Exercise 'can be as good as pills'

1 October 2013 Last updated at 19:56 ET By Michelle Roberts Health editor, BBC News online

Exercise can be as good a medicine as pills for people with conditions such as heart disease, a study has found.

The work in the British Medical Journal (BMJ) looked at hundreds of trials involving nearly 340,000 patients to assess the merits of exercise and drugs in preventing death.

Physical activity rivalled some heart drugs and outperformed stroke medicine.

The findings suggest exercise should be added to prescriptions, say the researchers.

Experts stressed that patients should not ditch their drugs for exercise - rather, they should use both in tandem.

Prescriptions rise

Too few adults currently get enough exercise. Only a third of people in England do the recommended 2.5 hours or more of moderate-intensity activity, such as cycling or fast walking, every week.

In contrast, prescription drug rates continue to rise.

There were an average of 17.7 prescriptions for every person in England in 2010, compared with 11.2 in 2000.

For the study, scientists based at the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine trawled medical literature to find any research that compared exercise with pills as a therapy.

They identified 305 trials to include in their analysis. These trials looked at managing conditions such as existing heart disease, stroke rehabilitation, heart failure and pre-diabetes.

When they studied the data as a whole, they found exercise and drugs were comparable in terms of death rates.

But there were two exceptions.

Drugs called diuretics were the clear winner for heart failure patients, while exercise was best for stroke patients in terms of life expectancy.

Continue reading the main story

Doing exercise regularly:

• Can reduce your risk of major illnesses, such as heart disease, stroke, diabetes and cancer by up to 50%
• Can lower your risk of early death by up to 30%
• Can boost self-esteem, mood, sleep quality and energy as well as keep weight off
• Moderate activity, such as cycling or fast walking, gives your heart and lungs a work-out

Source: NHS Choices

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said that although an active lifestyle brings many health benefits, there is not enough evidence to draw any firm conclusions about the merit of exercise above and beyond drugs.

"Medicines are an extremely important part of the treatment of many heart conditions and people on prescribed drugs should keep taking their vital meds. If you have a heart condition or have been told you're at high risk of heart disease, talk to your doctor about the role that exercise can play in your treatment."

Dr Peter Coleman of the Stroke Association said exercise alongside drugs had a vital role that merited more research.

"We would like to see more research into the long-term benefits of exercise for stroke patients.

"By taking important steps, such as regular exercise, eating a balanced diet and stopping smoking, people can significantly reduce their risk of stroke."

"Moderate physical activity, for example, can reduce the risk of stroke by up to 27%."

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Glasgow health board IT system fixed

3 October 2013 Last updated at 07:07 ET

Scotland's largest health board has said its IT system is working again after a two-day crash saw hundreds of appointments and procedures cancelled.

NHS Greater Glasgow and Clyde said it still does not know what caused the problem which affected 11 hospitals.

The health board said no patient information had been lost and data gathered during the crash would be manually added to update the system.

All patients with appointments on Thursday should attend as normal.

The computer system crash meant that 599 outpatient appointments were postponed along with 62 planned inpatient procedures and day cases and 48 chemotherapy patient treatments.

'Unreserved apology'

NHS Greater Glasgow and Clyde (GGC) chief executive Robert Calderwood reiterated his "unreserved apology" to patients and said those affected would be given new appointments.

"Although 709 patient episodes have had to be postponed our staff were able to see some 10,000 patients using manual back up systems," he said.

Continue reading the main story

Our IT teams and our external experts are continuing to run full diagnostic checks to try and understand exactly what caused the problem in the first place"

End Quote NHS GGC

"I can also report today that some of the patients affected have already been re-appointed and will be seen in the next few days.

"Arrangements are now being made to ensure that all the other patients affected will be offered a re-appointment as quickly as is possible."

Mr Calderwood said the "unprecedented" systems crash related to the health board's computer network and the way staff connected to clinical and administrative systems.

"The situation is that as users log on they go through a system called Microsoft Active Directory, a router system which recognises users and allows individual access to our clinical and administrative support systems," he explained.

