Healthcare Republic

Should the government ban 24-hour drinking (again)?

Neil Durham — Thu, 04 Dec 2008 00:01:00 GMT

Whilst tempting to raise both a glass and 2 fingers to the government's pre-Christmas efforts to crackdown on binge drinking perhaps we should first ask whether it has gone far enough?

After all in June 2007 CMO for England Sir Liam Donaldson urged a review of the 24-hour licensing change.

In the same month researchers found that overnight visits to emergency departments for alcohol-related problems have almost tripled since 24-hour licensing laws were introduced

Is the government's ban on ‘all you can drink' promotions in pubs and bars in yesterday's Queen's Speech a case of locking the stable door after the horse has bolted (or downing a glass of water, if you will, after half a dozen pints of Wifebeater)?

Other measures include ensuring that customers in supermarkets are not required to buy very large amounts of a product to take advantage of price discounts and ensuring that consumers are able to see unit content of all alcohol when they buy it.

All very laudable and perhaps odd, you might think, from a government which welcomed us with open arms to the wonderful world of 24/7 alcohol.

Should the government ban 24-hour drinking? Here's why I don't think it will.

When I was a crime correspondent in Exeter, Devon, in the mid 90s I accompanied the police on all manner of eye-opening operations, including patrolling the cathedral city's streets at both pub and club chucking-out times.

What I witnessed was the madness of throwing the city's most-inebriated population out on the streets from every licensed establishment at exactly the same time. Violence breeds violence and incredibly high police numbers at huge expense were required to deal with the phenomenon across the city at multiple locations at precisely the same times.

One of the few things 24-hour licensing achieved was the eradication of such flashpoints at 11.30pm and 1.30am (depending upon local licensing laws). However, whilst it made inroads into the 'one-for-the-road' culture of downing an actually-unwanted drink at last orders, it failed to do anything to tackle binge drinking.

Perhaps we should take a tip from Scandinavia and tax our alcohol so heavily it is prohibitively expensive to drink to excess instead?

neil.durham@haymarket.com

Are modern nurses uncaring and slovenly?

Sarah Wild — Wed, 03 Dec 2008 11:53:00 GMT

Nursing has always been a trusted profession, strongly associated with caring. Doctors also register high in dependability, topping Ipsos Mori's ‘most trusted' poll once again this year (funnily enough, journalists languish at the bottom, only beaten by politicians in the least trustworthy stakes); however it is nurses who tend to be considered most empathetic, most approachable and most likely to see the human side of a patient's condition.

Doctors might argue that nurses have time on their side thanks to their longer consultations, but nurses feel that ‘caring' is integral to their profession which embraces an holistic ethos of patient care and is all about treating the person and not the illness.

Working for several years on Independent Nurse has shown me first-hand how closely nurses identify with their patients: it can be harder to ascertain nurses' views on their own pay and conditions than their concerns about patients. When they do consider their own needs, it is often in relation to the potential impact on the people for whom they care. For example, the knock on effects of insufficient training or understaffing on essential services or opportunities to innovate.

However, criticisms of nursing have been gathering momentum: in yesterday's Daily Mail, an article appeared entitled ‘Uncaring. Slovenly. Some of our nurses are a disgrace.' Written by lecturer in nursing Lorraine Morgan, this outlines Ms Morgan's outraged account of the treatment of her elderly aunt at the hands of hospital nurses, between 2005 -2006.

She describes the ‘neglectful care' experienced by her aunt due to inattentive staff who ‘consistently failed to wash her for months, feed her or give her anything to drink'. Lack of fluids and nutrition left her aunt frailer, weaker and suffering kidney failure and she contracted cellulitis, followed by MRSA. She also fractured an arm falling out of bed (no protective cot sides having been attached to her bed) and her condition generally deteriorated.

On one occasion, Ms Morgan found her aunt dressed in a gown four sizes too big for her; this had fallen off her right shoulder, exposing her naked chest to the elderly man in the nextdoor bed.

This is not just a one-off case of Daily Mail hyperbole; earlier this year, nurses were branded ‘grubby, drunken and promiscuous' by Tory peer Lord Mancroft, during a debate in the House of Lords.

He insisted that it was ‘a miracle' he was still alive after his experience of filthy wards and ‘slipshod and lazy' nurses, when admitted to the Royal United Hospital in Bath.

Lord Mancroft particularly objected to nurses talking over his bed, as if he wasn't there, so that he knew ‘exactly what they had got up to the night before, how much they drank, and exactly what they were planning to do the next night.'

In light of such experiences, patient representative organisation, Patient Concern, has accused nurses of losing touch with the job by ignoring patients' basic needs as they take on more responsibility in their specialist roles.

The perception is that reductions in ‘care' are directly proportional to medical advances, with the focus now being on new drugs and treatments rather than on the quality of care and attention provided to patients; nurses are becoming increasingly trusted as experienced professionals, taking on advanced roles and prescribing from the full formulary, but less trusted by their patients, who value the human touch they used to receive.

Not all nurses should be tarred with this brush (criticisms are generally aimed at the younger, less experienced nurses working in hospitals, and at agency staff); nor are pressures on time, money or hospital beds the fault of the nursing profession.

However, mud sticks.

Let's hope that this shift of image can be swiftly nipped in the bud. After all, much lip-service is paid by ministers to the concepts of ‘patient-centred care' and ‘patient choice' and most nurses generally are attentive and caring.

Helpful initiatives include the RCN's recently launched campaign to ‘put dignity at the heart of health and social care'. This provides a complete package of resources created by nurses, for nurses, to help put dignity at the heart of everything they do.

As RCN chief executive and general secretary Dr Peter Carter makes clear: ‘Dignity should not be an after thought or an optional extra. Each and every patient - whether they are in a hospital, a GP's surgery, in the community or in a care home - deserves to be treated with dignity and respect. Dignity should be integral to nursing care and this campaign is a big step in the right direction.'

Fighting cuts to dementia services

Emma Bower — Tue, 02 Dec 2008 10:34:00 GMT

Today, the Daily Mail launched its Christmas appeal to raise funds for the Alzheimer's Society using figures exclusively obtained by GP as the basis for the campaign.

These figures, which we first published in October, showed that one in four PCTs had closed or reduced dementia services in the past three years and less than half have early detection services in place. This is despite the fact that 98 per cent claimed that dementia care was one of their main priorities. The findings were revealed after GP obtained data from 57 PCTs across England under the Freedom of Information Act.

These statistics are shocking and astonishing, particularly given the grim predictions about the number of people who will develop dementia in the coming years.

Dementia is a terrible condition that slowly robs people of themselves and is agonising for family members. GPs, faced with patients and carers who are struggling to cope, have little option in terms of where to refer them because, as our figures show, the services are simply not there. It is difficult, and in some cases impossible, for them to get their patients the help that they need.

