Monthly Archives: September 2014

.. paved with good intentions: Cameron tells GPs to work at weekends

In a front page headline in The Times the Conservative party shows how out of touch they are with the profession that they have neglected. Francis Elliott and Matt Dathan report 30th September 2014: Cameron tells GPs to work at weekends

The language shows the dissonance. “Forcing GPs” to do anything when they are self employed and have a legally agreed contract for patient care is negative. Promising to increase numbers over a short timescale when it takes 10 years to train a GP is real “denial” of the hapless political system with 5 year changes in direction and first past the post elections. Fortunately Mr Cameron is only talking about England…. Other Regions are unlikely to follow.. I suppose every citizen would like to think that his personal GP would see him at any time… good intentions on a very rough road ahead. The threat may lose most GP votes, and it may affect the career choices, particularly of women, who find General Practice much more child friendly that other careers in medicine. Perhaps GPs wanting more normal hours will think more of the other regions when they choose where to live, giving these regions a competitive advantage.. I have not even touched on the lack of trainers, appropriate posts, and postgraduate training capacity…. Medical and Dental Education

We could import more doctors. Perhaps we could clone our current GPs? (sic)

Weekend NHS

Patients will be able to see their doctor on Saturdays and Sundays under plans to be set out by David Cameron today.

A pledge to force GPs to open their surgeries on seven days a week within five years is part of a wider package of measures to improve access to family doctors. Others could include 12-hour surgery opening, consultations and prescriptions by email and the right to register at more than one practice.

The “doorstep offer” on weekend doctors’ appointments comes after Ed Miliband put the NHS at the heart of Labour’s election campaign last week by pledging to use a mansion tax to boost health service coffers.

It comes on the third day of the Conservatives’ last conference before the election. In other developments yesterday:

George Osborne, the chancellor, announced a £3 billion two-year freeze on benefits that will affect more than five million working households. Combined with moves to stop benefit claimants blowing their welfare payments on alcohol by using pre-paid cards, the measures spawned fears from MPs that the party would isolate blue-collar voters.

Boris Johnson, the mayor of London, appealed to Nigel Farage and other Ukip supporters to return to the “great Conservative family”.

Philip Hammond, the foreign secretary, added to unease over Europe after he admitted that Britain could fail to secure EU treaty change.

The GP access package will cost £400 million during the course of the next parliament and will be paid for from existing budgets, Mr Cameron will say. He will also promise to bring back named GPs for all patients, placing the responsibility for each person’s out-of-hospital care under one doctor. The measure was scrapped by the last Labour government.

“People need to be able to see their GP at a time that suits them and their family,” Mr Cameron is to tell the conference in Birmingham today. “That’s why we will make sure everyone can see a GP seven days a week by 2020. We will also support thousands more GP practices to stay open longer, giving millions of patients better access to their doctor….

NHS History

Update 1st October 2014:  Francis Elliott and Matt Dathan  Cameron tells GPs to work at weekends

 Patients will be able to see their doctor on Saturdays and Sundays under plans to be set out by David Cameron today.

A pledge to force GPs to open their surgeries on seven days a week within five years is part of a wider package of measures to improve access to family doctors. Others could include 12-hour surgery opening, consultations and prescriptions by email and the right to register at more than one practice…..

Kat Lay reports: Give us more resources or forget out-of-hours surgeries, warn GPs

and LYNDSAY BUCKLAND reports for The Scotsman 30th September 2014: Stressed doctors urged to work part-time in bid to avoid burnout

The cheap drug anastrozole could save 4,000 a year from breast cancer

Kat Lay in The Times 29th September 2014 reports: The cheap drug anastrozole could save 4,000 a year from breast cancer 

Of course this drug was never cheap until it had run out of patent. I expect the opinion voiced in the article would ever have been aired whilst the drug was under patent….Now it is generic the good news is that it could save many more lives… But the rationing system inherent in the need for a new trial will ensure delay.. Who should/will conduct the trial..?

