Tag Archives: Doctors

Army poised to cover for striking NHS doctors

Army medical staff are expected to be drafted into NHS hospitals as cover for striking junior doctors, according to a document uncovered by The Telegraph.

The first of three strikes by junior doctors is due to begin on Tuesday Dec 1, when only emergency care is planned, with full stoppages on Dec 8 and Dec 16.

It would be the first full walkouts by doctors in NHS history.

In official guidance on industrial action issued by the British Medical Association (BMA), it said it expects medics from the Armed Forces will be used to help plug the gap on strike days.

The BMA advises striking doctors manning picket lines to be friendly to Army doctors – not least because as military employees, they have no right to strike.

In the Guide to Safe Picketing, published by the BMA, the professional trade union states: “It is likely that our Armed Forces colleagues will be asked to step in to provide support for clinical services on the days of action.

“The law does not permit them to take part in industrial action, but their support for services during the industrial action is welcome.”

A BMA spokesman said: “We don’t expect there will be a huge number of Army turning up at hospitals, but we are expecting a number of Army medics.”

The spokesman added: “We want to keep the NHS going. We have said from the very, very beginning we didn’t want to get to the stage of strike action. But junior doctors feel they have no other way of getting their voices heard.”

Army Medics parade through the City of London during the Lord Mayor’s ShowArmy Medics parade through the City of London during the Lord Mayor’s Show  Photo: PA

In the first strike, on Tuesday, doctors would offer emergency care only for 24 hours, while the following two strikes would mean a full walkout from 8am to 5pm.

It is expected that Army medical staff will cover Accident and Emergency services.

Department of Health officials remain locked in negotiations with unions.

Source The Telegraph

Call to punish GPs over overprescribing antibiotics

“Soft-touch” and “hazardous” doctors should be disciplined for prescribing too many antibiotics, a leading NHS figure says.

The National Institute for Health and Care Excellence’s Prof Mark Baker said 10 million prescriptions a year were inappropriate.

He said regulators need to deal with overprescribing doctors who failed to change their ways.

The Royal College of GPs said the call was “counter-productive and unhelpful”.

There is universal consensus that the very basis of modern medicine is under threat due to rising numbers of infections that are resistant to drugs.

The “antibiotic apocalypse” not only means that long-forgotten infections could kill again, but jeopardises procedures including surgery and chemotherapy.

Using antibiotics inappropriately for sore throats and colds increases the risk of resistance. Yet the number of prescriptions continues to rise.

NICE has prepared fresh guidelines on antibiotic prescribing for the NHS in England, which can be adopted by other parts of the UK.

The guidelines acknowledge that there is huge pressure from some patients for the drugs.

Prof Baker even said some people were “addicted” to the idea of getting antibiotics, even for conditions that would clear up on their own.

He added 97% of patients who asked for antibiotics ended up getting them, often by identifying a “soft-touch” doctor.

The guidelines say doctors should tell patients when antibiotics are inappropriate and refuse to write prescriptions.

Prof Mark Baker, director of the organisation’s centre for clinical practice, said: “We are proposing that evidence is collected so the finger can be pointed at people who are a soft touch.”

He said antibiotics could cause more harm than good in some patients, so overprescribing was “really hazardous practice”.

And, he said, doctors should be encouraged to change their habits. But ultimately some cases should be dealt with by the General Medical Council, which has the power to withdraw a doctor’s right to practise, “if necessary”.

NICE admits that if previous guidelines on respiratory tract infections, which include colds, were actually followed then prescriptions would be 22% lower.

The latest rules for doctors should cut the 42 million prescriptions given each year by around a quarter.

Dr Tim Ballard, from the Royal College of GPs, said the focus needed to be on “societal change” – not doctors.

He said: “Any suggestion that hard-pressed GPs – who are already trying to do their jobs in increasingly difficult circumstances – will be reported to the regulator is counter-productive and unhelpful.”

NICE will be publishing guidelines on educating the public next year.

Other recommendations include the use of “delayed prescribing” where a patient can only use a prescription if his condition gets worse and creating “antimicrobial stewards” who identify high levels of prescribing.

