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Seven days in medicine: 6-12 June 2018

BMJ 2018; 361 doi: (Published 14 June 2018) Cite this as: BMJ 2018;361:k2573

General practice

Target to recruit 5000 GPs by 2020 will be missed, Hunt admits

Jeremy Hunt, England’s health secretary, admitted that the government will struggle to fulfil its pledge to increase the number of GPs in England by 5000 by 2020. The pledge was made in 2015, but the number of GPs has fallen by over 1000 in the past year. In an interview with the Guardian newspaper Hunt said that “we are struggling to deliver that pledge, but I’m absolutely determined to do so. This is not a pledge that we’re abandoning . . . it’s just taking a bit longer than I had hoped.”

Vulnerable people were wrongfully refused GP registration

A fifth of vulnerable patients in England are being wrongfully refused registration at GP surgeries despite being entitled to access, research by the campaign group Doctors of the World UK showed. In 2017, 337 of 1717 attempts by the group’s case workers to register patients with their local GP were refused. Two thirds of refusals were due to lack of ID or proof of address, while 34 (10%) were based on the patient’s immigration status. Pregnant women, children, homeless people, and victims of torture and trafficking were among those wrongly turned away.


High Court rejects challenge to NHS prescription ban

A legal challenge by the British Homeopathic Association to NHS England guidance stating that GPs should not prescribe homeopathic treatments was comprehensively rejected by the High Court. The association had challenged a consultation by NHS England on the use of homeopathy and a decision to issue guidance to clinical commissioning groups in November 2017. This had recommended that GPs should not prescribe homeopathic remedies to new patients and that doctors should be “supported in de-prescribing” such treatments for all patients who currently had them prescribed. (Full story doi:10.1136/bmj.k2513)


Northern Irish law breaches human rights, say judges

Pressure is growing for reform of Northern Ireland’s strict abortion law after a majority of the seven judges considering the issue in the UK Supreme Court decided that it breached the European Convention on Human Rights. However, a majority of the justices also held that they were unable to make a binding decision that the law needed changing because the Northern Ireland Human Rights Commission, which had brought the case to court, had no standing to bring it. Technically, therefore, they had to dismiss the appeal.

MPs push for reform in Northern Ireland

A cross party group of over 30 MPs will bring forward a bill that would allow decriminalisation of abortion in Northern Ireland. On 11 June they sent the home secretary, Sajid Javid, written questions demanding that the Domestic Abuse Bill be brought before parliament by this autumn. The bill would enable pro-choice MPs to table an amendment that would give women in Northern Ireland the right to access a termination in their own country rather than travelling to England for it.

Research news

Introducing PrEP may increase risky behaviour

Although taking antiretroviral drugs as pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV infection and is recommended by the World Health Organization for high risk populations, an Australian study published in the Lancet HIV journal found that a rapid uptake of PrEP by gay and bisexual men was accompanied by an equally rapid decrease in consistent condom use, which could undermine PrEP’s effectiveness. Martin Holt, study leader from the University of New South Wales, said, “PrEP has been heralded as a game changer for HIV, but declining condom use may impede its long term, population level effectiveness.” (Full story doi:10.1136/bmj.k2514)


First Venezuela case in nearly 30 years

Venezuela reported its first case of polio in nearly three decades amid a growing public healthcare crisis in the country. The Venezuelan Society of Public Health reported three suspected cases in the state of Delta Amacuro. Health workers said that many people in the state had not been vaccinated since 2016, as basic vaccine coverage has continued to fall amid political and economic turmoil. Rising cases of diphtheria, tuberculosis, measles, and malaria have also been reported.


Trainees rise by a third

The number of trainees in psychiatry in England has risen by over 30% from last year, the Royal College of Psychiatrists said. Data from Health Education England show that 368 doctors will start core psychiatry training in England this August, the most since 2009. Last year 277 doctors were accepted into psychiatry training. The news comes after the college launched its #choosepsychiatry social media campaign last September to promote the specialty to medical students. (Full story doi:10.1136/bmj.k2535)

NHS reform

Dump “acronym spaghetti” of integrated care, say MPs

Local leaders and representatives from the NHS, local government, professional bodies, patient groups, and the voluntary sector should lead on and formulate legislative proposals to remove barriers to integrated care, the UK parliamentary Health and Social Care Committee said. It warned that current progress towards integration of services is held back by current legislation. The MPs added that proposals driven by local leaders could be laid before parliament by the government in draft form and presented to the committee for pre-legislative scrutiny. (Full story doi:10.1136/bmj.k2561)

Emergency care

Almost 1.5 million emergency admissions were avoidable last year

The NHS could have averted almost 1.5 million emergency admissions to hospitals last year if the service had invested in better preventive care outside hospital, a report by MPs concluded. Some 5.8 million emergency admissions were recorded in England in 2016-17, of which 24% might have been avoided if people had had more effective community healthcare and case management to stop them becoming so unwell that they needed emergency hospital care, said the House of Commons Public Accounts Committee. (Full story doi:10.1136/bmj.k2542)

Tackling loneliness may cut emergency admissions

The Local Government Association urged ministers to provide more funding for councils to expand on and introduce initiatives to tackle loneliness. The association said that work to prevent loneliness by individual councils, in partnership with community and voluntary organisations, had demonstrated clear improvements to people’s quality of life and had reduced emergency admissions to local hospitals by as much as 20%. The association cited examples such as line dancing classes, choirs, and communal lunches that had improved wellbeing.

New medicines

NHS strikes deal on lung cancer drug

NHS England negotiated a deal with the drug company MSD to make the lung cancer drug pembrolizumab available for routine use on the NHS. The drug, also known as Keytruda, has been endorsed by the National Institute for Health and Care Excellence after trial results showed that it can extend life in certain adults with lung cancer for over a year. It would have cost around £84 000 (€95 200; $112 200) per patient at full list price, but NHS England and MSD agreed a confidential arrangement for reimbursement.

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