Three times variation in number of patients GPs send for cancer tests

Thousands of cancer patients may be treated too late because some GPs are three times less likely to refer them to a specialist, official figures have revealed for the first time.Three times variation in number of patients GPs send for cancer testsSome family doctors are referring three times more patients with cancer symptoms to specialists than others, raising fears that large numbers of people are missing out on an early diagnosis which can affect their chances of survival.

The official figures mean that for the first time patients can compare the referral rates for suspected cancer at their own GP practice with others nearby and with the local and national averages.

Experts said the wide variation in referral rates was ‘worrying’ because those GPs sending relatively few patients to hospital for tests may be missing cases while others sending large numbers of patients may be causing unnecessary anxiety.

The figures from the National Cancer Intelligence Network (NCIN) found 1,000 GP practices referred more than 2,550 people per 100,000 and a similar number sent fewer than 830 patients per 100,000 for tests.

The correct number of referrals is yet to be established but it is thought those at either end of the spectrum are likely to be due to variation in standards of care.

In most cases the primary care trust areas with the highest referral rates match the areas which are known to have high prevenance of cancer such as the north west and south west.

The individual GP practice with the highest referral rate was 5,591 per 100,000 at Netherton primary care trust practice in Sefton and the lowest referral rate recorded was Dr C B Patel in Hillingdon, London with 89 per 100,000.

The figures also reveal the proportion of patients who were referred to specialists who went on to be diagnosed with cancer.

The so-called conversion rate showed that on average across England almost 11 per cent of patients suspected by their GP of having cancer and referred urgently, did in fact have the disease.

However the conversion rate also varied widely, again suggesting that some GPs are missing cases of cancer while others are overly cautious.

The highest value rate by primary care trust area is 15.6 per cent in Herefordshire compared with 2.3 per cent in Hammersmith and Fulham which has the lowest conversion rate.

Sarah Woolnough, executive director of policy and information at Cancer Research UK, said: “It’s very worrying to see a more than threefold variation in the rate of urgent cancer referrals among GPs.

“And although the number of people GPs suspect have cancer and send for further tests will naturally vary depending on the age and demographic of their patients this level of variation suggests differing approaches by some GPs.  We urgently need to learn more about what’s behind these differences and tackle any poor practice.”

“We already know that some patients present several times with cancer symptoms before being referred for further investigation, which can lead to late diagnosis. And a delayed cancer diagnosis could prove critical for a patient’s chance of survival.”

It has been calculated that if cancer survival rates matched the European average, 5,000 lives could be saved per year with earlier diagnosis and better treatment. If England’s survival rates matched the best in Europe then 10,000 lives a year could be saved.

The average GP will only see seven patients who have cancer each year. These break down as one case each of breast, bowel, prostate and lung cancers, plus three cancers of other types.


Curries to be tested for cancer cures

A chemical found in curry is to be tested for its ability to kill bowel cancer tumours in patients.Curries to be tested for cancer curesCurcumin, which is found in the spice turmeric, has been linked to a range of health benefits.

Studies have already shown that it can beat cancer cells grown in a laboratory and benefits have been suggested in stroke and dementia patients as well.

Now a trial at hospitals in Leicester will be investigating giving curcumin alongside chemotherapy drugs.

About 40,000 people are diagnosed with bowel cancer in the UK each year.

If the disease spreads around the body, patients are normally given a combination of three chemotherapy drugs, but about half will not respond.

Forty patients at Leicester Royal Infirmary and Leicester General Hospital will take part in the trial, which will compare the effects of giving curcumin pills seven days before starting standard chemotherapy treatment.

Prof William Steward, from Leicester University, who is leading the study, said animal tests combining the two were “100 times better” than either on their own and that had been the “major justification for cracking on” with the trial.

He said: “Once bowel cancer has spread it is very difficult to treat, partly because the side effects of chemotherapy can limit how long patients can have treatment.

“The prospect that curcumin might increase the sensitivity of cancer cells to chemotherapy is exciting because it could mean giving lower doses, so patients have fewer side effects and can keep having treatment for longer.

“This research is at a very early stage, but investigating the potential of plant chemicals to treat cancer is an intriguing area that we hope could provide clues to developing new drugs in the future.”