"This was corrupted over the weekend which became apparent when staff logged on to the system on Tuesday after the holiday weekend."

Although the problem has been resolved, NHS GGC still does not know what caused it.

A statement from the health board said: "The platform on which NHS GGC's IT systems are built are in common with most large organisations in the UK and indeed the world.

Cause 'unknown'

"At this stage it remains unknown what exactly caused this problem to occur and this is one of the major issues and we continue to work closely with Microsoft to get to the root of the problem."

The statement said: "Our IT teams and our external experts are continuing to run full diagnostic checks to try and understand exactly what caused the problem in the first place."

"NHS GGC IT teams working in collaboration with international experts from our suppliers at Microsoft and Charteris will continue to closely monitor the situation as clinical staff begin their work today."

BBC Scotland understands that the IT systems crash affected patients with appointments at 11 hospitals. These were:

• New Victoria Hospital
• Victoria Infirmary
• Vale of Leven
• Royal Alexandra Hospital
• Inverclyde Royal Hospital
• Gartnavel
• Stobhill
• Glasgow Royal Infirmary
• Southern General Hospital
• Western Infirmary
• The Royal Hospital for Sick Children

Maternity and emergency services were maintained throughout the crash.

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GP services 'face cuts catastrophe'

3 October 2013 Last updated at 10:03 ET By Nick Triggle Health correspondent, BBC News

Please turn on JavaScript. Media requires JavaScript to play.

Dr Clare Gerada: "The front door of the NHS is the GP surgery, if that gives, the rest of the NHS will give very rapidly"

The GP system in England is facing a "catastrophe" because of cuts in funding, doctors' leaders are warning.

Analysis by the Royal College of GPs suggests that over the past three years, investment in general practice has fallen by £400m in real terms.

That is equivalent to a 7% cut in spending per patient, it says.

Health Secretary Jeremy Hunt told the RCGP, which is meeting in Harrogate, he government wanted to increase access to GPs by extending opening hours.

On Tuesday, the prime minister said he wanted more patients to be able to get help in the evenings and at weekends, as he set out details of a £50m pilot programme in nine areas of England to widen access.

But the college said its analysis - based on official data from the Health and Social Care Information Centre - showed the government was taking money away from GPs despite claiming it wanted to move care away from hospitals.

The RCGP's chairwoman Dr Clare Gerada said the cuts meant doctors were being required to do more work with fewer resources, damaging services for patients.

'Increasing workloads'

In 2012-13, £8.5bn was invested in general practice, when everything from spending on pay, IT, tests and drugs was taken into account, it said.

Continue reading the main story

Are patients being hit?

In many ways it is hard to measure what effect the cuts cited by the RCGP might be having.

The most obvious measure of judging performance used to be through the 48-hour target for waiting for an appointment. But this was scrapped by the coalition.

The Patients Association has consistently said the feedback it gets flags longer waits as an issue.

The RCGP also says it is getting harder to keep extra services going; such as dieticians and talking therapies.

Some of the biggest cuts have been among these 'enhanced services' - and in longer opening hours, the very thing ministers were talking about extending earlier this week.

For a government that makes a big play of protecting the NHS budget, it raises some tricky questions.

That compared with £8.3bn in 2009-10, which is the equivalent of £8.9bn in 2012-13 prices.

In terms of spending per patient, that represents a fall from £168.40 a year to £156.45 - a drop of 7%.

Dr Gerada also pointed out that the investment represented 9% of the entire NHS budget, even though GPs had 90% of the contacts with patients.

She said: "Our figures should send out a warning to government and the rest of the NHS that we will soon have a catastrophe on our hands if urgent action is not taken to reverse the decline in funding.

"GPs are keen to do more for their patients, but we are heaving under the pressure of ever-increasing workloads and diminishing resources.

"Some of us are routinely working 11-hour days with up to 60 patient contacts in a single day and this is not safe or sustainable.

"You do not want a tired GP seeing you. You do not want a tired GP any more than you want a tired pilot or a tired surgeon."

'Tipping point'

Dr Gerada also expressed concern about the season ahead and said general practice was close to reaching a "tipping point" which would see the profession "fall over".

