Editors' Blog

September 2008 - Posts

• A holistic view of Primary Care Live

  I am attending the Primary Care Live conference today at the swanky ExCel Centre in east London and I am not disappointed. I managed to get here on time despite going into the Courier & Parcel Logistics Expo 2008 by mistake which is taking place in the same venue. This kind of thing usually happens before I have my morning coffee. The exhibition village at the heart of Primary Care Live is filled with charities, healthcare organisations and companies all here to showcase their products/services/fancy stands for GPs, nurses and healthcare professionals.   There are also sixteen conference streams over the two days of the conference, covering everything from managing diabetes to an analysis of the future landscape of primary care. The effects of the credit crunch are definitely felt with seminars on managing shrinking budgets in general practice. Although some organisations such as NHS Choices don’t seem to be affected at all by the current global economy turmoil – I just walked by their stand and almost got blinded by the opulence of fluorescent lights, flat screens and lit floor. I am not even getting started on the glamorous hostesses (I can’t believe they are actually NHS staff) helping conference attendees make their way through Choose and Book… I haven’t had chance to attend any of the sessions yet as I spent the past hour trying to get connected to the world wide web - something that’s proven highly challenging at the ExCel Centre. I was also too busy participating in the CPR Challenge organised by a health training company where participants have to perform CPR on a silicone mannequin for two minutes to get a chance to win an iPod. A computer analyses the rhythm and depth of the compressions to select the winner. There was a queue forming before the conference had even started… I have to go as I realise it’s time for my Indian head massage on the Federation of Holistic Therapists’ stand… Sorry I mean I am almost late for the session on the NHS next stage review… Posted Sep 30 2008, 11:29 AM by Emilie Reymond with no comments

• Forget the party conferences, it's all happening in primary care

  This week there will be hundreds, nay thousands, of GPs from around the country travelling to two of the biggest conference dates in the primary care calendar. Primary Care Live starts tomorrow in London, before moving to Manchester next month, and the RCGP's annual conference kicks off in Bournemouth on Thursday. For those of us reporting on the highlights - so that the few people left staffing surgeries do not lose out on any key learning points - it's going to be a very busy week. And with the government sending along some of its leading lights in to speak in London and Bournemouth, it will be interesting to compare the messages. At Primary Care Live, we have Dr David Colin-Thomé, the national director for primary care commissioning, giving his thoughts on what the NHS Next Stage Review means for GPs. Just a few days later, Lord Darzi himself will be doing a similar job on stage at the seaside. Will they have agreed the details beforehand? Will the audience tease out some new information? Will either of them turn up? Who knows? Whatever happens, let's hope the sparks fly. Though I note that the RCGP have thoughtfully balanced their keynote speakers over the three days of the conference. Lord Darzi sets out his multi-provider vision on Thursday, Professor Allyson Pollock attacks the commercialisation of general practice on Friday, and UN peacekeeper Major Phil Ashby is called in on Saturday to calm things down before everyone heads back home. Don't worry, you don't have to miss a thing. We'll have staff at both events, so expect lots of news and analysis in GP and Independent Nurse, and every day on Healthcare Republic. Posted Sep 29 2008, 09:58 AM by Colin Cooper with no comments

• Someone please call 911

  It might finally happen here in England. What we see in Hollywood movies when someone is involved in an accident, gets attacked/shot/killed, has what looks like a heart attack or just simply faints on the street, and suddenly the hero of the movie or even just a passer by screams "Someone call 911"! (They never say call an ambulance for some reason, do they?). It is simple there in America, you have an emergency – whatever that is – you call one emergency number. You don't have to think for a couple of minutes whether it is truly an emergency and if you should call A&E, or is it urgent but not a question of life or death in which case should you should call a GP? An out-of-hours service? Or NHS Direct? Well, this conundrum could be a thing of the past if the big hats at the Healthcare Commission have it their way. The health watchdog has just published a report which found that NHS emergency services are not providing the swift, integrated care that patients should expect. The report also found that the transition between services can be difficult and people are often confused about which services to use. According to the watchdog, the government should support the integration of services and simplify the way services are accessed, for example, through piloting of a single telephone number for urgent care services. "A single telephone number has the potential to ensure fewer people attend the wrong services," said the report. In a statement released this morning, the DoH said: "As announced in Lord Darzi's review of the NHS, we are looking at the benefits of a national number and will outline the next steps for this later in the year." The Healthcare Commission review examined out-of-hours GP services, A&E services, urgent care centres, and emergency ambulance services. (Un)surprisingly, London was one of the worst offenders as urgent and emergency care services in the capital were found to be lagging behind those in other areas, according to the report. Half of the 28 PCTs designated ‘least well performing' by the Healthcare Commission were in London. By contrast, services in the north of England scored much better with 42 per cent of the 48 PCTs designated as 'best performing' in the north of the country, with those in the north east performing particularly well. But it's not all as bad as it sounds. The review found that the majority of services are performing well, with 60 per cent of PCT areas scoring the top two ratings. It is the first time the quality of urgent and emergency care services has been examined from the perspective of the patient rather than according to which organisation provided the care. I might start practicing my "Someone please call 911" line, Mary J Blige style… You can find out about each PCT's scores on the Healthcare Commission website. Posted Sep 26 2008, 10:51 AM by Emilie Reymond with no comments

