Category Archives: Alergies

Family doctors working ‘beyond safe levels’, says GPs’ leader

As doctors describe dealing with up to 70 patients a day, college warns of risks to public health

Waiting room of GP practice


Patients face longer waits to see a GP, says the Patients Association. Photograph: Alamy


GPs across Britain are working above safe levels because of relentless and unmanageable workloads, leading doctors have warned.

Prof Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said that family doctors were “regularly working way beyond what could be considered safe for patients”, potentially jeopardising their own health and wellbeing.

Her comments were made in response to a survey by GP magazine Pulse. It heard from 900 GPs across the UK and found that each deals with 41 patients a day. The European Union of General Practitioners (UEMO), a leading forum of European family doctors, has said that seeing around 25 patients is safe.

The Pulse poll found that one in five family doctors (20%) deal with 50 daily patient contacts, which include face-to-face and telephone consultations, home visits and e-consultations. Some GPs told Pulse they have 70 contacts a day.

Prof Stokes-Lampard said: “GPs expect to be busy, and we are making more consultations than ever before as we strive to deliver the best possible care to all our patients who need it. But the workload at the moment is relentless and it’s taking its toll.”

One doctor, who reluctantly left a career carrying out 13- to 14-hour days as a partner for a more manageable workload as a salaried GP and 31 to 40 daily contacts, told Pulse: “I felt I was at a risk of making mistakes and causing potential harm to my patients and my career.”

Another spoke of one exceptional “horrendous” Monday where he had 71 contacts. Since then the practice has since increased the number of on-call doctors on Mondays to three.

Prof Stokes-Lampard said the survey backed up what the college has been saying for years – that many GPs are regularly working way beyond what could be considered safe for patients.

It was not necessarily the number of consultations, but the content of those consultations, she added. “Our patients are increasingly presenting with more complex, chronic conditions, many of which require much longer than the standard 10-minute appointment,” she said.

“Our workload needs to be addressed – it has risen at least 16% over the last seven years,” she added. “Yet the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.”

Dr Richard Vautrey, British Medical Association general practitioners committee chair, said: “We know that an unmanageable and unsafe workload is the primary reason behind doctors leaving general practice, which is leading to serious issues including practices closing to new patients and other surgeries closing entirely. This workload pressure also means GPs are increasingly suffering from burnout and patients are being put at risk of unsafe care.”

He urged the government to work with the BMA to come up with a longterm solution “to ensure the needs of a growing population with increasingly complex conditions can be met safely on the front line”.

Patients’ groups and MPs also expressed concern at the findings. Liz McAnulty, chair of the Patients Association, said: “We have gone past the point where efficiencies can be found, and firmly into territory where GPs’ workloads are unsustainable and where patients face growing waits to access GPs and greater risks to their safety.”

Shadow health secretary Jonathan Ashworth said the Royal College’s warning should serve as an urgent wake-up call to ministers. “The truth is, since 2010 years of severe underfunding of our NHS has left general practice squeezed with tired, overworked and overstretched GPs. We have lost 1,000 GPs in the past year.”

May appoints minister to tackle loneliness issues raised by Jo Cox

Tracey Crouch tasked with implementing recommendations from commission set up after the MP’s death

An elderly woman sits alone in a bedroom


Theresa May cited research saying that 9 million people often or always feel lonely. Photograph: Education Images/UIG/Getty Images/Universal Images Group

Theresa May has appointed one of her ministers to lead on issues connected to loneliness, implementing one of the main recommendations of a report into the subject by the Jo Cox Commission.

Tracey Crouch, the minister for sport and civil society, will head a government-wide group with responsibility for policies connected to loneliness, Downing Street said.

In parallel, the government said it would develop a wider strategy on the issue, gather more evidence and statistics, and provide funding for community groups to start activities which connect people.

The move follows a cross-party report by the commission set up in honour of Cox, the Labour MP murdered by a rightwing extremist in 2016, who had campaigned about loneliness.

May is expected to formally announce the appointment on Wednesday, and to say that she has accepted many of the recommendations from the commission. She will also host a Downing Street reception in honour of Cox’s work.

Citing research saying that 9 million people often or always feel lonely, the prime minister said: “For far too many people, loneliness is the sad reality of modern life.

“I want to confront this challenge for our society and for all of us to take action to address the loneliness endured by the elderly, by carers, by those who have lost loved ones – people who have no one to talk to or share their thoughts and experiences with.”

May paid tribute to Cox’s work, saying she hoped the initiative would aim “to see that, in Jo’s memory, we bring an end to the acceptance of loneliness for good”.