"We're trying to squeeze more and more activity out of a smaller and smaller pot of money," she added.

"If we have a cold winter, I'm really afraid that patients will suffer considerably.

Continue reading the main story

"Start Quote

We're very frightened that there is a tsunami of work coming out, without the resources"

End Quote Dr John Crompton GP

"The front door of the NHS is the GP's surgery. If that gives, the rest of the NHS will give and very rapidly."

Health Secretary Jeremy Hunt, who addressed the conference on Thursday afternoon, did not object to the figures.

But he said the problems with investment in GPs "goes back further than three years".

"In the NHS we have invested in hospitals, in A&Es and we have not had a parallel investment in primary care."

He added the government was now looking to invest in programmes that increased access to GPs - hence the announcement this week to extend opening hours and increase the use of technologies such as email and Skype.

Patients Association chief executive Katherine Murphy said: "This chimes with what patients are saying to us. They are finding it harder to access GPs both in and out of hours.

"The mantra is about moving care out of hospitals and into the community, but if we are going to achieve that we have to stop throwing money at hospitals and invest in GPs so they can provide quality care."

Shadow health secretary Andy Burnham said: "These figures are embarrassing for a prime minister who got elected on a promise not to cut the NHS.

"They make a mockery of yet more promises he has made on GP access this week and show he simply can't be trusted on the NHS."

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Exercise 'can be as good as pills'

1 October 2013 Last updated at 19:56 ET By Michelle Roberts Health editor, BBC News online

Exercise can be as good a medicine as pills for people with conditions such as heart disease, a study has found.

The work in the British Medical Journal (BMJ) looked at hundreds of trials involving nearly 340,000 patients to assess the merits of exercise and drugs in preventing death.

Physical activity rivalled some heart drugs and outperformed stroke medicine.

The findings suggest exercise should be added to prescriptions, say the researchers.

Experts stressed that patients should not ditch their drugs for exercise - rather, they should use both in tandem.

Prescriptions rise

Too few adults currently get enough exercise. Only a third of people in England do the recommended 2.5 hours or more of moderate-intensity activity, such as cycling or fast walking, every week.

In contrast, prescription drug rates continue to rise.

There were an average of 17.7 prescriptions for every person in England in 2010, compared with 11.2 in 2000.

For the study, scientists based at the London School of Economics, Harvard Pilgrim Health Care Institute at Harvard Medical School and Stanford University School of Medicine trawled medical literature to find any research that compared exercise with pills as a therapy.

They identified 305 trials to include in their analysis. These trials looked at managing conditions such as existing heart disease, stroke rehabilitation, heart failure and pre-diabetes.

When they studied the data as a whole, they found exercise and drugs were comparable in terms of death rates.

But there were two exceptions.

Drugs called diuretics were the clear winner for heart failure patients, while exercise was best for stroke patients in terms of life expectancy.

Continue reading the main story

Doing exercise regularly:

• Can reduce your risk of major illnesses, such as heart disease, stroke, diabetes and cancer by up to 50%
• Can lower your risk of early death by up to 30%
• Can boost self-esteem, mood, sleep quality and energy as well as keep weight off
• Moderate activity, such as cycling or fast walking, gives your heart and lungs a work-out

Source: NHS Choices

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said that although an active lifestyle brings many health benefits, there is not enough evidence to draw any firm conclusions about the merit of exercise above and beyond drugs.

"Medicines are an extremely important part of the treatment of many heart conditions and people on prescribed drugs should keep taking their vital meds. If you have a heart condition or have been told you're at high risk of heart disease, talk to your doctor about the role that exercise can play in your treatment."

Dr Peter Coleman of the Stroke Association said exercise alongside drugs had a vital role that merited more research.

"We would like to see more research into the long-term benefits of exercise for stroke patients.

"By taking important steps, such as regular exercise, eating a balanced diet and stopping smoking, people can significantly reduce their risk of stroke."

"Moderate physical activity, for example, can reduce the risk of stroke by up to 27%."