• Pregnant women, flu jabs and the Telegraph

  This week, GP reveals that the flu jab programme looks set to be extended to pregnant women after a study, published in the New England Journal of Medicine, found there was a 63 per cent reduction in influenza illness among infants born to women who were vaccinated while pregnant. The story, published in tomorrow's GP, received extensive coverage in the national newspapers this morning, including the front-page lead in the Telegraph, and articles in the Daily Mail, the Guardian and the Express. While the team at GP always write for our audience of general practitioners, every now and again some of our stories have national significance and will be of interest to the general public. In some cases these will be about organisational or political issues, for example polyclinics or extended hours, and in others they have a clinical focus, such as this flu jab story. And, while it's not our main aim to get ‘picked up by the nationals', there is something extremely satisfying about seeing one of our stories appear in the papers - particularly if it makes the front page. Of course, the reason this story is of interest to the newspapers is that it is about a change in health policy - and one that will have a big impact on both general practice and the wider public. In 2006, the Joint Committee on Immunisation and Vaccination recommended that pregnant women in their second or third trimester be given the flu vaccine. However the government, concerned about the cost implications, asked the committee to reassess the evidence. This latest NEJM study demonstrates that the evidence is there to back this move. It is now up to the government to find the funding to implement a change that will have health benefits for new mothers and their babies Posted Sep 25 2008, 02:27 AM by Emma Bower with no comments

• Restricting use of the chemical cosh

  Flicking through the papers this morning, I was relieved to note that Supernanny returns to our screens tonight for the start of a new series. Jo Frost is just in the nick of time! New NICE guidelines (covering England, Wales & N Ireland) state that attention-deficit hyperactivity disorder (ADHD) should be diagnosed in secondary care, and drugs such as Ritalin used ‘only as a last resort' and not given to the under-fives at all. NICE recommends that drugs should be limited to children over five with severe ADHD (when other interventions haven't worked) and must be used alongside psychological therapy and support. ‘Support' includes parent training and education programmes, to be offered as a first-line treatment for hyperactivity, both for pre-school and school-age children, teaching parents how to create a structured home environment, encourage attentiveness and concentration and manage misbehaviour. This sounds eminently sensible, particularly given the controversy surrounding the use of the ‘chemical cosh'. Googling ‘Ritalin' brings up stories questioning its efficacy, safety and long-term use, though it also highlights successes in children with genuine ADHD - a condition not to be confused with simple ‘bad behaviour'. The aim is not to deny drugs to children with severe ADHD but to reduce the over-reliance on medication, points out Dr Tim Kendall, a consultant psychiatrist from Sheffield who is joint director of the National Collaborating Centre for Mental Health and helped draw up the guidelines. Numbers of prescriptions have apparently soared, almost tripling between 1993 and 2003. However, whether there will be sufficient access to appropriate parent training and education programmes is highly questionable. Such resources must be tailored to the specific needs of ADHD patients, according to experts such as Andrea Bilbow, chief executive of the ADHD charity ADDISS. She warns that the courses mentioned by NICE are suitable for children with conduct disorder but not for those with hyperactivity. The worry for health professionals is that they will be guided away from prescribing drugs to hyperactive children, but left without access to adequate alternatives. If this is the case, we may find parents joining the hosts of unpaid carers unable to hold down jobs or look after their own physical or mental health needs, while Jo Frost and her many clones become permanent additions to our programming schedules. Posted Sep 24 2008, 11:13 AM by Sarah Wild with no comments

