National Association of Primary Care - Members

NAPC GP Bulletin 29 August 2012

Healthy Lifestyle Just As Good As Drugs For High Blood Pressure

A Finnish study followed 9,637 men and 11,430 women aged 25 to 74 who did not have hypertension and has concluded that exercising regularly, keeping weight down, drinking in moderation and eating plenty of vegetables can cut the chances of developing high blood pressure by two thirds.  

Adherence to a healthy lifestyle was recorded, and included alcohol consumption of less than 50g per week (roughly six units), exercise at least three times per week, daily consumption of vegetables, and normal weight.

Pekka Jousilahti, of Finland’s National Institute for Health and Welfare, presented the findings at the European Cardiology Congress in Munich.  He said: ‘The risk of hypertension was only one third among those having all four healthy lifestyle factors, compared with those having none.  Even have one to three healthy lifestyle factors reduced the risk of hypertension remarkably’.

Doctor’s Diary

The Cochrane Collaboration reported that millions of those diagnosed as having ‘mild’ hypertension gained no benefit from taking lowering blood-pressure medication.

Its review, published recently, of clinical trials involving more than 9,000 patients with pressures in the rand of 140-159 (for the upper, or systolic measurement) and 90-99 (for the lower, or diastolic) found that treatment had no effect on the intended purpose of reducing the subsequent risk of stroke or heart attack.

GPs Unsympathetic To Infertile Women – Study

Half of infertile women find their GP unsympathetic about their situation or ignorant about their condition and what services are available that might help them fulfil their desire to have a child, a survey has shown.

Dr Clare Gerada said the findings were surprising and worrying, and the profession should do more to help patients.

The National Infertility Awareness Campaign surveyed 456 women attending fertility clinics, asking if their GP was sympathetic and helpful.  Of the 419 who responded, 78% said yes and 22% said no.

Parents Are Being Urged To Have Measles Vaccinations For Their Children

Parents are being urged by doctors to make sure their children have had a measles vaccination as they return from their summer holidays to one of the largest outbreaks in decades of the potentially fatal disease.

In the first half of this year, there were 964 confirmed cases of measles, twice as many as occurred in the same period last year.  In the whole of 2010, there were just 380 cases of the disease, which can prove fatal if left unchecked.

The Health Protection Agency, which collects the figures, said that the latest outbreak was centred on Sussex and Merseyside, and, to a lesser extent, among traveller communities.

Stem Cells May Help Shattered Knees Mend Themselves

Ten patients at a Bristol hospital are to have pioneering treatment to help them regrow damaged knees.

Knee cartilage will be grown form the patients’ own stem cells on a framework known as a bio-scaffold implanted into the knee.  Scientists hope that the procedure will result in the knees eventually rebuilding themselves, leaving the patient more mobile and less at risk of developing painful osteoarthritis.

GP Training Falls Back As Specialists Surge

Deaneries are failing to respond to the growing workforce crisis in general practices, creating only eight more training places across the UK this year.

An investigation conducted by Pulse revealed a drop in the proportion of GP trainees compared with hospital trainees across the UK, amid falling numbers of GP training places in England.

The drop in GP places comes after the government announced in May it was targeting a 20% increase in GP training places by 2015, and as the RCGP called for 10,000 more GPs ‘just to stand still’.

The figures add to the growing concern over secondary care bias in education bodies.  The new Local Education and Training Boards are overwhelmingly dominated by hospital representatives.

Figures from the GP National Recruitment Office (GPNRO) showed 3,152 offers were accepted for GP trainee positions this year across the UK, compared with 3,144 offers last year, and despite a 6% rise in applications in 2012.  This compared with a rise of almost 700 hospital training places in England, with 4,725 place accepted in 2012, compared with 4,034 in 2011.  This meant the proportion of GP trainees fell from 40% in 2011 to 36% in 2012.

This year’s intake is the last by deaneries, with LETBs due to be authorised from October.