It is not good enough for PCTs to claim that their older peoples services or mental health services can provide such specialist care. As the Alzheimer's Society points out, dementia sufferers have very specific needs that require regular support.

But its not just specialist services that PCTs are cutting back. Over the past few years, GP's sister title Independent Nurse has regularly reported on cuts to district and community nursing teams. These are often the very staff that can help patients with dementia remain at home with their families for longer and provide much needed support to carers.

In October, when GP first ran the story on dementia service cutbacks, we also reported that the DoH was planning to release the first national dementia strategy in November. This has not materialised and, as yet, there is no sign of when it will be unveiled.

With rates of dementia likely to increase dramatically over the next decade it is vital that we start planning for the future and ensure the NHS can meet both current and future need - at present it is clearly unable to do either. The DoH's new strategy, backed by adequate funding and guidance and support for frontline staff and PCTs, would be a good place to start - let's hope that the department manages to publish it some time soon.

Condom sales rise as recession hits DIY activity

Colin Cooper — Mon, 01 Dec 2008 10:53:00 GMT

The recession might be curtailing our lifestyles in many ways but it seems that sexual activity is on the rise.

We heard last week how the BPAS was dishing out free emergency contraception for the festive season. And now I read that sales of condoms climbed to a new peak in the six months to September this year.

(Slight pause while I consider whether to continue with the onslaught of crude wordplays...)

Durex reported sales reaching a crescendo of £105m, up 7 per cent on the same period last year. So what's fuelling the surge in demand?

My theory is that the dreadful summer weather, coupled with reduced spending power, forced people to spend more time indoors and seek alternative entertainment.

There is also generally less to do indoors because people can't afford DIY products. This is borne out in the latest results from Topps Tiles, where revenues have fallen off a cliff.

And while some people have turned to cheap and cheerful sexual activity to help beat the credit crunch blues, and keep warm, others will have been taking a 'belt and braces' approach to their sex lives to ensure they definitely don't have any more mouths to feed during tough times.

But one thing still perturbs me. How can a company that sells condoms and sex toys also produce wooden sandals with the mission of enabling ‘people across the globe to enjoy healthier, more comfortable and better-looking feet'?

Saucy Santa and a bit too much Christmas spirit

Emma Bower — Fri, 28 Nov 2008 10:54:00 GMT

Today, the British Pregnancy Advice Service announced that it is to provide free emergency contraception at several of their city-centre clinics in the run-up to Christmas.

The move is being supported by an advertising campaign, with the strapline ‘Santa only comes once a year... but that's all it takes!' and an image of Santa about to do a little bit more than just kiss under the mistletoe.

As the charity points out, in the run-up to Christmas people tend to get a bit carried away. A heady mix of festive spirit and alcoholic spirits (or beer, or wine) can lead to unintended consequences. Or to women simply forgetting to take their regular contraception.

Then there is the problem of accessing emergency contraception over the holiday period when practices, pharmacists and family planning clinics are closed.

So, from next week, women will be able to go to BPAS and get a free ‘Emergency contraception pack' after a consultation with a nurse. It all sounds very sensible to me.

Of course some people will object and claim that it increases the likelihood of women having unprotected sex, but research suggests this is not the case.

The Faculty of Family Planning and Reproductive Health Care support advanced prescribing of emergency contraception. Its guidance says that randomised trials have shown that, for selected women, advance supply is safe and effective and may reduce the rate of unintended pregnancies without increasing the number of women having unprotected sex.

BPAS's plans made me wonder if anyone else was attempting to tackle other problems caused by Christmas excess. A cursory look round the net threw up another winning idea. Apparently female revellers in Torbay, Devon, who look like they might be struggling in their high heels, and therefore more prone to injury, are to be offered flip-flops to help them get home.

And, of course, all of the high street stores are now so desperate for our business they are slashing prices, which will clearly help protect our wallets.

Now, if someone could just come up with something to help us deal with the family stress associated with Christmas excess, that would be the best present of all. Any suggestions on this are welcome...

Make love not war - but don't call me 'dearie'

Neil Durham — Thu, 27 Nov 2008 01:00:00 GMT

I wonder what nurses make of the Nursing and Midwifery Council (NMC) draft guidelines that they should not call older patients 'dearie' or 'love'?

The NMC argues that nurses should treat people as individuals, find out what they would like to be called and then do so.

But I can't help but wonder whether any of those responsible for drawing up the guidelines have ever travelled north of Watford or indeed west of Winchester?

It might come as a shock to them to know that there are some parts of the UK where you can't pop out for so much as a pint of milk without someone referring to you as 'love' or 'dearie' and surely such terms of endearment make the world a rosier, lovelier and less gloomy place? Or perhaps that's just me.

Would I find it less acceptable to be referred to in such terms if I were subject to an intimate procedure rather than popping out for a pint of milk? Possibly.

The guidelines do say: 'It is important to recognise that regional variations exist where such terms may be part of everyday speech and it may appear unusual if they are omitted.'

I can't help but wonder what my grandparents would think? I suspect my grandmother would probably call me 'love' or 'dearie' when she answered.

Shadow Conservative health minister Anne Milton says: 'I think most people will see guidance such as this as the world having gone mad.'

I think she has a point.

What next? Should we lobby for the sacking of Strictly Come Dancing judge Craig Revel Horwood on the grounds of his over-use of the word 'darling'?

As a patient (although admittedly not yet an older one) I want the best treatment in the most hygienic surroundings. Everything else, including the words used to accompany my care, is secondary and calling me 'love' or 'dearie' might actually be preferable to plain old 'Neil'.

But what do you think?

neil.durham@haymarket.com

Why won't nurses be able to issue 'fit notes'?

Sarah Wild — Wed, 26 Nov 2008 11:46:00 GMT

Malingerers be warned: from 2010, paper ‘sick notes' are to become electronic ‘fit notes', shifting the focus from what patients are not able to do due to their illness or disability, to what they can achieve.

It is interesting to note how this simple exchange of words has totally changed the emphasis of the concept, much like renaming ‘credit cards' ‘debt cards' or describing musty old second-hand clothes as 'vintage'.

Unlike ‘sick notes' which were often misused by healthy patients who fancied a few days (or years) off work, the new system aims to help people to stay in work rather than drifting into extended sick leave; it will support those with disabilities or long-term sickness to find jobs that they are capable of doing (should any jobs still exist by 2010).

The package of initiatives was announced yesterday by work and pensions secretary James Purnell and health secretary Alan Johnson in the report Improving health and work: changing lives. Proposals include providing people in the early stages of illness with access to services such as physiotherapy and counselling, to prevent their condition from deteriorating.

