X-ray tricks cut breast scan dose

23 October 2012 Last updated at 08:02 ET

An international research team has proposed a way to make high-resolution, 3D images of breast tissue while reducing the delivered X-ray dose.

Breast tissue is particularly susceptible to X-ray radiation so 3D scanning is generally not employed.

Now a team reporting in Proceedings of the National Academy of Sciences suggests a different form of X-rays and a new image analysis approach.

However, new compact X-ray sources are needed to bring the idea to the clinic.

Taken together, the two improvements lead to high-resolution 3D images while reducing the delivered dose to just 4% that of standard "computed tomography" (CT) scans.

A phenomenally successful technique in X-ray scanning over the past half-century, CT scans are made with a number of X-ray images taken from various angles that are analysed to yield a 3D view.

The approach is reserved for the imaging of parts of the body for which these multiple X-ray exposures is deemed safe, generally excluding "radiosensitive" breast tissue.

Instead, what is known as dual-view mammography is employed, producing two conventional X-ray images of the breast - a methodology that is known to miss 10-20% of tumours.

One to watch

Recent years have seen growth in the use of what is called phase contrast imaging, which measures not only how much X-ray light gets through tissue, but also in a sense how long it takes to get there. This yields a far clearer picture of subtle changes in density that can show tumours.

Now researchers from the US and Germany working at the European Synchrotron Radiation Facility in France have refined the phase contrast approach using what they call equally sloped tomography.

The improvement is in the mathematics used to analyse X-ray images - instead of taking a number of images at evenly spaced angles around a sample, EST takes images at irregular angle intervals and uses improved equations to reconstruct the 3D representation.

Co-author of the study Paola Coan of Ludwig Maximilians University explained that an analogy of the process is a watch.

"Instead of having a hand that measures every second, we have a hand that follows a certain scheme, the first hand movement is 1.2 seconds, then 0.7 then maybe 0.9, but at the end, thanks to EST, we still measure perfectly the minute," she explained to BBC News.

"With this mathematical trick we avoid interpolation and the image looks better - we even need to take fewer radiographs to reconstruct the computed tomography full image."

Testing the approach at the ESRF with a whole mastectomied breast, the team showed that they could acquire images as sharp as those of conventional CT scans using just a quarter of the delivered X-ray dose.

But they carried the work further by using the ESRF's capabilities to run the same test with higher-energy X-rays. Soft tissue is more transparent to these "harder" X-rays and therefore less radiation is absorbed.

As members of the team showed in an article in Physics in Medicine and Biology in April, images of a quality comparable to standard CT can be acquired with harder X-rays corresponding to just a sixth the radiation dose.

In combination, the techniques result in the resolution of a full CT scan while delivering a dose just 4% as large.

"We've demonstrated that by combining X-rays at high energy plus this sophisticated CT reconstruction, we're able to perform a complete CT with high resolution, but with a dose that is much lower than than in conventional CT and potentially... lower than dual-view mammography," Prof Coan said.

"This is an extraordinary result."

However, she added that compact, high-quality X-ray sources capable of the higher-energy regime are still necessary to get the technique established in the clinical setting, a research effort that is underway for a number of industries.

21.24 | 0 komentar | Read More

Exercise 'may beat brain shrinkage'

22 October 2012 Last updated at 22:25 ET By Michelle Roberts Health editor, BBC News online

Exercising in your 70s may stop your brain from shrinking and showing the signs of ageing linked to dementia, say experts from Edinburgh University.

Brain scans of 638 people past the age of retirement showed those who were most physically active had less brain shrinkage over a three-year period.

Exercise did not have to be strenuous - going for a walk several times a week sufficed, the journal Neurology says.

But giving the mind a workout by doing a tricky crossword had little impact.

The study found no real brain-size benefit from mentally challenging activities, such as reading a book, or other pastimes such as socialising with friends and family.

Continue reading the main story

More research is also needed to tease out how physical activity might be having a beneficial effect"

End Quote Dr Simon Ridley Alzheimer's Research UK

When the researchers examined the brain's white matter - the wiring that transmits messages round the brain - they found that the people over the age of 70 who were more physically active had fewer damaged areas than those who did little exercise.

And they had more grey matter - the parts of the brain where the messages originate.

Experts already know that our brains tend to shrink as we age and that this shrinkage is linked to poorer memory and thinking.