• Dispatches from a parallel universe

  At a distinctly uncivilized hour yesterday morning I found myself in a back room at the Labour conference in Manchester, listening to various techie types discussing government IT. There were around 30 of us listening, bleary eyed, as the man from Microsoft held forth on the potential computers had to transform public services. Besides us another dozen or so were watching the meeting from the online virtual world Second Life. In this other reality, the meeting had been upgraded to the main conference hall, where politically minded avatars could watch proceedings on the screen and occasionally throw out questions to the participants. A broadcast in this alternative reality seems oddly apt for a meeting that seemed to take place in a parallel universe. No one here is worried about cost over runs or repeatedly prolonged deadlines, and paranoia about data security was nothing but a barrier to progress. Any concerns people have about lost data discs are simply paranoia whipped up by the Daily Mail. But then, the entire conference seems to be taking place in some other Britain. Here the party is united, despite the string of MPs calling for a leadership contest. Here the economy is strong, despite soaring food costs and banks dropping like flies. (In one faintly surreal incident Alastair Darling frantically tried to cut short his own standing ovation after 20 seconds, apparently petrified he'd look out of touch.) The health debates, too, diverge startlingly from the GPC's agenda. A King's Fund debate on the state of the health service was packed out, but the issues uppermost in people's minds were dentists, top ups and prescription charges. In three days I have not heard a single reference to polyclinics, GP-led health centres or MPIG, and just one mention of Lord Darzi. The only sign that GPs aren't entirely contented with the way things are going is the solitary figure of Dr David Baker, hyperactively lobbying against the pharmacy White Paper. The GPC, one suspects, would say this is no bad thing. They'd argue that the important conversations are the ones that happen with NHS Employers. It has limited time for political work, and schmoozing a party likely to be out of power within two years isn't the best way of using it. Perhaps. But Dr Baker's cautious optimism suggests that a few quiet words with the right people might do wonders to redirect the government  away from painful policies. The next time you find yourself furious that the Labour party doesn't understand general practice, you might wonder when anyone last tried to explain it to them. jonn.elledge@haymarket.com Posted Sep 23 2008, 11:53 AM by jonn elledge with no comments

• I have a complaint about patient complaints

  It's understandably difficult to be on the receiving end of a patient complaint and still see it as something positive and valuable to behold. But that's exactly what the Patients Association is suggesting that health professionals and managers should be doing. Of course, if you feel that you are doing a good job, often against the odds, and you simply can't see why the patient should be upset, then their complaint seems little more than an irritating interruption that is wasting your time and that of other patients. The Patients Association's assertion that complaints should be treasured is not a new concept, and probably litters the NHS regulations on handling grievances. But its survey of 500-or-so members, of whom 68 per cent felt that making a complaint had been 'pointless', should be heeded as a warning by health professionals who will soon be undergoing revalidation. For GPs, at least, this will involve 360-degree appraisals, taking the views of patients in to account when deciding whether to renew their licence to practice. And it's worth remembering that most of the complaints received by the GMC involve the doctor's communication skills. They are not necessarily the root of the complaint, but they quickly become relevant when the grievance is raised and the doctor is required to confront the issue. Their handling of the initial complaint often becomes the reason for a second complaint, and is also likely to make the patient even more determined to succeed in their action. All of us expect to be treated fairly and respectfully by the companies and organisations we deal with in our daily lives, and especially our public services. This survey by the Patients Association is a wake-up call for those in the NHS who think of complaints simply as an interruption to ‘normal services'. In the increasingly competitive environment of healthcare provision, the providers who offer a responsive, customer-focused service will be the ones who prosper. And who can complain about that? Posted Sep 22 2008, 11:27 AM by Colin Cooper with no comments

