sleep problems than people who have strong social support. All of these things can have a negative effect on your general wellbeing.Being lonely can also contribute to mental health problems, such as anxiety and depression. Social isolation has also been linked to rarer mental health conditions like schizophrenia. If you are concerned that
your feelings of loneliness are developing into a mental health problem, you may find it helpful to talk to your GP.Sometimes feeling lonely can feel so overwhelming that you have suicidal thoughts. If this happens, remember that you can pick up the phone at any time of night or day and talk to the Samaritans. See how to cope with suicidal feelings for more information.
How can a mental health problem lead to loneliness?
There are many different reasons that having a mental health problem can make you feel lonely. Your mental health problem may affect the way you see yourself or you may feel lonely because of how other people see you.
How you see yourself
Mental health problems can often lead to low self-esteem and a poor
self-image. This may be part of your mental health problem, or it may result from stigma or discrimination you have experienced because of your mental health. You may not feel confident that people want to have social contact with you, or you may feel that people don’t understand you or see you as different or strange. This could lead you to avoid social contact and isolate yourself, making you increasingly lonely. See How to increase your self-esteem for more information.If you have a condition such as anxiety or a phobia, you may find social contact or leaving the house difficult. As a result, you may become socially isolated, leading to feelings of loneliness. For more information see anxiety and panic attacks and phobias, or visit Anxiety UK's website. Medication that you take for your condition can affect the way you see yourself. It may have changed your appearance or the way you communicate. You may have lost or put on weight, or your medication may make you feel drowsy. Some medication can cause shaking or slurred speech and you may worry that other people will make incorrect judgements about you. Or you may have to avoid drinking alcohol and find it difficult to admit this to your friends. All of this can have an impact on how confident you feel about meeting people socially, and cause you to withdraw from social contact.
How other people see you
If you have a mental health problem, you may find that some people are reluctant to engage with you because of the prejudice they feel towards people they see as different. You may have found that your friends stopped keeping in contact with you when they found out about your mental health problems or that the way they reacted made you question your friendships. This may mean you become less willing to trust other people, and you may start to avoid social contact with others.Once I was told people don’t want to be around me as I depress them, so I became somewhat [of] a recluse.
You may also find that people don’t know how to react to you or what to say when you are unwell, perhaps because they don’t understand your condition or because they are worried that they might make you feel worse.
For example, if you were feeling suicidal, your friends may have been afraid that anything they said might have encouraged you to attempt suicide. This can make you feel that nobody understands you, and make you feel isolated and lonely.Sometimes your mental health problems can affect the way you interact with people or cause you to behave in a way that other people find difficult. For example, your condition may mean that at times you lack inhibitions or you may find it hard to care for your appearance. You may have behaved angrily or aggressively during a period of mental ill-health, or falsely accused a friend of something, causing them distress. This could mean that it is sometimes difficult to make friends or maintain existing relationships.In these situations, it may be worth trying to have an open conversation with your friends so that they understand more about your condition and the way it can affect you.
How can I overcome feelings of loneliness?
For many people, overcoming loneliness is about increasing the level of social contact that they have with other people and there are different ways to do this. However, if you experience feelings of loneliness that are unrelated to social contact, you may need to develop different strategies to help you overcome this. We discuss both types of strategy here.
Connecting with the world around you
The way I deal with loneliness is to go out and spend time outside, have a small conversation with the cashier as I pay for my things, phone my mum or see a close friend.
For some people, feeling lonely is not about how many friends they have, but about feeling disconnected from the rest of the world. In this case, it can help to take small steps to feel more connected with the world around you.Making contact with people you know can be a useful first step in helping you feel less alone. If you have friends or family, phoning someone, or sending a text or email, can help make you feel more grounded and remind you that there are people in your life. Sometimes just going outside for a walk and seeing other people in the street, perhaps saying hello to someone you know, can make you feel a bit better.If you are with other people or in a group situation, it can be easy to stay quiet or hide behind your phone. However, this can make you feel lonelier in the long run. Although it may feel difficult, joining in the conversation, even a bit, can often help you feel less isolated.
Making the most of social contact
If you are lonely, it can help to make the most of opportunities for social contact, however small.If you work, pick your children up from school, or have a friendly neighbour or shopkeeper, starting a conversation – or even just saying hello – can make you feel less alone.If you are out of practice talking to people, starting a conversation may seem daunting at first. If you find it hard knowing what to say, try asking people about themselves and what they are interested in.
If you don’t get an enthusiastic reply, the main thing is not to take it personally. The other person may be having a bad day that is nothing to do with you or may feel shy too. You might get a more positive response from someone else.
Meeting people and making friends
For many people, meeting new people and making friends can help them overcome their feelings of loneliness.Many people meet their friends through their daily lives – for example, through work, their children’s schools or through people they already know. But for people who do not work, or live away from friends and family, it can be difficult to meet new people.One way is through making links with people with shared experiences, values or interests. Think about something that interests you. This could be anything from walking or watching films to making model cars. If you join a social group to do with something that genuinely interests you, you should find that you meet people who share your interests and get to do something you enjoy. You can find information about local groups, clubs or classes at your local library, in local newspapers or magazines, or online.I have joined groups and made new friends, very good friends, and met like minded souls. I am creating connections and starting to engage with the world around me.Here are a few ideas:
- exercise classes or walking groups
- social groups for lesbian, gay or bisexual people
- art, music or poetry groups
- church, religious and spiritual meetings and services
- dance classes
- gardening groups
- IT classes
- parent and baby clubs
- meditation groups
- political groups
- slimming clubs
- sports clubs
- voluntary organisations
Meeting people online
For many people, the internet is a good way to connect with people and make friends. There are a huge number of forums, social networks and dating sites that can put you in touch with people you share interests with. Many strong and long-lasting relationships start on the internet, including many where people only ever meet online.However, it’s important to use common sense when you’re online. You don’t always know who you’re talking to so you should think carefully about what information you want to share. It is a good idea to use well-known websites and never share bank details or personal information with people you don’t know.
If you feel lonely because of a mental health problem, you may find that going to a peer support group could help. In a peer support group, people with mental health problems can share their feelings and experiences with people who have gone through similar things. In the UK, there are many local support groups for people with mental health problems, including at some local Minds. The internet can also be a useful resource for peer support. There are many websites and blogs about mental health, and some organisations, such as Mind, also have online communities where people with mental heath problems can discuss their experiences and offer each other support.
Reading about, and talking to, people who have shared experiences of mental health problems online may help you feel less alone. Elefriends is a safe, supportive online community where you can listen, share and be heard.
Learning to spend time alone
I never feel a sense of loneliness when I’m at home. I have made my home into a warm, tranquil place where I feel safe and secure.
It may be that, despite your best efforts, you do not succeed in achieving the social contact that you feel you need. Or you may be someone who constantly seeks others out to avoid inner loneliness, and panics when left alone. In either case, it may be worth learning how to make the best of being alone and how to feel comfortable in your own company.Periods of time spent alone can be rewarding. Being on your own gives you a chance to do something that you enjoy or really interests you. This could be anything, from visiting a tourist attraction to cooking something from a more complicated recipe than you would usually use. Focus on the pleasure it gives you and the fact that being alone can be a positive thing.If you usually avoid being on your own, learning to be alone can be hard and may involve facing difficult feelings. However, having time to think and reflect on things when you’re on your own can be positive.Techniques like yoga, meditation, or keeping a journal, can help you to relax and replace frantic activity with a calmer sense of yourself.If you spend a lot of time alone, you may also find that having a pet, such as a dog or a cat, can also help reduce your feelings of loneliness.
What other help is available?
After living a life full of loneliness, I thought nothing could change. But after I started therapy, I realised things can actually get better, despite the neglect, abuse and mental health difficulties I suffered with.
You may find that, despite your best efforts, you are unable to get the social contact that you need or that you experience feelings of constant loneliness that you can’t resolve by yourself. In these cases, a talking treatment, such as counselling or psychotherapy, may help. Talking to a therapist allows you to explore and understand your feelings of loneliness and can help you develop positive ways of dealing with them. See talking treatments for more information.If anxiety about social situations has made you isolated, cognitive behaviour therapy (CBT) may help. CBT is a form of therapy that focuses on how you think about the things going on in your life – your thoughts, images, beliefs and attitudes – and how this impacts on the way you behave and deal with emotional problems. It then looks at how you can change any negative patterns of thinking or behaviour that may be causing you difficulties. It has been found to be particularly effective for anxiety-based conditions, including agoraphobia and social phobia. See cognitive behaviour therapy for more information.If you want to try a talking treatment, your GP should be able to provide information and refer you to a local service, or you could contact the Mind infoline for details of voluntary or private services
What can family and friends do to help?
This section is for friends and family who want to support someone they know who is lonely.You may be worried that a friend or relative is lonely, perhaps because they are socially isolated or because someone has told you they are lonely. You may not be able to resolve this for them but there are things you can do to help.
Keep in touch
If you think, or know, that someone is lonely – for example, after a bereavement or relationship break-up – a small gesture, such as inviting them for lunch, or even just saying hello, can make them feel less alone.If someone lives far away or you are too busy to visit, make whatever contact you can. Phone, email, text or Skype to let them know you are thinking of them.
Show your support
Be aware of how your behaviour might impact on someone who is lonely, and think about how you can be more supportive and encouraging. For example, if you cancel a date that your friend or relative was looking forward to, it may have more of an impact on them than you realise. Or you may want your friend or family member to meet new people in their area but, if you are negative about the activities available, they may not want to go.You can also support someone in building a social network. Be encouraging about opportunities for social contact and find out what activities or groups there are in their area. Go with them to a class or group for the first time if they feel nervous. If transport is an issue, you could help your friend or family member get a bus pass or work out their local transport network.
If someone tells you that they feel lonely, despite seeming to have lots of friends and social contact, talk to them about why they feel like this and listen to their feelings and concerns. Help them feel that someone cares and wants to understand.If you are worried that someone’s loneliness is because of a mental health problem, or might become one, talk to them about what might help. This might be going to see their GP, getting a talking treatment or joining a support group. See Understanding mental heath problems for more information
Mind Infoline: 0300 123 3393 (Monday to Friday 9am to 6pm)
Details of local Minds and other local services, including peer
support groups and volunteering opportunities in Mind shops, and
Mind’s Legal Advice Line. Language Line is available for talking in a
language other than English.
advice line: 0800 169 65 65
Advice and information for older people.
helpline: 08444 775 774
Support and information for people suffering from anxiety disorders.
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
tel: 0161 705 4304
Details of accredited therapists.
British Association for Counselling and Psychotherapy (BACP)
tel: 01455 883 300
Details of practitioners in your area.
advice line: 0808 808 7777
Independent information and support for carers.
Contact the Elderly
tel: 0800 716 543
Social activities for people over 75 with little or no social support.
Elephant in the Room
Mind’s online peer support Facebook page.
helpline: 0808 802 0925
Advice and practical support for single parents.
Help for Adult Victims of Child Abuse (HAVOCA)
Support and advice for adults suffering from past childhood abuse.
London Lesbian and Gay Switchboard
helpline: 0300 330 0630
Support and information for lesbian, gay, bisexual and transgendered
people in the UK.
tel: 0300 100 1234
Counselling for adults with relationship difficulties.
Chris, PO Box 90 90
Stirling FK8 2SA
helpline: 08457 90 90 90
24-hour support for anyone in distress or despair.
Information about volunteering opportunities.
Information about volunteering opportunities.
Medical- The NHS has failed the public over access to Urgent & Emergency Care
Updated: 08 May 2013
NHS England announces plan to tackle A&E waiting times
3 May 2013 | By Sofia Lind
NHS England has told its local area teams to prepare a plan by the end of the month to tackle waiting times in
A&E departments, including how primary care and other services can ease the rising pressure on emergency
NHS chiefs also said today that they will publish a plan over the next week about how they will support local
commissioners and when they will intervene if a CCG is failing to control demand for urgent care services.
The move comes after a political row over waiting times at A&E departments, with Jeremy Hunt blaming ‘poor
primary care provision’ for a rise in A&E attendances since the 2004 GP contract allowed GPs to opt out of out-
of-hours care provision.
Earlier this month, the Labour Party published figures that showed the NHS had missed the national four-hour
A&E wait target every week for six months.
At a board meeting today, NHS England interim chief operating officer Dame Barbara Hakin said she will ask
local area teams to work with CCGs and local government to put together a full plan for how urgent care should
be managed in their local area to reduce waiting times for patients in A&E, involving primary care as well as NHS
She said: ‘I will be asking our area team directors to take responsibility for a plan for their local area… and to put
together a full plan by the end of the month.’
‘They will take repsonsibility to make sure patients don’t wait an unreasonable time.’
NHS England chief executive Sir David Nicholson said NHS England will also launch two ‘interventions’ to
ensure continued good care for patients locally next week.
One will be the ‘whole systems plans’ for urgent care, while the other will outline how NHS England will work to
‘develop and support’ CCGs as well as when it is approporate for NHS England to intervene to ensure patients
receive good care locally.
He said : ‘We know there are real pressures on social care, primary care, hospitals… We have been working to
support A&E services and in the last week we have seen some improvement to services but this is a whole
He said: ‘We will next week publish two interventions. The whole system plans that we expect to be put
together… so that we can begin to see improvements. This is a very important intervention. We will also publish
[a plan for] how to develop and support CCGs, and how to intervene when it is appropriate.’
The board meeting also saw NHS England approving its future plan for NHS 111, which will include an external
review to learn lessons from the failings of the rollout as well as as an internal look at how the service should be
taken forward including whether it has ‘got the scope right’ and if there is ‘a good balance’ between clinical and
non-clinical call handling.
Dame Barbara said: ‘NHS 111 services have been undeniably unacceptable in some places but it is really
important that we remember that in most places it has worked very well.’
She added: ‘Our ambition continues to be that over the next few months we will have 111 available everywhere.’
But the RCGP has called today for better support for NHS 111 to help it properly direct patients to the most
appropriate form of care.
RCGP chair Dr Clare Gerada said: ‘It is extremely worrying that there is still so much uncertainty around the
delivery and reliability of the advice provided by NHS 111 in some areas.
‘We are also concerned that patients are losing confidence in the new service before it is even fully up and
running. We call on NHS England to provide more reassurance about its effectiveness and ability to deliver the
necessary standards of care for all patients using the service, right across England.
Medical- Doctors Criticised For Not Questioning Poor Hospital Care
Updated: 03 May 2013
Analysis: Do GPs have the teeth to act as hospital watchdogs?
2 May 2013 | By Caroline Price
As the NHS absorbs the implications of the Mid Staffs report, Caroline Price asks how GPs can monitor hospitals
if their complaints are not acted upon
The inquiry led by Robert Francis QC into the horror story that was the Mid Staffordshire scandal sent
shockwaves through the medical profession as well as the rest of society.
Doctors have been criticised for not being ready enough to question the system when things go wrong.
Mr Francis himself singled out local GPs for only raising ‘substantive’ complaints once the investigation had
already been set up.
And with GPs now in the commissioning driving seat, the onus appears to increasingly be on general practice to
stop the next Mid Staffs before it happens.
But are GPs really in a position to police quality across the wider NHS?
A Pulse survey of 343 GPs suggests even when the profession does raise concerns about the quality or safety of
hospital care, they are too often ignored. Some 40% of the GPs who responded had raised concerns about care
with their local hospital in the past 12 months alone.
But of those who had raised concerns, almost a third (31%) said their information was not listened to or, where
appropriate, acted on, while a similar number (30%) said they do not know if their complaint was acted upon.
Among the issues the GPs reported were medication delays, discharge errors and high rates of readmissions
after premature discharge.
Patient ‘shouted at’
One GP from Birmingham, who says their patient was shouted at and then refused admission to A&E at their local
foundation trust, despite needing urgent care, says: ‘It turned out the patient was in terminal renal failure and our
registrar had every right to send him in.
‘The patient eventually went to another hospital and ended up in intensive care.
‘The consultant sent a letter back saying it would be investigated in the hospital and it should not happen again
but we have heard nothing since – it was just to protect themselves.’
‘Sometimes you don’t get [discharge information] at all, sometimes after a few weeks.
And not enough information is given, especially from A&E.
We learned that A&E discharges were done by receptionists on night duties.
‘The main [problem in the past 12 months] was the quality of discharge letters from A&E, which we have raised
officially to no satisfactory outcome.’
GP from north-west England
‘The registrar on call sent the patient away – he shouted at him. It turned out the patient was in terminal renal
failure and our registrar had every right to send him in. The patient eventually went to another hospital and ended
up in intensive care.’
GP in Birmingham
‘[Complaints] are just not responded to, or I’m told I’ll get a response within a certain time and then it is either half-
baked or doesn’t really answer the query.’
GP from north-west London
Dr Mary Hawking, who recently retired after over 30 years as a GP in Bedfordshire, said she had raised many
concerns stemming from the poor quality of discharge from hospitals.
She says: ‘The problem is, you send off a complaint and it gets completely lost. I’ve tried various tactics, sending
it to the chief executive [of the trust], to the PCT, trying to get the official channels involved and nothing at all
A duty of candour
Problems of this kind are not new.
Last year, Pulse revealed a similar high level of concern among GPs about standards of care at local hospitals,
with one GP in seven claiming that one or more of the departments at their local hospital was ‘dangerously
But the Francis Inquiry has concentrated minds on the role of GPs in ensuring quality of hospital care.
One of its central recommendations was that GPs should play an active role in monitoring hospital care and have
systems to identify ‘patterns of concern’.
At the time of the publication of the report, Prime Minister David Cameron backed the recommendation, calling for
GPs to be ‘more enquiring’ about what happens to their patients in hospital.
Ministers have said that they want all providers to have a ‘duty of candour’ over their mistakes but have not
clarified how this will apply to practices.
The Government is introducing chief inspectors for hospitals and care homes – and considering the equivalent
for primary care – but it is not clear how this will prevent the ‘next Mid Staffs’ that is predicted by some
Dr Grant Ingrams, a GP in Coventry, says: ‘There is still a question over what duty is going to be placed on GPs. If
it is to notify whoever we believe is the appropriate person each and every time we find a problem and to actively
monitor patients when they are in hospital, we can’t do it.
We don’t have the resources.’
A spokesperson for NHS England says it ‘strongly supports’ the recommendation that GPs should take a greater
role in monitoring the quality of their patients’ hospital care.
She says: ‘The introduction of clinical commissioning groups provides an unprecedented opportunity for GPs
and GP practices to work together more collaboratively and systematically in sharing intelligence about quality of
care for their patients.’
RCGP chair Professor Clare Gerada says there must be better systems for GPs to ‘feed back patient concerns
about hospital care’, but she draws the line at the profession having formal responsibility for what goes on in
She says: ‘Patients and their GPs need to be confident that they will receive good and safe care in hospital.
we do need to be clear about where the boundaries lie in terms of the GP’s role here.
‘GPs should not ultimately be responsible for the standards of care in hospitals but it is important that any
concerns GPs have are raised, to help hospitals improve patient care.’
The GPC agrees, saying CCGs should assume the responsibility for collecting data and making it easier for
practices to raise concerns.
Dr Chaand Nagpaul, GPC negotiator, says: ‘Individual practices should certainly be able to relay feedback, but we
need to be realistic about the extent to which GP practices can provide information about hospitals – we can’t
assume GPs hold all the keys to assessing hospital performance.
‘I think this a role for CCGs – they should be facilitating the processes to allow practices to raise concerns as part
of their commissioning function.
‘In my area we have a “service alert” form. The GP practice sends that to the CCG so even for a single event, if
many practices notice the same problem it helps to identify trends and take action on service issues.’
CCGs take action
There are signs that CCGs are getting the message.
The CCGs that have taken over the Staffordshire area say they are looking closely at how they can monitor their
providers more closely.
Andrew Donald, chief officer for Stafford and Surrounds and Cannock Chase CCGs, says: ‘We’re Mid Staffs, we
have to be exemplars for the new system.’
He adds: ‘We have a fairly structured way of getting feedback.
There’s an information sheet that we ask people to complete and send through, and if there’s a problem with an
acute trust there’s a GP advice line that directs into Mid Staffs.
This has been well established for three years now.
‘We’re also asking GPs to get their patients to keep diaries to write about their experiences as they go through the
We have had discussions on Francis – about GPs not abdicating responsibility for their patients once they have
left the surgery.
It’s about saying, “how do we follow patients through?”.
‘The idea of having patient diaries could be a good way of doing that – creating opportunities for patients to give
feedback as they’re going through the process.’
Dr Michael Dixon, interim president of NHS Clinical Commissioners, says CCGs will be ‘morally obliged’ to act on
the concerns of GPs.
He adds: ‘I think CCGs will want to put resource towards this, because this is part of improving and redesigning
This will not only involve totting up the problems but also the solutions as well – which probably pay for the job in
terms of saving resources for the future.
‘I think there may be short-term benefits – if patients receive atrocious care I can see CCGs not paying the bill,
putting a service on hold or on probation.
‘What we’re stymied by at the moment is the complete paralysis of the past, where if a patient had a bad deal, all
the payments had been made in the past through payment by results.
This is exactly the sort of re-engineering that CCGs are going to need to do; if you get
a shoddy service, you don’t pay for it.’
One complicating factor for GPs in this new era of openness could be the CCGs themselves, however.
Last month a Pulse investigation revealed that hundreds of GPs have been obliged to sign up to ‘gagging
clauses’ under their CCG constitutions.
While GPs have historically been free to speak publicly and to the media about their local NHS, from 1 April more
than 200 practices across five CCGs – NHS Newbury and District, NHS Sutton, NHS Dorset, NHS Thurrock and
NHS Windsor, Ascot and Maidenhead – have been prevented from making any ‘public statement’ about CCG
matters without prior written approval. Members of the governing bodies of five further CCGs are bound by similar
Such clauses do not remove GPs’ ability to blow the whistle on specific concerns about patient safety, and CCG
leaders have defended the move, insisting it is simply to ensure a ‘consistent view’ on local services.
But critics have attacked the clauses as unacceptable, with the GPC warning that ‘in the post-Francis world,
practices should not be restrained or put under any pressure with regards to not voicing concerns’.
A key plank of the reforms was to shift power and influence into GPs’ hands, but it seems GPs will need to keep
fighting on all fronts to make sure their voices are heard
Medical- How to Blow the Whistle on Hospital Care Concerns
Updated: 02 May 2013
How to blow the whistle on hospital care
29 April 2013
Dr Michael Devlin talks through what GPs should do if they have concerns about care at their local hospital, in
light of the Francis report recommendation that GPs should monitor their patients’ care in hospital.
GPs have a duty to raise concerns with their own employer or with external providers under the GMC Good
Medical Practice guidance.
Their overriding ethical responsibility means they have an obligation to take action if they think that patient safety,
dignity or comfort has been seriously compromised. GPs should not enter into a contract that prevents or
restricts them from raising concerns about patient safety.
The GMC’s supplementary guidance Raising and acting on concerns about patient safety (2012) explains how to
take action and what to do if the concerns are not acted on, or are not acted on properly. Paragraphs 7 and 8
explain the duty to raise concerns as follows:
‘All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by
the practice of colleagues or the systems, policies and procedures in the organisations in which they work. They
must also encourage and support a culture in which staff can raise concerns openly and safely.
‘You must not enter into contracts or agreements with your employing or contracting body that seek to prevent you
from or restrict you in raising concerns about patient safety. Contracts or agreements are void if they intend to stop
an employee from making a protected disclosure.’
Most GPs will have very constructive working relationships with colleagues in secondary care and will be able to
resolve any concerns informally in a prompt and satisfactory way.
Where there is a systemic or significant patient safety concern then it is appropriate to go to someone higher up
in the organisation who has operational oversight and will be able to delegate responsibility for investigating the
concerns to the right person and take the necessary action.
Where serious patient safety concerns are identified, the stages described below will help ensure that they are
raised in a prompt, proportionate way.
- Report concerns immediately – do not delay as you are not in a position to put the matter right yourself.
- This may be by telephone initially, but put your concerns in writing to the trust’s medical director or other appropriate officer to ensure that they are accurately summarised and reported
- Keep a clear record of concerns, the steps you have taken and all correspondence
- Expect a prompt investigation and a written response from the trust explaining what was found and any action taken to rectify the problem
- If no response or an unsatisfactory response is received, consider escalating complaint further – see Stage 2.
- Escalate the complaint within the trust. Contact the trust’s chief executive, including all details and correspondence
- Also consider informing commissioners. Speak to your CCG board, CSU or NHS England local area team medical director
- If no response or an unsatisfactory response is received, consider escalating complaint further by raising the matter with the relevant regulator – see Stage 3.
- If you have not been able to raise the issue locally with the responsible person because they are part of the problem, or where your concerns have been dismissed without good cause and where there remains an immediate and serious risk to patients then your duty is to raise the matter with the regulator (e.g. GMC or CQC) who may have responsibility to act.
- If you are unsure get advice from your medical defence organisation, BMA/LMC, professional bodies, the NHS Whistleblowing helpline (http://wbhelpline.org.uk/) or Public Concern at Work (a charity that provides free, confidential legal advice)
- In exceptional circumstances, where the stages above have been followed but you believe that patients remain at risk of harm, you may consider whether to make your concerns public
- You should get advice from your medical defence organisation or other bodies mentioned in stage 3 before taking such action, and refer to GMC guidance on making concerns public. This guidance says that this is justified provided the concern is formed in good faith and you must be scrupulous in protecting patient confidentiality
- Don’t disclose confidential information and manage the process carefully. Consider making a single disclosure of essential information to one media organisation you can trust
Dr Michael Devlin is head of advisory services at the Medical Defence Union
Medical- GP support for Tories plummets
Updated: 02 May 2013
GP support for Conservatives plummets
as party loses trust over health policies
1 May 2013 |
By Alisdair Stirling
Exclusive GP faith in the Conservative Party has plummeted over their health reforms, with only 12% of the
profession saying it is the political party they trust most to manage the NHS.
The Pulse survey of 364 GPs showed Labour was the most trusted on the NHS, with 28% backing the party on
managing the health service. Only 12% backed the Conservative Party, 8% each backed the Green Party and the
Lib Dems, and 6% said UKIP.
By far the largest percentage (35%) thought no party was trustworthy when it came to managing the NHS.
This margin was also translated to GP voting intentions, with 26% saying they would vote for Labour in the next
election and 19% of GPs saying they would vote Conservative.
On the eve of local elections across the country, around 10% of GPs plan to vote for each of the Green Party and
Some 8% said they would vote Liberal Democrat and 4% for a range of other parties including the Scottish
Nationalists, Plaid Cymru, the British National Party, the National Health Action Party and the Monster Raving
The 255 GP partners who responded were more distrustful of all the main political parties than their colleagues as
a whole, with 36% saying they would not trust any party with the NHS.
The 47 salaried GPs who responded were more likely to vote Labour (44%) and to trust Labour with the health
service (42%) than were other types of GPs.
A Pulse poll in 2009 found fewer than one in ten GPs now planned to vote Labour in the next general election,
with support for the Conservatives at more than 50%.
A similar poll in 2010 found just 15% would vote Labour, and only 17% prefer Labour’s health policies, compared
with 53% who planned to vote Conservative and 30% who supported their health policies.
Which party do you trust most in managing the NHS?
Lib Dems 8%
Source: Pulse survey of 364 GPs
Dr Robert Morley, executive director Birmingham LMC, said: ‘Trust in this Government has fallen because it is the
current Government and it has shafted us.
Just like the previous Government shafted us, and the just like the next Government will shaft us.
‘It is to do with everything they are doing, through the GP contract, the NHS reforms… they are politicians and
they act to their own ends. We have a job to do which is to look after patients, while their job is to get votes.’
Family Doctor Association chair Dr Peter Swinyard, a GP in Swindon, illustrated GPs’ disillusionment’ with the
political reforms of the NHS.
He said: ‘Politicians don’t run the NHS, they meddle in it. The last politician who tried to do something useful with
the NHS was Andrew Lansley and look where that got him.’
Dr Paul Charlson, a GP and former chair and now head of policy for Conservative Health, said he was ‘not
desperately surprised’ that GPs were cynical over the Government’s handling of the NHS.
He said: ‘I find it a bit disingenuous and disappointing that we spent a lot of time thinking about how to get GPs
involved in running the NHS and so many of them don’t appear to be up for it.’
Dr Richard Vautrey, GPC deputy chair said: ‘The changes in the past two to three years build on those introduced
under previous governments, so all parties are complicit in the changes. And because of the coalition, those GPs
who hoped the Liberal Democrats would bring a new take on things have not been proved right.’
Dr Catti Moss, a GP in Guilsborough, Northamptonshire, said she would vote Green in the next election. She said:
‘The problem is I’ve been a GP since 1982 and I’ve worked through five major reorganisations. All of us can see
the problems but the constant temptation to reorganise gets us into a cycle where the system gets changed but
people don’t benefit.’
Jamie Reed, Labour’s shadow health minister, said: ‘This is a damning indictment of David Cameron’s NHS
‘GPs repeatedly warned the Prime Minister over his chaotic NHS re-organisation and decision to force GP
commissioners to put every contract out to tender, but he ploughed on regardless. Doctors are now abandoning
him in droves – showing a complete lack of faith in the Tories’ handling of the NHS.’
A Conservative spokesperson said: ‘The Conservative Party is putting patients at the heart of the NHS, working
to ensure that the quality of care is as good as the quality treatment, and protecting the NHS budget.’
Medical- A&E-Poor Primary Health Service- Secretary Hunt & GP Out of Hours Care
Updated: 30 Apr 2013
Hunt will take steps to improve GP out-of-hours care
'in the next few months'
29 April 2013 | By Sofia Lind
Jeremy Hunt has pledged to improve the quality of GP out-of-hours services within ‘the next few months’, after a
week of rhetoric blaming the poor provision of primary care for A&E pressures.
Speaking to Pulse, the health secretary acknowledged there was ‘some good out-of-hours care’, but said that the
system was currently ‘disjointed’. He refused to say whether NHS England medical director Sir Bruce Keogh’s
ongoing review of urgent and emergency care might result in GPs being asked to resume responsibilty for out-
of=hours provision, but did not rule it out.
Asked whether there would be changes to the GP contract to hand out-of-hours responsibility back to the
profession, Mr Hunt said: ‘Well I have put the issue on the table, because I think we do have an issue with the
quality of out-of-hours care and I think that the changes in the GP contract were one of the main reasons why we
I don’t think that was the only reason that we have problems in many A&E departments but I do think it is one of
But I haven’t said how we are going to address it because there is a lot of work that we need to do over the
coming months to work out the best way of addressing this.’
‘But the point we have to get to at the end is where the public have confidence in out-of-hours care.
There is some good out-of-hours care, don’t get me wrong, but the system can be very disjointed.
You can feel that your GP might know about you, but [if] you contact someone out of hours they might know
nothing about you and then there’s the option of A&E and 111 and we need to find a way of making sure that we
have a more joined-up system which gives people confidence so that they don’t feel they have to go to A&E,
which is very often not the best place to go.’
When put on the spot on whether this would require GPs to take back out-of-hours responsibility, he added: ‘Well
I know you are trying to draw me, but let me… It might mean lots of things, but the point I really want to make is
that we need to improve out-of-hours care as one of the key things and this is something that we will be applying
ourselves to in the next few months.’
Sir Bruce Keogh’s review, which has looked at out-of-hours provision as part of its remit, is due to report next
Medical- GP's have "untapped potential" to improve preventing ill health
Updated: 27 Apr 2013
GPs urged to take 'proactive approach' to preventing ill-health
25 April 2013 | By Madlen Davies
GP practices have ‘untapped potential’ and should take a more ‘proactive approach’ to improving the health of
their patients, an NAPC-commissioned report says.
The report, carried out by the Nuffield Trust on behalf of the NAPC, said that GPs need to go beyond curing
immediate illness and should proactively prevent ill-health.
It said interventions from the health services could help educate patients on the leading risk factors for illness and
disability, which include hypertension, tobacco, alcohol misuse, high body mass index and low physical activity
to prevent ill health.
GPs, with their registered lists of patients and neighbouring practices with whom collaborations could be
organised, have ‘untapped potential’ to take a more active role in improving health and preventing illness, it said.
The report drew on current research, analysed routine data taken from a notional general practice of 10,000
patients to identify potential actions to improve community health and interviewed GPs and practice managers
currently developing and testing new approaches to population health management with the NAPC.
The report said: ‘General practices, with its registered list of patients, has untapped potential to engage in a more
proactive approach to improving the health and wellbeing of the local population. Such a focus is essential if the
NHS is to meet the challenges of responding to the rising rates of chronic illness at all ages of the population,
during a time of financial austerity.
‘There are already examples of GP-led practices engaging in work to improve access, outreach and management
of both their chronically ill patients and those who are still healthy.’
Stroke and cardiovascular disease are top of the list of conditions underlying emergency admissions, and while
many are appropriate, others may have been avoidable through better preventative care, it said.
It added that significant number of patients would not attend the practice once over the course of a year, therefore
GPs will need to devise ways of reaching out to those registered but not regularly attending, in order to
understand their lifestyle risks.
The report’s final recommendation was that the NHS should encourage CCGs to fund GP lead roles in population
health, in order to create enthusiastic leaders who will articulate a vision of proactive general practice.
However, the report also found there were barriers to GPs taking on a more proactive role. It admitted that many
GPs do not accept that population health is their responsibility, and they lack the training and skills to use public
health data and techniques.
There are also fears the current reforms will distance the NHS from wider public health efforts coordinated by
Public Health England, when public health professionals have not worked closely with general practice in the
past. The report called on the DH to assess whether public health officials are building the required relationships
with CCGs and GPs.
Another barrier is that the financial pressure on NHS England may result in CCGs focusing on meeting short-term
goals resulting in quick financial wins (such as reducing elective or emergency admissions) rather than investing
in preventative initiatives which can take years to change results, it said.
Ms Ruth Thorlby, Nuffield Trust Senior Research Fellow and author of the report said: ‘Many people have called
for general practices to take a more proactive approach to population health in recent decades. We found that in
this report for the NAPC that there is enthusiasm in general practice to make this vision real: at seems to be
important is to allow local practices to define what this means for themselves, alongside identifying and
supporting a cadre of GPs and other primary care staff to act as leaders
‘The immediate financial pressure on the NHS must not squeeze out investment in more prevention initiatives,
which can often take several years to come to fruition.
‘In theory, NHS England and Monitor should enable flexibility in pricing and contractual systems, which could
support innovation between general practice and other providers, and tilt the financial system away from the
acute sector. However this means creating space for general practice to innovate as providers and not being
inhibited by concerns about conflicts of interest.’
Medical- A&E historically treated as a second class service against other Surgical Specialities
Updated: 25 Apr 2013
The Telegraph reports that A&E patients are sleeping in cupboards and corridors, as waiting times routinely reach
12 hours in some parts of the country and ‘queue nurses’ are appointed to watch over patients brought in by
Nurses said the problems have exploded in recent weeks, following the national rollout of the 111 urgent care
Official figures submitted by NHS trusts to the DH show that 27,247 patients spent longer than four hours in an
emergency department in the week ending 17 March, compared with 13,200 in the same week last year
Medical - Freedom From Torture Dr's investigate physical and psychological abuse
Updated: 23 Apr 2013
A day in the life: Dr Angela Burnett, lead doctor at Freedom from Torture
18 April 2013
Dr Burnett talks Pulse through a typical day at the charity for the treatment and rehabilitation of survivors of torture
and explains how their data is influencing international research
Name Dr Angela Burnett
Location North East London
Role GP and lead doctor at Freedom from Torture
After dropping my younger daughter at school I set off on my bicycle to Freedom from Torture’s office in Finsbury
Cycling is often the quickest way to get around London plus it’s cheap and good exercise.
I started volunteering at the human rights organisation in 1995, ten years after it was founded, when it was the
Medical Foundation for the Care of Victims of Torture. I work here two days per week and the rest of the week I
work as a GP with people who are homeless and vulnerably housed.
At Freedom from Torture I work as one of the lead doctors in the Medico Legal Reports Team. Freedom from
Torture’s doctors, the majority of whom are volunteers, have an important role in assessing the health of survivors
Those in my team write medico-legal reports (MLRs), documenting medical evidence of a person’s physical and
The reports are commissioned by legal representatives and are submitted as expert reports – to the Home Office,
for first instance asylum decisions, or to the Tribunal, for appeal cases – to help their case for protection in the UK.
The account of torture is assessed in accordance with international guidelines set out in the Istanbul Protocol,
asserting the consistency of the evidence with the individual’s account of torture.
I catch up with our administrative team who provide excellent support, obtaining and processing important
documents and importantly sending the finished reports to lawyers.
Our multi-disciplinary team also includes lawyers, so we have a rich mixture of expertise.
I catch up with the other doctors and legal colleagues and discuss any challenging cases and urgent deadlines of
an imminent court hearing
All our MLRs are independently checked by a medical specialist reviewer, of which I am one, and also by a legal
Each report takes about an hour to review – I need to check that no relevant details have been omitted
I chair a monthly meeting for doctors where we discuss clinical and administrative issues arising from the work,
workload and anything that the doctors wish to raise.
It’s also a good opportunity to catch up with each other.
I’m meeting my mentee who is a GP from London who started working here six months ago.
As the work is so different from what doctors have done before we offer all new doctors a mentor who works with
them 1-2-1 and offers guidance and support. All the doctors who work here are driven by a passion to help and
support people who have experienced trauma that most people would find impossible to comprehend.
A few years ago I set up peer support groups which meet monthly so doctors can meet to discuss the challenges
of the work, exchange thoughts and ideas and gain support.
The issues discussed with mentors and peers are practical and emotional, as the work doctors do here can be
A doctor will typically see a patient for three, two hour assessments – though these can be longer, where they
document the account of torture in detail.
This involves noting down a full history of their ill-treatment, which may include beating, burns or rape.
Physical scars are assessed and other injuries such as badly healed fractures, lacerations, burns, damaged
ligaments, or chronic bone infections, including where they are on the body, are meticulously recorded.
They also document evidence of severe psychological problems.
This is why we allow such a lot of time.
It is important that the patient does not feel hurried or pressurised and they can disclose at their own pace - it’s
crucial we build trust with patients so they feel able to reveal even the most distressing things that happened to
Many clients require interpreters and we have a skilled team with whom we work.
To enable patients to get the best care and support we may refer them to Freedom from Torture’s clinicians who
can provide them with the long-term psychological help and support they may need.
Doctors also liaise with a patient’s GP, (if given consent to do so) which is an important part of the work. As a GP
myself I am fully aware of the pressures which many GPs work under – lack of time, lack of continuity and poor
access to interpreters. A letter from one of our doctors here can be extremely helpful for a GP who may not even be
aware of a patient’s history of torture.
I meet with a colleague for her appraisal. Many of our doctors are retired or have a portfolio career, and may
therefore not have an NHS appraisal.
We have our own Responsible Officer and can therefore offer appraisals and revalidation for any of our doctors
who need this.
I head home.
My daughters are home from school and college and my husband cooks dinner as he’s home before me (I’ll be
doing some cooking at weekends).
He’s a fantastic support for me – he works as an imaging assistant in hospital. In the evening I’ll help my daughter
with school work and do a bit of reading to stay on top of the latest research.
Our department works with Freedom from Torture’s policy and external affairs team where our MLRs form the
basis of our research reports, which aims to hold torturing states to account.
Our most recent report on torture in Iran was based on evidence from the MLRs we produced for Iranian patients.
The UN Special Rapporteur on Iran, Dr Ahmed Shaheed, drew on, and included, our research in the report he presented to the UN Human Rights Council in March.
Our MLR team is commissioned to write about 600 reports a year and we’re currently looking for more volunteers
in London, Manchester and Birmingham. Volunteers work a varying amount of time - the minimum required is a
session (at least four hours) per week or fortnight.
The work can be intensely stressful, as you’re dealing with such extreme accounts of brutality.
The doctors we recruit are suitably qualified and are trained in the methods of documentation of torture.
We’re currently looking for volunteer doctors who are looking for the challenge of working here and the
extraordinary help you can provide to survivors of torture - you can see the job descriptions
Medical- GP's have become agents of State Privatisation through their own inaction !
Updated: 23 Apr 2013
GPs are 'agents of state privatisation', says GPC
19 April 2013 |
By Madlen Davies
GPs have become ‘agents of state privatisation’ in a development that threatens the integrity of the whole
profession, says the GPC in the most strongly worded attack it has issued on the Goverment’s reforms so far.
The motion says CCG membership means GPs have become ‘integral agents of state rationing, cost control and
privatisation’ which ‘seriously threatens’ the trust between GPs and their patients, and poses a risk to the integrity
of NHS general practice.
The GPC added that there were significant obstacles in the way of GPs implementing the recommendations of the
Francis report as they will be under pressure from their CCGs to stay within budgets.
The news comes after Pulse revealed that two practices were forced to join their CCG by NHS England against
their wishes, in a move which the GP leaders said flew in the face of the idea that the NHS reforms put more power
into GPs hands.
Hundreds of GPs have also been asked to sign legal agreements in the form of CCG constitutions which prevent
them from speaking in public about anything related to their CCG.
The motion was passed at yesterday’s GPC meeting. Dr Richard Vautrey, deputy chair of the GPC, said: ‘It is
highlighting the difficulty in which GPs are placed because of their position as being both members of the CCGs
and the desire and professional responsibility to provide a service to their patients.’
Dr Chaand Nagpaul added: ‘This motion is describing concerns about how things may pan out. The idea of
membership is a misnomer - in normal membership, you have a choice about whether you want to be a member.
‘The Government speaks of membership as some sort of club where members are all in agreement. But actually
GPs have been forced into it… it forces GPs to be bound by the rules of those organisations even when they
explicitly dissent from the view of the organisation.’
A spokesperson for the Department of Health said: ‘Decisions on treatments should be made by clinicians, based
on what is most clinically appropriate for the patient.
‘Far from putting GPs at odds with the interests of their patients, the changes we have made to the health service
will ensure that it is clinicians who take these decisions in future, based on clinical evidence and in the interests of
The full GPC motion
That the GPC believes that compulsory practice membership of CCGs with statutory duties as defined by the
Health and Social Care Act:
1.risks placing GP partners in a position of untenable conflict between their professional obligations to patients
and the statutory obligations of their practices as CCG members;
2. fundamentally changes the role and nature of general practices, and, in view of recent regulatory changes, risks
forcing them to be integral agents of state rationing, cost control and privatisation, seriously threatening the trust
between GPs and their patients and therefore posing a risk to the very integrity of NHS general practice
3.places significant obstacles in the way of GPs and practices acting in accordance with the recommendations of
the Francis report as they will be under inevitable pressure to comply with their CCGs’ statutory obligations to stay
within budgets and to achieve financially and managerially-driven targets which conflict with the needs of their
4. adds to competing pressures on general practice, particularly following the recent contract imposition, and GPC
recognises that practices must and will prioritise providing safe essential services to their patients and are
therefore very likely to consider limiting their engagement with their CCG and its activities to their contractual
5.leads it to call upon the BMA and local medical committees to rubustly support doctors which are placing the
interests of their patients as their first concern and who may be unable to comply with obligations placed upon
them by the constitution of their CCG where there is evidence that patient safety may be compromised by the
requirements of CCG policy
Medical- Nurses in Training treated as just another pair of hands,just to make up the numbers
Updated: 23 Apr 2013
Nurses: New training plans are 'stupid'
Monday 22 April 2013
by Will Stone Health & Social Affairs Reporter
Plans to force prospective nurses to work for 12 months as healthcare assistants before beginning their nursing
training were slammed as a "really stupid idea" by the Royal College of Nursing (RCN) today.
RCN president Andrea Spyropoulos said that the move was not part of the 290 recommendations made by Robert
Francis QC following his inquiry into deaths at Mid Staffs.
She branded the proposals a waste of taxpayers' money that would roll nursing back by 100 years and said that
the government should instead concentrate on dangerously low staffing levels, which nurses felt are "regularly
The RCN pointed out that the Mid Staffs inquiry did address staffing levels, with Mr Francis stating that hospital
bosses should consider the "benefits and value for money of possible staff-patient ratios."
A poll carried out by the union, which begun its annual conference in Liverpool on Sunday, revealed that 74 per
cent of 2,000 surveyed said staffing levels dropped to unsafe levels at least once a month, while one-third said
patients were put at risk on a weekly basis due to diminished staff numbers.
Even more worryingly, 9.5 per cent of respondents claimed that staff numbers fell to an unsafe level on every
A huge nine in 10 nurses said they would support the introduction of mandatory staffing levels to protect patient safety.
"Without a doubt understaffing is the single biggest challenge facing the NHS today," said RCN general secretary Dr Peter Carter.
"The introduction of mandatory safe staffing levels, enshrined in law is now a matter of extreme urgency.
"Mandatory staffing levels are proven to reduce patient mortality. With correct management, flexibility and
transparency there is no reason that introducing mandatory staffing levels will become a 'race to the bottom' as
some have described it."
A defensive Health Secretary Jeremy Hunt attempted to turn the tables by pointing out that the RCN had come in
for criticism in the Francis report.
He said: "Before they start criticising the government for accepting recommendations that are going to improve
compassionate care throughout the NHS, they need to answer those very, very serious criticisms themselves."
Yet he ignored the issue of staffing levels
Medical- "Handmaidens" silenced by incompetent administrators
Updated: 23 Apr 2013
Whistleblowing nurses 'discouraged'
Press Association – 2 hours 7 minutes ago
A quarter of nurses have been discouraged about blowing the whistle on concerns over patient care, a poll has
The Royal College of Nursing (RCN) survey found that 24% of nurses said they had been warned off raising
concerns - in spite of the Stafford Hospital scandal.
RCN leader Dr Peter Carter said many nurses faced a culture of fear and intimidation at work and this was placing
patient safety at risk.
The poll, conducted on more than 8,200 nurses, found that 44% would think twice about whistle blowing because
of worries about victimisation or reprisals.
One of the key recommendations made by the Mid Staffordshire NHS Foundation Trust public inquiry chairman,
Robert Francis QC, was that concerns and complaints should be able to be raised "freely without fear".
But Dr Carter told the RCN's annual Congress in Liverpool: "These responses illustrate that despite the recent
attention which has been drawn to the importance of whistle blowing, many nurses are still experiencing a culture
of fear and intimidation if they try to speak out.
This is putting patient safety at risk.
"One of the key lessons from the Francis report was that frontline staff must feel confident that they can raise
concerns about patient safety without fear of reprisals.
"Nursing staff want to provide excellent care, but sometimes the systems they work in do not allow this.
Staff know what is safe for their patients and what is not.
However, they cannot raise concerns if they feel unsure about what their employer's policy is or what the
repercussions will be. In particular, nurses have told us about occasions when they have been bullied, ostracised
or belittled when they have tried to raise concerns on behalf of their patients.
"The stakes are simply too high for this to be allowed to continue.
Trusts which don't encourage an open culture from the very top will only continue to make mistakes, sometimes
with devastating consequences."
A third of nurses questioned said they didn't know whether their organisation had a whistle blowing policy, and of
the 64% who had raised concerns, nearly one in ten said they had raised concerns as little as a week ago.
Nearly half of the concerns raised were about staffing levels and 21% were about patient safety, said the RCN.
Meanwhile, 45% of nurses who had raised concerns said their employer took no action.
Medical- Nurses demanded recognised ward staffing levels 60 years ago-Minimum Staffing= Minimum Care
Updated: 20 Apr 2013
Unison members have called for minimum staffing levels to protect hospital patients from the impact of the cuts,
the BBC reports.
A poll of 1,500 midwives, nurses and healthcare assistants across the UK suggested services were under strain.
60% said they did not have enough time to deliver safe and compassionate care.
The union said the government missed an opportunity to implement minimum staffing levels, a proposal put
forward by the public inquiry into the scandal at Stafford Hospital, but that was not agreed to by ministers in their
response last month.
The government said hospitals needed ‘freedom and flexibility’ on staffing
Medical- Abortion rates are highest in countries which impose a ban
Updated: 20 Apr 2013
Rate of abortion is highest in countries where practice is banned
In Africa and Latin America researchers found that 95 to 97 per cent of abortions were unsafe
Friday 20 January 2012
Abortion rates are higher in countries where the procedure is illegal and nearly half of all abortions worldwide are
unsafe, with the vast majority in developing countries, a new study concludes.
Experts could not say whether more liberal laws led to fewer procedures, but said good access to birth control in
those countries resulted in fewer unwanted pregnancies.
The global abortion rate remained virtually unchanged from 2003 to 2008, at about 28 abortions per 1,000 women
aged 15 to 44, a total of about 43.8 million abortions, according to the study. The rate had previously been dropping
About 47,000 women died from unsafe abortions in 2008, and another 8.5 million women had serious medical
complications. Almost all unsafe abortions were in developing countries, where the number of family planning and
contraceptive programmes have stopped increasing.
"An abortion is actually a very simple and safe procedure," said Gilda Sedgh, a senior researcher at the US-based
"All of these deaths and complications are easily avoidable," said Dr Sedgh, the study's lead author.
Dr Sedgh and colleagues concluded that the proportion of unsafe abortions rose from 44 per cent in 1995 to 49 per
cent in 2008, the last year for which statistics were available and studied in the report. Dr Sedgh acknowledged it
was difficult to get an accurate number for unsafe abortions in particular and described their estimates as modest.
They used sources including official statistics, national surveys and hospital records. To account for unreported
abortions, they made adjustments and relied on information from other kinds of studies, expert assessments and
surveys of women.
The research was published yesterday in The Lancet medical journal.
Abortion rates were lowest in Western Europe – at 12 per 1,000 – and highest in Eastern Europe at 43 per 1,000.
The rate in North America was 19 per 1,000.
Dr Sedgh said there was a link between higher abortion rates and regions with more restrictive legislation, such as
in Latin America and Africa. They also found that 95 to 97 per cent of abortions in those regions were unsafe. The
authors defined unsafe abortion as any procedure done by people lacking necessary skills or in places that did not
meet minimal medical standards.