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Blood pressure drug 'fights cancer'

1 October 2013 Last updated at 19:57 ET By Michelle Roberts Health editor, BBC News online

A commonly used blood pressure drug could help fight cancer by opening up blood vessels in solid tumours.

Used beside conventional cancer-fighting drugs, it could improve life expectancy, experts believe.

Following successful testing in mice, doctors plan to give losartan to patients with pancreatic cancer to see if it can tackle this hard-to-treat disease, Nature Communications reports.

Currently, only 5% of pancreatic cancer patients survive for at least 5 years.

This is partly because only one in 10 people with the disease has a tumour that is operable.

Future hope

Investigators at the Massachusetts General Hospital in the US are currently recruiting volunteer patients with inoperable pancreatic cancer to test out the new drug combination of chemotherapy plus losartan.

Continue reading the main story

We don't yet know if they work exactly the same way in people"

End Quote Dr Emma Smith of Cancer Research UK

Although the treatment will not cure them, the researchers hope it will give the patients more months or years of life than they might otherwise get.

Losartan has been used for more than a decade as a safe blood pressure medication.

It works by making the blood vessels relax or dilate so that they can carry more blood, easing pressure.

The Massachusetts team found that the drug was beneficial in mice with breast and pancreatic cancer.

It improved blood flow in and around the tumours allowing more of the chemotherapy drugs to be delivered to their target.

Mice given this treatment, rather than standard chemotherapy alone, survived for longer.

Dr Emma Smith of Cancer Research UK said: "This interesting study in mice sheds light on why drugs for hypertension might improve the effectiveness of chemotherapy, but we don't yet know if they work exactly the same way in people.

"The fact that these drugs are already widely used to treat high blood pressure will hopefully cut down the amount of time it will take to test their potential in treating cancer but they may not be safe for all patients or when combined with other cancer treatments, so we need to wait for the answers from clinical trials which are already under way."

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Apology as NHS IT problems continue

2 October 2013 Last updated at 09:09 ET

Scotland's largest health board has made an "unreserved apology" over an IT problem which is continuing to affect services for a second day.

NHS Greater Glasgow and Clyde said it had only restored "a basic level of IT service to enable some of the clinical services affected to resume normally".

It confirmed that over the past 36 hours, some 564 patients have had their treatment or appointments postponed.

The problem may have affected up to 10 hospitals across the health board area.

The computer failure has impacted on staff access to clinical and administrative systems.

NHS Greater Glasgow and Clyde (GGC) chief executive Robert Calderwood said: "I apologise unreservedly for the inconvenience this has caused to our patients who have had their procedures postponed, and I will ensure that everything possible is done to get their treatment carried out at the earliest possible opportunity.

"I can assure everyone that our senior management team, IT specialists and clinical leads have been working around the clock and will continue to do so until this issue is resolved."

'Regrettably' postponed

Mr Calderwood said that the "vast majority" of hospital services had been maintained and about 7,400 planned procedures and appointments had gone ahead during the IT systems crash.

He said: "Those which have had to be postponed were as a result of clinical decisions taken because the treatment or consultation was reliant on detailed imaging and other patient information which was unavailable as a result of the network issue.

Continue reading the main story

The place was in utter chaos can't believe there is no back-up"

End Quote John Greer NHS outpatient

"Arrangements have also been made to maintain the vast majority of chemotherapy sessions today (Wednesday), although a small number of sessions have regrettably been postponed.

"The unprecedented IT issue relates to our network and the way staff can connect to some of our clinical and administrative systems."

NHS GGC said further work would be carried out during Wednesday afternoon to ensure that the partial fixes put in place were "sustainable" and that "full IT functionality is restored".

The health board confirmed that by late morning on Wednesday, it had postponed some 459 outpatient appointments.

It said that 14 planned inpatient procedures were also postponed, along with 43 day cases and 48 chemotherapy patient treatments.

NHS GGC said earlier that emergency operations and community services had not been compromised by the ongoing problem.

The Scottish government confirmed it had been informed about the problem.

Twitter anger

A spokesman said: "We have been made aware of an issue related to IT at NHS Greater Glasgow that has resulted in a number of postponements.