And previous studies have shown that exercise helps reduce the risk of dementia and can slow down its onset.

But scientists are still baffled about why this is.

'Never too late'

Exercise increases blood flow to the brain, delivering oxygen and nutrients to brain cells, which may be important.

Or it may be that as people's brains shrink, they become less inclined to exercise.

Regardless of why, experts say the findings are good news because exercise is an easy thing to do to boost health.

Dr Simon Ridley, head of research at Alzheimer's Research UK, said: "This study links physical exercise to fewer signs of ageing in the brain, suggesting that it may be a way of protecting our cognitive health.

"While we can't say that exercise is the causal factor in this study, we do know that exercise in middle age can lower the risk of dementia later in life.

"It will be important to follow these volunteers to see whether these structural features are associated with greater cognitive decline over the coming years. More research is also needed to tease out how physical activity might be having a beneficial effect."

Prof James Goodwin, head of research at Age UK, the charity that provided the funding for the research, said: "This research re-emphasises that it really is never too late to benefit from exercise, so whether it's a brisk walk to the shops, gardening or competing in a fun run it is crucial that, those of us who can, get active as we grow older."

21.24 | 0 komentar | Read More

NHS hearing services 'being cut'

22 October 2012 Last updated at 22:30 ET By Nick Triggle Health correspondent, BBC News

NHS hearing services are being scaled back in England, an investigation by campaigners suggests.

Data obtained by Action on Hearing Loss from 128 hospitals found more than 40% had seen cuts in the past 18 months.

In particular, the study found evidence of rises in waiting times and reductions in follow-up care.

The report is the latest in a growing number to have suggested front-line care is being rationed as the health service struggles with finances.

The NHS is in the middle of a £20bn five-year savings drive.

The government believes the savings can be made by increasing productivity.

Continue reading the main story

Making savings from hearing service cuts right now is a false economy because it will only lead to higher NHS and social care costs to support people with untreated loss in the long run"

End Quote Paul Breckell Action on Hearing Loss

But in the past year reports have suggested everything from hip and knee operations to eye surgery is being cut.

'Concerning'

Using the Freedom of Information Act, Action on Hearing Loss asked all 135 hospitals with audiology units whether they were having to scale back services.

In total 128 replied, with 43% reporting some kind of cut.

The most common problems were rises in waiting times, reductions in follow-up appointments - considered vital to helping people adapt to their hearing aids - and a lack of specialist staff to deal with complex cases.

But the report also found evidence of trusts starting to provide only one hearing aid when two had been judged to be clinically necessary.

The seven health boards in Wales were also asked about cuts, but only two responded, with one saying waiting times were increasing.

Action on Hearing Loss chief executive Paul Breckell said: "People with hearing loss have the right to expect the very best local services, so it's concerning that so many audiology departments have already felt the impact of budget cuts.

"Making savings from hearing service cuts right now is a false economy because it will only lead to higher NHS and social care costs to support people with untreated loss in the long run."

Health Minister Lord Howe said: "It is important that patients get high quality audiology services.

"We are working with stakeholders, including Action on Hearing Loss, to set out what needs to be done in the future to improve results for hearing loss in adults and children."

He also pointed out that the latest figures showed more than 98% of patients were being treated within 18 weeks - the official target for waiting.

21.24 | 0 komentar | Read More

Brain change bad behaviour link

21 October 2012 Last updated at 22:29 ET By Caroline Parkinson Health editor, BBC News website

The brains of teenage girls with behavioural disorders are different to those of their peers, UK researchers have found.

The Journal of Child Psychology and Psychiatry study of 40 girls revealed differences in the structure of areas linked to empathy and emotions.

Previous work has found similar results in boys.

Experts suggest it may be possible to use scans to spot problems early, then offer social or psychological help.

An estimated five in every 100 teenagers in the UK are classed as having a conduct disorder.

It is a psychiatric condition which leads people to behave in aggressive and anti-social ways, and which can increase the risk of mental and physical health problems in adulthood.

Rates have risen significantly among adolescent girls in recent years, while levels in males have remained about the same.

Fear detector

In this study, funded by the Wellcome Trust and Medical Research Council, UK and Italian researchers conducted brain scans of 22 teenage girls who had conduct disorder and compared them with scans of 20 who did not.

Continue reading the main story

It would be possible to use scans where a person is at high risk of offending in the future"

End Quote Dr Graeme Fairchild, Researcher

They also checked the scans against others previously taken of teenage boys with conduct disorder.

