Heather Ryan – Page 2

Nits – sorting facts from fiction!

Autumn term is well underway and talk at the school gates is turning to nits (or rather head lice – nits being their eggs). Many parents feel itchy as soon as they receive the first WhatsApp message about them, whether or not they or their child are affected!

Did you know…

1. The most reliable way of detecting head lice is by using a nit comb. A 2008 study showed that “detection combing” is almost four times more effective than just looking at your child’s scalp.

2. Old eggs can remain glued to the hair for up to 6 months, even after successful treatment has eradicated the head lice – so experts advise that you only treat your child if you see a living, moving louse.

3. There is no evidence that head lice prefer clean hair, despite the urban myths.

4. Head lice are more common in girls than boys, and the peak age for infestation is around 7-8 years.

5. Many parents use essential oils such as tea tree oil to repel nits. However, there is no good evidence that this works (but your child will smell nice!).

6. The use of other treatments to prevent nits is controversial. One trial in 2014 showed that 1% 1,2-octanediol spray (which is sold as Hedrin Protect & Go Spray) gave a significant amount of protection from head louse infestation – though it did not always prevent it. However, the official NHS website advises against using chemical sprays regularly to prevent nits in case they irritate the scalp. For what it’s worth, in the 2014 trial, very few children had any problem with the spray, and so we (Heather and John) do choose to use it on our children.

7. If your child has a confirmed head louse infestation, there are various methods you can use to treat it. Evidence suggests that mechanical removal of lice (e.g. by wet-combing with a nit comb) is less effective than chemical methods. However, some parents prefer to try a chemical-free option first, using kits like “BugBuster” or the “NittyGritty” comb.

8. Agents such as dimethicone and cyclomethicone have been shown to be highly effective in clinical trials. Rather than being conventional insecticides, these chemicals work by suffocating the lice or by damaging their skeleton. These treatments are great because, unlike traditional insecticides, head lice can’t develop resistance. Treatments available over the counter include Full Marks Solution and Hedrin 4% dimeticone lotion.

9. There is growing concern that head lice are developing resistance to insecticide treatments such as malathion and permethrin, so we would not recommend them. Make sure you read the label or speak to the pharmacist so you understand what you are buying.

10. Experts suggest that there is no need to use a course of head louse treatment on your child because there are cases of lice at school – the advice is to use a nit comb to check the hair and treat only if you find a live louse.

11. Although head lice are unpleasant and cause itching, they almost never cause serious health problems. If your child gets nits, don’t panic!

I hope this has been helpful. Here are some helpful links and references:

https://www.nhsggc.org.uk/…/stafford-head-lice-2012.pdf

https://bmjopen.bmj.com/content/4/5/e004634

https://pubmed.ncbi.nlm.nih.gov/10937452/

https://www.nhs.uk/conditions/head-lice-and-nits/

Why Britons are going private to see GPs

As a recent YouGov survey has revealed that one in eight Britons has paid for private healthcare in the preceding year, a new private GP service has opened in Merseyside.

Formby GP is a private GP service in Freshfield, run by married couple Dr Heather Ryan and Dr John Cosgrove. Heather and John launched Formby GP in January. Clinical Director Dr John Cosgrove says, “It’s no surprise that patients are turning to the private sector.

Recent media coverage of private services has focused on the potentially steep costs involved – some private providers charge up to £550 per hour. Formby GP, however, charges just £120 for a standard unhurried consultation, and £200 for a home visit within the practice area.

The team at Formby GP describe their service as “ethical”. Managing Director Dr Heather Ryan, added, “We like to think we are offering something a bit different. Some other private GP services target healthy young people by offering “wellness” treatments and screening packages. If tests are done inappropriately, they risk causing unnecessary worry, and may pick up so-called problems which weren’t causing any symptoms and would never have caused any harm.

“At Formby GP, we aim to be a traditional GP practice, focused on treating medical problems. We won’t try to sell you tests and treatments that you don’t need.”

Many people do not realise that private doctors can often refer patients back into the NHS. Dr Ryan explains, “We are able to refer patients for specialist NHS treatment. This includes urgent suspected cancer referrals.”

Clinical Director Dr John Cosgrove added, “It’s no surprise that patients and doctors alike are moving into the private sector. In recent years, NHS General Practice has become a lot busier. NHS GPs are now required to offer rapid consultations by phone and email. They cannot also offer the face to face consultations that both GPs and their patients value most. At the same time, because their workload is overwhelming, the number of NHS GPs have been decreasing for years. Many of those NHS GPs that remain are just exhausted, and surgeries struggle to offer the care that patients and GPs would both want.

