National Health Service Patients Research Articles

PHYSICAL MORBIDITY IN PATIENTS ADMITTED TO A PRIVATE HOSPITAL FOR DETOXIFICATION FROM ALCOHOL

A survey of patients admitted to a private hospital for detoxification from alcohol found similar levels of physical morbidity and withdrawal complications to a group admitted to a National Health Service alcohol treatment unit. Although private patients tended to be older than National Health Service patients, the two groups were similar on a number of other variables. The implications for those involved in the management of patients who abuse alcohol are discussed.

The use of family health services authority registers as a sampling frame in the UK: a review of theory and practice.

Accepted for publication March 1995 In epidemiological and social scientific studies the choice of an appropriate, accurate sampling frame listing eligible subjects is a meth odological decision which will influence the representativeness of the sample selected, and hence the generalisability of findings. The most widely used population sampling frame of adult individuals in the UK is the electoral roll.12 Telephone listings have become more popular in recent years while other studies use sampling frames related to property by which to identify individuals.34 An increasingly used population sampling frame is the list of persons registered with UK general practitioners (GP) held by family health services authorities (FHSA). These registers were developed so that FHSAs (previously Family Practitioner Committees and Executive Councils) could arrange payment of GPs for National Health Service patients.1 FHSAs are usually based on counties or metropolitan bor oughs, and are accountable to regional health authorities and so to the NHS Executive. Re cent major developments in FHSA registers mean that they have a number of important advantages over more usual sampling frames.

Rhinoplasty patients revisited

National Health Service (NHS) rhinoplasty patients have been shown to differ from normal in their performance on psychological tests. In this study the same psychological parameters of two groups of private rhinoplasty patients are documented and compared to that of NHS patients. The two groups of private patients do not differ from each other either in content or in psychological performance. All three groups show consistent differences from normal in their psychological performance. Patients with no history of injury before their rhinoplasty, especially if treated in the NHS, are found to be more psychologically disturbed than other patients. It appears that the NHS is used particularly for treating those with a history of injury, and those with greatest psychological problems.

Trades union conference.

Union leader Rodney Bickerstaffe last week called on the Government to open wards for National Health Service patients in the same way as it had for Gulf war casualties.

Review of dermatophytoses in Galicia from 1951 to 1987, and comparison with other areas of Spain

We have reviewed all the dermatophytoses diagnosed in Galicia during four consecutive 9-year periods 1951-86 and 1987. From 4571 patients, we isolated 3351 fungal strains belonging, in decreasing order of frequency, to the following dermatophyte species: Microsporum canis (25.5%), Trichophyton rubrum (24.6%), T. mentagrophytes (21.4%), Epidermophyton floccosum (11.8%), M. gypseum (5.2%), T. tonsurans (3.9%), T. verrucosum (3.1%), T. schoenlenii (2.5%), T. violaceum (1.2%), T. mengninii (0.3%), M. audouinii (0.2%), T. equinum (0.1%) and T. soudanense (0.1%). Tinea capitis has diminished in frequency since 1951, though there was been a slight increase since 1978; M. canis has always been the most common agent, and between 1951 and 1959 T. schoenleinii was also very frequent but is no longer found. The frequency of tinea corporis, on the other hand, has experienced a considerable increase. Its most common causal agents in the last few years have been T. mentagrophytes, M. canis and T. rubrum. Until 1977 the most common tinea cruris dermatophyte was E. floccosum, but since then it has been T. rubrum. The commonest tinea pedis dermatophytes have been T. rubrum and T. mentagrophytes. Tinea unguium and tinea barbae have been the most frequent dermatophytoses, and their commonest causal agents T. rubrum and T. mentagrophytes respectively. We have documented the distribution of the various causal agents by location of the lesions, age and source of the patients (private or National Health Service patients), and we have compared the results with those obtained in other regions of Spain.

Should radiologists talk to patients?