"We have been assured that staff are working hard to return services to normal and to reschedule appointments at the earliest opportunity."

A question on the issue is due to be raised in the Scottish parliament on Wednesday afternoon.

Reacting on Twitter, John Greer, from Glasgow, said he had waited six months for an appointment on Tuesday, only for it to be cancelled.

He added: "The place was in utter chaos can't believe there is no back-up."

However, Annemarie Monaghan, from Bearsden, said: "Hospital appointment at 9am - despite no IT system was seen on time, good consultation, future treatment organised. No problem. Well done NHS."

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Breast cancer 'research gap' warning

30 September 2013 Last updated at 20:01 ET By Helen Briggs BBC News

Ten "critical" gaps in knowledge about the development of breast cancer must be addressed, say leading experts.

Finding out how breast cancer spreads and evades therapy is a key concern, they report in Breast Cancer Research.

Plugging the gaps in research would lead to improved clinical care for patients within five years, their review of evidence suggests.

Projections suggest 185,000 UK lives will be lost by 2030 at current progress rates, say cancer charities.

In their review of recent progress in research, more than 100 scientists, doctors and healthcare professionals looked at how limitations in knowledge of breast cancer are affecting the setting of priorities for the future.

They identified 10 key gaps that need be plugged:

• better understanding of genetic factors
• pinpointing sustainable lifestyle changes
• targeted breast screening to those who will most benefit
• understanding how breast cancers grow and spread
• understanding how cancer cells with different characteristics form within a tumour
• tests to measure how well patients will respond to chemotherapy or radiotherapy
• improving drug regimens
• developing better imaging techniques
• practical support
• tissue donation and analysis

Prof Alistair Thompson, of the University of Dundee, co-author of the analysis, said advances in science had transformed knowledge of breast cancers over the past four or five years.

"We're beginning to understand some of the greater complexities of what we're having to deal with and unpick some of the mechanisms by which cancer cells work, divide and spread," he said.

Continue reading the main story

If we look at the impact of doing nothing, of not moving forward, then by 2030, we'll have more than 1.2 million women living with breast cancer, and, between now and then, we will lose around 185,000 lives"

End Quote Baroness Delyth Morgan Breast Cancer Campaign

Prof Thompson said the most important gap in research was to find out how cancer progresses.

One "real" advantage to patients with breast cancer that had spread was to take a biopsy of the secondary tumour to see how much it had changed, he said.

This would enable treatment to be better targeted in one in six women, which could "transform" care, he said.

Prof Sue Eccles, of the Institute of Cancer Research, co-author of the analysis, said it was also important to focus on prevention.

"We need to understand more about preventing breast cancer in the first place and how women, particularly those of high risk, can be best informed about the lifestyle changes they might make or interventions available to them to reduce their risk.

"For people unfortunate enough to suffer from breast cancer, we need to find better ways of diagnosing it earlier and following it through, from screening or imaging.

"And finally we have to provide practical and effective support for all of those affected by breast cancer."

Future hopes

Baroness Delyth Morgan, chief executive of the charity Breast Cancer Campaign, said funding for breast cancer research had fallen in recent years.

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Adrienne Morgan says she assumed her diagnosis was "a death sentence"

"Time is pressing," she said. "If we look at the impact of doing nothing, of not moving forward, then by 2030, we'll have more than 1.2 million women living with breast cancer, and between now and then we will lose around 185,000 lives, and that's what we're up against if we do nothing."

Breast cancer is the most common cancer in the UK, with about 50,000 women diagnosed each year.

It is the second biggest cause of death from cancer in women, with about 12,000 losing their lives from the disease.

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Baby born after ovaries 'reawakened'

30 September 2013 Last updated at 15:36 ET By James Gallagher Health and science reporter, BBC News

A baby has been born through a new technique to "reawaken" the ovaries of women who had a very early menopause.

Doctors in the US and Japan developed the technique to remove the ovaries, activate them in the laboratory and re-implant fragments of ovarian tissue.

The technique, reported in Proceedings of the National Academy of Sciences, has resulted in one baby being born, with another expected.

