Seven days in medicine: 9 to 15 November 2016
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6106 (Published 17 November 2016) Cite this as: BMJ 2016;355:i6106
NHS
Public must pay for better NHS, says Stevens
People must pay more if they want a better NHS, the chief executive of NHS England said. Asked about the possibility of rationing NHS services at the King’s Fund’s annual conference in London on 9 November, Simon Stevens said that he would have to be “persuaded of the benefits” of limiting healthcare, adding, “At some point the British people will need to put their hands in their pockets if they want to see continued improvement and growth in what the NHS can do for each and every one of us.” (Full story doi:10.1136/bmj.i6069)
Nursing assistants are linked to higher death risk
Replacing professionally qualified nurses with lower skilled nursing assistants is linked to a raised risk of patient death and other indicators of poor quality care, a large European study showed in BMJ Quality and Safety. In every 25 patients just one professional nurse substitution was associated with 21% higher odds of dying in a hospital with an average nurse staffing level and skill mix, the findings showed, prompting researchers to conclude that “diluting” the hospital nurse skill mix “is not in the public interest.”
General practice
Schools demand antibiotics for conjunctivitis
An estimated 160 000 appointments a year could be freed up at UK general practices if schools stopped sending home children with infective conjunctivitis, the Royal College of General Practitioners claimed. It said that some schools defy clinical guidance by refusing to admit children with the condition unless they have an antibiotic prescription. It has written to the schools regulator, Ofsted, to request that nurseries, preschools, and other childcare providers rethink policies that unintentionally “clog up” the general practice appointments system. (Full story doi:10.1136/bmj.i6109)
Public health
NHS can fund HIV prevention drug
NHS England does have the power to commission pre-exposure prophylaxis (PrEP) for HIV infection, the Court of Appeal found. The case arose after NHS England refused to include PrEP using Truvada (tenofovir disoproxil/emtricitabine) in a list of potential specialist services. It argued that preventing HIV infection was a public health obligation and that local authorities should pick up the tab. The ruling means that NHS England must consider commissioning PrEP, at an estimated cost of £10m-£20m (€11.6m-€23.3m; $12.5m-$25m) a year. (Full story doi:10.1136/bmj.i6082)
Regulation
GP is struck off for poor care of three patients
Klaas Bogena, who was a general practitioner in Germany and then worked as an out-of-hours locum in Cornwall, was struck off the UK medical register for providing inadequate care to three patients in 2013 and 2014. In one case, “Patient A,” who was 33 weeks pregnant and an insulin dependent diabetic patient, saw Bogena out of hours to complain of vomiting, headache, and lower back pain. He prescribed migraine drugs and told her to stop her insulin. That night she was taken to hospital and had diabetic ketoacidosis diagnosed. She delivered a stillborn baby eight hours after seeing Bogena. (Full story doi:10.1136/bmj.i6076)
Maternity services
Pilot sites to improve services are named
Seven sites were named as early adopters of recommendations set out in February’s Better Births report to test ways to transform England’s maternity services. The sites are sustainability and transformation plan areas in Birmingham and Solihull, Cheshire and Merseyside, Dorset, north central London, northwest London, Somerset, and Surrey Heartlands. They will test ideas such as using small teams of midwives to offer greater continuity of care, creating single points of access to a wider range of maternity services, making better use of electronic records, and improving postnatal care.
NICE recommends test to identify fetal rhesus D status
Maternity services should start offering pregnant women who are rhesus negative a test to identify the status of their fetus, under final guidance issued by the National Institute for Health and Care Excellence. Non-invasive prenatal testing for fetal rhesus D status is carried out during routine antenatal appointments and analyses the baby’s DNA found in its mother’s blood. This test means that only women whose baby is rhesus D positive will be treated with anti-D immunoglobulin, saving the NHS more than £500 000 (€582 000; $624 000) a year spent treating 40 000 women who do not need anti-D.
Research news
Sponge test instead of endoscopy for Barrett’s oesophagus
Researchers used the “cytosponge”—a pill on a string that expands when swallowed—to collect throat cells in nearly 500 people with Barrett’s oesophagus. They found that 35% (162) were at low risk of developing oesophageal cancer by looking for genetic markers and cell changes and combining these with information such as age and obesity. “Compared with endoscopies performed in hospital, the cytosponge causes minimal discomfort and is a quick, simple test that can be done by your GP,” said the lead researcher, Rebecca Fitzgerald. (Full story doi:10.1136/bmj.i6080)
Stroke prevention drugs are underused
Just over half (54%) of patients (9579/17 680) with a first stroke or transient ischaemic attack had not received at least one prevention drug that was clinically indicated, an analysis of UK primary care data found: 49% had not received lipid lowering drugs, 25% were not given antihypertensives, and 52% of patients had not received anticoagulants. “We estimate that approximately 12 000 first strokes could potentially be prevented annually in the UK through optimal prescribing of these drugs,” said the researchers. (Full story doi:10.1136/bmj.i6105)
Antibiotics
Stop antibiotic misuse in farming, say doctors
Fifteen senior medics, including presidents of 13 royal colleges, wrote to the UK government calling for urgent action to tackle the routine misuse of antibiotics in UK farming. They called on Jeremy Hunt, England’s health secretary, and Andrea Leadsom, secretary of state for environment, food and rural affairs, to ban the routine preventive mass medication of animals, curb farm use of “critically important” antibiotics, and support action during upcoming negotiations in Europe.
Climate change
Plan to phase out coal power is welcomed
The UK Health Alliance on Climate Change welcomed the UK government’s plan to phase out coal power by 2025. A consultation document outlined government plans to fulfil a 2015 pledge to replace coal power with cleaner technology, such as gas, to help significantly reduce emissions from the United Kingdom’s energy use. It set out a roadmap for closing unabated coal power stations by 2025 and suggested proposals for constraining coal generation by 2025. The alliance said that ending coal power would prevent 1600 premature deaths and save as much as £3.1bn (€3.61bn; $3.87bn) in health costs each year. (Full story doi:10.1136/bmj.i6066)
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