Radiologists often are relectant to discuss their findings with patients, reasoning that the patients are only temporarily under their care, and that the diagnosis is better communicated by the referring physician. In this study, National Health Service patients, radiologists, and clinicians were surveyed to determine their views on what radiologists should discuss with patients after performing barium studies. The patients, many of whom feared cancer, overwhelmingly preferred to be told the findings immediately by the radiologist. The opinions of the radiologists and clinicians on disclosure varied depending on whether a malignancy was discovered. Given patient anxiety when cancer is a possible diagnosis, the authors recommend that radiologists communicate normal or nonmalignant findings immediately. When a malignancy is discovered, radiologists and clinicians should consult as soon as possible so that patients may be told quickly and privately.

Referrals to Specialists: An exploratory investigation of referrals by 13 General Practitioners to medical and surgical departments

Several aspects of referrals to medicine and surgery of National Health Service (NHS) patients in thirteen Dutch General Practices were investigated. In The Netherlands active and passive referrals have to be separated. Only one out of three referrals to medicine was an active referral on the initiative of the GP. With regard to surgical referrals about half were active referrals. About half the passive referrals were referrals in retrospect. The thirteen GPs differed in the percentages of active and passive referrals. There was a strong positive correlation between the percentages of passive referrals to medicine and surgery (Spearman Rs = .81). The correlation between the percentages of repeat cards for both groups of specialists was almost as strong (Spearman Rs = .73). In four out of five active referrals the GPs informed the specialist about some aspects of the referral, usually by letter and rarely by telephone. GPs who sent information along with a referral to medicine often did the same with a referral to surgery (Rs = .60). The legibility of the written information was, in general, moderate to poor. Only occasionally the GPs formulated clearly what they expected from the specialist. Suggestions are formulated to improve the referral process between primary and secondary care.

A record of patient encounters in neurological practice in the United Kingdom.

Thirteen consultant neurologists working in ten different towns or cities in the United Kingdom were asked to log all their encounters with patients in 1 week. The median number of encounters was 79 (range 33-144). Forty-one per cent were new patients; 85% of all new patient encounters were with National Health Service patients. In more than four-fifths of all encounters, the neurologist felt that the consultation was a justified use of his experience. Consultations for headache/migraine and epilepsy together accounted for over a quarter of all encounters.

Radical reforms call.

A new report from the Centre for Policy Studies claims that facilities for National Health Service patients are so poor that 'it is doubtful whether long stay prisoners in maximum security gaols fare much worse'.

Going to law to get treatment.

Judicial review as a remedy for National Health Service patients in Britain who suffer delays in, or even denial of, treatment is explored. Two cases are described where publicity combined with the threat of legal action and pressure from members of Parliament rather than a court ruling resulted in patients receiving the treatment they sought, even though the Court of Appeal turned down one patient's application on the day he had his operation. The court may review NHS decisions, but jurisdiction will be exercised sparingly, and only if the Secretary of State's discretion has been exercised "unreasonably" according to the "Wednesbury principle." This principle holds that "a person entrusted with a discretion must...call his own attention to the matters he is bound to consider [and] exclude from his consideration matters which are irrelevant."

Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy.

Since March 1985, over 1000 patients have been treated on the lithotripter at St Thomas' Hospital. Since it is the only machine in the country offering treatment to National Health Service patients at no cost to the referring Health Authority, there has been a heavy demand for treatment and 97% of referrals have been accepted. Analysis of the first 1000 patients shows extracorporeal shockwave lithotripsy (ESWL) to be a safe procedure with a low morbidity rate and no mortality. The number of patients who were stone-free 3 months after treatment was low (44.1%) compared with the numbers reported in other series. The most likely reasons for this are the poor follow-up rate (48.9%), the stringent criteria for the diagnosis of "stone-free" and a possible skewed referral and follow-up pattern.

Increasing patient charges in the National Health Service: a method of privatizing primary care.