Joanna Reynolds, from Cancer Research UK, said: “By doing a clinical trial like this, we will find out more about the potential benefits of taking large amounts of curcumin, as well as any possible side effects this could have for cancer patients.”


6,000 patients die a year due to poor staff checks

Six thousand patients are dying every year because hospital staff are not properly monitoring vital signs.6,000 patients die a year due to poor staff checksThe health of patients is deteriorating and going unnoticed because important signs, such as blood oxygen levels which can predict heart and lung problems, are either not being recorded at all or often enough.

Bedside health charts are not designed to pick up subtle physiological changes which together can indicate if a patient’s condition is going downhill, according to the Royal College of Physicians.

Doctors would be able to intervene much more promptly and save thousands of lives every year if hospitals used a more comprehensive chart, the report states.

Hospital staff are also being left confused by the more than 100 different types of chart which are used across the country.

There should be just one system used for all staff who check on patients’ conditions – whether they are in care homes, hospitals or in ambulances, a working group set up by the college said.

It has developed a new chart which it is campaigning to have rolled out across all hospitals in the UK.

The chart is a ‘traffic light’ monitoring system of six vital signs such as pulse, temperature and blood pressure, in which each is given a risk score.

The healthcare worker then adds up the score for each sign to give an indication of the severity of illness and whether the patient needs more urgent care.

Bryan Williams, professor of medicine at University College London, chair of the working party which developed the new chart, said it would have a “major impact”.

“Most improvements we make are incremental, but we see this as transformational. It’s going to make a big difference,” he said. “Subtle changes identified together are often more significant than a single extreme change. That’s why deterioration is often missed.”

“If you go into hospitals, you will find very different systems in place. Sometimes staff are not taking all six measurements, but even where they are, they are not being scored in the same manner – sometimes even between wards.  There is also tremendous variation between hospitals in frequency of monitoring.”

The National Early Warning Score will require nurses and healthcare assistants to monitor temperature, pulse, blood pressure, breathing rate, level of consciousness, and oxygen saturation.

The last is a measure of how much oxygen is in the blood, and has only recently been adopted by hospitals. A low score can indicate heart and lung problems.

The Patients Association welcomed the new chart system, saying it should be implemented “urgently”.

Katherine Murphy, chief executive of the association, said: “The public will be shocked to learn that the NHS has been operating such an ad hoc system of monitoring deterioration in a patient’s condition – with different approaches in each hospital.”

The Royal College of Nursing has been closely involved in the project.

Janet Davies, director of nursing and service delivery, said: “There is nothing nurses and doctors should prioritise more than patient safety, and this system, if implemented across the board, will be a great leap forward for patient care.”

The Society for Acute Medicine also welcomed it, saying the “lack of consistency” between hospitals “may be a contributory factor in the higher levels of mortality in early August when many junior doctors change jobs”.


Patients swamp A&E as GPs cut surgery hours

Hospital Accident and Emergency departments are being swamped by patients who cannot visit GP surgeries or NHS walk-in centres, leading to longer waiting times.Patients swamp A&E as GPs cut surgery hoursThe reduction in opening hours is forcing some patients to wait up to three weeks for a GP’s appointment.

Information provided by almost two thirds of NHS primary care trusts indicated that almost 500 surgeries in England have stopped offering evening and weekend appointments.

Andy Burnham, the shadow health secretary, who commissioned the research, raised concerns that the NHS was being turned into an organisation that works for the convenience of doctors, rather than patients.

In April 2010, David Cameron promised that the Conservatives would ensure that GP surgeries remained open “until 8pm, seven days a week”.

The Coalition has abolished the official survey of GPs’ opening hours and is giving more power to doctors to commission and organise health services for patients in their areas.

However, figures from 91 primary care trusts, obtained by Labour under the Freedom of Information Act, showed a fall in the number of surgeries offering extended opening hours in half of NHS trusts.

Nationally, the survey suggested there had been a 5.7 per cent decline in surgeries offering weekend and evening appointments. This would be equivalent to 477 surgeries serving more than two million patients across England.

Labour said 26 emergency care units, including 12 NHS walk-in centres, had closed in the last year. At the same time, hospital emergency departments have been overwhelmed by one million more patients this year than in 2011, the Opposition claimed.