The findings were described as early, but a "potential game-changer".

The 27 women involved in the study became infertile around the age of 30 due to "primary ovarian insufficiency". The condition affects one in 100 women who essentially run out of eggs too young, leading to an early menopause.

Women have a fixed number of eggs at birth and those with the condition tend to use them up too quickly or are born with far fewer eggs in the first place.

Wake-up

Eggs in the ovaries are not fully formed; rather, they stay as follicles and some mature each month.

The teams at Stanford University, US, and St Marianna University School of Medicine, Japan, were trying to activate the last few remaining follicles, which may be present.

Continue reading the main story

"Start Quote

It's potentially really, really, interesting, but we need a lot more investigation to confirm this is not another false dawn"

End Quote Prof Charles Kingsland Liverpool Women's Hospital

They removed the ovaries from the women and used a combination of two techniques to wake up the sleeping follicles. First they cut the ovaries into fragments, which has been used in the past as a fertility treatment. Then a chemical to "take the brakes off" egg development was applied.

The fragments were put back at the top of the fallopian tubes and the women were given hormone therapy.

Following the treatment, residual follicles started to develop in eight women. Eggs were taken for normal IVF and so far one couple has had a baby and another woman is pregnant.

Prof Aaron Hsueh, from Stanford, told the BBC: "It has to be improved to figure out the best way to do it, but we estimate it could help 25 to 30% of the women.

"We think it could help in two other forms of infertility. Cancer survivors after chemotherapy or radiotherapy; if there's any follicles left there's a chance this will help.

"And also women aged 40 to 45 with an irregular menstrual cycle."

Continue reading the main story

The end of the menopause?

Some reports have described this study as "beating the menopause" - so does it?

It is certainly an exciting, if early, development for those who go through the 'early menopause'. Yet even for these women, far more research is needed before it could be considered as a therapy.

But what about the 'conventional menopause' in women normally over the age of 50?

This technique is very unlikely to help any women have children at this stage.

Even if they had follicles which could be cajoled into becoming eggs there would be issues of quality.

Women are born with all the eggs they will ever have; as time goes by they deteriorate. And as the quality falls, the odds of successful pregnancy plummet dramatically.

The difference between the eggs of a 25-year-old and a 50-year-old is huge.

As Prof Nick Macklon from the University of Southampton put it: "Quality and quantity are two very different things."

Major interest

The implications for women with early menopause are still unclear as the technique will require further testing and refinement before it could be used in clinics.

Prof Charles Kingsland, from Liverpool Women's Hospital and the Royal College of Obstetricians and Gynaecologists, said: "It's really clever, but will it work for everyone? We don't know.

"It's potentially really, really, interesting, but we need a lot more investigation to confirm this is not another false dawn.

"I will see primary ovarian insufficiency on a regular basis in my clinic so if it's effective in the long term, it's something we'd be interested in."

Prof Nick Macklon, from the University of Southampton, told the BBC: "Finding a new way to get new eggs by waking up sleeping follicles is very promising. It's potentially a game-changer.

"It's a very important and very exciting piece of science, but it is not ready for the clinic. It still needs good randomised control trial data."

He added that performing the technique outside of a research study would be unfeasible, but a deeper understanding of the mechanisms of egg development could lead to new medications.

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PM promises more flexible GP hours

1 October 2013 Last updated at 08:33 ET

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David Cameron: ''This is about getting services right''

David Cameron says he wants to offer more patients the chance to visit a GP in the evening or at weekends.

Under a scheme to be piloted in nine areas of England, surgeries will be able to bid for funding to open from 8am to 8pm seven days a week.

The prime minister said the £50m project would mean doctors "fit in with work and family life".

Mr Cameron has also denied his plan for a budget surplus in the next Parliament will lead to further spending cuts.

The prime minister said the 2008 banking crisis had brought the UK economy "to the brink" and it would be irresponsible not to put money aside for a "rainy day" when the economy improved.