Those who are off work due to illness will be given a tailored ‘fit to work' programme, which might include exercise, therapy, occupational health support, or advice and support on issues such as finance, housing and childcare, enabling a gradual return to work schedule. It might involve them taking on restricted duties or accepting changes to their role.

This seems a practical revamp of the scheme (which hasn't been altered since 1948), enhanced by welcome messages of positivity and self-responsibility. The DoH and RCGP are producing guidance to train GPs on handling work issues, while the BMA is broadly supportive of the new system, though GPC deputy chair Richard Vautrey warns that GPs cannot become an arm of the Benefits Agency!

Other potential downsides include the electronic nature of the system, given the way in which NPfIT has progressed (perhaps soon to be renamed NPSICK?), and the workload implications for GPs.

Then there's the report's failure to mention nurses, who have repeatedly urged ministers to allow them to sign sick notes. They have pointed out the ridiculous anomaly that nurse practitioners are allowed to advise people to take time off work, yet have not been not allowed to sign the forms.

This overhaul of the scheme would have been a sensible time to address this issue, which is a significant bugbear for nurses, who now carry out a a third of GP surgery consultations. It would also lessen the workload implications for GPs.

Commitments to piloting the writing of sick notes by nurses have been made - and reneged on - in the past and it seems that yet another opportunity has now been missed, and for no good reason.

What will Darling's pre-Budget mean for primary care?

Emilie Reymond — Tue, 25 Nov 2008 11:54:00 GMT

It's replaced the Baby P scandal on the front page of every national newspaper in the past couple of days, and in these times of economic turmoil, was probably the most anticipated government's announcement of the year: the pre-Budget report 2008. Although I am not sure which of the two stories makes me more depressed.

Chancellor Alistair "Diamond" Darling morosely unveiled his plans to tackle the economic recession and of course the medical community - well at least I am - was waiting with bated breath to know how bad it would be for the NHS.

To be honest, there is not much surprise here. Just a couple of mentions about the NHS budget - both expected - and lots of 'fiscal stimuli', as planned.

Darling said the government will bring forward £3bn of planned spending, which had been due to take place in 2010/11, and will now be carried out this year and next.

The DoH will introduce 'new models for providing primary care estate by enabling PCTs to extend Local Improvement Finance Trust (LIFT) public-private partnerships to the management of their entire estate'. In other words, PCTs will be asked to contribute to an extra £5bn of annual public sector savings in the next couple of years.

For those who need a bit of jargon buster here, LIFT is a form of public-private partnership implemented in 2001, involving the private sector in financing health infrastructure. It aims to upgrade or replace 3,000 primary care premises and fund 500 one-stop primary care centres, enabling co-location of GP, community and social care services. Concerns have been raised over affordability of these schemes.

The problem is only around a half of PCTs were involved in the original programme and the government recently announced it would develop an 'accelerated' version of LIFT, which will be open to other PCTs.

The pre-Budget report also said that £100m will be invested to upgrade of up to 600 GP surgeries into training practices, 'creating opportunities for small firms and targeting funding on those areas that have historically had a lower provision of doctors'.

That's what I call a stimulus plan. This, Darling said, will reduce the need for new hospital space by up to £3bn and save up to £100m per year of estate costs over the next spending period.

The risk here is that the DoH will end up spending money before it manages to save it...

The GPC was right to ask for 4 per cent

Colin Cooper — Mon, 24 Nov 2008 10:37:00 GMT

So at last it's out in the open. The figure we had all been waiting for has finally been uttered.

The GPC is seeking a 4 per cent rise in practice income for next year. In other words, double the rise that NHS Employers recommended in their evidence to the Review Body.

Is that really enough for GMS practices that will see net income fall 10.6 per cent in 2008/9 compared to 2005/6? And how about the increase in expenses, that has see staff costs rising by 8.5 per cent a year since 1999/2000?

Of course, this is not the time to be asking for big pay rises, and even four per cent looks huge against the pay freezes, pay cuts and job losses, that fill the national media every day.

Little matter that practices have been going through their own recession since the government decided to start clawing back the benefits of the GMS contract.

People have short memories. People read what is put in front of them. ‘Fat cat docs want double pay rise', would be an easy headline from the GPC pay evidence.

And yet, if they don't ask, they don't get. Look what happened to the nurse pay deal when the RCN cosied up with Alan Johnson.

The government has to be challenged to provide adequate funding for primary care. After all, that's what being asked for here. Less money going in to general practice means less money for patient care and less money for all staff working in practices.

So 4 per cent might seem big, but the case is strong and has to be put on record - even if there isn't a hope in hell of the government doing the right thing.

Facebook: nurses' friend or foe?

Emilie Reymond — Fri, 21 Nov 2008 11:26:00 GMT

Most people use Facebook and other social networking websites to (admittedly or not) impress their friends by posting pictures of themselves on holiday in Ibiza's top clubs, winning an award, climbing sand dunes, or just getting slightly tipsy at their friend's birthday bash (insert what makes you swollen with pride here).

There are always "friends" who feel the need to post pictures of you looking err... let's just say worse for wear, and then tag you just to make it even more irritating. But recently there have been examples of people, in particular from the medical community, who've taken it a little too far.

You might remember last August, a Swedish nurse was so keen to show off in front of her Facebook friends that she published photos of a patient going through brain surgery on her profile.

Not only did it obviously violate basic ethical codes, as pointed out by her chief of service - right after he suspended her - but you have to wonder how she managed to get a camera in an environment where recording devices are clearly banned (well, except for training purposes). Apparently the nurse, who reportedly 'wanted to impress her Facebook friends with her high-powered job', used a phone camera. She is now facing dire consequences for her behaviour.

Her actions were not only outrageous - who is actually impressed by someone showing off with pictures of medical staff holding bleeding bits of human flesh - but also open up a new can of worms as they could potentially break the trust between patients and operating staff. I mean, imagine waking up from 9-hour brain surgery and then a few weeks later discovering that one of the nurses helping the surgeon during the operation spent her time taking snaps of your open head instead of focusing on her job.

More recently, the press reported that staff at Northampton General Hospital have been banned from using social networking websites after a picture of a nurse flashing her breasts appeared on Facebook with, wait for this, patients visible in the background.

The hospital management said the picture, which was taken in February, is a breach of patient confidentiality and of course is inappropriate'.

It's just a shame as those incidents are clearly isolated - the brain surgery scandal appears to be the first case of medical indiscretion - but, because they're widely reported by the media, they tarnish the image of our nurses.

And Facebook gets more bad press. But there is another issue raised. It's the nurses' right to privacy. Details on how these pictures were found on the nurses profiles are unclear. Were they reported by other users? By their friends? In any cases, they were on the users' private profiles so they should have only been seen by their network of "friends" - which might have been considerably diminished since the incident...

