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  1. GP targets leading to unwanted treatments - report

    Big changes in GP services should help doctors move away from a "target culture" - and this may lead to patients getting treatments they do not want, according to a major report prepared for the profession.

    GPs are afflicted by multiple guidelines and targets pushing them to recommend particular interventions or treatments, according to the report prepared for the Royal College of GPs.

    The report says: "Some patients are pushed into treatments that they do not want, while they are denied other forms of support they need."

    It adds: “In some cases, high levels of compliance have become a requirement of the regulator. In these circumstances, the GP is under considerable pressure to persuade a patient to accept a certain medicine or intervention.”

    The report sets out a range of measures to "transform" general practice, including a government "transformation" fund and a call for the profession to move away from being a "cottage" industry.

    The report calls for recruitment of more GPs and says practices could increasingly work together in federations and other arrangements.

    The report was written by former NHS Confederation chief executive Mike Farrar for the college, working with a team including senior college members and Dr Anita Donley a vice-president of the Royal College of Physicians.

    It says: “The shift to delivering more proactive and patient-centred care within general practice is also in some instances being held back by traditional attitudes and behaviours in regard to care delivery.

    “It will be vital to encourage and enable health professionals to provide holistic and personalised care, and to support patients to play an active role in managing their own health. This requires professionals to work with patients in a very different way, demanding new skills, knowledge and ways of thinking about the dynamics of power between professionals.”

    College chair Dr Maureen Baker said: “The sustained growth in the number of patients with more than one long term condition, coupled with the plummeting level of investment in community care, has left general practice, as we know it, withering on the vine.

    “GPs across the country will embrace the call to adopt new ways of working in order to ensure better patient care, but – as this report highlights – this can only be delivered with far greater levels of investment in community care, and we call on the Government to act on this as a matter of urgency.”

    Labour blamed the government for GP morale "plumbing new depths."

    Citing a doubling of the number of GPs seeking to work abroad - 529 last year - shadow health secretary Andy Burnham said: "This week’s misjudged GP ratings announcement has seen the profession’s morale plumbing new depths.

    “Cuts to the GP budget are placing intolerable pressure on services and forcing many GPs to move abroad or retire early in despair. People are already struggling to get GP appointments and things are set to get even worse.”

  2. Row over hospitals' winter report

    A row has broken out over the mysterious disappearance of a regular winter NHS monitoring report.

    The "Winter Watch" reports emerged from a flu epidemic and brought together information about flu and viruses together with reports of how hospitals were coping.

    Yesterday critics queried why the reports had not begun in November as in previous years.

    It comes amid concern about the ability of hospitals to cope with any extra pressures over the winter.

    The government recently pumped some £700 million into the service for the winter - but there were doubts about how quickly the money could be deployed.

    Andrew Gwynne, a Labour shadow health minister, told the Independent on Sunday: "This sudden decision raises fears Jeremy Hunt doesn't want people to know what's happening on the front line. The Government's boasts on transparency may be proved hollow."

    A spokesman for NHS England said: "Weekly information on winter NHS services and activity will commence in the week starting 8 December following a short review of information requirements.

    "It is for NHS England to decide when to start and stop the publication of winter data."

    * Meanwhile Labour said massive fines imposed on errant banks could provide cash for the NHS.

    Shadow chancellor Ed Balls, speaking over the weekend, said there could be as much as £1 billion available from this source.

  3. Tapeworm found in brain

    A man in London has been treated for tapeworm in the brain, it has been reported.

    It took four years to identify that the parasite had found its way to the man's brain, according to a report in Genome Biology.

    Eventually doctors at St Thomas' Hospital, London, identified it after taking biopsies of brain tissue.

    The patient is reported to be aged 50 and of Chinese origin.

    The tapeworm Spirometra erinaceieuropaei is reported to be rarely found in humans, leading to British scientists deciding to sequence its genome to learn more about it.

    One source of infection is thought to be raw frog poultice, a Chinese remedy for the eyes.

    Doctors found the worm had travelled 5cm through the man's brain.

    The patient was successfully treated and has recovered.

    The research showed the species of worm has a genome ten times larger than other known tapeworms - and one third the size of the human genome.

    Researcher Dr Effrossyni Gkrania-Klotsas, from Addenbrooke’s Hospital, Cambridge, said: “We did not expect to see an infection of this kind in the UK, but global travel means that unfamiliar parasites do sometimes appear

    “We can now diagnose sparganosis using MRI scans, but this does not give us the information we need to identify the exact tapeworm species and its vulnerabilities. Our work shows that, even with only tiny amounts of DNA from clinical samples, we can find out all we need to identify and characterise the parasite."

    Researcher Dr Matt Berriman, of the Wellcome Trust Sanger Institute, added: “The genome sequence suggests that the parasite is naturally resistant to albendazole – an existing anti-tapeworm drug.

    "However, many new drug targets that are being explored for other tapeworms are present in this parasite and could offer future clinical possibilities.”

  4. Brain medicine threat to babies

    Women who have to take a particular epilepsy drug should be advised not to get pregnant, according to new European guidance.

    The drug valproate poses a high risk of babies being born with malformations and developmental problems when taken during pregnancy, according to the European Medicines Agency.

    The drug is also prescribed for bipolar disorder and in some countries is used for migraine.

    The new guidance says the drug should not be given for migraine to women unless they are on effective contraception.

    According to the agency, up to 40% of infants exposed to the drug in the womb have shown developmental problems.

    The children are also thought to face an increased risk of developing autism - and possibly attention deficit hyperactivity disorder.

    A statement said: "Doctors in the EU are now advised not to prescribe valproate for epilepsy or bipolar disorder in pregnant women, in women who can become pregnant or in girls unless other treatments are ineffective or not tolerated.

    "Those for whom valproate is the only option for epilepsy or bipolar disorder should be advised on the use of effective contraception and treatment should be started and supervised by a doctor experienced in treating these conditions.

    "Women and girls who have been prescribed valproate should not stop taking their medicines without consulting their doctor as doing so could result in harm to themselves or to an unborn child."


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