In other developments on the penultimate day of the Conservative Party's annual conference in Manchester:

• Mr Cameron said he would welcome Mayor of London Boris Johnson back to Parliament and says they could make a "strong team"
• The proposed marriage tax break is "very much a first step" to recognising the institution in the tax system, Mr Cameron said
• The prime minister said he "understood" Ed Miliband's reaction to an article in the Daily Mail about his father and newspapers and politicians should show "judgement" about press limits
• Work and Pensions Secretary Iain Duncan Smith outlined plans to force the jobless to attend 9-5 classes at job centres
• Culture Secretary Maria Miller says a new £10m fund will be set up to mark UK historic events, such as forthcoming anniversaries of the Magna Carta and the Battle of Waterloo

Manchester is already piloting an extended-hours scheme for GPs, with GPs grouping together to offer extra care, in what is being billed as an attempt to prevent "unnecessary" visits to hospital A&E wards.

'Skype appointments'

The wider scheme will see practices applying for a share of a £50m "Challenge Fund", with surgeries becoming "pioneers" in each of nine regions, starting in 2014/15.

Continue reading the main story

Extended opening hours for GPs. Sounds familiar? It should.

The Labour government encouraged practices to open later in the evening and on weekends - offering them extra money if they did so.

Most GPs gave it a go. But the problem was that in many places there was just not the demand and so the funding was reduced and hours cut.

There are still plenty of surgeries that offer out-of-hours appointments, particularly in large urban areas.

But the truth is that the people who are most likely to make use of the service - those of working age - are the least likely to need a GP.

Whereas, the elderly and children who are the most frequent users tend not to have a problem attending appointments during regular hours.

Mr Cameron is also promising more "flexible access", including email, Skype and telephone consultations for patients who prefer this to face-to-face contact.

He told the BBC: "Many hard working people find it difficult to take time off to get that GP appointment, so having these pilot schemes... is, I think, a very positive step forward.

"It also links to the problems we have seen in our accident and emergency departments because the number of people going to A&E departments is up by four million since the changes to the GP contract that Labour put in in 2004.

"What we need to do is enable the right people with the right ailments, as it were, to either go to a GP or to accident and emergency."

Health Secretary Jeremy Hunt said: "We live in a 24/7 society, and we need GPs to find new ways of working so they can offer appointments at times that suit hard-working people.

"Cutting-edge GP practices here in Manchester are leading the way, and we want many more patients across the country to benefit."

'Social care collapse'

The Royal College of GPs said doctors were keen to do more, but were already struggling with their workload.

Shadow health secretary Andy Burnham said: "Under the Tories, hundreds of GP surgeries are shutting their doors earlier after David Cameron scrapped Labour's successful extended opening scheme.

"Patients are also finding it harder to get appointments, and turning to A&E instead, after he removed Labour's guarantee of an appointment within 48 hours."

He added: "So I sincerely hope Jeremy Hunt isn't expecting applause on GP hours, given how they have taken the NHS backwards from the position they inherited from Labour. An apology for the inconvenience they have caused to millions would be more appropriate.

"I also hope he won't claim that this will solve David Cameron's A&E crisis. It is the collapse of social care that is driving vulnerable, older people into hospital in ever greater numbers and this is the crisis they continue to neglect."

'No splurge'

In his speech to the conference on Monday, Chancellor George Osborne said he planned to continue the government's policy of fiscal restraint throughout the next parliament - if the Conservatives are re-elected - with the aim of achieving a budget surplus.

Mr Cameron said this would require tough decisions for the next six or seven years but did not "necessarily mean" there would have to be more cuts on top of those announced up to 2016.

"What it definitely means once those years are over you cannot sort of plan another spending splurge. We are going to have to be responsible in our country for very many, many years into the future."

The government was right to focus on containing spending, he added.

"I don't think you tax your way to a strong recovery and we need to recognise that hard working people need more money in their pockets to spend as they choose."

The prime minister also insisted that the government would find the money to freeze fuel duty until 2015, describing help for motorists as a "real priority".

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Young mum 'child death risk' link

29 September 2013 Last updated at 19:07 ET

Children born to mothers under 30 are more likely to die than those born to older mums, a report on child deaths in the UK suggests.