Perhaps the line simply draws where personal use of these networking sites ends and the use of this type of platform to publish work-related content starts...

Sites like Facebook are fantastic tools, however, like any other new technology, as long as they are used reasonably for what they are intended to provide in the first place: social networking. I am not saying that only because we recently launched our Healthcare Republic page on Facebook, which by the way you can check out here.

There have been countless cases of people using their work email to send inappropriate messages (bullying, racist, misogynist, and perhaps the most deplorable one but I won't elaborate, click here if you want to find out more) but I haven't heard of any company banning the use of email by staff.

PBC must not end up on the scrapheap

Emma Bower — Thu, 20 Nov 2008 10:38:00 GMT

When practice-based commissioning launched in 2005 it was instantly hailed as the solution to all the NHS's ills in England.

The term ‘PBC' quickly slipped into the DoH's lexicon of acronyms, as ministers claimed it would unleash innovation among frontline staff, giving them the opportunity to shape how services were delivered. This, they said, would improve patient care and save huge sums of cash.

So here we are in 2008 and little progress has been made, according to a report published today by the King's Fund. The think tank says that in some areas PBC has completely ground to a halt.

This is not that surprising, considering that when the policy was launched there was little indication of how it would actually work in practice. There was an idealistic vision of a future utopian health service, but little about the nitty-gritty of actually achieving it.

The DoH, just embarking on its mission to decentralise the NHS and devolve decisions/any accountability to local trusts, left it up to PCTs to decide how things would work. This, coupled with some very vague overall aims and objectives, clearly made progress impossible.

Then there was the issue of ‘indicative budgets'. When PBC launched, the NHS was in the grip of huge financial deficits. PCTs were looking to claw back funds from wherever possible, so it is not surprising that GPs were wary about whether they would ever see the benefits of any money they saved.

Indeed, the King's Fund is recommending that government must give real budgets to commissioning groups if it is serious about getting PBC off the ground. This is a sensible idea, and would provide a proper incentive for commissioning groups, as is the idea to develop a ‘matrix' model that acknowledges the different levels of commissioning.

It is hard to argue against the sentiments behind PBC. Giving GPs and other frontline staff including nurses the ability to redesign services is surely to be encouraged. Clinicians have a much better idea about how services can be improved than office-bound managers and number crunchers at the PCT and this, therefore, means better care for patients.

More needs to be done to make PBC work. The DoH needs to go back to the drawing board and come up with a plan to move things forward. As the King's Fund points out, there is enthusiasm for local commissioning out there, but it is dwindling. It would be a real shame if that was lost and PBC was consigned to the DoH's ‘failed policy' scrapheap.

COPD overhaul long overdue

Sarah Wild — Wed, 19 Nov 2008 11:30:00 GMT

It still amazes me that, although chronic obstructive pulmonary disease (COPD) affects 3.7 million people in the UK, and is expected to become the world's biggest killer by 2020, barely anyone I know (outside of the office) has heard of it.

Emphysema is better understood, but not necessarily by younger people, if my recent straw poll of family and friends is anything to go by; those who are smokers did not particularly associate COPD with their habit, despite the fact that smoking is the primary cause of the disease

It seems that a public awareness campaign is much needed, along with systematic spirometry testing, according to the British Lung Foundation (BLF). In a recent editorial in Independent Nurse, the Foundation's chief executive Dame Helena Shovelton stressed that spirometry testing should be included in proposed health MOTs.

This would need to involve significantly improved training and confidence in spirometry testing for primary care given that, this week, the BLF revealed that most GPs have difficulty telling COPD from asthma. A poll of 776 GPs showed that 80 per cent of doctors found differentiating between asthma and COPD ‘quite' or ‘very challenging'.

The study also identified that one in 10 GPs did not have staff who had been trained to carry out or interpret the necessary tests. The BLF is consequently calling for everyone over 35 with asthma or COPD to be retested, since the long-term aims of asthma and COPD treatment are different and it is vital that people with either disease have an accurate diagnosis.

Preventing misdiagnosis may involve changes to the Quality Framework (the BLF says the GMS contract must reward clear diagnosis of asthma and COPD), plus an overhaul of NICE spirometry definitions: a recent story in Independent Nurse reported Dutch researchers' findings that, where a fixed cut-off definition of airway obstruction was used (as is recommended by NICE and other COPD guidelines) this led to misdiagnosis in around a quarter of patients

Meanwhile, The National COPD Audit 2008 (carried out by National COPD Resources and Outcomes Project and backed by the Royal College of Physicians (RCP), the British Thoracic Society and the BLF) found that treatment of COPD had improved since 2005 but is still patchy across the country.

Staffing in many COPD assessment units remains below the level recommended by the RCP; insufficient information is given to COPD patients; and the provision of palliative care services is highly variable.

Clearly, a great deal needs to be done to reduce inconsistencies in COPD services, to boost public and physician awareness of the disease, and to improve skills in testing and diagnosis.

The good news is that the government in England is due to publish a national strategy for COPD next year, which should aim to address at least some of these issues.

The bad news for busy primary care health professionals is that it looks as if a great deal more work is about to be coming their way!

Should nurse practitioners replace GPs?

Neil Durham — Tue, 18 Nov 2008 08:41:00 GMT

Healthcare Republic rubbed shoulders with 160 or so nurse practitioners at their annual conference in Liverpool on Friday and Saturday - and what a fine setting it was.

The main hall at Aintree Racecourse is actually on the fourth floor of the main stand and has windows the entire length of one side looking out on to the historic course.

But this wasn't the only eye-opening view available over those two days.

Check out this week's GP for former GPC negotiator Dr Simon Fradd's thoughts (and figures) on how nurse practitioners could replace 88% of GPs.

Yes, 88%.

If you thought that unemployment was the biggest issue facing the GP profession, as GPC chairman Dr Laurence Buckman does, this view from one of his former colleagues (and co-architect of the new GMS contract) might set alarm bells ringing.

Tomorrow lunchtime Healthcare Republic invites you to debate this issue as we launch our Young GP Forum on this website.

The mood among those present at the Nurse Practitioner Association conference seemed to be that the profession needs accreditation before private providers truly make their mark on primary care.

As a journalist it baffles me why the DoH has dragged its heels over this issue for so long. Is it simply a question of cost to the taxpayer or does it conveniently leave the door open to private providers to employ nurse practitioners in name only at a fraction of the cost of either trained nurses or GPs? As a patient it sounds like something to worry about.

Elsewhere, a nurse practitioner who supervises FY2 doctors explained how she was treated by GPs during training days.