Niall Dickson, the chief executive of the General Medical Council, said doctors should reflect on their prescribing habits as part of an annual appraisal.

He said “doctors can, and do, face sanctions for mis-prescribing.” But the message is “more about changing the norms of practice generally than pursuing individual doctors”.

Source BBC News

Turn the music down, doctor! Background noise during operations found to be causing serious communication problems between medical staff

Background music during operations is causing serious communications breakdowns between medical staff, according to new research.
Surgeons were found to be five times more likely to have to repeat requests for medical instruments when a soundtrack was played in theatre.
Around 70 per cent of operations are performed with music playing in the background – with drum and base surprisingly popular among staff – contrary to common perceptions that surgeons perform to the sound of calm classical music.
But a team of researchers from two top London universities recorded footage of 20 operations in the 
UK which revealed disturbing problems such as surgeons having to repeat requests for instruments as well as tension over the choice of soundtrack. 
The report suggests communication within theatre teams can be impaired by music.
Music was first introduced into operating theatres in 1914 to reduce anxiety in patients.
Now, patients are placed under anaesthetic outside the theatre and music is routinely played for the benefit of clinical staff.
New theatre suites are often equipped with docking stations and MP3 players and portable speakers are routinely used during operations.
Researchers placed multiple cameras placed at strategic points in operating theatres. Twenty operations were analysed, 70 per cent of which had music playing.
How the music was played and controlled was also highlighted as an issue. If playback volume from digital sources was not standardised, volume could increase without warning when a track changes.
Staff were seen to occasionally turn up a popular song, leading to a sudden increase in volume that could mask instructions and other verbal communications.
The study has been published in the Journal of Advanced Nursing.
Author Dr Terhi Korkiakangas, from University College London said: ‘In the operating theatres we observed, it was usually the senior medics of the team who made the decision about background music.
‘Without a standard practice of the team deciding together, it is left up to junior staff and nurses to speak up and challenge the decisions of senior doctors, which can be extremely daunting.’
Dr Korkiakangas continued: ‘Public perception of music in operating theatres is shaped by media portrayals of surgical teams always working to a background of smooth music. We found that often dance and drum and bass were played fairly loudly.’
Author and PhD candidate Sharon-Marie Weldon, from Imperial College London, said: ‘Music can be helpful to staff working in operating theatres where there is often a lot of background noise, as well as other distractions – it can improve concentration.
‘That said, we’d like to see a more considered approach, with much more discussion or negotiation over whether music is played, the type of music, and volume, within the operating teams.’ 
The study comes after previous research found playing music actually inhibits concentration.
A study by Cardiff University found university students who listened to their tunes while trying to memorise a list of letters fared worse than those who worked in silence. 
Listening to music – including tunes that they liked – hampered their recall, researchers found. 
However, a US study published last week revealed doctors who listened to their favourite songs while performing a set procedure, had better surgical technique and efficiency.
That is, their stitches were better and faster. 
Source Mail Online

Stop handing out so many drugs, doctors are warned: ‘Over-treating’ patients is wasting the NHS money and can cause harm

Doctors must avoid prescribing drugs to patients needlessly as it may be causing them harm, according to top health experts.

The Academy of Medical Royal Colleges is urging medics to ‘choose wisely’ and not dole out prescriptions or refer patients for tests simply because they feel under obligation.

The academy – which represents 220,000 doctors in the UK – warns a culture of ‘defensive medicine’ and lack of knowledge is leading medics to overdiagnose and overtreat patients.

In guidance issued today, it is urging all doctors to pick five tests or drugs commonly used in their field, and ask themselves whether those things are really necessary.

The intervention comes as another senior academic warns half a million Western patients are dying each year because they are needlessly prescribed antidepressants, sleeping pills and antipsychotics used in dementia treatment.

Professor Peter Goetesce, a renowned Danish researcher, said doctors should stop handing out these drugs altogether as their benefits have been ‘overstated’ by pharmaceutical firms and the side effects are ‘immensely harmful’.