The Jo Cox Commission, which is chaired by the Labour MP Rachel Reeves and Seema Kennedy, a Conservative, has been working for the past year with more than a dozen charities on ideas to approach the problem.

In a joint statement, Reeves and Kennedy said they welcomed the government response, and would work with Crouch and various groups to tackle the issue.

They said: “Jo Cox said that ‘young or old, loneliness doesn’t discriminate’. Throughout 2017 we have heard from new parents, children, disabled people, carers, refugees and older people about their experience of loneliness.”

Crouch said she felt privileged to be taking forward the work begun by Cox: “I am sure that with the support of volunteers, campaigners, businesses and my fellow MPs from all sides of the house, we can make significant progress in defeating loneliness.”

Mexico: 500 years later, scientists discover what killed the Aztecs

Within five years, 15 million people – 80% of the population – were wiped out in an epidemic named ‘cocoliztli’, meaning pestilence

Scientists identified a typhoid-like ‘enteric fever’ for which they found DNA evidence on the teeth of long-dead victims.


Scientists identified a typhoid-like ‘enteric fever’ for which they found DNA evidence on the teeth of long-dead victims. Photograph: FabioIm/Getty Images

In 1545 disaster struck Mexico’s Aztec nation when people started coming down with high fevers, headaches and bleeding from the eyes, mouth and nose. Death generally followed in three or four days.

Within five years as many as 15 million people – an estimated 80% of the population – were wiped out in an epidemic the locals named “cocoliztli”. The word means pestilence in the Aztec Nahuatl language. Its cause, however, has been in questioned for nearly 500 years.

On Monday scientists swept aside smallpox, measles, mumps, and influenza as likely suspects, identifying a typhoid-like “enteric fever” for which they found DNA evidence on the teeth of long-dead victims.

“The 1545-50 cocoliztli was one of many epidemics to affect Mexico after the arrival of Europeans, but was specifically the second of three epidemics that were most devastating and led to the largest number of human losses,” said Ashild Vagene of the University of Tuebingen in Germany.

“The cause of this epidemic has been debated for over a century by historians and now we are able to provide direct evidence through the use of ancient DNA to contribute to a longstanding historical question.”

Vagene co-authored a study published in the science journal Nature Ecology and Evolution.

The outbreak is considered one of the deadliest epidemics in human history, approaching the Black Death bubonic plague that killed 25 million people in western Europe in the 14th century – about half the regional population.

European colonisers spread disease as they ventured into the new world, bringing germs local populations had never encountered and lacked immunity against.

The 1545 cocoliztli pestilence in what is today Mexico and part of Guatemala came just two decades after a smallpox epidemic killed an estimated 5-8 million people in the immediate wake of the Spanish arrival.

A second outbreak from 1576 to 1578 killed half the remaining population.

“In the cities and large towns, big ditches were dug, and from morning to sunset the priests did nothing else but carry the dead bodies and throw them into the ditches,” is how Franciscan historian Fray Juan de Torquemada is cited as chronicling the period.

Even at the time, physicians said the symptoms did not match those of better-known diseases such as measles and malaria.

Scientists now say they have probably unmasked the culprit. Analysing DNA extracted from 29 skeletons buried in a cocoliztli cemetery, they found traces of the salmonella enterica bacterium, of the Paratyphi C variety.

It is known to cause enteric fever, of which typhoid is an example. The Mexican subtype rarely causes human infection today.

Many salmonella strains spread via infected food or water, and may have travelled to Mexico with domesticated animals brought by the Spanish, the research team said.

Salmonella enterica is known to have been present in Europe in the middle ages.

“We tested for all bacterial pathogens and DNA viruses for which genomic data is available,” and salmonella enterica was the only germ detected, said co-author Alexander Herbig, also from Tuebingen University.

It is possible, however, that some pathogens were either undetectable or completely unknown.“We cannot say with certainty that S enterica was the cause of the cocoliztli epidemic,” said team member Kirsten Bos. “We do believe that it should be considered a strong candidate.”

Mental health still losing out in NHS funding, report finds

King’s Fund says physical health services are still getting bigger budgets, five years after ministers promised ‘parity of esteem’

Mental health


The King’s Fund has warned about the continuing inequality in funding. Photograph: Alamy Stock Photo

Mental health care providers continue to receive far smaller budget increases than hospitals, five years after ministers pledged to create “parity of esteem” between NHS mental and physical health services.