Frequent increases in the real value of National Health Service (NHS) patient charges have been made since the Conservative Party's return to office in 1979. For those patients subject to these charges the increases have led to a substantial reduction in the level of subsidization of the cost of the service. The rationale for the subsidization of health care is shown to be unrelated to 'ability to pay' considerations. Consequently the 'backdoor privatization' of these services is inconsistent with the objectives of the NHS even though the Government has continually committed itself to these objectives. Alternative policies to increasing patient charges are suggested which would encourage the efficient use of NHS resources without compromising NHS objectives.

Contraception, pregnancy, childbirth--when things go wrong.

This discussion of contraception, pregnancy, and childbirth covers the following: accepting and discharging patients; legal duty of care; contract law; consent; records; time limit; criminal law; sanctions; children under 16; contraception; failed sterilization, vasectomy, and abortion; abortions; pregnancy; delivery; postnatal care; birth at home; and unqualified persons. The relationship of the doctor to the private patient is governed by the law of contract and in a particular case may impose a greater duty on the doctor than that imposed by tort. The doctor must obtain the consent of the patient and must adhere to the proper standards of competent professional practice, either the generally accepted practice or, if there are 2 or more alternative procedures, one which can be professional supported. Where sterilization (tubal occlusion) is proposed, advice and counseling should be offered. On the birth of a child, drugs may not be administered without the mother's consent. The records of the National Health Service patient appear to belong to the Secretary of State for Social Services and the records of the private patient to the patient. The patient may sue within 3 years from the date of the alleged negligence or the discovery of the negligence. The doctor is most unlikely to be prosecuted for a criminal offense but failure to attend the patient, or gross carelessness, could possibly lead to a manslaughter charge. The Family Practitioner Committee may give a warning, a reprimand, and may stop the payment of fees. The doctor may give contraceptive advice and treatment to an adolescent female under age 16, but the doctor must first conform to 5 guidelines, known as the Fraser Guidelines. These guidelines are listed. The doctor must be aware of the possible risks and side effects of the various contraceptive methods and must evaluate each method and each patient accordingly. A doctor may be liable under the law of contract for a failed sterilization, vasectomy, or abortion. There is no abortion on demand or at the discretion of a dctor. An increasing number of claims are being brought against doctors. The patient who has suffered the consequences of negligence, as opposed to bad luck, ought to be compensated, and the doctor who was not guilty of negligence, but was unlucky, ought to be vindicated.

Use of post-aural aids by National Health Service patients.

The amount of use made of post-aural aids issued through the National Health Service was investigated by monitoring the discharge rate of zinc air cells supplied to two matched groups of patients. Each group consisted of 36 subjects, the first group received an aid in the normal routine manner but without any extra counselling. The second group received both pre- and post-issue counselling. Subjective reports for the patients on use showed some degree of exaggeration, though not as much as was seen in a previous study of users of body-worn aids. Use was substantially greater with the head-worn aids than with the body-worn models previously supplied through the NHS. Use has at least doubled on average and the percentage of non-users has fallen. Counselling (as provided through the Manchester Scheme) appears to effect a significant reduction in the percentage of non-users regardless of the type of aid supplied. Use among those receiving counselling is significantly greater than in those not so being helped. Use tends to diminish with increasing age of the subjects on application for assistance. It tends to increase over the first year of use, but the rate of change is dependent on many factors. In this study, no relationship was found between hearing-aid use and hearing loss, but this may be due to the rather close clustering of hearing losses of subjects under consideration. No relationship was found between use and living circumstances (alone or with family, etc.) but this is more likely to reflect the weakness of the measurement tool than any real differences. No relationship was found between use and stated duration of hearing loss or across the sexes. The zinc air cell proved to be a very satisfactory method of assessing use, and could be used for initial assessment of use in newly issued patients to identify those making poor use of the aid who might be in need of counselling or other forms of assistance.