NHS figures show more than a billion prescriptions are handed out in England every year – 2.7million a day – and the number has risen by two thirds in a decade. The academy warns that doctors often feel under pressure from patients to ‘do something’ at every appointment.

Its guidance, published in The BMJ, adds: ‘This has resulted in patients sometimes being offered treatments that have only minor benefit and minimal evidence despite the potential for substantial harm and expense.

‘This culture threatens the sustainability of high quality healthcare and stems from defensive medicine, patient pressures, biased reporting in medical journals, commercial conflicts of interest, and a lack of understanding of health statistics and risk.’

The academy’s Choosing Wisely programme aims to encourage doctors to question whether certain interventions have any real benefit.

The initiative, started in the US and Canada, has also been adopted in Germany, Switzerland, Japan and the Netherlands. Professor Dame Sue Bailey, chairman of the academy, said: ‘The whole point of Choosing Wisely … is not and will never be about refusing treatment or in any way jeopardising safety.

‘It’s just about taking a grown-up approach to healthcare and being good stewards of the resources we have.’

The academy is urging doctors to give patients more information about the risks of medication. It also wants NHS managers to consider financial rewards for hospitals and health bodies where doctors prescribe fewer drugs.

The BMJ piece cited a recent report by the academy, which argued doctors have an ‘ethical responsibility to reduce this wasted use of clinical resource because … one doctor’s waste is another patient’s delay’.

In another BMJ article, Professor Goetesce, of the Nordic Cochrane Centre, Copenhagen, warns drugs including antidepressants, sleeping pills and antipsychotics are causing more than half a million deaths in the Western world a year. His research did not estimate the number of UK deaths but if the trends are applied, there would be about 37,000 annually.

The professor states that the odds of a patient over 65 dying within a year is 3.6 per cent higher if they are on antidepressants.

It is 1 per cent higher if they are taking a benzodiazepine medication – a tranquiliser or sleeping pills – and 1 per cent higher for antipsychotics used for dementia.

These drugs have been linked to heart disease, brain damage, suicide and in the case of antipsychotics, rapid memory decline and early death.

Professor Goetesce said ‘biased’ or unfair trials by drug firms ‘overstated’ the benefits and ‘understated’ the number of deaths.

Source Mail Online

Britain has fewer doctors, nurses and crucial medical equipment than other wealthy nations

The UK has fewer doctors, nurses, hospital beds and crucial medical equipment than most other wealthy nations, a report has found.

There were just 2.8 doctors and 8.2 nurses for every 10,000 people in 2012, according to the Economist Intelligence Unit (EIU).

The other wealthy countries in the Organisation for Economic Co-operation and Development (OECD) had averages of 3.2 and 8.9 respectively, with the EIU describing the UK figures as ‘worrying’ – as there is a strong link between staff numbers and patient outcomes.

It pointed to the Mid Staffs scandal which saw hundreds die as a result of poor care, with low staffing given as a reason for the hospital’s failings.

The report also warned that although both Labour and the Tories are promising more doctors if they are in power after the General Election, self-employed GPs in the UK are already the highest-paid in the list, earning 3.6 times the average wage, meaning it would be expensive to employ more.

At the same time, too much wage restraint would put off new recruits, it added.

Salaried GPs and hospital doctors have far more modest earnings although nurses’ wages are also comparatively high, it said.

The EIU said it would be cheaper in the long term to invest in more permanent staff rather than spending millions on agency workers.

It described administrative staff as an ‘easy target’ for job cuts because their contribution to care is less obvious, but it said the administrative costs of the NHS are low compared with other countries.

The UK has fewer doctors, nurses, hospital beds and crucial medical equipment than most other wealthy nations, a report has found

In terms of physical resources, the report said the situation in the UK was even worse, ranked near the bottom of the OECD league with just 2.8 hospital beds per 1,000 population against an OECD average of 4.8. In Japan there were 13.4 per 1,000.

The UK had less than half the amount of equipment – such as CT scanners and MRI units – than the average, at 6.8 and 8.7 for a million people.