Mr Burnham said: “People are turning up at accident and emergency sicker and you get fewer staff to deal with them. David Cameron made a lot of promises on the NHS and one by one we are seeing them broken. The combination of the financial challenge with the biggest ever reorganisation of the NHS has served to severely destabilise the NHS.”

Mr Burnham said that more than 1,300 patients had contacted the party with concerns, many reporting that it takes two to three weeks to secure a doctor’s appointment. The worst affected area for cuts to opening hours was Hartlepool, where 31 per cent of surgeries were operating a reduced service. In Newcastle and Haringey, a quarter of practices were reducing opening hours.

The research also found that accident and emergency wards in 46 NHS trusts were not meeting the maximum waiting time of four hours.

A Conservative party spokesman said it was “more than a bit rich” for the Labour to complain about doctors’ opening hours “when it was their disastrous GP contract which meant that 90% of surgeries stopped offering this service altogether”.

“Our plans to put doctors back in charge of the NHS, which were opposed by Labour, will mean that local doctors will once again be responsible for caring for their patients out of hours and will offer patients a real choice of which GP surgery to go to,” he said.


Physiotherapists and podiatrists to be able to prescribe drugs

Physiotherapists and podiatrists are to be able to prescribe their patients with medicines including painkillers and anti-inflammatory drugs, it has been announced by the Department of Health.Physiotherapists and podiatrists to be able to prescribe drugsIt will mean that podiatrists and physiotherapists will no longer have to refer their patients back to a doctor if medication is needed.

Physiotherapists and podiatrists will join some senior nurses and pharmacists who already have prescribing powers in the first scheme of its kind in the world.

Under the new legislation, physiotherapists who have had extra training will be able to prescribe medicines for issues such as chronic pain and other conditions where appropriate.

A physiotherapist specialising in respiratory conditions would be able to prescribe asthma medication.

However the drugs each will be able to prescribe will be limited to their own speciality, a spokesman for the Department of Health said.

The College of Podiatry said the move will particularly benefit diabetic patients with infections of the feet and people suffering from other infections such as wounds and ingrown toenails and fungal infections.

The Chartered Society of Physiotherapy (CSP) welcomed the move, saying it will mean that patients are offered quicker and more direct access to the medicines and treatment they need.

Dr Helena Johnson, chairman of the CSP, said: “Giving physiotherapists the opportunity to prescribe independently will hugely improve the care we can provide in the future.

“Patients will now receive a more streamlined and efficient service, meaning they get the medicines they need more immediately.  An unnecessary burden will be removed from doctors, with physiotherapists taking full responsibility and accountability for the prescribing decisions they make.”

“For patients, the chance of faster relief from pain or other symptoms will also mean many can benefit more quickly from their physiotherapy treatment.”

Alison Wishart, chairman of the Society of Chiropodists and Podiatrists, said: “Independent prescribing provides podiatrists with the opportunity to deliver more flexible services for patients – ensuring timely access to medicines, care closer to home and enabling innovation.”

The new legislation is expected to come into effect in April next year, with the first intake of podiatrists and physiotherapists to go into Health Professions Council-approved education programmes in autumn 2013.


Doctors fear catastrophes on hospital wards at weekends

One in eight doctors does not think hospitals provide high quality care at weekends and “catastrophes” are feared on wards because staff cover is so poor.Doctors fear catastrophes on hospital wards at weekendsA survey of senior doctors has found that many are concerned about the care patients receive at weekends, when most hospitals only have a skeleton staff.

One respondent to the Royal College of Physicians poll said: “I often feel relieved on Monday that nothing catastrophic has happened over the weekend.”

Sir Bruce Keogh, medical director of the NHS, has told The Daily Telegraph that hospitals should look no different on a Saturday to the way the look on a Wednesday.

He wants the NHS to offer a full seven day service with routine appointments and operations carried out at weekends instead of emergencies only.

At a meeting at the Royal College, Prof Tim Evans, academic vice-president, reported on progress that the college had made with its Future Hospital Commission, which is investigating how to improve care. He said hospitals were under substantial stress and were providing a disjointed service to patients with a lack of compassion and continuity of care.

The Royal College survey found that hospital doctors were concerned that patients saw a succession of medics and had to repeat their problems each time.

More than one in eight said they rated their hospital’s ability to provide high-quality care seven days a week, as poor or very poor.