While overall child mortality fell by 50% in the past 20 years, young maternal age was found to be a risk factor for death in early childhood.

Support should be extended to mothers of all ages, not just first-time teenage mums, the report said.

The research was led by the Institute of Child Health at UCL.

It looked at why children die in the UK using death registration data from January 1980 to December 2010.

It focused on child injuries, birthweight and maternal age to assess the risk factors for child deaths.

The research found that in England, Scotland and Wales, the difference in mortality between children of mothers under 30 and those born to mothers aged 30 to 34 accounted for 11% of all deaths up to nine years old.

This is equivalent to an average of 397 deaths in the UK each year, the report said.

Continue reading the main story

"Start Quote

Young maternal age at birth is becoming a marker of social disadvantage as women who have been through higher education are more likely to postpone pregnancy until their 30s"

End Quote Prof Ruth Gilbert Institute of Child Health, UCL

Deaths in children born to mothers under 20 accounted for just 3.8% of all child deaths up to nine years old.

The study compared children with similar birthweight in each age category.

'Alcohol use, smoking and deprivation'

It reported that the biggest difference in deaths was in infants aged from one month to one year.

Among this age group, 22% of deaths in the UK were due to "unexplained causes", the report said, "which are strongly associated with maternal alcohol use, smoking and deprivation".

The report added that the current policy, which focuses support on teenage first-time mothers, was not wide-ranging enough because mothers aged under 30 account for 52% of all births in the UK.

Ruth Gilbert, lead researcher and professor of clinical epidemiology at UCL Institute of Child Health, said the findings were important.

"Young maternal age at birth is becoming a marker of social disadvantage as women who have been through higher education and those with career prospects are more likely to postpone pregnancy until their 30s.

"Universal policies are needed to address the disparities."

Jill Rutter, head of policy and research at the Family and Childcare Trust, said the government needed to do more.

"Disadvantage and maternal age are factors often associated with child deaths. The government has recognised the vulnerability of the children of teenage mothers and given these families extra help with parenting.

"In England the Family Nurse Partnership is an intensive, structured, home-visiting programme, which is offered to first-time parents under the age of 20.

"A specially trained nurse visits regularly from early pregnancy until the child is two years old. This project has excellent results, but is not available to older mothers.

"We would like the Family Nurse Partnership to be extended to take older mothers who need help."

Toll from injuries

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"Start Quote

The lack of decline in intentional injuries calls for a concerted focus on reducing violence and self-harm in older children."

End Quote Dr Hilary Cass Royal College of Paediatrics and Child Health

The study, commissioned by the Healthcare Quality Improvement Partnership and published by the Royal College of Paediatrics and Child Health, had other key findings.

First, injuries continue to be the biggest cause of death in childhood, but they are declining,

Between 1980 and 2010, injuries accounted for 31% of deaths in one to four-year-olds and 48% of deaths in those aged 15 to 18.

England had consistently lower rates of deaths from injury than the other UK countries, particularly among older boys.

But there was no decline in deaths due to intentional injury or self-harm over 30 years, the report found.

Dr Hilary Cass, president of the royal college, said this was worrying.

"Injuries remain the biggest cause of child deaths but are declining, so we need to continue to build upon public policy interventions such as traffic calming.

"The lack of decline in intentional injuries calls for a concerted focus on reducing violence and self-harm in older children."

Disabilities and serious diseases

The study also found that up to 70% of children who die in the UK have chronic conditions such as cancer, cystic fibrosis or epilepsy.

This was not necessarily the cause of their death but likely to be an underlying factor in it.

Prof Gilbert said that although the overall number of children dying is falling, the picture was complicated by the increasing number of children now surviving with disabilities and serious diseases, and this meant that proactive care was vital.

"For some children with serious chronic conditions who are expected to die, this means high-quality end-of-life care for the child and to support their families.

"For others, their death may have been premature or completely preventable. Most children with chronic conditions are managed at home by parents with support from primary and community care services as well as hospitals. We need to focus on the quality of long-term care at home for these children as well as in hospital."

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