GPs 'lose track of patients at risk


Rebecca Smith

[Daily Telegraph- Medical Editor-December 5-2007]


GPs 'lose track of patients at risk


MILLIONS of patients with heart disease and diabetes are at risk because GPs are failing to monitor their health properly , a health watchdog said yesterday.


Family doctors in half the 152 primary care trust areas do not have up-to-date registers of people with such long term conditions. The registers should be used to recall patients at regular intervals for vital check-ups. the Healthcare Commission's chief executive, Anna Walker, said that although patients may have registered as having a condition they were not being followed up and risked ending up in

Accident and Emergency Departments.

The State of Healthcare report said the NHS has some way to go before everyone received world class care and more must be done to tackle SUPERBUGS, improve DIGNITY and meet child protection obligations.

Good management of long-term conditions by family doctors and others in primary care is essential if this is was to become a reality, it said.

Problems with the NHS computer systems had caused difficulty in creating and maintaining the registers. Ms Walker said: Around 2,000 GP practices do not have registers in place. The REPORT also said that GPs did not measure obesity among 2.3 million patients may not be picking up signs of heart failure in some areas and the poor data on the levels of sexually transmitted diseases. A proportion of GP earnings is related to hitting targets on matters such as measuring blood pressure and recording cholesterol levels but these do not always tally with records held by the primary care trust that oversees practices in their area.

Primary Care Trusts, which hold the majority of the NHS budget in order to purchase care from hospitals and the private  sector for patients in their area, are often not up to scratch, the report said.

Dr Lawrence Buckman Chairman of the British Medical Association's General practice Committee, said it may not always be appropriate to measure weight, especially if the patient has an unrelated problem.

"Blaming just GPs for fewer diagnoses of heart disease is unfair as it is the responsibility of health professionals across the NHS to diagnose heart disease,"

He said:  " The current scientific evidence also says that heart disease needs to be diagnosed with the use of an echocardiogram and that needs to be done in hospital.

The proportion of primary care trusts scoring excellent or good on quality of services has dropped from a third to a quarter in the past year

Around 60,000 people with serious long-term conditions are not being cared for by community matrons, and primary care trusts did not buy enough crisis services for people with mental health problems, the Commission said.

The majority of trusts do not provide information to diabetics to keep them well he added.


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Instant test for a failing heart


Roger Dobson

[Daily Mail-GOOD HEALTH-Tuesday November 6,2007]


A SIMPLE hand -held device that uses sound to detect the early signs of heart disease could dramatically speed up diagnosis.

Its speed, simplicity, relative cheapness and ease of use - it can be used over clothing - means it could also be suitable for mass screening.

Around 2.5 million men and women have some form of heart disease - it is the UK's biggest killer, responsible for more than 100,000 deaths each year.

Heart problems can be electrical or mechanical. Electrical problems, such as heart rhythm disorders or arrhythmias, are diagnosed with electrocardiography or ECG, which measures the electrical activity of the HEART.

The electrical impulses made while it is beating are recorded and shown on a piece of paper in the form of an electrocardiogram.

Mechanical problems in the structure of the heart are picked up by ultrasound echocardiograms. These use sound waves to produce images of the heart and can be used to identify any abnormalities in the muscle and valves.


The problems with these diagnostic tools is that they are expensive and need highly -trained staff to use them. They are also time consuming for the patient. An ECG, for example , can take up to an hour.

The new device is expected to cost just a few hundred pounds. It provides instant results and doesn't need a specialist to operate it - which means it could be used as  a large-scale screening tool for detecting early, treatable signs of disease.

The ViScope relies on phonocardiographic technology -it detects the sounds  the HEART makes as it pumps blood.

These are then compared to the sounds from a healthy heart to show up any problems. the sound of blood going through narrowed arteries, for instance, is different to the sound of blood going through healthy ones.

It also displays the sound waves on a visual display unit which the operator can compare with the image from a healthy heart. It can also store data for later comparisons.

A wide range of problems have distinctive sound fingerprints, including heart murmurs, value defects. stenosis or narrowing of blood vessels, and holes in the heart.

The new device is about to be tested in a clinical trial in Melbourne, with 500 men and women -100 healthy people, 100 with risk factors for heart failure, and 300 with different types of heart failure.

'As there are many therapies available to prevent and treat this condition, it is believed that detecting it early will help reduce the burden of the disease and permit more effective treatment

'It gives both visual and audio information and that is going to be very useful, and makes screening for heart defects more feasible,' says Dr Chris Morley, consultant cardiologist at Bradford University Teaching Hospitals.

   'When I was training, cardiologists made diagnoses  on the basis of what they heard through a stethoscope. With the arrival of new technology like ultrasound we no longer relied on what we heard with the ear so skill levels have declined.

'But ultrasound is expensive and needs highly-trained operators and that makes it unsuitable for large scale screening.

'The decline in stethoscope skills means that screening for sound with a stethoscope is not possible either. This device is relatively inexpensive and makes up for the lack of those skills.'



[Well! the question of the medical profession using or even having the equipment on view has been raised before as it appears that many in the profession no longer bother to connect the very useful nature of the equipment to the also calming effect it no doubt it projects from the doctor to the patient of that very professionalism which has been placed in jeopardy because of the displacement and hiving off of the duties of a doctor to others in the medical profession.]

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[The  article above of the risks to patients by their not being monitored by GPs is most timely as confirmed by our own experience of a case study which began on the 29th October, 2007 and the lack of development as at the 5th December, 2007.