Thousands of women are being denied a 7p-a-day drug that could halve their chances of developing breast cancer, according to two leading charities.

Experts have said that if all post-menopausal women with a high to moderate risk of the disease were given anastrozole, almost 4,000 lives a year could be saved. NHS red tape means that they are unable to access the drug, however, while new research suggests that many women may not be aware that they are among the 10 per cent at higher risk.

The National Institute for Health and Care Excellence (NICE) recommends that women deemed to be at moderate or high risk of breast cancer should be offered the chemoprevention drugs tamoxifen and raloxifene, which reduce the risk of getting the disease by around 35 per cent if taken daily for five years. However, trial data published after the guidance was released showed that anastrozole, already licensed for treatment, prevented 53 per cent of cases over the same time frame.

Professor Tony Howell, director of research at the Genesis breast cancer prevention charity, said that NICE was not expected to revisit its guidance for years, and that in the meantime women would struggle to access the drug, which has “very few” side effects.

Baroness Morgan of Drefelin, chief executive of Breast Cancer Campaign, said that the healthcare system was geared toward creating new drugs, rather than repurposing older ones. “There aren’t the same drivers in the system to give this new evidence the push that it needs to get into practice,” she said. For a drug to be licensed for a new purpose, its manufacturer must apply to the Medicines and Healthcare Products Regulatory Agency (MHRA), a process costing thousands of pounds. Professor Howell said that companies were uninterested in doing that for a 30-year-old product…..

…Women with the highest density are twice as likely to develop the disease compared to those with average breast density. The research also found that women did not realise that factors such as age, weight or having a first pregnancy at a later age could put them at higher risk.

NICE said that it reviewed its guidance at regular intervals.

An MHRA spokesman said that it would need to receive a medicines licence application in order to approve anastrozole for chemoprevention.

NHS health checks fail to improve odds

James Dean reports in The Times 29th September 2014: NHS health checks fail to improve odds

 

Something all GPs are aware of, and it looks as if the shortage of GPs in training allied with the early retirees and leavers mean GPs will become rare as hen’s teeth. This is good news and we should spend elsewhere… and ration screening out wherever it is questionable… How about mammography and cervical smears being paid for at cost by all except those on benefits?

 Paul Myers describes our skills as “skilled diagnostic assessment and holistic management of multifactorial and undifferentiated problems” (RCGP Wales Update newsletter: Message from the Chair). He is correct: an accurate diagnosis in physical, social and psychological terms was the old parlance, but as populations get older they get many diseases in the one person; hence the complexity. Any time spent on doing other than diagnostic assessment should always be questioned – and chronic disease management, the cost of which accounts for much of the expenditure on GP, could be reduced by divesting this aspect in simple cases.

Wait for NHS will cost my life, says ex-GP

Sarah Kate-Templeton reports in The Sunday Times, 28th September 2014: Wait for NHS will cost my life, says ex-GP -No mention of rationing overtly – yet

PATIENTS with eye cancer have revealed how they are being forced to seek private treatment or risk dying while waiting for treatment on the NHS.

People with ocular melanoma, the most common form of eye cancer, with some 400 cases a year, have written to The Sunday Times Beat Cancer Campaign to highlight their struggle for NHS treatment.

They include an accountant who claims he was told by NHS doctors to “go away and die”, and a former NHS GP who says she was forced to go private to save her life.

Iain Galloway, 46, who has already lost his left eye and most of his liver to cancer , says that when he asked doctors what he could do to prolong his life, the reply was: “How much do you earn?”

Galloway was diagnosed with ocular melanoma in June 2010 but heard through OcuMel UK, a charity that represents sufferers, that consultants at Southampton General Hospital took a special interest in the disease.

Galloway, who wants to live to see his 17-month-old son start school, claims that during an appointment there last December a doctor suggested he create a “war chest” to fund his treatment.