Prof Evans said: “I’d rather have a hospital working at 80 per cent of its best seven days a week than one that is 100 per cent five days and only 20 per cent at weekends.” The commission, chaired by Sir Michael Rawlins, aims to come up with ideas to ensure hospitals can cope with the increasing complexity of cases, an ageing population and changes to doctors’ working patterns.

Almost 7,000 doctors responded to the survey. Other studies have disclosed concerns from junior doctors who feel out of their depth at having to look after patients outside their areas of expertise when covering wards at weekends and at night.

The General Medical Council has warned that hospitals may be facing significant problems because juniors were being asked to cope with issues beyond their competence.


Sex really does make men fall asleep

Men automatically fall asleep after having sex because their brains are programmed to shut down, scientists claim.Sex really does make men fall asleepResearchers from the French government took scans of men’s brains during and after sex to monitor changes in their mental activity.

They found that the cerebral cortex, which governs conscious thought, switched off during orgasm.

Two other areas, the cingulate cortex and the amygdala, then sent a message to the rest of the brain telling it to remove all sexual desire, via the release of sleep-inducing chemicals including serotonin and opioids.

Serge Stoléru, one of the scientists who conducted the research, said “These experiments give us the first hints as to what happens in the brain during orgasm.”

The findings may provide men with a helpful excuse to turn off the light and go to sleep, but they are unlikely to be welcomed by their partners who do not experience the same effect.

Dr Stoléru explained: “After men have an orgasm they usually experience a refractory period when they cannot be aroused.

“For women it seems to be different. They don’t seem to have such a strong refractory period and may be asking for more when their partners just want a rest.”

A recent study also suggested that men think about sex 19 times a day – almost 8,000 times less than previously thought.  They also think about food almost as much as sex – 18 times a day – closely followed by sleep, which crosses their mind 11 times a day.

This confounds the long held stereotype that men think about sex every seven seconds while awake, amounting to 8,000 times over an average 16-hour day.

However, US scientists discovered that, on average, men still think about sex twice as much as women, who entertain the thought just ten times a day. Women also thought less about food and sleep daily, thinking about them just 15 and 8.5 times respectively.

They put the new numbers down to previous studies, which they say were headline-grabbing but poorly set-up.

The researchers say that in those studies volunteers were often asked to make a guess at how often they thought about sex rather than actually recording it, with the results wrongly influencing men and women for years after.

The team, from Ohio State University recruited 160 women and 120 men aged 18 to 25 to monitor their thoughts. In the group, 59 were randomly assigned to count how often they thought about food, 61 sleep and 163 sex.


NHS pays out record £1.2 billion in claims

The NHS has paid out a record £1 billion in litigation claims in one year.NHS pays out record £1.2 billion in claimsA surge in the number of claims made by NHS patients or their families led to the health service paying out £1.2 billion for its clinical negligence compensation bill between 2011 and 2012.

The payouts, which represent legal costs and compensation payouts, is a huge rise on the previous year when the bill was £863 million, the NHS Litigation Authority’s (NHS LA) annual accounts show.

The bill for “non-clinical claims”, which include payouts for people falling and hurting themselves on wet floors where there was no sign, was £52.4 million. Such claims could have been made by patients, staff or visitors.

The NHS LA, which was created to deal with claims from patients harmed while undergoing treatment as well as from staff and visitors, said the figure represents a surge in the number of claims between 2010 and 2011 – which were paid out this year.

In 2009 to 2010, there were 10,726 individual claims, but this jumped to 13,001 in 2010 to 2011.

In 2011 to 2012 this figure increased further to 13,761 – indicating that the compensation payouts for next year could rise higher.

Tom Fothergill, director of finance at NHS LA, said: “The financial year 2011 to 2012 has seen further increases in claims activity at every level of the NHS LA’s work.

“We were able to close more claims than ever before, but the combined effect of sharply increased claims in recent years and a continuation of the growth in new claims received this year still resulted in there being more than 5% more claims open at the end of the year.”

The Medical Defence Union (MDU) called for urgent legal reform to address the huge bill. Dr Christine Tomkins, MDU chief executive, said the current situation is unsustainable.

She said: “NHS damages payouts have increased substantially in the last year and in our experience of settling cases on behalf of our GP and independent practitioner members, we have even seen compensation awards exceeding £5 million.

“We have also seen claims in general practice rise significantly in number for each of the last two years.