• Why the DoH should value general practice

  In this week's GP, we reveal the results of our Valuing General Practice campaign survey. Sadly, some of the figures make for depressing reading. One in seven of the 276 practices that responded said they were threatened with closure or relocation to a polyclinic. There was also widespread opposition to government reform, with 90 per cent saying it will damage continuity of care and 92 per cent saying the DoH's polyclinic plans should be abandoned until they have been piloted. But it was not all bad news. On a more positive note, 3,980 patients signed petitions backing the aims and objectives of our campaign, and many included statements explaining why they valued general practice. The results of this aspect of the campaign, which are also published in this week's GP, are heartening - and will not be any surprise to those who work in general practice. Whether it is because the practice treats them as an individual, or because they have good relationships with the doctors, nurses and support staff, or simply because it is just down the road and therefore more accessible, the statements show that patients really do value the care and support they receive. Polyclinics appeared to be particularly unpopular among the elderly and those with young families - perhaps unsurprisingly, because these are the people who use general practice most frequently. What these groups want is a local surgery, that is easy to get to and familiar faces. Any GP, practice nurse, receptionist or practice manager knows that this is the case. But the government just doesn't seem to get it. It has fixated on access, seeing it as more important than anything else. But, as our petition suggests, this isn't the most important issue for patients. Yes, many members of the public might want to see a doctor or nurse more quickly, but this does not make the case for rushing wholesale towards establishing a network of polyclinics. There are other ways improved access could be achieved. It seems that the DoH has already cottoned onto the fact that ‘polyclinics' are unpopular among health professionals and patients alike. According to GPC chairman Dr Laurence Buckman the term has been barred from the NHS. ‘The word has gone out from Number 10 never to use the word,' he says. ‘It's seen as a vote loser.' If that's the case, perhaps it is time that prime minister Gordon Brown reviewed the whole policy and started to value the fantastic job that general practices across the UK do every day. Posted Sep 18 2008, 02:25 AM by Emma Bower with no comments

• Who is actually eating their five-a-day?

  Despite expensive government campaigns and the best efforts of Jamie Oliver, Britons are still missing their ‘five-a-day' fruit and veg targets. A study of the consumer habits (entitled 'Health of Britain - Perspective on Nutrition 2008' ) revealed that just 12 per cent of the population eats the recommended five portions of fruit and vegetables per day. Another 12 per cent do not eat any fruit and vegetables at all. Unsurprisingly, the study found that the groups most likely to meet the target are the wealthy and the over 45s, with children and the poor more likely to consume none at all. This must be depressing for ministers, who have been immersing themselves in ‘youf culture' in order to encourage young people to eat healthily. Not only does the DoH's 5-a-day site offer ‘vegetable makeovers' and an interactive game called ‘sumo smoothies', the Food Standards Agency is bang on trend with its ‘Strictly Yum Dancing' feature, involving characters such as ‘Tina Tuna', ‘Barry Burger' and ‘Terri Tomato'. This is apparently based on the FSA's new live spectacle, performed at this year's BBC Good Food Show. The mind boggles. Real life D-list celebrities are also helping out the Department, for example, EastEnder's Patsy Palmer provides a video message on healthy eating as does former glamour model Melinda Messenger. However, even celebs are finding it a challenge to entice people away from their turkey twizzlers. Poor Jamie Oliver is reportedly fed up with mothers sabotaging his healthy school meals campaign and people generally giving him stick. This is so much the case that (according to his mum) he is on the verge of abandoning his healthy eating crusades: his latest TV project, to revive home cooking skills in Rotherham, took him to the local football club..where he was the subject of ‘obscene chanting'. Jamie is surely disappointed to hear that despite shaming ministers into funding healthier school meals, new figures show that kids in two thirds of schools shun canteen meals for unhealthy packed lunches or fast food from nearby outlets. A separate survey by Babybel suggests that even those bringing in wholemeal sandwiches and carrot sticks may not be eating them. According to the poll, seven out of ten children regularly swap the contents of their lunchboxes, while one in five chucks them straight in the bin. Celebrities may walk away, acknowledging defeat. However, for health professionals, the battle goes on and ministers too are faced with no alternative but to continue campaigning. Their only other option would be to alter the target, a course of action health secretary Alan Johnson may well be advised to take. As he joked on the Politics Show:  ‘It's important to get the message that five-a-day isn't five bottles of wine, it's five portions of fruit and veg.' If only it were five bottles of wine a day, binge boozing Britons would have a much better chance of hitting the jackpot!   Posted Sep 17 2008, 03:41 AM by Sarah Wild with no comments