The team found part of the brain called the amygdala was smaller in the brains of male and female teenagers with conduct disorder than in their peers.

The amygdala is involved in picking up whether or not others feel afraid - and plays a role in people feeling fear themselves.

Girls with conduct disorder also had less grey matter in an area of the brain called the insula - linked to emotion and understanding your own emotions.

However the same area was larger in boys with conduct disorder than healthy peers, and researchers are not yet sure why that is the case.

The brains of those with the worst behaviour were most different from the norm.

Biological basis

Dr Andy Calder, from the MRC cognition and brain sciences unit, who worked on the study, said: "The origins of these changes could be due to being born with a particular brain dysfunction or it could be due to exposure to adverse environments such as a distressing experience early in life that could have an impact on the way the brain develops."

Dr Graeme Fairchild, of the University of Cambridge who also worked on the study, said there were potential uses for the finding.

"In the US, people are already using brain scans to argue diminished responsibility. I think we're too early in our understanding to really do that, but it is happening.

"It would also be possible to use scans where a person is at high risk of offending in the future.

"More help could be given to the family and, in the same way that someone with language impairment receives extra help, help could be given to teach a person to understand emotions - and the emotions of others - better."

Dr Michael Craig of King's College London's Institute of Psychiatry, who is also looking at using scans to pick up early signs of conditions such as anti-social behaviour, autism and attention deficit-hyperactivity disorder (ADHD), said: "The important thing is that in the studies to date there has been an absence of research looking at females, so this work is an important first step.

"And it suggests that at least a component of this has a biological basis - and there are people who don't believe there is one."

21.24 | 0 komentar | Read More

Earlier abuse at hospital found

22 October 2012 Last updated at 01:13 ET

The family of a man who was punched in the face as a patient at a private hospital in Bristol is calling for the incident to be re-investigated.

Eleven care workers are to be sentenced later for the maltreatment and neglect of five patients at Winterbourne View.

But a BBC Inside Out West investigation has found evidence of alleged abuse involving different staff members.

Police have agreed the assault on Ben Pullar was "not acceptable" but said they would not re-open the case.

Mr Pullar is autistic and bi-polar, with severe learning difficulties, and when he was 18, he spent almost a year at Winterbourne View from July 2009.

He lost two teeth when he was punched in the face.

His twin, Tom, said his behaviour changed drastically after going to the hospital.

"He's burst out crying on me and demanded to talk about Winterbourne View - and this is two years after Winterbourne View - so it still affects him today," said the 21-year-old.

'Teeth pushed back'

The BBC has seen daily care notes from his time at the hospital which state Mr Pullar "had an accident with his teeth" just weeks after he arrived.

His family said they were given mixed messages about what happened and were told at one point he had "bitten the floor".

He was taken to Bristol Dental Hospital by Winterbourne View staff as an emergency patient, and two doctors there raised the alarm with the authorities because of the severity of his injuries.

Senior dental consultant Dr Jane Luker said: "I think they thought the injury he sustained wasn't consistent with what they were being told.

"He had allegedly bitten a carer and the injuries were sustained from him biting that carer.

"[But] because the teeth were pushed back palatally, towards the back of the mouth, it would be consistent with a punch or a blow to the front of the face."

The authorities met several days after Mr Pullar was assaulted, but his family was not invited.

Tom Pullar said: "I think that care staff are supposed to care for patients, not punch them."

'Acted instinctively'

Notes obtained by Inside Out said the nurse was bitten and retaliated in order to remove his fingers - and later, that he had pushed and pulled to get them out.

The nurse involved, Maxwell Nyamukapa, was suspended and later reinstated. Despite repeated attempts to contact Mr Nyamukapa, he has refused to comment.

The police logged it as an assault, and said the nurse had acted instinctively and in self-defence.

Continue reading the main story

Looking back on that incident now and understanding the whole pattern of what was happening at that residential hospital, it is clearly not acceptable."

End Quote Det Ch Supt Louisa Rolfe

Forty concerns were raised about patients in just over three years with the local safeguarding board run by South Gloucestershire Council.

The police were also contacted 29 times, nine of those times related to carers suspected of using restraint of involved in violent incidents with patients - including Mr Pullar.