ALTERNATIVE PATHWAYS FOR ABORTION SERVICES

The interests of women seeking abortion and of doctors opposed to abortion are best served by alternative referral abortion facilities. Of 22 area health authorities in England with day-care gynecology in 1977, only 13 had day-care abortion units. The 2 abortion charities were doing about 3 times as many abortions as all National Health Service Hospitals put together. At day-care abortion facilities, part-time nurses and doctors sympathetic to abortion are supportive to women in a vulnerable situation. There is no pressure for valuable hospital beds. Women being treated for infertility are not housed next to abortion patients. Resources are not available for women seeking abortion under the 1967 Abortion Act. In 1 district 66% women succeeded in obtaining their abortion through the National Health Service (NHS). Over half the women in Wessex had to go to another region to obtain abortions. Many local gynecologists have conscientious objections to abortion. Subcontracting or referral of NHS patients to charitable organizations running day-care facilities is one answer to the lack of facilities.

Towards Earlier Diagnosis in Primary Care

The expertise required to assess practically and accurately the office patient guarantees an eager approach to a book entitledTowards Earlier Diagnosis in Primary Care. The author, Keith Hodgkins, MD, has correctly diagnosed a medical training deficiency, namely, inadequate experience with office problems. The author has also correctly established the cause of the deficiency—many common problems of general practice are never encountered in the hospital. The author's book, prescribed as therapy, consists of two phases. The first phase is an excellent overview of the primary physician's job of assessment and the patient's development, behavior, and responses to societal influences. The second phase of the therapy involves 400 pages of suspected or confirmed diagnoses of National Health Service patients in Britain, with compilation of symptoms and signs. Few of the ensuing suggestions for practice audit are applicable in this country and the Clinical Pointers are considered an inadequate part of Hodgkin's

Prospects for Private Practice — Better Terms for Doctors? — Brave Struggle

THE Health Services Board, which was set up in 1976 to advise the government on the phasing out of pay beds from National Health Service (NHS) hospitals, to suggest methods of establishing common waiting lists for private and NHS patients and to monitor the building of new private hospitals and the extension and improvement of existing ones, has recently presented its first annual report.1 The report reveals that by the beginning of this year, 1400 pay beds had been phased out from the hospitals, leaving about 3000 throughout the country. Further withdrawals will take place when the demand for private . . .

By the London Post. Profiteering in drugs?--Selection and training of medical students--William Harvey's revolutionary circus.

BECAUSE there is only a nominal charge for drugs prescribed for National Health Service patients, neither the doctors nor the patients are particularly concerned about their true cost. Nevertheless, the annual cost to the Service is about £300 million, but because nearly all drugs are prescribed through the Service, the government has been able to negotiate competitive contracts and establish a system of voluntary price regulation with most of the pharmaceutical companies, so that drug prices in Britain are lower than in any other Western country. Even so, the price of drugs is often claimed to be excessive, and a . . .

Towards Earlier Diagnosis: A Family Doctor's Approach.

The author is a general practitioner in the British National Health Service. The book is an outline of ten year's experience. All his patients are seen either in the office or at home. Patients requiring hospitalization are referred. It would appear that in England the great bulk of medical care begins with the general practitioner, ie, the family doctor. It is in this setting that early diagnosis is accomplished. The author breaks down the usual disease classifications listing diseases as they are in standard textbooks. Each entity lists etiology, diagnostic incidence, age incidence, and sex incidence. The incidences are as found in his personal practice and indicated as so many cases per thousand National Health Service patients per year. These data are portrayed by age and by season. This is a unique feature of the book and sets forth a clear picture of what family practice entails in one area

Psychiatric Morbidity in a London General Practice

This paper presents an account of morbidity in a suburban practice in London with special reference to psychiatric disability. Clinical and administrative features of this practice (Chalke and Fisher, 1957) and its social and demographic characteristics (Stein, 1960) have also been described, and an outline of the present investigation has been presented elsewhere (Shepherd, Fisher, Stein, and Kessel, 1959). All registered National Health Service patients aged 15 years or over whose surnames began with four randomly chosen letters (A, B, U, V) were surveyed for one year (March, 1956, to February, 1957). These 911 adults represent about 10 per cent, of the practice and are all included in the 20 per cent, sample described by Stein (1960).