Editors' Blog

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

2008-12-04T00:01:00Z

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?

2008-12-03T11:53:00Z

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

2008-12-02T10:34:00Z

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

2008-12-01T10:53:00Z

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

2008-11-28T10:54:00Z

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'

2008-11-27T01:00:00Z

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'?

2008-11-26T11:46:00Z

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?

2008-11-25T11:54:00Z

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

2008-11-24T10:37:00Z

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?

2008-11-21T11:26:00Z

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

2008-11-20T10:38:00Z

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

2008-11-19T11:30:00Z

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?

2008-11-18T08:41:00Z

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

2008-11-17T11:02:00Z

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

2008-11-14T11:00:00Z

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.