• Reaching breaking point…

  Unless you've been leaving under a stone for the past few days, you'll have noticed the global panic following the bankruptcy of Lehman Brothers. The bank, one of the oldest in America, which went bust on Sunday literally imploded leaving its 5,000 UK employees jobless - according to media reports, they might not even get paid for this week's work. Yesterday, while I was looking at pictures of Lehman Brothers staff clearing their desks and leaving the building with all their belongings packed in card board boxes (so American...), it became clear that the amplified credit crunch was just the beginning of a big recession - some analysts are already comparing yesterday's stock exchange mayhem to 1929's Black Tuesday. Although it is unlikely that direct consequences of the collapse of Lehman will be felt on British consumers, dramatic effects on the London Stock Exchange and therefore on the British economy as a whole are undeniable. And we certainly didn't need this... I was sent a press release yesterday, and just the subject line made me shiver: "More than half of all health students consider quitting due to debt". It's widely known that students get themselves into high levels of debt during their university years but it's quite scary to think that "50 per cent of students considered leaving their course due to financial difficulties, an increase of 7% since last year." The grim findings are from Reaching Breaking Point - UNISON National Survey of Health Students, a report published today by the staff union. I kept reading and it kept getting worse... Nursing diploma students start their careers owing an average of 40% of their annual salary. If they paid back £100 per month it would take them almost seven years to fully repay the debt, even before interest is taken into account, the report found.   90 per cent of health students are in debt, and average debt is £6,934, while almost a quarter of students have debts of over £10,000. So what to do? Unison is calling on the government to "comprehensively review to the current bursary system, including considering a return to paying health students a salary." Could this be the government's own version of Roosevelt's New Deal? Let's hope so.  Posted Sep 16 2008, 11:15 AM by Emilie Reymond with no comments

• Darzi faces recurring nightmare of NHS activity data

  It's a long time since the progress of fundholding practices was frustrated by the inadequacies of NHS data collection during the 1990s. But the same problem reared its head at the launch of practice-based commissioning and again drained the enthusiasm of all but the most dynamic of GP pioneers. So it comes as little surprise that Lord Darzi's reforms are also going to feel the pain of innumerable errors and omissions that characterise NHS activity data - a bit like running in to a vertical bed of nails. This sad state of affairs was brought to light this week with the revelation in GP newspaper that a PCT is wasting millions developing two new APMS practices, following a decision based on ‘out-of-date or simply incorrect data'. Meanwhile, another NHS IT contract has imploded, with the DoH and Fujitsu now demanding hundreds of millions of pounds in compensation from each other, and one wonders whether we will ever get our data handling right, at any level. Even the NHS Information Centre felt it had to buy health information company Dr Foster to achieve some credible number crunching capability - in a deal lambasted by the Public Accounts Committee. Incidentally, Dr Foster has since lost the contract to run the NHS Choices website, said to be worth £80 million. Part of the data problem, of course, lies in who controls the numbers. If hospitals are responsible for creating and keeping the activity data, then it's never going to be in their interest to be accurate, open or, dare I say it, honest. Perhaps this is an opportunity for the private sector to step in and really make a difference to operation of the NHS? Or perhaps it's best left alone until the next raft of NHS reforms comes along...   Posted Sep 15 2008, 11:11 AM by Colin Cooper with no comments

• Ageing is reversible!