Det Ch Supt Louisa Rolfe, of Avon and Somerset Police, said: "We have carried out an extensive investigation into incidents at Winterbourne View and no stone has been left unturned.

"We consulted with the CPS and our partners in terms of action we could take.

"Looking back on that incident now and understanding the whole pattern of what was happening at that residential hospital, it is clearly not acceptable.

"However, at the time, the officer was dealing with information, reliable information, that came from patients and carers, and that came from other experts in that field. And perhaps they relied upon that information too much."

She added: "We accept that there is learning for us as an organisation and we will do things differently in future."

Det Ch Supt Rolfe said the force had carried out an extensive investigation into incidents at the hospital and had improved how it dealt with people with learning disabilities.

The council has declined to comment on Mr Pullar's case.

Castlebeck, the hospital's owner at the time, said its new board and management had already, and would continue to, rigorously review what happened at Winterbourne View.

The firm said if any other matters come to light, immediate action would be taken and the appropriate authorities informed.

It has also referred Mr Nyamukapa twice to the Nursing & Midwifery Council, who declined to comment.

Inside Out West is on BBC One West at 7.30pm on Monday or for seven days after on the iPlayer.

21.24 | 0 komentar | Read More

Dentist told old mags 'pose risk'

22 October 2012 Last updated at 07:38 ET

An NHS dentists says she was told to get rid of old magazines from her waiting room because they posed an infection risk.

Monica Symes, a dentist in Lyme Regis, Dorset, says an NHS infection control worker warned her that keeping back issues of Country Life could make her fail health and safety inspections.

The NHS regulator denies such a rule.

The British Dental Association said dentists were being stymied by heavy-handed rules.

Miss Symes, who has practised as a dentist for more than 30 years, says she was also told not to use adhesive putty, such as Blu-Tack, on posters in her waiting room because of "the danger of cross-infection".

Miss Symes said: "She also told me to reupholster the cushions in my waiting room for patients to sit on in plastic rather than fabric.

"It seemed a bit over the top."

The trust that employs the infection control worker said magazines should be in "good condition and free from obvious contamination".

Cleanliness

A spokesman said: "The [primary care trust] PCT's current advice to NHS dental practice owners is that patient waiting areas should be kept clear of unnecessary clutter to facilitate regular effective cleaning.

Continue reading the main story

Providing magazines in waiting rooms for patients to read is a good way of helping them to relax and can ease the concerns of anxious individual"

End Quote Dr John Milne British Dental Association

"There is no specific requirement for practices to remove magazines within a specified time period; however, practice owners, as part of a cleaning schedule, should ensure that magazines are in good condition and free from obvious contamination. This advice will be kept under review and may be modified in the event of any future community infection outbreaks."

The Care Quality Commission, which regulates dental surgeries to ensure they meet national standards on things like hygiene, said the regulator had never ordered dental surgeries to remove any magazines, nor set any rules about using Blu-Tack.

A spokesman said: "The only time these things would be an issue would be if our inspectors found them being used in such a way as to compromise the safety of someone using the service."

Dr John Milne, chair of the British Dental Association's General Dental Practice Committee, said: "Patients are at the heart of everything dentists do and cleanliness and hygiene is taken very seriously by dental practices.

"Providing magazines in waiting rooms for patients to read is a good way of helping them to relax and can ease the concerns of anxious individuals. Blu-tack is often used to display posters that reinforce positive oral health messages or advise patients about the care that the practice provides.

"Dentists are not opposed to regulation, but believe that it should be proportionate, cost-effective and non-duplicatory. Too often, in recent years, it has felt like regulation has been designed to hinder, rather than support, dentists' efforts to care for their patients."

21.24 | 0 komentar | Read More

Doctors facing new era of checks

19 October 2012 Last updated at 02:17 ET By Nick Triggle Health correspondent, BBC News

Please turn on JavaScript. Media requires JavaScript to play.

Health Secretary Jeremy Hunt: "Doctors will get a chance to address deficiencies"

Regular checks on doctors' skills will start from December, heralding the biggest shake-up in medical regulation for more than 150 years.

The UK's 220,000 doctors will have annual appraisals, with a decision taken every five years on whether they are fit to continue working.

But it will be April 2016 before the vast majority of the first round of checks have been done.

The health secretary said it was about addressing "deficiencies" in skills.

Jeremy Hunt said that if doctors failed to satisfy the standards of the General Medical Council (GMC) they would be prevented from practising.