Medical - Age and Ageing - Pain Management in Older People
Updated: 19 Apr 2013
Ten top tips - pain management in older people
17 April 2013
Consultant physician Dr Aza Abdulla and colleagues offer their tips on how to manage pain in older people
1. Use numerical and verbal rating scales to assess pain in older people
Assessment of pain is always challenging, but the range of pain assessment tools that have been validated in
the literature is improving.
Use of verbal descriptors – such as ‘none’, ‘mild’, ‘moderate’, ‘severe’ -and numerical rating scales are well
documented as being appropriate for the older population.
Guidelines for the assessment of pain in the older population are being updated this year by the British Pain
Society and British Geriatric Society.
2. Use the Abbey or Doloplus scale in patients with dementia
The Abbey or Doloplus are tools which are useful for assessing patients with reduced levels of cognitive ability
or communication difficulties, such as those with dementia.
These scales are gaining more evidence in a variety of settings.
3. Don’t overlook pharmacological treatment options because of concerns about potential side effects
Advancing age should not be a barrier to considering pharmacological treatment options for pain -
Having said this, there are surprisingly few studies examining the use of analgesics in older people specifically.
Generally, younger populations have been used and the results then extrapolated to older people -
this can be problematic because of the physiological changes in aging and the impact of comorbidities.
Consider lower initial doses and titrate more slowly than you may in younger patients to minimise side effects.
4. Try paracetamol first line
Paracetamol is the first-line pharmacological treatment for persistent pain in older people, particularly for
musculoskeletal pain as it has good efficacy and relatively few side effects.
Before considering alternatives, recommend regular use.
5. Be cautious with NSAIDs
NSAIDs must be used with caution in older people, and for the shortest duration at the lowest dose. A PPI
should be coprescribed and the patient should be closely monitored for renal and cardiovascular side effects,
and drug or disease interactions.
6. Be aware that tricyclics and anti-epileptic drugs are often poorly tolerated by older people
For neuropathic pain, drugs used such as tricyclic antidepressants and anti-epileptic drugs do have
demonstrated efficacy, but tolerability and adverse effects limit their use with older people.
7. Consider interventional therapies, especially in patients with localised or regional chronic pain
Pain in the older population tends to affect the knees, hip and back.
When pharmacological treatments are ineffective or not tolerated, interventional therapies should be
considered, especially in patients with chronic pain. Intra-articular corticosteroids are recommended in
osteoarthritis of the knee although there is no evidence for their efficacy in other joints in older people.
Facet joint interventions may be beneficial for both cervical and lumbar pain.
There is some evidence for epidural steroid injections in patients with spinal stenosis, but this is not strong
enough to support their use in radicular pain or sciatica.
8. Psychological interventions may be used as an adjunct to medication
Psychological factors often influence how patients respond to, and cope with, pain.
Psychological interventions can help to modify beliefs and attitudes.
Few studies have focused on older adults but cognitive behavioural therapy may be effective in decreasing
chronic pain, improving disability and mood.
9. Aim to customise exercise programmes to the patient’s needs and capabilities
Evidence supports the use of exercise programmes that comprise strengthening, flexibility and endurance
They increase physical activity, improve function and pain.
The choice of exercise depends on patient preference and programmes should be customised to individual
capacity and need.
There are lots of options, including progressive resistance exercise, walking, water-based exercise, and
adaptations of tai-chi and yoga.
10. Consider complementary therapies in patients with osteoarthritis or musculoskeletal pain
Complementary therapy, for example acupuncture, transcutaneous electrical nerve stimulation, and massage,
should be considered - although the evidence is limited.
Acupuncture applied singularly or in combination with other modalities reduced pain and improves quality of
life in patients with osteoarthritis.
Percutaneous electrical nerve stimulation combined with physiotherapy reduces pain and self-reported
disability for up to three months.
Similarly, conventional TENS and massage can be used for relief of musculoskeletal pain.
Dr Aza Abdulla is a consultant physician with a specialist interest in elderly care at South London Healthcare
He participated in the production of the upcoming national guidelines on management of pain in older people.
This article was written with help from Professor Pat Schofield, professor of nursing at the University of
Greenwich and Professor Roger Knaggs, associate professor in clinical pharmacy practice at the University of
See the Age and Ageing website for a copy of the guideline on the management of pain in older people produced
by the British Geriatrics Society and the British Pain Society.
Schofield P (ed) et al Guidelines for the management of pain in older adults. March 2013. Age and Ageing.
Medical- Jeremy Hunt, Health Secretary -There is a "Lack of Support for Dementia Sufferers"
Updated: 19 Apr 2013
Hunt vows to 'change GPs' minds' over dementia diagnosis
17 April 2013 | By Sofia Lind
The health secretary has vowed to ‘change GPs minds’ over the value of diagnosing dementia earlier, by
tasking the Department of Health to improve the services offered by the NHS.
Jeremy Hunt said some GPs think diagnosing dementia is ‘pointless’ and that it will not make a difference, but
that this is a ‘misconception’ that he wants to change.
Taking questions on health in the House of Commons yesterday, Mr Hunt was asked by Mark Menzies,
Conservative MP for Fylde, what steps he is taking to support GPs in achieving his ambitious targets for
He responded: ‘There is a misconception amongst some GPs that a dementia diagnosis is pointless and can’t
make a difference when we know that in fact the correct medicines can help between one-in-three and one-in-
four of people who have the condition.’
However he also conceded that there is currently a lack of support available for patients who have received a
Mr Hunt added: ‘But some GPs also have a point when they are concerned that it is very, very difficult to access
good services for people who have dementia.
‘So the way that we will change GPs’ minds is for them to appreciate that something will change if someone
gets a dementia diagnosis and that is the big challenge that this ministerial team has set the Department.’
He said a key priority to achieve in England, learning from good practice in for example Scotland, is to have a
‘proper integrated care plan’.
introduced this year, said: ‘I think [Jeremy Hunt] has a misconception of GP concern over dementia screening,
‘I don’t think any GPs think that diagnosis is pointless but that we should leave to the patient to decide when is
the right time for diagnosis. I am glad that he has conceded that there is a lack of support available for patients
receiving a diagnosis.
‘I also welcome what he says about medication helping between one-in-three and one-in-four dementia patients
because I don’t dispute that.
Earlier he said it could stave off symptoms for several years.
That I disagree with.
Medical-Failure to test for Prostate Cancer leading to increase in cases
Updated: 18 Apr 2013
Over at the Daily Telegraph, experts are claiming that almost half of potentially fatal prostate cancer cases could
be detected by screening men in their late forties, giving them the opportunity to have early treatment.
Doctors routinely test men for warning signs of prostate cancer by monitoring levels of a protein known as
prostate specific antigen (PSA) which is often an early sign of the disease, although the use of the tests remains
controversial because it does not directly detect cancer, and can lead to patients receiving unnecessary
But now experts claim that testing men in their late forties can identify almost half of all deadly cases of the
disease, while minimising the number of ‘false positive’ results.
Medical- Patient Survey - Dr's still talking over the head of patients
Updated: 18 Apr 2013
Hospital doctors talk as if patients are not there, headlines the Daily Mail this morning.
The newspaper reports on the CQC-commissioned annual patient survey for hospitals, in which a quarter of
patients made the claim, while a further third of patients did not understand what the doctor told them and a fifth
of patients did not trust the doctor treating them.
However the survey did show that care had improved on the whole since the previous year.
Medical- At a Stroke !
Updated: 17 Apr 2013
What is a stroke?
A stroke happens when the blood supply to the brain is disturbed in some way.
As a result, brain cells are starved of oxygen.
This causes some cells to die and leaves other cells damaged.
Types of stroke
Most strokes happen when a blood clot blocks one of the arteries (blood vessels) that carries
blood to the brain.
This type of stroke is called an ischaemic stroke.
Transient ischaemic attack (TIA) or 'mini-stroke' is a short-term stroke that lasts for less than 24 hours.
The oxygen supply to the brain is quickly restored and symptoms disappear.
A transient stroke needs prompt medical attention because it indicates a serious risk of a major stroke.
Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies blood to the brain.
Blood vessels that are furred up with fatty deposits (atheroma) make a blockage more likely.
The clot prevents blood flowing to the brain and cells are starved of oxygen.
Cerebral embolism is a blood clot that forms elsewhere in the body before travelling through the blood vessels
and lodging in the brain. In the brain, it starve cells of oxygen.
An irregular heartbeat or recent heart attack may make you prone to forming blood clots.
Cerebral haemorrhage is when a blood vessel bursts inside the brain and bleeds (haemorrhages).
With a haemorrhage, blood seeps into the brain tissue and causes extra damage.
What are the symptoms of a stroke?
Strokes usually happen suddenly.
No two strokes are the same and people can be affected in quite different ways.
To an extent it depends on which area of the brain is damaged, because different parts control
different abilities such as speaking, memory, swallowing and moving.
The most common signs of a stroke are:
weakness down one side of the body, ranging from numbness to paralysis that can affect the arm and leg
weakness down one side of the face, causing the mouth to droop
speech may be difficult or become difficult to understand
swallowing may be affected
loss of muscle coordination or balance
brief loss of vision
People who have had a severe stroke may lose consciousness.
Unfortunately, the likelihood of such patients making a good recovery is poor.
Face-arm-speech test (FAST)
The Stroke Association says three simple checks can help you recognise whether someone has had a stroke or
Facial weakness: can the person smile? Has the mouth or eye drooped?
Arm weakness: can the person raise both arms?
Speech problems: can the person speak clearly and understand you?
Test these symptoms.
If you see any of these signs, call 999 for an ambulance.
How is a stroke treated?
In hospital, brain scans are needed to find out what type of stroke you've had.
If a blood clot is the cause, 'clot busting' medication may be used to dissolve the clot, but this must be given
within three hours of the stroke.
Anti-clotting medication such as aspirin may also be given to stop the stroke from getting worse.
Anti-clotting medication is not given in strokes caused by haemorrhaging because it will make the bleeding
Other treatment includes:
tests on key functions like swallowing and movement
checks on oxygen, glucose and blood pressure levels.
If swallowing is affected,
you may be fed by a tube or given fluids into a vein (intravenously) to avoid food going into the lungs.
Medical-Behind the Mask-Written Health Records must be Transparent & Freely Accessible to Patients
Updated: 17 Apr 2013
Five tips on managing online access to patient records
16 April 2013
MPS medico-legal adviser Dr Pallavi Bradshaw offers five tips on giving patients online access to their GP
1. The primary purpose of medical records is to document all matters related to the health of a patient and to
ensure continuity of care.
Whilst you should write with a medical audience in mind you should be prepared to
share and explain the content with patients.
- Medical records should be clear, accurate and legible. Although abbreviations are used commonly, you should take care to use them only where their meaning is unambiguous and unlikely to cause offence.
- Patients have the right, under the Data Protection Act, to ask for factual inaccuracies in the record to be rectified or deleted and such requests may become more common with online access. You should only comply with a request if you are satisfied that it is valid, although it is rare to delete an entry in its entirety. Any disputed entries can be annotated with the patient’s view.
- Practitioners should be cautious when recording particularly sensitive information such as child protection issues. Only information related to the individual patient should be available, whilst protecting third parties’ confidentiality.
- Doctors must ensure that information which may cause serious harm to the mental or physical health of the patient or third parties is limited from access, if possible.
Dr Pallavi Bradshaw is a medicolegal adviser at the Medical Protection Society
Medical - Long Term Chronic's (LTCs) accounts for 70% of spending on Health & Social (Sick) Care
Updated: 14 Apr 2013
Chronic conditions are killing old models of primary care,
slowly but surely
11 April 2013
The Radical says - We have a "Sick" Health Service but where is the "Preventative" Health Service ?
Telling patients what to do doesn’t work - new types of conversation are needed, argues Dr Robert Varnam
The soaring prevalence of long terms conditions is a tsunami threatening to engulf the NHS – with primary care
suffering the first breach in the sea defences.
As the King’s Fund reported last autumn, treatment and care of people with long-term conditions (LTCs)
accounts for 70% of spending on health and social care. Half of our appointments as GPs involve LTCs. It is
expected that by 2018, 2.9 million people will be living with three or more LTCs – a million more than in 2008.
The time to think differently is now. Instead of wringing our hands in despair, primary care can lead the NHS’s
embrace of new ways of working, such as including the use of health coaching. We need to work with patients to
develop genuine shared decision-making and care planning, based around patients’ own goals and motivation
Telling them what to do doesn’t work - new types of conversation are needed.
The focus on the NHS reforms means we may have been distracted from looking at changing the way we work in
response to new challenges - especially in primary care.
Research has shown that, perhaps out of an understandable desire to keep the patient safe and manage time
effectively, the average doctor interrupts the patient after around 18 seconds, seeking to ‘diagnose and fix’.
While having a directive consultation style is helpful in some situations, patients with long term conditions often
need a different approach to encourage them to self care.
To motivate patients to become more active participants in their care clinicians need additional skills in
Adopting a heath coaching approach sees patients as truly resourceful, as an equal in the clinician-patient
relationship, and as the holders of the solutions to the health challenges they face.
It sees a clinician’s role as providing expert information when required, but is more about being able to
communicate in a way that is empowering and shared based around a patient’s own aspirations and goals and
framing consultations in a way, using additional tools and techniques, that supports patients to make decisions
about their own health.
Health coaching that supports people with LTCs to self-care - particularly those with multiple conditions - builds
on the government’s mantra of ‘no decision about me without me’.
The typical patient with an LTC spends around three hours a year with a health professional.
Health coaching equips them with the skills, knowledge and confidence to thrive during the other 8,757 hours of
It is to be hoped that the NHS Commissioning Board’s forthcoming national strategy on LTCs will, without being
prescriptive, highlight the possibilities health coaching offers both patients and hard-pressed clinicians and NHS
Robert Varnam is a GP and clinical lead for primary care and commissioning for the NHS Institute for Innovation and Improvement
Medical- The BRCA2 gene - Have you got it ? Ask your GP
Updated: 10 Apr 2013
'Aggressive' prostate cancer gene find
9 April 2013
By Michelle Roberts Health editor, BBC News online
Genetics appear to dictate how the cancer behaves
Men with prostate cancer and an inherited gene mutation have the worst form of the disease, research reveals.
The BRCA2 gene is linked to hereditary breast cancer, as well as prostate and ovarian cancer.
Now scientists say that as well as being more likely to get prostate cancer, men with BRCA2 are also more likely
to develop aggressive tumours and have the poorest survival rates.
They say these men should be treated quickly to save lives.
“This study shows that doctors need to consider treating men with prostate cancer and a faulty BRCA2 gene
much sooner than they currently do, rather than waiting to see how the disease develops”
Prof Ros Eeles Lead researcher
Around one in every 100 men with prostate cancer will have the BRCA2 mutation.
These men might benefit from immediate surgery or radiotherapy, even if their disease is at an early stage and
would normally be classified as low risk, according to the latest work in the Journal of Clinical Oncology.
Prostate cancer can grow extremely slowly or very quickly, and this is something that is hard to predict early on.
Some men may live symptom-free for a lifetime, despite having this cancer.
For many, treatment is not immediately necessary.
But researchers say men with BRCA2 and prostate cancer should be treated early and aggressively because
their tumour is more likely to spread.
Prof Ros Eeles and colleagues at The Institute of Cancer Research in London and The Royal Marsden NHS
Foundation Trust found prostate cancers spread more quickly and were more often fatal in men who had
inherited a faulty BRCA2 gene than in men without the faulty gene.
They looked at the medical records of prostate cancer patients which included 61 men with BRCA2, 18 men with
a similar gene mutation called BRCA1, and 1,940 men with neither mutations.
Patients with BRCA2-mutations were significantly less likely to survive their cancer, living an average of 6.5
years after diagnosis compared with 12.9 years for non-carriers. They were also more likely to have advanced
disease at the time of diagnosis.
'More deadly type'
Prof Eeles said: "It is clear from our study that prostate cancers linked to inheritance of the BRCA2 cancer gene
are more deadly than other types.
"It must make sense to start offering affected men immediate surgery or radiotherapy, even for early-stage cases
that would otherwise be classified as low-risk.
"We won't be able to tell for certain that earlier treatment can benefit men with inherited cancer genes until we've
tested it in a clinical trial, but the hope is that our study will ultimately save lives by directing treatment at those
who most need it."
More than 40,000 men are diagnosed with prostate cancer every year.
Men with a significant family history of breast and/or ovarian cancer in addition to prostate cancer can be
offered BRCA1/2 testing at diagnosis, but it is not routinely offered to all patients diagnosed with prostate
cancer in the UK.
Dr Julie Sharp of Cancer Research UK, said: "This study shows that doctors need to consider treating men with
prostate cancer and a faulty BRCA2 gene much sooner than they currently do, rather than waiting to see how
the disease develops.
"We knew that men who inherit a faulty BRCA2 gene are at a greater risk of developing prostate cancer but this
is the largest study to show that the faulty gene also makes the disease more likely to develop quickly and
Medical- Less qualified NHS Hospital Medical care but not on the cheap ?
Updated: 10 Apr 2013
Trainee doctors are being paid more than £2,000 a day for locum shifts in NHS hospitals, a Telegraph
investigation found. In some cases doctors were being paid rates of £15,000 a week, the equivalent of £700,000
a year, while ministers warned NHS managers that the costs were spiralling out of control.
Hospitals spent more than £2 billion on locum doctors in three years, with hundreds of millions spent on
doctors via agencies, which a take a cut of the payment.
The Telegraph uncovered cases such as a consultant cardiologist hired for £15,000 a week by North Cumbria
University Hospitals Trust and one lucky locum paid £2, 794 for 24 hours cover in the A&E department at North
Lincolnshire and Goole Hospitals Foundation trust.
Health minister Dan Poulter said the market had been fuelled as a result of the previous Government’s decision
to sign up to the European Working Time Directive, which sets a maximum 48-hour-week for doctors.
However, he added that the best NHS trusts did not rely heavily on locums, and that the excess spending was
frankly, a sign of poor management and a need to get a grip
Medical- DNAR- Do Not Attempt Resusitation ?- Tell your GP and get it in writing
Updated: 10 Apr 2013
Following the five steps below can help you create a watertight policy for
agreeing to write a DNAR request for a patient.
1 Consider the options
Is CPR likely to be successful? If it is not then consider the wishes of the patient, if they have capacity to make
their own decision. If the patient does not, check whether they have ever given any indication of their wishes on
2 Discuss decisions
Talk to the rest of the healthcare/multi-disciplinary team and with the next of kin/family/close friends (or legal
proxy) and find out what they think. Ensure that they are aware of the decision made and why it was made. If the
person lacks capacity and has no family or close friends or legal proxy then take further advice from your
medical defence organisation about the way forward.
3 Record discussions
Ensure you record any discussions in the medical records clearly, along with the reasons for the decisions
made. Consider that any such decisions can be reversed, should it become apparent that the patient’s situation
changes and that it is felt that CPR may be successful.
4 Reassure relatives
Reassure worried family and friends that a DNAR order does not mean that they are going to miss out on active
treatment. Provide information on what the decision will mean. Good communication is vital to build and
maintain a good doctor-patient relationship and can help prevent complaints.
5 Inform clinicians and carers
Make sure that the immediate care/nursing staff are aware of the DNAR order and that it is visible and
immediately apparent to anyone accessing the medical/nursing records. Should there continue to be
disagreement about the DNAR order then seek further advice from your medical defence organisation.
Dr Zaid Al-Najjar is a medico-legal advisor at the Medical Protection Society (MPS) and a practising GP in London.
Medical-GP Whistleblowers encouraged as "inappropriate" gagging clauses in CCG constitutions remain
Updated: 10 Apr 2013
GP duty of candour undermined
by 'inappropriate' gagging clauses in CCG constitutions
5 April 2013 | By Jaimie Kaffash
Exclusive Hundreds of GP practices are blocked from voicing concerns over NHS care in their area under their
CCG constitutions, despite the Government’s declarations that ‘gagging’ clauses are now unacceptable in the
health service after the Francis Inquiry.
Legal agreements covering more than 200 practices from 1 April include clauses that prevent GP members from
speaking about the CCG’s work without prior approval from the board.
The GPC said that it was ‘inappropriate’ that the clauses were inconsistent with the legal ‘duty of candour’
placed on health professionals after the publication of the Francis Inquiry into failures of care at Mid
Staffordshire NHS Foundation Trust.
Pulse first reported the gagging of GP practices last year in two CCGs in a move that marked a shift in the
independent status of GP practices, who are currently able to speak publically and to the media about PCT business.
Since then, Pulse has learnt NHS Newbury and District, NHS Sutton, NHS Dorset, NHS Thurrock and NHS
Windsor, Ascot and Maidenhead CCGs have all retained a clause in their constitutions that prevents member
practices from speaking out on CCG matters without getting prior approval from CCG leaders.
A further five CCGs have clauses that prevent those on the governing body from speaking out to voice concerns.
Four CCGs – Hull, Northumberland, Kingston and Oldham - that did have gagging clauses in their draft
constititions have since removed them, with one saying that they did not want to prevent their members from
speaking out ‘on issues of concern to them’.
The clause for Newbury & District, which covers 11 practices, and Windsor, Ascot & Maidenhead, which covers
20 practices, states: ‘No member will make or permit the making of any press release or other public statement
concerning the CCG without the prior written approval of the [operational leadership team].’
In Sutton (29 practices), Dorset (103) and Thurrock (36), the clause reads: ‘None of the members or members of
the Governing Body shall make or permit or authorise the making of any press release or other public statement
or disclosure concerning the group or any of the members or members of the governing body without the prior
consent in writing of the governing body.’
The clauses are very similar to a controversial Londonwide LMCs draft constitution published in 2011, which
chief executive Dr Michelle Drage said at the time would strengthen governance and decision-making
But the GPC said that the clauses were unnacceptable. Dr Chaand Nagpaul, a GPC negotiator, said: ‘In the post-
Francis world, practices should not be restrained or put under any pressure with regards to not voicing
concerns especially given they could be held culpable as members of a commissioning organisation.
‘One of the key Francis recommendations is that GPs need to be aware of the quality of care provided to
patients, including in hospital services, and there is a duty on individual GPs to express and report concerns. It
is inappropriate for CCG constitutions to curtail this clear recommendation.’
Dr Brian Balmer, chair of Essex LMC, said: ‘There is a big difference between setting out the corporate
responsibilities for board members and telling everyone they are not allowed to say anything as members of the
CCG. If it is to apply to member practices, how are they going to enforce it? Are they going to tell people they will have to leave CCGs? It’s daft.’
The chair of NHS Newbury and District CCG, Dr Abid Irfan, defended their constitution, saying that they had met
today to discuss it and had decided to keep the clause because it was a ‘helpful guideline’.
He said: ‘Everyone recognised that it was a way to support GPs and practices - there was no feeling that anyone
was being “gagged”. If there was any serious issue that an individual GP felt strongly about then they would
naturally be free to speak out.’
Dr Adrian Hayter, CCG chair designate at NHS Windsor Ascot & Maidenhead CCG, said the clauses were
designed to so the views of individual GPs and the CCG were not confused.
He said: ‘We have no Machiavellian plan to not allow free speech and indeed we encourage this in our GP
community. It is however important for the public to have a consistent view from their local NHS Commissioning
organisation for the shape of their local services.’
A spokesperson for NHS Oldham CCG explained that they had removed the clause in their constitution banning
members from speaking out: ‘It was never the intention to “gag” our members. The revised constitution better
reflects our long standing position that we recognise our members duty to speak out on issues of concern to
A spokesperson for NHS Sutton CCG said they ‘actively encourage’ their members to escalate any concerns or
issues about patient safety and none had raised concern about that particular clause. NHS Dorset CCG
reitterated the CCG’s position that the clause would only be applied to ‘statements of a confidential nature’ and
insisted they were not trying to stop GPs speaking to the media ‘in general’.
But a DH spokesperson said CCG constitutions were not intended to gag their members and that they were
committed to transparency in the health service.
He said: ‘We would not expect CCG constitutions to prevent individuals from raising concerns or speaking out
in the public interest.
‘They are intended to set out the operating arrangements of the CCG, to ensure that all members work in
partnership with the governing body on any public messages.’
A spokesperson for NHS England said: ‘CCGs are independent statutory organisations, and their constitutions
have been developed as a means of achieving consensus between member practices on their organisational
behaviours. Most CCGs have included provisions within their constitutions to ensure their organisations speak
with a single, united voice, in order to secure maximum public understanding of the CCGs and their work.’
Medical- Half of all GP's bring forward their retirements as the NHS Crisis looms
Updated: 10 Apr 2013
GPs bring forward their retirement plans in looming crisis for profession
8 April 2013 | By Alex Matthews-King
Exclusive Almost half of GPs have brought forward their retirement plans compared with five years ago, as
worsening morale and rising workload takes its toll on the profession, a Pulse survey shows.
The survey of 364 GPs found 43% are looking to retire earlier than they intended five years ago, with the average
GP intending to down tools at age 61 years.
Only 19% of GPs predicted they would continue in the profession beyond 64 years, despite the Government
reforms to pensions meaning some junior doctors would be forced to work until 68 to get their pension.
The GPC warned this was a trend that would add to the current GP shortages in some areas, and it follows
LMCs saying in January that half of GPs are considering quitting general practice due to the Government’s
planned contract changes.
Respondents to the Pulse survey said they had made the decision as general practice was reaching ‘crisis
point’, with pay freezes, spiralling QOF work and the Government’s pensions reforms pushing them to quit earlier.
Of the GPs who responded to the survey, 30% said they planned to retire at 55 to 59 years, 44% at 60 to 64 years
and 12% at 65 to 70 years. Some 5% said they would continue working as a GP past 70 years.
Some 43% said they had decided to retire earlier than they had planned five years ago, 48% said their retirement
plans remained unchanged from five years ago, and 9% said they were unsure.
GPC chair Dr Laurence Buckman said rising early retirement rates would worsen the rising workforce crisis in
the profession revealed by Pulse last month, with GP vacancy rates quadrupling in the past two years.
Dr Buckman said it was an ‘inevitable corollary’ of the way the Government had treated the profession.
He told Pulse: ‘The contractual changes and the pressure of work related to that, the inability to earn a living, the
changes to GP pensions and the capping of pensions more generally, as well as revalidation. Between all of
those, there are now a lot of reasons why GPs will consider premature retirement.
‘There will be less GPs as a result.’
Dr Nigel Watson, chair of the GPC commissioning and service development subcommittee and chief executive
of Wessex LMCs, said earlier retirement of older GPs would undermine the profession.
He said: ‘I have practices with three or four doctors going soon and so the younger GPs will have to take on the
responsibilities of partnership, and they’ll struggle.
‘The exodus is quite significant. In any year you’ll always have a cohort of GPs that have done their time, but the
feel that’s different this year. The decision to leave is with regret- but they can’t work like this anymore.’
Dr Richard Kippax, a GP in Herefordshire, said the NHS reforms and the most recent contract changes were
behind his decision to retire earlier.
He said: ‘I think more than anything what is influencing me to plan to retire early is how the GP contract has
been steadily eroded ever since its introduction. What is such a shame is that I still enjoy trying to do a decent
job for the patient in front of me.’
Dr Jyotsana Patel, a GP in Wembley, north west London, said he would retire in six weeks due to the strains on
He told Pulse: ‘The reason is the seamless amounts of work that has been dumped on me, without thought of
capacity for that sort of increase.
‘I am pleased I can turn my life around finally and save my health and sanity.’
Dr Sally Dowler, a GP in Tottenham, north London, said the rising de-professionalisation of GPs was behind her
decision to quit general practice earlier than planned.
She said: ‘Scrips, monitoring, doing hospital ‘errands’ as per their letters, medical reports, sitting on committees
and constant need to prove that my skills and knowledge are good enough - despite no hint of evidence to the
contrary - is getting quite demoralising.
Medical - Dr's bury their mistakes and in patients medical records
Updated: 05 Apr 2013
Patients given legal right to have 'factual errors' corrected in medical records
3 April 2013 | By Madlen Davies
Patients have the right to ask their GP to correct any factual errors they see in their medical records,
according to the new NHS Constitution.
In the Government’s response to its consultation on the NHS Constitution, they re-asserted patients’ right to
access their health records, and added that they have the right to ‘have any factual inaccuracies corrected’.
The accompanying handbook clarified that this did not give the patient the right to change a clinical opinion
and that if a GP disagreed there was an error then the patient’s disagreement should be written into their notes.
The news follows comments made by Dame Fiona Caldicott, who is leading the Government’s information
governance review. Last November she said patients should be able to amend errors in their records, but
should not be able to change their medical histories.
The changes to the NHS Constitution come as the Government began to implement its target for GP
practices to offer patients access to full patient records, appointment booking and test results by 2015, with
a new DES beginning this year.
The handbook said: ‘You have the right to have any factual inaccuracies corrected. Ask your health
professional about amending your records if you believe they contain a factual error.’
It added: ‘There is no obligation to amend professional opinion, however sometimes it is difficult to
distinguish between fact and opinion. Where you and the health professional cannot agree on whether the
information in question is accurate you can ask that a statement is included to set out that the accuracy of
the information is disputed by you.’
They added that they removed a statement which said that health records ‘will always be used to manage
your treatment in your best interest’ as this could sound ‘paternalistic’.
The handbook clarified that there are only a few exceptions where patients should be denied access to their
records, such as where the information includes details about another person, or where the information may
be harmful, for example, where serious mental illness means the patient may be a risk to themselves
Medical- A&E -But do they know what an Emergency means to the patient ?
Updated: 04 Apr 2013
Urgent need to review access to A&E services
'We cannot ignore the changes coming down the tracks … the NHS must organise changes in a much better
way than it has in the past'. Photograph: Cate Gillon/Getty Images
The NHS is internationally renowned for its excellence but is under increasing pressure.
There is a growing consensus that it must change to meet the needs of an ageing population, make the most of
healthcare technology, reduce the UK's childhood mortality rate and allow the NHS to live within its means. A
big part of the problem is that too many services are in the wrong place.
This often means that care is not as effective as it could be, and it is increasingly unaffordable.
Firstly, we need far more investment in good care closer to people's homes, helping to keep patients out of
hospital and in the community where it is in their best interests.
This means co-ordinating care across primary, community, secondary and social care, and making better use of
technology, to meet people's needs and take the pressure off acute services.
Secondly, some hospital services need to be centralised so that, for example, people requiring urgent stroke
care get access to the best doctors and nurses 24 hours a day.
Sometimes it makes sense to travel further to be treated by high-quality specialists rather than be treated locally
by staff who do not see enough patients with a particular problem to become adequately skilled.
Changes of this kind are often highly controversial locally, with the result that they can be stalled or ducked,
sometimes for years. In the current climate, such fudging will make matters worse. It will risk increasing numbers
of NHS organisations becoming unsustainable, while quality suffers.
We cannot ignore the changes coming down the tracks.
If we fail to address this issue now we risk an increasing number of NHS organisations becoming unsustainable
– this will mean change within more narrow limits later.
The NHS must organise changes in a much better way than it has in the past. Medical Royal Colleges, the
Academy, the NHS Confederation and National Voices are working together to ensure that this happens.
To make these changes successful we need to see: services developed around patients, not the interests of
organisations or staff; patients, communities and local political representatives being fully included in the
decision-making process from the outset; changes justified by quality improvements and backed by clinical
evidence, not solely driven by finances; and people's concerns about safety and access to services, including
transport issues, properly resolved.
Debates on this are happening all around the country. Local communities have to decide the best way forward,
but no change is not an option.
We must grasp this nettle – the NHS will not have a sustainable future unless we do.
Mike Farrar Chief executive, NHS Confederation, Professor Terence Stephenson Chairman, Academy of Royal
Medical Colleges, Jeremy Taylor Chief executive, National Voices, Dr Hilary Cass President, Royal College of
Paediatrics and Child Health, Dr Clare Gerada Chair, Royal College of General Practitioners, Professor Norman
Williams President, Royal College of Surgeons
Medical- A&E fails to treat all it's patients within four hours
Updated: 04 Apr 2013
The NHS has failed to meet its target of dealing with 95% of A&E patients within four hours for the last two
months, the Guardian reports.
The health service has missed the target in each of the nine last weeks, with 93.3% of patients being admitted,
transferred or discharged within four hours in the week ending 24 March - the most recent week for which data
The four-hour target covers A&E units at major hospitals, specialist hospitals and minor injury units or urgent
Major hospitals are under the most intense pressure, with hospitals offering consultant-led A&E care – which
treat more than 60% of all emergency patients- not having met the target for 26 consecutive weeks.
In the week ending 24th March, 27 273 of the total of 272, 505 emergency patients- some 10%- were not admitted
transferred or discharged within four hours.
The data follows the news that the East of England ambulance service erected a ‘major incident tent’ outside
Norfolk and Norwich University Hospital to relieve pressure on its A&E unit over the Easter weekend
Medical- Measles outbreak in Wales as a result of children failing to get the MMR vaccine
Updated: 30 Mar 2013
Welsh measles outbreak spreading at ‘alarming rate'
27 March 2013 | By Caroline Price
Parents in Wales have been urged to take their children to their GP to get the MMR jab, if they have not had it yet,
after the number of cases in an outbreak centred on Swansea soared to 432.
Cases have doubled in the past three weeks, up from just over 200 at the beginning of March, with 116 cases
reported in the past week alone, Public Health Wales reported.
The latest figures have heightened concerns that unvaccinated children are increasingly likely to come into
contact with the virus. Cases are expected to continue to rise for some time yet and could reach 1,000 by the end
Dr Marion Lyons, director of health protection at Public Health Wales, said: ‘Measles is now spreading at an
alarming rate across areas of Wales.
Worryingly there are still tens of thousands of susceptible children across Wales, yet our weekly monitoring of
vaccination rates shows only a slight increase in numbers receiving MMR jabs.
‘If the numbers of parents bringing their children for MMR jabs does not dramatically increase, measles will
continue to spread and quickly reach levels last seen in the outbreak in Dublin in 1999/2000.
In that outbreak over 1,200 children were infected and three died.’
Medical - £5 Saliva test for Cancer just 5 years away
Updated: 30 Mar 2013
A £5 saliva test to check patients’ risk of major cancers could be just five years away as a result of
‘groundbreaking’ research, the Telegraph reports this morning.
The test could be offered in GP surgeries and would allow more ‘personalised’ preventative treatment in people
found to be at high risk of the diseases, while those at lower risk could potentially be spared additional, more
Researchers looked at 200,000 genetic variants in over 100,000 cancer patients and found 49 that up the risk of
breast cancer, 23 that increase the risk of prostate cancer and 11 that predispose women to ovarian cancer.
They hope to develop tests to analyse saliva for these variants – which could be done by GPs.
Professor Ros Eeles from the Institute for Cancer Research said the test could be ‘widely available within five
years’, while a version for women already know to be at high risk of breast cancer could be ready in 18 months
Medical - DNA screening for inherited diseases to be available on the NHS ?
Updated: 28 Mar 2013
27 March 2013 Last updated at 16:01
DNA test reveals 80 markers for inherited cancer risk
By Fergus Walsh Medical correspondent
This chip was used to identify genetic markers
More than 80 genetic markers that can increase the risk of developing breast, prostate or ovarian cancer have
been found in the largest study of its kind.
The DNA of 200,000 people - half of them with cancer and half without - was compared, revealing an individual's
inherited risk of the diseases.
British scientists, who led the research, believe it could lead to a DNA screening test within five years.
They also hope it will boost knowledge of how the cancers develop.
The research was led by scientists at the University of Cambridge and the Institute of Cancer Research (ICR) in
London and funded by Cancer Research UK (CRUK) and the Wellcome Trust.
The main findings are published in five articles in the journal Nature Genetics.
Study author Prof Doug Easton said: "We're on the verge of being able to use our knowledge of these genetic
variations to develop test that could complement breast cancer screening and take us a step closer to having
an effective prostate cancer screening programme."
Continue reading the main story
Inherited cancer risk
Our genetic hand of cards
Each of us is born with a genetic hand of cards passed down from our parents.
This is called our genome and is made of three billion pieces of code made of just chemical letters: A, C, T and G.
A single nucleotide polymorphism is a single letter difference in DNA between individuals.
We each have millions of variations and most of these seem benign. This study looked at more than 100,000 common differences found in at least one in 10 people.
By comparing cancer patients with healthy controls the scientists could identify genetic spelling mistakes that occurred repeatedly in the cancer group.
Forty nine new single nucleotide polymorphisms (Snps) were found associated with breast cancer, bringing the total identified to 76.
For prostate cancer, 23 new markers were found, bringing the total to 78. And for ovarian cancer, eight new regions were found, bringing the total to 12.
The scientists looked for common genetic variations - known as single nucleotide polymorphisms (Snps) - linked to the three cancers.
Each alteration raised the risk of cancer by a small amount. However, a small minority of men with lots of the markers could see their risk of prostate cancer increase more than fourfold and for women the breast cancer risk increase threefold.
By contrast, the test can also identify those with a smaller than average risk of developing the cancers.
A woman's lifetime risk of breast cancer is one in eight, but among the 1% with lots of these newly identified genetic variations the risk rises to one in two.
The test could also help the one in 300 woman who carry a faulty gene known as BRCA1 or BRCA2. Two-thirds of them will develop breast cancer before the age of 80 and 45% who carry BRCA1 will get ovarian cancer.
At present the options to reduce their risks are limited - a double mastectomy or having their ovaries removed.
By combining the gene test for BRCA1 and BRCA2 with this extra genetic information, women who have a high number of the newly identified markers could find they have a nearly 100% risk of getting breast cancer.
In contrast, those with the protective versions of the genetic changes could see their risk drop to as low as 20%.
Dr Antonis Antoniou, CRUK senior fellow at the University of Cambridge, said: "Our research puts us on the verge of being able to give women a much more accurate picture of how likely they are to develop breast or ovarian cancer and would help to guide them about the most appropriate type and time of prevention or monitoring options for them."
For men, the lifetime risk of developing prostate cancer is one in eight. But for 1% who carry a significant number of genetic alterations, the risk rises to one in two.
Unlike for breast cancer, there is no screening programme for the disease.
The prostate-specific antigen or PSA test, looks for protein markers in the blood and high levels may be an indicator or prostate cancer. But it is unreliable.
Furthermore, about two-thirds of men who get prostate cancer have a slow-growing "indolent" form of the disease that will not kill them.
Treatment options include prostate removal, radiotherapy and hormone treatment, But for every life saved through treatment for prostate cancer, it is thought that between 12 to 48 men are treated unnecessarily. Many patients opt for "watchful waiting", monitoring the cancer.
Sixteen of the 23 newly identified genetic markers are associated with aggressive forms of the disease so may help clinicians and patients decide on the best form of treatment.
Prof Ros Eeles, from the ICR, said: "These results are the single biggest leap forward in finding the genetic causes of prostate cancer.
"If further studies show such men benefit from regular screening, we could have a big impact on the number of people dying from the disease, which is still far too high."
Medical-GP's lack paediatric training is a national scandal. 2000 children die each year as a result
Updated: 28 Mar 2013
The Independent brings uncomfortable news this morning, covering a study which concludes almost 2,000
British children die each year from ‘avoidable’ causes because GPs lack training in paediatric care.
Dr Ingrid Wolfe, programme director for the Evelina London Children’s Hospital at Guy’s and St Thomas’s NHS
Foundation Trust, who led the study, said the deaths were a ‘national scandal’, with the UK at the bottom of a
European league made up of the 15 members states of the European Union ranked according to the number of
excess child deaths.
The UK child mortality rate is more than 60% higher than that of the best performer, Sweden, which sets the
benchmark for excess deaths. In Sweden, fewer than 30 children in every 100,000 die, compared with more than
47 per 100,000 in the UK.
The researchers blamed Britain’s health system, saying it had not adapted to meet children’s needs.
The UK has one of the highest child death rates from pneumonia, twice as high as Sweden’s and three times
those of France and Austria, even though the condition can be treated with antibiotics.
In place of infectious diseases that were dominant a generation ago, today’s children are more likely to face
such chronic problems as asthma, diabetes or behavioural difficulties.
Dr Wolfe said British GPs required more paediatric training and should work more closely with child specialists,
as family doctors do in Sweden
Medical -Women should be screened in pregnancy for psychiatric disorders likely to develop postnatal
Updated: 28 Mar 2013
Screen pregnant women for psychiatric disorders, say researchers
27 March 2013
There should be routine psychiatric screening in pregnant women so that treatment can begin earlier and post-
partum depression can be averted, say researchers.
Women who had given birth in the maternity ward at Magee-Women’s Hospital were visited on the ward and
offered screening by phone at four to six weeks post-partum.
All women who were reached by phone and who had screen-positive findings, defined as an Edinburgh
Postnatal Depression Score of 10 or more, were offered a home visit evaluation for psychiatric diagnostic
assessment. A total of 10,000 women underwent phone screening, with 826 of the 1,396 screened positive
accepting a home visit.
Episode onset was most frequent in the post-partum period, with 40.1% of the 826 women visited experiencing
a depressive episode in the first four weeks after giving birth.
33.4% experienced an episode during pregnancy and 26.5% before pregnancy.
The most common primary diagnoses in visited women were unipolar disorders, with 68.5% having at least one
unipolar episode. 22.6% experienced bipolar disorder and 5.6% an anxiety disorder.
What does it mean for GPs?
The US researchers concluded that ‘these data suggest consideration of screening during pregnancy to
identify psychiatric disorders and intervene earlier in the episode course.’
They added that a ‘comprehensive screening and diagnostic characterisation coupled with diagnosis-specific
intervention strategies might reduce maternal disability, improve function and avert a new generation risk.’
Medical- GP's given legal "duty of candour" to highlight bad patient care
Updated: 28 Mar 2013
GPs to be given legal 'duty of candour' to highlight bad patient care
26 March 2013 | By Sofia Lind
GPs face a new statutory ‘duty of candour’ to report treatment or care that they believe has caused death or
serious injury, says the Department of Health in its official response to the public inquiry into the failures of care
at Mid Staffordshire NHS Foundation Trust.
The duty will apply to all all providers registered with the CQC, but the Department of Health said it would look at
how how broadly the duty should apply.
Health secretary Jeremy Hunt also said they would explore whether to introduce a new ‘chief inspector of
primary care’ to sit alongside chief inspectors for hospitals and care homes, which would act as ‘whistleblower
in chief’ for the NHS.
But it stopped short of recommending an Ofsted-style quality rating for indivividual GPs - with ratings of
’inadequate’ to ‘outstanding’ - but the measure will be intrdoduced for hospitals and care homes.
Mr Hunt said the ratings could not be entirely ruled out for GPs in the future.
The DH document said: ‘A spirit of candour will be critical to ensuring that problems are identified quickly and
dealt with promptly. Openness is a key element of healthy organisational cultures in health.’
It added that while such a contractual duty already exists, it intends to go further and make this a statutory duty.
The document added: ‘We intend to go further and introduce a statutory duty of candour on health and care
providers to inform people if they believe treatment or care has caused death or serious injury, and to provide
We will need to carefully consider the scope of this duty on all providers.’
It comes as the DH also published its revised version of the NHS Constitution today but it said further changes
are likely to be consulted on in light of Francis later in the year.
Other actions that may come to be of relevance to GP practices include making nurses subject to revalidation;
the CQC adopting a new peer-review model for assessments that will take into account whether patients are
being listened to and are treated with dignity and respect; as well as the DH asking the GMC to tighten and
speed up its procedures dealing with breaches of conduct.
Mr Hunt said: ‘The health and care system must change.
We cannot merely tinker around the edges - we need a radical overhaul with high quality care and compassion
at its heart.
‘Today I am setting out an initial response to Robert Francis’ recommendations.
But this is just the start to a fundamental change to the system.’
GPC deputy chair Dr Richard Vautrey said that the development was ‘concerning’ as GPs already had a
professional responsibility to be open and honest and engage their patients.
He said: ‘To actually impose a statutory responsibility actually risks, paradoxically, the situation being made
less transparent because of a fear of litigation affecting your livelihood.
It may actually make it harder rather than making it easier.
‘So there is the potential for a lot of unintended consequences as a result of this and we are not really sure this
is the best way to proceed. We want a change in culture of the NHS without a fear of criminalisation in the
He also cautioned against the prospect of a chief inspector of primary care: ‘We already have significant
regulation with GMC, CQC looking at quality of primary care.
I think we are yet to be convinced that it would do anything other than duplicate what is already there.’
Dr Michael Devlin, head of advisory services at the Medical Defence Union, said: ‘We note that the Government
is planning to introduce a statutory duty of candour for providers of care to NHS patients and that it would
apply only in cases where there is serious injury or death.
At the moment, there are too many unanswered questions such as whether/how it would apply to primary care
and how serious injury would be defined.’
‘We see no need for a statutory duty of candour because GPs are already under an ethical duty to tell patients
as soon as anything goes wrong, irrespective of whether it is ‘serious’ or not.
So far as we know GPs are already fully aware of and comply with that professional duty to be open and honest
if something goes wrong.’
Dr Stephanie Bown, director of policy and communications at the Medical Protection Society, added: ‘MPS has
long held the view that while you can mandate disclosure, legislation cannot deliver the attributes of high
quality and open communication such as empathy, sincerity, and comprehensiveness.
A culture change is what is needed.’
‘We will be further highlighting to Government that despite the understandable appeal of a legislated duty, this
will not achieve the objective of effective open communication.
The risk of any legislation is creating a ‘tick-box’ mentality, which does not support the intensely sensitive,
personalised and patient-centred conversations that should happen with patients and their families when
something has gone wrong.’
Medical-Placebos take power away from the patient and give power to the doctor.
Updated: 26 Mar 2013
At best, placebos are a cop-out.
At worst, they're downright deceitful
22 March 2013
The sooner patients realise and doctors admit the limitations of medicine, the sooner we will get the demand for
NHS services back on track, argues Dr Steve Laitner
When I heard Professor Clare Gerada and Dr Margaret McCartney on the Today programme discussing the news
that three quarters of GPs ‘administer placebos once a week’, I was surprised.
I am not sure I have never knowingly prescribed a placebo.
I might have been persuaded by a patient to prescribe something I wasn’t 100% sure about – but that’s shared
decision-making in practice. I am concerned about deceit of medicine at many levels.
I can understand why some GPs are tempted to prescribe when they think it may not be effective. It’s quick, and
it gets patients out of the door faster than you could with an honest conversation, or at least it does for that
consultation, but it also encourages help seeking behaviour and repeat attendances.
But at my surgery – where this week we triage 115 patients on the phone one morning – if we gave every patient
a face-to-face consultation then we’d never give everyone the time they need. Most of the solutions to patients’
problems can be found in their history, and many of the problems they bring to GPs can be solved through
information, reassurance, advice about self-care or over the counter treatment.
Strictly speaking, any treatment a patient doesn’t need is a placebo – examinations included. For instance, I
would resist performing a chest examination in a child just because the mother wants me to do one.
If there is no clinical indication such as suspicion of pneumonia because of other features (such as chest pain,
high fever, unwell, breathlessness), then I really don’t need to listen to the chest.
To do so without an explanation as to why it is unnecessary would be deceitful.
When you take time to explain why it is not helpful, then most parents are happy.
You give them confidence to know when to be worried, and most of all when not to be.
For the same reason most GPs would instinctively decline to prescribe an antibiotic, a viral URTI doesn’t need
me to listen to them breathing.
However, it still needs me to understand their concerns, inform, reassure, advice and most importantly empower
to self assess and self care.
The ‘magical stethoscope’ myth
Placebos take power away from the patient and give power to the doctor.
We begin to see magical treatments and examinations – the stethoscope that can hear a virus, or the antibiotic
that can cure all infections. But this myth hurts everyone.
The sooner patients realise and doctors admit the limitations of medicine, the sooner we will get the demand for
NHS services back on track.
I have said before that the NHS is a paternalistic institution. Like all professions, medicine is a myth-builder which
relies on its own jargon and tools of the trade to keep a bit of mystique.
But the time has come to be open and honest about what medicine can offer, and what it can’t.
We have so much opportunity now for patients to self-care, for everything from self-limiting respiratory infections
to diabetes and hypertension, and it’s a big missed opportunity.
GPs are key patient educators, and the solution to demand is by admitting that sometimes it’s more effective if
we don’t intervene.
I myself have a long-term condition and just this morning, emailed my GP and consultant a few questions about
my treatment while I travelled down to London on the train.
Doing that was more time- and cost-effective than booking an appointment, and although I admit that I probably
get a bit of ‘special treatment’ because I myself am a GP, there are a couple of doctors at my surgery who use
email to communicate with their patients.
The NHS has been incredibly slow at adopting new ways of communication.
We should always come clean with the public and our patients. To any GP who would defend placebo treatments
and examination I would ask, why can’t we have an open and honest conversation with patients?
It’s my belief that it’s a doctor’s duty to be honest and open with patients, and that means cutting down on our
use of anything with a placebo effect, examinations and treatments alike, it is a short-term solution and frankly a
bit of a cop-out.
Dr Steve Laitner is the clinical lead for the Department of Health-funded programme on shared decision-making, and a GP in St Albans.
Medical -What Quality of Life after Death, so "Do Not Resuciate" me -thank you !
Updated: 19 Mar 2013
Hours after death, we can still bring people back
Resuscitation specialist Sam Parnia believes we can bring many more people back to life after they die –
it’s just a matter of training and equipment
Are the people you resuscitate after cardiac arrest really dead?
Isn't the definition of death that it is irreversible?
A cardiac arrest is the same as death. It's just semantics.
After a gunshot wound, if the person haemorrhages sufficiently, then the heart stops beating and they die.
The social perception of death is that you have reached a point from which you can never come back, but
medically speaking, death is a biological process.
For millennia we have considered someone dead when their heart stops beating.
People often confuse the terms cardiac arrest and heart attack.
Clearly, they're very different.
A heart attack happens when a clot blocks a blood vessel to the heart.
The portion of the heart muscle that was
supplied blood and oxygen by that vessel will then die.
That's why most people with a heart attack don't die.
What is the biggest problem in bringing someone back to life?
Reversing death before the person has too much cell damage.
People die under many different circumstances and under the watch of many different medical specialists.
No single speciality is charged with taking and implementing all the latest advances and technology in resuscitation.
How long after they die can someone still be resuscitated?