RCN chief executive and general secretary Peter Carter explained that much-criticised health minister Lord Ara Darzi was actually ‘a friend of nursing' because he had trained the first nurse endoscopist in the 1990s despite being accused of treachery by his colleagues.

Nurses didn't get off scott free - Mr Carter said they had been ‘politically naïve' to barrack former health secretary Patricia Hewitt two years ago.

Look out for more coverage from the conference, including how to set up a social enterprise to be commissioned to take on work from primary care organisations (PCOs), in the next edition of Independent Nurse dated 8 December.

On the Friday evening the assembled nurse practitioners were able to let their hair down to the sounds of an Abba tribute act.

Whatever your thoughts about nurse practitioners, there is no doubting their enthusiasm to take on more responsibility in primary care.

The question is: do you think nurse practitioners should replace GPs?

Will your answer be I Do, I Do, I Do or SOS?

neil.durham@haymarket.com

Another assault on patient confidentiality

Colin Cooper — Mon, 17 Nov 2008 11:02:00 GMT

Not content with nationalising the banks, Gordon Brown is looking to take control of our most intimate medical details.

He thinks that it's perfectly okay to allow researchers direct access to patient records in order to identify and contact candidates for medical research.

According to The Guardian (which is always right), the government has squeezed this in to the smallprint of the NHS constitution, which makes me wonder if we need an alternative constitution to protect our rights.

Apparently the government believes that having a medical professional involved the selection of research candidates is just slowing down the system.

But not every part of human life benefits from being quicker and more simply done - sometimes more time and thought is required to do things properly.

In this case we would be losing ethical checks and balances on patient confidentiality in order to boost some ill-defined factor of competitiveness in the international research market.

We're back to what Lord Owen described as the Hubris Syndrome, where political leaders stop listening to advice and start believing that they are instinctively right about everything. And we all know how good the government is at looking after our personal data...

GP reporter wins top news award

Emma Bower — Fri, 14 Nov 2008 11:00:00 GMT

Last night, a bevy of medical hacks, PRs and some of the great and the good from the world of medicine gathered together for the annual jamboree that is the Medical Journalism Awards.

It was a good night for GP. News reporter Tom Ireland scooped the best newcomer award for his story ‘GPs face charges for patients' visits to A&E'.

‘Within weeks of starting, Tom got this front page splash which was picked up by the nationals - a great achievement which bodes well for the future,' the judges said. Naturally everyone at GP and Healthcare Republic is delighted with the result.

GP's former deputy news editor, Rachel Liddle, was also shortlisted in the trade news category for her story ‘Bid to swap 60 QOF points for extended hours'.

Tom and Rachel were in good company, other winners included the BBC's Fergus Walsh, Guardian columnist and standard-bearer for scientific accuracy Ben Goldacre and The Times's science editor Mark Henderson.

The standard of entries was, as ever, exceptionally high and it is fantastic that members of GP's news team were judged to be among the best around.

As well as celebrating the best of medical journalism, the awards were also a chance for us journos to drink far too much wine, eat some rather nice nibbles and mingle with each other. It was a great opportunity to talk with our rivals (guardedly, of course), catch up with former colleagues and find out all the latest gossip.

One of the things that became clear to me last night is that healthcare remains a truly exciting area to report on. Whether it's recent scientific advances, the latest financial calamity or a new bit of DoH policy - there is always something interesting to write about.

Don't forget, that the GP and Independent Nurse editorial teams provide you with all the latest primary care and medical news every day on Healthcare Republic. You can sign up for our daily bulletin here.

Will replacing GPs with nurses boost appointments by 50%?

Neil Durham — Thu, 13 Nov 2008 09:47:00 GMT

Tomorrow I'm reporting from the annual Nurse Practitioner Association conference in Liverpool.

Chair Jenny Aston hopes in her welcome letter that we ‘will all go home refreshed and inspired'.

She describes the two-day conference at Aintree Racecourse as offering ‘many opportunities to update your skills and hear what is happening in different parts of the UK'.

One of the events I'm most looking forward to is an optional lunch-time session tomorrow with Dr Simon Fradd, chairman of Concordia Health and former GPC negotiator.

Dr Fradd holds the record on Healthcare Republic for being the subject of our most commented story.

In March Dr Fradd exclusively told Independent Nurse that practices could offer 50% more appointments if they replaced GPs with nurses.

The abstract of his session promises: ‘The medical world is now the nurses' oyster. Concordia Health has put prescribing nurses in the front line of its organisation. The results are so dramatic they are almost unbelievable.'

Elsewhere tomorrow Dr Michelle Drage, chief executive of Londonwide LMCs and a former GPC negotiator, talks about nurses and doctors sharing common goals but achieving them in different ways.

A talk on the Advanced practice succession planning development pathway by Maggie Grundy, programme director at NHS Education for Scotland, Aberdeen, and Janet Corcoran, lead practitioner for professional role and development, NHS Lothian, Edinburgh, is a subject close to the hearts of many of those planning to be present.

Saturday lunchtime Sue Cross, senior research fellow for primary care at London South Bank University, will talk about the future of the advanced nurse in primary care.

Read all about the content of the conference - including those dramatic and 'almost unbelievable' results potentially involving nurses replacing GPs - across Healthcare Republic, in Independent Nurse and my blog next week.

Big fat gimmick or genuine innovation?

Sarah Wild — Wed, 12 Nov 2008 11:41:00 GMT

Another day, another initiative to combat obesity. Sometimes feels as if we're fighting a losing battle against the bulging waistlines of the UK population. Same old advice, same old results.

I therefore empathise with the reaction of Lib Dems health spokesman Norman Lamb to the government's newly launched ‘healthy towns' scheme, which is part of its wider Change4Life campaign, announced in September. Under ‘healthy towns', Dudley, Halifax, Sheffield, Tower Hamlets in London, Thetford in Norfolk, Middlesbrough, Manchester, Tewkesbury and Portsmouth will share £30m of funding to develop innovative schemes related to cycling, walking, healthy eating and green spaces. The areas will all match the government funding.

Mr Lamb describes ‘healthy towns' as ‘at risk of being yet another time-wasting gimmick', while shadow health secretary Andew Lansley warns that it is ‘typical of a short-sighted approach to tackling public health issues', comparing it with the now defunct Health Action Zones.

And it seems they not alone in being cynical. Online news stories about ‘healthy towns', announced on Monday, have unleashed a plethora of furious comments. Apparently, people are tired of hearing about ‘new' ways to tackle the same problems.

Those who are within a healthy weight range are fed up that so much time and money is expended on a problem that they feel is within each individual's capacity to control. In a challenging financial climate they are angry that yet another £30m is being spent on ‘fatties, with zero self-control' (I quote, don't shoot the messenger).