But he said the new system was about identifying where there were "gaps" in knowledge or skills and giving doctors a "chance to put those issues right".

He said the vast majority of doctors "do a brilliant job" but when the government carried out a survey last year of 300 health bodies there were "serious concerns" with 0.7% of doctors - a figure Mr Hunt described as "significant".

"At the end of the day if the GMC is not satisfied that someone is up to speed then, yes, they will be prevented from practising," he told BBC Breakfast.

He said this would give the public confidence that the UK had the most thorough regulatory process for its doctors.

'Improve quality'

The move comes after years of discussions about the way doctors are monitored.

At the moment there are no mandatory checks on the performance of individual doctors, a situation which has been compared unfavourably to the airline industry where pilots face regular, on-going assessment.

Annual appraisals do happen in some places - particularly for medics in training - but they are by no means routine.

Continue reading the main story

• Revalidation by the General Medical Council will take place every five years.
• It will run separately to the GMC's disciplinary regime that can lead to a doctor being struck off the medical register.
• A decision on whether or not to allow a doctor to continue to practise will be based on annual appraisals and feedback from patients and colleagues.
• It will be up to responsible officers in each organisation, normally medical directors, to make a recommendation to the GMC.
• Minor issues may lead to revalidation being deferred for a short period while the problems are addressed.
• Something that constitutes a risk to safety would lead to revalidation being rejected. The doctor would then not be allowed to work.
• The revalidation process will start in December for senior medical leaders, including national and regional medical directors.
• From April it will be rolled out among the general doctor population and within 12 months a fifth of doctors should have been through the process.
• By April 2016 the "vast majority" of medics should have been checked.

There is, of course, a system of registration which the GMC is in charge of.

When serious complaints are made about performance, the GMC can start disciplinary procedures.

But this system essentially only picks up problems when things have gone wrong.

Revalidation has been designed to ensure issues are dealt with before they reach that stage.

GMC chief executive Niall Dickson said: "This is an historic moment. It is the biggest change in medical regulation for 150 years [since the creation of the GMC]."

He said the system should help improve quality, but he admitted the health industry had been "slow to recognise" the importance of such checks.

The introduction of regular checks - dubbed a medical MOT - has been talked about for more than 30 years.

Serious consideration started being given to the issue in the mid-1990s.

But over subsequent years scandals like that of the family GP and serial killer Harold Shipman and the deaths of the Bristol heart babies led to reviews and re-evaluations about what the process was intended to do.

Government and GMC officials have also had to have detailed discussions with the British Medical Association (BMA).

Dr Mark Porter, chair of the BMA's Council said it supported revalidation.

He added: "It is important to recognise, that while revalidation will undoubtedly enhance the rigorous testing that doctors undergo, clinicians are already offering patients a very high quality service and robust systems are currently in place to deal with any concerns.

"There is too much bureaucracy in the NHS and so we have to be careful that revalidation does not add to this unnecessarily."

Dean Royles, director of NHS Employers, said: "It is a very positive step forward and should herald greater patient safety and build confidence.

"Patients need and expect this. It has been a long time coming."

NHS medical director Professor Sir Bruce Keogh added it was a "powerful opportunity" to ensure standards of quality and professionalism are kept to across the country.

'4% concerns'

Each NHS organisation from hospitals to local networks of GP practices will have a responsible officer, such as a medical director, in charge of revalidation.

They will assess the annual appraisals along with feedback from patients and colleagues to make a recommendation about revalidation to the GMC every five years.

Minor issues that do not constitute a risk to safety may lead to revalidation being deferred for a short period, but major problems will result in the doctor not having their licence to practise revalidated.

Such a scenario could also lead to disciplinary procedures being started by the GMC, the ultimate sanction of which is being struck off the medical register.

During piloting and testing of the new system, concerns were raised over the performance of 4.1% of doctors.

In 2.4% of cases the issues were judged to be lower level, such as lateness, in 1% they were medium level, which included problems with behaviour including rudeness to patients, while in 0.7% the problems were serious and would have had an impact on safety.

21.24 | 0 komentar | Read More

Science will guide me - Hunt

19 October 2012 Last updated at 07:29 ET

Health Secretary Jeremy Hunt has promised to follow scientific advice in the decisions he makes.

Mr Hunt was only appointed last month, but has already sparked controversy by saying he favours halving the abortion time limit to 12 weeks.

