NAPC News In Brief 25 June 2009

Many UK Cancer Deaths 'premature' 
 
Cancer is becoming an increasing problem as the population ages, up to 15,000 people aged over 75 may be dying unnecessarily from cancer each year in the UK, according to research.

The North West Cancer Intelligence Service said their lives would be prolonged if UK cancer survival rates matched the best in Europe and the US.

Researchers said delays in diagnosing cancer in the UK and poorer treatment after diagnosis may be to blame.

The government's national cancer director said urgent action was needed over the study's findings.

The researchers, who will present their findings to the National Cancer Intelligence Network, said the number of under-75s dying in the UK was down, but little progress had been made among over-75s and the gap with other countries is growing.

Cancer survival rates are calculated on the basis of those who are alive five years after diagnosis.

Managers Review GP Contract

GPs face years of contractual and financial upheaval as managers plan for the drastic funding shortfall predicted over the next decade.

NHS policymakers are considering everything from a salaried GP workforce to charging patients for appointments.  PCTs will start by reviewing all types of GP contract to work out how savings can be made, according to David Stout, PCT Network Director.

NHS managers will eventually have to consider whether GPs should work for managed care organisations, if the model of GPs as independent contractors proves to be unsustainable, Mr. Stout said. 

Charging patients to see their GPs was ‘on the long list’ of radical ideas to reduce demand on the NHS and make savings he said.

Professor Chris Ham, professor of health policy at the University of Birmingham, said GPs should expect pay freezes and an expansion of their core work.

Nigel Edwards, Policy Director at the NHS Confederation said that ‘no sector would be exempt’ from the cutback.  The GP contract would have to be reviewed of the Conservatives were elected next year, he said.  One of the first targets for savings would be from the QOF, said Mr. Edwards.  There was growing evidence that too much income was derived from the QOF, he continued.

Shadow Conservative Health Secretary, Andrew Lansley, said recently that GPs would have their own budgets within a year of the Tories coming into power.

NICE QOF Change Hampered By Lack Of Evidence

Lack of evident on cost-effectiveness will limit NICE’s ability to compare indicators proposed for inclusion in QOF with those already in the framework, the Institute has said.

Detailed guidance on how current QOF indicators and proposed new indicators will be assessed was published recently.

Indicators will be deemed cost-effective if they cost under £25,000 of each quality-adjusted life year (QALY) added, in line with NICE’s usual threshold.    QOF points will be reduced for indicators that are not cost-effective enough to justify further incentives.  Indicators requiring further incentives could have their QOF points value increased.  However, NICE acknowledges that assessment of the cost effectiveness of existing indicators will be constrained by a lack of data on the cost-effectiveness of current indicators.

In the absence of appropriate evidence, NICE argues that a judgment should be made on how likely it is that an intervention is cost-effective.  This would be based on the minimum patient benefit required for a given QOF point’s value, Nice suggest.

Profess Helen Lester, Deputy Director of the National Primary Care Research and Development Centre, which is leading the review of indicators, said the new guidance would add transparency to the review process.  She added that the Centre was currently approaching practices to review indicators, which was a further opportunity for GPs to influence the development of the QOF.

DH To Set Up Social Enterprise Support Framework

The Department of Health has launched a procurement drive to set up a framework of organisations to help primary care trust provider arms becomes social enterprises.

The Department is hoping to recruit a panel of business support providers to offer PCTs ‘tailored support that is unlikely to be available from within the PCT itself.

A Department of Health spokeswoman said there was no value for the tender as support would be commissioned by PCTs.

Routine Rapid Testing For HIV IS Acceptable To Patients

UK research suggest that offering a rapid HIV test as part of a general check-up could help boost testing rates and was acceptable to patients.

A quarter of patients living with HIV in Britain are currently unaware of their infection.

Rapid tests are used in sexual health clinics, but are not offered in primary care because of concerns that patients would feel uncomfortable being asked to take the test.

Last year, the British HIV Association recommended that GPs offer HIV testing to tackle the high proportion of undiagnosed HIV cases.

For this latest study, researchers recruited 85 patients aged 18 to 55, who were attending an inner-city practice in London for a new patient health check.  A total of 38 of the patients agreed to have a rapid HIV test.

These patients received a pre-test discussion, including a description of the testing process and a talk on the benefits of testing.  The majority of the patients who refused the test did so because they had already been tested for HIV.

The researchers carried out interviews with 17 patients who accepted a test and three patients who declined the test to explore the acceptability of offering HIV testing.  The main reason that patients accepted the test was because it was given as part of a general health check.   All interviewees said that having rapid HIV tests in general practice was appropriate.

Lead researcher, Dr Audrey Prost, from University College, London, concluded that offering a rapid HIV test as part of a general check-up seemed to eliminate a lot of stigma around the test.