“Large awards are usually a result of the cost of providing for future care or compensation for loss of earnings, or both. While patients should be compensated quickly and fairly when they have been negligently harmed, the massive cost to society cannot be overlooked.

“Awards are escalating much faster than price and wage inflation. Everyone has ultimately to bear the burden of paying for this. These rises in compensation are unaffordable and can’t be allowed to continue, especially in the current economic climate, which affects us all.

“Many other countries such as the USA and Australia were forced to tackle the problem of unsustainably high compensation awards in the face of a compensation crisis. As illustrated by the figure of £1.2 billion from the NHS LA, awards are getting higher and higher and we should not wait for a crisis. We need legal reform now.”


Diabetes blood pressure control warning

Half of people with diabetes are failing to keep control of their blood pressure, risking “damaging” complications, figures suggest.Diabetes blood pressure control warningThe analysis of NHS data in England by Diabetes UK showed the number of people not hitting their target has been stuck at about 50% in recent years.

High blood pressure increases the risk of conditions such as heart disease, kidney failure and stroke.

The charity said people needed more support to control their condition.

People with diabetes are normally told to keep their blood pressure below 130/80, slightly lower than the target for the rest of the population.

For someone without diabetes, blood pressure should be no higher than 140/85 mmHg. Ideally, we should all have a blood pressure below 120/80.

Those at risk of exceeding the target can be given medication as well as support in improving diet and losing weight to get their levels down.

But the figures – based on the National Diabetes Audit, which covers nine in 10 people diagnosed with the condition in England – showed that just 50.7% of patients had control of their blood pressure.

The proportion was almost exactly the same as the previous year.

It means that if the figure was replicated across the UK, 1.4 million out of the 2.9 million people with the condition would be at risk.

Diabetes UK chief executive Barbara Young said: “It is extremely worrying.

“People with diabetes need to be aware that high blood pressure can have a hugely damaging effect on their health.  But instead we are in danger of high blood pressure becoming the norm in people with the condition.”

“This is one of the reasons they are experiencing record rates of stroke and kidney failure and are dying years younger than the rest of the population.”

Breast cancer linked to bra size

Women with larger breasts are more likely to develop breast cancer scientists now believe.Breast cancer linked to bra sizeA study of more than 16,000 women found those with a larger bra size were at greater risk of the disease.

The link could be down to the sex hormone oestrogen that can trigger the growth of mammary glands and tumours.

The researchers found seven genetic factors significantly associated with breast size – three of which are strongly correlated with mutations already linked to breast cancer.

Dr Nicholas Eriksson said: “One of the variants is known to regulate the expression of the oestrogen receptor gene which plays a vital role in breast growth and in the majority of breast cancer cases.

“Another one of these mutations is located in a region of the genome that often shows abnormalities in people with a certain subtype of breast cancer.”

He used data from his California-based personal genetics company 23andMe to make the first concrete link between breast size and breast cancer risks.

His findings, Genetic variants associated with breast size also influence breast cancer risk published online in BMC Medical Genetics, are based on the participants answers to survey questions including bra cup size and bra band size and comparing them with genetic data on millions of mutations.

Dr Eriksson said: “Social norms and preferences aside, it turns out that breast size matters – but not quite in the way you think.  The paper shows genetic factors influence whether women have double As or double Ds.”

“This might sound a bit frivolous at first but our research uncovered surprising connections between the genetics of breast size and the genetics of breast cancer.”

“In our case, no one’s personal space was violated – all of our data was self-reported by female 23andMe customers of European descent who have opted into research and filled out an online survey.

“We specifically asked about bra cup size as an approximation for breast size using a 10-point scale ranging from ‘Smaller than AAA’ to ‘Larger than DDD.'”

His team also took into account age and breast-related surgeries including augmentation or reduction.

Dr Eriksson said: “Most of the genetic factors we identified for breast size lie in regions of great importance for breast cancer.

“These findings show some of the same biological pathways underlie both normal breast growth and breast cancer.

“This isn’t a huge surprise if you think of cancer as unrestrained growth. But the relationship between breast size and breast cancer is complicated.

“Some studies have found that larger breast size as a young woman is associated with a slight increase in breast cancer risk, but only in women who were lean at a young age. The genetic factors we found aren’t enough to explain this association, but support the idea that breast size and breast cancer are related.”