  The horrible realisation that I am not eligible for GP35 (and not just because I lack a medical degree) made me ponder the issue of ageing. I therefore turned to the infallible reference source that is Wikipedia and was relieved to find that I have some way to go before I can describe myself as officially ‘old': apparently, the ‘young old' are in the 65-74 age bracket; the ‘middle old' 75 - 84 and the ‘oldest old' are those aged 84 and above. The good news is that I currently fit into the phase known as ‘early adulthood', one of 11 stages of life outlined by Wikipedia encompassing everyone aged 20 - 40. The bad news is that five stages are already behind me. Still, I do have ‘middle and late adulthood' to look forward to. Followed by ‘death' and ‘decomposition' - thanks, Wikipedia. Determined not to waste any more time (or frown lines) worrying about something as inevitable as ageing, I was rewarded for my positivity with some good news on the subject - not least that it might soon be 'stopped in its tracks', to paraphrase a recent article in the BMJ. According to this, ‘evidence suggests that all living things, including humans, possess biochemical mechanisms that influence how quickly we age and these are modifiable.' ‘For example, dietary restriction and genetic alteration have been shown to extend the lifespan of many laboratory organisms including mice, flies and worms, and postpone age related diseases such as cancer, cataracts and cognitive decline.' The authors, Professor S Jay Olshansky and colleagues, argue that because our susceptibility to disease increases as we grow older, the most efficient approach to combating disease and disability is a ‘systematic attack on ageing itself.' This is fine by me, and I was particularly heartened by the article's accompanying Analysis piece, by Professor Colin Farelly from Canada's University of Waterloo in Canada, who asserts that success in increasing longevity in laboratory organisms has demonstrated that ageing is not an irreversible process! The second bit of good news also came from the BMJ which reported that ‘an increasing number of 70-year-olds are having good sex and more often', adding that ‘women in this age group are particularly satisfied with their sex lives.' Published on BMJ.com, the study revealed that, over the thirty-year period, the number of 70-year-olds of both sexes reporting sexual intercourse increased: married men from 52 per cent to 98 per cent, married women from 38 per cent to 56 per cent, unmarried men from 30 per cent to 54 per cent, and unmarried women from 0.8 per cent to 12 per cent. (Its serious message was, of course, the need for health professionals to be trained to ask all patients, regardless of age, about their sexual concerns.) Thirdly, new research has identified ‘a number of positive brain and behavioural changes in the second half of life that set the stage for psychological growth and creative expression such as art and music.' These developments occur, not in spite of ageing, but because of it, explains Professor Gene D Cohen, a prominent specialist from George Washington University, who is working to dismantle a number of long held negative myths and stereotypes about ageing. This means that, not only are older people having great sex, they are also wiser and more creative than those younger than them and when it comes to their looks, there are some fantastic innovations out there, including a new handheld device called ‘stop'. This uses low-powered beams of electricity fired into the skin to reduce the appearance of wrinkles, according to the manufacturers. It was being modelled earlier this week by ‘veteran supermodel' Marie Helvin who enthused that ‘for the first time, non-invasive technology to reduce signs of ageing is literally in our hands and now we can renew our skin as easily as we renew our clothes.' So even if ageing does turn out to be irreversible (in genetic terms) there's always a silver lining to be found on the high street! Posted Sep 12 2008, 11:45 AM by Sarah Wild with no comments

• One reason why Labour will lose the next election

  GP received a letter last week from a West Yorkshire GP complaining that the government had decreed that during extended hours practices could not offer flu vaccinations or Heavy Goods Vehicle medicals. This seemed ridiculous to us and we almost pulled it from our letters page because the PCT involved and the DoH were initially unable to comment. But this week, on the day the page was to be printed, it emerged that the GP involved was correct and that the DoH has barred practices from providing non-NHS services in extended hours. Read this week's GP for the full story and the letter which provoked it. If win-win policies are the must-haves for politicians, surely this is the first lose-lose? It's a loss for patients who can only attend their practice in extended hours but find the service they require is unavailable at that time and they must return in hours. And it's also a loss for the practice team working extended hours (which it probably didn't want to provide in the first place) which finds that it can't deal fully with its patient who must now return in hours, adding to its workload. To complete the farce, the lack of clarity with which the DoH has expressed its policy means that at least one PCT is interpreting it to mean that enhanced services cannot be undertaken during extended hours. So, if you want flu jabs, travel vaccinations or HGV medicals amongst many other things in extended hours, then tough. Thanks for that Gordon.  Surely the GPC is right when it argues that extended hours should deal with the services that patients expect during the day and the DoH is wrong to decide what can and can't form part of the consultation between GP and patient? Isn't this bureaucracy-gone-mad exactly the sort of government micro-management that NHS workers are tiring of and one reason why Labour will lose the next election? neil.durham@haymarket.com Posted Sep 11 2008, 09:13 AM by Neil Durham with no comments