She added that the rapid test for HIV had the advantage of producing results in just 20 minutes compared with the commonly used blood test which produced results after 10 days.

Drug Combination Can Protect Bones

Research has found that rosiglitazone does not appear to cause bone fracture if used in combination with metformin, research has found. 

Previous studies suggest that rosiglitazone could lead to bone loss and NIC recommends that GPs should discuss the risks and benefits of treatment with glitazones with patients.  

Researchers investigates whether taking rosiglitazone with meformin could reverse bone loss in rats with bone damage.  Rats were given metformin, rosiglitazone, both drugs, or a placebo.

After 30 days of treatment, rates given metformin showed signs of bone healing.  Rats given rosiglitazone showed decreased bone healing compared with the control group.  In the rats given both drugs, metformin completely reversed the ability of rosiglitazone to inhibit new bone formation.

Further research is required to see whether the results can be translated to humans, the researchers stressed.

Surgery Improves Heart Outcome In Diabetes

Prompt coronary bypass surgery can improve cardiovascular outcomes for patients with type-2 diabetes and heart disease compared with intensive medical therapy alone, research has shown.

Over 2,000 patients with type-2 diabetes and heart disease were assigned to either prompt revascularisation with intensive medical therapy or intensive medical therapy alone.  Patients also received either insulin sensitisation or insulin provision therapy.

The primary end points of the study, results of which have been published in the New England Journal of Medicine, were the rate of death and a composite of major cardiovascular events, including MI or stroke.

After five years, there were no significant differences between the revascularization and medical therapy groups, or between the insulin sensitisation and insulin provision groups in the study.

Patients had been stratified according to whether pecutaneous coronary intervention or coronary artery bypass grafting was the most suitable intervention for them.

Within the coronary artery bypass grafting subgroup, the patients who received prompt surgery had significantly fewer strokes or MIs than the medical therapy group (22.4 per cent compared with 30.5 per cent).

Adverse events were generally similar across the groups in the study.

Swine Flu Policy Remains Based On Containment

GPs should continue with containment measures to control the spread of swine flu, despite the World Health Organisation (WHO) declaring a pandemic (phase 6),according to the Royal College of General Practitioners (RCGP).

Current BMA/RCGP guidelines state that once phase 6 has been reached, the focus should shift form efforts to contain or delay the spread to minimizing the impact of the pandemic.

However, Professor Steve Field, Chairman of the RCGP, said that there would need to be evidence of the virus spreading across the whole of the UK before GPS moved away from the containment measure to treating patients.  He said that he did not think that a move to pandemic level would change anything for GPS.  Only when the virus had spread across the UK was there a need to look at additional measures such as suspending the QOF and bringing in retired GPS to bolster the workforce.

Darzi Centres Fail to Deliver Pay And Job Benefits For Nurses

GP-led healthcare centres are offering nurses pay and conditions that are worse than Agenda for Change (AfC), nursing leaders have warned.

In guidance earlier this year, former health minister, Ben Bradshaw said he expected the centres to have nine nurses to three GPS.  Some observers argued that the resulting demand for nurses would bring better terms and conditions for staff.  Many also expected that ‘nurse-led’ centres would offer primary care nurses unprecedented levels of responsibility.  However, none of the new centres is led by its nursing team and nurses have reported that employment terms were less than AfC.

NHS Staff Still Miss Out On Appropriate Training

NHS staff are still not receiving appropriate training nearly three years after the implementation of AfC, MPs have warned.

The Knowledge and Skills Framework was introduced as part of AfC to ensure staff had access to training and development and included an annual appraisal.

This and other changes were to bring £1.3 billion of efficiency savings, the Department of Health promised.  But a House of Commons public accounts committee (PAC) report found that by autumn 2008, 46 per cent of NHS staff had yet to have an annual review.

The PAC found that AfC had helped nurses to take on more senior roles and expand their practices into areas such as prescribing.  However, the report also found that higher pay meant that NHS productivity had actually fallen by an average of 2.5per cent a year from 2001 to 2005.

Lowering BP Too Fast Could Increase CV Risk

Aggressive blood pressure lowering could increase the risk of cardiovascular events among patients with type-2 diabetes, an international study has found.

A subgroup analysis of the ONTARGER trial involving 9,603 diabetic patients followed up over 4.5 years, found that bringing BP below 130mmHg systolic and 80mmHg diastolic increased heart attack risk.

Lead researchers, Professor Joseph Redon, from the University of Valencia, told delegates at the European Meeting of Hypertension in Milan, that lowering BP in high-risk diabetic patients offered protection against stroke but did not protect against cardiac events.  Where patients had a greater risk of stroke then lowering BP would be beneficial, but where patients had a risk of coronary disease, care was needed.