People have been resuscitated four or five hours after death – after basically lying there as a corpse.
Once we die the cells in the body undergo their own process of death.
After eight hours it's impossible to bring the brain cells back.
What is the best way to bring people back?
The ideal system – and they do this a lot in South-East Asia, Japan and South Korea – is called ECPR. The E
stands for extra corporeal membrane oxygenation (ECMO).
It's a system in which you take blood from a person who has had a cardiac arrest, and circulate it through a
membrane oxygenator, which supplies oxygen and removes carbon dioxide.
Then you pump the blood back into circulation around the body.
Using ECMO, they have brought people back five to seven hours after they died.
ECMO is not routinely available in the US and UK, though.
So, when I go into cardiac arrest, ideally what steps do I want my doctors to take?
First, we start the patient on a machine that provides chest compressions and breathing.
Then we attach the patient to a monitor that tells us the quality of oxygen that's getting into the brain.
If we do the chest compressions and breathing and give the right drugs and we still can't get the oxygen levels to
normal, then we go to ECMO.
This system can restore normal oxygen levels in the brain and deliver the right amount of oxygen to all the
organs to minimise injury.
At the same time you also cool the patient.
This slows the rate of metabolic activity in the brain cells to halt the process of cell death while you go and fix the
How do you cool the body?
It used to be ice packs.
Today a whole industry has grown up around this, and there are two methods.
One is to stick large gel pads onto the torso and the legs.
These are attached to a machine that regulates temperature.
When the body reaches the right temperature, it keeps it there for 24 hours.
The other way is to put a catheter into the groin or neck, and cool the blood down as it passes by the catheter.
Cooling benefits the heart and all the tissues, but we focus on the brain.
There are also new methods in which people are cooled through the nose.
You put tubes in the nostrils and inject cold vapour to cool the brain down selectively before the rest of the body.
If I had a cardiac arrest today, what are the chances I would get all of that?
Why isn't this type of care routine?
Cardiac arrest is the only medical condition that will affect every single one of us eventually, unfortunately.
What's frightening is that the way we are managed depends on where we are and who is involved.
Even in the same hospital, shift to shift, you will get a different level of care.
There is no external regulation, so it's left to individuals.
There is disagreement over the interpretation of near death experiences (NDEs) – such as seeing a tunnel or a
When a person dies, when do these experiences shut off?
One of the last things to fall into the realm of science has been the study of death.
And now we have pushed back the boundary of death.
In order to ensure that patients come back to life and don't have brain damage, we have to study the processes
that go on after they die.
Whether we like it or not, we have gone into the "afterlife" or whatever you want to call it.
For people who have NDEs, they are very real.
Most are convinced that what they saw is a glimpse of what it's like when we die.
Most come back and have no fear of death, and are transformed in a positive way – becoming more altruistic.
As a scientific community we have tried to explain these away, but we haven't been successful.
So how can a doctor, or any person of science, deal with such otherworldly experiences?
We have to accept that these experiences occur, that they are real to the people who have them, in the same way
that if a patient has depression you would never say, "I know that you are feeling depressed but that is just an
I'm the doctor.
I'm going to tell you what your feelings really mean."
But with NDEs, we do this all the time: "I know you think you saw this, but you really didn't."
Aren't NDEs just hallucinations?
We know from clinical tests that the brain doesn't function after death, therefore you can't even hallucinate.
It's ridiculous to say that NDE people are hallucinating because you have to have a functioning brain.
If I take a person in cardiac arrest and inject them with LSD, I guarantee you they will not hallucinate.
For your study of out of body experiences (OBEs), you placed images in hospital rooms on high shelves only
someone floating near the ceiling could see.
So far, two patients have had OBEs, but neither in a room with a shelf...
We had 25 hospitals that had an average of 500 beds working on the study.
To put a shelf above every single bed, we would have to put up 12,500 shelves.
That was completely unmanageable.
We selected areas where cardiac arrest patients are frequently treated but even with that, at least half of those
who had cardiac arrests and survived were in areas without shelves.
Are you continuing the experiment?
Yes. It's part of an overall package to improve resuscitation to the brain.
We are trying not to forget during resuscitation that there's a human being in there.
In your book, you imply that death might be pleasant.
Why do you think that?
The question is, what happens to human consciousness – the thing that makes me into who I am – when my
heart stops beating and I die?
From our external view, it looks like it simply disappears.
But it sort of hibernates,
in the same way as it does when you are given a general anaesthetic.
And it comes back.
I don't believe that your consciousness is annihilated when you reach the point of death.
How far does it continue?
I don't know.
But I do know that at least in the period of time in which we can bring people back to life that entity of the human
mind has not been annihilated.
What does this mean?
Those people who have pleasant experiences after death suggest that we should not be afraid of the process.
It means there is no reason to fear death.
This article appeared in print under the headline "Resurrection man"
Sam Parnia is a director of resuscitation research at Stony Brook University Medical Centre.
His new book is The Lazarus Effect (Rider), sold as Erasing Death (HarperOne) in the US.
Dick Teresi is the author of The Undead (Vintage, 2012
Medical- Sleep Apnoea - Patients on CPAP machines may be managed by GP's
Updated: 19 Mar 2013
GPs able to manage sleep apnoea 'as well as specialists'
18 March 2013
Patients with sleep apnoea treated in primary care experience no difference in outcomes compared with those at
specialist sleep centres, concludes a new study.
Some 155 patients aged 25 to 70 years with sleep apnoea were randomised to receive either management in
primary care or in a specialised sleep centre.
All patients were deemed to have a high diagnostic likelihood of moderate to severe sleep apnoea, defined as a
score of five or more on a four-item screening questionnaire and an overnight 3% oxygen desaturation index of
at least 16 events per hour.
Primary care management consisted of advice on managing continuous positive airway pressure (CPAP)-related
adverse effects, encouragement to maintain adherence and education about lifestyle changes to improve sleep
Specialist centres also had a patient’s overnight oximetry trace and further investigations if necessary.
Mean Epworth Sleepiness Scale (ESS) scores for the primary care group improved from 12.8 to 7.0 after six
months, and in the specialist group from 12.5 to 7.0.
The adjusted difference in the mean change in ESS score was not significant between the two groups.
Improvements were also present in both groups for the Functional
Outcomes of Sleep Questionnaire, but there was no significant difference between the two groups for the change
from baseline to six months.
The estimated costs per patient for primary care were £1,217, compared with £2,052
in the specialised care group.
What does it mean for GPs?
The Australian authors concluded that ‘with adequate training of primary care physicians and practice nurses
and with appropriate funding models to support an ambulatory strategy,
primary care management of obstructive sleep apnoea has the potential to improve patient access to sleep
JAMA 2013, available online 13 March
Medical- General Practitioner's role - Less General,More Specialist,Less Sick Service, More Health ?
Updated: 14 Mar 2013
Is the golden era of British general practice coming to an end?
Looking at my work patterns over the last few years, it is becoming clear that the model of general practice as we
have experienced it since the inception of the NHS is changing irreparably.
There are some commentators who believe that a GP is an obsolete role.
How can one doctor know what there is to know about all the various medical subspecialties and all the
In an era of empowerment of patients, if the patients has a heart problem for example they should be managed
by a cardiologist, or if the patients has diabetes they should see a diabetologist.
I can see some validity in this argument, as I cannot hope to know as much about cardiology and diabetes as the
But over the last few years I have seen a salami-slicing of tasks that we used to be responsible for - maternity
care has been taken away from general practitioners and handed to midwives, management of breast disease
has been moved to breast clinics, and we now have MS nurses, Parkinson’s nurses, heart failure nurses and the rest.
Some of my patients now have a multiplicity of people providing medical attention.
Advice is clearly contradictory at times and the patients face an endless streams of appointments with a series of
different people whose skills vary in both quality and ability.
Each one focuses on their own microcosm of activity, and rarely contributes anything of much use to the
Complex elderly patients now spend much of their time being ferried around from department to department,
with minor changes in therapy recommended as that is what they do.
Many clinicians spend time in their departments arranging investigations that have little or no value, and merely
is inconvenient to patients.
Much in hospital follow-up care is ill-thought-through and can sometimes cause more problems than it is worth.
Follow-up is often pointless, sometimes counter-productive.
So could we GPs do it better?
There’s the rub, as Hamlet said.
Can a generalist look after complex cases better than a collection of specialists?
The specialists will have greater knowledge of a smaller area, and more experience in terms of caseload.
They will also have specific skills (procedures, and so on) which I cannot offer.
They have colleagues that can cover other areas in the patient’s care.
So on the face of it, there is little role for the GP in 21st century medicine.
And yet, I see my role as changed and unchanging.
The ‘changed’ bit is medical progress is and can do.
The ‘unchanging’ bit is when I sit down with my patient, take a history and do a clinical examination.
That bit is just as difficult and rewarding as it always has been.
Other roles continue.
The advocacy role, for instance, is important, and so is your role as co-ordinator.
I will sometimes directly disagree with colleagues when managing cases - either recommending that certain
procedures are, in my view, not needed or futile.
That is another vital part of my job.
The modern GP is like a orchestra conductor - all the specialists have their roles but who directs it all?
This is the role I feel that I play.
So yes: I believe there is still a place for us.
The Jobbing Doctor is a GP in a deprived urban area of England. You can follow him on Twitter @jobbingdoctor.
Medical- Preventative Care for Diabetes - Starts with reducing Sugar and Salt in manufactured food
Updated: 09 Mar 2013
GPs face crackdown on adherence to NICE guidelines after Government
unveils new targets for diabetes
8 March 2013 | By Michael Woodhead
GPs will be expected to double the percentage of adults with type 2 diabetes who achieve NICE-recommended
blood glucose, blood pressure and cholesterol levels in five years, under new targets set by the Government.
The Government said more should be done by GPs to make sure that risk factors were controlled in diabetes and
set a target for 40% of patients with diabetes to be within NICE-recommended levels, which is double the current rate of 19.8% by 2018.
It also recommends a dramatic increase in the proportion of patients with diabetes being given nine basic care
processes annually - such as foot checks and microalbuminuria tests - from 50% to 80% by 2018, possibly by
bundling the QOF indicators together.
Pulse revealed last year that ministers had written to NICE to ask it to explore the practicality of raising QOF
thresholds and creating a ‘composite’ indicator in QOF for diabetes worth over £5,000.
The targets were revealed in a response from the Treasury to a report published by the House of Commons
Public Accounts Committee that was very critical of GP management of diabetes last year.
The PAC said too few patients were achieving the recommended levels for blood pressure, cholesterol and
diabetes and called for QOF indicators to be bundled.
In its response, the Treasury said: ‘It will never be appropriate for every person with diabetes to be within the
recommended outcomes ranges defined by NICE, which are set for the UK population as a whole. The specific
proportion cannot be defined, particularly for glucose control.
‘However, the department agrees that more can be done to increase the proportion of people with diabetes
achieving the recommended levels for blood glucose, blood pressure and cholesterol.’
The Treasury said it recommended changes to QOF, although this would be up to NICE’s assessment of whether
to bundle indicators and the NHS Commissioning Board.
It said: ‘The current payment system is not driving the required outcomes. GPs are paid for each individual test
they carry out rather than being rewarded for ensuring all nine tests are delivered.’
The QOF revisions – especially relating to microalbuminuria testing and the DM13 indicator – are expected to help
achieve ‘universal’ annual coverage for the nine basic diabetes care processes, the Treasury added.
But it rejected a recommendation for GP contracts to include mandatory provisions for multi-disciplinary care and
structured support for people with diabetes.
‘The Government does not consider it is appropriate for the department or the NHS Commissioning Board to
mandate which individuals should provide specific elements of care,’ it said.
Dr Bill Beeby, chair of the GPC’s clinical and prescribing subcommittee said the targets set by the Treasury were
unrealistic as they depended on patients attending appointments and acting on the medical advice they were given.
He said: ‘One of the main reasons why things are often out of control in diabetes is because patients just don’t
listen to medical advice.
‘The QOF was never designed to achieve the things the Treasury is suggesting. The concept that it is all about
incentives and that we GPs will chase these things down until the last man standing is quite erroneous. If a
patient does not come in for a test there’s only so many times you can phone them.
Medical-NHS Re-organisation means more GP's leaving the profession.That cannot be good for patients.
Updated: 09 Mar 2013
Patients are ‘gambling with their lives’ when they register with some GPs,
the architect of Prime Minister David Cameron’s ‘Friends and Family Test’ of the NHS has claimed.
Writing in The Daily Telegraph, Dr Neil Bacon argues general practice ‘remains one of the last bastions of
monopolistic protectionism with no transparency on quality.’ Dr Bacon, chief executive of health ratings firm
iWantGreatCare, said it was essential to extend the friends and family test to primary care, as he thought the
variation in quality was even greater among GP practices than it was between hospitals.
He concluded: “Remember, your doctor chooses very carefully to get the best care for their family. Shouldn’t you
have the same choice?”
However, Dr Clare Gerada, chairman of the Royal College of GPs, said he was overstating his case. She said: ‘I
think he’s wrong. There has been variability but it has been addressed over the last 20 years. To say people are
risking their lives when they sign up is overly dramatic.’
Medical-Health Secretary Hunt expects miracles on death rates & life expectancy from reduced budgets
Updated: 07 Mar 2013
Hunt to call on commissioners to tackle UK's
'shocking underperformance' on public health
The health secretary has called on commissioners to tackle the UK’s ‘shocking underperformance’ on public
health after a study showed the UK has performed ‘substantially worse’ in death rates, years of life lost and life
expectancy than comparable nations.
The study, carried out by Institute for Health Metrics and Evaluation and published in the Lancet today, compared
the UK’s performance in public health with the other 14 original members of the European Union plus Canada,
Australia, Norway and the USA. It used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010.
It found that the UK ranked around 14th of the 19 countries in terms of life expectancy in 2010, down from 12th in
1990, despite life expectancy increasing in absolute terms by 4.2 years.
The worst relative mortality rates were for men and women aged between 20 and 54.
Jeremy Hunt will say in a statement on the study today that the UK was a long way behind its global counterparts.
He will call for action by local health commissioners to tackle the five big killers – cancer, heart disease, stroke,
respiratory and liver diseases.
He will say: ‘Despite real progress in cutting deaths, we remain a poor relative to our global cousins on many
measures of health, something I want to change.
For too long we have been lagging behind and I want the reformed health system to take up this challenge and
turn this shocking underperformance around.’
He is expected to announce a strategy to tackle cardiovascular disease, which he says could save 30,000 lives a year.
The study found that compared with the other countries, the UK had significantly lower rates of years of lives left
for ischaemic heart disease, COPD, lower respiratory infections, breast cancer, other cardiovascular and
circulatory disorders, oesophageal cancer, preterm birth complications, congenital anomalies, and aortic aneurysm.
However, the rates were higher than average for road injury, diabetes, liver cancer, and chronic kidney disease.
The study concluded: ‘The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action. Further progress in premature mortality from several major causes, such as cardiovascular diseases and cancers, will probably require improved public health, prevention, early intervention, and treatment activities.’
Professor John Newton, chief knowledge officer of Public Health England and one of the authors of the report, told the BBC: ‘Despite some enviable recent success, for example on smoking, we in the UK need to take a hard look at what can be done to help people in the UK achieve the levels of health already enjoyed by other some countries. Central and local government, charities, employers and retail businesses all have a part to play.’
Medical- Patient/GP Consulations start with their receptionists !
Updated: 21 Feb 2013
Patient complaints rise over 'surly' GP receptionists
Patients' complaints about their local GP practices have risen to more than 1,000 a week, with a surge in
grievances over "surly" receptionists, a lack of appointments, and difficulty getting through on the phone.
GP receptionists Photo: Alamy
Figures showed that more than 53,590 written complaints were lodged against local surgeries last year, a rise of
almost 10% from the previous year when the figure was 49,765, and up a quarter from 2007/8 when data was first collected.
The biggest increase involved complaints relating to the attitiude of receptionists, to the phone lines being
engaged or the lack of appointments, the Daily Mail reported.
There were 9,924 grievances about what is described collectively as "general practice administration", a rise of
nearly a quarter in just 12 months.
Katherine Murphy, of the Patients Association, said the figures were the "tip of the iceberg".
She said: "Our helpline is inundated with calls from patients who have either been put off from complaining
because they have no faith in what can be a hugely difficult system to navigate, or they have gone through a
process only to receive no response."
She described a recent experience going into a surgery with an elderly friend who had been trying all morning to
make an appointment, only to be told by a receptionist when she went in that she should not have done that as "it
wasn't the policy, and she should have rung between 8 and 9am".
"There seems to be no rule for practices, they can just operate as they like," said Robins. "GP services have got
worse over the last two to three years, or at the very least that is patients' perception."
The data also showed there were a total of 162,129 complaints made about the NHS last year, averaging at more than 3,100 a week.
Paul Burstow, minister for care services, said: "For the first time, all NHS organisations have submitted
information about their complaints. This has led to a small rise in the number recorded."
Medical- Patient/ GP Consultations - Its not a Confessional !
Updated: 21 Feb 2013
Patients should choose their own appointment duration, say researchers
Allowing patients to choose the length of their consultation when booking a GP appointment could improve
patient’s control over their health, say researchers.
The small study at Cairn Medical Practice in Inverness, where 174 patients were allowed choose between five, 10,
15 or 20-minute consultations.
Satisfaction levels were not measured in the study, but GPs kept a diary and recorded their thoughts during the
They found that patients seemed to be more empowered and better able to express themselves.
But some doctors said the experience was stressful because they worried that too many five-minute
appointments would overrun.
One GP said: ‘I felt less rushed and more relaxed. I enjoyed the surgery more.
I felt on a more equal footing with
the patient because they had some choice in their appointment time.’
Dr Rod Sampson, an Inverness GP who led the research team, said: ‘Choice is an important issue for patients and
they can usually assess accurately how long a consultation they need.
‘The results of this study suggest that there may be a number of benefits to be gained by giving patients greater
responsibility for choosing the length of their appointments.’
The research will be published in next month’s edition of the British Journal of General Practice.
Medical- Protect Vulnerable Migrants from Health Inequalities says GP - Not act as Immigrant Police
Updated: 20 Feb 2013
GPs should not be forced to police immigration
Practices need greater support to care for migrants, writes Dr Les Goldman
The results of the recent Pulse survey of GP views on health provision for migrants and asylum seekers were not
surprising to me.
A large majority of GPs were confused about regulations regarding the entitlement to NHS care of different groups
of migrants and asylum seekers.
They fear being caught between anti-discrimination regulations and the threat of investigation if they register
And faced with ever increasing workload in the context of major threats to practice funding, many practices were
reluctant to take on groups of patients that could create very significant extra workload for little or no financial
This is not a new problem.
When Bradford first experienced a significant influx of asylum seekers in 1999, it was noted that many of them
experienced difficulty in getting registered with a GP. Homeless people in the city had faced similar problems for a
number of years, leading to the development of a specialist Homeless Health Team.
In response to these difficulties a bid was developed for a PCT-managed third-wave PMS practice specifically to
register homeless people, people in temporary or unstable accommodation, asylum seekers and refugees.
The bid was successful and in October 2003 the new practice opened its doors.
Almost 10 years on, our practice has developed beyond recognition. We left PCT control in September 2011 and
now run as an independent Social Enterprise – Bevan Healthcare (named after the founding father of the NHS, Aneurin Bevan).
We have around 2,000 registered patients funded through a 5 year APMS contract with the PCT.
Health care is provided by a committed team of sessional clinicians who have actively chosen to work with these
vulnerable groups, and who have developed considerable specialist expertise in dealing with the complex
problems they face.
We work closely with other health care providers such as mental and sexual health services as well as with social
care, housing, benefits advice and interpreting services providing easy access to services on site whenever possible.
The age-sex and morbidity profile of the practice is unusual. There are very low levels of many of the chronic
diseases incentivised by the national QOF. For that reason a practice specific QOF was developed, focusing on
areas such as mental health, sexual health and substance misuse.
Points from clinical domains in which the practice had very few patients are transferred to targets in these more relevant areas.
This has encouraged us to improve quality of care for our patients, rather than penalising us financially for
registering these unusual groups.
Our contract also allows 15-minute appointments, recognising the increased complexity of our caseload and the
extra time needed when using interpreting services.
We have been able to develop innovative services responding to the particular needs of our patients, such as on-
site HIV testing and providing easy access to counselling for victims of sexual violence.
We have also had the capacity to provide medical input for refugees arriving in Bradford through the Gateway Protection Programme.
This is a scheme run by UKBA in partnership with the UNHCR to resettle some of the world’s most vulnerable and deprived refugees.
This has included groups of Iraqis from camps in Syria, Burmese Rohingyans from camps in Bangladesh,
Somalis from camps in Kenya and Congolese from camps in Tanzania.
All this relieves strain on already overworked mainstream city practices.
It’s not down to us I don’t believe that tightening the rules about eligibility for NHS care will reduce the difficulties
caused for GPs by migration. Inevitably stricter rules will lead to more trouble for people at the sharp end, such as
receptionists. The BMA’s view is that GPs shouldn’t be forced into making decisions about eligibility.
I fully support that. We also need to think about the effect that even tighter rules will have on the health of many
vulnerable migrants living in poverty or destitution. It’s a complex issue, not one that will be resolved by
superficial political soundbites.
Our model is a specialist one that ‘mops up’ problems that neighbouring practices find it hard to cope with.
Doctors are compassionate by vocation but I know local GPs in Bradford have at times felt overwhelmed by the
needs of migrants, especially some of the unanticipated waves of migration from the EU. Our own situation at the
practice is not without its difficulties.
Like many GPs we are grappling with increasing demand, high A&E usage and hospital appointment DNA rates.
We will also face huge risk when our contract comes up for renewal in 2016.
However our experience has shown that with personal commitment alongside proper strategic planning and
investment, it is possible to mount an organised and effective response to the specialist health problems posed
by homelessness, migration and the need for asylum. The PMS model was key to the development of Bevan
Healthcare – I still believe in the power of developing unique local solutions to local problems, but I know we were
lucky to get access to sources of funding when we set the practice up.
As doctors it is our responsibility to show compassion and provide the best medical care possible for those most in need.
But without planning, funding, support and training there is a risk that clinicians become overwhelmed and
demoralised and that care for the most vulnerable ends up haphazard and of poor quality.
We need to make care for all vulnerable migrants a commissioning priority as a key part of wider strategy on
Dr Les Goldman is the chair and acting medical director of Bevan Healthcare CIC, and a GP in Bradford
Medical-Morning After Pill-Should be freely available the morning after to stop unwanted pregnancies
Updated: 20 Feb 2013
School nurses 'should give out morning after pill'
Medical leaders have called for a greater role for school nurses in reducing teenage pregnancies in Scotland, by
handing out the morning after pill and contraception.
The Scottish Sexual Health Lead Clinicians Group (SSHLCG) argues that introducing such powers for nurses
would help cut teenage pregnancy rates in Scotland, which are higher than in most European countries.
SSHLCG chair Dr Ruth Holman made the case in a written submission to the Scottish Parliament’s Health and
Sport Committee, which is examining ideas for tackling unplanned pregnancies.
The submission said: ‘The potential for the school nursing service to make an impact is restricted by lack of
finance for posts and also timidity on the part of Government and local authorities.
‘Why is emergency contraception not available in schools? Why are condoms and contraception to accessible?
Vaccination against a sexually transmitted infection (HPV) is given in schools, why can’t pregnancy and other
STIs be prevented?
‘The Scottish government is prepared to make a stand on controversial subjects like gay marriage, why does it
run scared of its critics on the subject of making emergency contraception available in schools?’
But GP experts had mixed views on the plans. Dr Paula Briggs, a GPSI in sexual health in Sefton, Liverpool, said
she doubted whether giving out emergency contraception would reduce teenage pregnancy rates.
She said: ‘Emergency contraception became available in pharmacies and walk-in centres, but it hasn’t resulted in
a significant reduction in unplanned pregnancies. Intrauterine contraceptive devices are the best thing by far as
contraception, but giving out those in schools won’t happen.’
She added: ‘We are also concerned that focussing on teenage pregnancy often leads to focus on teenage
females, while the males who impregnate them are ignored.’
Dr Anne Connolly, a GP in Bradford and chair of the UK-wide Primary Care Women’s Health Forum, said it was a ‘great idea’.
She said: ‘Giving out emergency contraception should not be just seen as an easy option done in isolation, but
part of a wider programme.’
Medical-GP's bury their mistakes,but "Mid Staffs deaths not the CEO Nicholson's fault", says GP boss
Updated: 20 Feb 2013
GP leaders back Sir David Nicholson
GP leaders have backed the head of the NHS, after calls for Sir David Nicholson to resign over the failures in care
at the Mid Staffordshire NHS Foundation Trust.
They said the failings identified in the recent Francis report were systemic, rather than the fault of one individual,
and that he should not be blamed.
Sir David, who in 2005 acted as interim chief executive of the health authority that oversaw Stafford hospital,
where up to 1,200 patients died because of failures in care, has apologised for his handling of the case.
But campaigners have called for his resignation following the publication of the Francis report.
GP leaders have refused to join the calls. GPC chairman Dr Laurence Buckman, said blaming Sir David was not
‘useful’ and wouldn’t’ spark the necessary change in NHS culture.
He said: ‘I don’t think it’s useful to blame leaders. If you’re trying to change a culture, you don’t change one
individual. There are a lot of people to blame, pinning the blame on one individual will not achieve a culture change.’
Dr Michael Dixon, of the NHS Alliance agreed that the system was to blame: ‘It’s difficult being at the top.
Staffordshire was a fault in the system, not of the system. It was inevitable given the fact that the health service
had a strong hierarchy that was accountable to the centre.
RCGP chair Professor Clare Gerada said that leaders should be held to account over the failings at Mid-
Staffordshire NHS Foundation Trust, but said Sr David should not resign.
She said: ‘Yes of course people should be held to account- it’s the last 20 years drive to marketise our NHS that
has led to people not looking at the patients in front of them but at the metrics.
‘But really it’s all of our jobs. We’re all responsible. In the end I think Francis has identified that when you take your
eye off the ball, away from patient care, then patients suffer.
Medical- GP's ( and Practice Managers) need to listen to their patients more.
Updated: 18 Feb 2013
If there is hope for general practice, it lies within your patient participation group
15 February 2013
Radical says - It took 9 minutes, at 8am to get through to my Surgery and make an appointment for that day.
I blame the Practice Manager.
A two hour meeting that began at 7pm was never going to get a queue of GPs clamouring to attend.
But, with CQC registration around the corner, we had to do something to re-animate our inert patient
So we advertised for patients, and got it organized - and it turned out to be rather wonderful.
If there is hope, it lies in the patients.
Nobody outside of medicine is going to take the threats of workload and box-ticking culture seriously, if only
clinicians are seen to be flagging them up.
Perhaps this is understandable – after all, no industry welcomes external scrutiny and impositions.
Most people in most jobs think they’re overworked.
Why should our carping be treated as anything other than inevitable, the predictable discontent to be expected
from any group of workers undergoing enforced change?
Maybe we had an unusually insightful group of patients that evening.
They asked questions which really deserve to be asked, and answered, in the public domain: How can you still
concentrate and make good decisions in your 12th consecutive unbroken hour? Why do your QOF points
count for so much, when they might be nothing to do with what the patient came in for?
They suggested workable ideas for improvements in access to appointments, and changes to the structure of
our clinics. We had feared it might degenerate into a forum for sharing individual grievances and complaints.
But in fact, they wanted to use the group to take some of the pressure off us.
As a profession, we have legitimate concerns about the direction of the NHS, which go far deeper than self-
interest, but we have failed to communicate them effectively.
I wonder if we are overlooking a huge resource, hidden in plain sight in our surgery waiting rooms.
Perhaps our negotiations with the Government need the service of an advocacy group, made up of patients,
who can voice concerns whilst staying immune from allegations of professional partisanship. They have as
much, if not more, at stake.
Dr Nick Ramscar is a GP in Bracknell, Berkshire
Medical-Heart Beating Organ Donors need an Anaesthetist present !
Updated: 15 Feb 2013
Donation: ethics and worries
Radical-There are a shortage of Heart Beat donors but one reason is
that the team needs an Anaesthetist, on call. The one on call may be working
so getting one out of bed at night used to be
one of the problems. I wonder if it still is ? Remember the donation is free!
There are a lot of issues and fears surrounding organ donation.
Here are some common questions and answers.
Will the doctors fight to save me?
The doctors looking after a patient have to make every possible effort to save the patient's life.
That's their first duty. If, despite their efforts, the patient dies, organ and tissue donation can be considered.
A completely different team of donation and transplant specialists will then be called in.
How will they know I'm dead?
Organs are only removed for transplantation after a person has died.
Doctors who are entirely independent of the transplant team will confirm death.
Death is confirmed in exactly the same way for people who donate organs as for those who don't.
Most organ donors are patients who die because of a brain haemorrhage, severe head injury or stroke, and who
are on a ventilator in a hospital intensive care unit.
Under these circumstances, death is diagnosed by brain stem tests.
There are very clear and strict standards and procedures for these tests, which are always performed by two
The ventilator provides oxygen that keeps the heart beating and blood circulating after death.
These donors are called heart-beating donors.
Organs such as hearts, which deteriorate very quickly without an oxygen supply, are usually only donated by a
Patients who die in hospital but aren't on a ventilator can, in some circumstances, donate their kidneys and other organs.
They're called non-heart-beating donors.
Heart-beating and non-heart-beating donors can donate their corneas and other tissue.
Will I be left disfigured?
Organs and tissue are always removed with the greatest of care and respect for the person.
This takes place in a normal operating theatre under the usual conditions.
Afterwards the surgical incision is carefully closed and covered by a dressing in the normal way.
Tissue can be removed in an operating theatre, mortuary or funeral home.
Specialist healthcare professionals carry out the operation.
They ensure that the donor is treated with the utmost respect and dignity.
Only those organs and tissue specified by the donor or their family will be removed.
Is it possible to see the body after donation?
Families are given the opportunity to spend time with their loved one after the operation if they wish.
The transplant co-ordinator will arrange this.
Arrangements for viewing the body after donation are the same as after any death.
Does a donor's family have to pay the cost of donation?
There's no payment at all.
The NHS meets the costs related to the donation of organs and tissue.
Does joining the NHS Organ Donor Register mean I am agreeing to donate my face or limbs for transplant?
We require specific agreement for these forms of donation, either from you, during your lifetime, or from your next of kin after death.
Let those close to you know your wishes.
Can I agree to donate to some people and not to others?
No. Organs and tissue cannot be accepted unless they're freely donated. No conditions can be attached in terms
of potential recipients.
The only restriction allowed is which organs or tissue are to be donated.
Could my donated organs and tissue go to a private patient?
However, patients entitled to treatment on the NHS are always given priority for donated organs.
These include UK citizens, members of Her Majesty's forces serving abroad, and patients covered by a reciprocal health agreement with the UK.
Other people will only be offered an organ if there are no suitable patients entitled to treatment under the NHS.
Every effort is made to ensure that a donated organ does not go to waste if there is someone who can benefit.
Donated tissue is made available to any hospital in the UK where there's a patient in need.
Could any of my organs or tissue be given to someone in another country?
There's an agreement that any organs that cannot be matched to UK patients are offered to people in other European countries.
Likewise, UK patients benefit from organs offered by other European countries.
This co-operation increases the chance of a suitable recipient being found, ensuring that precious organs do not go to waste.
Tissue might also be offered to patients in other countries.
Are there religious objections to organ and tissue donation?
None of the major religions in the UK object to organ and tissue donation and transplantation.
If you have any doubts, discuss them with your spiritual or religious adviser.
In addition, the Organ Donation Directorate of NHS Blood and Transplant (Organ Donation) has produced a
series of leaflets that focus on the six major religions in the UK.
Does the colour of my skin make a difference?
However, organs are matched by blood group and tissue type (for kidney transplants).
The best-matched transplants have the best outcome.
Patients from the same ethnic group are more likely to be a close match.
A few people with rare tissue types may only be able to receive a well-matched organ from someone of the same
ethnic origin, so it's important that people from all ethnic backgrounds donate organs.
Successful transplants are carried out between people from different ethnic groups wherever the matching criteria are met.
Is there any point in making a special appeal if someone desperately needs an organ?
Yes and no. Any special appeal usually results in more people agreeing to become donors and can increase the number of organs available.
However, family appeals through the newspapers and television will not result in an organ immediately becoming available.
The patient will still be on the transplant list, just like everyone else, and the rules that govern the matching and
allocation of donor organs to recipients still apply.
Can I agree to donate some organs or tissue and not others?
You can specify which organs you would wish to donate.
Simply tick the appropriate boxes on the NHS Organ Donor Register form or on the donor card.
Let those close to you know what you've decided.
Will organs or tissue that are removed for transplant be used for research purposes?
Organs and tissue that cannot be used for transplant will only be used for medical or scientific research purposes
if specific permission has been obtained from your family.
How is organ donation different from organ retention?
The problems of organ retention arose because proper consent was not obtained from parents or relatives for
organs and tissue removed at post-mortem to be kept for research or other purposes.
Because of these problems, the law was changed and the Human Tissue Act 2004 and the Human Tissue
(Scotland) Act 2006 were introduced.
Organs and tissue are only removed for transplantation if permission has been given.
Would a donor's family ever know who the recipient was?
Donation and transplantation is an anonymous process.
Those involved may want to exchange anonymous letters of thanks or good wishes through the transplant co-ordinators.
However, over time and if both sides want to, NHS Blood and Transplant can facilitate written contact between
donor and recipient and this can eventually result in face-to-face contact.
It's not always possible to provide recipient information to donor families for some types of tissue transplant.
Can people buy or sell organs?
No, the transplant laws in the UK absolutely prohibit the sale of human organs or tissue.
Can a deceased person donate sperm or eggs for future use?
While it is possible to retrieve sperm or eggs, it is illegal to store them or to create an embryo without the prior written consent of the donor.
Can someone with HIV or hepatitis C donate?
Yes. In very rare cases, the organs of donors with HIV or hep C have been used to help others with the same conditions.
This is only ever carried out when both parties have the condition.
All donors have rigorous checks to guard against infection.
Medical - Middlemen without a Care Qualification broker appointments between GP's and Consultants
Updated: 29 Jan 2013
GPs should have right to contact consultants directly,
Government review finds
GPs’ right to pick up the phone and freely communicate with consultants should be protected, concludes a
Government report that found evidence of hospitals ‘gaming’ the system to boost the number of appointments
patients were expected to attend.
Radical states that these Lincoln (UK) none medics, holding the purse strings, broker and are allowing me a
local NHS Neurosurgeon appointment, but refused the cost of any surgery required.
This is instead of a Private/ NHS Consultant appointment they made which was 20 miles away, who presumably would have been given to operate if required. More to follow !
The review from the Cabinet Office found that patients were being inconvenienced because the lines of
communication between medical professionals were not being preserved and called for this right to be protected
by regulators, or enshrined in the NHS Constitution.
It also called for patients to be given the right to consultations by Skype, if GPs agreed, and for patients who
move house to have the right to remain with their GP practice, irrespective of catchment area.
The review was commissioned to look at the barriers to patient choice in the NHS and found that hospitals
favoured face-to-face appointments and were discouraging phone and email consultations - for which they
received less revenue - even if this would save time and the patient would prefer this type of consultation.
It also found evidence that one hospital banned GPs from talking to consultants in case they discouraged them
from arranging an appointment with a patient, when a quick phone call might save both patients and doctors time
and create more capacity for the NHS as a whole.
The review was led by former Liberal Democrat candidate Mr David Boyle, and included roundtables across
England, a call for evidence from stakeholders, a literature review and a survey by Ipsos MORI.
The review found about 36% of the population still found exercising choice difficult and that patients without
internet or a car were ‘doubly disadvantaged’.
Choice in healthcare was more accessible to the educated, confident and articulate, the review found, with
women, non-white patients, renters and the unemployed identified as the groups most unable to exercise choice.
It recommended that hospitals were prevented from ‘gaming’ the system in order to increase their income.
It said: ‘Long term hospital outpatients are often expected to travel to see their consultant at regular six month
intervals when they are quite well, but are unable to see them when they really need to.
‘Some kinds of behaviour may also need to be ruled out by NHS regulators under the NHS constitution. In
particular, free communication between doctors and patients and between professionals, needs to be protected.’
After the review heard of perverse incentives such as hospitals gaining revenue by referring patients back to
their GP rather than straight on to a specialist within the hospital, or booking patients into phantom appointments
which are later cancelled so as not to breach waiting time targets, an evaluation into the prevalence of gaming in
the Choose and Book system was also recommended.
The review recommended that patients who move house should have the right to remain with their GP practice,
irrespective of catchment area, though said that decisions about this issue would need to wait until the results of
the GP Choice pilots were published.
It says: ‘Consideration should be given to drawing up town or city specific catchment areas for this purpose
while lessons from the GP Choice pilots are being learned.’
Where both sides agree it is appropriate, patients should have a right under the NHS Constitution to ask for
consultations with GPs using a range of communication methods, such as telephone or Skype, it added.
Dr Peter Holden, a GPC negotiator and a GP in Matlock in Derbyshire agreed that GPs should be free to talk to
He said: ‘GPs need to consult with consultants as much as patients.
The pen pushers should stick to pen pushing. Managerial greed is inappropriate to come in the way of
healthcare, and that is what this is: managerial and trust greed.’
He added that the proposals for removing all practice boundaries were unworkable.
He said: ‘What the policy wonks don’t understand is that there is a good reason for boundaries.
If I’ve got a patient 25 miles away, then going to visit them will take time and degrade the service for all.
‘General practice is a team activity and I might require the opinion of a team member who may not have the
geographical freedom a GP has.
‘The bottom line is that choice costs resources and implies a surplus of resources which currently the NHS just
Medical- Patients are becoming addicted to some pills
Updated: 18 Jan 2013
New guidelines released by the Royal College of GPs, the Royal College of Nursing and the British Psychological
Society suggest GPs slash prescriptions of painkillers and sleeping pills amid concerns that patients are becoming
addicted, the Daily Mail reports.
The guidelines warn about the long-term side-effects of some pills, particularly benzodiazepines and painkillers
A Harvard University study last year found pensioners who had taken the pills were 50% more likely to develop
Medical- Emergency Hospital Admissions continue to rise
Updated: 18 Jan 2013
Emergency admissions continue to rise
15 January 2013 |
By Michael Woodhead
Preventable emergency admissions have risen by 40% in a decade despite extra resources being ploughed into
programmes aimed at preventing such admissions, new figures have shown.
A study of 140 million emergency admissions at NHS hospitals between 2001 and 2011, published in the BMJ,
concluded that more radical approaches will be needed to tackle avoidable emergency admissions, a measure that
will form a quarter of CCGs’ quality premium payments.
Researchers from the Nuffield Trust found that the number of unplanned admissions for clinical conditions that
could have been reduced by timely and effective primary care increased by 40% between 2001 and 201.
They rose from 701,995 to 982, 482 - an increase of 280,487 admissions per year.
Most of the increase in admissions was for acute conditions such as urinary tract infections, gastroenteritis and for
vaccine-preventable conditions such as pneumonia. Increases were seen across most age groups, and even after
taking into ageingdemographics, admissions still rose by 21% over a decade.
Some decreases were seen in avoidable admissions for conditions such as perforated and bleeding ulcers, pelvic
inflammatory disease and ischaemic heart disease, but the scale of the reductions was much lower than the
increases seen for other conditions, according to the study.
The reductions seen in admissions for cardiovascular disease could be due to changes in health-related
behaviours such as reduced smoking and availability of effective preventive treatments such as statins, the
researchers said. Likewise the reductions seen in avoidable admissions for ulcer complications might be linked to
increased use of antibiotics and PPIs, they suggest.
But the overall increase in avoidable emergency admissions could be attributable to health service system
changes, the study said. .
‘It may be that admission decisions are in part influenced by the perceived lack of alternatives to inpatient care,’
they authors added.
However, the study provided only weak evidence to link increases in avoidable admissions with policies such as
the introduction of the four-hour A&E target and changes to the GP out-of-hours contract.
The study authors said it was notable that unplanned admissions increased despite funding incentives in primary
care aimed at preventing hospital admissions and major changes to OOH care.
‘Increases in rates of emergency admissions suggest that efforts to improve the preventive management of certain
clinical conditions have failed to reduce the demand for emergency care.
Tackling the demand for hospital care needs more radical approaches than those adopted hitherto if reductions in
emergency admission rates for ambulatory care sensitive conditions overall are to be seen as a positive outcome
of for NHS,’ they report said.
Dr Andrew Mimnagh, a Liverpool GP and chairman of the Sefton LMC, said that the findings raised more doubt
about the decision of the NHS Commissioning Board to link 25% of quality premium payments for CCGs to
reducing avoidable emergency admissions.
He said the target had been set despite there being no evidence to suggest it was achievable.
‘Our own review of emergency admissions as part of the QoF suggested that the majority arose from the out of
hours and other periods. One of the only areas where there is room for clinical improvement would be in better
co-ordination of OOH and general practice care.
Obviously there is then the difficult question of would you look at the resources to genuinely extend the
comparable levels of standards across a large area of the day? I suspect the government hasn’t got the funding to
do that,’ he said.
‘The evidence would suggest extending the quality of provision and staffing.
We already work effectively from 8am till 8pm, five days a week, and the system would appear to really need 6pm-
midnight cover and that means workforce expansion and a very major structural change.
‘So is it workable? Yes. Do the CCGs have the levers to do it? No. Is there political will to really tackle the issue?
Not with the budget there currently is.
“You need to be looking much broader than a CCG remit.
You need a whole NHS remit.
We’ve had a wealth of resources poured into the NHS creating novel ideas over the last decade.
They would have been a lot better just reinforcing and increasing the current models rather than having so many
novel models of care.
Medical- The case against charging for NHS care because of lifestyle choices
Updated: 29 Dec 2012
Why charging for care is not the answer
Posted by: Nick Ramscar
28 December 2012
Dr Philip Lee recently wrote an article arguing that some individuals should contribute financially to their NHS
care, because of their lifestyle choices. I enjoyed his piece, and admire him for sticking his head over the parapet in this way.
It is vital that we have free debate regarding ways to make the NHS viable.
But I don’t believe the system he advocates would work, and I find it morally uncomfortable.
On the small off-chance that it isn’t abundantly clear by the end of this piece, let me say at the beginning that I
have no special qualifications in medical ethics or economics, these are just my thoughts as a GP.
Firstly, let me quickly confess a personal interest: wariness of any bill that proposes ‘to require GPs to issue
annually, to each person eligible for care provided by the NHS, an itemised account of the cost of his or her
healthcare’. I‘ll say no more, except to refer you to Copperfield’s excellent rant on the fact that most GPs have physically run out of time.
Secondly, this strikes me as another example of profound confusion over the nature of our role.
Are we advocates for our patients, on their side when things go wrong, or are we agents of the Government? Is
our first duty to the person in front of us or to the coffers of Whitehall?
The answer may be that in straitened times we have no choice, if the system is to survive.
But gathering data for the purpose of implementing charges on individuals is a sea-change, even from QOF. We should not breeze over it so easily.
Thirdly, I doubt our patients are really so foolish that they would give us accurate information, if it would inflate their healthcare bills.
The bill would prompt a sudden increase in self-reported jogging, and the pubs would be full of people who had just lied to their GP.
But if this system wouldn’t work on self-reporting, how would it work?
The prospect of cross-checking people’s claims about their lifestyles against their real activities will lead us
rapidly into deep, dark, and dystopian waters.
Dr Lee doesn’t specifically mention which lifestyle choices would prompt an additional charge.
But I imagine that the familiar four horsemen of medical apocalypse will amble by on wheezing steeds:
Smoking, Alcohol, Poor Diet, and Sedentary Lifestyle.
These are the easiest targets – highly visible, chronic choices that unarguably have an impact on health, and
which already have honourable mention in the more ‘nanny state’ parts of QOF.
But even introducing charges for these would not be a simple thing.
These risk factors are overwhelmingly more common in deprived areas.
Imposing additional charges for them would crank up the power of the inverse-care rule. It would also be
practically unenforceable; if your patients are anything like mine, the ones who make the most self-destructive
lifestyle choices usually don’t have the healthiest bank accounts either.
Would we squeeze what money we could out of them, before withdrawing their medicines when funds ran out?
Would we never provide them with any care they couldn’t pay for, and risk the media’s fury?
Or would individual clinicians quietly sabotage the system by caving in and treating them anyway, regardless of
ability to pay, because that’s what we all joined the NHS to do?
It isn’t clear where the lines would be drawn.
There is something Puritanical that delights in punishing smoking and drinking – and they already pay heavy ‘sin taxes’.
But what about nice middle-class activities like rugby, or horse-riding, which predictably increase the risk of injury?
If I get run over crossing the street, and the NHS has to patch me up, should I be billed if CCTV footage can prove I showed scant regard for the Green Cross Code?
Should golfers and tennis players be charged more for their epicondylitis than anyone else?
And this is before we have started considering concurrent mental health problems.
Will A&E units charge for dealing with overdoses? What will we say to patients who tell us their poor lifestyle choices were driven by depression?
I believe that lawyers, not patients or the NHS, will benefit from the imposition of charges on a selected subsection of the population.
Not just because people will inevitably challenge any assessment that makes them pay more than their
neighbour (and probably with added costs for the distress of the whole affair).
The study of genetics is advancing every day.
If in 2013 we charge somebody for treatment of her diabetes, because her lifestyle probably contributed to its
development, we are sowing trouble for the future. Imagine that in 2023 a court sees her personalized genome
report, proving that she was doomed to become diabetic however she behaved:
could the NHS avoid ten years of reimbursements, with interest, and additional payments for compensation?
Conversely, would we offerlower tariffs for those who could show protective genes?
The challenge to all this is, of course, to come up with something better.
There is an urgent need to make NHS finances more robust.
I would love to hear Dr Lee’s reply to the above, and if we can get a productive debate going, I will be thrilled.
But in its current format, the system he proposes seems to me unworkable, likely to drive a further wedge
between doctors and patients, and potentially fraught with unintended consequences.
Dr Nick Ramscar is a GP in Bracknell, Berkshire
Medical - Treat the Causes, not just the Consequences of Obesity
Updated: 28 Dec 2012
We must go beyond the 'fat register' in the QOF
26 December 2012
Instead of our profession chasing our tails and treating the consequences of obesity, we should start to treat
one of the known and obvious causes, writes Dr Matt Capehorn.
Harm from obesity may already be worse that that from smoking, and prevention has certainly failed.
Treatment should now become the priority and GPs must provide more direct help to our patients, as we do
when we refer smokers to structured cessation clinics.
The National Obesity Forum (NOF) is urging the Government to tackle this head on, and in particular to address
the irony of the Quality Outcomes Framework (QOF), which rewards GPs for recording the numbers of obese
patients – but not for doing anything about it.
Although this information is useful, merely drawing up a register will not prevent a single overweight person
from developing type-2 diabetes or a single obese person from having a heart attack.
NOF began a campaign in June 2012 to reform the way in which GPs are paid.
QOF needs reform in order to reward those GPs who steer their overweight and obese patients into structured
weight management programmes that help them to lose weight in a safe way and with the necessary support
and advice to help them maintain this weight loss.
What is needed are QOF indicators for the identification of obese patients (similar to the eight points that
currently exist for having an obesity register).
But we also need further indicators for the appropriate screening of these ‘at risk’ patients for the other common
associated co-morbidities (such as diabetes, dyslipidaemia and obstructive sleep apnoea) plus additional
indicators for ensuring that appropriate weight management advice has been given and that a referral has been offered.
In an ideal world we would have enough time to deal with all of the problems that our patients have on every
occasion, but we rely on the QOF to help us identify priorities.
The NOF agrees with the BMA and our medical colleagues that a GP’s pay should never be determined by the
weight of their patients, or their success in a weight management clinic, but that GPs should be incentivised to
refer obese patients into structured weight management programmes, similar to the successful smoking cessation programme.
This can be achieved very easily with QOF points for appropriate screening and referral of such patients.
It may also drive up the number and quality of weight management services.
A Government White Paper already insists that each PCT must have an obesity strategy, but it lacks specifics – if
we incentivised more referrals then over time we would end up with more programmes, and more effective ones.
See what we’re doing
At present there is a huge geographical variation in the quality of weight management services.
The obesity strategy in some areas may just be to rely on GPs referring patients to practice- or secondary care-based dietitians.
In other areas, such as Rotherham (where I work), there are services that include comprehensive specialist multi-
disciplinary teams, and facilities for weight management.
Over time having more weight management programmes across the country will add to the existing evidence
base and allow us to see what works best for patients.
It is reassuring that MPs are finally beginning to grasp the scale of Britain’s obesity epidemic, and its central role
in the range of potentially fatal and highly expensive ailments.
However, some may still need to get out and spend some time in our surgeries to appreciate the problem.
My invitation goes out to them to spend a day at the Rotherham Institute for Obesity.
After all, it is urgent that we start to deal with obesity more effectively.
Currently one in four adults is clinically obese, and this is predicted to rise to one in two by 2050.
Direct and indirect costs of obesity may reach a staggering £50bn a year, or more by then, which we are told will bankrupt the NHS.
The latest National Child Measurement Programme figures show that the numbers of overweight and obese
children in Year 6 (aged 10-11) is still increasing, and this will be adding to the future burden on the NHS.
The Government wants us to tackle diabetes and other long-term conditions, as well as reduce admission etc,
and we need to appreciate that obesity causes or worsens nearly all of these long-term problems.
Instead of our profession chasing our tails and treating the consequences of obesity, we should start to treat
one of the known and obvious causes: the weight of the nation.
The latest Health Survey for England data (2011) and shows obesity prevalence is 24% in men and 26% in women.
The percentages that are overweight or obese are 65% men and 59% women.
Source: HSE, 20 Dec 2012
Dr Matthew Capehorn is a GP in Rotherham and clinical director of the National Obesity Forum
Medical-NHS Health Boards still employ GP's who don't speak English ?
Medical- Amoxicillin now no benefit for chest infections especially in the elderly ?
Updated: 21 Dec 2012
Amoxicillin provides no benefit in patients with uncomplicated lower respiratory tract infections, an analysis of the latest trial evidence has confirmed.