Overall it ranked 28th out of 30 countries for healthcare resourcing, with only Israel and Turkey coming out worse.

The UK fared better on the charts for healthcare spending – in 16th place out of 30 – but the report suggested this meant it is not getting the best value for money, while the amount being spent seems to be running ahead of funding, leading to growing budget deficits at many hospitals.

It said that although the UK healthcare system holds up well against its OECD peers judged on cost-efficiency, compared with other wealthy countries, the UK does not spend much on healthcare ‘and, in terms of equipment and staffing, it shows’.

The UK was also ‘mediocre’ in terms of outcomes, with life expectancy lower than in countries such as Japan, where older people are healthier.

Cancer mortality rates are higher than the OECD average, but the prevalence of diabetes is still relatively low compared with countries including France, Germany and Japan.

There was also good news for the UK’s performance in terms of equity, where the report said it ‘outperforms’ due to the NHS principle of free care at the point of use, meaning the gap between the care received by those on low incomes and those on higher incomes is smaller than in most OECD countries.

The report’s author, Ana Nicholls, said: ‘Although recruitment has already picked up, it is clear that NHS resources are very stretched compared with those in other OECD countries.

‘A tight budget will make it hard for politicians to fulfil their promises of extra funding, but resourcing will only become a bigger issue as the population ages.’

‘GREEDY’ PRIVATE SPECIALISTS UNDER FIRE FOR ‘PREYING ON THE NEEDY’

Doctors who treat patients privately are like the ‘greedy preying on the needy’, a consultant claims.

Heart specialist John Dean said private healthcare was a ‘con’ as doctors were more worried about making a fat fee than providing the best care. The consultant – who has just given up private work – said the conduct of some private doctors ‘bordered on criminal’.

Doctors tend to keep NHS patients waiting ever longer so they pay to have private treatment, he said. And a ‘jealousy’ exists between many consultants over how much each earns privately.

About 40 per cent of the 40,000 NHS consultants do some private work. Some can more than double their salaries, which range from £75,000 to £100,000.

The rules in their contract state that they must carry out ten sessions for the NHS a week – each lasting three to four hours – but are then free to work privately.

Dr Dean, who is based at the Royal Devon and Exeter Foundation Trust, said in an article for the BMJ that this private work ‘deprives the NHS of a valuable resource’.

The British Medical Association said doctors had to put NHS patients first. It added: ‘There should be no conflict of interest.’

Source Mail Online

British Medical Association under fire for offering doctors cheap alcohol

The British Medical Association (BMA) is facing allegations of hypocrisy after the magazine distributed to its 153,000 members contained cut-price drinks deals.

The professional body has previously pledged support for minimum alcohol pricing. But last week, readers of the British Medical Journal (BMJ) received a £60 voucher from Naked Wines.

Don Shenker, the founder of the awareness group Alcohol Health Network, described the decision as “retrograde”.

“It’s very surprising that the BMA has allowed this to happen as doctors more than anyone know the damage that alcohol can cause if abused,” he told The Independent.

The row comes less than a year after the group cut ties with another wine club amid concerns that the position was at odds with its support for minimum pricing.

Owned by the BMA, the BMJ is free to all members but also has thousands of private subscribers. A spokesman for the BMA said: “Every decision is taken by the editorial board of the BMJ. The BMJ publishing organisation makes the decisions.”

Sourced from the Independent Online

New medal for medical staff and military personnel who battled Ebola Prime Minister announces new medal for doctors, nurses and soldiers who battled Ebola epidemic in west Africa

Doctors, nurses and military personnel who travelled to West Africa to battle Ebola will receive a new medal, the Prime Minister has announced.

David Cameron said that the 2,000 UK nationals who took part in the fight against Ebola will be eligible for the medal. Hundreds of NHS workers responded to a nationwide appeal and travelled to Sierra Leone, risking their lives to stop the epidemic.

Mr Cameron said that he was in talks with the Queen over a new campaign medal to be awarded for volunteering to help with the Ebola crisis.

