Kings Medical Practice News www.kingmedicalpractice.co.uk

Treating women with cystitis seems fairly straightforward. Unlike many conditions. in women who attend with cystitis bacterial infection is likely to be present and treating women who complain of symptoms alone is cost effective. However treating on the basis of symptoms alone would mean that 10% of our adult female patients would receive antibiotics each year. Is there a better way of doing this and as the boys on *Top Gear say – how difficult can it be? In the BMJ this week is an editorial and three linked research papers which have investigated how best to manage individual patients and how to reduce the number of antibiotics GPs prescribe. The conclusions of these papers are however unclear. The use of MSU is unhelpful and expensive (if you delay prescribing till you get the result of an MSU women have more symptoms). Beyond this the best next approach is unclear. Prescribing based on patients symptoms, or a delayed prescription (that is advising women to start antibiotics if thei

The practice is set an annual budget for our prescribing costs. This is the costs of drugs that we prescribe. This year the budget is £1,603,110 and Wakefield Primary Care Trust has several ways of trying to get the practice to keep to this budget. The PCT has sent one of their pharmacy technicians to do various things with our prescribing. So far this year she has swapped patients from an expensive osteoporosis prevention drug to a more cost effective (i.e. cheaper on) and this week she rationalised seven patients Pregabalin treatment and made a potential saving of £5,400 per year. Pregabalin is a drug used in epilepsy and for neuropathic pain and all the drug doses amounts cost the same. A 50 mg capsule costs the same as 100mg and we had a few patients taking two 50 mg casules that she swapped to 100mg – easy if you know how! There is an incentive scheme whereby if we can keep our prescribing cost growth down to below 6.9% then if the practice achieves some quality indicators we ar

In the news this morning is a new campaign from the Family Planning Association – Conceivable? – about the rise in unplanned pregnancies in the over 35’s. Looking at the abortion statistics – the most obvious and reliable illustration of unplanned pregnancy – you’d expect the rate of abortion to be very low in the over 35 age group. However, in 2008, women aged 40–44 years old had the same rate of abortion as women under the age of 16. And almost 20,000 women aged 35–39 had an abortion. The message is that if you’re over 35, although your fertility is declining, it hasn’t disappeared completely. Fertility is an individual thing. It changes with lifestyle, varies hugely from woman to woman and essentially from couple to couple. So, if you are over 35, ovulating, having regular periods, unprotected sex and you know you or your partner is not clinically infertile, every month there’s a chance you’ll get pregnant If you don’t want to get pregnant the bottom line is to keep using contracept

Two new trainee doctors have joined us. Dr Sarah Renga and Dr Mohammad Shaikh started today and will be with us for six months. They are both on a GP Training Scheme as part of the West Riding GP Specialist Training Programme. This programme has training posts in Pontefract, Wakefield and Dewsbury. When new doctors join the practice they have an induction period when they meet members of the team and learn our systems and the computer! Learning how to use our clinical computer is one of the biggest challenges for new trainees – sometimes it feels more daunting than seeing patients! But we start trainees off with consultations of 30 minutes – 10 minutes to see the patient and 20 minute to make sure that it is entered correctly on the computer. Trainee doctors have an education programme in the practice and their clinical work is closely supervised. Anyway, we are very pleased that Sarah and Mohammad have come to us and hope we have given them a warm welcome to Normanton.