UK researchers looked at data from primary care practices across Europe and found that patients on amoxicillin were only 6% more likely to experience resolution of symptoms they had rated as ‘moderately bad’, at seven days, compared with patients on placebo.
Patients older than 60 years on amoxicillin were 5% less likely to experience resolution of symptoms, compared with those on placebo, while those younger than 60 years were 12% more likely compared with placebo – both interactions were not significant.
The study randomised 2,061 patients aged 18 years or over to receive either amoxicillin or placebo three times daily for seven days. They presented for the first time to their primary care practice with an acute cough as their main symptom, and were asked to rate their symptoms on a six-point scale, with three representing ‘moderately bad’.
The authors concluded: ‘Amoxicillin provides little symptomatic benefit for patients presenting in primary care who are judged to have clinically uncomplicated lower respiratory tract infections.’
Medical- Too many arrogant POMS (Prescription only medicines ) ?
Updated: 18 Dec 2012
The BBC also reports that a number of pharmacists in London have been caught selling drugs to people without a prescription.
In a an Inside Out report seven pharmacies sold prescription drugs for as much as £200 to investigators who had
no prescriptions for the drugs.
Those pharmacists who were convicted face a maximum of two years in prison and an unlimited fine.
The documentary has led to a call to the government to crack down and overhaul pharmacy regulations.
Shadow health secretary Andy Burnham said:”People will be shocked to see pharmacists acting like small time
drug pushers.” Meanwhile the Department of Health insists it is concentrating its effort on prescription drug abuse.
Medical - Hangover tips
Updated: 18 Dec 2012
In the Guardian Dr Dillner gives out a few tips for the Christmas party season to avoid a hangover.
A recent article in the BMJ found that none of the fabled cures, including hair of the dog and green tea, have any
evidence showing that they work.
Instead the best cure is prevention.
Drinks to avoid are ones that are high in cogners, which are added for taste and appearance, such as red wine and whiskey.
Instead sticking with ones with more ethanol, such as gin and vodka, reduce, but don’t remove, the likelihood of
having a hangover.
Other tips include eating dry toast to reverse the drop in blood sugar level and staying away from paracetamol and
aspirin as they will irritate your stomach.
Medical - Gallstones
Updated: 17 Dec 2012
- Published by Bupa's Health Information Team, May 2011.
This factsheet is for people who have gallstones, or who would like information about them.
Gallstones are solid lumps or stones that form in the gallbladder or bile duct.
They form when bile, which is usually liquid, hardens.
One large stone may develop, or many small ones.
The gallbladder is a small, pear-shaped pouch in the upper right part of your abdomen (tummy).
It’s connected to your liver and bowel through the bile duct which is also attached to your pancreas.
Between meals it stores bile that is produced by your liver.
Bile is released into your bowel when you eat to help your body to digest fats and other substances.
What are gallstones?
Gallstones are hardened lumps of bile.
Bile contains cholesterol, bile salts and waste products, for example bilirubin (a pigment formed in the breakdown of old red blood cells).
Gallstones develop when these substances in your bile harden, forming stones.
They can vary in size, anything from as small as a grain of sand to the size of a golf ball.
There are two main types of gallstone.
- Cholesterol gallstones are the most common type and form if you have too much cholesterol in your bile.
- Pigment gallstones form when there is too much bilirubin in your bile.
- These are less common and tend to develop if you have liver disease, an infection in your bile duct or an inherited blood disorder, such as sickle cell anaemia, where your body breaks down blood cells too quickly.
Symptoms of gallstones
About eight in 10 people with gallstones get no symptoms and so you may not be aware that you have them.
If you do get symptoms, it's usually because gallstones have blocked your gallbladder which then becomes inflamed or infected.
This is called cholecystitis.
Common symptoms of gallstones may include:
- upper abdominal pain – this may last for several hours
- jaundice (yellowing of your skin or the whites of your eyes) – if a stone has blocked your bile duct
- feeling sick or vomiting
- a high temperature, shivering and sweating – if your gallstones have caused an infection
These symptoms aren't always caused by gallstones but if you have them, see your GP.
Complications of gallstones
If your gallstones are causing you symptoms and aren't removed, they can cause further problems such as inflammation, infections and blockages of your gallbladder, bile duct, pancreas and bowels.
Causes of gallstones
You can develop gallstones at any age, but your chances of getting them increase as you get older.
Women are up to three times more likely to get gallstones than men.
You're more likely to get gallstones if you:
- have a family history of them
- are overweight
- have lost weight quickly
- are pregnant
- take hormone replacement therapy
- have high cholesterol
- have diabetes
- have Crohn’s disease
- have an inherited blood disorder, such as sickle cell anaemia
Diagnosis of gallstones
Although you may have symptoms of gallstones, many people don't and so they are sometimes found by chance during medical tests for other conditions.
If you visit your GP with symptoms of gallstones, he or she will ask you about your symptoms and examine you.
This may involve him or her feeling your abdomen to see if your liver or gallbladder is tender or enlarged.
Your GP may also ask you about your medical history.
You will usually have blood and urine tests to check your liver function and to look for signs of inflammation or jaundice.
Your GP may also arrange for you to have an ultrasound scan.
An ultrasound uses sound waves to produce an image of the inside of your body.
This will help to show where any gallstones are and how large they are.
If your gallstones are in the bile duct, you may have an endoscopic retrograde cholangio-pancreatography.
This is a detailed X-ray of your pancreas and bile ducts and is useful to see if gallstones have passed into them.
The test is done using a narrow, flexible, tube-like telescopic camera called an endoscope, which is guided using X-rays.
Treatment of gallstones
If your gallstones aren’t causing you any symptoms, your doctor may suggest leaving them alone as they usually don’t cause any problems.
If your gallstones are causing you problems, you will need treatment because they won't go away by themselves.
It's advisable to eat a healthy, balanced diet and to control your weight.
Your GP may recommend a low-fat diet to help ease your symptoms.
If your gallstones cause you frequent and severe pain or if you are jaundiced, you may be advised to have your gallbladder removed.
Gallstones will continue to form if you don't have your gallbladder removed.
You can live without your gallbladder and most people don't have any problems.
However, all surgery carries some risk. Your surgeon will discuss the benefits and risks with you.
There are two types of gallbladder removal and both are done under general anaesthesia, which means you will be asleep during the operation.
This is a method of keyhole surgery to remove your gallbladder.
Your surgeon will make small cuts through your abdomen or belly button.
A laparoscope (a long, thin telescope with a light and camera lens at the tip) is inserted through one of these small cuts.
Specially adapted surgical instruments are then inserted to remove your gallbladder.
At the end of the operation, the instruments are removed and the wounds are closed with stitches or clips.
Open cholecystectomy surgery
This is sometimes used if you can't have keyhole surgery, for example if your gallbladder is severely inflamed or if you have had previous surgery to your abdomen.
Open cholecystectomy involves removing your gallbladder through a larger cut in your abdomen.
It's likely to take you longer to recover from this type of surgery than keyhole surgery, and you may need to spend more time in hospital.
If you can't have surgery, sometimes gallstones can be dissolved using medicines.
These medicines often take a long time to work and are only effective on certain types of gallstones, therefore aren't suitable for everyone.
Gallstones often come back after treatment with medicine, therefore it's rarely used.
If you have gallstones in the bile duct and not in the gallbladder, you can have an endoscopic retrograde cholangio-pancreatography to find and remove them.
The procedure is usually done under sedation – this relieves anxiety and helps you to relax during the procedure. Your surgeon will pass an endoscope into your mouth and down to your bile duct.
Special instruments can be passed inside the endoscope to allow your surgeon to remove gallstones from the bile duct.
If any gallstones are found in the gallbladder itself, you may need gallbladder surgery as well.
Prevention of gallstones
Many of the risk factors for gallstones, such as age, gender, family history can't be altered.
Try eating plenty of fresh fruit and vegetables and small amounts of meat and dairy products to help prevent gallstones.
If you're overweight, try to lose excess weight and take regular exercise as this can also help to prevent gallstones
Medical - An Endoscopy
Updated: 17 Dec 2012
Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopy is an established and reliable method of investigating the body’s internal organs.
An endoscope is a long, flexible fibre optic tube with a tiny camera and a light on the end.
ERCP is an endoscopic procedure that is valuable in both examining your biliary and pancreatic structures.
It can identify problems with the biliary tree, cystic duct obstruction, gallstones, narrowings and tumours.
As a treatment ERCP can drain pus as well as dislodge, break down and remove gallstones.
You should get instructions from the hospital where your ERCP has been scheduled.
These will provide you with guidelines on what preparations you need to make before the procedure. It is
important for you to know how long before the procedure you will need to stop eating and drinking and about any possible changes in your medication.
At the beginning of the procedure, the doctor will spray the back of your throat with a local anaesthetic to make it feel numb.
Sometimes a local anaesthetic lozenge is used, or you will be given a sedative injection through the drip (venflon) in your hand or arm.
This will make you drowsy so that you can put up with the discomfort of having a tube passed into your gullet.
You will be positioned on your side to follow the curvature of your gut.
The doctor will ask you to swallow the first section of the endoscope.
After this the doctor will push it further down your gullet into your stomach and duodenum.
The doctor will look at images on a TV monitor which come from the endoscope’s camera which is filming the procedure.
Air is also passed into the tube into your gut to make it easier to see the lining of the gut.
This may make you feel bloated.
The endoscope has a side attachment down which small instruments and tubes can pass.
It has many uses:
- Contrast dye can be placed into the bile and pancreatic ducts. X-ray pictures are taken immediately after the dye has been given. This may show narrowings (strictures), any gallstones that might be stuck, tumours pressing on the ducts etc.
- A small tissue sample (biopsy) from the lining of the gut can be taken to check for abnormal tissue or cells. The sample is used for two types of test, histology and pathology
- If the X-rays show a gallstone obstructing the bile duct the doctor can widen the duct by making a cut to let the stone into the duodenum. This is called a sphincterotomy.
- If there is a narrowing in the bile duct the doctor can place a stent to open it up and keep it from collapsing. The stent can remain in place to help to drain away bile into the duodenum.
The endoscope is gently pulled out when the procedure is completed.
It takes around 30 minutes to one hour, depending on what is done.
Your aftercare will depend on the findings of the ERCP.
You might be booked in for an overnight stay if you have received a stent or had gallstones removed.
You should not drive for 24 hours after receiving a sedative.
Ask a friend or relative to drive you home from hospital.
Also make sure that someone can stay with you for the first 24 hours after discharge from hospital.
The hospital will also provide you with information when you are discharged that will help with any problems that
might arise after an ERCP procedure.
Medical-As Poverty Knocks- A Public Health Campaign and Free Cod Liver Oil to prevent Rickets
Updated: 15 Dec 2012
In news that makes you feel like you’re in the Victorian times the Guardian says cases of rickets are on the rise due to lack of vitamin D.
Over the last 15 years there has been a fourfold increase in the number of cases reports the Royal College of Paediatrics and Child Health.
Doctors say that ministers need to start a public campaign to inform people about the dangers of having too little vitamin D in your diet.
Interventions, such as low cost supplements, are needed because of how little sunlight is seen in Britain and the
fact that foods that are rich in vitamin D only offer 10 per cent of the ideal amount.
Medical- "Monday Blues" for missed GP appointments
Updated: 15 Dec 2012
It appears that those ‘Monday Blues’ are the reason that many patients miss GP appointments.
Radical says - Encouraging good health - Close GP Surgeries on Monday and open on Saturday when many are not at work ? At least rotate opening times !
A study done at Glasgow University found that patients were more likely to turn up to surgery appointments if they were at the end of the week.
The team recommends that GPs try to have more appointments on Thursday and Friday as it would have both health and financial benefits.
Monday was the worst day for appointments leading researchers to believe there was a psychological cause.
Past research has shown that different days of the week illicit different emotions with Monday being the most
negative while Friday is the most positive.
Dr Robert Jenkins, one of the authors, said it appeared that patients were susceptible to this week’s psychological cycle.
He said: ‘Missed appointments seem to follow the psychological peaks and troughs of the weekly cycle, with
emotionally positive days boosting patient resilience and improving attendance.’
Medical- GP services online ?
Updated: 15 Dec 2012
Patient survey supports move to boost online GP services, says minister
13 December 2012 |
By Madlen Davies
Almost a third of patients would like to book a GP appointment online, but only 3% are currently able to, the
results of the national GP Patient survey show.
The DH said the annual survey of patient opinion supports their move to increase online services in GP practices.
Carried out on the DH’s behalf by Ipsos Mori, the survey showed the majority of respondents - 87.6%- said their
overall experience of their GP practice was good.
This figure is 0.7 percentage points lower than the results for 2011/12, though the DH warned changes made to the
survey this year made the data incomparable.
The survey found that almost all patients trust their GP; 92.8% of patients reported a level of confidence and trust
in the last GP they saw, though this figures drops to 81.8% for out-of-hours clinicians.
Medical -No Cure for his Sick Service?- Keep the NHS a Right not a Privilege & focused on Prevention
Updated: 15 Dec 2012
Patients must learn the cost of care
10 December 2012
Those who increase their burden on the NHS through their lifestyle choices must share the cost, argues Dr Phillip Lee
Future healthcare services may be at risk if we stand back and do nothing.
Younger generations are in danger of no longer having access to a health service free at the point of use, the
same health service which older generations have had the opportunity to take for granted for so long.
Changing demographics, rising obesity levels and increased treatment costs are a significant constraint on the current NHS.
Healthcare costs, driven upwards by an inexorable increase in patient demand, have reached a tipping point.
Politicians who think the current NHS funding model can be sustained in the medium to longer term under that
onslaught are deluding themselves.
The reality of healthcare demand in Britain today has changed and will be changing even further in the next decade.
This is why it is time to take action to save the future of our health service before it is too late.
Governments of all colours have been avoiding any key decisions involving the long-term future of our country.
We cannot continue to rule day by day, in a risk-averse fashion, and we need to be more honest about how we will deal with this challenge in the future.
We must ensure there is a long-term vision for our health service – on the current trajectory, public sector
spending will eventually account for well over 50% of GDP and that is simply not sustainable.
If we dismissively continue to increase debt beyond the £1 trillion it is currently at, and if we continue to raid
public-sector pension pots beyond the £300 billion we already have, there will be dark consequences at the end of the road.
I suggest that 85% of NHS expenditure should continue to be funded by the state, but the remaining 15% should
be taken on by individuals incrementally – a meagre £15 billion out of the total £400 billion welfare budget. Is that
really too radical to contemplate?
I care about my country and its people and that is why I am emphasising the need to focus on the demand side of healthcare provision.
In these challenging times, healthcare responsibilities should be shifted from the state to the individual, to reflect people’s choices of lifestyle.
No doubt changing the public’s mindset on this issue will be an extremely arduous political process with no short-
term reward, but we have no choice. For those of us who want to protect the fundamental principle of access to
all, we need to start engaging the British public in this difficult debate now.
People need to realise the cost implications of their lifestyle choices.
I want people to be free to choose any lifestyle they wish at the same time as understanding the implications of such a choice.
I want to give more to the truly deserving because we are spending less on those who are perfectly able to provide for themselves.
If we do not act now, then the truly vulnerable will be at risk. Consequently, I believe moving the responsibility for
drug costs away from the state to the individual would allow the individual to attach such a sense of responsibility.
Earlier in the year, I argued in a Ten Minute Rule motion in the House of Commons for a bill that would require GPs
to issue annual statements on healthcare costs.
The bill would require GPs to issue annually, to each person eligible for care provided by the NHS, an itemised account of the cost of his or her healthcare.
The bill was rejected in Parliament: a clear demonstration of how little people understand the increasing burden the NHS is facing.
As a medical professional, I have seen over 50,000 patients, and it has been striking to see the stark difference in attitude between the generations. The stoical, post-war attitude appears significantly different to that of younger generations.
When baby-boomers hit their eighties after 2025, around 25% of the NHS budget will then be being spent on diabetes alone.
Without doubt, an increasing number of people are getting prescription medication for conditions predominantly to do with lifestyle choices.
Clearly, I am not saying that all do, but to ensure that the chronic and terminally ill patients of the future have the care that they will need, we need to make some tough decisions about future funding now.
Dr Phillip Lee is the Conservative MP for Bracknell and a practising locum GP
Medical - Aspirin - Still Underrated ?
Updated: 13 Dec 2012
The Daily Mail reports that next year ministers will consider
whether patients who are at risk of certain cancers should be prescribed aspirin.
Jessica Harris, of Cancer Research UK, said: ‘Research suggests that regularly taking low doses of aspirin can reduce the risk of developing and dying from cancer’,
however, aspirin can also cause stomach bleeds and ulcers, which although they are not often fatal usually require hospital treatment.
The article says doctors will need to weigh up the options and may decide to only prescribe aspirin for cases of high risk.
Medical- Preventative Medicine cut backs - Cancer Stroke & Heart
Updated: 11 Dec 2012
The BBC reports that clinical networks which oversee the care of cancer, heart and stroke patients in the NHS
have had their budgets and staff cut.
Some of the groups say they are postponing projects due to uncertainty from the changes made in England.
The data comes as a result of Freedom Of Information (FOI) questions put to the networks by Labour.
More than 75% of the clinical networks responded to the FOI request.
The cancer teams said funding had been cut by around 25%, and 73 staff had been lost since 2009.
The teams looking after heart and stroke care said their funding had been cut by 12% and 38 posts had gone in
the past three years.
Medical- World Aids Day -Dec 1st -Global Priorities
Updated: 29 Nov 2012
Top Global Priorities on AIDS in 2013
Written by Bobby Ramakant, CNS
Wednesday, 28 November 2012
The world is running behind on its HIV priorities as it approaches World AIDS Day, Dec. 1
A new report argues that despite considerable advances in the fight against AIDS, the world is already falling behind pace in the effort to begin stopping the spread of the virus.
But it doesn't have to be that way - according to the assessment in the report, the top-five critical actions over the coming year could have a substantial impact.
This report, 'Achieving the End: One Year and Counting', released by ‘AVAC: Global Advocacy for HIV Prevention’ outlines top-five list of critical global priority actions in 2013.
Considerable gains have been made in the fight against AIDS in different countries around the world, but are they enough to keep us on track to end AIDS?
According to another important report, the UNAIDS Report on the Global AIDS Epidemic 2012, released last week, unprecedented gains have been achieved in reducing the number of both adults and children newly infected with HIV, in lowering the numbers of people dying from AIDS-related causes and in implementing enabling policy frameworks that accelerate progress.
But the AVAC report calls for more urgency.
"Recent scientific breakthroughs give us reason to be optimistic like never before, but our chances of success are already imperiled," said Mitchell Warren, Executive Director, ‘AVAC: Global Advocacy for HIV Prevention’.
"Right now, the world isn’t moving as fast as it should be to begin ending the epidemic. There is still time to get back on a winning pace but only with focused, aggressive action now.
This can be the year that HIV prevention begins to achieve its potential – in fact, it has to be."
AVAC’s 'top-five' priority recommendations for 2013 are as follows:
1.End confusion about "combination prevention." In 2012, there was long-overdue recognition that different countries will need to implement different combinations of HIV prevention interventions for different populations at risk.
But the hard work of defining those combinations and establishing priorities has not been done. In 2013, donors, policy makers and civil society need to be held accountable for choosing, implementing and evaluating the right packages of interventions for specific circumstances.
2.Close the gaps in the HIV "treatment cascade." Antiretroviral treatment not only improves and prolongs the lives of those infected, it is among the most powerful HIV prevention strategies available, reducing the risk that an infected person will pass on HIV by up to 96 percent.
But only a small proportion of people diagnosed with HIV are linked to antiretroviral treatment and an even smaller share stay on treatment and have their HIV infection suppressed to levels low enough to prevent transmission to others.
A range of studies is looking at ways to narrow this gap, but these efforts are uncoordinated and incomplete. In 2013, researchers and funders need to convene and establish a clear research and implementation agenda to close the gaps in the treatment cascade.
3.Prepare for new non-surgical male circumcision devices. In 2013, the World Health Organization (WHO) is expected to approve new male circumcision devices that could eliminate the need for surgery, speed recovery and lower costs in many of the 14 priority African countries where VMMC could reduce HIV infections by 20 percent.
While the new devices may not be right for every country or setting, there could be months or years of lost opportunities unless national health leaders immediately take action to evaluate their benefits, costs and optimal uses.
4.Define and roll out needed PrEP demonstration projects. Global health agencies including WHO and UNAIDS have said they are awaiting the results of real-world demonstration projects before they can provide guidance on the use of PrEP – yet there is no clarity on what range of studies is needed, and few are under way.
By the end of 2013, a core set of studies must be defined and moving ahead.
5.Safeguard HIV prevention research funding.
New momentum on research into HIV vaccines, microbicides and other new tools is threatened due to the possibility of federal budget sequestration in the US and similar pressures in other countries.
The potential cuts could slow or halt progress on some of the most promising HIV prevention research in many years. Policy makers must have the courage to preserve this vital research in 2013.
"The most urgent questions about new prevention tools have been clear for months or even years, and yet the work to answer them is barely under way," said Warren.
"That’s as unconscionable as it is unnecessary.
Millions of lives depend on our ability to pick up the pace."
UNAIDS' Ten specific targets for 2015
While we prepare ourselves as best as we can to act upon top-five priorities as enlisted above from AVAC's report, the UNAIDS Report on the Global AIDS Epidemic 2012 also draws upon the 2011 Political Declaration, and articulates 10 specific targets for 2015 to guide collective action:
1.Reduce sexual transmission by 50 percent.
2.Reduce HIV transmission among people who inject drugs by 50 percent.
3.Eliminate new infections among children and substantially reduce the number of mothers dying from AIDS-related causes.
4.Provide antiretroviral therapy to 15 million people.
5.Reduce the number of people living with HIV who die from tuberculosis by 50 percent.
6.Close the global AIDS resource gap and reach annual global investment of US$22 billion to US$ 24 billion in low- and middle-income countries.
7.Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV.
8.Eliminate stigma and discrimination against people living with and affected by HIV by promoting laws and policies that ensure the full realization of all human rights and fundamental freedoms.
9.Eliminate restrictions for people living with HIV on entry, stay and residence.
10.Eliminate parallel systems for HIV-related services to strengthen the integration of the AIDS response in global health and development efforts.
In 2013, the fight against AIDS in different countries and contexts, has to regain its urgency to end AIDS.
This needs more than just aiming to meet 2015 targets listed above.
As AVAC's report points out clearly, the world is set to begin 2013 behind where it was supposed to be in the global fight against AIDS.
(Bobby Ramakant, is Director (Policy and Programs) Citizen News. Email: firstname.lastname@example.org
Medical- Bloodletting - Radical Remedy or Mumbo Jumbo
Updated: 26 Nov 2012
Bloodletting: Return of a radical remedy
20 November 2012 by Lindsey Fitzharris
It was unsanitary and dangerous, but for centuries bloodletting was standard practice.
Could it now be used to relieve some of the complications of obesity?
See more old-style medicine in our gallery: "Misguided medicine, from bloodletting to radium"
WHEN King Charles II suffered a sudden seizure on the morning of 2 February 1685, his personal physician had just the remedy.
He quickly slashed open a vein in the king's left arm and filled a basin with the royal blood.
Over the next few days, the king was tortured by a swarm of physicians buzzing around his bedside.
They gave enemas and urged him to drink various potions - including boiled spirits from a human skull.
The monarch was bled a second time before he lapsed into a coma.
He never awoke.
Even without his doctors' ministrations, the king may well have succumbed to whatever ailed him, yet his final days were certainly not made any easier by the relentless bloodletting and purging.
By the time of Charles II's death, however, bloodletting was standard medical practice.
Bleeding would very rarely have been beneficial.
In fact, it would usually have been unsanitary and dangerous - sometimes even deadly.
But now it seems that, with certain caveats, drawing off blood could have some health-giving properties for a select group of people.
Bloodletting dates back to the Roman physician, Galen, who lived in the 2nd century AD.
Galen taught that blood was the product of food.
After reaching the stomach, food was liquefied and then sent to the liver, where it was turned into blood.
Sometimes people produced an excess of blood, he believed, which was the cause of all manner of disorders, including fevers, headaches - even seizures.
The only recourse was to rid the body of this superfluous fluid.
As vital as bloodletting was felt to be, many physicians believed the "cutter's art" was beneath their station.
Instead, they referred those in need of bleeding to barber-surgeons, who carried out this duty in addition to a diverse range of other personal services.
The traditional striped barber's pole harks back to that era, when it served as an advertisement for their proficiency as bloodletters.
The pole represents the rod that the patient gripped to make their veins bulge and the brass ball at the top symbolises the basin used to collect the blood.
The red and white stripes represent the bloodied bandages.
Once washed and hung to dry on the rod outside the shop, they would twist in the wind, forming the familiar spiral pattern adorning poles of today.
Most practitioners used a double-edged knife called a lancet, which later gave rise to the name of the famous medical journal. An array of different-sized lancets were available, to prevent cutting into a vein too deeply.
The Greek physician Hippocrates cautioned bloodletters to be careful when choosing their lancet, "for there are certain parts of the body which have a swift current of blood which is not easy to stop".
People could be bled from various parts of the body.
In the 16th century, the German surgeon Hans von Gersdorff identified 41 suitable points, including the forehead, neck, arm, wrist, thigh and even genitals.
During this period, veins were seen as belonging to the heart, breast or head.
The nature of the illness indicated where a person should be bled.
To treat nosebleeds, for instance, Galen advised bleeding from behind the knee.
This kind of thinking fell out of favour after the English physician, William Harvey, described how blood circulated around the body in his groundbreaking publication, De Motu Cordis (On the Motion of the Heart), in 1628.
As word spread, most practitioners began confining their attention to the median basilic vein on the inside of the upper arm.
Bloodletting reached its apogee in the 18th century.
By then, people were not just bled when they were ill, it was also used for preventative purposes, typically in the spring, seen as a time of rebirth and rejuvenation.
While bloodletting seems barbaric to modern eyes, it was considered a standard part of medical treatment, demanded by many people when they felt ill.
Take George Washington, who woke on the morning of 14 December 1799 complaining that he couldn't breathe.
Fearing his doctor would not arrive in time, Washington asked for the overseer of his slaves to step in and bleed him.
The cut was deep, and Washington lost nearly half a pint before the wound was closed.
Eventually, the physicians arrived and proceeded to bleed Washington four more times in the next 8 hours.
By evening, America's first president was dead.
One of his physicians, James Craik, later admitted that he thought the blood loss was partly responsible.
By the mid-19th century, bloodletting was falling out of favour as different medical techniques emerged, reflecting new understandings of disease and its causes.
Yet it may be that this ancient practice would be beneficial for people with a particularly modern problem: obesity.
Many people who are overweight have a cluster of medical problems including high blood pressure, high cholesterol and poor control of blood sugar levels, which is a precursor to diabetes.
Together these are known as "metabolic syndrome".
While not one of the classic signs, another common symptom in metabolic syndrome is a high level of iron in the blood, which seems to be caused by a genetic predisposition combined with a diet high in red meat.
While it is unclear how these factors interrelate, high iron seems to play a causal role in high blood pressure and poor blood sugar control.
It has also been implicated in fatty liver disease, another condition in which an unhealthy diet plays a part.
When we give blood - typically up to 470 millilitres - it takes a few weeks for our blood iron levels to be restored.
That raises the intriguing possibility that a key mediator of at least some of the harmful effects of obesity could be combatted by the simple act of regularly siphoning off some blood.
It almost sounds too good to be true, but earlier this year, a study suggested it could, in fact, be that easy (BMC Medicine, vol 10, p 54). The trial involved 64 obese people with metabolic syndrome.
Half had 300 millilitres of blood withdrawn at the start of the trial and a further 250 to 500 taken a month later.
Six weeks from the start, those who had undergone two bleedings had improved blood pressure, cholesterol and glucose levels.
It is only one trial, of course, and a small, short-term one at that - further work is needed to see if the effect is real.
But the results chime with a couple of other small studies that show bloodletting benefits people with high blood pressure or diabetes.
Given that rising rates of obesity and its knock-on effects are arguably the western world's biggest health problem, perhaps this line of investigation should be prioritised.
"It would have a big impact on public health if this is borne out," says Andreas Michalsen, a physician at the Charité-University Medical Centre in Berlin, Germany, who led the recent trial.
In the meantime, anyone with high iron levels and metabolic syndrome or fatty liver disease who finds it hard to switch to a healthier diet might want to consider donating blood as often as it is safe to do so, suggests Michalsen.
In the UK, men are allowed to donate once every three months and women once every four months.
A surge in the popularity of blood donation would have benefits for our blood banks, too.
"Everyone's a winner," says Michalsen.
Lindsey Fitzharris is a Wellcome Trust research fellow at Queen Mary, University of London.
She runs a website on the history of pre-anaesthetic surgery, The Chirurgeon's Apprentice.
Money - In Life and Death - The Medical Rackets ?
Updated: 22 Nov 2012
Why GPs sometimes charge fees
Isn’t the NHS supposed to be free?
The National Health Service provides most health care to most people free of charge, but there are exceptions:
prescription charges have existed since 1951 and there are a number of other services for which fees are charged.
Sometimes the charge is made to cover some of the cost of treatment, for example, dental fees; in other cases, it is because the service is not covered by the NHS, for example, providing copies of health records or producing medical reports for insurance companies.
Answers to questions patients may ask
Surely the doctor is being paid anyway?
It is important to understand that many GPs are not employed by the NHS; they are self-employed and they have to cover their costs - staff, buildings, heating, lighting, etc - in the same way as any small business.
The NHS covers these costs for NHS work, but for non-NHS work, the fees charged by GPs contribute towards their costs.
What is covered by the NHS and what is not?
The Government’s contract with GPs covers medical services to NHS patients, including the provision of ongoing medical treatment. In recent years, however, more and more organisations have been involving doctors in a whole range of non-medical work.
Sometimes the only reason that GPs are asked is because they are in a position of trust in the community, or because an insurance company or employer wants to ensure that information provided to them is true and accurate.
Examples of non-NHS services for which GPs can charge their own NHS patients are:
• accident/sickness certificates for insurance purposes
• school fee and holiday insurance certificates
• reports for health clubs to certify that patients are fit to exercise
Examples of non-NHS services for which GPs can charge other institutions are:
• life assurance and income protection reports for insurance companies
• reports for the Department for Work and Pensions (DWP) in connection with disability living allowance and attendance allowance
• medical reports for local authorities in connection with adoption and fostering
Do GPs have to do non-NHS work for their patients?
With certain limited exceptions, for example a GP confirming that one of their patients is not fit for jury service, GPs do not have to carry out non-NHS work on behalf of their patients.
Whilst GPs will always attempt to assist their patients with the completion of forms, for example for insurance purposes, they are not required to do such non-NHS work.
Is it true that the BMA sets fees for non-NHS work?
We suggest fees that GPs may charge their patients for non-NHS work (ie work not covered under their contract with the NHS) in order to help GPs set their own professional fees.
However, the fees suggested by us are intended for guidance only; they are not recommendations and a doctor is not obliged to charge the rates we suggest.
Can a fee be charged by a GP for the completion of cremation forms?
A deceased person cannot be cremated until the cause of death is definitely known and properly recorded. Before cremation can take place two certificates need to be signed, one by the GP and one by another doctor.
Cremation form 4 must be completed by the ’registered medical practitioner who attended the deceased during their last illness’.
Form 5 must be completed by a ’registered medical practitioner who is neither a partner nor a relative of the doctor who completed form 4’.
A fee can be charged for the completion of both forms 4 and 5 as this does not form part of a doctor’s NHS duties
(1). Doctors normally charge these fees to the funeral director, who, generally passes on the cost to the family.
Doctors are also entitled to charge a mileage allowance, where appropriate.
The fees for cremation forms 4 and 5 (which are agreed with the National Association of Funeral Directors, NAFD, the National Society of Allied and Independent Funeral Directors, SAIF, and Co-operative Funeralcare) are available on our website.
Can VAT be charged by GPs for some non-NHS services?
Since 1 May 2007, certain medical services have become subject to Value Added Tax (VAT).
This follows a European Court of Justice Ruling in 2003, and subsequent changes to VAT rules introduced by HM Revenue & Customs.
The original Court ruling made it clear that, where the main purpose of a medical service is the ’protection, maintenance or restoration of the health of an individual’ then that service should continue to be exempt from VAT.
All heathcare provided either through the NHS, or the private sector, is therefore not subject to VAT.
However, where the purpose of a medical service is not, primarily, the treatment of a patient (for example, the completion of medical insurance reports by a doctor), the Court ruled that this service should be subject to VAT.
Such GP reports have been subject to VAT since 1 May 2007.
In the UK this applies where a medical practitioner’s income exceeds the VAT registration threshold.
Why does it sometimes take my GP a long time to complete my form?
Time spent completing forms and preparing reports takes the GP away from the medical care of his or her patients.
Most GPs have a very heavy workload and paperwork takes up an increasing amount of their time, so many GPs find they have to take some paperwork home at night and weekends.
I only need the doctor’s signature - what is the problem?
When a doctor signs a certificate or completes a report, it is a condition of remaining on the Medical Register that they only sign what they know to be true. In order to complete even the simplest of forms, therefore, the doctor might have to check the patient’s entire medical record.
Carelessness or an inaccurate report can have serious consequences for the doctor with the General Medical Council (the doctors’ regulatory body) or even the Police.
What will I be charged?
We recommend that GPs tell patients in advance if they will be charged, and what the fee will be.
It is up to individual doctors to decide how much they will charge, but we produce lists of suggested fees which many doctors use.
Surgeries often have lists of fees on the waiting room wall based on these suggested fees.
What can I do to help?
• Not all documents need a signature by a doctor, for example passport applications.
You can ask another person in a position of trust to sign such documents free of charge.
• If you have several forms requiring completion, present them all at once and ask your GP if he or she is prepared to complete them at the same time to speed up the process.
• Do not expect your GP to process forms overnight: urgent requests may mean that a doctor has to make special arrangements to process the form quickly, and this will cost more.
What report work doesn’t have to be done by my GP?
There is some medical examination and report work that can be done by any doctor, not only a patient’s GP.
For this work there are no set or recommended fees.
There is a list of the kind of reports which can be done by any doctor.
Read our FAQ s to find answers to the questions we are most frequently asked about the professional fees which doctors can charge.
(1) It is important to differentiate between death certificates (which must be completed free of charge) and cremation forms.
Cremation forms, unlike death certificates, require doctors to make certain investigations which do not form part of their NHS duties.
Medical- NHS Patients treated by Private firms - should sign a Collision Damage Waiver form ?
Updated: 20 Nov 2012
The Guardian is reporting that almost 20 per cent of all NHS patients are treated by private firms.
The figures are reported to come from a study by the Institute for Fiscal Studies which also said that the previous Labour Government’s embrace of competition was partly to blame.
The report shows that private firms carry out 17 per cent of hip replacements, 17 per cent of hernia repairs and six per cent of gall bladder removals each year in England.
According to the report, in 2006, GPs referred patients to an average of 12 different healthcare providers a year, mainly in the NHS.
By 2010 that had risen to 18, mainly because they were encouraged to offer patients a wider list of places to be treated.
A Labour spokesman said: ‘The last Labour government used these agreements to add extra capacity to the NHS and allow patients to be treated in record times.’
Lifestyle- The Late Morning Life Crisis Point
Updated: 20 Nov 2012
The Daily Mail reports that the gene variation affects the body clock so much that it predicts the time of day that a patient is most likely to die.
According to the report – which looked at the sleeping patterns of 1,200 healthy 65-year-olds - the scientists found a single molecule near a gene called ‘Period 1’ that had as its base, either adenine (A) or guanine (G).
Type A is more common by a ratio of six to four, so because people have two sets of chromosomes, an individual has a 36 per cent chance of having two As, a 16 per cent chance of having two Gs, and a 48 per cent chance of an A and a G
The report said that people AA or AG genotype died just before 11am on average, but those with the GG genotype tended to die at just before 6pm.
The study’s lead author Andrew Lim, from the Department of Neurology at Beth Israel Deaconess Medical Center in Boston, said:
‘The internal “biological clock” regulates many aspects of human biology and behaviour.
It also influences the timing of acute medical events like stroke and heart attack.’
Medical- A List of Beta Blockers
Updated: 13 Nov 2012
List of Cardioselective Beta Blockers
Radical says - More patients are now on ACE -inhibitors. ACE = Angiotension Converting Enzyme
Beta blockers, also known as beta-adrenergic blocking agents, are a class of medication widely prescribed for the treatment of high blood pressure and cardiac arrhythmias.
They are also helpful in treating migraines and glaucoma, according to MayoClinic.com.
The second generation of beta blockers brought to market is described as cardioselective, in that drugs in this group mostly block the binding of norepinephrine and epinephrine to beta-1 adrenoceptors, which help to control the heart's rate and contractile force.
Approved by the U.S. Food and Drug Administration (FDA) in December 1984, acebutolol is also marketed under the brand names Prent and Sectral, according to MedicineNet.com.
As a cardioselective beta blocker, acebutolol is prescribed to help the heart function more efficiently.
By blocking the beta-1 receptors, the drug reduces the workload on the heart by causing it to beat more slowly and move a lesser volume of blood overall. In lessening cardiac workload, acebutolol also reduces the heart's oxygen requirements.
The medication is marketed in capsules of 200 and 400 mg, one of which is usually taken once or twice a day.
Also marketed under the brand name Tenormin, atenolol is available in 25, 50 and 100 mg tablets that are administered orally, according to RxList.com.
It is also a cardioselective beta blocker that is prescribed for the treatment of angina, as well as high blood pressure. Common side effects of this and other cardioselective beta blockers include diarrhoea, dizziness, drowsiness, fatigue, leg pain, lightheadedness, nausea and vision problems.
These usually disappear after a short time. If they do not, consult your physician.
This cardioselective beta blocker, also marketed under the brand name Kerlone, is available in tablets of 10, 20 and 40 mg.
Most patients start with a once-daily dose of 10 mg, which may be increased in strength if the response to 10 mg is less than your doctor anticipated, according to Drugs.com.
Betaxolol, as well as other cardioselective beta blockers, can interact with a variety of other drugs, so inform your doctor about all medications you are presently taking.
Also sold under the brand name Zebeta, bisoprolol is available in 5 and 10 mg tablets.
The usual daily dosage is between 2.5 and 20 mg, according to MedicineNet.com.
This drug was brought to market shortly after it received FDA approval in July 1992.
Marketed under the brand name Brevibloc, esmolol is a cardioselective beta blocker that is administered by a medical professional via injection.
It is a short-acting medication that can be particularly effective in the control of arrhythmias.
Widely prescribed to treat hypertension, metoprolol is also marketed under the brand names Lopressor and Toprol XL, according to MayoClinic.com.
It is most commonly taken orally in regular tablets of 25, 50 and 100 mg, or extended-release tablets of 25, 50, 100 and 200 mg. It is also available in an injectable form.
This drug, also marketed under the brand name Bystolic, is available in 2.5, 5 and 10 mg tablets and is prescribed primarily for the treatment of high blood pressure, according to RxList.com
Medical- Beta Blockers- Blood Pressure reducing drugs that don't work
Updated: 13 Nov 2012
Beta blockers are busted – what happens next?
12 November 2012 by Josh Bloom
They have treated heart disease for 40 years, but it now seems that beta blockers don’t work.
What went wrong?
IT IS very rare for new evidence to question or even negate the utility of a well-established class of drugs.
But after four decades as a standard therapy for heart disease and high blood pressure, it looks like this fate will befall beta blockers.
Two major studies published within about a week of each other suggest that the drugs do not work for these conditions.
This is a big surprise, with big implications.
The first beta blocker, Inderal, was launched in 1964 by Imperial Chemical Industries for treatment of angina. This drug has been hailed as one of great medical advances of the 20th century.
Its inventor, James Black, was awarded the Nobel prize in medicine in 1988.
The 20 or so beta blockers now on the market are very widely used - almost 200 million prescriptions were written for them in the US in 2010.
They are standard issue for most people with heart disease or high blood pressure.
This may now change.
A large study published last month in The Journal of the American Medical Association found that beta blockers did not prolong the lives of patients - a revelation that must have left many cardiologists shaking their heads (JAMA, vol 308, p 1340).
The researchers followed almost 45,000 heart patients over three-and-a-half years and found that beta blockers did not reduce the risk of heart attacks, deaths from heart attacks, or stroke.
While this is not definitive, it's pretty damning, especially when another study - published just days earlier - found pretty much the same thing (Journal of the American Geriatrics Society, vol 60, p 1854).
The goal of this second study was to examine the effect of drug compliance on death rates in patients who had had heart attacks.
About half of patients complied with their drug regimen.
Unsurprisingly, these people were nearly 30 per cent less likely to die than those who did not comply.
This was to be expected, but there was one big surprise.
While the result held for the standard classes of heart drugs - statins, anticoagulants and antihypertensives - it did not for beta blockers.
Regardless of whether or not patients stuck to their regimen, their risk of dying was the same.
Taken together with the JAMA study, it becomes very reasonable to question the benefit of beta blockers for treating these conditions.
To understand what is going on, consider how they work.
Like many drugs, beta blockers target receptors embedded in the surface of cells.
Receptors are "molecular switches" - when a specific molecule binds to them, they change shape and send a signal to the cell to perform a certain function.
Beta blockers target beta receptors, which respond to the "fight or flight" hormones adrenalin and noradrenalin.
In humans, there are two principle types of beta-receptor - beta-1, primarily found in the heart, and beta-2, located at multiple sites, including the smooth-muscle cells of the bronchial tubes and in veins.
When adrenalin and noradrenalin bind to beta-1 receptors, they signal the heart to beat faster and pump harder.
Binding to beta-2 receptors causes smooth muscle relaxation, especially in the airways, explaining why beta-2 activators are used as asthma drugs.
Beta blockers bind to both types of receptor, but do not activate the cellular response.
This blocks adrenalin and noradrenalin from reaching their target and activating the response.
By preventing the normal hormone-receptor interaction, the beta blockers slow the heart and cause it to pump less forcefully, lowering blood pressure.
The premise of beta-blocker therapy has been that giving the heart a rest will diminish the frequency of heart attacks.
In the light of the two new studies, it is clearly time to question this.
Which raises the question: why has it taken so long to find out?
It is worth noting at this point that this is not yet another case of a drug entering the market only to be withdrawn later because of lack of efficacy or even adverse reactions which could have been noticed with longer or larger trials.
It is simply a new medical revelation.
The authors of the JAMA paper provide a reasonable explanation of the conflict between their results and earlier studies.
The key word is "earlier". Most clinical trials on beta blockers took place before reperfusion therapy became standard treatment following heart attacks.
Reperfusion involves opening the blocked artery by surgery or pharmaceuticals, and has been shown to significantly reduce damage to the heart.
Damaged hearts are more prone to fatal irregular beats, and beta blockers are useful in controlling this.
But with the advent of reperfusion therapy, people who survived heart attacks suffered less cardiac damage, so the frequency of fatal arrhythmias was lower.
Put simply, the beta blocker effect was significant before the advent of this improved treatment, but the beneficial effect has since disappeared.
Additionally, newer and better drugs such as anticoagulants, statins and antihypertensives are now routinely used in heart disease.
These more effective therapies swamp any smaller benefit that the beta blockers might provide, minimising any measurable effect.
What comes next is impossible to predict, but we may well be seeing a rare case of medical wisdom being overturned almost overnight.
Beta blockers are not dangerous and have been in use for such a long time that it is unlikely that we will see an immediate cessation.
But these results are hard to ignore, and cardiologists will be paying careful attention.
Josh Bloom is the director of chemical and pharmaceutical sciences at the American Council on Science and Health, a consumer-education consortium based in New York CityJosh Bloom
Medical- An NHS Complaints Team is not fit for purpose-without Patient Care qualifications
Updated: 09 Nov 2012
NHS failings aggravate distress over blunders
Latest annual report into NHS's handling of complaints records rise in
dissatisfaction on part of patients and relatives
Denis Campbell, health correspondent
The Guardian, Friday 9 November 2012
Dame Julie Mellor: 'The NHS needs to get better at listening to patients and their families and responding to their concerns.'
The NHS is adding to the distress of patients who have suffered because of staff blunders by handling their complaints badly, for example by not explaining what went wrong, the health service ombudsman warns.
The number of patients and relatives complaining about the NHS in England failing to acknowledge mistakes jumped by 50% last year from 1,014 to 1,523.
Complaints about trusts providing poor explanations also rose sharply, from 1,163 to 1,655 – up by 42%.
Complainants dissatisfied with the explanation the NHS organisation had given them also increased, from 1,362 to 1,542 (up 13%), according to the latest annual report into the NHS's handling of complaints by the parliamentary and health service ombudsman, Dame Julie Mellor.
"All too often the people who come to us for help are unhappy because of the careless communication, insincere apologies and unclear explanations they've received from the NHS.
A poor response to a complaint can add to the problems of someone who is unwell, struggling to take care of others or grieving", said Mellor.
"The NHS needs to get better at listening to patients and their families and responding to their concerns."
Too often the NHS's response to a complaint about mistakes by its staff "gets it wrong" by, for example, using "equivocal language and sitting on the fence; getting key facts wrong; using technical language without appropriate explanations; fake apologies, for example 'I'm sorry you feel the care wasn't good enough'," the report adds.
Mellor cited the case of one relative denied the chance to be with their mother as she passed away who was later told: "Death is rarely an ideal situation for anyone.
I accept you would have liked to have been there in those last few minutes but in practice this is so hard to achieve and like life itself is left to chance.
Truth be told your mother probably said her goodbyes long before the final moments."
Dan Poulter, the health minister, said planned changes to the NHS constitution, including a new right for complaints to be acknowledged within 72 hours and enhanced rights to ensure complaints are handled openly, would help improve the situation
Medical- Records- Dr's Write or Wrong -But I want free access to his notes about me !
Updated: 09 Nov 2012
Patients should be given power to correct record errors, says DH adviser
8 November 2012 |
By Madlen Davies
Patients should have the power to correct errors in their medical record, but should not be able to change their medical histories, says the head of the Government’s information governance review.
Dame Fiona Caldicott told delegates at the EHI Live conference in Birmingham that patients should be able to correct their records, but they should have the same level of control as they have over their bank statements.
Pulse reported earlier this year that NHS Future Forum chair Professor Steve Field had recommended patients should be able to add to their records, correct errors and agree transfer of information to other parts of the NHS.
Dame Caldicott – who is leading an ongoing review for the Department of Health on how records should be used - said Professor Field had raised an important point that the data belongs to the patient.
She said: ‘There are records being developed which are actually managed by the patients. They control what’s in them and they work with the clinicians in order to ensure the record is up to date.
But she added: ‘It’s fair to say, that that evokes quite a lot of professional anxiety, about how you can have assurance that that’s a complete record.
‘Patients certainly have the right to have errors corrected and for that to be recorded on the record, but they will not be able to change some of the information in the record.
‘One of the analogies we look at is with your bank statement, where you’ve got all sorts of facilities available but actually you can’t change what the bottom line of what the balance is without very complicated discussions with people at the bank.’
As part of her address Dame Caldicott said the main challenges facing the information governance review was that patients and doctors had a ‘fear of sharing’.
She said this was intensified by an increased awareness of data breaches by NHS organisations highlighted in the media.
The Government recently proposed the NHS Constitution was amended to allow the NHS to use patient data for research and to allow pharmaceutical companies better access to patient records.
The information governance review will make recommendations on the balance between sharing personal information and protecting individuals’ confidentiality in January next year.
Medical- A Cat may get the cream but the Govt thinktank confines itself to serving up puke
Updated: 01 Nov 2012
A new brain for the government thinktank
From: Through the K Hole
Posted by: Through The K Hole
31 October 2012
“We’d run out of really terrible ideas, so we decided to ask Mr Nibbles,” said the Department of Health.
Mr Nibbles, a fairly ordinary cat living under a fairly ordinary shed in Basingstoke says: "To be honest with you I was quite surprised when I was invited to participate in a government thinktank.
There I was, quite content puking up fur balls and shitting all over the neighbours garden when I was cordially invited to give my opinion about the Carr-Hill formula."
"It was obvious to me that practices full of scummers, the type you see in the park picking fleas off themselves, need a lot more money than posh practices full of Abyssinian cat owners.
I base this assessment on no evidence whatsoever, but I am adept at telling Sheeba from Whiskas so there!"
It seems that Mr Nibbles’ complete stab in the dark over practice funding has been taken very seriously and parliament are now happy to pour millions into socially deprived practices on the whim of a badly groomed cat.
Mr Nibbles was unavailable for further comment but his concerned owners, Sue and John, were:
"He was a rescue cat and used to be so loving, didn’t he John?
He’d bring back the chewed remains of a mouse and leave loving little puddles of piss around the house, but then he got into politics.
We were so worried about his parliamentary antics that we ended up taking him to the vets to have his clackers cut off."
Unphased by this, the Department of Health now plans to consult Samantha, a Syrian hamster who loves seeds but hates humanity.
Dr Kevin Hinkley is a GP in Aberdeen
Medical - A Fishy story on reducing the risk of Strokes
Updated: 01 Nov 2012
It's a Halloween special - so proceed with caution
31 October 2012 |
By Jamie Kaffash
A round-up of the health news headlines on Wednesday 31 October
Forget ghouls and ghosts – for many, nothing strikes fear like the thought of taking cod liver oil.
But a new study suggests that fish oil supplements do not reduce the risk of stroke.
The Telegraph reports today that the Cambridge University research of 38 separate studies said there was no link between taking the capsules and a cut in the risk of stroke.
However, it also found that eating oily fish at least twice a week may have a significant impact.
People who ate two to four servings a week were 6% less likely to suffer a stroke compared with those eating less.
Five or more portions of oily fish led to a 12% lower risk.
Over at the Mail, it is not quite a horror story, but many GPs will be spooked by a survey that suggests one third of patients think their GP is so busy that they could be misdiagnosed.
The survey found one quarter of those had been wrongly diagnosed in the past five years, or knew someone who had been misdiagnosed.
