Lorna Powell

Half way through medical school Lorna realised she didn't want to be a doctor. She loved medicine, just not the profession. But she finished the course and spent a year working for the Leeds Teaching Hospitals Trust before traversing the path of medical journalism.

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Find Lorna’s blog here www.lornaslarynx.wordpress.com

Doctors are divided as to whether the changes will help or hinder the NHS

GP consortia are designed to ensure good clinical care lies at the heart of NHS management and patients are as close to the decision making process as possible. Yet with huge budget reductions looming across all areas of Government, inevitably there is the whiff of financial and political motivations.

Doctors, although affected by the fundamental issue of cost, are primarily concerned with delivering high quality, effective care to patients. This makes them key figures to consult when considering the effects GP consortia will have on healthcare in England. Doctors are divided as to whether the changes will help or hinder the NHS and the care it delivers.
Andrew Lansley defends his proposals by saying “GPs know patients best”. Although many GPs agree they know the needs of individual patients, many are concerned this does not translate into understanding the public health needs of whole communities.

Dr Kate Adams, a GP in Hackney, said public health management is “a very different skill”. She and her colleagues are preparing for the changes but are nervous about the impact they will have on the care they can deliver. Dr Adams believes the desired improvements to care could have happened “without such a radical shake up.”

Dr Adams expressed concerned over how care of very unwell patients will be funded. If a consortium has a high number of patients with complex health conditions, a significant proportion of their budget might be spent on the care of a few patients. This would mean less money is spent on other patients in the area creating an unethical situation where patients receive diminished care as a result of the health of their neighbours.

A list of serious illnesses which will receive extra funding has been produced to try to reduce such disparities. Yet as more and more expensive treatments emerge for dozens of conditions, uncertainties continue to grow over the management of chronic illness.

Care has already been moved away from hospitals in many circumstances in an effort to reduce costs and allow patients to receive treatment closer to home.
Carpal tunnel syndrome, a condition where the nerves to the hands become inflamed causing pain and numbness, is relieved by a minor surgical procedure. Hundreds of GPs have been trained to perform the surgery in their clinics, with varying degrees of success.

Many fear the move towards GP consortia will lead to even more community based treatment of conditions that are better managed in a hospital setting.
Consortia GPs will also handle cancer services for their patients. Dr Adams finds it shocking that general practitioners could be expected to make decisions that are very complex, even to experienced hospital oncologists. However a GP in Bristol, who asked to remain anonymous, is in favour of making such choices. He said: “GPs will not be required to make any decisions beyond their experience.”

The introduction of GP consortia will have a significant effect on mental health care. Some GPs have expressed concern over the changes as they feel psychiatric services are so specialised a consortia system will put the care of an extremely vulnerable group of society at risk.
Dr Sammad Hashmi, a consultant psychiatrist in Humberside, is in favour of the changes however. He recently published an article which examined the potential benefits GP consortia will bring to community mental health care provision.

Dr Hashmi said the NHS has become highly bureaucratic and operates via unnecessarily complex systems of service delivery which amount to “an uneconomical way to transform cash into care”.

At present, mental health services straddle the primary and secondary care systems and are subdivided into various teams. These include the generic community mental health team, the assertive outreach team, early psychosis services and crisis resolution.

Many psychiatrists feel the disjoined interaction between these teams reduces overall effectiveness and to some extent the patient gets lost in the system.
By allowing consortia to commission just one multi-faceted community mental health team Dr Hashmi believes the new system would “minimise the risk of over-inclusive bureaucracy and communication failure within the multiple team structure.”

Dr Paul Wallang, a specialist registrar in psychiatry at London’s Homerton Hospital, also feels the introduction of GP consortia will improve the NHS. “You can’t just keep pumping money into the system mindlessly and I think Lansley realises that. GP commissioning will improve quality of services as providers will have to compete with each other in order to gain contracts.”

In contrast, a cardiologist at a central London hospital (who would like to remain anonymous) believes this competition will have a negative effect, driving down cost and ultimately reducing investment in the NHS. Dr Wallang also feels the introduction of patient choice is vital to a modern health service: “Where, in any other system, do users have no say over the services they receive?” The divide in doctors’ opinions about GP consortia is striking. One side argues the changes are a financially motivated move towards privatisation which will ultimately weaken the NHS. Yet many doctors view restructuring as the only practical way to ensure the organisation can improve and remain sustainable.

Image courtesy of Huji via wikimedia commons

Studies on lab mice have found a potential method of reversing the effects of Down's syndrome

Developmental and learning problems have been reversed in mice with a condition that mimics Down’s syndrome.

Scientists at the National Institutes of Health in Maryland genetically engineered mice to give them an extra chromosome 16.

The genetic alteration produces similar clinical problems to those seen in people with Down’s syndrome, a condition caused by having an extra chromosome 21.

The scientists injected two genes into a separate group of mice while they were still in the womb. The genes lead to the production of proteins usually made by specific brain cells called glial cells which have been found to malfunction in patients with Down’s syndrome.

The proteins were then extracted and given to the first group of mice orally for four days, after which the mice performed just as well in problem solving tests as mice with normal genetics.

Around 750 babies are born with Down’s syndrome in the UK each year. The condition is associated with reduced cognitive ability and physical growth but symptoms can vary significantly between patients.

This variation is thought to be caused by complex interactions between the extra genetic material and the environment a baby grows up in.

Congenital heart defects, recurrent ear infections and thyroid gland dysfunction are also commonly associated with the syndrome.

Although results have been encouraging, the technique carries too many risks for the team to attempt the treatment in children. The next step is to test the procedure on adult mice.

Craig Heller, co-director of Stanford University’s Down Syndrome Research Centre in California, says the study does make one thing clear: “Learning disabilities that were considered permanent are treatable.”

Image by Steve Berger