The disclosure, in a new report by the King’s Fund, has sparked concern that mental health patients are receiving poorer quality care because of the widening gap in income.

Budgets of NHS mental health trusts in England rose by less than 2.5% in 2016-17, far less than the 6% boost received by acute trusts and those providing specialist care.

It is the fifth year in a row that NHS bosses gave physical health services a larger cash increase, even though ministers have repeatedly stressed the need to give mental health services more money.

Mental health trusts in England received income increases of just 5.5% between 2012-13 and last year, whereas budgets for acute hospitals rose by 16.8% over the same period, new research by the thinktank shows.

The author Helen Gilburt, a fellow in health policy at the King’s Fund, warned that the continuing inequality in funding was preventing mental health trusts employing enough staff, which is damaging patient care.

“While the NHS is in a difficult position, the slow growth in mental health trust funding and the problem of not having enough staff are both having a real impact on patients, who are having to put up with services that are being stretched to the limit,” she said.

Paul Farmer, the chief executive of the charity Mind, said: “Mental health has been under-resourced for too long, with dire consequences for people with mental health problems.

“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line.”

More positively, 84% of mental health trusts last year received a budget increase from NHS clinical commissioning groups (CCGs) – a rise on the 51%, 60% and 56% which had done so in the previous three years. The mental health investment standard, brought in in 2015-16, compels all CCGs to give mental health services an annual rise which at least mirrors their own budget increase.

Gilburt said, however, that “the [overall] funding gap between mental health and cute NHS services is continuing to widen. As long as this is the case, the government’s mission to tackle the burning injustice faced by people with mental health problems will remain out of reach”.

NHS England said funding for mental health services rose in 2016-17 by 6.3% to £9.7bn, compared with a smaller increase – of just 3.7% – in other parts of the health budget. It said mental health was also receiving a slightly larger share of overall CCG spending, at 13.6%.

Mental health still losing out in NHS funding, report finds

King’s Fund says physical health services are still getting bigger budgets, five years after ministers promised ‘parity of esteem’

Mental health


The King’s Fund has warned about the continuing inequality in funding. Photograph: Alamy Stock Photo

Mental health care providers continue to receive far smaller budget increases than hospitals, five years after ministers pledged to create “parity of esteem” between NHS mental and physical health services.

The disclosure, in a new report by the King’s Fund, has sparked concern that mental health patients are receiving poorer quality care because of the widening gap in income.

Budgets of NHS mental health trusts in England rose by less than 2.5% in 2016-17, far less than the 6% boost received by acute trusts and those providing specialist care.

It is the fifth year in a row that NHS bosses gave physical health services a larger cash increase, even though ministers have repeatedly stressed the need to give mental health services more money.

Mental health trusts in England received income increases of just 5.5% between 2012-13 and last year, whereas budgets for acute hospitals rose by 16.8% over the same period, new research by the thinktank shows.

The author Helen Gilburt, a fellow in health policy at the King’s Fund, warned that the continuing inequality in funding was preventing mental health trusts employing enough staff, which is damaging patient care.

“While the NHS is in a difficult position, the slow growth in mental health trust funding and the problem of not having enough staff are both having a real impact on patients, who are having to put up with services that are being stretched to the limit,” she said.

Paul Farmer, the chief executive of the charity Mind, said: “Mental health has been under-resourced for too long, with dire consequences for people with mental health problems.

“If people don’t get the help they need, when they need it, they are likely to become more unwell and need more intensive – and expensive – support further down the line.”

More positively, 84% of mental health trusts last year received a budget increase from NHS clinical commissioning groups (CCGs) – a rise on the 51%, 60% and 56% which had done so in the previous three years. The mental health investment standard, brought in in 2015-16, compels all CCGs to give mental health services an annual rise which at least mirrors their own budget increase.

Gilburt said, however, that “the [overall] funding gap between mental health and cute NHS services is continuing to widen. As long as this is the case, the government’s mission to tackle the burning injustice faced by people with mental health problems will remain out of reach”.

NHS England said funding for mental health services rose in 2016-17 by 6.3% to £9.7bn, compared with a smaller increase – of just 3.7% – in other parts of the health budget. It said mental health was also receiving a slightly larger share of overall CCG spending, at 13.6%.

Don’t knock the flu jab – it’s a modern miracle

As the flu season begins to ramp up, so too do the annual complaints about the vaccine

Woman with cold on computer at homeFrome,UK


Varying rates of flu vaccine effectiveness are to be expected, but shouldn’t stop you getting it Photograph: Cultura RM Exclusive/Colin Hawkins/Getty Images/Cultura Exclusive

“The flu jab DOESN’T work, officials admit,” scolded a recent headline from the Daily Mail.