Finally, this Halloween special would not be the same without an obvious monster, and one again smoking steps into the role.
A report in the journal Addiction showed that smokers miss an average of two or three more days of work each year than non-smokers, with this absenteeism costing the UK alone £1.4bn in 2011, the Guardian reports.
Smokers miss an average of two or three more days of work each year than non-smokers, with this absenteeism costing the UK alone £1.4bn in 2011, according to a British study.
The study by the University of Nottingham analysed 29 separate studies conducted between 1960 and 2011.
Current smokers were 33% more likely to miss work than non-smokers and were 19% more likely to miss work than ex-smokers
Medical- 15 Minute appointments ? Yes, if it improve GP's keeping appointment times.
Updated: 01 Nov 2012
Practice dilemma: Introducing 15-minute appointments
31 October 2012
Radical says :- NO - if it means patients wait even longer to get an aoopintment to see a GP.
Save One partner has suggested we begin to extend our routine appointments from 10 to 15 minutes.
How do we reach an agreement that protects patients’ interests without giving ourselves an unmanageable workload?
If one partner has recommended an extension of appointment slots from 10 to 15 minutes it is important to understand the reasons why this is being suggested.
You might ask:
•Does the partner in question feel that, without such an increase, service to patients is inadequate?
•Is this due to the abilities of the partner in question, who finds it difficult to deliver the services in a reasonable time?
It is important that the views of all partners are sought and a realistic assessment made of the input on the number of patients seen and hours worked.
An increase from 10 to 15 minutes will result in only four consultations per hour rather than six, which will lead to a greater delay in patients getting appointments and consequently could reduce patient satisfaction.
Your PCT is likely to require you to provide a minimum number of patient appointments each day dependent upon your list size, so this should also be checked.
On this basis, the extension of length of appointments will have to be met either by the current partners agreeing to work longer hours to accommodate this or by agreeing to pay other doctors to do so, with the resultant hit on profits.
Could the time pressure problem faced by the individual be better accommodated by another means? For example:
•If he or she sees a high number of patients who require more time, should they be encouraged to book double appointments?
•Alternatively, could the receptionists book out a few ‘blank’ slots during the course of a clinic to allow time to catch up?
•If the problem is an admin one, can additional (and less expensive) labour be introduced to undertake routine tasks which the individual GP is attempting to undertake him or herself within the allotted appointment time?
With the ever-increasing competing pressures on a GP’s time, partners need to work together in order to ensure they provide the range of services required pursuant to their Contract.
With this in mind in is worth considering the requirements of your partnership agreement in terms of the expectations of commitment from each of the GPs.
Where partners reach agreement to vary their obligations as set out under this document, a variation to the partnership arrangements is relatively straightforward.
If specific obligations are unspecified, it is likely that the overall work will need to be spread between the partners.
This may require a further variation of the roles each partner performs, with some dealing with longer sessions to accommodate longer appointment times (if necessary) and others taking on other obligations.
Above all, it is essential to ensure that obligations are clear – and that the partnership agreement permits sufficient flexibility to enable further change as the need arises in order to reflect changing NHS requirements.
Edwina Farrell is an Associate at Hempsons law firm
Medical- Obesity can be irreversible
Updated: 27 Oct 2012
Over at the Daily Mail today you’ll find some good and bad news for those trying to lose weight.
A study found that being obese can reset your ‘normal’ body weight to an elevated level, meaning the longer you remain overweight the more irreversible it becomes.
Tests on mice found that those that were obese found it difficult to lose weight even after dieting and taking part in strenuous activity.
The longer they remained overweight, the more likely their condition would become irreversible, and the harder it was to lose weight.
Study author Dr Malcolm Low, from the University of Michigan said the results emphasise that intervention in childhood is crucial, as losing weight as an obese adult is much more difficult.
He said: ‘Our model demonstrates that obesity is in part a self-perpetuating disorder and the results further emphasise the importance of early intervention in childhood to try to prevent the condition whose effects can last a lifetime.
‘Our new animal model will be useful in pinpointing the reasons why most adults find it exceedingly difficult to maintain meaningful weight loss from dieting and exercise alone.’
But it’s not all doom and gloom because the Mail also featured an American study which found that only two and a half minutes of intense exercise a day can make you slim, leaving few excuses for those who claim they are too busy for the gym.
The study from Colorado State University found that men who carried out four 30 high intensity sprints on an exercise bike, each sprint followed by four minutes of recovery, burnt almost 200 extra calories.
The news comes with the caveat that three quarters of British adults are failing to meet the recommended guidelines of 150 minutes of moderate exercise three times a week.
Medical- Managing Sleep Apnoea
Updated: 27 Oct 2012
Ten Top Tips - Sleep apnoea
26 October 2012
GP and sleep apnoea specialist Dr Robert Koefman offers his ten top tips on spotting and managing sleep apnoea
1. Remember that sufferers often don’t know they have sleep apnoea
Sleep apnoea often goes undiagnosed because the sufferer is mostly unaware of their condition until it is pointed out by someone else that they snore excessively or make loud snorts or gasps in their sleep as they try to resume breathing. Daytime symptoms, such as excessive tiredness, are often attributed to living a busy life and, even if the sufferer visits a GP, sleep apnoea is often initially missed.
2. Shirt collar size in men is a useful guide to risk
Sleep apnoea affects between 2-4% of the UK’s adult population; middle-aged men are particularly affected. Sleep apnoea is frequently seen in obese and overweight patients because of the increased pressure on the airway caused by excess weight around that area - a collar size greater than 17 inches is a risk factor. Other common risk factors include retrognathia, macroglossus and large, obstructing tonsils. Smoking and alcohol are also known to increase the risk and severity of obstructive sleep apnoea.
3. Look for daytime symptoms
Symptoms can be varied. As well as excessive snoring and gasping while sleeping, daytime symptoms include waking tired and feeling unrefreshed, morning headaches, nocturia, nocturnal palpitations, poor memory and lack of concentration, low libido and depression.
4. Remind patients to inform the DVLA of their diagnosis
The law requires sufferers to tell the DVLA when they are diagnosed with sleep apnoea.
Untreated sleep apnoea is a major contributory factor in up to 20% of motorway traffic accidents, and it has been estimated that obstructive sleep apnoea increases the risk of a road traffic accident by up to seven times. Due to associated lifestyle factors, sleep apnoea is common among professional drivers.
5. Assess with the Epworth sleepiness scale
If you suspect that a patient is suffering from sleep apnoea, the easiest thing is to assess them using the Epworth sleepiness scale – click here to access an online version of the scale from our tools and resources section. This is a series of questions to assess how tired someone. Generally, a score above 10 indicates that further investigation and a sleep study are necessary. This can be done in a variety of ways, such as using screening pulse oximetry or by using polysomnography machines, including portable devices that can be taken home, which do the same as hospital-based overnight studies without the video component. Most sleep studies measure oxygen saturation as well as apnoea-hypopnoea index, body position, pulse and loudness of snoring.
6. Don’t leave sleep apnoea untreated
Sleep apnoea can have a serious impact on health – it is linked to hypertension, possibly increased risk of stroke and to type 2 diabetes. It poses a serious economic health burden if left untreated. Sleep apnoea can seriously affect the quality of life of the patient and their immediate family, because of their lack of energy and the effects of the symptoms above.
7. The gold standard treatment is CPAP
The main indicator for treatment is an apnoea-hypopnoea index of greater than 15 per hour and or desaturations of greater than 5% of 15 per hour. Once sleep apnoea is diagnosed, mild-to-moderate cases can be treated with a mandibular advancement device, but for moderate-to-severe sleep apnoea, continuous positive airway pressure (CPAP) should be recommended. I have seen it improve patients’ quality of life dramatically and, with the continued support of the sleep team, the outcomes can be amazing and life changing.
Weight loss can help to reduce the severity of sleep apnoea and resolve symptoms to the point where treatment is no longer required. Considerable weight loss is required to achieve this but being on CPAP will help give the patient sufficient energy to start an exercise programme to lose the weight. If jaw abnormalities or tonsils are contributing to sleep apnoea, weight loss alone may not resolve the condition and CPAP may need to continue.
8. Patients often feel the benefits of treatment overnight
I have seen patients who have been suffering for a long while - not able to function properly during the day and unable to cope in their jobs and relationships - manage their lives for the first time in years. CPAP enables patients to experience a good night’s sleep and the results are sometimes immediate.
9. Advise patients that surgery is not always effective
Each case is unique, so a sleep specialist is the best person to advise on treatment. Aside from CPAP, other approaches include lifestyle advice - stopping smoking and reducing alcohol consumption - and mandibular jaw splints. With the exception of a few cases though, surgery has little place in the treatment of sleep apnoea. It may help in the short term but even tonsillectomy for large obstructing tonsils has very little evidence of success.
10. Be aware that the number of patients with sleep apnoea is rising
Due to rising obesity levels the number of patients with sleep apnoea is increasing, but fewer than 10% of patients with sleep apnoea are thought to be receiving treatment. Sleep apnoea has a similar prevalence to type II diabetes, but treatment levels are far lower, so there is a need to raise awareness of this potentially life-threatening condition.
Dr Robert Koefman is a GP in Binfield, Berkshire, where he runs specialist sleep apnoea clinics
For further information and guidance on spotting sleep apnoea, visit http://www.realsleep.co.uk
Medical- NHS Patient Choice- A hollow mockery and deceitful sham !
Updated: 25 Oct 2012
A mockery of patient choice
24 October 2012
Ask politicians about the choice agenda, and it’s likely that they’ll wax lyrical about patient rights, competition and the benefits of a free market. Ask a GP, and they’ll probably tell you about Choose and Book.
For all the NHS’ ideological rhetoric, in practice the choice agenda generally boils down to a GP asking a patient where they would like to be referred, and then using Choose and Book to arrange for them to be seen at the hospital of their choice.
Or not, as the case may be. For, as Pulse reveals this week, more than seven years after it was launched Choose and Book is still plagued with operational gremlins, and patients are suffering as a result.
Hospitals are routinely cancelling appointments if GPs fail to attach referral letters within an arbitrary three-day time limit. They are failing to record when consultants have booked holiday, then cancelling appointments that clash. In some cases they even seem to be failing to inform practices that appointments have been cancelled – leaving GPs, as ever, to pick up the pieces with understandably angry patients.
Such behaviour is completely unacceptable in a modern health service. Unilaterally cancelling appointments makes a mockery of the notion that patients should be able to choose where and when they are seen.
But, while the issues we cover this week are the latest in a long line of Choose and Book complaints, two factors make this story particularly significant.
First, the latest revelations come on the back of a Department of Health consultation earlier this year, Liberating the NHS: No decision about me, without me, which outlined a series of proposals to boost patient choice.
Practices were told they would have to use Choose and Book, offer choice through ‘alternative, potentially labour-intensive, methods’ – perhaps even phoning around hospitals – or face as-yet-unspecified sanctions. GPs may soon no longer have any choice about offering choice.
And secondly, there are growing questions about the wider principle of offering patients choice at all. We also report this week fears among CCGs that choice is destabilising secondary care, with some hospitals struggling to cope with rising demand and others struggling with lack of it.
In one respect, this is a triumph for patient choice. As funding follows the patient, and the fortunes of hospitals wax and wane, politicians can celebrate the fact that, at last, the drive to create a demand-led market in healthcare appears to be making progress.
GPs, though, stuck with the reality of Choose and Book and battling ever-tighter funding constraints, may wonder if the choice agenda as a whole is not a little wasteful
Medical- NHS Clinical Commissioning Groups 9 (CCG's) accepting privatisation through the back door !
Updated: 25 Oct 2012
CCGs embrace advice from private firms
24 October 2012 |
By Gareth Iacobucci
Leading private companies are already advising scores of CCGs on how to spend NHS cash, as the Government’s new commissioning marketplace takes shape.
PricewaterhouseCoopers (PwC) revealed this week it is now working with around 100 CCGs, while KPMG is working with 50 CCGs and Capita around 40.
The companies are providing a mixture of short-term support to CCGs and commissioning support units on areas such as governance and authorisation, alongside longer-term advice on how to meet the daunting £20bn efficiency challenge set by the Government’s QIPP agenda.
Pulse reported last year that private consultancy firm McKinsey had been enlisted by dozens of CCGs to advise on QIPP, budget-holding and governance, although McKinsey this week declined to comment.
A Pulse investigation in January found four in 10 CCGs had begun to seek advice from the private sector.
Speaking at a Westminster Forum event last week, Tim Rideout, associate at KPMG, said the expertise provided by the private sector was vital as CCGs ‘do not have the capacity and capability to commission in an effective way’.
He said: ‘The key message that comes from CCGs is that commissioning support is absolutely essential if they are going to succeed.’
Dr Jonathan Steel, senior clinical consultant to PwC and a GP in Uley, Gloucestershire, said: ‘We’re seeing the more advanced CCGs asking for help with service redesign.’
Liz Jones, director of commissioning services at Capita, told Pulse the firm was helping CCGs on issues ranging from helping them set up their boards to meeting QIPP targets.
Ms Jones said: ‘What we’re seeing now is a fair number of [CCGs] starting to move beyond the authorisation hurdle. QIPP still needs to be delivered, can we bring a fresh pair of eyes to what they’ve been doing, [look at] why have they struggled to meet the numbers, what have they missed out, what could they do differently?’
Dr Michael Dixon, interim president of NHS Clinical Commissioners, said the dynamics of commissioning support was ‘entirely a master-servant issue’.
But he added: ‘Commissioners need to be very much awake in terms of [judging] when commissioning support is just that, and when it begins to infringe upon their ability to make a decision.’
Dr Louise Irvine, a GP in Lewisham, South east London, said she was ‘very concerned’ that private companies were being handed ‘enormous power and influence over commissioning’.
Dr Irvine said: ‘It is not the small friendly image of commissioning by your local GP that was promoted in the white paper.’
Medical- Cancelled Hospital Appointments by those with no Patient Care qualifications is scandalous
Updated: 25 Oct 2012
Choose and Book chaos as trusts cancel appointments
24 October 2012 |
By Madlen Davies
Exclusive: Overzealous hospital managers are routinely delaying or blocking Choose and Book referrals for administrative reasons, leaving GPs to deal with angry patients whose appointments have been cancelled, a Pulse investigation reveals.
Some practices are reporting up to 15 cancellations a day as hospital trusts increasingly insist that all referrals made through the controversial system are confirmed within three days.
And LMCs have also claimed that Choose and Book is listing ‘phantom’ slots when consultants are away or on holiday, and that GPs are not being told when appointments are cancelled.
Department of Health guidelines suggest Choose and Book appointments should be followed up with a GP referral letter within three days to ensure the appointment is ‘clinically appropriate’.
But Dr Philip Fielding, chair of Gloucestershire LMC, said ‘significant’ numbers of appointments were being cancelled without practices being informed, and ‘irate’ patients were chasing up their appointments.
He said: ‘A system designed to give greater choice and speedier referrals is being limited by bureaucracy and has disadvantaged patients.
‘The whole idea of Choose and Book is to plan ahead. For elderly patients, it has caused more delay and angst.’
He added that GPs were also booking patients into ‘phantom’ appointments that were later cancelled as the system could not tell when a consultant was due to be away.
Dr Andrew Mimnagh, chair of Sefton LMC, told Pulse local practices were experiencing ‘14 to 15’ cancellations a day, and booking of appointments when consultants were away was a particular problem.
Dr Manoj Pai, former chair of Coventry LMC, said practices in his area had also been hit: ‘We have referred and it has gone through and patients have been told to ring again because the appointment is not possible.’
Eric Gatling, director of service delivery at Gloucestershire Hospitals NHS Foundation Trust, said: ‘From September this year we have been taking a more robust approach to ensuring that patient appointments are confirmed by the GP within the three day period, in agreement with the PCT.’
Richard McCarthy, deputy director of performance at Southport and Ormskirk Hospital NHS Trust, said the trust ‘recognises there are shortcomings in the operation of the service on both sides’.
A spokesperson from University Hospitals Coventry and Warwickshire NHS Trust said: ‘The trust’s procedures ensure that all referrals to the trust are placed onto the patient administration system as soon as the trust receives them. The system is monitored by the patient access team to ensure all patients receive the care they need in a timely manner.’
The controversy comes at a crucial time for Choose and Book. GP usage has fallen to about 50% of referrals, but DH plans outlined in May revealed GPs may soon be forced to use Choose and Book or adopt ‘labour-intensive’ alternatives.
GPC negotiator Dr Chaand Nagpaul said: ‘It is unacceptable for patients to be penalised this way. There is no legal requirement for a letter to be received within three days.’
A DH spokesperson said national figures on cancellations were not collected: ‘We would expect local hospitals to take action so that appointments are not cancelled unnecessarily if there are any delays in receiving referral letters.’
Medical- A Sleep Study at Boston, Lincolnshire
Updated: 25 Oct 2012
Sleep Study at Boston
Booked in for a Sleep Study at Boston yesterday for Sleep Apnoea
I was phone in the afternoon to assure me that a bed was available and was I coming for 7pm ?
To which I answered Yes
I arrived from Lincoln 45 miles away due to a road diversion, only to be told the Study had been cancelled because other of my other medical conditions, which had already been recorded in my notes.
So in miserable drizzle conditions I drove home again.
No blame can be attached to the Nursing staff but the Registrar noted I had already been diagnosed with the condition and was on CPAP treatment.
CPAP means Continuous Positive Airway Pressure. ( I do so hate Medical Abbreviations, don't you)
Air is delivered under pressure through a mask or nose piece to keep a patients airway open and to prevent periods where the patient stops breathing through closure of the airway and reduce snoring.
The machine does not do much for ones love life and the mask can be claustrophobic but as the patient is unaware of the condition, which only occurs when at sleep, they would be unaware of any problem if they did not wake up at all. I should add that at some stages in ones living, love takes a priority.
Maybe the Medical team wanted to make sure I was awake when I attended for the aborted sleep study test which apparently, involves a tube with pressure points being placed through ones nose and into ones airway with the intention of discovering if surgery is appropriate to open ones airway.
I have an appointment with the Consultant at Boston shortly which is to learn of the test results, I did not have.
Perhaps I should sleep my way through that appointment to make a point.
Or should I ask Lincoln ULHT for 45p a mile standard hospital travelling expense claim for the wasted journey - £40.50p ?
Medical- Dr Revalidation-"Fit to practice" -but by whom, to what effect and at what cost ?
Updated: 20 Oct 2012
Reaction: Revalidation rollout approved
19 October 2012
Read all the latest reaction to the announcement that revalidation is to go ahead.
‘We have worked hard to ensure that revalidation will be as effective for GPs and patients as possible.
We have listened to the ideas and concerns of patients, GPs and colleagues and are confident that revalidation will not be an onerous task for GPs: it will help them in many ways to ensure they provide good care for patients and get the most out of their own careers.’
Professor Mike Pringle, RCGP president
‘We will continue to provide leadership and practical support throughout the introduction of revalidation and beyond. It is vital that we get this right for patients– and for doctors.
We want to make sure sure that revalidation is fair for all doctors, regardless of their working circumstances.’
Professor Nigel Sparrow, RCGP medical director for revalidation,
‘The BMA has always supported the principle of revalidation – we believe it is important that our patients have confidence that doctors have up-to-date skills and knowledge to be able to offer them the best possible care.
‘It is important to recognise, that while revalidation will undoubtedly enhance the rigorous testing that doctors undergo, clinicians are already offering patients a very high quality service and robust systems are currently in place to deal with any concerns.’
Dr Mark Porter, BMA chair
‘It is essential that revalidation is reviewed every step of way so that we can be sure that the system works for patients and for doctors. Regular participation in the revalidation process will support physicians to develop and maintain the highest standards of care for their patients, and to achieve excellence in their professional lives.’
Sir Richard Thompson, president of the Royal College of Physicians
‘The Academy, along with other stakeholders, has made a major commitment to developing processes of revalidation because it believes that it will make an important contribution to improving patient care.’
Dr Anthony Falconer, chair of the Academy Revalidation Steering Group
‘The introduction of regular tests and more appraisals will help engage doctors positively with the mandatory process of retaining their licence to practise. Many patients will be surprised this isn’t happening already.’
Dean Royles, director of NHS Employers
‘Revalidation will be a powerful tool to help NHS boards keep a close eye on the quality of service doctors provide to their local populations.
These new checks will be an opportunity to address the bigger picture of clinical governance.’
Mike Farrar, chief executive of the NHS Confederation
Medical- Annual assessments, 5 year checks for all Doctors to ensure "fitness to practice"
Updated: 20 Oct 2012
Hunt announces revalidation plans
Friday 19 October
In top news today, the health secretary, Jeremy Hunt, has announced that, from December, all doctors will be given annual assessments and full five-yearly checks to ensure they are still fit to practice.
Jeremy Hunt describes the new system as being about identifying gaps in knowledge or skills, and giving doctors a ‘chance to put those issues right’.
The move comes after discussions dating back to 2000, when the former General Medical Council president Sir Donald Irvine launched the revalidation proposals on the basis that the public assumed checks were made to ensure that doctors continue to be fit to practice but that this wasn’t the case.
Hunt said: ‘We want to have the best survival rates in Europe for the major killer diseases.
Doctors save lives every day and making sure they are up to speed with the latest treatments and technologies will help them save even more.
This is why a proper system of revalidation is so important.’
The BBC reports that the plans for revalidation herald the biggest shake-up in medical regulation for more than 150 years.
However, it will be April 2016 before the vast majority of the first round of checks have been done.
Medical -UK- "Decriminalise Drug Use"
Updated: 16 Oct 2012
Decriminalise drug use, say experts after six-year study
Advisors say no serious rise in consumption is likely if possession of small amounts of controlled drugs is allowed
Alan Travis, home affairs editor
Monday 15 October 2012
A review of the government's appraoch to cannabis and other drugs is needed, says the independent body that analyses drug laws
A six-year study of Britain's drug laws by leading scientists, police officers, academics and experts has concluded it is time to introduce decriminalisation.
The report by the UK Drug Policy Commission (UKDPC), an independent advisory body, says possession of small amounts of controlled drugs should no longer be a criminal offence and concludes the move will not lead to a significant increase in use.
The experts say the criminal sanctions imposed on the 42,000 people sentenced each year for possession of all drugs – and the 160,000 given cannabis warnings – should be replaced with simple civil penalties such as a fine, attendance at a drug awareness session or a referral to a drug treatment programme.
They also say that imposing minimal or no sanctions on those growing cannabis for personal use could go some way to undermining the burgeoning illicit cannabis factories controlled by organised crime.
But their report rejects any more radical move to legalisation, saying that allowing the legal sale of drugs such as heroin or cocaine could cause more damage than the existing drugs trade.
The commission is chaired by Dame Ruth Runciman with a membership that includes the former head of the British Medical Research Council, Prof Colin Blakemore, and the former chief inspector of constabulary, David Blakey.
The report says their analysis of the evidence shows that existing drugs policies struggle to make an impact and, in some cases, may make the problem worse.
The work of the commission is the first major independent report on drugs policy since the influential Police Foundation report 12 years ago called for an end to the jailing of those possessing cannabis.
The UKDPC's membership also includes Prof John Strang, head of the National Addictions Centre, Prof Alan Maynard, a specialist in health economics, and Lady Ilora Finlay, a past president of the Royal Society of Medicine.
The report says that although levels of illicit drug use in Britain have declined in recent years, they are still much higher than in many other countries.
The UK has 2,000 drug-related deaths each year and more than 380,000 problem drug users.
The 173-page report concludes: "Taking drugs does not always cause problems, but this is rarely acknowledged by policymakers.
In fact most users do not experience significant problems, and there is some evidence that drug use can have benefits in some circumstances."
The commission's radical critique says the current UK approach is simplistic in seeing all drug use as problematic, fails to recognise that entrenched drug problems are linked to inequality and social exclusion, and that separating drugs from alcohol and tobacco use makes it more difficult to tackle the full range of an individual's substance use.
It says the £3bn a year spent tackling illegal drugs is not based on any evidence of what works, with much of the money wasted on policies that are not cost-effective.
It argues that even large-scale seizures by the police often have little or no sustained impact on the supply of drugs; that Just Say No campaigns in schools sometimes actually lead to more young people using drugs; and that pushing some users to become abstinent too quickly can lead to a greater chance of relapse or overdose and death.
The commission argues a fresh approach based on the available evidence should be tested. Its main proposals include:
• Changing drug laws so that possession of small amounts of drugs for personal use would be a civil rather than criminal offence.
This would start with cannabis and, if an evaluation showed no substantial negative impacts, move on to other drugs.
The experience of Portugal and the Czech Republic shows that drug use would not increase and resources can be directed to treating addiction and tackling organised crime.
• Reviewing sentencing practice so that those caught growing below a specified low volume of cannabis plants faced no, or only minimal, sanctions.
But the production and supply of most drugs should remain illegal.
• Reviewing the level of penalties applied against those involved in production and supply, as there is little evidence to show that the clear upward drift in the length of prison sentences in recent years has proved a deterrent or had any long-term impact on drug supply in Britain.
• Reviewing the 1971 Misuse of Drugs Act so that technical decisions about the classification of individual drugs are no longer taken by the Advisory Council on the Misuse of Drugs (ACMD) or politicians but instead by an independent body with parliamentary oversight.
• Setting up a cross-party forum including the three main political party leaders to forge the political consensus needed to push through such a radical change in approach.
Blakemore said: "Medicine has moved past the age when we treated disease on the basis of hunches and received wisdom.
The overwhelming consensus now is that it is unethical, inefficient and dangerous to use untested and unvalidated methods of treatment and prevention. It is time that policy on illicit drug use starts taking evidence seriously as well."
Blakey, who is also a former president of the Association of Chief Police Officers (Acpo), said the current approach of police taking action against people using drugs was expensive and did not appear to bring much benefit.
"When other countries have reduced sanctions for low-level drug users, they have found it possible to keep a lid on drug use while helping people with drug problems to get into treatment," the former chief constable said.
"But at the same time, we need to continue to bear down on those producing and supplying illicit drugs.
This is particularly important for those spreading misery in local communities."
Runciman said government programmes had done much to reduce the damage caused by the drug problem over the past 30 years, with needle exchanges reducing HIV among injecting drug users and treatment programmes which had helped many to rebuild their lives.
The commission's chair said: "Those programmes are supported by evidence, but much of the rest of drug policy does not have an adequate evidence base.
We spend billions of pounds every year without being sure of what difference much of it makes."
The home secretary, Theresa May, last month ruled out any moves towards decriminalisation, saying it would lead to further problems.
She told MPs she considered cannabis a gateway drug: "People can die as a result of taking drugs, and significant mental health problems can arise as a result of taking drugs."
Medical- Surgeries denied to the Elderly
Updated: 16 Oct 2012
Surgeries denied to the elderly
Older people are being denied surgery for cancer, hernia repairs and joint replacements
because of NHS ‘cutoff’ thresholds which are based on ‘outdated assumptions of age and fitness’,
reported the Guardian today.
The study by the Royal College of Surgeons, the charity Age UK and communications consultancy MHP Health Mandate, advised that biological- rather than chronological- age should be used by health professionals deciding whether a patient should receive surgery.
Increasingly good health and longer life expectancy of older people made birth date alone unreliable as the major deciding factor, it said.
Professor Norman Williams, president of the Royal College of Surgeons said:
‘The gap between the increasing health need and access to surgery means many older people are missing out on potentially lifesaving treatment,”
‘It is alarming to think the treatment a patient receives may be influenced by their age.
The key is that it is a decision based on the patient rather than how old they are that matters.
Medical- Its Good to Talk - on the "Ward"- to the Patient, not above the patient
Updated: 05 Oct 2012
Call to make ward rounds 'cornerstone of hospital care'
By Nick Triggle
Health correspondent, BBC News
Ward rounds have become neglected, the royal colleges say
Vital ward rounds are being neglected in hospitals - to the detriment of patients, experts say.
The royal colleges of physicians and nursing said they needed to be re-prioritised and become a "cornerstone" of daily life in hospitals again.
The guidance said they were essential for communicating with patients, monitoring progress and arranging treatment and discharge.
But it said too often key staff were not available to take part in them.
This meant doctors were left to do them themselves without the input of other staff, particularly nurses.
The royal colleges said the problem had arisen because staff were being stretched too thinly and poor organisation meant they were not always carried out at the most appropriate times.
The guidance is the second time in three months the two colleges have published advice jointly.
Dr Linda Patterson, Royal College of Physicians said nurses and doctors need support from hospital management to spend more time with patients
In July they issued standards for the monitoring of vital signs, such as blood pressure and pulse rates.
It is part of a concerted effort to ensure the basic foundations of good care are in place amid concern that the combination of financial pressure, increasing admissions and the complex nature of modern medicine have skewed priorities.
Dr Linda Patterson, clinical vice-president of the Royal College of Physicians, said: "We have heard from patients that care can be fragmented and not holistic.
“High quality, consistent ward rounds in every hospital would contribute to a more patient centred culture in the NHS - this is crucial reading for the government and trusts”
"Despite being a key component of daily hospital activity, ward rounds have been a neglected part of the planning and organisation of patient care.
"There are no national guidelines or templates on how to run a ward round, there is still considerable variation across hospitals.
"We often under estimate the importance of ward rounds for patients, and sometimes don't allow enough time for patients to discuss their anxieties or for relatives to be involved with care."
The guidance makes a number of recommendations to hospitals to help them get ward rounds right.
These include preparing properly by holding a pre-round briefing, carrying them out in mornings to allow the completion of tasks during the day and ensuring a nurse and other staff crucial to the care of the patient are present.
Patients and their relatives should also be provided with a "summary sheet" clearly presenting the information discussed during the ward round.
It also includes examples of best practice, including the approach taken by University College London Hospitals, which has drawn up a ward safety checklist - based on the World Health Organization's surgical safety checklist - which is used to ensure staff carry out all the correct checks during ward rounds.
Katherine Murphy, chief executive of the Patients Association, said: "High quality, consistent ward rounds in every hospital would contribute to a more patient centred culture in the NHS. This is crucial reading for the government and trusts."
Medical- GP's "Day of Action"-Threats of sanctions dropped
Updated: 05 Oct 2012
PCTs drop threat of sanctions on GPs over day of action
3 October 2012 | By Jaimie Kaffash
(General Practioners) GPs who took part in the BMA’s day of industrial action in July will face no sanctions from (Primary CAre Organisations ) PCOs, Pulse has learned.
NHS North Central London and NHS South West London NHS have confirmed they are not taking action against GPs, and have no plans to do so, having previously failed to rule it out.
All PCTs in London wrote to the capital’s 6,000 GPs prior to the day of action to warn them they may face a breach-of-contract notice or withheld pay if they opted to take part.
The remaining clusters in London had already ruled out taking any action against GPs.
Meanwhile, the ( General Medical Council) GMC has refused to confirm whether it is investigating complaints against three doctors who took industrial action.
Dr Chaand Nagpaul, a GPC negotiator and a GP in Stanmore, north London, said: ‘I’m glad common sense has prevailed and ( Primary Care Trusts) PCT clusters have chosen to spend their time and efforts on more important priorities.’
In the letter prior the industrial action, PCTs warned: ‘We expect all of our primary medical services contractors to continue to deliver the contract in full.
‘Although it is of course an individual’s right to take lawful industrial action, any GP practice that fails to provide a service during core hours on the day of action will be regarded as having been in breach of contract, even if the individual participating in that industrial action carries out the majority of work he or she would normally undertake.’
Medical- GP's say they are becoming more receptive to Mental Illmess ?
Updated: 03 Oct 2012
UK workers 'most depressed' in Europe,
By Alex Wellman |
01 Oct 2012
The spotlight has fallen on depression today with the Daily Telegraph reporting that UK workers are the most depressed in the whole of Europe.
The broadsheet reports that more than a quarter of the UK workforce has been diagnosed with the condition at some point, while just 12% of their Italian colleagues have.
The BBC reports that the Mori survey, carried out on 7,000 people by the European Depression Association, showed that one in four of people with depression said they did not tell their employer, while one in three of said they were worried it could put their job at risk.
But support groups said the situation in the UK was improving for people suffering with the condition.
Emer O'Neill, chief executive of the Depression Alliance, said: ‘We have moved forward significantly.
Depression and anxiety is being talked about more and is more widely recognised.
GPs are more receptive.'
Medical- GP Trainees - are plugging staffing gaps
Updated: 03 Oct 2012
Trainee GPs ‘drafted in to plug staffing gaps’
By Julia Gregory |
01 Oct 2012
GP trainees are being widely used to fill NHS staffing shortages and have even been asked to complete two placements in the same specialty, the new head of the BMA's junior doctors' committee has claimed.
Dr Ben Molyneux, a GP trainee in London who was elected to chair the committee last week, warned medical training is suffering as a result of economic pressures on the NHS, and said some trainee GPs had reported that they were struggling to fulfill recommended training requirements.
He said trainees in a number of places in the south of England were being used to plug staffing gaps, and claimed that trainees with the Surrey, Sussex and Kent Deanery had been made to complete two placements in psychiatry to help a trust's staffing shortage.
The deanery said trainees had been asked to complete two placements on educational grounds rather than to fill gaps.
But Dr Molyneux said: ‘Some trainees have been forced to complete two placements in psychiatry because the trust is short staffed.
Junior doctors should not be denied a rounded training programme which exposes them to a range of specialties.'
‘It puts a strain on their learning.
If they are doing paediatric and psychiatry it is much more easy to demonstrate their learning than if they are doing two psychiatry placements.'
He said the BMA was exploring the issue to find out how widespread the problem was but added that ‘it is a significant minority'.
He said: ‘The economic climate in the NHS coupled with major changes introduced by the Health and Social Care Act has created a perfect storm for the potential erosion of high quality medical training. We have already seen evidence that the financial pressures are taking their toll on medical training.'
However the BMA claims were rejected by the Surrey, Sussex and Kent Deanery.
A spokesperson said: ‘The purpose of the additional placements - two four-month [placements] compared to other deaneries who offer six month placements - in psychiatry and other specialties is because the deanery places importance on that area of GP training.
There is no evidence to suggest it is due to staff shortages.'
Earlier this year a BMA survey of junior doctors' career plans showed half of those questioned said they were more likely to leave the NHS and work overseas compared with two years ago.
Dr Molyneux said: ‘This would represent a massive potential loss to the NHS.
Continued pay freezes and the raid on doctors' pensions will further demoralise a profession who face an intense and lengthy training programme.'
‘I hope there will be opportunities for the BMA to work closely with the Government to address the concerns of junior doctors and that they will work in partnership with us to improve the quality of training.'
Medical- Chronic Pain- STEPS or Suffering in silence
Updated: 28 Sep 2012
25 Sep 2012
Dr Tim Williams, a GP and community pain specialist, offers his top tips on this tricky primary care problem
1. View pain as a chronic disease.
Chronic pain is now seen by many as a chronic disease in its own right.
An acceptance of this premise helps both patient and practitioner take a more long-term view of management, as we do with chronic lung or heart disease.
This changes the aim of treatment to helping the patient regain control rather than seeking out nonexistent cures.
2. Avoid prescribing more painkillers initially.
It is important for the patient and practitioner to take time to consider the most appropriate course of action (which is rarely to arrange further investigations).
Also, possibly the most unhelpful thing to do on first contact is to prescribe yet another painkiller.
3. Split your assessment into two appointments.
Splitting the assessment into two appointments stops you being overwhelmed by what may be a complex situation.
The first appointment can seek to answer the question: ‘How did the patient get to this point?'
Ask when the pain started, how it has progressed and how it is now.
Also ask about previous investigations and management, including helpful – or otherwise – medications and interventions.
The second appointment can then ask: ‘Where is the patient going?'
A realistic plan can help to avoid frustration for both the patient and GP.
4. Explain pacing techniques to patients.
It is useful for you to be able to explain some concepts and managements techniques to patients – for example pacing, where patients gradually increase their level of activity.
1 Discussing pacing is a particularly good rapport-building tool, as most patients can relate this to their own experiences.
I've found this discussion can be done in a couple of minutes of the precious 10-minute consultation and is time well spent.
These and other concepts can be found on www.paincommunitycentre.org.
5. Ask specifically about neuropathic pain.
It's worth asking specifically about neuropathic pain symptoms, such as constant burning pain, intermittent shooting pain that is like an electric shock, dysaesthesia, paraesthesia, hyperalgesia and allodynia.
Neuropathic pain will often coexist with chronic pain and responds poorly, in many cases, to standard analgesics.
I would suggest familiarising yourself with a few medications that may be helpful for these patients. NICE offers some useful guidance on neuropathic pain management.2
6. Use the STEPS to manage medications.
A useful approach to medicines management in chronic pain is to follow these STEPS:
Safety – is it safe for the patient to continue on this medication in the long term?
Tolerability – can the patient tolerate this medication and its side-effects?
Effect – is the medication effective?
Price – are patients taking the best priced treatment? Expensive medications are fine, as long as they work.
Simplicity – is the analgesic regime as simple as possible? Would a long-acting preparation be preferable to frequent doses of short-acting analgesics?
Also consider non-drug treatments such as warmth, ice, transcutaneous electrical nerve stimulationand acupuncture, which are helpful for some patients, and relaxation techniques, which are useful for most.
7. Use strong opiates with care.
The patient needs to be clear about what you're trying to achieve by prescribing strong opiates.
Used correctly, strong opiates can be very effective in chronic pain management for some patients, but they should be used by practitioners who are confident in doing so.
Opiates used in this context are distinct from palliative care, where the emphasis is primarily on symptom alleviation using a combination of short- and long-acting preparations.
In contrast, chronic pain management is more about function, in my opinion, and short-acting strong opiates have a very limited – if any – contribution to make.
In particular, short-acting strong opiates can quickly lead to a patient and practitioner feeling out of control on ever-escalating doses.
The British Pain Society has produced useful guidance on this issue.3
8. Encourage self-management.
Successful pain management depends more on the patient than the GP.
Pain management is the patient's responsibility and the skilled practitioner is able to help the patient find their ability to respond to their chronic pain and its consequences.
This may involve simply directing patients to self-management resources such as the pain toolkit, which can be downloaded from pulsetoday.co.uk/tools-and-resources, or self-help groups such as the Expert Patient Program.
9. Remove the focus from the pain.
Patients with chronic pain can have their life dominated by it. In a patient who is managing their pain well, the focus starts to shift away from pain as they begin doing more and getting their ‘life back'.
Sometimes the pain may actually stay the same and it's the other aspects of life that improve, including sleep, exercise tolerance, mood and general wellbeing – which are also very worthy end points.
Some time spent addressing poor sleep and depression, although not necessarily directly affecting the pain, can make living with chronic pain more manageable.
10. Aim for continuity.
Take an active interest in your patients' onward management – enjoy the benefits of a patient-practitioner partnership centred in self-management. Do your best to avoid other practitioners getting involved as this can lead to the patient receiving inconsistent advice, unhelpful medication changes or referrals for often fruitless further investigations.
Dr Tim Williams is a GP principle and community pain specialist in Sheffield.
Dr Williams has received payment for pain-related presentations from the pharmaceutical companies including Pfizer, Grunenthal and Napp.
He also deliberated as part of an expert panel, funded by Astellas Pharma, that recommended Qutenza as an appropriate topical treatment for some patients with neuropathic pain.
For the last twelve months Dr Williams has led a Health Trainer Community Pain Management Pilot in Sheffield.
1.The Pain Community Centre. Cardiff University. paincommunitycentre.org (accessed 9 August 2012)
2.NICE. Neuropathic pain – pharmacological management. 2010;CG96
3.The British Pain Society. Professional publications. britishpainsociety.org/pub_professional.htm (accessed 9 August 2012)
Medical- Is your GP compassionte ?
Updated: 28 Sep 2012
Senior GPs stand up for doctors
as patient survey accuses them of lacking compassion
By Helen Mooney | 27 Sep 2012
This morning the news is more doom and gloom with The Guardian leading on a Patient Association report claiming that many doctors lack compassion.
According to the survey's findings large numbers of patients have cause to be dissatisfied with the contact they have had with the primary care sector.
Analysis of the experiences of NHS primary care relayed by a sample of 500 patients who called its helpline between January and June this year shows a small but growing minority of patients have major concerns about how their GP treated them.
The paper quotes Dr Richard Vautrey, deputy chair of the British Medical Association's GPs' committee, saying that the report is hard to reconcile with the last Department of Health survey of patients' experiences, which found that 88 per cent rated their overall experience with their GP practice as good and 93 per cent had trust and confidence in the last GP they saw.
However, although based on a small number of patients, Dr Vautrey said the findings highlighted some real concerns. Some patients were being denied the chance to see a consultant because of 'arbitrary' money-saving limits set by NHS primary care trusts that restricted GPs' ability to refer patients to hospital.
He said that could pose a medical risk to a patient whose condition was not picked up.
Running the same story the Daily Telegraph quotes Dr Clare Gerada accusing The Patients Association of 'unfairly criticising GPs'.
She said: 'We are really disappointed by this report. GPs actively encourage patient feedback and take concerns very seriously but we must put these numbers in perspective and view them in the context of other formal and more representative studies such as the annual Patient Experience Survey which shows overwhelming support for GPs.'
Medical - In the NHS the "Eyes" don't have it, thanks to the blindness of the Nasty Party cuts
Updated: 26 Sep 2012
Only half of patients with wet age-related macular degeneration are being seen within the recommended timeframe of two weeks, according to a survey of opthalmologists.
Four out of 10 clinics say they are not adequately meeting demand, despite adding patients to clinics and putting on extra sessions at evenings and weekends.
Winfried Amoaku, chairman of the Macular Interest Group, said that the NHS needs to ‘urgently consider how it will meet demand for this treatment.
If it doesn't, patients will lose their sight unnecessarily.
Medical- Doctors in Trouble
Updated: 26 Sep 2012
Doctors keep jobs despite sex offence convictions,
By Gemma Collins | 25 Sep 2012
RADICAL SAYS- Maybe these convictions are time served and one should always be sceptical of emotional publicity that the Police seems to revel in. On the other hand each case should be taken seriously.
The GMC is in the headlines today as the Daily Mail reports that at least 31 men are practising as GPs, consultants and surgeons despite having convictions for assaulting women, possessing child pornography or soliciting prostitutes.
According to the Daily Telegraph, the GMC has said it is unable to ban medics for being on the sex offenders' register as it had been advised that such a move would not be compatible with human rights legislation.
Niall Dickson, the GMC's chief executive, said: ‘Cases of doctors convicted of sexual assault or child pornography offences are very rare and in the vast majority of these cases these doctors are struck off the medical register so they cannot practise medicine in the UK.'
But a spokesman for the Council said the decision on whether to strike off a doctor was taken by an independent panel of experts and the GMC could not appeal against it.
Medical- The operation was a great success,unfortunately the patient died !
Updated: 22 Sep 2012
Twice as many people die after surgery
in NHS hospitals as previously thought.
It says the overall chance of dying within two months of surgery is one in 28 (3.6 per cent) according to a study published in The Lancet which finds serious shortcomings in the way many patients are treated.
The paper says the latest study examined 10,630 cases in British hospitals during one week in April 2011.
These included both pre-planned and emergency operations, but excluded those not requiring an overnight stay, as well as cardiac, neurological, radiological or obstetric surgery.
It quotes author Dr Rupert Pearse, a reader in intensive care medicine at Barts and the London School of Medicine and Dentistry, as saying that patients are also being sent back to general wards after surgery rather than critical care beds because of a ‘one-size fits all' approach that is ‘ingrained' in the NHS.
Lessons need to be learnt from cardiac surgery, where information on death rates is freely available and hospitals vie to be the best, according to the Telegraph.
Medical- Gastric balloons to help weight loss is more than just hot air
Updated: 19 Sep 2012
A balloon swallowed inside a capsule before being inflated in the stomach by a doctor could be an effective weight loss treatment.
Approved in the UK although not yet available, the silicone balloon has been shown in small 12-week trials to lead to weight loss of up to 50 per cent.
Unlike existing gastric balloons, no endoscopic intervention is needed to get the balloon into position but more research is needed on longer-term use of the device.
Professor Paul Trayhurn, professor of nutritional biology at Liverpool University, said: ‘It sounds promising.
Gastric balloons and gastric bypass operations are being used to reduce the effective size of the stomach so that you feel full more quickly, with the result that you eat less.'
Medical-It takes guts to complain about a GP & a lifetime to complain about poor hospital treatment
Updated: 19 Sep 2012
Nearly half of all complaints to GMC are against GPs
By Helen Mooney |
18 Sep 2012
Nearly half of all patient complaints about doctors are made against GPs, according to a detailed new report from the GMC.
The number of complaints against doctors overall has also hit a record high, with more patients raising concerns about their treatment.
GP leaders told Pulse that the numbers did not suggest a reduction in patient satisfaction with GPs, but said it was ‘far easier' for patients to complain against GPs than ever before.
The total number of complaints to the GMC increased by 23% from 7,153 in 2010 to 8,781 in 2011 - a figure which has been rising since 2007.
The GMC's second annual State of Medical Education and Practice in the UK report also found that nearly three quarters of all complaints in 2011 were about male doctors, though only 57% of all registered doctors were men.
General practice, psychiatry and surgery were overrepresented as specialties. Some 47% of all complaints made were against GPs, who represented 24% of those on the medical register.
But thereport said the number of complaints made against GPs was not surprising given the large number of interactions GPs have with their patients, and said there was no evidence that this points to falling standards of practice.
It said initial analysis suggested that greater expectations, an increased willingness to complain, less tolerance of poor practice within the profession as well media attention for high profile cases may be behind the increase.
Commenting on the findings, GMC chief executive Niall Dickson said: ‘While we do need to develop a better understanding of why complaints to us are rising, we do not believe it reflects falling standards of medical practice.
‘Every day there are millions of interactions between doctors and patients and all the evidence suggests that public trust and confidence in the UK's doctors remains extremely high.'
GPC negotiator Dr Chaand Nagpaul said it was important to put the results in context.
'The number of GP consultations that occur on a daily basis is far higher than consultations with hospital doctors,' he said.
‘This, coupled with the fact that GPs have facilitated patients in making comments which includes complaints-many of which are constructive-means that it is far easier for patients to complain against GPs and this is something GPs can learn from.'
Dr Nagpaul also suggested that patients were more likely to make a complaint against a GP as they were an 'easily identifiable service' whereas making a complaint against hospital staff was harder because it was 'difficult to pinpoint which element resulted in a problem.'
Dr Mark Porter, BMA chair said: 'Even though medical standards remain high and the number of complaints is very small, compared to the millions of consultations every year, we should always strive to find ways of improving the quality of care.
'It is essential that the new system of checking doctors' fitness to practice, known as revalidation, does protect patients while also being fair to doctors.'
Mike Farrar chief executive of the NHS Confederation, said that it was 'essential' that doctors listened to their patients' experiences in order to improve professionally.
'We must keep a careful eye on these complaints.
A rise may partly be a result of patients, rightly, being more assertive in voicing dissatisfaction about their care, or it may be something more substantial.
'Employers and individual doctors need to analyse this data and look carefully at the cases where doctors have not met the standards patients expect, and what action they need to take when they fall short".
Medical- New Scientific facts constantly change accepted practice
Updated: 18 Sep 2012
Is medical science built on shaky foundations?
17 September 2012
by Elizabeth Iorns
More than half of biomedical findings cannot be reproduced –
we urgently need a way to ensure that discoveries are properly checked
REPRODUCIBILITY is the cornerstone of science.
What we hold as definitive scientific fact has been tested over and over again.
Even when a fact has been tested in this way, it may still be superseded by new knowledge.
Newtonian mechanics became a special case of Einstein's general relativity; molecular biology's mantra "one gene, one protein" became a special case of DNA transcription and translation.
One goal of scientific publication is to share results in enough detail to allow other research teams to reproduce them and build on them.
However, many recent reports have raised the alarm that a shocking amount of the published literature in fields ranging from cancer biology to psychology is not reproducible.
Pharmaceuticals company Bayer, for example, recently revealed that it fails to replicate about two-thirds of published studies identifying possible drug targets (Nature Reviews Drug Discovery, vol 10, p 712).
Bayer's rival Amgen reported an even higher rate of failure - over the past decade its oncology and haematology researchers could not replicate 47 of 53 highly promising results they examined (Nature, vol 483, p 531).
Because drug companies scour the scientific literature for promising leads, this is a good way to estimate how much biomedical research cannot be replicated.
The answer: the majority.
The reasons for this are myriad.
The natural world is complex, and experimental methods do not always capture all possible variables.
Funding is limited and the need to publish quickly is increasing.
There are human factors, too.
The pressure to cut corners, to see what one wants and believes to be true, to extract a positive outcome from months or years of hard work, and the impossibility of being an expert in all the experimental techniques required in a high-impact paper are all contributing factors.
The cost of this failure is high.
As I have experienced at first hand as a researcher, attempts to reproduce others' published findings can be expensive and frustrating.
Drug companies have spent vast amounts of time and money trying and failing to reproduce potential drug targets reported in the scientific literature - resources that should have contributed towards curing diseases.
Failed replications also quite often go unpublished, thereby leading others to repeat the same failed efforts.
In the modern fast-paced world, the normal self-correcting process of science is too slow and too inefficient to continue unaided.
Many have wrung their hands and proposed various penalties for scientific studies that cannot be reproduced.
But instead of punishing investigators, what if there was a way of rewarding them for pursuing independent replication of their most significant scientific results - the ones they want to see cited and built on - before or shortly after publication?
I believe this could be a substantial boon to science and society, which is why I started the Reproducibility Initiative.
I am the co-founder and CEO of Science Exchange, part of the initiative.
It is an online marketplace to connect scientific services, such as DNA sequencing, with people who need them.
The exchange lists more than 1000 experts in techniques including sequencing, electron microscopy and mass spectrometry.
They mostly provide services to their own institute, but are open to other work on a fee-paying basis.
Thinking about the reproducibility problem, I realised that Science Exchange could help by providing investigators with the means and incentives to obtain independent validation of their results.
Here's how it works. Scientists submit studies to us that they would like to see replicated.
Our independent scientific advisory board - all members of which are leaders in their fields as well as advocates on the reproducibility problem - selects studies for replication.
