Over a billion NHS prescription medicines are issued by pharmacists in England every year – at a cost of over £9 billion. Many of these are prescribed by GPs to manage long-term health conditions, such as diabetes or cardiovascular disease.
The current “repeat prescription” system allows patients to request a further supply of medicines without the inconvenience of another doctor’s appointment.
The UK Department of Health advises that the frequency of repeat prescriptions should “balance patient convenience with clinical appropriateness, cost-effectiveness and patient safety”.
However, it does not recommend a specific time period. As a result, local health service commissioners have developed their own guidance, with many encouraging GPs to issue short-term supplies of repeat medications, typically 28 days in length. This is supported by … Read more
Clinician intuition and gut feelings are often talked about in health care but are largely mysterious. Clinicians describe just knowing that there was something wrong with a patient but not exactly how they came to that conclusion.
In a recent study we aimed to unpick how clinicians form their gut feelings, how they use them to influence treatment decisions, and whether their gut feeling was good at predicting whether a child with infectious cough would get sicker in the 30 days after seeing them.
Using gut feeling to predict outcome in children with infectious cough
Infectious cough in children is the most common problem managed by health services internationally. Although the majority of children get better on their own, a small proportion end up hospital with a serious illness. Clinicians do not always find it easy to … Read more
Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.
At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad.
The situation requires clarification. Currently, if a doctor in the UK writes a specific report to help with an assisted death abroad (three organisations in Switzerland accept UK citizens), the General Medical Council (GMC) may view this as a “fitness to practice” issue.
However, if a doctor provides copies of medical records, even with the knowledge that … Read more
I was recently invited to address the annual general meeting of PROSPECT, a local prostate cancer support group. The brief I was given was to discuss the GP’s role in diagnosing prostate cancer and the latest research in this area; a daunting task to tackle in a room full of men with prostate cancer at various stages on their cancer journey.
I spoke of the GP’s role across the continuum of cancer, from prevention and early diagnosis through to survivorship support and palliative care. I tried to discuss some of the latest studies in the field, such as the PROMIS study and the CAP trial, in a digestible form for these men. I also mused with them about the potential role new genetic technologies will have in the future in guiding GPs in determining cancer risk … Read more
There has been a transformation in social and scientific attitudes to depression in my working lifetime. It is no longer acceptable to stigmatise mental illness or psychological distress. The idea that the common mental disorders of depression and anxiety are an inescapable part of being human has been replaced by a belief that these disabling extremes of sadness and worry are treatable conditions.
Changes in the treatment of depression have been part of wider cultural changes. There is an increased openness about sadness and distress, and a widespread belief, beginning with Freud, that at the very least ‘neurotic misery can be transformed into ordinary unhappiness’. The invention of psychotherapy has spawned numerous schools and sub-disciplines, but all hold to the common belief that with help, … Read more
Imagine being given £400m of taxpayers’ money to spend on drugs for the benefit of NHS cancer patients. How would you decide which therapies to fund? Would you decide that all cancer patients should benefit equally, or would you decide to spend more on particular types of cancer, or on particular types of patient?
These issues were confronted by the Cancer Drugs Fund (CDF), the 2014/15 expenditures of which were £416m (against a budget of £280m). The CDF was created to make available to patients in England cancer drugs not recommended by the National Institute of Health and Care Excellence (NICE) on the basis of cost-effectiveness, not yet appraised by NICE or which were being used outside market authorisations.
The effects of the CDF on population health are controversial: one estimate is that the CDF has caused five … Read more
While violence against men continues to fall in the UK, women affected by violence and domestic abuse are bearing the brunt of a hidden rise in violent crime. This rise coincides with the austerity-led cutting of domestic violence services.
Domestic violence and abuse (DVA) damages physical and mental health resulting in increased use of health services by survivors of abuse. The prevalence of DVA among women attending general practice is higher than in the wider population. Women experiencing DVA are more likely to be in contact with GPs than with any other professionals. Reduced investment in specialist domestic violence services further increases the demand for direct general practice responses to DVA. Although victims tend not to disclose spontaneously to their GP, they have an expectation, often unfulfilled, that doctors can be trusted with disclosure, and can offer them … Read more
‘If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health’
– Mark Cuban, Twitter
With this one tweet Mark Cuban started a twitter storm. Advocates argued that the future of medicine lies with new technologies, with online companies and even future smartphone dongles allowing patients’ to test their own blood for everything from allergies to zinc.
This brave new world overlooks the responsibility of doctors to ‘first do no harm’. I have been qualified as a doctor for over 10 years but am still in training as a GP registrar and ‘junior doctor’. I have gradually learned that my well-meaning enthusiasm to do more and more tests to try to find out what is wrong with patients can quickly lead to … Read more
When I first started researching infectious cough in children, lots of clinicians told me they couldn’t understand why so many parents brought in children who were well enough to turn the consulting room upside down before they even started the examination. As a parent of two young children myself, I had some idea, but as a qualitative researcher, I was keen to get a balanced view.
In the TARGET Programme* we wanted to answer two questions. Given that most coughs will get better on their own:
1) Why do so many parents consult when their child has a cough?
2) Why do so many clinicians prescribe antibiotics for children with coughs?
We conducted five qualitative studies and began to notice common themes, not just across the studies but also shared by parents and clinicians. We found normative beliefs … Read more