Doctor goes on holiday while urgent drugs for heart patient were left in practice dispensary had by his return been there for almost three weeks. No letter-no phone call, and the patients house only a matter of a minute away and although the patient or his wife called each week to the practice since seeing the Heart Specialist neither were told that the drugs were available for collection and this all happened in a time period of five weeks.

An early return visit in approximately a week after the first visit to the hospital to find out if there was a protocol system in place brought the reply there was none but that a letter had been sent to the doctor on 7th November, 2007 and on successive follow-up calls the answer from the patients practice was that no letter had yet been received from the Heart Specialist with the detailed instructions for medication and treatment. The Doctor a few days after his return at the time of the appointment asked the patient why he did not ask for an appointment earlier and that the Heart Specialist had told the patient what the intended medication and treatment was to be.

The patient said that until the doctor had received the letter with the details of medication and treatment there would have been no purpose in doing so as without the letter the doctor would not know what to proscribe and hence the weekly visit by the patient or wife to the practice.  They assumed that the successive visits to the surgery to ask the question would get as far as the doctor otherwise how would they be able to say that a letter had been received. Surely, it would have made more sense for the practice to notify the patient when the information is to hand rather than leaving it up to a stressed and untreated patient with concerns of further ill health problems who had been informed by the Heart Specialist of the need to get things moving as he wished to see me again in four months.

The patient had nothing but praise for the way the Consultant carried out the examination and his professionalism and excellent manner and sensitivity. His good work was undermined by a small practice of two doctors and three other staff. The Reception area was immediately alongside the Dispensary so we are at a loss to find that though the staff were only a few feet apart that they did not talk together about a proscription that had not been picked up for almost three weeks.

This same practice over a year ago refused to look at a 74 -year-old patient that had been in a car crash only a few hundred yards away from the practice when the patients car was struck from the left broadside which resulted in the patient suffering severe shock/trauma the effects of which are still with the patient today.  He had at the time been told to wait a few minutes but a member of staff returned shortly after to say that the patient should find his way to the A & E in the town a few miles away.

The whole matter shows no system whatsoever in place. To leave it in the hands of a patient to do all the running around-particularly a HEART PATIENT shows how bad the NHS has become. There should be a PASSPORT to HEALTH which identifies the treatment and medication and which has a time-scale in place to ensure that it is the responsibility of the NHS to ensure that medication and treatment are carried out with less stress to the already ill patient particularly a HEART PATIENT.

But it is not only the local doctor practice that fails to look after HEART PATIENTS the local Hospital A& E are also lackadaisical about the concerns of those with heart problems  particularly elderly persons who inadvertently on taking their first dosage of a medication recommended by a specialist and emphasised the necessity of the regular taking of that drug had taken a full daily dosage instead of the three times a day and as it was stated on the enclosed drug leaflet that an over dosage would necessitate a visit to the doctor or hospital had phoned the hospital and was told that it was necessary to call in to A & E for a check-up.

The pensioner on arriving at the hospital was told  that a nurse would see him shortly. After 25 minutes and after an hour from taking the overdose he became concerned because he noticed that the waiting time was 2hrs 15 minutes. He went back to the receptionist and mentioned his concern that there appeared no priority for those particularly with heart complaints to be seen urgently and was told that he should return to his seat and that a nurse would again see him.

Shortly after returning to his seat he noticed that another person had been admitted to the  attention of the nurse who the waiting pensioner had been ensured that he was the next to be seen. So the pensioner went back yet again to the counter as a staff nurse came forward with details and he immediately asked the nurse why he had not been seen earlier in view of the fact that he had taken an overdose -he was a heart patient and elderly and that the nursing staff could not know if the person to be seen was of greater risk until seen by their staff.

The staff nurse responded by saying that the pensioner appeared in good heath -had good facial colour and good breathing and not of any immediate danger. The pensioner then mentioned that he would not have visited the hospital if he had been ensured over the phone that he was in no danger and that as they had no priority for those with heart conditions and elderly and could not give a firm assurance that he would be seen immediately and after the assurance of good health from the nurse he would leave .He then left the hospital and returned home.

The Government a week ago talked of giving priority to present and past members of the Armed Forces when they were in need of treatment in the NHS and they also gave an undertaking to improve the care of HEART PATIENTS in general. The above instances proves they have a long way to go before they have a world-class HEALTH SERVICE instead of as indicated last week is possibly nearer  THE WORST HEALTH SERVICE in Europe or possibly even in the  WORLD at large.

How it was possible for the hospital to have no clear policy to cover the events outlined above knowing where it treated with no urgency a case of over-dosage they not knowing at the time of arrival the health of the the HEART PATIENT particularly the elderly at the time is staggering as instead of the patient above who survived the ordeal there will be a case in the future where the prognosis is most deadly and any delay could result in a loss of life.

We are informed in an article (Daily Mail-November 29,2007) that blunders in hospitals are linked to 90,000 patient deaths a year.

Among the problems identified are:

  • hospital acquired infections such as MRSA

  • complications during or after surgery

  • wrong diagnosis

  • 20,000 patients a year die from blood clots after operations

  • pressure ulcers

  • drug complications

  • falls

  • unplanned transfers to operating theatre and intensive care

  • unplanned readmissions.




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Daniel Martin

Political Reporter

[Daily Mail-Wednesday, June 18,2008]

MORE THAN HALF of voters believe Britain should drop the controversial European Treaty in the wake of its rejection in last week's


The poll comes as the Tories launch a last-ditch bid in the


today to delay the



10,000 people

have signed a


on the


within the past few days


, calling on the





Downing Street website is


JUNE 18-2008