Service providers are then selected at random to conduct the experiments, and the results are returned to the original investigators, who can then publish them in a special issue of the open-access journal PLoS ONE.
We will issue a "certificate of reproducibility" for studies that are successfully replicated.
In our pilot phase, we expect to attempt to replicate 40 to 50 studies.
We also plan to publish an analysis of the overall success of what is essentially an experiment in reproducibility.
Initially, investigators must bear the cost of replications, which we estimate will be approximately one-tenth the cost of the original study.
If we are successful, we believe funders will eventually see the value of supporting these replication studies.
In fact, we are in discussions with numerous public and private funders who believe our mechanism may meet their own acknowledged need for independent validation.
We hypothesise that the success rate for replications will be quite high, mainly because investigators will submit studies that they are confident can be replicated.
And that is one of the points we want to make - we want to identify the most robust, important findings and mark them in a highly visible way.
What we are not doing - a point that many have misunderstood - is trying to police the entire scientific literature.
Nor are we calling for a doubling of the budgets required to repeat every experiment, every time.
We also won't demand the publication of reproducibility failures - although, for obvious reasons, we and PLoS encourage investigators to publish all outcomes.
Our goal is to provide a much-needed imprimatur of robustness that will ultimately increase the efficiency of research and development and bring us one step closer to perfecting the scientific method, for the benefit of all.
Elizabeth Iorns is co-founder and CEO of Science Exchange, based in Palo Alto, California.
For more information, visit reproducibilityinitiative.org
Medical-Learn First Aid- 140,000 preventable deaths each year
Updated: 18 Sep 2012
St John Ambulance's new hard-hitting TV advert aims to show how many deaths could be prevented if people learn basic first aid skills, according to the Guardian .
It says that approximately 140,000 people every year die in situations where their lives could have been saved if somebody had known first aid – as many deaths as there are from cancer.
The 60-second film features a man who is diagnosed and treated for cancer.
He recovers, only to choke to death on a piece of meat at a barbecue, because none of his family knows what to do to help.
Medical- GP's Plan for the Future NHS- More GP's,Better Training, Longer Consultation times
Updated: 18 Sep 2012
RCGP consults on 10 year plan for the future of general practice
By Madlen Davies |
17 Sep 2012
The RCGP has launched a consultation on its vision for the future of general practice, including ambitions for more GPs, longer training and increased consultation times; as part of a new ten year plan to improve patient care and put general practice at the heart of the NHS transformation.
Responses to the College's largest ever consultation- called ‘General Practice 2022'- will inform a newly-gathered ‘compendium of evidence' demonstrating how general practice should be the driving force behind health service changes.
Once finalised, this will form the basis of the College's blueprint for patient care, as well as the requirements and responsibilities necessary to deliver it.
The consultation, which runs from 14 September until 8 October this year, examines the current role of GPs in the UK, and general practice as a driver of improved health outcomes, through disease prevention, rapid diagnosis and their role in providing access to specialist care.
It also looks at future challenges for GPs including ageing populations, increased volume and complexity of patient care, financial constraints, structural changes and health inequalities as well as discussing new models of delivering care, developing new skills and taking on new roles.
Three main areas for action are set out: increasing the number of new GPs by promoting general practice as a career amongst medical students, retaining the existing workforce by increasing levels of support and resources and extending postgraduate training from three to four years to advance the profession's development.
Commenting on the launch of the consultation, RCGP chair professor Clare Gerada said: ‘We are keen to receive views from as many people as possible - from GPs working across the UK and other health professionals to politicians in all four governments; from managers in the NHS, to those working in the voluntary and social care sector; and from patients and the wider public.
‘We must look ahead to enable us to deliver the care and services that our patients will need and expect over the next few years. The stakes are too high not to get this right.'
Damaged Hearts at risk from Common Painkillers
Updated: 12 Sep 2012
Your Damaged Heart is at risk from Common Painkillers
NSAID- Non- Steroidal Anti- Inflammatory Drugs
Common painkillers can increase the chances of a second heart attack or death in those who have already had a heart attack, says the Daily Mail.
It comes from a Danish study of 100,000 people who had had a heart attack, which found that NSAIDs, including ibuprofen, increased the risk of death from any cause by 59 per cent one year after their heart attack, and 63 per cent higher after five years.
The risk of having another heart attack or dying from coronary artery disease was 30 per cent higher one year later and 41 per cent higher after five years, the study in Circulation reported.
Study leader Dr Schjerning Olsen said: ‘The results support previous findings suggesting that NSAIDs have no apparent safe treatment window among heart attack patients, and show that coronary risk related to using the drugs remains high, regardless of the time that has passed since the heart attack.'
Medical- Alzheimers -A form of Diabetes ?
Updated: 04 Sep 2012
Brain diabetes: the ultimate food scare
03 September 2012
Big trouble lies ahead if Alzheimer's is proven to be a form of diabetes
THE human brain evolved to seek out foods high in fat and sugar.
But a preference that started out as a survival mechanism has, in our age of plenty, become a self-destructive compulsion.
It is well known that bad diets can trigger obesity and diabetes.
There is growing evidence that they trigger Alzheimer's disease too, and some researchers now see it as just another form of diabetes (see "Food for thought: Eat your way to dementia").
If correct, this has enormous, and grave, implications.
The world already faces an epidemic of diabetes.
The prospect of a parallel epidemic of Alzheimer's is truly frightening, in terms of human suffering and monetary cost.
This outcome will not be easily averted. Few people need to be told that too much high-fat, high-sugar food is a health hazard.
And yet sales of fast food remain healthy (or should that be hefty?). Part of the reason is "future discounting", another evolved feature of the human brain that makes us value short-term rewards over long-term risks.
What can be done? One option is to call in the lawyers.
Some moderately successful attempts have already been made to sue food companies for their role in creating the obesity epidemic.
If a causal link between fatty, sugary food and Alzheimer's can be established, it is highly likely that more lawsuits will follow.
Such actions have their place, but this is a laborious and expensive way to enact change.
Nor do the policy levers at our disposal appear promising.
Public awareness campaigns have been of limited use in reversing the tide of obesity.
Will the added threat of dementia prove harder to ignore? "Sin taxes" on unhealthy foods may work - Denmark and a handful of other countries are experimenting with them - but it is not yet clear whether they make any real difference.
What's more, they raise questions about personal responsibility and nanny-statism.
We may be left with only the option of medically blocking either the craving for fast food, or its consequences.
That has its own complications, and sidesteps the problem rather than addressing it.
But the human brain also evolved to find ingenious solutions to intractable problems.
It may yet come to its own rescue.
Medical- Addiction-Treating the Whole Patient is essential
Updated: 01 Sep 2012
Whole-patient care is essential for successfully treating addiction
By Dr Gianni Barone | 31 Aug 2012
For many years, drug addiction treatment in the UK has been marred by dispute and confusion.
All too often, the debate around how best to treat those with a drug addiction has seen people divided into two camps: those who promote abstinence and those recommending substitute prescribing.
This lack of nuance has seen too many people ‘parked on methadone' indefinitely, based on a system that focuses solely on harm reduction; while the alternative, abstinence, has problems just as significant, and can result in dangerous relapses.
Against this backdrop, the National Treatment Agency's recent report on prescribing substitute medication is a breath of fresh air, finally formalising the ideas that have been developing in the sector over the last decade.
The reality, as is expressed so clearly in the recent report, is that the abstinence versus prescribing debate is a false dichotomy: we don't have to choose one or the other.
I have specialised in addiction treatment for more than five years.
Through my work with the national health and social care charity, CRI, I have come into contact with thousands of individuals, and one thing I have learnt for sure is that every situation is different.
Addiction is a very personal matter – it's tied to medical and social factors that go far beyond the basic question of how much of what drug they are taking.
What doctors and treatment organisations in this field must do is develop a holistic approach that uses whatever approach is best for the individual.
For this reason, every treatment programme must be considered individually.
For some patients, abstinence-only approaches might be effective, but for others they could turn out to have disastrous consequences.
For many, prescribing a substitute drug gives them the opportunity to quit street drugs, stop committing crime, preventing viruses like Hepatitis C or AIDS from spreading, and enter a structured recovery programme, but the ultimate aim must be becoming free of dependence on drugs wherever possible.
We all know that for many this option will be very difficult to achieve and could take many years; even if they never manage to get off drugs or substitute medications, we should work in partnership to help them to recover other aspects of their life that could have been neglected when all the treatment they have received over the last ten years is just a methadone prescription.
There must also be more of an emphasis on personal responsibility: treatment must be a partnership between the doctor and the individual.
GPs have a responsibility to consider the individual's circumstances, to make sure they understand all of the options available to them.
Likewise, the individual must, based on informed consent, take charge of their treatment programme.
So how should doctors start putting this into practice?
On the clinical side, this may include optimised doses of appropriate medications, and the reintroduction, reduction or dropping of supervised consumption as appropriate so the patient can improve self esteem, confidence and freedom.
Patients should be offered the opportunity to come off medication at a rate that works for them.
If agonist or antagonist medications are being prescribed then the GP should work jointly with each patient to assess the benefit still being obtained.
What's vital is that prescribing is part of a holistic approach.
It must sit alongside case management and psychosocial interventions.
Exits from treatment must be visible to individuals from the minute they walk through the door of your service: offer links to a recovery community or employ ex-service users as recovery mentors and coaches.
Efforts should be made to strengthen or develop patients' social networks, involving families where appropriate.
Ensure they are able to access support around employment and housing; essentially, services need to help them plan and build a new life.
Measurement of progress must take into account quality of life factors as well as simple clinical data.
Taking these steps at services across the country will lead to better outcomes for individuals, as well as for society.
It is time to end the division within the sector around recovery methods and pathways, and put the needs of drug users first by recognising that there are numerous pathways to recovery.
Dr Giani Barone is a GP in Greenwich, and the Crime Reduction Initiative's clinical lead for drug and alcohol services in the area.
Medical- Statins - and the risk of muscle cramps
Updated: 01 Sep 2012
High-potency statins ‘raise risk of muscle damage’
By David Swan | 31 Aug 2012
GPs should consider prescribing a lower-potency statin if a patient experiences a muscle-related adverse event, concludes a major analysis of US adverse event data.
The study analysed all case reports of muscle-related adverse events with statins from the US Food and Drug Adminstration's adverse event reporting system database over six years, including rhabdomyolysis, muscle atrophy and myalgia.
Of the 57,000 case reports identified, rosuvastatin was found to have the highest risk of muscle-related adverse events compared with all other statins.
With rosuvastatin designated a 100% relative risk to the other statins, the next highest risk was atorvastatin with a 55% risk of events, followed by simvastatin at 26%, pravastatin at 17% and lovastatin at 7.5%.
These risks were found to approximately track with per milligram potency, meaning the relative potency of each statin appeared to be a predictor of muscle adverse effect reporting risk. The exception was fluvastatin, the least potent statin, but one that had a 74% risk of adverse events, compared with rosuvastatin.
The study authors concluded: ‘This data offers important reference points regarding the selection of statins for cholesterol management. If statin reinitiation is considered following the muscle-related adverse events, statins of lower expected potency should be preferred.'
PLoS One 2012, online 22 August
Medical- Pacemaker Battery Change?
Updated: 01 Sep 2012
Pacemaker Battery Change?
Had a brutal experience?
My Pacemaker put in 2003 needed a battery change
I attended Lincoln County Hospital for a battery change in 2012
“Just a Scratch” as the local anaesthetic needle was stuck in several times
Thought I was going to have a heart attack
Then the Pacemaker which had tissue growth around it was gouged out and exposed before the replacement battery could be inserted.
Have you had a painful and bruising experience ?
Get in touch and I will post it here if you wish
Medical- OMG -Complaints about GP's up 8.2% -Communication and Attude problems were No 1
Updated: 30 Aug 2012
Complaints against GPs up by 8.2%
By Jaimie Kaffash | 30 Aug 2012
Complaints against GPs in England increased by 8.2% from 2010/11 to 2011/12, official figures have shown.
A new report by the Health and Social Care Information Centre (HSCIC) showed there were 54,870 written complaints against general practice (including dental) health services in 2011/12 compared with 43,942 in 2007/08.
The majority of complaints were around clinical issues, which attracted 19,336 complaints in 2010/11, 35.4% of the total.
Communication and attitude attracted the second highest number of complaints, with 11,650, 21.7% of the total.
This was followed by general practice administration, with 9,924 complaints, some 18.5% of the total.
The figures showed that 33.8% of complaints were upheld.
But the HSCIC said comparison of 2010-11 and 2011-12 figures for general practice could be partially affected by some PCTs reporting incomplete data in either year.
For hospitals, there was a decrease in written complaints of just over 2% (from 98,200 to 96,000) if taking into account hospital trusts who submitted data in both years.
Earlier this month, the Medical Defence Union published new figures which showed that disciplinary cases against GPs and hospital doctors increased by 56% in 2011, claiming the challenges were‘unmatched in the company's 126-year history.'
Dr Barry Moyse, secretary of Somerset LMC, said he felt the increase was symptomatic of general practice being seen as more of a ‘consumer commodity'.
He said: ‘My feeling is that we live in a consumer society where we are encouraged to complain.
General practice is looked upon increasingly as a consumer commodity.
Governments have encouraged that view.
Therefore it is no surprise that people should come forward more often.
‘As an LMC, we appreciate that colleagues do find complaints upsetting.
It challenges our sense of worth.
But he added: ‘It is always good, if someone is unhappy, that they discuss it openly.
It can help us improve and we should try and look at them in a positive light to see if we can learn from them.'
Medical - Cock- up theory (or are GP's just a medical liability ?)
Updated: 29 Aug 2012
10.30AM 28 August 2012
Conspiracy theorists can be difficult to argue against.
I’ve had a few experiences of lively debates with people who think that the Moon landings were staged on a set in California.
If you really want to, you can pass an enlightening evening chatting on the internet to people who believe the Bush administration rigged the World Trade Center with explosives.
Whenever the majority of opinion tends in one direction, there will be people who see this as conclusive proof that the truth lies elsewhere.
This is especially so if strong or unpopular authority groups are supported by the general consensus.
And once a conspiracy theory has developed, there’s no point trying to counter it with evidence.
That will just confirm you as either a stooge or a simpleton. In the case of the Moon landings, don’t waste breath addressing specific points about the angles of shadows, or exactly how a flag should move in a vacuum.
I used to think that the best counterargument was that the Soviets were monitoring the mission and never thought to mention that the astronauts were actually staying in a small motel outside Los Angeles.
But even this argument is trumped by ‘cock-up theory’.
First developed, I believe, by the comedian David Mitchell, it states that grand conspiracies are unlikely because they demand too much competence from their perpetrators.
A faked Moon landing would require thousands of people to do their jobs flawlessly and then never brag unguardedly or take the tabloid editor’s shilling.
It couldn’t happen.
Somebody would cock it up.
But what is the relevance of all this to general practice?
The answer is that cock-up theory has the potential to turn our day of strike action from a dithering debacle into a triumph.
Recently, I had the unusual experience of knowing exactly what was wrong with a patient and, stranger still, that it could be easily cured.
She needed an antibiotic – the indication was unequivocal, it would almost certainly work and without it she was likely to get very much worse.
Inevitably, she didn’t want my antibiotic.
It was ‘unnatural’, a ‘chemical’ and I was probably in league with big pharma.
She didn’t actually check me for a store cupboard full of Pfizer-branded pitchforks, but only because the case was so cut and dried.
I had obviously sold my soul to the drug companies, and that was that.
Except it wasn’t. Usually, I’d witter endlessly about balancing risk and benefit, the fact that everything you eat is a chemical and so on.
But post-strike, I could deploy cock-up theory.
I asked her if she really thought rank-and-file GPs were capable of running devilish international plots when we can’t agree on what to do for one day to save our own pensions.
She left with her prescription.
There’s an outside chance she may even have got it filled.
Dr Nick Ramscar is a GP in Twickenham
Medical- Measles cases "nearly double" in a year
Updated: 29 Aug 2012
Measles cases 'nearly double' in a year
By Madlen Davies | 24 Aug 2012
Parents are being urged to visit their GP to check if their child had both doses of MMR vaccine, after HPA figures show cases of measles have almost doubled this year compared with last.
The latest figures from the Health Protection Agency show that 964 cases of measles were reported in the first six months of 2012, almost twice as many cases compared to the same period in 2011, when 497 cases were reported.
Instances of rubella have also soared, The 57 cases reported between January and June this year exceeds the annual totals for each of the previous nine years.
Dr Mary Ramsay, head of immunisation at the HPA, said: ‘It's extremely concerning that measles cases are continuing to rise.
Measles can be very serious and parents should understand the risks associated with the infection, which in severe cases can result in death.
‘Although uptake of the MMR has improved in recent years some children do not get vaccinated on time and some older children, who missed out when uptake was lower, have not had a chance to catch-up.
‘Therefore, there are still enough people who are not protected to allow some large outbreaks to occur among unvaccinated individuals.'
‘It's vital that children receive both doses of the MMR vaccination and ahead of returning to school after the holidays, we are urging parents to ensure their children have received the two doses, which will provide the best protection against the risks associated with measles, mumps and rubella.
‘If you are unsure if your child has had two doses of the vaccination, speak to your GP who will have a record of which vaccinations your child has received.'
Medical- Note well- Dr Freddy Patel reported on patients for 35 years before being struck off
Updated: 24 Aug 2012
Ian Tomlinson pathologist Freddy Patel struck off
Pat Hurst Thursday 23 August 2012
The pathologist who botched the post-mortem examination on newspaper seller Ian Tomlinson who died in the G20 riots was banned from working as a doctor today.
Dr Freddy Patel, described as being arrogant and having a bad attitude, was finally banned from practising as a medic after being investigated numerous times and suspended on two previous occasions over his shoddy work dating back a decade.
Dr Patel was found guilty of misconduct but was not at the Medical Practitioners Tribunal Service (MPTS), sitting in Manchester, where he was struck off the medical register.
The medic's actions were found to be misleading, dishonest and liable to bring his profession into disrepute over parts of his handling of the post-mortem on Mr Tomlinson.
After the hearing Mr Tomlinson's family said Dr Patel should not have been doing the examination in the first place given his record.
The doctor, who qualified at the University of Zambia in 1974 and has practised as a pathologist for 35 years, was excused attendance but listened in on the hearing by conference call from London.
He had already botched previous post-mortem examinations dating as far back as 2002 by the time Mr Tomlinson died in 2009.
Dr Patel was found guilty of serious misconduct and suspended for four months over his post-mortem examination reports in 2002 into the death of a victim of so-called "Camden Ripper" Anthony Hardy.
The naked body of Sally White, 31, was discovered in a room in Hardy's flat in January 2002.
Dr Patel explained away her injuries and ruled she died from natural causes. In fact she was the first victim of serial killer Hardy and suspected of having been asphyxiated.
Mr Tomlinson, 47, died on April 1 2009 after he became caught up in the G20 riots in the City of London as he tried to get home and was forcibly pushed over by Pc Simon Harwood.
Dr Patel carried out the post-mortem examination on Mr Tomlinson and concluded that he died from a heart attack, but questions were raised when an American tourist came forward with a video recording of him being shoved by the officer.
Further medical reports suggested that Mr Tomlinson died from an injury to his liver that caused internal bleeding and then cardiac arrest.
At the inquest into Mr Tomlinson's death, Dr Patel's claim that he died of a heart attack was discredited by the jury in favour of the string of experts who said he died of internal bleeding.
Dr Patel's first post-mortem examination also made it all but impossible to conclude with any certainty how Mr Tomlinson came to die.
The inquest jury ruled Mr Tomlinson was unlawfully killed.
The Rev Robert Lloyd-Richards, chairman of the MPTS fitness to practise panel, told Dr Patel today: "Your rigid mind-set, illustrated by your inability to reflect on the case of Mr Tomlinson and your unwarranted confidence in your own abilities does not convince this panel that it would be appropriate to impose conditions, even with the most stringent supervision, on your registration.
"The panel considers that you have a deep-seated attitudinal problem.
"You have twice been suspended for your failings in relation to post-mortem examinations you have carried out.
"You have now appeared before a fitness to practise panel three times.
"The failings against you both historically and presently involve five separate post-mortem examinations."
Along with Mr Tomlinson and the Camden Ripper case, other botched cases conducted by Dr Patel include those of a four-week-old baby, a five-year-old girl and an elderly woman.
After today's MPTS hearing Mr Tomlinson's widow Julia said: "We aren't surprised he has been struck off. It is more of a surprise that he was able to work as a pathologist for so long and that he was selected to do the post-mortem on Ian.
"We are pleased that he will not be able to put any more families through the ordeal he caused us, but the damage he has done can't now be undone."
Last month, Pc Harwood was found not guilty of the manslaughter of Mr Tomlinson following a criminal trial.
Evidence about his chequered disciplinary history as an officer was ruled inadmissible and the jury was not told about a series of allegations about his behaviour in the past.
The officer, who serves with the Metropolitan Police, faces an internal disciplinary hearing being held by his employers next month
Medical- A Lifeline for Heart Failure sufferers
Updated: 24 Aug 2012
A lifeline for heart failure sufferers
By Hannah Bass | 23 Aug 2012
Today could mark the start of a new dawn for heart failure sufferers as the first British patient will be implanted with a new device that could help treat the condition, reports the Telegraph.
Unlike current devices which help the heart to pump, the CardioFit system stimulates the vagus nerve in the neck. This allows the heart to pump more slowly, relieving the strain.
If it is successful, it could save heart failure patients from a lifetime of drugs and heart pumps.
The system is being trialled at Glenfield Hospital in Leicester and has already seen promising results in 32 patients across Germany, Italy, The Netherlands and Serbia.
The Telegraph quotes Professor Jeremy Pearson, associate medical director at the British Heart Foundation: "Heart failure affects more than 750,000 people in the UK alone and we need new ways to tackle this often debilitating condition.
"This new procedure uses an implantable device to stimulate the vagus nerve in order to ‘calm' the heart and could help patients who are responding poorly to current treatment.
"This is the first large trial to test if the treatment really works and we look forward to seeing the results, which may help thousands of people."
Medical- Dr God's Confessionals -Sorting the Wheat from the Chaff as "Ther's nowt queerer than folk"
Updated: 22 Aug 2012
Balancing out the 'epics' with the 'quickies'
5.58PM 20 August 2012
According to Professor Amanda Howe, RCGP honorary secretary and GP in Norwich, GP appointments lasting 30 minutes should be the norm rather than the exception.
Hmm, I know where she’s coming from - Norfolk, where the perception of ‘normal’ is distorted by the isolation, the flat landscape and the proximity of farmyard animals.
That aside, there’s a danger we’re confusing two different things: appointment time and consultation length. As any GP knows, they’re not the same.
Consultation length is the time it takes to deal with the patient.
This varies from a few seconds (my personal record being a woman who mistook the dirt stuck to her foot as a possible melanoma) to God only knows how long.
We give patients the time they require, mostly, including those who feel as though they could quite possibly continue their consultation for the entire duration of my life and who, even as I dissolved into dust, would be saying, ‘While I’m here...’.
The appointment length, though, is something else entirely.
It’s simply a convenient unit of time that GPs use to organise their work.
By pragmatically divvying up prime consulting space, we more or less balance out the epics with the quickies.
We use the 10-minute slot as a tool, too – slicing problems into a sequence of consultations, or booking double appointments if we really want to wade through multipathological treacle.
And it does act as a subtle constraint for those who really do bang on.
A 10-minute slot doesn’t entitle us to club them to a pulp – as they deserve when the clock strikes 20 – but it is a parameter we can highlight, particularly when the rest of the waiting room is trying to jemmy the door open.
The trouble is, the half-hour consultation drum-bangers will take away this flexibility and effectively railroad us into being a new breed of general physicians who only deal with complex cases.
Sod that for a game of doctors.
I need the odd pill check and sore throat to keep me sane.
Besides, consulting at half-hourly intervals would make my day 60 hours long.
Either that, or the average co-morbid punter would have to wait beyond his prognosis for a spare appointment.
Put that way, though, it doesn’t seem such a bad idea.
Dr Tony Copperfield is a GP in Essex.
You can email him at email@example.com
and follow him on Twitter @DocCopperfield
Medical - Diabetic drug cost soars (as does the Arms bill)
Updated: 16 Aug 2012
Soaring costs of Diabetic drugs
By Emma Wilkinson | 15 Aug 2012
It seems like the Olympics spirit has finally left with the papers returning to doom and gloom and another NHS budget crisis.
Most papers, including the Daily Mail, are today reporting that soaring prescriptions for diabetes threaten to bankrupt the NHS.
It comes after figures from the Health and Social Care Information Centre show a record 40 million prescriptions were made out for diabetes drugs last year, 50% higher than six years ago.
The NHS diabetes drugs bill has risen from £514million in 2005/6 to £760.3million last year, the figures show. Barbara Young, chief executive of Diabetes UK, said: ‘We face the real possibility of diabetes bankrupting the NHS within a generation.
This is why we need to grasp the nettle on preventing type 2 diabetes.
Medical- Poverty is Painful too.
Updated: 12 Aug 2012
The new sickness benefit process will fail those who need it most
08 Aug 2012
I have worked as a GP principal in the NHS since 1986 as a doctor providing primary care services for patients.
I have also recently been diagnosed with breast cancer, and have had to undergo a mastectomy and sentinel node biopsy.
I now need post-operative chemotherapy, herceptin and radiotherapy to give myself the best possible chance of a long-term cure.
This means I have been unable to work since 9 July 2012, and will probably be off for at least the next six months through illness.
Everyone, myself included, has encountered patients who have talked about the difficulties they have when trying to claim sickness benefit, but this would be my first time experiencing the system.
I have always paid my National Insurance contributions throughout my working life, after I qualified in 1982.
I wanted to claim employment and support allowance, a non means-tested benefit based on the amount of National Insurance contributions which have been paid to date.
So I went to the Department for Work and Pensionswebsite, naïvely thinking that I would be able to complete an online claim.
This is not possible, nor can you obtain a claim form to complete at home and then it post back.
Instead, I was expected to ring a 0845 telephone number at my own expense, be kept on hold for 30 minutes for someone to answer and then complete a 40-minute interview with a person in a call centre who went through a tick-box menu of questions and answers.
She then said she would post out the forms to me for signature and verification.
Unfortunately, when I received the forms there were a number of errors, the most important of which was that she had recorded me as a dental practitioner instead of general practitioner and had put down the dentist's address instead of my surgery address.
I then had to ring again on the 0845 number, wait another 30 minutes for the call to be answered, and then tell her the forms had been wrongly completed.
I asked if it were possible to send the forms back with amendments, but this was not possible.
Instead, I had to write a covering letter, pointing out the errors and discrepancies and provide the correct information instead.
I was also asked to produce my original birth certificate, marriage certificate, medical certificate of sickness and details of any pensions or sickness insurances I paid for privately.
These documents then had to be sent recorded delivery to the local DHSS office for processing – which is still on going.
The point I wish to raise is how shocked I was by the bureaucracy of a system that is supposed to be there as a safety net for people who have paid their National Insurance contributions all their lives and who fall sick through no fault of their own.
Fortunately, in my case I am not reliant on receiving any benefits for my family, mortgage or personal living expenses – I have private provision for these – but I am sure that many of my patients are not in such a fortunate position.
Furthermore, I do not feel ill or unwell – if I did, I'm sure I would not have had the strength or perseverance to persist with my claim.
I also don't have a speech impairment or any hearing loss that would make a telephone interview impossible.
And I am lucky to be organised enough to know where to find my birth and marriage certificate and so on, all which are essential to the claims process.
But it seems a scandal to me that the system is so complicated and bureaucratic, and is likely to fail the very people who are most in need of help.
I suspect this may be a deliberate Government ploy to reduce the number of benefit claims and therefore the overall cost of welfare. If this is so, then experiences like mine should be publicised nationally and the scheme shown for what it is.
The system would be simpler if claimants were allowed to complete a submission online or by post rather than spending a long time on the phone, and then having their information recorded incorrectly.
Fraud checks could still be conducted to ensure the accuracy of the information supplied by the claimant.
I have already sent a letter to my local MP, John Whittingdale, to let him know about my experiences and recommendations, but would welcome the support of any other GPs who feel the way I do about the current system.
Dr Anne Dyson is a GP in South Woodham Ferrers, Essex
Medical- Integrated Care- Bring back GP Cottage Hospitals ?
Updated: 11 Aug 2012
would cut '2.3 million emergency hospital admissions in older people'
By Sofia Lind | 09 Aug 2012
More integrated care between GPs and community and social care services could prevent millions of emergency hospital admissions in the over-65s each year, a leading think tank has suggested.
The paper from the King's Fund said that if the bottom 75% of PCTs performed as well as the top 25%, PCTs could save £462m a year that could instead be used in community support and primary care services.
It said this would reduce emergency bed use in over-65s by 7,000 beds, equating to a reduction of overnight stays by 2.3 million per year.
The think tank said that while links between bed use and access to community services such as GPs, community nursing and social care are not clear-cut, areas with low bed use tended to run a more integrated service overall.
By contrast, the areas with the highest bed use tended to have excessive lengths of stay for patients for whom hospital was a transition between home and supported living, while areas that have well-developed, integrated services for older people have lower rates of bed use.
Interestingly, areas with higher numbers of older people were found to have proportionally lower rates of bed use.
The think tank said these areas might be more likely to have prioritised the needs of older people and to have developed more integrated service models.
Candace Imison, deputy director of policy at The King's Fund, said: ‘There is no clear correlation between investment in community beds, social care or GPs and use of hospital beds.
‘The answer seems to lie in how the whole system operates together to ensure services deliver more than the sum of the individual parts.'
Dr David Jenner, a GP in Cullompton, Devon, and senior policy adviser at the NHS Alliance, said: ‘This research is hugely interesting for GPs in their CCG and commissioning roles, because hospital use has been estimated to count for up to two-thirds of CCG budgets if you take out prescribing costs.
‘They should look at the figures broken down by area and reflect on the reasons behind the variations.
Medical- Doctors resign from BMA as it breaks ranks with Unions over Pensions
Updated: 09 Aug 2012
Rival unions take hard line on pension negotiations
as BMA battles to win concessions
By Sofia Lind | 08 Aug 2012
Exclusive: The BMA is facing an uphill battle in fresh talks over the Government's pension reforms, after rival health unions said they were unlikely to back any move to apply the proposed hike in contributions more equally across the NHS.
The Department of Health reopened talks on its ‘final offer' last month after the BMA suspended industrial action and agreed to inter-union talks on contribution increases next month.
It will also begin a review into the safety of NHS workers retiring at 68 next month.
But BMA leaders hoping to win concessions on contributions have been met with intransigence from other unions, while rank-and-file members expressed anger at the return to talks.
The DH has offered to reconsider some parts of the deal it tabled in March, which spared NHS workers earning less than £26,000 at the expense of higher earners.
But it said it would only consider an alternative distribution of contribution rises within the same overall cost envelope, and with the agreement of all unions.
Unite's national officer for health Fiona Farmer told Pulse the unions were unlikely to agree an alternative: ‘We have just been put in an impossible position here.
If the Government wants to make this change, then the Government should decide who makes what contribution.
If we try tinkering around with it then it shifts the blame onto the unions.'
Jon Restell, chief executive of the managers' union Managers in Practice, said he would support ‘flatter tiering of contributions' among higher-paid NHS workers, but warned: ‘Managers in Practice is committed to protecting low-paid NHS workers from the brunt of the increased pension contributions.'
The BMA will join separate talks next month as part of the Government's Working Longer Review, which will look at whether NHS workers should be working until 68, if they can move into back-office roles and how the DH can make it easier to purchase earlier retirement.
Dr David Bailey, deputy chair of the BMA pensions committee, said: ‘We know age is a significant risk factor with GMC fitness-to-practise hearings. While there will be GPs who are capable of working longer, others will not.
There aren't really any back-office tasks suitable for GPs, so I suspect they will be forced to work longer, with any safety risks to be locally managed by the NHS Commissioning Board.'
Some grassroots members reacted furiously to the BMA's decision to suspend industrial action, with a number saying they had quit the association in protest.
The BMA refused to disclose how many had resigned, but new chair Dr Mark Porter, writing in Pulse this week and understood to be personally heading up the pension talks, said his ‘postbag has been full of emails and letters from GPs', both for and against the decision.
Dr Andrew Thomson, a GP in Dundee, described the BMA's decision as ‘very disappointing'.
Although he had not personally resigned, he said: ‘I do not doubt there will be some members who will feel the need to walk away. It is important doctors send a message back to the BMA that it is not a good move and makes us look weak at a time when we were looking strong'.
But Dr Mark Sanford-Wood, chair of Devon LMC, said most of his members were ‘happy enough' with the decision: ‘I think the BMA recognises it isn't going to get all that it wants on pensions'.
Medical- The BMA "a spineless, castrated body"
Updated: 04 Aug 2012
Comment from a Retired Health Care Professional
“Welcome to the "Working Class struggle" Discovering you are no longer considered as the Capitalist "elite" must have come as a terrible culture shock for some GP's. Acknowledge that the NHS is good socialist principle and is worth fighting for to protect it from the Nasty Party, just as those you cannot do without fight for it, the patients and the health workers, through their respective registered Trade Unions.”
This is what defeat looks like
12.20PM 01 August 2012
Rarely has a retreat felt so momentous – and rarely has it prompted such white-hot anger.
When the BMA announced two weeks ago that it had suspended plans for any further industrial action over the Government’s pensions reforms, the response from readers was immediate.
‘Capitulationism!’ cried one. ‘The BMA is a spineless, castrated body,’ declared another. ‘What a damp lettuce our union is,’ thundered a third, somewhat mystifyingly.
Another GP gave a more considered overview.
‘And so we retire to a dark corner with our tail between our legs to lick our wounds,’ he wrote. ‘No matter what the rhetoric says, the message we are giving the Government is clear. We have lost the war. Feel free to hit us even harder next time.’
The extent to which the BMA really had lost the war became more apparent on Monday, when Pulse revealed that the Government was to take a back seat in any further negotiations on the planned hike in pension contributions due to come in next year – and instead leave it to the different health unions to thrash it out among themselves.
Last December, the Government’s final tweak to the offer on the table involved sparing NHS workers earning less than £26,000 a year an increase in contributions, with GPs and other high earners picking up the tab with an even steeper hike. Now ministers have said they will only consider amending that deal if all health unions sign up to an alternative within the same cost envelope – a prospect that seems remote.
As Dr David Bailey, deputy chair of the BMA pensions committee, put it, the Government is ‘trying to play one union off against the other’.
The reality is though, that having called the first industrial action by doctors in a generation, and then with no meaningful progress having suspended it, the BMA is short on options.
Writing exclusively for Pulse this week, new BMA chair Dr Mark Porter offered a spirited and straightforward defence of the decision to suspend action. After ‘carefully considering the impact of the action on 21 June’, he said, BMA Council decided a repeat ‘would probably not have the same level impact’. Given that impact was limited at best – between a quarter and a third of doctors took part – that was clearly a non-starter.
BMA Council instead considered whether to suspend industrial action or to escalate it into a full-blown strike, and after a protracted debate opted to suspend action. It was a vote that was far from unanimous.
The big question for many GPs, of course, is why the BMA didn’t consider other forms of industrial action, and in particular a boycott of commissioning. It was a question tackled head-on by Dr Porter, who argued that withdrawing from CCGs was a form of action only open to a minority of BMA members, GPs in England, and claimed that in any case ‘there is a strong argument that it would not have influenced the Government and would even have proved counterproductive, creating opportunities for the private sector to become more involved’.
That won’t satisfy all the BMA’s detractors, of course, and in fact the association’s reluctance to link commissioning with pensions may be a little more nuanced. Whether boycotting CCGs would have had any meaningful impact is open to debate, but what it certainly would have done is inextricably tie the BMA’s principled opposition to the NHS reforms with doctors’ narrow self-interest. There are those who see the BMA exclusively as a terms-and-conditions trade union for whom that might have been no bad thing, but it would clearly have been a defining, and risky, step.
Could doctors’ leaders have handled the earlier stages of the dispute differently? Undoubtedly. But now the BMA is where it is – and the harsh reality for its grassroots critics is that it is largely there because of its members. One GP’s take on the climbdown was to compare the BMA to the Grand Old Duke of York – it had marched its troops to the top of the hill and it marched them down again – but that’s not quite accurate. It could certainly be argued that the BMA asked its members to march to the top of the hill, found only a third followed, and therefore decided on balance against further mountaineering.
This, unfortunately, is what defeat looks like. Both the BMA and the wider medical profession have expended a serious amount of political capital, to very little effect. GPs are rightly angry – but whether the situation they now find themselves in can simply be blamed on poor leadership is a much harder question.
Steve Nowottny is acting editor of Pulse. You can follow him on Twitter at @stevenowottny.
Medical- GP's missing patients with a drink problem -unless they are drunk at a GP appointment.
Updated: 03 Aug 2012
40% of problem drinkers unidentified,
By Jaimie Kaffash | 02 Aug 2012
Today's daily digest shuns Olympic glory and kicks off with a damning report on GPs failing to spot drinking problems, unless their patients are drunk during appointments.
The study in the British Journal of Psychiatry, and reported in the Telegraph today, said that when patients are not already intoxicated, GPs on average are only able to identify 40% of problem drinkers.
The Leicester University researchers reviewed 39 previous studies, covering 20,000 patients.
Worryingly, the study authors also said that the patients were not refusing to admit alcohol problems.
Dr Alex Mitchell, who led the study, said:
‘When clinicians try and spot alcohol problems they often miss patients who have serious alcohol problems but who are not currently intoxicated.
Further they can misidentify about 5 per cent of normal drinkers as problem drinkers.'
Medical- The Media's Parenting Guide ?
Updated: 25 Jul 2012
The media’s guide to good parenting
By Sofia Lind | 24 Jul 2012
Two out of three severely obese children show signs of heart disease by age 12, a Dutch study of 500 children has found.
The trial showed they had signs of high blood pressure, cholesterol, and blood glucose - with the likelihood that the same could be found in British children, who are now developing type 2 diabetes by the age of seven, writes the BBC as well as The Telegraph, Metro and the Scotsman this morning.
But don't drag the kids away from their Nintendo games just yet.
Researchers believe that the kind of 'brain training' exercises made popular by Nintendo's handheld computer could be the key to curbing the desire to snack, writes the Daily Mail.
The team from the universities of Exeter, Cardiff, Bristol, and Bangor discovered that an individual's brain 'reward centre' response has more of an effect on the amount they ate than their feelings of hunger or how much they wanted the food.
In other news, children in care run a much higher risk of developing mental health problems than children brought up in loving homes.
Researchers from Harvard have now been able to find a scientific link to why this happens with care children found to have less grey and white matter in their brains than those brought up in a typical home environment.
Meanwhile, it may be a good idea to keep Scottish offspring out of the sun, as BBC Scotland writes that the explosion in cheap package holidays and sunbeds in the 1970s may explain the rise in skin cancer in the over 50s.
Cancer Research UK figures show melanoma diagnoses among middle-aged men and women in Scotland have trebled within 30 years.
Lead researcher, Professor Jonathan Rees, said Scottish skin ‘isn't designed for sunshine'.
At least, Britons in work are generally healthier compared to five years ago.
The Independent reports that the amount of time lost through sickness absence has now fallen to less than 3% in Britain, with employees taking an average of six days off sick last year.
This is equivalent to 2.8% of working time, compared with 3.6% in 2007.
Medical- Physiotherapists and Podiatrists given prescribing rights
Updated: 25 Jul 2012
Physiotherapists and podiatrists gain independent prescribing rights
By Madlen Davies | 24 Jul 2012
Physiotherapists and podiatrists will be granted the right to prescribe painkillers and anti-inflammatories without the authorisation of a doctor, under changes to be announced by the Department of Health today.
The changes will mean after specific training, physiotherapist and podiatrists will be prescribing drugs relevant to their area of expertise from 2014.
The plans to make care more ‘streamlined' for patients with conditions such as asthma, neurological disorders, chronic pain and mobility problems.
Health minister Lord Howe said physiotherapists and podiatrists were ‘highly trained clinicians'.
He added: ‘By introducing these changes, we aim to make the best use of their skills and allow patients to benefit from a faster and more effective service, without compromising on safety.'
Dr Helena Johnson, chair of the Chartered Society of Physiotherapy, said the move would mean patients get their medicines more quickly.
She said: ‘Patients will now receive a more streamlined and efficient service.
‘An unnecessary burden will be removed from doctors, with physiotherapists taking full responsibility and accountability for the prescribing decisions they make.'
Dr John Dickson, a member of the Primary Care Rheumatology Society and a GP in North Yorkshire, said the move ‘made sense'.
He said: ‘You can get a lot of these painkillers over the counter.
Patients might get more advice from trained physiotherapists about how to take the drugs.'
Medical - Health Warnings- Salt -Obesity -Weekend Lie-Ins
Updated: 24 Jul 2012
Health warnings over salt, obesity … and weekend lie-ins
By Alisdair Stirling | 23 Jul 2012
The Guardian is among the papers warning this morning that better ‘traffic light' food labelling is needed to reduce the number of stomach cancers linked to salt.
Too much salt is believed to promote cancer by damaging the stomach lining.
An estimated 14% of stomach cancers in the UK – one in seven cases – could be avoided by reducing salt intake to recommended levels, the paper says.
People in the UK consume an average of 8.6 grams of salt each day, much of it hidden in processed food.
This is 43% higher than the maximum recommended amount of six grams - equivalent to one level teaspoonful.
A standardised form of colour-coded ‘traffic light' food labelling would help consumers monitor their consumption of salt, sugar and fat, according to a World Cancer Research Fund spokesman quoted in the paper.
More than half of over-50s know that they are overweight yet one in three does no exercise at all, according to a survey picked up in the Daily Mail.
The Populas survey commissioned by Saga health insurance found that while 37% said they were physically unable to exercise, for a third the problem was simply that they had 'no motivation'.
But the survey did find that the over-50s eat more healthily than later generations, with a third getting their five-a-day compared to just a fifth of younger adults.
And in case you´re suffering from that Monday morning feeling today, the Daily Mail is on hand to explain that you may be experiencing ‘social jet lag'.
Researchers say sleeping in at the weekend can leave us too tired for the start of the working week, with many remaining groggy until Wednesday.
The immediate effects include poorer memory and reaction times, which would explain that familiar Monday morning feeling of sluggishness, according to the Mail.
A study carried out at Rush University in Chicago into how changes in sleeping patterns affect reaction times suggests that a shift of just two hours can leave you worse off in the week.
Test subjects were asked to hit a button when they saw a bullseye appear on a screen.
Unsurprisingly, they were slower in the mornings than in the evenings – but they were also far slower after a pattern of sleep similar to getting up early on a Monday morning after a weekend of late starts, results published in the journal Applied Ergonomics showed.
Medical- Asda to sell salbutamol without prescription - the scandal of POM's
Updated: 24 Jul 2012
Asda to sell salbutamol inhalers over the counter without a GP prescription
By Madlen Davies | 23 Jul 2012
Radical - POM's Prescription only medicines. The scandal of POM's - many cost less than the prescription charge, Dr's holding on to power and patients are not as stupid as some think !
Salbutamol inhalers will be sold over the counter at supermarkets for the first time this month, meaning patients will no longer have to visit their GP for a prescription.
From Tuesday pharmacists at 218 Asda stores will start dispensing the inhalers to customers aged 16 and over, with two inhalers available every eight weeks at a cost of £7.
Patients will need to fill out a questionnaire to receive the medicine, with the scheme being monitored by Asda pharmacists and online doctor service DrThom.
Salbutamol is still classified as a prescription-only medicine but Asda will be selling the inhalers under a Patient Group Direction.
Faisal Tuddy, deputy superintendent pharmacist at Asda, said the scheme would make accessing an inhaler more convenient for patients.
He said: ‘It can often prove to be stressful trying to book a GP appointment when your inhaler is running low.'
However, there are concerns that making inhaled beta-agonists more readily available could mean patients neglect use of inhaled steroids.
Dr Bill Beeby, chair of the GPC's clinical and prescribing subcommittee, said: ‘There are already a large number of people who overuse relief medication.
People will overuse relievers but neglect preventers and prevention is an essential part of long-term management of asthma. I'd be very concerned if over-the-counter inhalers made this worse.'
He added that it was worrying that asthma and COPD patients could bypass a GP consultation: ‘It allows them to just treat the system without them going through the process of talking through long term management with GPs.'
‘The sort of usage we're talking about here- two inhalers every eight weeks- would normally trigger a review with a doctor to discuss preventative treatments. It's concerning that patients will be able to bypass this.'
A DH spokesperson said: ‘Medicines should be dispensed by appropriately qualified staff and in line with all legal requirements.'
Medical- BMA throws in the towel- Patients impact cited, but expect GP backlash
Updated: 20 Jul 2012
BMA faces GP backlash over pensions climbdown
By Sofia Lind | 19 Jul 2012
The BMA's decision to suspend all industrial action in the pensions dispute has been met with fierce criticism from sections of the profession.
BMA Council ruled yesterday not to take any further industrial action in the on-going dispute with the Government, as it was clear that ‘only escalated action' would prompt ministers to rethink the changes, which the BMA said it was ‘unwilling to do' because of the impact on patients.
But some GPs said they feared the decision could potentially open the gateway for the Government to hit the profession with other sanctions in future, while others questioned the BMA's roles as a union, and threatened to consider withdrawing their membership.
The BMA told Pulse that Council had debated further action at length, but felt options such as boycotting commissioning or revalidation would be ‘counterproductive'.
It said the council vote was not unanimous, but insisted the outcome reflected the views gathered from the profession.
It said the council had debated at length other means of action, including potential boycotting of clinical commissioning or revalidation, but said it had opted against these ways forward because of concerns that it could be counterproductive and open the door for the private sector to step in.
The BMA also said it will continue the campaign against GPs working longer.
A BMA spokesperson said: ‘There was a lengthy debate where a wide range of views were expressed.
The main focus was on which course of action would most further the interests of members and their patients.
Council also considered views of the wider membership which also reflects the decision that was reached.'
‘[Boycotts] along with various other forms of action has been considered at length. There is a strong argument that advising GPs to withdraw from commissioning would not influence the government, and would be counterproductive, creating opportunities for the private sector to become more involved.'
The spokesperson added: ‘The BMA continues to provide a wide range of benefits to members.
The decision to suspend plans for further industrial action does not mean we have given up the fight on pensions.
We will continue to voice doctors' anger with the pensions changes, both in talks with the Government, and by campaigning against the planned increase to the Normal Pension Age.'
But GPs responding to the news yesterday were unhappy with the decision.
Dr Richard Van Mellaerts, a GP in Kingston-upon-Thames, said on Twitter: ‘BMA capitulates over pensions. Towel been thrown in then. Rolled over yet again.'
GPs on Pulstoday.co.uk expressed similar sentiments, with one saying: ‘No matter what the rhetoric says, the message we are giving the Government is clear.
We have lost the war. Feel free to hit us even harder next time.
Out of hours for no extra pay, anyone?'
Another GP added: ‘Regardless of spin in terms of protecting our patients, the role of the BMA as a union fighting for its members has been seriously undermined. ‘
Dean Royles, director of NHS Employers, said: ‘The NHS will breathe a sigh of relief that there will be no more industrial action for the moment.
We understand that there is a great deal of concern around the pensions issue but it is right that we move on and get patients out of the argument.
The suspension of possible industrial action will help us all to redouble our work, in partnership, on this challenging NHS pension agenda.
Medical- BMA suspend action to negotiate Pension Cuts with other Unions
Updated: 19 Jul 2012
BMA suspends industrial action over pensions
By Sofia Lind | 18 Jul 2012
The BMA has suspended plans to take further industrial action over the Government's pension reforms after a crunch vote at today's Council meeting in Edinburgh.
BMA Council met to determine the next steps following the day of industrial action taken by doctors on 21 June, with discussions held on whether to take further days of action, or boycott revalidation or clinical commissioning to try and force the Government back to the negotiating table.
But the association said it was suspending plans for further industrial action, as it was clear that ‘only escalated action' would prompt ministers to rethink the changes, which the BMA said it was ‘unwilling to do' because of the impact on patients.
It comes after Pulse reported earlier today that yesterday's meeting between BMA chair Dr Mark Porter and health secretary Andrew Lansley failed to yield concessions from the Government, dampening the BMA's hopes of using the meeting to reopen negotiations.
The BMA has instead opted to join other health unions in talks with the Government about the detail of the changes to the NHS pension scheme. BMA Council also agreed to step up campaigning to achieve improvements in the longer term, particularly around the increase in retirement age.
The BMA also released the results of an Ipsos MORI poll on industrial action to coincide with the announcement, which showed that 81% of the public were aware of action, and 49% supported doctors in the dispute, while just 29% supported the Government.
The poll also found that 42% supported doctors taking further action, while 35% were against.
Dr Mark Porter, chair of BMA Council, said: ‘Last month's action enabled thousands of doctors to send a strong and clear message to government about how let down they felt, while also honouring their commitment to protect patient safety.
Independent research by Ipsos MORI shows that the public were more likely to support doctors in the dispute than the government, and that the majority were confident about our commitment to protect their safety above all else.'
'Industrial action was never our preferred way forward.
We would always far prefer to seek changes to the government's plans for NHS pensions through negotiation and lobbying, rather than taking action that could jeopardise the much valued relationship with our patients.'
'We always said that we would review our action in order to determine next steps.
Having done that, it is clear that only escalated action has any possibility of causing the Government to rethink its whole programme of changes.
The BMA and the profession as a whole are unwilling to do that at this point because of the impact on patients.'
But he added: 'Doctors' anger with the Government will not just go away.
We have not ruled out taking further industrial action in the future and we are committed to continuing to fight for a fairer deal in the longer term.
Medical- 25% of adults have considered suicide
Updated: 18 Jul 2012
CALM PRESS RELEASE:
A QUARTER OF ADULTS HAVE CONSIDERED SUICIDE
A quarter of adults have considered suicide
Suicide is biggest killer of young men in England and Wales[i]
30 percent of 25 to 34 year olds have thought about ending their life
- 53 percent of those who considered suicide did so fairly or very seriously
Gender should be at the heart of Government suicide-prevention policy says CALM, which is now expanding its service remit to cover all men
A new YouGov survey from CALM, the Campaign Against Living Miserably, published shortly before the Government is due to launch its new suicide prevention policy, has revealed the scale of suicidal contemplation in England and Wales with as many as one in four people (25 percent) expressing they have considered taking their own life.