CCGs Remodel GP Out Of Hours Contracts

CCGs have begun remodelling GP out of hours contracts to enable direct referrals from new NHS 11 services and tie providers into targets for reductions in A&E attendances.

More than half a dozen commissioning organisations across England have already placed GP out of hours services in their areas out to tender under revised specifications, with more set to follow as a host of contracts expire when CCGs become statutory bodies in April 2013.  The move signals CCGs’ intent to reshape out of hours services to help them meet QIPP targets.  

In Staffordshire, where six CCGs are leading on the procurement of two new out of hours services set to start on 1 April 2013, GPs are looking to reshape the service to try and reduce the burden on A&E by integrating it closely with the new 111 urgent care line.

Prescribing Study Prompts Change

One of the country’s biggest software providers has implemented changes to almost 2,000 practice systems in the wake of a GMC-funded study that estimated that there were errors in one in 20 GP prescription nationally.

The PRACTICE study, published in May, looked at prescribing in a random sample of practices using a range of different software providers and found on average 4.9% of prescriptions contained errors.

The TPP SystmOne has become the first software provider to implement a series of improvements base on the study’s findings.  The changes include warnings for clinicians who issue repeat medication without appropriate tests and changes to encourage clinicians to partake in more active monitoring of patients prescribed drugs such as warfarin and methotrexate.

The country’s largest provider, EMIS, said it had not made any changes because its new system already incorporated many of the report’s recommendations.

NHS Ready To Go On Revalidation

The NHS has made ‘impressive’ progress, but there are still likely to be areas not completely ready to begin revalidation, according to the Department of Health body responsible for rolling out the scheme later this year.

In a crucial report on the readiness of the NHS for revalidation of doctors, the NHS Revalidation Support Team said over 90% of GPs had participated in an annual appraisal in 2011/12 and almost all were now linked with a responsible officer who had received appropriate training.

The report, however, also showed one in ten PCTs was ‘red’ or ‘amber’ rated on revalidation, with less than half of GPs linked with a body that has a policy for remediation of struggling doctors and less than two-thirds with a system for GPs to obtain feedback from patients and colleagues.

The report will form the basis of the Secretary of State’s final decision on whether to go ahead with revalidation of all doctors from the end of this year.  It comes after the British Medical Association chairman, Dr Mark Porter, acknowledged that revalidation was not going to be perfect from the start and that the profession would probably have to proceed without all issues the BMA was fighting for being resolved.

The first round of revalidation is due to begin from December this year and will involve revalidating responsible officers and medical leaders.

GPs Get Faster Broadband

GPs are set for broadband access at double current speeds, as the Department of Health plans to install faster digital lines in up to 7,000 GP practices by March of next years.

The GP Next Generation Access Project will update the broadband network N3, which underpins services such as Choose and Book to double its current speed using 21 DSL technologies.

The plans will see surgeries benefit from increases speeds on primary and backup links and remote-hosted GP systems.

The new technologies are fibre to the cabinet (FFTC) meaning they use fibre-optic cables to give faster broadband speeds and where possible will give speeds of up to 40MBps.

Where FFTC is not available, ADSL2+ will give speeds of up to 20MBps.

The project was funded by Connecting for Health and will be delivered by BT  The NHS Informatics Business Plan 2012/13 said the update will be rolled out to 70% of practices by March 2013.

GPs Face Record Negligence Claims

GPs are finding themselves at the centre of more medical negligence claims than ever before, according to new data from medical defence experts.

The Medical Defence Union’s annual report for 2011 shows disciplinary cases against GPs and hospital doctors increased by 56% since last year, with the union opening 17% more medical claims’ files and seeing an 18% rise in requests for assistance with GMC investigations.

The MDA said the number of medicolegal challenges faced by doctors were ‘unmatched in company’s  126 year history, and it expected the numbers to grow with the introduction of revalidations and Care Quality Commission registration.