Mr Cameron announced the new medal during his weekly questions in the House of Commons. The Prime Minister said it was to mark the “immense debt of gratitude” owed by the country.

NHS medics train to tackle to Ebola in Sierra Leone

The medal will be an “Order of Wear” decoration, so that military personnel can also wear it.

Pauline Cafferkey and Will Pooley are two British nurses who contracted the virus after working in Sierra Leone. Both recovered after being treated in the UK.

The number of people contracting Ebola has fallen dramatically in recent weeks, although more than 7,800 people have died, almost all in West Africa, since it broke out a year ago.

The World Health Organization says the number of people infected by the disease in Sierra Leone, Liberia and Guinea has now passed 20,000.

Most of the British health staff worked at the Kerry Town complex outside the capital Freetown. The facility was built by British military personnel and includes an 80-bed treatment centre managed by Save the Children.

Mr Cameron was asked by Conservative MP Margot James whether the bravery of people working to tackle the “scourge” of Ebola would be recognised.

The prime minister agreed, saying they were “incredibly brave people who have worked in very difficult conditions, including many of them over Christmas”.

He said: “They are the people who are helping to save thousands of lives in Africa and protecting the UK from the potentially disastrous consequences of the disease spreading. In recognition of the bravery of those from the UK, I intend to recommend to Her Majesty the Queen a new medal to pay tribute to their efforts.” 

Source The Telegraph

Learning disability GP health checks ‘show results’

A scheme getting GPs to offer health checks to patients with learning disabilities in England is helping to pick up problems, research suggests.
A study in Lancet Psychiatry, looking at data for more than 8,000 patients, found surgeries in the scheme were twice as likely to identify problems.
But many patients who are entitled to the checks are still missing out.
The Down’s Syndrome Association said there was a lack of awareness that the health checks were available.
Learning disability health checks were introduced in 2008 through GPs surgeries as a way of monitoring the health of this vulnerable group of people.
NHS England decided to pay GPs as part of an incentive scheme for carrying out the health checks.
People with learning or intellectual disabilities, such as Down’s syndrome, are known to have significantly poorer health than other people.
This is because they find it more difficult to talk about symptoms and are less likely to make appointments to talk about their health problems.

‘Barriers’

Lead researcher Andre Strydom, reader in intellectual disabilities at University College London, said there was good evidence that health checks for people with learning disabilities could help identify previously unrecognised health problems.
His study, comparing the results of health checks performed by GP surgeries who signed up to the scheme and those surgeries who did not, found that health concerns were picked up twice as often when surgeries got involved.
“We found that surgeries who did health checks did much better – they offered blood tests, reviewed the patients’ medication, and drew up health action plans for the next year.”
But even with six out of 10 surgeries signed up to the scheme in England, 40% of patients with learning disabilities did not receive a health check.
Dr Strydom said this may be owing to the fact that a large number of people with these disabilities were not on the list to receive a health check.
Either they were not known to local social services or their GP, or they were known but had been given the wrong patient code which meant they missed out when the list was collated, he said.
Stuart Mills, information officer at the Down’s Syndrome Association, said there could be many reasons why this group of people were not being offered the health checks.
“It’s a relatively complicated picture. It’s down to a lack of awareness, not being on the disability register, and the fact there are more barriers for people with Down’s syndrome.”
He said the Association wanted to increase awareness that people with Down’s syndrome were entitled to a health check.
The charity has also produced information booklets for GPs about potential health problems, which can include hearing and sight problems, thyroid conditions and muscular-skeletal problems. Depression is also a common health issue.
Although there was evidence some people were being given good health checks, others reported that their health checks were poor and lasted only 15 minutes, however.
Source BBC News

Visit hospital in the morning to be sure of a doctor with clean hands

Patients are more likely to see doctors and nurses with clean hands, putting them at lower risk of acquiring an infection, if they go to hospital in the morning, a study suggests.

Researchers looked at three years of hand-washing data involving 4,157 staff at 35 hospitals in the united states

Long days on the wards lead to medical staff increasingly neglecting to wash their hands towards the end of a shift, researchers discovered.