CALM welcomes the Government’s commitment to reducing suicide, and the success of work to date in reducing young male suicide.
However, 1,110 suicides were completed in 2010 by those under the age of 34, of which 868 (78 percent) were men[ii].
CALM chief executive Jane Powell says: “Our research shows that thinking about suicide is more common than we realise, and that men and women are almost equally liable to feel suicidal. What is significant is that more men actually go on to take their lives[iii].”
Of those who have considered suicide, 53% state that they have thought about it fairly or very seriously, with women (28 percent) more likely to have suicidal thoughts than men (22 percent).
However, statistics show that three times as many men as women take their own lives each year.[iv]
The Office for National Statistics figures show that 4,517 people took their lives in England and Wales in 2010 of whom a staggering 75.5 percent (3,411) were men.
Powell continues: “This survey debunks the myth that suicide is only caused by mental illness.
Any of us can feel suicidal at some time in our life, but not everyone is able to seek help.
What is striking is that even though women are more likely to consider suicide, men find it so much harder to seek help when they hit rock bottom.
Gender is the biggest single factor in suicide, so any prevention policy must have gender at its heart.”
Amongst men, the age group most at risk are those aged 45 to 54 (53%).
This reflects the fact that suicide rising amongst older men and has led to CALM reassessing its remit.
Number of suicides: by sex & age, England & Wales, 2001 to 2010 (ICD-10 codes X60-X84, Y10-Y34)
Age group 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
15-34 1,248 1,171 1,155 1,075 987 900 934 972 951 868
35-54 1,503 1,503 1,501 1,545 1,552 1,509 1,444 1,570 1,648 1,527
55-74 676 648 674 681 683 730 674 717 712 760
75+ 266 211 250 275 259 241 244 228 242 256
15-34 289 313 291 297 288 247 218 265 248 242
35-54 461 453 487 495 509 450 419 453 457 470
55-74 294 279 271 323 288 302 258 266 288 284
75+ 154 173 167 180 136 125 115 116 129 110
CALM, which has successfully focused on reducing suicide among young men since its launch in 1997, is now extending its remit so that it can expand its phone line services to include older men, reflecting the rising number of suicides in that generation.
Powell says: “Although young men will remain our core focus, an increasing number of older men have been calling the helpline and we are here to help them.
We know that they often simply have nowhere else to go and if they feel they can turn to us to talk about what is going on in their lives, especially as cuts and reductions in other services are hitting hard, then we will always be here for them.”
A key factor impacting the likelihood of suicidal thoughts is relationship status: 36% of respondents who had been separated or divorced had considered suicide, compared with lower rates for those married or in a civil partnership (22%), living as married (27%), widowed (23%) or never married (26%).
43 percent of those not working for a reason other than unemployment, education or retirement, also admit to thinking about suicide.
The number of children in the household also appears to have an impact with 33 percent of those in a household with three or more children expressing they had experienced suicidal thoughts compared to 25 percent in two children households and 23 percent in homes with just one child.
Notes for editors:
About the survey: All figures, unless otherwise stated, are from YouGov Plc.
Total sample size was 917 adults from England and Wales. Fieldwork was undertaken between 2nd – 4th July 2012. The survey was carried out online.
The figures have been weighted and are representative of all adults in England and Wales (aged 16+).
About CALM: CALM began as a Department of Health pilot project in 1997 and was launched as a charity in 2006
. It focuses on preventing suicide among young men aged up to 35. Suicide is the single biggest single killer of young men in the UK.
CALM promotes and delivers a free, confidential and anonymous helpline and website (www.thecalmzone.net); publishes the CALMzine, a bi-monthly magazine distributed through Topman stores, student Unions and various venues across London.
It is commissioned by Primary Care Trusts in London and on Merseyside.
It is also a broader campaign that seeks to encourage emotional openness in men, and lobbies for change in wider mental health policy.
Since CALM started operating on Merseyside the number of young male suicides dropped by 55% from 1999-2009 – more than the general decrease regionally and nationally by 20%.
Following a major consultation with supporters and key funders during June, CALM’s Board took the decision on 3/7/12 to expand its remit to cover all men in England and Wales.
Financial support for CALM has increased month on month over the past year, and has actually doubled in the last couple of months, reflecting a growing concern with depression and suicide among men.
CALM launched an ad campaign in London last year under the headline ‘The Silence Is Killing Us’.
The campaign, created by agency BMB, featured high profile names including actors Ashley Walters and Kayvan Novak and rappers Scroobius Pip, Bashy and Killa Kella.
For further information visit www.thecalmzone.net.
[i] Source: Death Registrations Data, Office for National Statistics, England & Wales 2010, ICD-10 Code(s)X60-X84 & Y10-Y34 (excluding pending verdicts), suicide and undetermined deaths accounted for 868 deaths of men aged aged 15-34 vs Land Transport Accidents, V01-V89 accounted for 608 deaths of men aged 15-34.
[ii] Source: Death Registrations Data, Office for National Statistics, England & Wales 2010, ICD-10 Code(s)X60-X84 & Y10-Y34 (excluding pending verdicts), suicide and undetermined deaths accounted for 868 deaths of men aged aged 15-34 and 242 women aged 15-34.
[iii] Death Registrations Data, Office for National Statistics, England & Wales, 2010, ICD-10 Code(s)X60-X84 & Y10-Y34 (excluding pending verdicts),: there were 3411 male suicide and undetermined deaths over the age of 15, and 1106 female deaths.
[iv] Death Registrations Data, Office for National Statistics, England & Wales, 2010, ICD-10 Code(s)X60-X84 & Y10-Y34 (excluding pending verdicts),: there were 3411 male suicide and undetermined deaths over the age of 15, and 1106 female deaths.
Medical-Contact CALM-Campaign against Living Miserably
Updated: 18 Jul 2012
Campaign against Living Miserably
Talk to CALM
You can call us. Our helpline is open 5pm-midnight on Sat / Sun / Mon / Tues, every week of the year.
Call 0808 802 5858 within London – or if you’re outside London call 0800 585858. It’s free, confidential and anonymous.
Text 07537 404717, start your first text ‘CALM1’ (service only available within London, until we get more funding). We don’t charge, but your network might.
Find a service near you that can help
There’s loads of great organisations out there that can help you get something sorted in your life, getting expert advice and support is often the best way to get a problem solved or fixed.
So choose what issue you want some help with and which area of the country you’re in, or if there’s no CALMzone where you live, choose National.
Medical- Relationships - Give CALM a call ?
Updated: 18 Jul 2012
There’s this idea that blokes aren’t bothered about relationships,
But this isn’t true.
CALM receives lots of calls about relationships from men and it’s the biggest cause of depression, loneliness and stress.
This might be because of a relationship ending or tension and argument within a current relationship.
Perhaps you’re frustrated by friends or family who won’t accept the person you’re in a relationship with.
So why do relationships go wrong?
It might be that you’re feeling down or you’re under stress from work, college or school and this is affecting your relationship.
Bad experiences in past relationships can also affect our ability to trust someone.
All relationships have their ups and downs and it’s easy enough to ride with the highs, but how do you cope when you’re on a downer?
But if talking to your partner only causes an argument, then confide in someone you can trust – a mate or someone in your family.
Talking things over and getting things off your chest can help bring things back in perspective.
It might stop you making a hasty decision that you later regret.
You might feel you can’t talk to friends and family, either because they’re too close to those involved or because they’re part of the problem, or perhaps because you need to discuss intimate sexual problems and you don’t want to talk to people you know about them.
This is when talking to someone outside the situation can help.
Often it’s good to hear yourself saying the words – once you start to talk, you can start to make sense of things. Why not give CALM a call?
Medical - Suicidal ?- Depressed ? -We all need mates, but can you tell your GP ?
Updated: 18 Jul 2012
Suicide is one of the biggest killers of young men in England and Wales.
That’s an awful fact.
People who feel depressed, irritable and down don’t have to feel that the only way out is to kill themselves.
While suicide is more common than we’d like to admit, it doesn’t mean that it’s the answer for you.
You can feel suicidal for all sorts of reasons:
Something might have happened to you that has upset you a great deal.
When someone close to you has attempted or actually committed suicide.
You have been using drugs or drinking heavily.
You may be upset and angry for no reason at all. This is very frightening.
People become depressed not just because sad things happen to them in their lives.
The chemicals in the brain which control how happy and sad we feel can get messed up, so that they’re not in balance and we feel depressed.
A combination of any of these things.
Feeling suicidal is actually fairly common.
It’s normal for people to get into situations that make them panic, and they briefly think about wanting to take their own life.
It’s a passing feeling and normal, so long as those feelings don’t last too long or become too intrusive.
When they start taking control of what you’re thinking, then it can be dangerous and you should talk to someone about how you’re feeling.
Don’t just sit there and let your mind run wild.
Talk it through.
It’s hard to generalise, but many people who think about taking their own lives:
Are very sensitive to failure or criticism.
Feel like they have no friends.
Set themselves targets which are difficult to achieve.
Find it hard to cope with disappointment.
Find it difficult to admit to having problems they don’t know how to solve.
Find it hard to tell others how they are feeling.
Most suicidal people don’t actually want to die, they want an answer to their problems.
It’s a decision made when other decisions seem impossible.
While suicide can seem like the only way to deal with the pain, there’s ALWAYS another way – it’s just finding it that can sometimes be tricky.
So don’t try and find it on your own.
Two heads are better than one.
Talk it over with someone.
Tell them what you’re thinking and why.
If you’re feeling worthless, hopeless about the future or believe that no one cares about you – or even that the world would be a better place without you – talk to CALM.
CALM’s helpline workers are there to listen, not to judge, have links with other helpful organisations and could offer you the support you need to stop feeling sad and suicidal.
Although CALM is targeted at young men aged 15-35, we offer help, information and support to anyone calling within the UK, regardless of age, gender or geographic location; no one is turned away.
Worried about someone else
Another organisation that can help is called Papyrus and they run something called HOPElineUK.
HOPElineUK is staffed by professionally qualified advisers who can give support, practical advice and information to anyone who is concerned that a young person they know may be suicidal.
HOPEline UK aims to:
Support those who live or work with suicidal young people
Commission research and campaign for change
Share expertise and good practice
Produce resources for families and professionals
Their line is open Monday – Friday from 10am – 5pm and 7pm – 10pm, and 2pm – 5pm on weekends.
Tel 0800 068 41 41
Who can call HOPEline UK?
Young people (35 and under)
Family and concerned friends
Medics and mental health professionals
Schools, Colleges and Universities
Others who work with young people
Medical- Census on health and well being
Updated: 18 Jul 2012
Stay close to the sea
and clear of authoritarian bosses
to maximise your health
By Sofia Lind | 17 Jul 2012
People living close to the English coastline are more likely to say they are "fit and well", according to last year's census.
Researchers at the European Centre for the Environment and Human Health in Truro, said people living less than 1km away from the seaside are happier, with the good news picked up by a host of national news outlets this morning, including the BBC, ITV and The Telegraph.
The benefits may be explained by scenic sea views encouraging taking outdoor exercise but the study said it could also be the sea itself has a calming effect, creating a more relaxed environment.
More cynically, researchers added that it could be that wealthier, healthier people are more able to move to the coast.
The seaside tip may just come in handy for wealthy UK bosses, who increasingly are feeling both stressed and depressed, according to news picked up by The Financial Times and the Daily Mail.
Nearly one in five has suffered depression in the past year and 42% suffered stress.
Six in ten said they were ‘constantly tired' but had experienced insomnia in the past three months.
Unsurprisingly, the news was linked to difficult financial times putting more pressure on businesses but the survey of over 1,000 managers also found that "negative management styles" are on the rise in the UK and taking a toll on job satisfaction.
While overall job satisfaction dropped from 62% to 55% in the last five years, among those working in "authoritarian" and "bureaucratic" organisations only 28% were happy compared to 67% otherwise.
The report by professors at Coventry and Lancaster universities, said these management cultures are linked to employee disengagement, decreasing job satisfaction, poor health, reductions in productivity and business decline. It also said bosses work nine weeks a year for free in fear of losing their jobs.
The news coincided with new data showing that suicide is on the rise among older men in the UK, as reported in the Guardian.
Looks like it's time for us all to go for a seaside break. If only it would stop raining.
Medical- BMA Council meet Lansley & prepare for future industrial action
Updated: 18 Jul 2012
BMA to consider ‘all options’ on pensions
By Sofia Lind | 17 Jul 2012
BMA Council members have insisted ‘all options' for future industrial action are still on the table as the union battles to maintain the momentum of its campaign against the Government's pension reforms.
Ahead of this week's crucial council meeting in Edinburgh, BMA Council members said they were determined to keep up the pressure on ministers, but admitted there were ‘mixed views' on whether to take more action.
The meeting will decide the next steps for the BMA, with council members due to consider feedback on last month's ‘day of action'.
But it comes after the Treasury announced it was to press ahead with legislation to implement the pensions deal.
BMA council member and GPC deputy chair Dr Richard Vautrey said: ‘We will assess the issues at the meeting. All options [for action] are still there.'
Dr Peter Holden, BMA council member and GPC negotiator, said: ‘For a long time, doctors have not taken industrial action.
This reminded [the Government] we can't be taken for granted.
There are mixed views [on whether to repeat it], so we need to see sampling and reports.'
New BMA chair Dr Mark Porter was due to meet health secretary Andrew Lansley before the meeting, but the Department of Health said it was an introductory meeting and there would be no negotiations on pensions
Medical - BMA Staff on strike today in a dispute over pay
Updated: 18 Jul 2012
British Medical Association staff
to stage fresh strike tomorrow in dispute over pay
Alan Jones , Ella Pickover
Tuesday 17 July 2012
Staff employed by the British Medical Association will stage another strike tomorrow in a dispute over pay.
Members of the GMB union employed by the doctors' organisation will walk out for 24 hours, mounting picket lines outside offices across the country.
It will be the second stoppage by the staff and is timed to coincide with a meeting of the BMA's council in Edinburgh to decide whether to take more action in the separate dispute between doctors and the Government over pensions.
Last month doctors took industrial action for the first time in almost four decades by boycotting non-urgent care.
Health Secretary Andrew Lansley today met the new chairman of council at the BMA.
The meeting - Dr Mark Porter's first with the minister since taking up his new position - will have seen the pair discuss doctors' industrial action over the Government's pension reforms.
A Department of Health spokesman said: "This meeting is an introductory one and is not to reopen discussions on pensions.
"We have always been clear that we are happy to speak to the BMA about pensions, as long as that discussion is held alongside other health unions such as the RCN, but this meeting is not being held on that basis."
The BMA announced its first day of action after it accused ministers of pressing ahead with "totally unjustified" increases in pension contributions and a later retirement age for doctors.
The action on June 21 left thousands of patients unable to have a planned operation, or see their specialist or GP.
Figures show that a fifth of GP practices were affected. Across the country, 2,703 operations were postponed and 18,717 outpatient appointments rescheduled.
Another day of action could see doctors running a Christmas Day-style skeleton service with only emergency services operating.
The GMB said fresh talks had been held over its pay dispute, adding that no progress was made after the union rejected a 1.5% offer for this year.
A new proposal of 2.5% from April 2013 was not acceptable as it may not meet inflation, said the GMB.
Union official Anna Meyer said: "GMB members are angry because this is a real cut in living standards and pay at a time when they are working harder than ever in their efforts to defend doctors' terms and conditions.
"The BMA is not a poor organisation and has recently let part of BMA House to an Olympic client for a substantial sum of money which would easily pay for a decent pay increase for staff.
"While the BMA appear to be determined to drive down the salary levels of its workforce, it refuses to disclose the remuneration packages of its senior management group.
"This hypocrisy is draining staff morale and goodwill. GMB urges the BMA to end this dispute now by negotiating on an improved pay offer this year."
Medical- The BMA Strike - Lansley said -"Pointless" - as are a number of his own policies !
Updated: 17 Jul 2012
Britain: BMA strike - The Truth
by Tomasz Pierscionek
Sat 14th Jul 2012
London Progressive Journal
In the days leading up to the one day doctors’ ‘strike’ on the 21st June, the vitriol was in the air.
A number of mainstream papers, supposedly representative of the wide swathe of public opinion in the UK, took pot shots at the democratic rights of the BMA and the ‘audacity’ of the medical profession.
From the Daily Mail to the Independent, the rhetoric of coercion, guilt and blame could be seen both before and after the one day industrial action.
In a commentary piece printed on 17th June, the Daily Mail made reference to ‘handsomely paid NHS doctors’ belonging to the ‘militant British Medical Association’.
In its usual hurry to demonise a group, and create antipathy in the less than broad minds of its readers, the paper did what it does best.
The title of this commentary piece was ‘Striking doctors will destroy public trust... and it might never return’.
Perhaps not so surprising that a paper whose former owner Viscount Rothermere had a cosy relationship with a certain German dictator during the 1930s still has a habit of misdirecting public frustration against minority groups often too small or too poor to fight back. (First they came for the immigrants…)
More careful observers may have noted that the apparently ‘militant’ BMA (I wish) is hardly a regular when it comes to calling for industrial action.
The last time members of the BMA did anything similar was back in November 1975 when junior doctors took action over the introduction of new contracts meaning they would be doing an extortionate amount of overtime.
Then, as now, the medical profession did not abandon any of its patients. In 1975, during the strike junior doctors worked a maximum of only 40 hours a week in addition to dealing with any emergency cases.
This time around, the story was similar.
Despite healthcare unions agreeing to the implementation of a rise in pension contributions and an extension of the retirement age from 60 to 65 back in 2008, only a few years later the Coalition returned to cut further and deeper.
Consistent with its attacks on public sector workers across the board, they demanded the retirement age for NHS workers rise from 65 to 68 before they be allowed to collect their full pension.
Additionally, under new plans doctors will pay an even larger amount in pension contributions each month to receive a smaller sum on retirement.
The rise will see some doctors paying up to 14.5% of their pay into the pension pot.
Those early in their careers will be most affected.
The BMA spent many months engaged in discussions with the government requesting they rethink their plans.
During this time, prior to any ballot, the BMA surveyed its members to gauge their views about the pension changes and their willingness to take any kind of action should negotiations fail.
Once dialogue proved fruitless, ballot papers were sent to all 104,544 union members asking the following two questions:
a) Are you prepared to take part in industrial action short of a strike?
b) Are you prepared to take part in a strike?
Across the six different branches of medical practitioners balloted, there was a turnout of 49.8%. Of the 12,060 junior doctors who voted, 92.3% answered yes to question 1 and 81.92% to question 2.
In total, an average of 70% of doctors across the board voted for full strike action.
All BMA members were expressly told to attend their place of work on the 21st June with strict instructions that they treat all ill patients and deal with any emergency cases as they would any other day.
Some non-urgent tasks, such as routine clinics, were postponed.
These and other tasks may well have been postponed anyway if a doctor were ill or busy dealing with emergencies.
The largely symbolic industrial action also saw doctors wearing armbands or holding placards outside a hospital during their lunch hour.
A colleague of mine commented that she and all her colleagues ensured patients were adequately cared for.
The vast majority of doctors I know would not good conscience allow any patients under their care to suffer harm or neglect.
Contrary to how some ministers or media outlets portrayed the situation, the NHS was not going to collapse nor were patients going to suffer on the 21st June.
It is probably quite realistic to suggest that the action had less impact on services than a weekend or a bank holiday, when there are far fewer doctors working shifts compared to Monday to Friday. I
’m still looking out for articles that blame William and Kate’s wedding and the Diamond Jubilee for crippling the NHS.
Andrew Lansley criticised the BMA calling the action ‘pointless’, a term that could well be applied to a number of his party’s own ideas.
He added that ‘All the BMA is doing is creating uncertainty, discomfort and difficulty for patients, most of whom could only dream of getting a pensions like theirs’.
Granted that doctors receive better pensions than most public sectors workers but in line with his party’s ideology, Lansley evokes the rhetoric of ‘race to the bottom’ and divide and conquer.
Many public sectors workers have paltry salaries and pensions, their pay should be increased.
The attempts to strong arm doctors into abandoning the strike plays on Lansley’s knowledge that doctors, like other healthcare workers, would not wish to do anything to put their patients at risk.
His comments take irony to a new level as many doctors are fighting to defend the NHS from the very forces that accuse them of damaging it.
Lansley’s Health and Social Care Act allows for the slow and steady carve up of the NHS in a manner of ‘death by a thousand cuts’.
The Secretary of State for Health should really have thought twice before accusing anyone of ‘creating uncertainty, discomfort and difficulty for patients.’
The day of action was largely symbolic and the ‘strike’ action did not fit the pattern of that normally undertaken by unions such as the RMT or the PCS.
Nevertheless, doctors not only made their point but also stuck to their principles of putting the patient first in order that no one requiring emergency care be made to suffer on account of a situation brought on by ineptitude of the Coalition.
The thought of putting patients before profit is something that Mr Lansley and co might do well to consider.
Tomasz Pierscionek is an Academic Clinical Fellow in Psychiatry and co-editor of the London Progressive Journal.
This article first appeared in Socialist Appeal http://www.socialist.net/bma-strike-the-truth.htm
Medical - Dangers disclosed
Updated: 17 Jul 2012
'High-maintenance' women who cover themselves in nail varnish, self-tan and hair spray may be at higher risk of developing diabetes, writes the Daily Mail this morning.
A Boston-based research team has linked phthalates - a class of chemicals found in the above-mentioned products – with the disease.
The researchers found that those with the highest concentration of phthalates in their bodies faced twice the risk of developing diabetes as those with the lowest concentrations.
They were also able to link high concentrations of phthalates with insulin resistance among women.
However, the chemicals are also found in shampoos, soaps, plastics and packaging so take note: it may not be only the well-groomed that are in danger.
And while you're reeling from the thought hat your pink toenails are bad for you, in future you may be urged to think twice before pouring yourself a glass of red wine to unwind after a busy day at the practice.
The Guardian writes that doctors want harrowing images of livers after years of alcohol-related cirrhosis or victims of violent abuse to decorate beer cans, wine and spirit bottles going forward, to force us to realise the health risks of drinking.
It comes after the UK Faculty of Public Health (FPH) says harmful drinking has become so common that cigarette box-styled warnings are called for.
In related news, children are also likely to have some of their fun snatched away, as researchers have somewhat unsurprisingly linked the time toddlers spend watching TV with their future waist-line circumference.
The BBC and The Daily Mail both refer to a Canadian study that has concluded that children who increase the number of hours of weekly television they watch between the ages of two and four years old risk larger waistlines by age 10.
The study found an extra hour a week could add half a millimetre to their waist circumference and reduce muscle fitness.
The study, first reported in the BioMed Central journal, tracked the TV habits of 1,314 children, with experts concluding that children should not watch more than two hours of TV a day.
Well that's all right then.
Medical- GP's to mass-screen all patients aged 40 or over for Diabetes
Updated: 13 Jul 2012
GPs asked to mass-screen all patients aged 40 years or older for diabetes
By Sofia Lind |
12 Jul 2012
GPs have been urged to screen all patients aged over 40 years and offer annual checks to those at high risk of diabetes in a major drive to reduce the numbers of patients developing the disease launched by NICE today.
Practices will be expected to go through their lists and carry out a risk assessment in everyone aged 40 years or over without diabetes, and anyone 25 years or older in a high-risk group, under the NICE guidelines.
The public health guideline is designed to support commissioners and GP practices to design programmes to reduce the risk of patients developing diabetes, but has been criticised as ‘beyond the capability' of most GP practices.
NICE recommends anyone identified as high risk should have a blood test, and those with HbA1c levels that put them at high risk of developing diabetes should be offered an ‘intensive lifestyle change programme' and annual checks from practices.
In those whose blood glucose levels continue to rise, putting them at risk of diabetes, the guidelines also recommend GPs consider prescribing meformin off-label for the first time to ‘support lifestyle change'.
Those at moderate risk of diabetes should be offered a ‘brief intervention' to help them modify their risk factors and three-yearly checks, and those at low risk should be given ‘brief advice' and be reassessed every five years.
Professor Kamlesh Khunti, professor of primary care diabetes at the University of Leicester and chair of the programme development group at NICE, said: ‘Evidence has showed that an intensive lifestyle programme, where patients make simple changes, like changing their diet, can help prevent the onset of diabetes.
This is really welcome guidance.'
NICE say the guideline is designed to complement the existing NHS Healthcheck programme, but GP leaders said it would have huge financial implications for all GP practices and they would need additional investment to implement it.
Dr Laurence Buckman, GPC chair, said the Department of Health had to provide the resources needed to make NICE's proposals a success.
He said: ‘These current plans call for resources that are currently beyond the capability of most practices.'
‘If we are to make this ambitious initiative a reality the Government will need to commit significant extra resources, including additional diagnostic services, medication budgets and an expanded workforce necessary to deal with new patients.'
GPC negotiator Dr Peter Holden added: ‘It they are not willing to resource it then I am not willing to do it. GPs are already squeezed to the point where there is no more to squeeze.'
What does the guidance recommend?
The two-stage approach sees GPs risk assess all patients over 40, using a validated risk assessment tool or questionnaire, also including all patients over 25 who are in high-risk groups including patients in South Asian,
Chinese or black ethnic minorities and following the NHS Health Check process and protocols.
In high-risk groups, GPs should consider a blood test for South Asian and Chinese people aged over 25 and with a BMI over 23.
NICE recommends that GPs use the validated risk assessment tool developed by Diabetes UK and the University of Leicester as this also take into account the higher risk of developing type 2 diabetes in some ethnic minority groups.
Those found to be at moderate risk of developing diabetes should be reassessed at least every three years, while those at high risk should have their BMI reassessed and blood testing done annually.
Those at high risk should also be offered an ‘intensive lifestyle change programme' to increase physical activity, reduce weight and keep a healthier diet and meformin treatment should be considered for those who continue to have high glucose levels.
It has also suggested GP intervention should be reinforced by assessments in health and community services, workplaces, job centres, pharmacies, faith centres, libraries and shops.
Medical- GP's Pensions overhaul "not open for negotiation"
Updated: 12 Jul 2012
Treasury confirms plans to press ahead with pensions overhaul
By Sofia Lind |
11 Jul 2012
The Treasury has formally announced plans to force through its reforms to GPs' pensions, despite the BMA's day of industrial action last month, and before the association decides on its next move to try and reopen negotiations with ministers.
Treasury to force through reform of pensions before BMA decides on further industrial action
The move, first revealed by Pulse last week, was announced in a written ministerial statement from the Chief Secretary to the Treasury Danny Alexander.
The statement said: ‘Most unions have now consulted their membership on the final scheme designs for the NHS Pension Scheme, Teachers' Pension Scheme and Principal Civil Service Pension Scheme.
I am now confirming to the House that the Government will be taking forward legislation based on the position reached in March.
Legislation will be introduced during the current Parliamentary Session to take these changes forward, as announced in the Queen's Speech on 9 May.'
The statement concluded: ‘The Government will now focus on implementing the public service pension reforms and unions are invited to work with the Government to ensure the changes are introduced as effectively as possible.'
The announcement came ahead of the start of Parliamentary recess on 17 July, and before the next BMA council meeting in Edinburgh next Wednesday (18 July), where the BMA will discuss its next course of action for attempting to bring the Government back to the negotiating table, with further days of action or possible boycotts of commissioning or revalidation up for discussion.
Pulse can confirm that newly-elected BMA council chair Dr Mark Porter has secured a meeting with Health Secretary Andrew Lansley ahead of the Parliamentary recess, but the Department of Health insisted the meeting will not be open to negotiations on pension reform.
Both the DH and the BMA declined to comment on what would be discussed at the meeting or exactly when it will take place.
A BMA spokesperson said: ‘From Mark [Porter's] point of view, we hope the meeting will be an opportunity for a fresh look at the pensions dispute, and to explore opportunities to resolve it quickly, including through negotiations between the DH and the health unions
Medical- Elderly on anticoagulation therapy self manage
Updated: 11 Jul 2012
Elderly ‘benefit from anticoagulation self management’
By David Swan | 10 Jul 2012
Self-management in elderly patients taking anticoagulation therapy is associated with improved quality of life, compared with routine care.
German researchers followed a group of 195 patients, with a mean age of over 69 years, who were undergoing long-term anticoagulation therapy.
Those patients were randomised to a routine care group or a self-management group where patients underwent structured teaching and instruction.
Treatment-related quality of life was assessed at baseline and during a final follow-up visit using a validated questionnaire.
The most improvement was found in general treatment satisfaction for those undergoing self-management, with a median increase of 0.9 compared to no increase for routine care patients, a difference that was significant.
Routine care also outperformed self-management on the other questionnaire scales – general psychological distress, strained social network, daily hassles and self-efficacy.
The researchers from Goethe University, Germany, concluded: ‘It seems the benefits of self-management of oral anticoagulation on bleeding complications can be achieved without negatively affecting quality of life in elderly patients.'
Thrombosis Research 2012, 1 July
Medical-Care- Don't Extend Suffering, play God or do the Governments dirty work
Updated: 10 Jul 2012
Care pathway used to 'cut costs' claim doctors
Monday 09 July 2012
Hospitals may be withholding food and drink from elderly patients so they die quicker to cut costs and save on bad spaces, leading doctors have warned.
Thousands of terminally ill people are placed on a “care pathway” every year to hasten the ends of their lives.
But in a letter to the Daily Telegraph, six doctors who specialise in elderly care said hospitals across the UK could be using the practice to ease the pressure on resources.
The Liverpool Care Pathway, which withholds fluids and drugs in a patient's final days and is used with 29% of hospital patients at the end of their lives, is backed by the Department of Health.
But the six experts told the Daily Telegraph that in the elderly, natural death was more often free of pain and distress.
The group warned that not all doctors were acquiring the correct consent from patients and are failing to ask about what they wanted while they were still able to decide.
The doctors say that this has led to an increase in patients carrying a card stating that they do not want this “pathway” treatment in the last days of their lives.
One of the letter's signatories, Dr Gillian Craig, a retired geriatrician and former vice-chairman of the Medical Ethics Alliance, told the newspaper: “If you are cynical about it, as I am, you can see it as a cost-cutting measure, if you don't want your beds to be filled with old people.”
A Department of Health spokesman said: "People coming to the end of their lives should have a right to high quality, compassionate and dignified care.
"The Liverpool Care Pathway (LCP) is not about saving money. It is an established and respected tool that is recommended by NICE (National Institute for Health and Clinical Excellence) and has overwhelming support from clinicians at home and abroad.
"The decision to use the pathway should involve patients and family members, and a patient's condition should be closely monitored.
"If, as sometimes happens, a patient improves, they are taken off the LCP and given whatever treatments best suit their new needs.
"To ensure the LCP is used properly, it is important that staff receive the appropriate training and support."
Medical- Doctors told to blow the whistle on sub standard care
Updated: 09 Jul 2012
Doctors told to blow the whistle or be struck off
Doctors who fail to raise concerns about sub- standard patient care could be struck off, according to whistle-blowing guidance published yesterday.
The General Medical Council (GMC) has also banned doctors from signing "gagging clauses" that stops them raising patient safety issues amid increasing reports about trusts using pay-off agreements to silence health professionals.
The GMC yesterday said that the interests of the patient must "trump everything" and doctors must not sign such contracts, which risk their own careers and the health of patients.
Medical managers also face a regulatory clampdown if they fail to properly deal with concerns raised by more junior colleagues.
The new guidance, which comes into force from March, comes only weeks before the final report into the scandal at Mid Staffordshire hospitals, where up to 1,200 people died unnecessarily.
It makes clear that doctors should first raise concerns in their workplace, but then go to the GMC or the Care Quality Commission (CQC). Doctors can then go public if patients are still at risk.
The CQC has asked at least six employees since 2009 to sign confidentiality agreements that stop them from publicly criticising the organisation, it was revealed yesterday
Medical- The PM should pray for more rain
Updated: 07 Jul 2012
The PM should pray for more rain
9.59AM 06 July 2012
When David Cameron announced the abolition of housing benefit to the under 25s last month, it was clear that the Tories are badging themselves as the nasty party again.
Some 80,000 young people become homeless every year including, recently, two of my patients.
Both had broken relations with their family, had to leave home and had nowhere to go.
One then had to drop out of college, and the other ended up in a hostel. Staying at home would have resulted in someone being injured.
What a contrast to when I was medical student and then a young doctor in Tower Hamlets!
That was at a time when there were council houses being built and we got a hard to let flat on the tenth floor of a tower block. But there's no chance of that now.
David Cameron will cut off housing and housing benefit from the under 25s forcing people back into dysfunctional families.
He talks of £2 billion being spent on housing benefit for the under-25s - interesting, that one.
My first flat as a student cost me £6 a week.
Prices were kept low by the rent tribunal, council flats had affordable lets and there was no need to go to the (expensive) private sector.
But successive governments have stopped the building of new council homes dead in their tracks.
Our borough is handing over its housing stock to housing associations increasingly run as for profit corporations with a few notable exceptions.
The vast amount of money being spent on housing benefit is not the fault of the under-25s, but of the high rents they have to face.
Then another headline caught my eye: The Observer reported that Barclays are being fined £290m for falsely reporting low Libor interest rates.
Later on in the same article it was estimated that the under-reporting of Libor had a £45 billion effect on the market after borrowers (banks) failed to pay investors who bought their products.
So who were those who lost the money to the banks?
Well, certainly the pension funds did - an interesting aside on our recent pensions industrial action.
And, to a certain extent, local authorities now have less money to spend on housing, so rents and housing benefits will go up more.
So why do the bankers get away with it?
Their fine was 0.5% of what they stole.
Why are my patients left homeless, and why is Cameron slashing housing benefit for the poor and young?
My young patients tell me they can see the connections.
Cameron should pray for the rain to last all summer, and hope not to see riots on the city streets again.
Dr Kambiz Boomla is a GP in Tower Hamlets and City & East London LMC Chair
Medical- UK Govt to force through new GP Pensions - Drs-"The battle is not over, until it is won"
Updated: 04 Jul 2012
Treasury to force through reform of pensions
before BMA decides on further industrial action
By Jaimie Kaffash | 03 Jul 2012
Exclusive: The Government is to push through its controversial reforms to GPs' pensions before the BMA has a chance to decide whether to take further industrial action, Pulse understands.
A source close to health secretary Andrew Lansley told Pulse the Treasury is set to formally announce the reforms before parliamentary recess in mid- July, ahead of the next meeting of BMA Council on 18 July, where it will decide what action to take next.
Mr Lansley last week wrote to Unison, which is co-ordinating the NHS-staff side of the pensions negotiations, suggesting the overall package – which will lead to higher contributions from GPs and a pension age of 68 – will be formalised imminently.
The Treasury announcement will end all talks on higher contribution rates for GPs post-2015, and a move to career-average revalued earnings for salaried NHS staff. Mr Lansley said there were two outstanding issues to resolve – the contribution rate for 2013 and 2014, and the arrangements for NHS staff who felt unable to sustain their current role until the age of 68.
The source told Pulse these issues would not need to be resolved before the Treasury announcement.
The news comes after a disappointing turnout for the BMA's day of action last month.
Despite this, the BMA's Annual Representative Meeting passed motions last week calling on BMA Council to consider further industrial action including a boycott of the commissioning process, separate actions for different branches of practice and further days of action.
At the end of the conference in Bournemouth, BMA Council elected as its new chair Dr Mark Porter (see above).
However, the meeting did not discuss whether to take further industrial action.
Immediately after his election, Dr Porter said he would seek an ‘urgent meeting' with Mr Lansley to discuss pensions. But the Department of Health said any negotiations would have to be through the official trades union talks.
Rachael Maskell, the head of healthcare at Unite, said the Government was willing to discuss limited changes, but seemed determined to force through the major thrust of the reforms: ‘Lansley is saying: "Sign a blank cheque and we will sort out the issues."
That is unsatisfactory.'
Dr David Bailey, deputy chair of the BMA's pensions committee, said the total money available was still inadequate: ‘This is not a change, because the DH clearly said the Treasury is not prepared to change on the total cost envelope. Our position remains that there was a cost-sharing agreement reached in 2008, which said that the staff side will bear any future cost.'
Dr Peter Swinyard, chair of the Family Doctor Association, said: ‘The battle is never over until it is won.'
Medical- Foreigners Final Selection
Updated: 04 Jul 2012
One in three foreign nationals reviewed
in 'ghost patient' drive wiped from GP lists
By Madlen Davies | 03 Jul 2012
Exclusive: As many as one in three foreign nationals is being de-registered
as part of increasingly tough list-cleansing drives,
far exceeding projected numbers and raising fears
that genuine patients may be left without a GP.
Figures obtained by Pulse show that many more patients have been removed than anticipated as part of PCTs' drive to wipe so-called ‘ghost patients' from practice lists.
PCTs are scrambling to meet the Department of Health's target to identify and remove 2.5 million extra patients by next April.
But LMC leaders claimed the list validation exercises were removing genuine patients, and said the policy was discriminating against vulnerable patients who were unable to respond to letters or were confused by the process.
In Buckingham and Oxfordshire, 32% of foreign nationals reviewed – some 18,400 patients – were removed from practice lists in 2011/12, despite initial projections suggesting just 10% of patients would be deregistered.
NHS Surrey said it had removed more than a third of patients, including some foreign nationals, since April this year, with 363 of the 1,058 patients identified as possible ‘ghost patients' taken off lists.
In Berkshire, 26% of the foreign nationals checked were de-registered, with 10,800 patients removed.
The Thames Valley Primary Care Agency, responsible for carrying out the drive, had projected a removal rate of just 10%.
Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMCs, said patients whose first language is not English were being de-registered, and that students who remained in the area had been knocked off lists after letters were sent to student halls where they no longer lived.
Dr Roblin said: ‘The DH sends down diktats that the local NHS has to follow, and there are unforeseen consequences.'
Dr Harry Yoxall, medical secretary of Somerset LMC, told Pulse there were concerns in his area that members of the Polish and Portuguese communities would not respond to letters sent out by the PCT: ‘The formal letter is written in quite complex and bureaucratic English.'
Dr Marine Ullah, a GP in Maidenhead, Berkshire, claimed a number of current patients had been de-registered, and two such patients had left her practice as they were angry at their GP.
‘Understandably, we're not very happy about this,' she said.
‘Patients come back in quite angry with GPs. It reflects badly on the practice.'
A spokesperson for the Thames Valley Primary Care Agency said it worked ‘closely' with GP practices ‘to ensure the right people remain on lists'.
‘Patients are written to and if they fail to respond within two months the practice has to show they are still registered and using services, or they are removed from the list after six months,' the spokesperson said.
Medical - Expired ?
Updated: 02 Jul 2012
The gates to the workhouse slid open
10.21AM 29 June 2012
She cleaned out her drawers and somewhere in the distance the steam whistle blew, and the gates to the workhouse slid open.
She had worked at the practice for nearly thirty years but it was time to say goodbye.
As she stepped out into the street she shielded her eyes against the bright sun shine and passed the familiar trees with their ripped swaying shadows.
A breeze riffled her flowers.
She knew that something was wrong.
She staggered forwards and as she fell she saw a gothic grey spire touching the sky.
They worked on her for forty minutes, they intubated her and shocked her, they did everything they could, she had so many plans but was pronounced life extinct at exactly half past five.
She was only sixty eight.
As she fell she saw the spire. A
nd the spire touched the sky before it became lost in the cloud.
Dr Kevin Hinkley is a GP in Aberdeen
Medical- Doctors call for more Strikes over pension reforms
Updated: 29 Jun 2012
Doctors call for more strikes over pension reforms
Thursday 28 June 2012
Doctors have escalated their dispute with the Government over pension reforms by calling for more industrial action.
Another day of action could see doctors running a Christmas Day-style skeleton service with only emergency services operating.
At the British Medical Association (BMA) conference in Bournemouth, a large majority of delegates voted on a motion which said "further industrial action was necessary".
But they stepped back from demanding another day of action be called immediately.
Last week doctors took industrial action for the first time in almost four decades by boycotting non-urgent care.
The BMA announced the move after it accused ministers of pressing ahead with "totally unjustified" increases in pension contributions and a later retirement age for doctors.
Today doctors debated the pension reforms and the prospect of taking more action.
They proposed that further industrial action by the BMA should be co-ordinated with other unions to maximise its impact
Doctors urged BMA leaders - who are meeting this afternoon - to "consider a range of options in defence of our pensions" including "withdrawal from clinical commissioning activity" and "in secondary care, withdrawal of labour with emergency cover only".
Even though the motions were passed by delegates, under BMA rules only the council can authorise industrial action.
Proposing the motions, Dr Kevin O'Kane said: "If we want to protect our pensions, we need to stay united and have no choice but to take further industrial action.
"Mr Lansley, congratulations, you've driven doctors to take industrial action for the first time in 40 years, well done.
"We don't want to take this action, it doesn't come naturally to us, but be assured we are fast learners.
"Last Thursday we learnt that, for future days of action to be be effective, they need to be tailored by practice."
The action last week left thousands of patients unable to have a planned operation or see their specialist or GP.
Figures show the action last Thursday hit almost a fifth of GP practices.
Across the country, 2,703 operations were postponed and 18,717 outpatient appointments rescheduled, based on figures from strategic health authorities in England.
Medical- Lansley Resign ? He should fall on his Scalpel
Updated: 29 Jun 2012
BMA calls for Andrew Lansley to resign
By Jaimie Kaffash | 28 Jun 2012
The BMA has defied their leadership in calling for the health secretary to resign in a vote of no confidence at their Annual Representative Meeting in Bournemouth.
The no-confidence vote in Andrew Lansley was carried by 158 votes to 124. This was despite BMA chair Dr Hamish Meldrum calling on the conference to reject the motion.
Presenting the motion, Dr Gary Marlowe, a GP in Hackney, said Mr Lansley's NHS and pensions reforms meant he should no longer continue as health secretary.
He said: ‘I've heard the argument that we cannot ask someone to resign if we have to negotiate with them tomorrow but he doesn't listen anyway. He sticks his fingers in his ears.'
‘Trust lies at the heart of everything we do. I do not trust this man.
I call for the resignation of Andrew Lansley.'
However, Dr Meldrum said that it ‘was not about one man' and the BMA should continue to campaign against policies, not personalities.
He warned that it would be harder to negotiate with Government if the conference passed the motion.
‘I've got to negotiate with him, and it's awkward to say "here's your p45- let's talk".
This wasn't about one man, there was a whole Government, a Lib Dem coalition, that supported it and others that helped it through.
It's a lovely symbolic gesture, but I'm not sure it means that much.'
GPC negotiator Dr Peter Holden said: ‘Resignation's too good for Lansley, Cameron should sack him.
Medical- Statins reduce coronary risk in men with Erecitile Dysfunction
Updated: 28 Jun 2012
Statins reduce coronary risk by in men
with erectile dysfunction ‘by up to 15%’
By Emma Wilkinson | 27 Jun 2012
GPs should regard erectile dysfunction as an independent cardiovascular risk factor and treat even low-risk men aggressively, say the authors of a new cost-effectiveness analysis.
The researchers found treating older men with a statin was highly cost effective, even if they were at low coronary risk.
The UK study adds to the evidence base for routinely treating the cardiovascular risks of men with erectile dysfunction, and is under consideration for inclusion in national guidelines.
Erectile dysfunction is currently recognised as a marker for underlying vascular disease, and was included, for the first time this year, in the Joint European Cardiology Society guidelines on preventing cardiovascular disease.
But the authors of the study – published in BJU International this month - study say this does not go far enough to address the cardiovascular risks of men who may not currently be eligible for statin treatment.
The general practice-based study of 173 men with untreated erectile dysfunction specifically looked at those at low cardiovascular risk, who were not on any antihypertensive or lipid-lowering treatment
Those aged 55 to 65 years had a mean predicted 10-year cardiovascular risks of 12%, and those aged 65 years or older had a 10-year risk of 23%.
Simvastatin 40mg treatment reduced these risks by 10% and 15%, respectively over six months.
An analysis of costs and QALY benefits showed such a strategy was likely to be highly cost effective – with the probability of treatment being cost effective for willingness to pay thresholds of £20,000 to £30,000 86% and 83%, respectively.
The study also showed a significant improvement in sexual health-related quality of life, but no difference in erectile dysfunction.
Study leader Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire, said erectile dysfunction was being considered for inclusion as a risk factor in the upcoming JBS3 guidelines.
He recommended: ‘GPs should routinely ask men about erectile dysfunction and treat those who have it as potential cardiac patients for the future and manage their cardiac risk factors aggressively – that means doing lipid tests, HbA1C and blood pressure.'
He added that questions about erectile dysfunction should be included in the Government's NHS Health Check programme.
He said: ‘It is very cost-effective and we found those who were most severe got the most benefit.'
The research team are now planning another trial looking at high-dose atorvastatin and extending the six-month study period to better assess the impact on the condition itself.
Professor Kirby said: ‘Patients are embarrassed to mention it and in another study we found 66% of men who had a heart attack had suffered from erectile dysfunction but not told anyone. There are missed opportunities here.'
Dr Terry McCormack, a GP in Whitby, North Yorkshire, and cardiovascular lead in North Yorkshire, said there was a clear correlation between erectile dysfunction and coronary risk and GPs should not wait for men to come forward but ask them proactively.
He said: ‘In anyone with erectile dysfunction, the tests you need to be doing are testosterone and cholesterol. That is far more important than doing something like a PSA test.'
He added that health professionals and nurses had not really taken on board how important erectile dysfunction was as a marker of cardiovascular risk.
Statins in ED
Men aged 55 to 65 years
Mean predicted 10-year cardiovascular risk - 12%, and those aged
Reduction in risk with simvastatin 40mg - 10%
Men aged 65 years or older
Mean predicted 10-year cardiovascular risk - 23%.
Reduction in risk with simvastatin 40mg - 15%
Source: BJU International 2012, online 11 Jun
Medicine- Hospitals need to Ultrasound scan for for blood clots more routinely
Updated: 28 Jun 2012
Hospitals warned over blood clots
Wednesday 27 June 2012
Hospitals are putting patients' health at risk by failing to test for blood clots at an early stage, according to the healthcare watchdog.
The National Institute for Health and Clinical Excellence (Nice) said many lives could be saved if medics diagnosed and treated blood clots in the legs and lungs more quickly.
It also said diagnosis and treatment of the condition, know as VTE or venous thromboembolism, is patchy and varies significantly across the country.
Nice is advising hospitals in England and Wales to offer blood tests and an ultrasound scan within 24 hours of a patient reporting possible symptoms.
Blood clots in the legs or lungs affected more than 56,000 people in England last year with hospital patients being particularly susceptible because they are in bed for long periods.
Clots in the legs can cause long-term pain, severe swelling and disability, and can be fatal if they dislodge and travel to the lungs.
Hospitals in England are already obliged to check all patients for the risk of developing blood clots.
The advice has been welcomed by the thrombosis charity Lifeblood, which helped develop the guideline.
Medical director Beverley Hunt said: "This is a major advance in improving the quality of care patients receive.
It sets a clear standard of care."
Health Minister Simon Burns said: "Already the NHS has dramatically increased screening for venous thromboembolism (VTE), from around just 50% in September 2010 to a world first of 90% by December 2011, leading to better treatment and outcomes for patients suffering this serious and frightening condition.
"However, despite this improvement, we know more can be done in reducing the variation in VTE treatment.
"We expect the NHS to reduce this variation by following this Nice guidance.
VTE may have a number of different causes, which means that clinicians treating VTE patients have an excellent opportunity to identify other health problems at an early stage.
"I hope that encouraging clinicians to link VTE and cancer will lead to improvements in the diagnosis of both diseases."
Medical- Change Tack on Action says (One of Three) BMA Chair GP Candidates
Updated: 23 Jun 2012
Change tack on industrial action, says GP candidate for BMA chair
By Jaimie Kaffash | 22 Jun 2012
Exclusive: The GP standing to replace Dr Hamish Meldrum as chair of the BMA has called for it to switch the focus of its industrial action away from stopping routine patient care.
Dr George Rae, a GP in Newcastle and BMA Council member who is running for chairman of council at next week's annual representative meeting against consultant Dr Mark Porter and medical academic Professor Michael Rees, said winning public support must be the priority for the BMA after yesterday's day of action.
He told Pulse: ‘We have to look at how we move it forward.
If we are going to achieve anything, we have to have public opinion on our side.'
‘If we want to get the public on board, the one thing we have got to do is not inconvenience them.
We admitted that is what would happen yesterday.'
Dr Rae suggested the BMA could look at alternative forms of action which would not affect patients: ‘It is difficult with austerity.
You have to do something that hits home at the Government and not at the patients. That could be done.'
Dr Rae said further discussion would wait until the ARM next week.
However, his comments come amid increasing calls from doctors for the BMA to boycott the Government's NHS reforms rather than take further days of action.
Ahead of the day of action last week, Dr Peter Swinyard, chair of the Family Doctor Association, claimed the BMA plan to stop routine care represented a ‘spectacular own goal'.
The Department of Health's final figure of 25% of practices taking action yesterday was disappointing in the context of the 79% support for industrial action among GPs who voted in the BMA ballot, Dr Rae said.
GPs were going on radio talking about rich doctors.
It didn't 100% work yesterday.'
But he added: ‘I don't think it was a damp squib, certainly not where I am working.
It is obviously not as big an impact as if everyone who said they would take industrial action did.
But it did raise awareness. We've got to the point where the public understand, if not necessarily agree.'
Dr Rae said the low turnout was due to doctors' commitment to their patients.
‘It was partly down to the feeling of duty to patients, and that is something I am proud of. It is also very difficult to get a unanimous view in partnerships; it wasn't always an individual decision.'
Speaking at the end of the day of action, BMA chair Dr Hamish Meldrum said: ‘Our feedback from the doctors co-ordinating the action on the ground indicates that in England up to a quarter of non-urgent cases have been postponed, and around a third of GP practices have been taking some form of action.'
