Generic medication

Following on from a comment on the 'antibiotics' posting, a bit about generic medication. Wherever possible, RMC tries to use generic medication, rather than branded. The active ingredient in the drug is exactly the same, but there is a significant financial saving with generic drugs (e.g. the migraine drug 'sumatriptan' costs £13.60 for 6 tablets as a generic and £42.90 for the same as a branded drug). The current climate would suggest, at best, minimal further cash for the NHS over the next few years, and we must look to provide value for money to the tax payer. Money diverted away from drug company profits can be spent elsewhere on patient care. At RMC we would spend somewhere in the region of £250k a year on drugs and work within a tight budget. The NHS inspects our prescribing each month and there is an annual visit from the health authority to discuss our performance and value for money (next interrrogation is in February). Our practice has above average rates of generic prescribing compared to North Yorkshire and nationally, and our drug waste (unused drugs returned) is fairly small. Our prescribing spend per person is adjusted to account for a more elderly population and is usually less than the national average each month, although our quality score for clinical treatment was 100% last year, showing that we can achieve good quality care and good value for money!

Osteoporosis

A new risk calculator has been launched on the internet for osteoporosis. Although not intended for direct patient use, it may be helpful to get an idea of risk, which could then be investigated further. Patients wishing to use the tool should go to: www.qfracture.org and follow the instructions. Patients who are deemed at risk are more than welcome to come and discuss osteoporosis and further investigations, such as bone density scans, with the GP.

Over the counter medicines sales

The Department of Health is currently planning a consultation for a white paper regarding sales of over the counter medicines at GP surgeries. The website states:

The White Paper proposes reform to current arrangements whereby dispensing doctors may not sell over the counter (OTC) medicines to dispensing patients.

The rationale for this is that patients in some rural communities may have to travel substantial distances to access OTC medicines if there is no convenient alternative, such as a pharmacy, nearby. GPs are prevented through conditions in their NHS contracts which prevent them selling OTC medicines where the sale of such medicines could be seen as generating a profit linked to a course of treatment recommended by the GP. This leads to an anomalous position whereby a local filling station or newsagent can sell a pack of paracetamol but the GP surgery cannot. Relaxing this restriction would provide better services for dispensing patients – particularly in relation to higher strength “P” OTC medicines which cannot be bought through ordinary retail outlets and must be supplied by a pharmacy.

The Department has published, on its website, an initial Impact Assessment prior to full consultation later this summer. This analyses the proposal in more detail. It sets out 4 possible options:

Option 1: No change
Option 2: Permit certain dispensing GPs to sell OTC medicines where there is no convenient alternative
Option 3: Permit all dispensing GPs to sell OTC medicines
Option 4: Permit all GPs to sell OTC medicines

The Department at this stage prefers Option 2 as it meets the policy objectives of improving access to medicines and promoting self care in rural areas.

Option 2 would also make sense for Reeth patients, as it would save time and reduce the carbon footprint associated with driving to town for some medicines.
See www.pcc.nhs.uk/.../briefing_paper_10__market_entry__otcs__dispensing_doctors3.doc for further information.

Snow

By now we will be sick of the 'S' word.  Hopefully a thaw will come soon and we can get back to normal. Thank you to all who have helped in the adverse weather conditions including Phil Bastow and Co. from the Reeth Fire Brigade who came to help dig out the emergency ambulance from Back Lane on Thursday night.  The emergency crew had already been delayed by the weather getting to Reeth, and temperatures of -8 degrees had caused the vehicle to get stuck in the snow and ice. Thankfully after a spot of impromptu digging from the surgery staff and the firemen, the crew were able to leave.

Whole foods protect against depression

The British Journal of Psychiatry have published research to show that individuals with a high intake of vegetables, fruit and fish have a lower risk of depression, and those who eat a high amount of processed food have an increased risk.

No-one is quite sure of exactly why this is although some think that eating more processed foods causes more obesity, which in itself is a risk for depression. Other theories include the folic acid in leafy veg which is used for making one of the 'mood' hormones or the omega-3 fatty acids in fish which act as mood stabilisers.

The take home message for a happy new year is to avoid the Xmas pud and have an extra serving of the sprouts!

Antibiotics

I suspect my patients are fed up of hearing about viral infections by now. In the past, GPs used a lot of antibiotics, especially at winter times for coughs and colds. Unfortunantely, what we are now seeing is bacteria that are becoming resistant to more and more antibiotics. There have been reported infections in the UK which will now only respond to powerful antibiotics given via a drip in hopsital and some bacteria are emerging for which there is no antibiotic at all. The antibiotics we use in practice have been with us for decades and in the absence of new drugs, bacterial resistance is a real worry. Research shows that a lot of conditions get better on their own without the need for antibiotics- the less we use, the more likely they are to work when they are needed.

80% of ear infections in children will clear within 4 days, 64% of conjunctivitis will get better with a placebo medication, 70% of acute sinusitis will settle within 10 days and most sore throats will resolve within 8 days (taking antibiotics in this case will reduce the duration of symptoms by about 8 hours!).

As a GP, I have duty to not only give the best care to each patient, but also to look after our community as a whole. Reducing unnecessary antibiotic use is one small step to helping protect the vulnerable in our community from the threat of antibiotic-resistant bacteria.

Will cutting out salt save lives?

There is established research suggesting that reducing daily salt intake helps reduce blood pressure- most recently, scientists in Naples have also shown a reduced risk of stroke if salt intake is less. The average intake of salt in the UK is 8.6 grammes a day. Current recommendations are less than 6 grammes a day, but ideally we should aim for 3 grammes.

When I discuss this with folks, the majority say that they don't take salt with their food already. Most of our daily intake is actually already in the food we eat, so our focus should be on being aware of what foods have the most salt content and trying to eat these in moderation. For further information, visit: http://www.eatwell.gov.uk/healthydiet/fss/salt/