Meanwhile, in the comments under that article, and in shadier regions of the internet, conspiracy theorists are having their usual annual field day: the flu vaccine actually makes people sick; the World Health Organisation is in cahoots with Big Pharma; the vaccine is being deliberately sabotaged by its manufacturers to drum up business for more expensive anti-viral therapies.

Most sensible people understand that our impressive arsenal of vaccines is a modern miracle that prevents vast numbers of premature deaths. Together with improvements in nutrition, sanitation and modern medicine, routine inoculations have lifted us out of the dark ages.

The problem with influenza is that, unlike some other bugs, it’s a tricky shape-shifter. Because of this, the vaccine against it is not nearly as effective as others. For example, a complete course of MMR vaccine is 97% effective at preventing measles; two successive doses of the chicken pox vaccine are about 98% effective; and tetanus toxoid is about 100% effective. What’s more, these impressive figures stay relatively constant year on year.

In contrast, the success of the annual flu vaccine ebbs and flows dramatically, and the healthcare profession is pretty happy when it reaches a modest 40-60% efficacy. Some years it is much worse – as in 2004-05, when its effectiveness was only 10%.

It’s probably no surprise that people think the flu jab is rubbish – especially when the media is delighted to rub failures into the noses of those who work so hard to make it happen. We have become so accustomed to highly effective vaccines that it can be tempting to criticise those that don’t work perfectly. With such high prevention rates, many vaccinated people will feel disappointed when they succumb to the illness. Just as a man who pulled himself out of starvation to become rich might one day frown upon anything but a grand feast, the developed world – from its privileged, 21st century vantage – is happy to talk down a cheap and serviceable preventive measure that improves global morbidity and mortality and reaps significant economic benefit.

And the discontent is rife. In 2014-15, the US Centers for Disease Control issued an early press release warning that some circulating strains had drifted and the vaccine might not be as effective. Traditional media outlets tutted, and antivax interest groups went into meltdown, jeering at the august public health body for this admission, as if anything less than perfection was a humiliation.

In fact, predicting the three or four flu strains that will be included in each year’s vaccination is an astonishing feat of science and surveillance by countless individuals and reference laboratories around the world, on a par with forecasting the precise weather that will occur hour by hour in a month’s time. Every year as the needle slides into my own arm, I give a moment of quiet thanks to these hard-working folk.

Influenza viruses spread from person to person like lightning and also move through various animal reservoirs. In the process, they discard one coat for another, mixing and matching pieces of their genomes with other viruses in an endless game of cat and mouse with the immune systems of the various species they inhabit. Add overpopulated areas and global travel into the picture and what you have is a stochastic, messy and imprecise brew of many thousands of strains, from which only three or four must be plucked.

Once you choose you can’t go back. Because influenza will only grow – painfully slowly – in chicken eggs, it takes half a year to create and stockpile each year’s vaccine. When surveillance picks up crucial shifts after the February deadline, as it did in 2004, it’s far too late to do anything about it.

And let’s unpick the phrase “it didn’t work”. Even the 10% effectiveness rate in 2004-05 wasn’t a complete washout. In the US, as a result of being vaccinated tens of thousands of elderly people did not end up in hospital, and a number of people did not die.

For the price of a cinema ticket, you had a one in ten chance of dodging the disease had you been exposed to. There are lots of gamblers who would be happy to spin the wheel for those odds. I certainly am, having had the flu before and being painfully aware of how long it can wipe you out. Those one in ten who were protected helped to quell infection in others via herd immunity, and the vaccinated people who did get sick likely received some benefit from cross-reacting immunity elicited against the other strains in the vaccine.

There’s been a lot of hype about “Aussie flu” this year, but the offending strain (A H3N2) was around last year and is represented in this year’s vaccine. If the flu season turns out to be as bad in the northern hemisphere as it was in the southern, it won’t be the fault of the vaccine. Instead, we should remember that despite all its imperfections, it’s a remarkable achievement that doesn’t deserve the bad press it perennially suffers. What’s more, one hundred years on from the Spanish flu, which killed 50 million or more people in 1918, it’s comforting to know that we, as a species, have this annual chance to hone our skills of prediction and prevention for when the next pandemic comes.

Surgeons don’t have to sign their names… in us | Barbara Ellen

Surgeon Simon Bramhall, who burned his initials on to the livers of two transplant patients while working at the Queen Elizabeth hospital, in Birmingham, has been fined £10,000 and given a 12-month community order.