He is also known to be a supporter of homeopathy, despite many experts doubting its effectiveness.

Speaking on BBC Radio 4's Today programme his decisions would be "evidence-based".

But he declined to say whether he believed there was any scientific evidence to support his personal opinions.

'Positive contribution'

In reference to his comments to The Times newspaper when he said 12 weeks was the "right point" at which to limit abortions, he said: "I was simply answering a question as to why I voted in the way I did in a free vote in 2008.

"I made it clear when I said that that it was a free vote, this is not government policy to change the limit, and, as health secretary, my responsibility is to implement the democratic will of parliament.

"Parliament voted in 2008 not to change the limit on abortions and that is the policy I will implement."

The 24 week limit applies to England, Wales and Scotland. Abortion is illegal in Northern Ireland except in exceptional medical circumstances, such as when the mother's health is at risk.

There were nearly 190,000 abortions for women in England and Wales last year, the vast majority of which - 91% - were carried out in under 13 weeks.

In 2007, Mr Hunt signed a parliamentary early-day motion praising the "positive contribution" of homeopathic hospitals in the NHS.

This was despite repeated clinical trials which have found that homeopathic medicines - which contain heavily diluted traces of the substance causing the illness - are ineffective.

Asked whether he believes homeopathy works, Mr Hunt said: "I believe that my decisions as health secretary should be based on science and should be evidence-based and driven by evidence.

"I will follow the scientific advice."

21.24 | 0 komentar | Read More

Child throat hospital cases rise

19 October 2012 Last updated at 19:54 ET

Children admitted to hospital with throat infections have increased by 76% over the past 10 years, according to a study from Imperial College London.

Writing in the Archives of Disease in Childhood, researchers found that most children were discharged after a short stay.

This suggests that the severity of infection has not increased, they said.

Pressures on doctors and a maximum waiting time in A&E could be the reason behind the increase in admissions.

The study investigated hospital admission rates for children up to the age of 17 with acute throat infections between 1999 and 2010. They also looked at the number of tonsillectomies performed during that period.

Researchers were concerned that the decline in tonsil removal operations in recent years had led to an increase in hospital admissions for severe tonsillitis.

Continue reading the main story

Our findings suggest that many of the children admitted with acute throat infections could have been effectively managed in the community"

End Quote Dr Elizabeth Koshy Imperial College London

They found that admissions for throat infections rose from 12,283 in 1999 to 22,071 in 2010. The highest rates were among children aged between one and four years, followed by children aged under one.

Over the same decade they found an increase of 115% in short hospital stays lasting less than two days. These accounted for most of the admissions.

The researchers found no evidence of a link between tonsillectomy trends and admission rates for acute throat infections.

Instead, they suggest that the sharp rise in hospital cases of children with throat infections is probably explained by the large number of children being taken to A&E instead of to see their GP, especially if the infection flares up outside surgery hours.

Dr Elizabeth Koshy, lead study author from the school of public health at Imperial College London, said the rise in hospital admissions for this type of infection was concerning.

'Unnecessary'

"Our findings relating to short hospital stays suggest that many of the children admitted with acute throat infections could have been effectively managed in the community.

"Our study highlights the need to urgently address the issue of healthcare access, with improved models of integrated care within primary and secondary care, to avoid potentially unnecessary hospital admissions for relatively minor infections in the future."

The introduction of a four-hour maximum waiting time in A&E, in 2002, could have led under-pressure doctors to admit children with less serious throat infections, she said.

Dr Koshy said that further research was needed to confirm that declining tonsillectomy rates were not associated with an increase in more severe throat infections rates.

She added: "Tonsillectomy is a major and costly operation with potentially serious complications.

"So it seems sensible for clinicians to maintain a high threshold for referring children with recurrent throat infections for tonsillectomy and restrict it to those children who are most severely affected by these infections."

21.24 | 0 komentar | Read More

Doctors facing new era of checks

19 October 2012 Last updated at 02:17 ET By Nick Triggle Health correspondent, BBC News

Please turn on JavaScript. Media requires JavaScript to play.

Health Secretary Jeremy Hunt: "Doctors will get a chance to address deficiencies"

Regular checks on doctors' skills will start from December, heralding the biggest shake-up in medical regulation for more than 150 years.

The UK's 220,000 doctors will have annual appraisals, with a decision taken every five years on whether they are fit to continue working.