“I knew the severity of the cancer and I said, ‘How can I genuinely look at this long-term?’He replied, ‘Well, OK, how much do you earn?’ He wasn’t being flippant: we were having a candid conversation. He said it might be worth having a pot of money.”

Dr Lesley Kirkpatrick, a retired NHS GP who has survived longer with ocular melanoma than any other patient in Britain, attributes her survival to her medical contacts and having savings of £50,000 to pay for treatment. The melanoma has spread to her liver.

Kirkpatrick, 55, from Hampshire, who is married to a retired consultant anaesthetist, said: “The reason that I have survived so long is that I have a medical background. I am — or rather was — relatively wealthy and able to purchase scans and treatments.”

Kirkpatrick has paid privately for advanced MRI scans and for special radiation therapy and immunotherapy drugs. But she believes that delays while she unsuccessfully argued with the NHS over treatment may end her life prematurely.

“I think that delay just let my cancer get out of control,” she said. “There would have to be a miracle for me to be alive in three to six months’ time.”

Brian Carney, 58, a retired accountant from Yorkshire, claims that when his eye cancer was diagnosed in 2005 he was told there was little point conducting regular MRI scans because, if the cancer spread, he would die anyway.

He chose to fund private MRI scans and was treated privately when the spread of the cancer to his liver was detected.

“My own regional specialist hospital, one of three national eye cancer centres, only offered periodic ultrasound scans,” he said. They argued that early diagnosis of metastasis (spread) was irrelevant because ‘there is no meaningful treatment available; if you get metastasis, you die’.”

Sean Duffy, NHS England’s clinical director for cancer, said: “Doctors make treatment decisions, including diagnostic testing, on a case-by-case basis. Since April 2013, NHS England has funded the use of [the drug] Ipilimumab for the treatment of advanced melanoma where it is clinically effective to do so.”

The NHS needs a break from the surgeons of Westminster, Camilla Cavendish

In Manchester for the Labour party conference last week, I chaired a fringe session in which one doctor likened the NHS to a patient in A&E. “It’s rushed into emergency every few years, patched up, then discharged,” he said. “Then the whole thing starts again under another administration.”

It is almost obligatory for political parties to say they want to “save” the NHS. Ed Miliband said it on Wednesday when he made it clear that Labour will make the NHS the centrepiece of its general-election pitch, and Nigel Farage joined in with his own version on Friday. But save it from what?

The health service faces a host of challenges — an ageing population, increases in dementia and diabetes cases, PFI debt, rising public expectations and low staff morale. When politicians say the greatest threat to the NHS is “the other lot”,you wonder if what the NHS most needs saving from is politicians…..

…What patients want is what both Burnham and Hunt talk about: a compassionate service centred around them rather than NHS bureaucrats. This is the stated goal of all three main parties, but when any one party implies that money alone can fix all problems, the others are hamstrung.

No other European country has a healthcare system politicised in this way — the French and German governments set the budgets but do not meddle in the detail. In Britain I meet pioneering community nurses, doctors and local councillors who are quietly improving care. They are fed up with having to worry, every time there is an election, that there will be yet another five-year plan.

Some of these people are wondering where the substance in Labour’s proposals lies. What they would really like, I suspect, is for the politicians to lose the microphone.

Camilla Cavendish discusses the prognosis for the NHS at The Times and Sunday Times Cheltenham Literature Festival on October 11 at 1.30pm. cheltenhamfestivals.com

Solving the GP workforce’s problems

BMJ Careers 5th August 2014 publishes a report by Matthew Limb: Solving the GP workforce’s problems

With due respect to BMJ Careers, and to Matthew Limb, NHSreality feels the underlying lack of honest and open debate on the philosophy, and the cultural/political aspects, of today’s Regional Health Services is what puts off many..  Others are not keen to work as self-employed as the GP training programmes, which used to include business skills, no longer do so. Rationing needs to be overt to bring back engagement by the nursing, physiotherapy, psychology and midwifery professions as well as the doctors..