Examples are as follows (not all of these are from the Daily Mail!):

‘Nice one. I'm going to start putting on weight right now in time for the handouts.'

‘So those of us who try our best to eat healthily get nothing as usual.'

‘Nothing but leftist, trendy bribery'

‘These people don't need £30m of ‘support' or ‘education'. There is nothing they don't know already'

This ‘sheer venom' (to quote an overweight respondent), poured forth on the forums, reflects a growing intolerance towards fat people which increases every time the government spends taxpayers' money on new ways to tackle the rising tide of obesity.

In the case of ‘healthy towns', most of the criticism is targeted at a project in Manchester upon which much of the news coverage has focused. Called ‘Points4Life', this is a loyalty scheme to reward people with free activities or healthy food when they take exercise.

To an extent, I can identify with the critics. I'm not keen on the idea of ‘rewarding' people for looking after their own health, albeit with free activities (ie more exercise!) and healthy food. It is a little patronising, smacks of the nanny state and sends out the wrong message: people should be helped to help themselves, not necessarily rewarded for doing so. They will be rewarded, in any case, with better health and a trimmer waistline.

This approach angers people who feel they are already looking after themselves and receiving nothing back from the State.

By contrast, I whole-heartedly believe that the secret of success is to make being healthy easy. If you put barriers in people's way, they will simply go back the way they came or find an easy way of going round them, they won't necessarily rise to new challenges. Therefore, I love Tower Hamlet's award scheme to encourage local businesses to sell healthy food. If healthy options are readily available in most shops and cafes, and clearly labelled as such, people have fewer excuses for ignoring them.

Likewise, I'm in favour of Sheffield's plans to make the city more breastfeeding-friendly and Thetford's ‘cycle-recyle' scheme to encourage people to buy and maintain bikes. How many people consider cycling to work, or simply for fun, but lack the encouragement from their family and friends or do not know how to maintain their bikes?

Schemes need to make practical and economic sense, just like Halifax's ‘grow-your-own fruit and veg' - which appeals because of its health benefits, while also making perfect sense on the financial front - and innovations they should capture the imagination: Portsmouth's signage to help walkers, runners and cyclists time their progress encourages (healthy) competition against oneself and other people.

Projects must be tailored to a range of demographics. As one of our GP advisers recently stressed, there is little point in giving people advice that is unsuited to their personal circumstances.

He had been struggling to explain to a group GP registrars the need for health professionals (and ministers, when dreaming up innovations) to put themselves in their patients' positions, trying on their shoes (figuratively speaking) and letting go of the values and assumptions that they themselves hold dear.

So suggesting to a single mother of four, who works part-time, that she join an expensive gym is an unrealistic proposition. However, transforming parks into family health zones (as planned in Dudley) provides an ‘on-the-doorstep' facility that the whole family can enjoy, while healthy ‘breakfast clubs' encourage healthy eating but in an appealingly sociable way.

Call me naïve, but some of these projects have piqued my interest just a little (in principle, at least) despite my initial scepticism. And, since the ‘healthy towns' scheme is backed by £30 million that can only be accessed through innovation, I hope that it will encourage local people to come up with some long-lasting, genuinely unusual solutions to a problem that does need to be tackled, whether we like it or not.

Is this the end of blogging?

Emilie Reymond — Tue, 11 Nov 2008 11:16:00 GMT

I don't often read The Economist. I usually do to either show off on the tube or because it's the only magazine left on the coffee table (my partner is a subscriber) after a frantic trip to the recycling bin downstairs. But I have to admit that every time I do, I actually get pleasure from all the articles I read and always say to myself I should cut down on Vogue reading and dedicate the 'authoritative weekly newspaper focusing on international politics and business news' more of my precious time.

In last week's issue, there was a really well written leader on the outcome of Barack Obama's election as President and what it means for the country. And there was also a 14-page special report on Spain, wittily called After the fiesta.

Little did I know that my Sunday afternoon cheerful mood was about to get dampened. While I was flicking through articles from Zapatero's new challenges to the future of Spanish economy, suddenly, there it was: the article I have been dreading for months. The truth I have avoided because it would make my Tuesday morning feel absurd and the time I spend writing this blog completely passé. Mind, I could have avoided it as the headline "Oh, grow up" didn't give anything away. But my eyes quickly stared at the bold introduction: ' Blogging is no longer what it was, because it has entered the mainstream.'

666 words to put any blogger off their favourite activity. According to the article, blogging has entered the mainstream, 'which - as with every new medium in history - looks to its pioneers suspiciously like death.'

Ok, you might think, that's perhaps a bit exaggerated, but when you read that even the godfather of blogging, aka Jason Calacanis, founder of Weblogs Inc. - one of the pioneering blog empires - has announced his 'retirement from blogging', you start thinking that the sceptics might be right. Worse still, Calacanis has reverted to email to share his opinions - the equivalent for us would be to go back to our old ways, i.e. writing stamped letters, which is, let's be honest, unthinkable.

So, is this the end of blogging? Is it now so accessible and ubiquitous that it's no longer worth it? Well, surprise surprise, I tend to disagree. Yes blogging has become ordinary and everyone basically can give it go. But there is still an elite of bloggers who are respected in their field and just the way columnists have their fan base among newspaper readers, bloggers are still able to build a readership within the web 2.0 sphere. The main reason is that whereas 10 years ago, a handful of elite bloggers were writing about everything and anything, today, millions of bloggers write about highly specific subjects and stick to it.

Yes, The Economist article is right, every newspaper, radio and TV channel now runs blogs and updates them faster than any individual blogger ever could. But is that a bad thing? Does that mean the death the traditional blog pages as we know them? Certainly not. It's just that blogging is no longer a revolutionary dissident nor is it avant-garde to disseminate one's opinions, but it is an established and well-known form of commentary online.

By the way, Healthcare Republic is looking for fresh talent for its Blog. If you are a GP or a nurse, agree that it's definitely not the end of blogging and think you've got what it takes to be a Healthcare Republic blogger, then get in touch by email healthcare.republic@haymarket.com.

How committed are private providers?

Colin Cooper — Mon, 10 Nov 2008 10:56:00 GMT

So another private provider pulls out of running a surgery - where is their commitment to patients and the good old NHS?

Just seven months in to the contract and Atos Origin have given up and will be leaving at the end of the year. Until then, they will be operating reduced hours. Fantastic.

Is this how the government sees our healthcare services being run in the future? Is this Darzi's grand vision?

It all looks good when there's money to be made. Lots of promises and plush premises. But at the first sign of trouble, they're gone.

And this is a surgery that the PCT said was needed in 2005 to cope with growing demand. This is long-term planning compared to the Darzi centres, so what chance do they have?