But it will be April 2016 before the vast majority of the first round of checks have been done.

The health secretary said it was about addressing "deficiencies" in skills.

Jeremy Hunt said that if doctors failed to satisfy the standards of the General Medical Council (GMC) they would be prevented from practising.

But he said the new system was about identifying where there were "gaps" in knowledge or skills and giving doctors a "chance to put those issues right".

He said the vast majority of doctors "do a brilliant job" but when the government carried out a survey last year of 300 health bodies there were "serious concerns" with 0.7% of doctors - a figure Mr Hunt described as "significant".

"At the end of the day if the GMC is not satisfied that someone is up to speed then, yes, they will be prevented from practising," he told BBC Breakfast.

He said this would give the public confidence that the UK had the most thorough regulatory process for its doctors.

'Improve quality'

The move comes after years of discussions about the way doctors are monitored.

At the moment there are no mandatory checks on the performance of individual doctors, a situation which has been compared unfavourably to the airline industry where pilots face regular, on-going assessment.

Annual appraisals do happen in some places - particularly for medics in training - but they are by no means routine.

Continue reading the main story

• Revalidation by the General Medical Council will take place every five years.
• It will run separately to the GMC's disciplinary regime that can lead to a doctor being struck off the medical register.
• A decision on whether or not to allow a doctor to continue to practise will be based on annual appraisals and feedback from patients and colleagues.
• It will be up to responsible officers in each organisation, normally medical directors, to make a recommendation to the GMC.
• Minor issues may lead to revalidation being deferred for a short period while the problems are addressed.
• Something that constitutes a risk to safety would lead to revalidation being rejected. The doctor would then not be allowed to work.
• The revalidation process will start in December for senior medical leaders, including national and regional medical directors.
• From April it will be rolled out among the general doctor population and within 12 months a fifth of doctors should have been through the process.
• By April 2016 the "vast majority" of medics should have been checked.

There is, of course, a system of registration which the GMC is in charge of.

When serious complaints are made about performance, the GMC can start disciplinary procedures.

But this system essentially only picks up problems when things have gone wrong.

Revalidation has been designed to ensure issues are dealt with before they reach that stage.

GMC chief executive Niall Dickson said: "This is an historic moment. It is the biggest change in medical regulation for 150 years [since the creation of the GMC]."

He said the system should help improve quality, but he admitted the health industry had been "slow to recognise" the importance of such checks.

The introduction of regular checks - dubbed a medical MOT - has been talked about for more than 30 years.

Serious consideration started being given to the issue in the mid-1990s.

But over subsequent years scandals like that of the family GP and serial killer Harold Shipman and the deaths of the Bristol heart babies led to reviews and re-evaluations about what the process was intended to do.

Government and GMC officials have also had to have detailed discussions with the British Medical Association (BMA).

Dr Mark Porter, chair of the BMA's Council said it supported revalidation.

He added: "It is important to recognise, that while revalidation will undoubtedly enhance the rigorous testing that doctors undergo, clinicians are already offering patients a very high quality service and robust systems are currently in place to deal with any concerns.

"There is too much bureaucracy in the NHS and so we have to be careful that revalidation does not add to this unnecessarily."

Dean Royles, director of NHS Employers, said: "It is a very positive step forward and should herald greater patient safety and build confidence.

"Patients need and expect this. It has been a long time coming."

NHS medical director Professor Sir Bruce Keogh added it was a "powerful opportunity" to ensure standards of quality and professionalism are kept to across the country.

'4% concerns'

Each NHS organisation from hospitals to local networks of GP practices will have a responsible officer, such as a medical director, in charge of revalidation.

They will assess the annual appraisals along with feedback from patients and colleagues to make a recommendation about revalidation to the GMC every five years.

Minor issues that do not constitute a risk to safety may lead to revalidation being deferred for a short period, but major problems will result in the doctor not having their licence to practise revalidated.

Such a scenario could also lead to disciplinary procedures being started by the GMC, the ultimate sanction of which is being struck off the medical register.

During piloting and testing of the new system, concerns were raised over the performance of 4.1% of doctors.

In 2.4% of cases the issues were judged to be lower level, such as lateness, in 1% they were medium level, which included problems with behaviour including rudeness to patients, while in 0.7% the problems were serious and would have had an impact on safety.

21.24 | 0 komentar | Read More