Last month, a report commissioned by the government concluded that recruitment and retention problems in the GP workforce need to be tackled immediately. Matthew Limb looks at some of the potential solutions

The GP Taskforce report on the scale of the workforce crisis in general practice raised two important questions.[1] One was how a profession facing deep problems can be made more attractive as a career option to young people to boost numbers of general practitioners (GPs) in the future. The other was what can be done to prevent experienced GPs leaving when services are buckling under the weight of patient demand and unprecedented workloads.

The taskforce recommended enticing new recruits via a “professionally-led marketing strategy” aimed at a wide range of audiences to present an “accurate and positive image” of general practice. “We need concerted initiatives to promote general practice as a positive career choice, from school into medical school and then foundation programme training,” its chair, Simon Plint, says.

Tim Ballard, vice chairman of the Royal College of General Practitioners, believes a campaign is necessary but that it would be something of a “double-edged sword” in the context of a profession “on its knees.” He told BMJ Careers, “It has the potential to make people think, ‘If things are as bad as that then it’s not for me.’”

Ballard welcomes the idea of marketing aimed at undergraduates and foundation year levels, though he says he wasn’t aware that there was evidence showing an approach targeting school sixth formers would work. A compelling and “exciting” case for general practice could be put to people starting out in medicine and effectively turn the “current challenge that we face on its head,” he says. “The attractive side is the long-term relationship we have with patients and families, delivering holistic and whole person care.”….

…The taskforce said a powerful case could be made on the basis of cost effectiveness for both the returner and retainer programmes. The time has come to redesign and repackage the schemes across England, it argued.

Schemes should be centrally funded and priority should be given to GPs wishing to train and work in “underdoctored” areas, the taskforce said. It recommended NHS England should seek consensus on the threshold for assessing a doctor’s eligibility for reinclusion on a performer’s list and explore whether there could be flexibility in the managed return to practice.

Breath test for TB developed

Michael Eyre, BBC news reports 24th September 2014: Breath test for TB developed

Had to look hard for some good news!

Researchers have developed the first breath test for TB in the laboratory.

It provides rapid information on drug resistance that takes up to six weeks using standard methods, US scientists report in the journal, Nature Communications.

The bacteria emit a unique gas signature within 10 minutes of exposure to an inhaled antibiotic in rabbits.

TB infects 8.6m people each year worldwide and kills 1.3m, second only to HIV.

Early diagnosis and treatment are a priority in the global fight against TB, according to the World Health Organization…..

Facing the funding conundrum: reaction to Labour’s plans

Nigel Edwards (24th September 2014) provides The Nuffield Trust comments on Labour’s plans for the NHS.

The dishonesty and obfuscation will continue until after the next election… A paralysed political and administrative class needs to be freed from the shackles of fear, and only this will empower clinical staff to re-engage. Exit interviews, especially if made public, will help further..

The future funding of health and social care is arguably the big public policy conundrum of our age, yet politicians have been reluctant to address the unprecedented financial squeeze. That was until this week’s pledge by Labour of £2.5bn of new NHS spending. In this blog, Nigel Edwards examines the significance of the announcement and argues that without a plan for the NHS to break even in the next Parliament, Labour’s pledge would fall at the first hurdle.

Alarm bells have been sounding about the financial health of the NHS for some time now. Back in 2012 we warned of a yawning £30bn funding gap within a decade; earlier this year we warned of a funding crisis before the General Election; and figures released just last week showed that even the hospitals we’d expect to be financially viable are going into the red.

The situation for social care is, if anything, even bleaker: cuts of over £600m to adult social care since 2010 mean that almost a third fewer older adults receive publicly funded care now than in 2010. And concern is rising over the quality of social care as austerity bites.

Listen to Andy Burnham at the Labour Party Conference: NHS ‘not for sale’ in Labour hands – BBC News 24th September