How many of these private companies being encouraged by the government to destabilise primary care are really committed to providing quality services over the long term?

I recently interviewed Professor Allyson Pollock, head of the Centre for International Public Health Policy at the University of Edinburgh, who has very strong (and depressing!) views on the way that the NHS is being run by Labour.

She asked: ‘What happens when the NHS is deregulated, the commercial providers have creamed off the profits and there is no more money to be had? What happens if they walk away?' That might sound unnecessarily apocalyptic but I'm beginning to see where she's coming from.

Were we right not to publish Dr Muhammad Siddiq's homophobic letter?

Neil Durham — Fri, 07 Nov 2008 01:01:00 GMT

You may have read elsewhere this week that Walsall GP Dr Muhammad Siddiq was suspended for 12 months by a GMC fitness-to-practise panel after sending a letter to Pulse in July 2007. Pulse did not publish the letter but used comment from it in a later article.

He wrote that gay people needed ‘the stick of the law to put them on the right path'.

What you won't have read is that GP received a letter with similar content at about the same time but chose not to publish it. Did we make the right decision?

I wasn't editing the letters page at that time but I can remember quite clearly my colleague who was showing me the letter and deciding that Dr Siddiq's views didn't deserve the oxygen of publicity that we could give them.

We also felt that GP's role is very much to promote the profession of general practice and to publish such a letter from such a prominent GP (Dr Siddiq was president of the Islam Medical Association) risked lowering it in the eyes of right-thinking members of society.

Sometimes as much thought can go into what doesn't appear in print as into what does. Although in the blogging age, there is an increasing tendency to publish rather than withhold or edit information.

But were we being over-sensitive? Did Dr Siddiq's views deserve to be 'outed'?

One of my colleagues asked me this week what GP would have done if we had received a letter from Dr Harold Shipman confessing to his crimes.

What we're interested in is knowing what you think.

neil.durham@haymarket.com

Pseudoscience and the cosmetic industry

Emma Bower — Thu, 06 Nov 2008 10:49:00 GMT

While reading the news yesterday I spotted a story about safety fears over nanocosmetics. For those who don't know, nanocosmetics make use of nanotechnology - where atoms and molecules are manipulated - in order to make skincare products, such as moisturisers and anti-ageing products, easier to apply.

However, Which? has concerns about this process. It wants more checks on the safety of ‘nano particles' and tighter regulation on their use.

Doctors, and dermatologists in particular, have long complained about claims made by the cosmetics industry. Companies make bold statements about the efficacy of their products, using scientific-sounding words that woo consumers into thinking they will smooth out wrinkles or banish cellulite, without being required to publish the results of any research or clinical trials. Such practices are impossible with medicines, and rightly so.

The ‘pseudoscience' of the cosmetic industry is one of the things that bothers Dr Ben Goldacre, author of the Guardian's Bad Science column and his own website of the same name. He has devoted many column inches to discussing the claims these companies make, in particular the advertisements or statements that attempt to blind consumers with science.

There are also safety concerns to consider. A Channel 4 Dispatches documentary on anti-ageing creams earlier this year found that there is now a dizzying array of products claiming very powerful effects (more so than the average face cream), some of which contain potent ingredients. Unlike medicines, these products are not required to carry health warnings.

It seems to me that there is a very strong case for more regulation of the cosmetic industry and that companies should be required to publish data from the trials that they conduct.

Even if they do, I'm not sure it would make too much difference to profits. People today seem so desperate to look as young as possible for as long as possible, or have the shiniest hair, or dimple-free legs that they will probably be prepared to try anything - even if there is only a slim chance of success. Some already pay huge sums of money for products that common sense tells them are unlikely to work – after all, how can a cream help you lose weight off your thighs?

As further evidence: on a recent holiday my husband, who was reading the book version of Bad Science, quoted the following passage to me:
‘...all creams will hydrate your skin and make you look good [...] And most cosmetics research, since you ask, comes down to conserving the moisturising properties of Vaseline, but avoiding the greasiness. Diprobase, at less than £10 for a half-litre tub, represents a pretty good stab at solving this problem.'

‘Aha,' said my husband. ‘Perhaps you don't need to spend so much on all those things cluttering up the bathroom.' Of course, I ignored him.

Equity is already a myth

Sarah Wild — Wed, 05 Nov 2008 11:42:00 GMT

Since ‘patient choice' is the oft-repeated slogan of the DoH, it seems only right that the ban on topping up NHS care, by paying for drugs not available on the health service, is being lifted.

Existing rules mean that people are excluded from the NHS if they opt to pay for treatment not freely available: picking and mixing NHS and private care is strictly forbidden.

Under new proposals (being put out to consultation until the end of January), people will be allowed to pay for top-ups without losing their basic NHS package of care, though this will not apply to implants used during operations, such as hip surgery.

Those paying for extra drugs will also have to cover the cost of any staff time, tests, or scans associated with that treatment and will pay to treat any side effects. They will have their treatment away from NHS wards, either in private centres or private wings of NHS hospitals.

This may sound reasonable, however, it does mark the official end of the health service as we know it, undermining the founding principle of truly ‘universal care for all' with treatment ‘free at the point of need.'

Unison's head of health Karen Jennings argues that top ups will ‘shake the very foundations of the NHS' predicting that medicine will follow the pattern of dentistry, while Dr Rob Glynne-Jones, chief medical advisor to the charity Bowel Cancer UK, warns of a degeneration into a ‘mixed economy with very basic health care provided by the NHS and other things being paid for like the model in the States.'

These forecasts may sadly come true, but it is not possible for the NHS to simply stand still. With our ageing population, plus the ongoing development of expensive new drugs, there are real limitations to what our health service can afford to provide.

Besides, things are not equitable, even as they stand: consider the ‘postcode lottery' for services and treatment (inevitable, when decisions are devolved to local Trusts); the differing standards of care; and the disadvantages faced by those living in deprived areas and by those not able to stand up for their needs or rights. Access is variable and we've had a two-tier system for years.

A former colleague of mine once wrote a feature for a national newspaper, describing the poor care her father was receiving in a dirty and understaffed London hospital. She found nobody willing to listen to her concerns until the article's publication, upon which she received a grovelling call from the hospital's chief executive, promising immediate action.

Then there was the case of Number 10 sending health minister Lord Ara Darzi to take new Business Secretary Peter Mandelson to hospital when he suffered stomach pains; and his swift treatment after a diagnosis of kidney stones.

I fear it is naïve to think that everybody receives the same level of care under the current NHS system, or that this situation is likely to change. In light of this, I have no real objection to the concept of people topping up NHS care with private treatments. Moving with the times is probably the only way in which our health service will survive in any sort of recognisable form.

