NEWS
New guidance prevents doctors from being ‘gagged’
New guidance from the GeneralMedical Council will prevent doctors entering into contracts or agreements that seek to stop them raising concerns about poor quality care. The new guidance also makes clear that doctors must not sign contracts that attempt to prevent them from raising concerns with professional regulators. Nor must doctors in management roles promote such contracts or encourage other doctors to sign them. Niall Dickson, chief executive of the General
Medical Council said: “These clauses are totally unacceptable. Doctors who sign such contracts are breaking their professional obligations and are putting patients, and their careers, at risk.” The new guidance Raising and acting on
concerns about patient safety makes clear that doctors have a duty to act when they believe patient safety is at risk, or when a patient’s care or dignity is being compromised. The guidance explains when doctors need to raise concerns and advises on the help and support available to them, including how to tackle any barriers that they may face. Doctors also have responsibility for the safety
and wellbeing of patients when performing non- clinical duties – including when they are working as a manager. New guidance Leadership and management for all doctors is also being issued aimed at helping doctors understand their
responsibilities in relation to employment issues, teaching and training, as well as planning, using and managing resources. The two documents will be sent to all 240,000
doctors on the medical register and the new guidance comes into effect on 12March 2012. The GMC’s new Liaison Service, which strengthens the regulator’s local presence, will use the guidance and work with MedicalDirectors, doctors and patients’ groups to help foster openness and a willingness to speak out throughout the health service. Niall Dickson added: “Being a good doctor
involves more than simply being a good clinician. It means being committed to improving the quality of services and being willing to speak up when things are not right – that is not always easy but it is at the heart of medical professionalism. Healthcare today is seldom an isolated affair and using the eyes and ears of health professionals can be the most effective way of protecting patients and ensuring high quality care.” Public Health Minister Anne Milton said:
“We welcome the new guidance from the General Medical Council which states clearly that a doctor’s first duty must be to patient welfare. Any contract preventing a doctor from raising concerns about the welfare of his patients is completely unacceptable.”
NICE guidance on cardiac CT scanners
The latest NICE guidance on four new generation cardiac computed tomography (CT) scanners supports their use in the NHS in England for people with suspected or known coronary artery disease (CAD) in whom imaging is difficult with earlier generation CT scanners. The guidance, produced as part of NICE’s
diagnostics assessment programme, recommends Somatom Definition Flash CT scanner (Siemens AGHealthcare), Aquilion ONE (ToshibaMedical Systems), Brilliance iCT (PhilipsHealthcare) and Discovery CT750 (GEHealthcare) as options for first-line imaging of the coronary arteries in people with suspected stable CAD(with an estimated likelihood of coronary artery disease of 10%to 29%) and for first-line evaluation of disease progression to establish the need for revascularisation in people with known CADin whomimaging with earlier generation CT scanners is difficult. CT scans are performed to evaluate the arteries
of the heart, and can also be used to assess the function of the heart, the anatomy of the heart, and the degree of coronary calcification in the heart. However, in some people, imaging the heart and surrounding blood vessels is difficult with older types of CT scanners. This can be due to a number of reasons, including obesity, levels of coronary calcium higher than 400 and heart rates greater than 65 beats per minute that cannot be
10 THE CLINICAL SERVICES JOURNAL
lowered with drugs. New generation cardiac CT scanners have advantages over older types of CT scanners for these people because they can produce better images in a shorter time (within one or two heartbeats). Professor Carole Longson, NICE Health
Technology Evaluation Centre director, said: “From a patient perspective, a non-invasive cardiac diagnostic test is more appealing than the current alternative for people in whom imaging is difficult – invasive coronary angiography – because of the greater morbidity and mortality risks associated with angiography. New generation cardiac CT was found to be more cost-effective than angiography because of its lower imaging costs and the lower risk of adverse outcomes and associated reduced downstream healthcare costs from dealing with complications. “The independent Diagnostics Advisory
Committee concluded that the evidence presented indicated that new generation cardiac CT was more cost-effective for people in whom imaging is difficult than proceeding directly to invasive angiography. Service providers in England, working with commissioners and cardiac networks, should take into account the benefits of new generation cardiac CT scanners for use in the circumstances described in this guidance when selecting CT scanners.”
Benefits of aspirin questioned
A study at St George’s, University of London, has found that the benefits of aspirin are more modest than previously believed. People without a history of cardiovascular disease (such as heart attack or stroke) are unlikely to benefit from a regular dose of aspirin, given the risk of internal bleeding. This is the finding of the largest study into the effects of aspirin in people without cardiovascular conditions. Aspirin reduces the risk of clots forming
in blood vessels and thereby protects against heart disease and stroke. It is widely used to prevent a repeat heart attack or stroke among people who have already suffered from one of these conditions, known in the medical field as secondary prevention. Many medical experts have also prescribed regular aspirin as a primary prevention technique – a precaution among people without a previous history of heart attack or stroke, but who may be considered at increased risk of these conditions in the future due to the presence of risk factors for heart attacks or strokes. Dr Sharlin Ahmed, research liaison
officer at The Stroke Association said: “People who have been specifically told to take aspirin following a cardio-vascular event such as a stroke or heart attack should continue to do so. Equally, people who think that taking aspirin on a regular basis as a precaution without advice from their doctor should be aware of the potential harm.”
Faulty gene increases survival of ovarian cancer
Ovarian cancer patients who carry BRCA1 or BRCA2 mutations are significantly more likely to survive the disease than women without these faulty genes, according to research published in the Journal of the American Medical Association. The study, which combined the results of 26 international trials, showed 44% of women with BRCA1 faults and 52% of women with BRCA2 faults were alive five years after they were diagnosed with epithelial ovarian cancer. This compares with 36% of women without a fault in one of these genes who were alive five years after their diagnosis. The researchers say having a faulty BRCA
gene could alter the biology of a tumour, making it more responsive to treatment. It could also be because the normal role of a BRCA gene is to repair damage to DNA. Having a faulty BRCA gene could leave the tumour less able to repair damaged DNA and so more vulnerable to chemotherapy.
MARCH 2012
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