• In need of glucose at the diabetes conference

  The European Association for the Study of Diabetes congress is currently taking place in Rome, and I'm lucky enough to be here on the lookout for news and ideas for articles. Unfortunately it's not quite as glamorous as it sounds. So far my time at the congress has been extremely busy. Somehow the organisers managed to cram all the important press conferences into the Monday (presumably to ensure maximum attendance), while the main presentations are spread through the week.   Having noted the weather forecast in the UK this week I probably shouldn't complain but it's also been blisteringly hot - which is great if you're meandering through the historical streets of Rome in search of the next gelato. But it's not so great if you're stuck in the remote concrete aircraft hanger that is the conference centre, trying to concentrate on the next set of trial results or walking the 5km that seem to exist between the presentation halls and the press centre. I'll be interested to hear the full presentation of the 30-year data from UKPDS this morning, having only seen a sneak preview at the press conference so far. There's already been some interesting results from a trial looking at prevention of retinopathy and we've also heard from a number of other research groups presenting follow-on data from large studies.  There have been some entertaining moments - yesterday I wandered into the exhibitor hall to find delegates queuing for to have a photograph taken of them looking through one of those comedy cut-out figures more commonly seen at British seaside resorts. Except because this is a serious medical conference the cut-out is of a diabetic, showing all the associated complications... nephropathy, foot ulcers... you get the idea.   There was also a rather long queue to have a go at virtual tennis on a Nintendo Wii - not the sort of behaviour I was expecting from eminent diabetologists, but at least it's a healthy improvement on that of the cardiologists at the European Society of Cardiology conference last week.  It's been fantastic to meet and talk to so many enthusiastic doctors here at EASD. Hopefully some of them will be writing some interesting clinical articles for GP over the coming months.  For now, I'm in need of an espresso and a croissant before I attempt to interpret some more trial results. Posted Sep 10 2008, 09:35 AM by Sharon Pickett with no comments

• Can someone explain to me what a minor ailment is exactly?

  The topic of encouraging GPs and pharmacists to work together to take some of the burden off GPs is making the headlines today again. Back in April, the DoH published its Pharmacy White Paper where it pushed for a range of traditional GP roles - screening over-40s for vascular risk factors, managing long-term conditions, giving flu jabs, minor ailment care and issuing repeat scrips -  to also be offered in pharmacies across England. And yesterday, Steve Churton, president of the Royal Pharmaceutical Society of Great Britain emphasised the issue again by telling the British Pharmaceutical Conference that pharmacists could help reduce GP workloads by 20 per cent. How? By handling consultations of patients with minor ailments. This, he claims, could release an hour a day for every GP to see patients with "more complex needs". I agree that if a fifth of GPs consultations are for minor illness which could be handled by pharmacists, then the government should put all the resources in place to make it happen. My only worry is the definition of a minor ailment. Isn't it a bit subjective? Patients with serious conditions could present themselves as having minor ones. In that case, is a pharmacist sufficiently trained to make a diagnosis from patients' symptoms? And if so, how? Can we expect pharmacies to have a dedicated room where they can examine patients? Why not have a GP working in pharmacy then? I might be slightly biased on the subject as just last week while I was holidaying back home in the south of France, I found myself overwhelmed with the upheaval that comes with a sudden change of weather. I left London, its persistent rain and its thermometer stuck at 18 degrees and two hours later (thanks to my favourite low cost airline - you know the one that makes you think your ticket is free and then they add the taxes, check-in fees and luggage fee and you end up paying the equivalent of a business class ticket to New York) I literally arrived in the tropics, with bright sunshine, 31 degrees, a festival of air conditioning and a humidity rate that made my hair look like this. Unsurprisingly, after a couple of nights sleeping with the air conditioning on, I woke up one morning shivering with the most horrendous sore throat. A rapid mental assessment made me classify my condition as a "minor ailment" so on the way to the beach (I was not letting a sore throat get in the way of my yearly quota of sunbathing) I quickly stopped by the pharmacy to get some miracle solution - i.e. quick fix -  to my problem. I spent the next three days religiously sucking my strepsils, spraying my throat with anaesthetic anti-sore throat potion, and (don't forget this was France) using the suppositories highly recommended by my pharmacist - "they are the most efficient for acute sore throats," she said with a smile. You guessed it, the sore throat disappeared and gave way to a persistent cold, accompanied by a drowsy cough and a strong fever so after five days of carrying a suitcase of drugs with me I finally had to spent my precious "sun time" afternoon in my GP's waiting room to finally be diagnosed with a severe throat infection doubled with a beginning of bronchitis. And the question I dreaded the whole time: "Emilie, why didn't you come and see me when you noticed your first symptoms?" I was about to answer my loyal GP that I wanted to save his time for people who have much more serious illnesses but I just looked down and nodded embarrassingly. Posted Sep 09 2008, 11:31 AM by Emilie Reymond with 3 comment(s)