The demands of the job eroded the mental reserves that doctors and others dealing with patients needed to keep following the rules, they concluded.

Researchers looked at three years of hand-washing data involving 4,157 staff at 35 hospitals in the United States.

Protocols said that staff should wash their hands within a given time of going in and out of a patient’s room.

But the researchers found compliance dropped by an average of 8.7 percentage points between the beginning and end of a typical 12-hour shift. The effect was greater when staff were working harder.

It was enough to produce an extra 34 infections per 1,000 patients, a separate study cited by the researchers suggests.

“Just as the repeated exercise of muscles leads to physical fatigue, repeated use of executive resources (cognitive resources that allow people to control their behaviour, desires and emotions) produces a decline in an individual’s self-regulatory capacity,” the researchers wrote.

Staff tended to follow hand-washing rules more carefully after longer breaks during a shift, they discovered.

“Demanding jobs have the potential to energise employees, but the pressure may make them focus more on maintaining performance on their primary tasks (e.g. patient assessment, medication distribution), particularly when they are fatigued,” said Hengchen Dai of the University of Pennsylvania, the lead researcher.

“For hospital caregivers, hand-washing may be viewed as a lower-priority task and thus it appears compliance with hand hygiene guidelines suffers as the workday progresses.”

Hand-washing in hospitals has previously been demonstrated to reduce infections and save money.

In a Swiss study, researchers found that a 1 percentage point increase in hand-washing compliance reduced the number of infections by 3.9 per 1,000 patients.

Dr Katherine L. Milkman, another member of the American research team said it believed its study to be the first to look at the effect over the course of a working day, rather than over weeks, months or years.

She said similar research could be applied to ethics standards in banking, or safety in other lines of work.

The researchers employed data from a company that uses radio tags to monitor whether health staff wash their hands when entering and leaving a patient’s room.

Sixty-five per cent of the hospital staff in the sample were nurses.

Doctors accounted for 4 per cent, and therapists, technicians and others having direct contact with patients made up the rest.

The research is published by the American Psychological Association.

Source The Telegraph

Doctors and nurses told to slim down for sake of patients

Overweight doctors and nurses would be told to slim down to set a good example to patients under plans being considered by the NHS.

Burgers and chips in hospital canteens would be swapped for healthier options and staff would take part in weight loss competitions, the NHS England chief executive, Simon Stevens, told the Sun.

About 700,000 of the NHS’s 1.3 million staff were either overweight or obese, the newspaper claimed. To help address this, more gyms would be built and NHS sites would be made more cycle-friendly, while prizes such as pedometers would be offered to staff who shed pounds.

Stevens said rising obesity rates were bad both for people’s health and for the health service itself, and tackling obesity would put less pressure on the nation’s finances and free up funding for new treatments.

Recent figures show that almost three-quarters of people aged 45 to 74 in England are either overweight or obese. Young adults are the only age group who have a normal average body mass index, according to the Health and Social Care Information Centre.

The NHS is facing a funding crisis and senior health figures have said it may need an extra £30bn by 2020 to maintain the current level of service provision. Stevens told The Sun: “It’s hard for the NHS to talk about how important this is if we don’t get our own act together. I think the NHS has got to take an example in helping our own staff and hopefully other employers will follow suit.

“A lot of the food in hospital canteens, not just for patients, but for staff, is chips and burgers. The NHS as an employer, for our own nurses and other staff, could we offer positive incentives? Yes I think we could. And some hospitals have begun doing that.”

Stevens also called on parents to swap juices and fizzy drinks during meal times for water or milk.

Looking to the future, he said progress in technology would keep patients out of hospital as people lived longer, and he wanted greater partnership between the NHS and social services.

“What’s great about the NHS can’t excuse what needs to change about the NHS. That is the approach that we have got to take. We’ve got to support people doing great things, nurses, doctors, the frontline of healthcare. But we’ve also got to raise our game.”

Stevens called for thousands more GPs to be trained, and for them to have more power to make decisions about how NHS money is spent.

Source The Guardian