“We set up Formby GP to offer face to face consultations, whether in the surgery or in patients’ home, on request. Our patients tell us that we are delivering!”

ENDS

How can it be “ethical” to charge patients?

Access to our service will, unlike the NHS, be limited by ability to pay. However, NHS GP is not without barriers, especially now, as it can be limited by the ability to pick up the phone or internet at the correct time, or to prioritise one’s own needs appropriately.

Pillars of medical ethics

We are aware of the risks of describing ourselves as “ethical”. It is common to consider questions of medical ethics under four “pillars”: autonomy, non-maleficence, beneficence and justice.

Justice

We believe it is for society rather than individual GPs to ensure justice of access to general practice, whether that be by ensuring that all patients have the means to pay for care, or whether that be by providing excellent NHS general practice.

A growing private GP sector will support just access to primary care by providing additional capacity (we will increase my working commitment significantly, for example), and perhaps also by helping to define expectations of NHS GP by providing a contrast.

Non-malificence

What possibly sets us apart is our commitment to non-maleficence (“first do no harm“), perhaps not always a priority for private healthcare providers, for whom there can be a temptation to sell tests and treatments without certainty that they will not cause undue anxiety, or that any condition so found definitely merits the side effects and risks of treatment.

Safety and value for money

So yes, we have to charge our patients. But we will do our utmost to ensure that we do not charge patients for appointments, tests or treatments that are not completely necessary. That way, our patients get value for money whilst receiving medical care as safe and high quality as possible.

Do GPs work 7 days a week?

NHS General Practice is available 24/7, via GP Out of Hours services – both Heather and John have done GP Out of Hours work in the past (Heather during the second wave of the pandemic in 2020).

Most NHS GPs work incredibly hard – 10 to 12 hour working days are not uncommon, and many GPs do log on to their computer at the weekend to catch up on paperwork and filing results, even if they are not working in Out of Hours. The reason that many patients are struggling to access NHS General Practice are complex and are not due to GPs being lazy – rather, issues like funding, recruitment, and retention contribute.

Heather and John both work in the NHS too, and will mostly be working for Formby GP at times they would not otherwise be working. Furthermore, we plan to offer a 7 day advice service to subscribers.

One of the advantages for us in doing private work is that it gives us a high degree of control and flexibility about when we work, which is particularly important to us because we have a child with health needs which require us to be available a lot of the time. The alternative for us isn’t doing more NHS work.

On a personal note, we have recently had a very positive experience at Ormskirk Hospital when our child was unwell. We are grateful to everyone who works in the NHS for the incredible work that they do.

Do we offer “MOTs”?

Bodies are so much more complex than cars! Before every consultation, we will check your blood pressure, pulse and weight (amongst other things). You probably don’t need us to tell you to lead a healthy lifestyle!

When considering tests, our usual approach is to recommend targeted testing for conditions that you seem to be at increased risk of. Typically this would be based on new symptoms you have noticed, but your family history, lifestyle and occupation might also give clues.

Some private clinics perform a vast array of tests on every adult that consults them. We believe we can add more value by being more judicious, thus saving you money and worry, and – most importantly – harmful treatment for conditions that might never have troubled you. This is why we describe Formby GP as “ethical”.

When appropriate, we can organise extensive blood tests, ECGs, x-rays and scans and more, and we will work towards offering more and more of these on site.

Opening tomorrow!

Our appointment booking page is now live, just in time for our opening day tomorrow! You can find it on our website at www.FormbyGP.com/book.

We will very soon be launching our Priority Club. As well as a guarantee that we will offer you an appointment within a reasonable timeframe, access to our community forum, and half price text consultations, we will waive our prescription charges for Priority Club members. We are making final adjustments to our back office systems and will let you know when this is ready, probably within the next few days.

For those who have signed up for our email updates since the last message: welcome! Here is a quick recap.

We understand that most patients want to see a doctor face-to-face, so we offer face-to-face appointments as standard. You will be able to contact us and book a GP appointment face-to-face, no questions asked. You will be able to see us in our discreet premises in Freshfield, or we can visit you at home. If you would prefer to speak to us via phone, video call, or text, we will offer these modalities too.

If you need investigations (such as X-rays) or referrals, we can arrange these – either privately, or via the NHS in many circumstances.

We know that your time and money are precious. We will not recommend investigations or treatments that you don’t need. We believe in offering tests and treatments that are more likely to help you than to harm you! If you have symptoms or concerns, or a family history of a particular condition, we will talk to you so we can decide together which tests and/or treatments are appropriate.