Bramhall (now working for the NHS in Herefordshire) was fortunate not to have been struck off. It’s disturbing enough to think of your body being opened up for surgery, but to have somebody leave their mark there (“SB”) is grotesque; as the court found, it was “an abuse of power, and a betrayal of trust”. Bramhall’s defence argued that it was to lighten the mood in theatre. Really? In that case, put on some quiet background music – don’t sign a human organ, as if you’re some kind of rock star in scrubs being pestered for an autograph.

It seems that there was no lasting harm done – the marks wouldn’t have affected the performance of the liver and they would disappear in time. However, there’s always harm done; if nothing else, such incidents bolster the widespread public perception of surgeons being arrogant and superior.

Too many cases such as this and patient-surgeon trust would be in grave danger of breaking down.

Death and the cruel process that follows | Letters

Annalisa Barbieri was lucky to have been able to keep her father at home for 11 hours after he died (Family, 6 January). I found my mother (aged 90) who had died in her sleep at home. Not knowing what to do, I rang her GP. This started a legal process that whisked her body away before I had time to say goodbye. Because she did not die in hospital or hospice and hadn’t seen her GP in the last two weeks, the GP was required to contact the police, who had to come and keep guard on the body until the undertakers came to take it away, I assume in case she’d been murdered. They couldn’t even wait for my sister to arrive to see my mother dead in her bed.

If I’d been warned that this would happen, I would have spent an hour or two quietly with my mother’s body before I rang the GP.

It would be good to publicise this system so that others don’t have the same experience. Everyone was kind, but the process is cruel.
Christine Holloway
Winchester

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We need to raise taxes to fund our care needs | Letters

The obvious answer to saving the NHS is to train and recruit more care workers in both the NHS and social care – which would not only (alone) meet current crying care needs but provide good professional human-interface jobs in the coming hi-tech age (killing two currently worrying birds with one stone). This does, however, mean raising more public revenue by getting people to pay more taxes.

But to achieve this we must first counter the common idea that providing something that people want, and raising the revenue to provide it by appropriate pricing, is a clear case of “positive wealth creation” if done in the private sector – not only creating wealth for the sector in question (which may be private healthcare, as in the US) but stimulating activity in the rest of the economy – but is simply a “negative burden” if done in the public sector.

Providing separate healthcare budgets, linking specific tax increases to specific public care improvements (disinterring what we need to pay for care from more general taxation), which I think Chris Ham is recommending, may be the best way to get people to focus on the real issues. But until the debilitating myth of private good / public doubtful is scotched, we will not reach square one in solving our current healthcare crisis.
Bernard Cummings
Erith, Kent

It is now time for all opposition parties to combine to bring maximum pressure on the government to end the ever increasing and costly privatisation of the NHS and increase general taxation to pay for it. I think most people would agree to a tax that was hypothecated for the NHS and social care. Part of the problem the NHS is experiencing is due to bed blocking caused by such large cuts to social care.
Valerie Crews
Beckenham, Kent

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What I’m really thinking: the deaf parent

What’s going on? Am I missing out on something? Or should I say on something else: all the opportunities for small-talk that might make me feel more comfortable and confident in asking if your child wants to come to ours for tea, because our kids are friends. I am bamboozled. I feel the opening gambit has been lost.

My audiologist is great. He tries everything, but it’s about how the brain processes the reduced amount of sound I get, which is about half what anybody else might hear. Lip-reading goes only so far. I’d swap my arm for your hearing. Or my leg. It depends what day it is and how many times I’ve had to get someone else to answer my phone. Or how many times I’ve had to ask the woman in the supermarket to repeat herself, only to realise she’s asking if I have a loyalty card, as she has every other time I’ve been at her till. As a single dad, I’m in the shop a lot.

I think everybody else is friends, and even if I know this is untrue and ridiculous, it still bothers me. I can see fractures after a couple of years, anyway. People who have excised themselves from cliques, new ones brewing. I’m good at reading people’s faces, but I’d rather know what they were all going on about.

I worry I’m stopping my child from having the life yours have. I worry I won’t pick up on something he says, and he won’t repeat it because he’s embarrassed or tired. Could he miss out on a school trip because of me? Will he tell me about his work, because it takes so long? Maybe I’ll miss a clue that he’s being bullied, or not get the punchline to his jokes. It’s exhausting, because I’m deaf all the time. I even dream in mumbles.

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