‘Our intention has not been to maximise the impact on patients, but to communicate the scale of doctors' anger and to encourage the Government back to the table.
Doctors have sent a strong message that a fairer approach must be found.'
Dr John Canning, Cleveland LMC chair and member of the BMA pensions committee, told Pulse the day ‘was not the BMA's greatest'.
He said: ‘On local radio, there were a few supportive voices but the vast majority were not supportive.
It's not been an absolute disaster, but it hasn't been our greatest day.'
Medical -NHS- The Logic Behind the Cuts Chaos
Updated: 23 Jun 2012
The Logic Behind the Chaos
Friday 22 June 2012
Health Secretary Andrew Lansley may have spoken out urging doctors not to stage their industrial action against the great pensions rip-off, but secretly he will be delighted to see press attention diverted away from the mounting chaos across the NHS.
The BMA missed a trick by staging only limited action for one day, rather than an indefinite boycott of work on establishing clinical commissioning groups, which would have been popular and sustainable and would have put much more pressure on ministers.
Shocking figures from the Health Service Journal suggest that hospital trusts are planning a massive £2.3 billion in "efficiency savings" this year, with almost half (43 per cent) coming from the pay bill - not just by freezing pay but by axing jobs, cutting temporary staff, squeezing terms and conditions and further increasing the pressures on front-line staff.
And as trusts up and down the country unveil plans for cutbacks and closures - always coupled with the cynical claim that "patient care will not be affected" - the leader of the employers' body, the NHS Confederation, is warning of potential "disaster" if their cuts are not big enough.
He is urging them to close hospital departments, "consolidate" specialist services and provide more care "in the community," all with one single aim - to meet budget shortfalls.
It might all look as if the chaos is flowing from miscalculation or incompetence, but a fascinating conference organised last week by the fundamentalist neoliberal Institute of Economic Affairs - our British equivalent of the Tea Party crazies in the US - under the title "Should we abolish the NHS?" suggests that maybe it's all quite deliberate - an attempt to break the public faith and affection for the NHS.
A blog with the even more blunt title "How to abolish the NHS" was published on the IEA website by its deputy editorial director Richard Wellings back in January, as Lansley was battling to get the Bill through the Lords.
It called for measures to "bypass the NHS" and "liberate the private sector," with the aim of persuading people to "opt out of state provision to avoid long waiting lists and substandard care."
Wellings proposes to open up a full-scale free market in health care, even scrapping the compulsory licensing of health professionals - "anyone should be at liberty to practice as a doctor or a nurse."
He would allow all drugs to be marketed "without recourse to registered doctors or regulated pharmacies" and allow private firms to bring in "low-cost medical professionals from abroad."
This might seem like a joke or the ranting of a seriously disturbed person, but it reflects the views of a section of the Tory right - which has increasingly been setting the pace of David Cameron's government.
Some Tory MPs privately admit they have given up on the next election and just want to inflict maximum damage on the public sector to prevent the NHS ever being repaired.
But of course precisely because the ideas are electorally disastrous, the groundwork requires a covert process - discrediting the NHS, starving it of resources, creating the kind of deliberate chaos discussed by Naomi Klein and others under the heading of the "shock doctrine."
This column has always argued that the cuts and closures are inseparable from Lansley's wider plan for privatisation and a new competitive market in healthcare.
Without a reduction in public-sector capacity, there would be no space or justification for the services of profiteering private-sector providers.
But of course the cuts raise public hackles, far more than Lansley's complex restructuring and back-door privatisation of services that for now remain free at point of use.
That's why we see coalition ministers squirming and manoeuvring, hoping to dodge the blame for hospital closures in their constituencies.
Health Minister Paul Burstow in Sutton has even put a petition on his website opposing the closure of his local hospital, St Helier, that is driven by his own colleagues in government.
Another Lib Dem, Sarah Teather, is also in the frame for the run-down and closure of Central Middlesex Hospital.
Even Foreign Secretary William Hague has been posing on protests against a local hospital closure.
Ministers and coalition MPs, many of whom cynically campaigned against hospital closures while in opposition, could lose their seats in the tide of public anger.
None wants to be the next David Lock, the now forgotten Labour MP who lost his safe seat after backing the closure of services in his local hospital in Kidderminster - which now faces total closure in the latest cutbacks.
Even as the cuts chaos gathers, the Health & Social Care Act itself is being rolled out behind the scenes.
Part of the urgency in seeking to push through brutal cuts this year is to make sure that primary care trusts - to be abolished next April - set the pace and take the blame, before GP-led clinical commissioning groups (CCGs) take over the purse strings and find themselves in the firing line over cuts.
Some 150 primary care trusts are to be replaced by 212 CCGs.
But when the primary care trusts are finally wound up, it seems they will take with them many of the legal protections and much of the public accountability that were embodied in over 120 statutory duties.
Among the rights that are currently protected through primary care trusts are rights under the Mental Health Act, and child protection.
A host of other primary care trust legal responsibilities seem not to be transferring to the CCGs.
So the questions must be asked in every area and by MPs in the Commons - what will happen to these duties and how exactly will the CCGs be held accountable for their budgets, which will range from tens to hundreds of millions of pounds a year (CCG populations range from just 68,000 in Corby to a massive 900,000 in Devon).
The scrapping of the little-loved strategic health authorities underlines the confusion over the future of medical and professional education and training, workforce planning and the strategic organisation of services.
The recent reorganisations of stroke and other services would have been impossible if it had been left to CCGs, which will not even have to liaise with their immediate neighbour CCGs, let alone plan services across regional areas.
The loss of any overview and planning is especially serious in the current context of deep and localised cutbacks in services.
What if big cities like London, Birmingham or Manchester close down too many services and find they cannot cope with patient numbers?
Who could patients and pressure groups complain to or lobby for action?
Under the Act, and under pressure from the National Commissioning Board, CCGs are expected increasingly to show that they are opening up a growing range of NHS services to "any qualified provider."
This raises two key points.
The first is that Lansley, trying to smooth the ruffled feathers of furious GPs, promised them that they would not be compelled to open up services to any qualified provider.
It is vital that CCGs decide early and firmly that they will take advantage of this promise - and refuse to open up any services to companies and providers over whom they will have no control whatsoever.
The other question is what criteria will be used to decide which providers are "qualified."
The list of providers will be compiled nationally by Monitor and it is not at all clear how low the quality threshold will be, especially since Lansley's prime aim is to encourage maximum competition and maximise the private sector's slice of the NHS budget.
How far is this edging towards Richard Wellings's dream of deregulation?
It is important to keep a close watch on the list of providers, to check out and publicise their track record and performance.
And it is also important to keep up the fight against handing local community health services over to so-called "social enterprises" which may masquerade as non-profits but have to run and compete as businesses and behave as badly as any private provider.
The vigorous campaign by Stroud Against the Cuts in its battle against a social enterprise in Gloucestershire shows what can be achieved.
And the grim example of Central Surrey, where a social enterprise was pushed aside in a tendering exercise by Richard Branson's profiteering Virgin Healthcare, rams home the point that social enterprise is simply a transitional stage to full-scale privatisation.
There are more battles to be fought in each locality - on foundation trust boards of governors against any attempt to cash in on the new Act's increased limit on the amount of a trust's income can be made from private treatment; for local councils to open up their new health and well-being boards, and make sure they represent local communities; to use the continued powers in the hands of health oversight and scrutiny committees to block cuts and closures and force the Secretary of State to decide on every cutback; and the use of patient forums - and even the new toothless Health Watch groups - to pile on pressure in defence of local services.
The road to next April can be made painful and difficult for Lansley and his crew as they struggle to implement a Bill that was never put to the electorate and was opposed by doctors, health workers and the public who have increasingly recognised it as a privateers' charter.
Let's unite to make it hard for them at every step - and keep what we can of our NHS and its workforce in the public sector for as long as possible.
John Lister is director of Health Emergency.
Medical- Dr's 24 hr Work to Rule gets maximum publicity and support
Updated: 22 Jun 2012
Doctors' pension fund in the black despite Lansley's spin
Thursday 21 June 2012
Doctors took part in their first industrial action for decades today as it emerged that the pension scheme at the heart of the dispute has paid billions of pounds back to the Treasury.
The British Medical Association accused the government of trying to mislead the public - with Health Secretary Andrew Lansley claiming that taxpayers subsidise £4 out of every £5 of doctors' pensions.
In a detailed BMA briefing paper obtained by the Morning Star it said: "The government's main argument for its radical changes to the NHS pension scheme is that it is unaffordable and unsustainable.
"This does not stand up to scrutiny.
"In 2008, NHS staff agreed to major changes to their pension scheme to make it sustainable in the long term.
"This involved a large hike in employee contributions and the introduction of tiered contributions to protect lower-paid workers.
"It also meant an increase in the pension age for new entrants (to 65) and employees - not taxpayers - taking on responsibility for future rises in the cost of the scheme.
"The country is now in a very different financial situation.
However, this has not affected the sustainability of the NHS scheme.
"It is currently providing a positive cashflow of £2bn to the Treasury each year."
That's £8bn since 2008.
The government is claiming that will not always be the case.
The doctors' 24-hour work-to-rule action meant all non-urgent work was postponed - doctors were seeing anyone who was ill or who believed they were ill, but were not doing paperwork.
Accident and emergency departments and maternity services were running as normal and tests for critical conditions such as cancer were still available.
Doctors' participation in the action - which right-wing politicians and media tried to portray as a full-blown strike - varied up and down the country.
BMA chairman of council Dr Hamish Meldrum said that doctors' fight is not with patients but with the government.
Dr Laurence Buckman, chairman of the BMA GP committee, said: "The fact is somewhere, somebody had to do something.
"We thought long and hard about this action and most of us are very upset to have to be doing this."
Politics Britain-Dr's Pension Action- Tories bite the hand that cares for them - and us
Updated: 22 Jun 2012
UK doctors go on strike in pension row
Thu Jun 21, 2012 4:58AM GMT
Tens of thousands of British doctors have begun their first industrial action in nearly 40 years in a row over pensions that will target all non-urgent patient care.
The members of the 104,000-strong British Medical Association (BMA) voted by a 79 percent majority to go on strike back in May after the government tabled proposal that cut their £1 million pension pots, require them to work until 68 before retirement and pay more in annual pension contribution to earn pensions worth £68,000 a year. The BMA says they are targeting the government rather than the public as officials are changing arrangements made only four years ago and forcing doctors to pay more in pension contributions compared to other high earners in the public sector. However, British Prime Minister David Cameron has condemned the strike action arguing that the GPs will be getting “the sort of pensions that many people … can only dram of” even after the government’s controversial changes. The BMA has announced the GPs will only reject patients who are not in urgent need of care while hospitals will cancel all non-urgent surgeries. This comes as the issue has raised controversy with the Medical Defense Union, which provides legal advice to doctors, warning them that they could be forced to present good reasons for turning patients away in case of a complaint. AMR/JR/HE
Medical- Lansley "repeatedly and blatantly"distorted facts on Dr's action
Updated: 21 Jun 2012
Doctors expose Lansley's myths
Wednesday 20 June 2012
Health Secretary Andrew Lansley was accused today of "repeatedly and blatantly" distorting the facts during his keynote address to the NHS Confederation conference on the eve of historic industrial action by GPs.
Mr Lansley used his speech in Manchester to attack the British Medical Association for its planned action today over changes to doctors' pensions.
The minister, who has faced repeated calls for his resignation over his controversial NHS reforms, called on doctors to "think again before going on a strike.
"Rather than engage, the BMA chooses to ignore the financial issues facing the NHS.
"We cannot prioritise doctors over other public-service workers when we have to tighten our belts," he said.
"The BMA is seeking a less fair deal for NHS staff overall, something which others might not understand.
"Pensions will have to be paid for many, many years after people stop paying a contribution. The total cost of the pension scheme is £83bn - around three-quarters comes from the taxpayer.
"It is not fair and it is not sustainable."
BMA council chairman Dr Hamish Meldrum condemned Mr Lansley's "repeated and blatantly misleading comments."
He said: "The facts are that the NHS scheme was extensively reformed in 2008 to make it sustainable for the future.
"As well as staff accepting increased contributions and a higher normal pension age, they also took on responsibility for future increases in costs due to improved life expectancy," he said.
"The NHS pension scheme does not work by building up a 'pension pot' - staff working now pay for the pensions of NHS staff who are retired.
"Doctors rightly pay more than lower-paid workers and we are not seeking to change that."
NHS Confederation head Mike Farrar used his conference address to urge the government to do more to ensure its reforms went through.
Mr Farrar said: "Despite huge efforts to maintain standards of patient care in the current financial year, health-care leaders are deeply concerned about the storm clouds that are gathering around the NHS.
"Frankly without action on the way we provide health and social care, the NHS looks like a supertanker heading for an iceberg.
"The danger is clearly in view and looming ever larger. We know what needs to happen. But are we going to be able to take the assertive action needed in time?
"It is clear that what the NHS desperately needs is public support for planned change to services."
But Unison general secretary Dave Prentis said: "The real damage being done to the NHS is being caused by the government's unrealistic efficiency savings and the Health and Social Care Act which will drive in private companies which will put profit before patients."
Medical GP'S placed under threat and fight their consciences to defend their Pensions
Updated: 20 Jun 2012
Just one in four GP practices commits to taking industrial action
By Jaimie Kaffash | 19 Jun 2012
Exclusive: As few as one in four GP practices have committed to taking part in industrial action over pensions on Thursday, a Pulse investigation reveals.
In a blow to the BMA pensions campaign, early figures from trusts across the country suggest a majority of practices have decided not to stop routine appointments and will be open as normal.
It comes as thousands of GPs in London are facing the prospect of having contract payments withheld if they take industrial action, and amid mounting concern over public perception of the protest and the likely additional workload.
Two days before the first industrial action by doctors since 1975, around 22% of practices across the UK have notified their primary care organisation that they will be taking part, with this proportion dropping to one in 10 in some areas.
Figures obtained by Pulse from 20 primary care organisations show that 281 out of 1,265 practices have so far notified NHS managers they will be taking action - a disappointing return for the BMA after a ballot in which 79% of GPs who voted backed industrial action.
Both NHS managers and the BMA have asked practices to inform primary care organisations in advance if they plan to take action - and although it is not too late for GPs to notify PCOs, in some areas the majority of practices have already ruled out action.
Across Buckinghamshire, Oxfordshire and Suffolk, 134 of the combined 207 practices have confirmed they will remain open.
In Nottinghamshire and Nottingham City, only 28 out of 161 practices said they were taking action. Nottinghamshire LMC chair Dr Greg Place said local GPs were ‘steaming furious' about pensions, but were concerned about workload:
‘We will have to do everything we don't do on Thursday on Wednesday and Friday instead.
The only people who will suffer are us.'
In other areas even fewer practices will take part. In Surrey, just 15 out of 129 practices – 12% – have said they will take action.
The figures come after hundreds of practices in London were served with notice that they could be hit with ‘compensation' claims from NHS managers if they are found to be in breach of contract on 21 June.
Pulse revealed last week that a letter sent by PCT clusters to all 1,331 practices in London warned they were obligated to offer a ‘full service' even if they decided to take industrial action.
It said: ‘The local NHS may decide to withhold certain payments due to a contract holder by way of compensation for any breach, should it occur. In addition, formal contract breach notices would be issued.'
Legal experts said this could mean practices facing a ‘termination notice' in extreme cases.
Lynne Abbess, a partner at Hempsons Solicitors, told Pulse: ‘GPs have no in-built right to strike.
It would constitute a breach of contract if they only provide urgent care and in a worst-case scenario, it could lead to the end of the contract.'
Dr Chaand Nagpaul, GPC negotiator, said threats of contract sanctions were unwarranted: ‘I think it is unfortunate if PCTs colour requests for factual information with threats.'
Dr Jackie Applebee, a GP in Tower Hamlets, said she was confident the industrial action was not a breach of contract, but warned the threats could dissuade GPs from taking action: ‘I think it will put some people off, especially those who aren't as plugged in to the GP community, such as single-handed practitioners.'
Some GPs in Tower Hamlets are to stage a protest against the Government on the day of industrial action.
Dr Kirsten Shirke, a GP In the borough, said: 'All the doctors in our practice are supportive of action.
We see the pension reforms as one part of an attack on the NHS.
We all feel very angry about these proposals.'
Health secretary Andrew Lansley wrote to the BMA this week to urge GPs taking industrial action to work the following weekend: ‘I would ask your members who are GPs to consider working on Saturday 23 June to clear the backlog of appointments they will have created.'
The idea was quickly rejected by the BMA. A spokesperson said: ‘We do not anticipate the need for additional clinics.'
Medical- Depression in later life "Linked with Dementia"
Updated: 19 Jun 2012
Depression in later life ‘linked with dementia’
By Adam Legge | 18 Jun 2012
Depressive symptoms that develop in midlife or late life are associated with a substantially increased risk of developing dementia, say US researchers.
Almost 14,000 long-standing Kaiser Permanente members were studied and the risk of developing Alzheimer disease or vascular dementia was assessed in those with depressive symptoms recorded in their notes when they were aged between 40 and 55 years old, when they were around 70 years or older, or both.
The overall risk of dementia was increased by 21% in those with midlife depression, 72% for later life depression and 77% for both.
Looking at the two types of dementia, those who only had depression symptoms later in life had a more than two-fold increase in the risk of Alzheimer's (hazard ratio 2.06) while those with both mid and later life symptoms had a more than three-fold increase in vascular dementia (hazard ratio 3.51)
Study leader Dr Kristine Yaffe, a psychiatrist at the University of California, San Francisco, said: ‘We need to know whether adequate treatment of depression in mid or later life helps maintain cognitive function.
Even a small reduction in dementia risk would have a tremendous public health impact.'
Arch Gen Psychiatry 2012; 69: 493-498
Medical- Cost Cutting of NHS Services leads to Patients denied treatment and creeping privatisation
Updated: 18 Jun 2012
Report reveals stark dangers in opening up NHS services
Patients denied treatment, forced to pay for care
and faced worsening health after changes to physiotherapy provision
guardian.co.uk, Tuesday 27 March 2012 17.00 BST
Cost-cutting measures led to people only being able to see a physiotherapist twice, but not for hands-on treatment.
A controversial example of private companies being allowed to provide NHS services has resulted in patients in pain being denied treatment, forced to go private and enduring "extended suffering".
Those are the findings of an internal NHS report into how patients fared when physiotherapy services in Rushcliffe, Nottinghamshire were opened up to "any willing provider" – a version of which will start affecting a range of NHS community and mental health services in England from Sunday.
The report is a secret internal "review" conducted by practice-based commissioner Principia Rushcliffe, a social enterprise that in 2009 used the Labour government's opening up of NHS community services to replace the NHS as the sole local provider of musculoskeletal services for people with neck and back pain with nine private providers.
But a massive overspend in the planned £55,000 treatment budget in 2010 led to Principia last year bringing in drastic restrictions on patients' ability to access the care they needed.
Patients could not get physiotherapy services unless they had seen their GP twice, with the appointments at least six weeks apart. Even then, they could only see a physiotherapist a maximum of twice and could not receive any hands-on treatment.
Patients were only guaranteed one session of "assessment, diagnosis and exercise prescription".
For some people in pain that simply involved being shown how to do exercises or given sheets outlining postures that would best relieve their pain.
Under Principia's cost-cutting measures patients were only to see a physiotherapist for a second time "if required".
The document, obtained under the Freedom of Information Act and passed to Society, admits that rationing caused "dissatisfaction and anger" among patients and cost the NHS more because some people whose conditions did not improve had to be treated in hospital and take drugs to manage their pain.
But the appendices to the report – detailing the views of local GPs, physiotherapists and patients – are more explicit.
One unnamed GP's feedback stated: "Two sessions just isn't enough for anything.
There are occasional patients who can benefit from two sessions, but almost all are coming back to us saying that they haven't had enough appointments.
Waiting six weeks before being able to refer is no use for any acute injury, or indeed for those with acute significant back pain – with sciatica, for example.
Some do go private after the NHS offered sessions, with the same physiotherapist.
This system seems to be a retrograde step for physio.
I understand that it was a cost-saving [measure], but our primary concern ought to be treating our patients better than this, surely."
Another doctor was equally blunt: "I was appalled when the physio sessions went down to two.
Patients have been displeased with the two-session approach … I realise cost savings have to be made but to offer a half-hearted service is not the answer."
The policy has hit the least well-off the hardest, a third GP said.
"A lot of patients are gaining some improvement with their two sessions of physio and feel they would benefit from further, but most of the time they feel unable to pay.
Physiotherapists also ring us and ask if there is any way we can fund further sessions, as they feel they will be able to improve patients' symptoms given further sessions."
Some patients even needed hospital care because they did not get enough treatment to start with, the GP added, saying: "I have on a few occasions had to make another referral to secondary care, as a patient has not made the improvement we might have seen in the past with six or eight sessions of physio."
Unsurprisingly, patients' problems appeared to be aggravated by such minimalist care.
One physiotherapist told Principia: "We are not providing patients with the appropriate treatment for their condition, which has had a negative effect on outcomes.
Our outcomes data show that 41% of patients would respond favourably to more follow-up sessions. Another physio said:
"Although some patients will have done well with their self-care programmes alone, there are many who really needed further treatment.
Only a small proportion elected to continue privately.
Most could not fund it. Utilise our clinical skills rather than tying our hands."
The report should be seen as a cautionary tale of the chaos that can ensue when NHS services are opened up to competition, warns the Chartered Society of Physiotherapy.
"What we see is that patients are being denied appropriate treatment purely on financial grounds.
How can a physiotherapist be expected to treat a patient's condition without touching them? There is no published evidence to support that approach," says Phil Gray, the organisation's chief executive.
"This farcical situation is a direct consequence of opening NHS services to this form of open market competition when the health service is facing big financial challenges.
This scheme is a disgrace, but we fear it is a taste of what is to come with the introduction of this form of competition across the NHS," he adds.
The coalition government has changed the term of "any willing provider" to "any qualified provider", but not its thrust.
Primary care trusts in England have had to select three of eight services – including podiatry, back and neck pain services, talking therapies, and leg ulcer and wound healing – which from September at the latest they will have to allow non-NHS providers to deliver.
Critics see "any qualified provider" as the battering ram of impending privatisation, facilitated by health secretary Andrew Lansley's view that increasing competition as part of his NHS shake-up will drive down costs, extend patient choice and force providers to offer good quality care.
Race to the bottom
Gray, though, believes it will spark a race to the bottom in quality and that patients will be baffled rather than liberated by being able to choose between providers.
"Any qualified provider is a deeply flawed way to deliver healthcare and the government simply has to recognise the dangers it poses for patient care," he says.
Simon Burns, NHS minister at the Department of Health, denies the Rushcliffe experience is any sort of portent of what is to come.
"The Principia scheme was an entirely local initiative developed several years ago under the last government.
It has nothing to do with our plans for modernising the NHS, or the national 'any qualified provider' initiative, which seeks to give patients the choice of who provides their treatment. It was certainly not a pilot for it.
This local scheme is being re-used simplistically by those who oppose reform in an attempt to deny patients of choices they want," he says.
"We have always been clear that there is no excuse for imposing arbitrary restrictions that deny patients the treatment they clinically need.
That's why our reforms give control to those who know their patients best: doctors and nurses in the NHS.
We strengthened the health bill following the listening exercise to make clear that competition must only be used to benefit patients, never as an end in itself, and only where GPs, clinicians and experts deem it appropriate for their local communities.
"Unlike the Principia scheme, choice of any qualified provider will be based on quality standards developed with patient groups and clinicians, and fixed NHS tariffs so that there is no competition on price, only on quality of services," he adds.
Medical- Back to our roots- Foxglove protects,cleanses and cures
Updated: 18 Jun 2012
How extract from poisonous Foxglove
can PROTECT against high blood pressure and heart failure
• Plant has been used to cleanse wounds since the 13th century
By Daily Mail Reporter
PUBLISHED: 16:53, 15 June 2012 | UPDATED: 17:03, 15 June 2012
Deadly: Foxgloves are poisonous if eaten.
But an extract could prove beneficial to heart patients
A lethal poison made from a toxic plant once used as a Victorian murder weapon could help treat millions of people with high blood pressure.
Since the 13th century, the herb Foxglove has been used to cleanse wounds and its dried leaves were brewed by Native Americans to treat leg swelling caused by heart problems.
Researchers at the University of Michigan reveal that digoxin, the active ingredient in digitalis, or Foxglove, can enhance the body's own protective mechanism against high blood pressure and heart failure.
Around one in three people in Britain and the U.S have high blood pressure, also known as hypertension.
The condition is linked to obesity and can be prevented by reducing salt intake, being active and keeping a healthy weight.
Most current treatments prevent excess hormone and stress signals that can lead to high blood pressure and heart failure.
But recent studies have found that the body has the ability to keep excess stimulation in check through production of a family of inhibitors called RGS proteins.
Researchers looked for ways to 're-purpose' old drugs to tap into this protective mechanism which is lost among some individuals with high blood pressure and heart failure.
Case histories collected by Dr William Withering in 1775 determined that Foxglove contained the active ingredient, digoxin, now an important drug for treating patients with congestive heart failure.
This new action of digoxin was found by treating engineered human kidney cells with thousands of known drugs in a high-throughput screen at the U-M Center for Chemical Genomics.
Digoxin was then shown to have similar actions in isolated mouse blood vessel cells.
Dr Rick Neubig said: 'Low dose digoxin, the active ingredient of digitalis, was able to increase RGS2 levels in the heart and kidney.
'This new action of digoxin could help explain the fact that low doses seem to improve the survival of heart failure patients.'
The article was published online in Molecular Pharmacology.
Read more: http://www.dailymail.co.uk/health/article-2159863/How-extract-poisonous-Foxglove-PROTECT-high-blood-pressure-heart-failure.html#ixzz1y3HOfZEx
Medical-UK Cancer survival rates are poorer-"We need a "Which" guide for the best cancer services"
Updated: 18 Jun 2012
Which? style ranking needed to improve cancer treatment, says tzar
Britain’s cancer survival rates still lag behind other developed nations,
according to the country’s top doctor on the subject,
who says hospitals should be ranked on survival rates, waiting times and patient-satisfaction.
Survival rates for major cancer like those of the bowel and lung
still lag comparable nations like Australia, Canada ans Sweden -
although they are improving.
By Stephen Adams, Medical Correspondent
10:00PM BST 15 Jun 2012
Professor Sir Mike Richards, the NHS ‘cancer tzar’, said survival rates for major cancers were still worse in Britain than in other Western countries.
He believes cancer doctors in poorly-performing departments would feel compelled to improve their services if patients had at-a-glance Which? style information.
Prof Richards, the national clinical director for cancer, also wants more people to be diagnosed sooner so they can reap the benefits of improved treatment.
Speaking to The Daily Telegraph, he said:
“We know that cancer survival in the UK is poorer than that in countries like Australia, Canada, Sweden and Norway.
It’s very similar to cancer survival in Denmark.
“It is very clear that one of the major reasons for this is late diagnosis."
All six countries have thorough and reliable information on cancer diagnoses and deaths, making them comparable.
A study published 18 months ago in The Lancet, which compared survival rates across the six countries for breast, bowel, lung and ovarian cancer, found survival had improved for all four cancers in all the countries since 1995.
However, Britain had only closed the gap with the top four nations on breast cancer.
Prof Richards, who has led the NHS on cancer since 2000, said while treatment in Britain had improved since then, more could be done to drive up standards.
He said: “In an ideal world, we would want the equivalent of a Which? guide for cancer services. If you can do it in other sectors, why not for cancer?”
He explained: “People should be able to ask:
'Where can I get the care I need?
How do I know that the care is good?’ ”
He said there were “important differences” between some hospitals, with some excelling and other dragging behind.
Ranking cancer departments would improve standards by appealing to doctors' naturally competitive streak, he argued.
“No hospital team I know of likes to be in the lower half,” he said.
If patients were better able to make “informed decisions” about where to go, that would also increase pressure to improve, he said. In addition, a guide would help health commissions "who want to be buying services that provide good outcomes and value for money”.
He concluded: “All three will help drive up quality. It will improve survival and patient experience.”
Prof Richards also said it was crucial to get people diagnosed sooner.
He said:“The three countries that are the best for survival are Australia, Canada and Sweden, because they are diagnosing people earlier.”
“That’s partly because patients come forward earlier sooner and partly because it’s easier for their GPs to get diagnosis tests.”
He said there was “no evidence” that cancer treatment was worse here than in other countries, but explained:
“If we diagnose someone late they may not be suitable for curative treatment.
“Surgery is very important, but if your cancer has got to the stage where it’s not possible to remove it, you are very unlikely to be cured.”
He predicted: “I’m absolutely certain that if we get people into diagnosis and treatment sooner, we will eliminate the gap.”
On Friday Prof Richards also addressed the National Cancer Intelligence Centre (NCIN) annual conference in Birmingham, speaking about the importance of information.
He said doctors here needed to get better at recording the stage of a patient’s cancer on diagnosis, known as ‘staging data’, because without that it was impossible to tell if campaigns to get people diagnosed earlier were working.
Medical-Proctoscopes to you Lansley!His remarks will stiffen Doctors resolve on 21st June strike
Updated: 18 Jun 2012
Work Saturday to clear industrial action backlog,
Andrew Lansley tells GPs
Family doctors should work next Saturday to clear the backlog caused by their industrial action over pensions, Andrew Lansley, the Health Secretary, has said.
In the plain-speaking letter Mr Lansley made clear his irritation with the British Medical Association
By Stephen Adams, Medical Correspondent
5:50PM BST 15 Jun 2012
Tens of thousands of GPs and hospital doctors will refuse to see patients for routine appointments on Thursday, as they protest over the Government’s plans to make them work longer and pay more for their retirement benefits.
The action could lead to 1.25 million GP appointments being cancelled.
Mr Lansley has written to Dr Hamish Meldrum, the chairman of the British Medical Association (BMA), asking the union’s GP members to work on Saturday in lieu of the Thursday.
In the letter Mr Lansley also made clear his irritation with the BMA, warning Dr Meldrum that people “will not understand or sympathise” with doctors over the action they were taking.
Mr Lansley requested that Dr Meldrum ask GP members to work next Saturday “to clear the backlog they will have created on 21 June”. The BMA has rejected the idea.
Mr Lansley wrote: “The action GPs will take could potentially displace up to 1.25 million appointment bookings in primary care into the days and weeks following your strike, including appointments for some 140,000 children.
“As GPs understand better than anyone today’s routine appointments can become tomorrow’s emergencies.”
Doctors taking part in the action, which stops short of a full strike, have agreed to attend their usual places of work, but will see only urgent and emergency cases.
The dispute is over changes to pensions which the BMA argues are unfair and unwarranted, but the Government believes will leave doctors with very generous incomes in retirement.
Last week a YouGov poll found that almost two thirds of the public opposed the doctors’ action. A small survey of GPs also indicated that some were having second thoughts, although the BMA denies that is the case.
Mr Lansley wrote to Dr Meldrum: “I would like to reiterate once again, which I hope you now increasingly recognise, that the public will not understand or sympathise with the action doctors are taking.
“I set out, as you know from our several meetings, to secure continued access for NHS staff, including doctors, to an excellent pension scheme — amongst the very best available. We all want the best for NHS staff; but we all live in a very challenging financial environment.”
At the moment a full-time consultant retiring at 60 will receive a £43,000-a-year pension for life, and a tax-free lump sum of £135,000.
According to the Department of Health, the changes mean that a consultant who is 40 today will have to work 2.5 more years for the same pension, and a 24-year-old doctor another six years.
A BMA spokesman said that patient safety was doctors’ top priority during the action, but dismissed the idea of widespread Saturday catch-up clinics.
She said: “We have been very clear throughout this dispute that any industrial action doctors take will not put patient safety at risk.
“Anyone who considers themselves — or whose GP considers them to be — in need of urgent care will be seen by their GP on the day of action.
“Routine, non-urgent GP appointments will resume the following day.
Some surgeries will be open as usual on Saturday but we do not anticipate the need for additional clinics.”
Medical- Diesel Fumes are dangerous -"probably carcinogenic"
Updated: 16 Jun 2012
Diesel fumes no longer just 'probably' dangerous,
why we should forget fish oil pills
and a rethink on lifestyle factors affecting male fertility
By Emma Wilkinson | 13 Jun 2012
The biggest health story in the headlines today is the reclassification by the World Health Organisation of the dangers of diesel fumes.
A decision to move it from a ‘probably caricinogen' to ‘carcinogen' was based on a review of the evidence plus a consideration of how many people are exposed to diesel fumes.
'It's on the same order of magnitude as passive smoking,' said Kurt Straif, director of the IARC department that evaluates cancer risks in the Guardian.
'This could be another big push for countries to clean up exhaust from diesel engines.' However, experts pointed out the risk for most people remains small with the exception of those working around high levels such as truck drivers, mechanics, or miners.
Fish oil capsules are marketed as being good for the brain but the Daily Telegraph and others report that the supplements offer no protection against dementia, at least in the short term.
A UK review of data from 3,500 over 60s found that those taking omega-3 fish oil capsules performed no better in mental tests than those on placebo.
Co-author Alan Dangour from the London School of Hygiene and Tropical Medicine said: 'However, these were relatively short-term studies, so we saw very little deterioration in cognitive function in either the intervention groups or the control groups. It may take much longer to see any effect of these supplements.'
And finally men trying for a baby may feel they can relax a little after a reports that their lifestyle may not have the impact on sperm that has been previously suggested.
The Daily Mail says that drinking alcohol, smoking and being overweight probably do not harm the chances of fertility. In a study of 2,249 men UK researchers found that smoking, alcohol and recreational drugs did not affect swimming sperm numbers.
"This potentially overturns much of the current advice given to men about how they might improve their fertility," said Dr Andrew Povey from Manchester University.
Medical- Pacing Clinics are not informing GP Practices of patients at risk of a stroke
Updated: 16 Jun 2012
GPs ‘not being informed’ about patients at risk of stroke
By Alisdair Stirling | 13 Jun 2012
Patients with pacemakers are being left at a higher risk of stroke because pacing clinics are not informing GP practices when they develop atrial fibrillation, say UK researchers.
Their study found a quarter of patients at pacing clinics were not being considered for anticoagulation therapy after they developed atrial fibrillation, because GPs were not being informed.
The retrospective review of the records of 282 patients attending routine outpatient pacing clinics in Norwich found around a third - 95 patients - developed atrial fibrillation.
Of these, three quarters had persistent atrial fibrillation and a quarter had paroxysmal atrial fibrillation.
But the researchers – presenting their data at the British Cardiovascular Society's annual conference in Manchester last month – said only half of those with atrial fibrillation were not on anticoagulation therapy and that a major factor was that GPs were not being told.
For a quarter of the patients, their GP and hospital specialist were not informed that the patient had developed atrial fibrillation, so were never considered for anticoagulation therapy.
Lead author, Dr Vassilis Vassiliou, a specialist registrar in cardiology at Papworth Hospital said: ‘A routine pacing clinic review offers an ideal opportunity for identification of atrial fibrillation.
‘Liaising with the GP however, is essential to optimise anticoagulation uptake in this population.'
Dr Matthew Fay, a GP in Shipley, West Yorkshire, national clinical lead for NHS Improvement and adviser to the Atrial Fibrillation Association said the research demonstrated ‘the disconnect' between primary and secondary care.
He said: ‘I wonder if with a great deal of the pacemaker clinics in the country being clinician led and heavily protocol led, why a simple notification to the GP could not be built in to that protocol?'
‘It would seem a shame, that after we have tried so hard to improve the quality of someone's life we then leave them vulnerable to a disabling stroke.'
Medical-White collar workers take a stand- Call him a brother? Yes Yes- Don't scandalize his name
Updated: 15 Jun 2012
White-collar workers take a stand
Thursday 14 June 2012
Next week members of the British Medical Association will take their first industrial action for 37 years over the reforms to their pensions.
It is the latest in a long line of revolts by previously loyal public service professionals, their ranks now also comprising police officers, nurses, lawyers and prison officers.
The revolts by these professions, which are usually far from radical, are potentially far more damaging than criticism from what the government regards as the "usual suspects" - civil servants and local government officials.
The story of this emerging revolt started well before Cameron became PM.
He is merely further stoking the flames of a fire already alight.
In January 2008, 20,000 police officers marched to display their anger at their poor pay award and support the call by the Police Federation for members to have the right to take industrial action, including strikes.
The year before, Prison Officers Association members staged an unlawful national strike, again over pay.
Yet over the last few weeks the intensity of the flames has risen and the blaze has spread more widely.
The Royal College of Nursing (RCN) excoriated Health Secretary Andrew Lansley at its annual conference this year over cuts to staffing and their impact on standards of care.
Nurses are deeply uneasy over what many of them see as the coming destruction and fragmentation of the NHS as a result of the now passed Health Care Services Bill.
RCN members are in a position where they could take industrial action that does not damage patient care, having ended their self-imposed ban on doing so in 1995.
This year's Police Federation annual conference saw Home Secretary Theresa May heckled and jeered when she addressed delegates.
The week before, police officers had mounted an even bigger demonstration than in 2008.
Some 30,000 officers - all on their days off - had marched through central London.
Some 16,000 of them wore black caps, symbolising the number of posts that are due to be axed over the next few years as a result of 20 per cent cuts.
Again, the police officers renewed their call for the right to strike.
The day of the police officers' march was highly symbolic.
It was May 10, the same day hundreds of thousands of civil servants, lecturers and health workers went out on strike against reforms to their pensions.
Among the strikers were also thousands of prison officers, angered by the imposition of a raised retirement age.
At just before 7am that morning they received instructions from their union to leave work and strike - even though they have no right in law to do so.
And, finally, lawyers are up in arms too. Some 3,500 barristers, through their Criminal Bar Association, are contemplating taking strike action against legal reforms and cuts to the legal aid budget.
What makes this cocktail of revolt so potentially damaging for the government is not just that these professions are powerful and command a great deal of respect among the public.
It is also that these professions are not just revolting to defend their own sectional, vested interests.
Police officers and nurses have strongly argued that jobs cuts will massively harm their ability to provide services to the public.
And prison officers have pointed out that 68-year-old warders are not in a position to restrain violent and dangerous prisoners, bringing prison order into doubt.
If the Conservatives insist on continuing down the path of austerity, there is little that they can do to win back any Tory supporters among these professions.
That is because when it comes down to it their grievances centre on public spending - or lack of it.
Traditionally people among these professions might have given a protest vote to the Lib Dems.
But with the Lib Dems seen as soiled goods, Labour is the obvious likely beneficiary, as recent local elections have indicated.
However Miliband could still face difficulties despite his party's strong, continuing links with the unions.
Miliband has made it clear Labour is not against cuts per se - just not so many of them and not quite so fast.
This will prove an ever more difficult balancing act to maintain as the revolt grows.
He may make the odd supportive noise here and there, but it remains to be seen whether he will really grasp the potential of the situation and turn it to Labour's benefit.
Gregor Gall is professor of industrial relations at the University of Hertfordshire.
Medical- Prayer Requests by appointment-from the Medicine Man -but a more earthly diagnosis required
Updated: 15 Jun 2012
Christian GP given formal GMC warning
after discussing religion with patient
By Jaimie Kaffash | 14 Jun 2012
A Christian GP has been issued with a warning for a ‘significant departure' from good medical practice from the GMC after telling a patient that Jesus could help cure him.
The GMC's investigations committee found Margate GP Dr Richard Scott has caused ‘distress' that he should have foreseen, and that it was appropriate to issue a warning.
The investigations committee refuted Dr Scott's claim that the discussion around Christianity lasted two and a half minutes and accused the GP of being evasive in his answers.
The ruling, handed out by committee chair, Dr Christopher Hanning, noted Dr Scott's previous good record, but said: ‘On this occasion you caused the patient distress which you should have foreseen.
‘While the allegations relate to what occurred on a single occasion your actions nevertheless constitute a significant departure from the principles in Good Medical Practice.'
‘The committee considers that it is appropriate, proportionate and in the public interest for the protection of the reputation of the profession to issue you with a warning.'
The hearing was postponed from last year after the patient refused to appear.
The committee allowed the patient to give evidence over the phone, a move that was criticised by Dr Scott.
During the hearing yesterday, the prosecution had claimed Dr Scott had pushed his views on the ‘psychologically troubled' 24-year-old man, known as Patient A.
The prosecution also suggested to the doctor that because of his deep Christian convictions he had been over-eager to give faith as a solution to his problems and on this occasion ‘crossed the line'.
Cross-examined by Andrew Hurst, counsel for the GMC, Dr Scott denied telling the patient he would ‘suffer eternally' if he did not turn to Jesus and said it was an ‘absolute fabrication' that he had ‘belittled' the patient's own religion or sought to convert the patient to Christianity.
The GP, who is being treated for cancer, claimed the GMC had pursued his case with ‘excessive zeal' and is ‘singling out Christianity' as part of a ‘wider trend to marginalise Christianity'.
Dr Scott cited research claiming Christians had less chance of getting depressed, recover faster and are 85% less suicidal, Dr Scott claimed. ‘I'm not just a maverick doctor reaching out to patients,' he added.
The committee heard the patient was happy to talk about religion and Dr Scott said he broached the subject in a ‘gentle, non-threatening' way and was told to ‘go for it'. Patient A then turned on Dr Scott, he told the committee.
The GP replied: ‘Saying I pressed it too hard, I do not accept. I was eager but not over-eager.
Had it been an entire 25-minute preach, that would have been outside the guidelines.'
Medical- NHS 111 to be delayed whilst the Government add up the numbers again
Updated: 15 Jun 2012
DH agrees six-month delay to NHS 111 rollout deadline
By Gareth Iacobucci | 14 Jun 2012
The Government has announced a delay in the rollout of the NHS 111 urgent care number,
after accepting concerns that the looming April 2013 deadline for introducing the new 24/7
urgent care service was too tight for some CCGs.
In a letter to NHS colleagues, Jim Easton, national director for Improvement and Efficiency at the Department of Health, said CCGs wishing for an extension of up to six months would need to apply to an expert clinical panel by Friday 27 July.
It said the move ‘should not delay rollout in those areas that are ready to move ahead', but said it would ‘help ensure that in those areas that need it, time can be taken fully to engage local clinicians and build delivery models for NHS 111 that have the support and endorsement of all local stakeholders.'
The decision comes after pressure from the BMA to delay the rollout, with last month's LMCs conference raising 'serious concerns' that forcing CCGs to procure the service by April 2013 could compromise patient safety, and pile additional work on GPs.
NHS Direct, which is bidding to run the service in many areas, has also called for a delay to the rollout, as has private firm Capita – which last week urged the Government to delay to mitigate ‘significant risks' with the current tender process, after withdrawing from bidding to run the service.
The letter suggests the Government was eventually pressured into acting after feedback from CCGs themselves, in addition to other organisations.
The letter says: ‘The Secretary of State for Health and I are fully committed to the delivery of an integrated 24/7 urgent care service, accessed through NHS 111.'
‘However, after careful consideration, and having sought the views of senior CCG representatives and other stakeholders, we believe that an extension of up to six months of the original April 2013 deadline may be necessary in some cases.
It adds: ‘The clinical panel will publish the criteria that it will judge applications on shortly.
If CCGs would like their areas to be considered for an extension, they should submit an application in writing to their SHA Cluster Senior Responsible Officer, who will then pass this onto the expert clinical panel by Friday 27 July 2012.'
Dr Laurence Buckman, chair of the GPC said: "The decision to delay implementation of NHS 111 by up to six months in areas where more developmental work is still needed is a welcome one.
We have been pressing the Secretary of State to allow a delay for some time.
The principle behind NHS 111 – making patient access to urgent NHS services easier – is a good one, unfortunately the speed of the rollout was putting this at risk.
Hopefully now there will be sufficient time to ensure local clinicians are properly involved so services can be designed that will be safe, reliable and genuinely benefit patients."
Medical- GP's are workers being intimidated and need to fight for the right to withdraw labour
Updated: 14 Jun 2012
Hundreds of GPs threatened with
‘breach of contract’ notices over pensions industrial action
By Gareth Iacobucci | 13 Jun 2012
Hundreds of GPs have been threatened with contractual sanctions if they take industrial action on 21 June, in the first example of NHS managers cracking down on practices ahead of the BMA's day of action over pensions.
In a letter to its 1,300 GPs, NHS North West London warns it expects all GPs to continue to deliver their contracts ‘in full', says any practice that fails to provide a service during core hours will be regarded as having been in ‘breach of contract'.
The letter, from the PCT Cluster's chief executive Anne Rainsbury to 422 practices, warns GPs that take action run the risk having certain contractual payments withheld if they are found in breach of contract.
The move comes after Pulse reported widespread confusion over whether GPs would face contractual or financial sanctions after taking industrial action, with most PCTs yet to decide what action they would take.
But the letter from NHS North West London is the first example of managers taking a hard line on GP industrial action. It tells GPs: ‘We expect all of our primary medical services contractors to continue to deliver the contract in full.
‘Although it is of course an individual's right to take lawful industrial action, any GP practice that fails to provide a service during core hours on the day of action will be regarded as having been in breach of contract, even if the individual participating in that industrial action carries out the majority of work he or she would normally undertake.'
The letter goes on to say that even practices have a responsibility to meet the ‘reasonable needs' of its patients during core hours and to ensure a full service is delivered ‘despite the actions of individuals employed by you to deliver those services'.
The letter goes on: ‘Consequently the local NHS may also decide to withhold certain payments due to a contract holder by way of compensation for any breach should it occur.
In addition, formal contract breach notices would be issued.'
Medical- Senior GP Commissioner quits Clinical Commisioning Group over pension changes
Updated: 13 Jun 2012
Senior GP commissioner quits over pension changes
By Gareth Iacobucci | 12 Jun 2012
A senior GP commissioner has resigned from his CCG in protest at the Government's pensions reforms.
It comes as the BMA announced plans to debate withdrawing en masse from commissioning over pensions, with a motion tabled for debate at the association's Annual Representative Meeting in Bournemouth later this month.
Dr Prit Buttar, a GP in Abingdon, Oxfordshire, and former GPC member, has resigned from his role as deputy locality lead for Oxfordshire CCG, claiming he had become ‘utterly disengaged' because of his dissatisfaction with the enforced changes to GPs' pensions.
Dr Buttar, who will be taking part in the day of action on 21 June, said he ‘bitterly resented' having to take the decision and warned the Government it should expect more commissioning enthusiasts to lose heart because of the pension changes.
He said: ‘I have resigned from that post because, given how disaffected I am feeling, I did not think I could go round asking other people to engage when I'm feeling utterly disengaged.
I bitterly resent being put in this position.
‘At a time when the Government needs engagement of GPs like no other time before, it strikes me as curious to pick a fight with the entire profession.'
The resignation comes after LMC leaders backed a call last month to include disengagement from commissioning in any industrial action over the Government's pension reforms.
Dr Chaand Nagpaul, BMA Council member and a GP in Stanmore, north-west London, said: ‘We would consider any vote.
The Government should be warned if it damages the goodwill of English GPs, one of the casualties is likely to be disengagement in commissioning as a consequence.
‘It's a very real risk. The implementation of what are clearly blatantly unfair pension reforms is likely to damage that goodwill.'
The move comes as the chair of the Conservative Health Society admitted even Tory-supporting medics were turning against the Government over pensions.
Dr Paul Charlson, a GP in East Yorkshire, said there was ‘resentment' among active Conservative supporters about the reforms: ‘There is a general feeling that this was all sorted not so long ago and that the current pension is fair compared with other civil servants.'
Medical- BMA's Day of Action-21st June
Updated: 13 Jun 2012
Practices waver over BMA’s day of action
By Jaimie Kaffash | 12 Jun 2012
The BMA's decision to call a day of industrial action over ministers' pensions raid has split the profession, with a third of practices indicating they will not cancel routine appointments and even BMA Council members yet to confirm if their practice will take part.
Partners across the country have been holding meetings to decide if their practice will provide only urgent and emergency care on 21 June, with the extent of grassroots support for the BMA's action increasingly uncertain.
Pulse's snapshot poll of 161 GPs this week reveals just 29% so far expect their practice to take part fully in the day of action, with a further 15% reporting that some parts of the practice will participate.
Some 37% said their practice had already ruled out taking action, while almost one in five had yet to decide.
At the end of last month, BMA Council announced that the first industrial action by doctors
for almost 40 years will see practices stop all routine care for 24 hours.
The decision came after 84% of doctors voted for industrial action short of a strike in the BMA ballot – including 79% of GPs.
Most practices have yet to formally tell local NHS managers whether they plan to take part, but the Pulse poll's findings were also matched by a survey undertaken by NHS Gloucestershire.
Just 26% of the 51 practices and 261 GPs who responded to the PCT said they were planning to take action.
Even many BMA Council members, who took just two hours after the ballot results were announced to unanimously approve industrial action, were unable to confirm they would participate.
As Pulse went to press, just one out of 10 GPs on BMA Council contacted – GPC chair Dr Laurence Buckman – would say that his practice would definitely be closed for routine appointments on 21 June, with many yet to discuss it with their partners and several refusing even to discuss their own practice's decision.
A series of high-profile GPs have been fiercely critical of the BMA's decision to take action. NAPC president Dr James Kingsland warned it could harm patient safety, while the Times newspaper columnist Dr Mark Porter, who is a GP in Wotton-under-Edge, Gloucestershire, claimed it was the ‘wrong battle at the wrong time'.
Dr Sarah Wollaston, a Conservative MP on the House of Commons health committee and a former GP, told Pulse:
‘I get a lot of correspondence from doctors who are horrified at what the BMA is doing.
‘People have been in touch to say "I voted Yes/Yes in the poll, but now regret it and won't be taking action".
The risks of undermining the goodwill and trust [of patients] are just not worth it.'
But others were more enthusiastic. Dr Gaurav Gupta, a GP in Faversham, Kent, said his whole practice would be taking part: ‘Our pension was renegotiated in 2008, but the Government has decided to renege on this agreement.
‘We are being singled out, and it is time for the profession to take a stand.'
The Pulse poll does suggest there is some appetite for on-going action over pensions, with 45% of respondents prepared to consider further days of action if the BMA decides they are required.