Healthcare Republic jumps on the Facebook bandwagon

Emilie Reymond — Tue, 04 Nov 2008 11:37:00 GMT

If you are a regular Facebook user, you probably have felt the same kind of "been there, done that, got the t-shirt" feeling in recent months, as the initial buzz over the social networking website has slowly faded.

Now in its fifth year of existence, it seems though that FB is having a second wind. Or more a storm that is. The latest figures from web measurement company comScore reveal this week that Facebook overtook the BBC's network of websites in September and is now the UK's fifth most popular website, with over 18 million unique users.

Yes, that's right more than 18 million of us - that's almost a third of the UK's population logging in to Facebook every month.

The website is the brainchild of Mark Zuckerberg, who at 24 years old has already an estimated fortune of $1.5bn. Last week, Zuckerberg made his first appearance at a European conference in London where he said Facebook has now 100 million users worldwide.

And if you think that Facebook is still merely a social network for students and teenagers, you are sadly mistaken. 11% of users are over the age of 35, and the fastest growing demographic is users over 30.

A recent study from think tank Demos suggests that companies should not dismiss staff who use social networking sites such as Facebook at work as time-wasters. And the report said that some organisations are now even turning away from banning sites such as Facebook.

"Our findings demonstrate that networks can be as powerful - indeed may be more powerful - than the formal structures of an organisation. The vitality of networks in enhancing innovation, productivity and democracy is graphically demonstrated. And the turbo-charging of networks by certain forms of technological advance - in particular the rise of online ‘social networking' - is also clear," it says.

So Healthcare Republic has obviously jumped on the bandwagon and we now have our own Facebook page dedicated to the primary care community.

This page will be updated on a regular basis, and you will find updates on what's new on the website, how to take part in our surveys, enter new competitions, and details of how to subscribe to our print publications (GP, Independent Nurse, MIMS, MIMS Specialist Journals). You can also find a feed of all the upcoming courses and events carefully selected by our editorial team. You can also discuss with other primary care professionals and give us feedback on what you think of our website.

So get logged in and become a fan now. And if you get told off for spending too much time on Facebook, just use my favourite quote:

'Emails are so "1995", I am actually thinking of building a Facebook-style network for our team to streamline processes and network more easily, so that's why I doing some research to get ideas'.

Well, that's what I do anyway...

How do we know when a minister is too sick for power?

Colin Cooper — Mon, 03 Nov 2008 10:14:00 GMT

As the US election campaigns at last come to a close (please don't let there be a recount), many Democrats are reportedly visiting their doctors complaining of stress, anxiety, exhaustion etc.

They are racked with fear that the Republicans will pull victory out of the bag on the last day. But whoever wins, I'm more concerned with the health of the winning candidate once they are sworn in.

Last week I attended an event where Lord Owen talked about his book In Sickness And In Power, which examines the medical problems of government leaders over the past hundred years.

Lord Owen trained as a medical doctor before going in to politics, became foreign secretary under James Callaghan and co-founded the Social Democratic Party.

He brings a wealth of knowledge and experience to the job of documenting how illness and therapy have affected the decision-making of those in power.

So we learned that President Kennedy's relationship with Kruschev, and his handling of the Bay of Pigs incident, was heavily influenced by his consumption of amphetamines and cocaine.

And President Mitterand kept his treatment for prostate cancer secret - which is probably no surprise given that he also had a secret second family for 20 years.

Lord Owen also picks out numerous examples of how the personal doctors of these leaders had to provide false documentation to the media in order to avoid difficult questions about their fitness for office. How would the GMC feel about that?

It's a fascinating, if frightening, subject, and Lord Owen suggests a range of measures to protect societies from the impaired decision-making of sick heads of government. He believes that potential leaders should face an independent medical assessment, but can you imagine the clashes of opinion and court cases that would arise? And which political parties are actually going to campaign for such a change in legislation?

Another block would be a new syndrome that Lord Owen claims to have discovered among leaders such as Bush and Blair, which he calls the hubris syndrome. They become excessively self-confident and refuse to listen to any advice but their own - hence the invasion of Iraq without a plan.

One thing's for sure: whichever candidate wins tomorrow, it won't be long before their doctors are seeing symptoms of that particular syndrome.

When toothache becomes a headache for health professionals

Sarah Wild — Fri, 31 Oct 2008 11:15:00 GMT

On the face of it, keeping one's own teeth long into old age sounds like a good thing.

However, according to Help the Aged, improvements in dental care (which mean that fewer people have false teeth) are actually causing problems for older people, since those housebound or in care homes are struggling to access dental services.

A lack of flexible clinics, such as mobile dental units, mean that people often go without treatment, which leads to tooth decay and pain that can affect eating habits and nutrition, resulting in health problems.

Apparently, more than a third of over 75s fail to have regular check ups. However, it is not just pensioners who struggle to find an NHS dentist.

Last January, a poll for Citizen's Advice found that one in six people had been unable to see an NHS dentist for almost two years and there were warnings that the shortage of dentists was having an impact on doctors' workload: GPs have been seeing increasing numbers of patients with dental problems, which they cannot treat, extending waiting times for patients who need medical care.

In May, it was reported that the number of hospital admissions for abscesses had nearly doubled in ten years, to just under 1,500 a year. The situation was described as ‘a major public health problem' by Bristol University researchers, who laid the blame squarely at the door of the new dental contract, agreed in 2006.

The contract was designed to improve access to NHS dentists, but subsequent evaluation indicates that it has made little impact. A report from the House of Commons Health Committee, published in July 2008, suggests that the number of patients without an NHS dentist remains roughly the same, as does the patchy cover.

Meanwhile, it is said that NHS dentists are earning six figure salaries, without any increase in workload, an image which does nothing to endear them to the general public (nor to GPs and practice nurses, who have been bullied into offering extended hours). The Patients' Association has been quoted as saying that ‘dentists are working the system for themselves, not for the patients'.

Dentists deny their lives are cushy, a denial backed up by the fact that the new contract was rejected by one in ten dentists, according to the British Dental Association (BDA), with 60 per cent of those who did sign up ‘in dispute' over the deal offered to them. The contract has not curbed the exodus of NHS dentists into private-only practices and a massive 85 per cent of dentists have told the BDA that they feel the new system has not improved access to NHS dentistry.

It therefore seems that dentists, patients and medical professionals share the same desire for the 2006 dental contract to be scrutinised and changed.

However, despite the Commons Health Committee report, the Department insists that the benefits of the reforms are already emerging, highlighting its £200m investment in dentistry this year, over and above increases in the last three years, taking the total investment to more than £2bn.

When will ministers learn that blindly pumping cash into initiatives, in the face of evidence that they are not working, is simply a waste of taxpayers' money - and at a time when every penny counts, as never before?