October is Breast Cancer Awareness Month, and many well-meaning people – including some healthcare professionals, and charities such as Breast Cancer Now – have been sharing posts about the importance of breast self-examination. Unfortunately, the reality is rather more nuanced than most people realise. Research evidence suggests that breast self-examination does NOT result in fewer women dying from breast cancer, and it can do more harm than good; women who self-examine their breasts are more likely to undergo a biopsy of their breast, but this does NOT translate into a reduction in rates of death due to breast cancer.
For that reason, at Formby GP we do not recommend routine breast self-examination for healthy women with no symptoms. Instead, we would recommend keeping an eye out for any changes (such as a lump in the breast; skin changes; or nipple discharge) and consulting a GP if you notice any of these symptoms. If you have new breast symptoms and are over 30, your GP will almost always do an urgent referral to breast clinic so that breast cancer can be ruled out. (If you are under 30, you may well need referral too, but in some circumstances your doctor will watch and wait first.)
If you’d like to read more about why the evidence base does not support routine breast self-examination, the Cochrane Review is available online here.
Many private GP services offer “health checks” and “MOTs”, in which you pay a fixed price and have a set panel of blood tests and other checks. Here at Formby GP, we don’t offer set “MOT” packages – why not?
The problem with one-size-fits-all “health checks” is that research evidence actually shows that they don’t work. There is actually a Cochrane Review – the highest-grade evidence there is – which shows that “health checks” do not reduce patients’ risk of death from all causes, do not reduce patients’ risk of dying from cancer, and have little to no effect on heart disease outcomes.
Furthermore, there is actually a risk that generic “health checks” can do more harm than good. Whenever we do tests, there is a risk of false positives or other “red herrings”, which can result in patients having unnecessary tests and treatment, as well as causing a lot of worry and stress. There is also the risk that a patient with symptoms may be falsely reassured by normal test results. This is why it is best practice only to do tests when they are needed – such as if a patient has symptoms of an illness, or certain risk factors, or a relevant family history.
That’s why, if you contact Formby GP requesting a health check, we will advise you to book a GP appointment first. Patients almost never request a health check for absolutely no reason – perhaps you’re feeling tired and run down, or you’ve gained some weight recently, or your brother had a heart attack last year and you’re worried it’ll be your turn next. In your GP appointment, we will discuss any symptoms you have, your family history, your risk factors for illness, and we can explore anything that is worrying you. Then we can agree together on a plan, including any tests you need.
This approach often saves our patients money, as you don’t get charged for lots of unnecessary tests. But more importantly, it means you get a better standard of care.
This is why we describe Formby GP as “ethical”; our top priority is doing the right thing for our patients, rather than doing what is easiest for us or makes us the most profit.
If you’re worried about your health and would like to talk to one of our friendly GPs, you can book an appointment online:
Every Spring we see posts about the so-called “hayfever jab”. Unlike many of our competitors, we very deliberately DON’T offer Kenalog injections for hayfever. Why not?
Kenalog is an injection which was once approved to treat hayfever. The idea of just having one or two injections to keep hayfever at bay for months may seem appealing. However, the evidence shows that Kenalog, a long-acting steroid, is no more effective than safer treatments. For that reason, it is no longer approved for use in the UK (and most other countries) as a treatment for hayfever.
Most doctors no longer offer the treatment, and Allergy UK – a national charity supporting allergy sufferers – explicitly does not recommend its use for hayfever. International experts also warn against the use of steroid injections for hayfever. Yet despite this, many private medical clinics and aesthetic services offer the treatment. Many of those giving the treatment are beauty therapists rather than doctors or nurses.
Although steroid injections do usually help with hayfever symptoms, there is a real risk of side-effects, some of them serious – they can affect blood sugars, mental health, and bone health, and may make you more vulnerable to infections. So they are not routinely recommended because there are effective alternatives which are much safer. Alternatives include antihistamines – which can be given as a nasal spray, or as tablets – and nasal steroid sprays, which are much safer than Kenalog because much less of the steroid is absorbed into the bloodstream. Most of these options can be bought from your local chemist. If those don’t work, then your GP – either NHS or private – will be able to advise about prescription-only treatments.
If, despite those prescription-only treatments, your GP can’t get on top of your symptoms, then it may be appropriate for you to be referred to an allergy specialist. Specialists can sometimes offer options like immunotherapy treatment, though that isn’t an option for everyone.
Patients sometimes seek Kenalog because they have an important event coming up, but even then, we would not recommend it; there are other alternatives which are as effective but safer, such as a short course of oral steroid tablets.
At Formby GP, we want our patients to know that they can trust us. We will not try to sell you things which we believe would do you more harm than good. As doctors our duty is clear: to first do no harm.
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:
Instructions for collecting midstream urine samples
First, remove and set aside any packaging from the sample bottles. In the kits we provide, the sample bottles themselves have red tops, and will need to be taken out of the larger transport tube with a white top, and the foam insert. Before you collect the sample, please make sure that your name, date of birth and the date of collection are on the bottle(s). If we have labelled them for you, do please correct the collection date if appropriate.
Please also check that the request card has been completed correctly.
We recommend collecting two samples, preferably before starting any antibiotics. The first sample should ideally be collected on the first occasion that you pass urine in the morning. If you would prefer not to wait until the next morning, please try to collect the first sample more than two hours after you last passed urine, if possible. Alternatively, if your symptoms tend to be worse later in the day, you can collect the first sample then.
The second sample should be collected on the next occasion that you pass urine.
Before collecting the sample on each occasion, women should rinse and squeeze out a clean baby wipe, and gently insert it into the lower vagina (even if on their period). This helps to prevent contamination.
Please do not part your labia or pull back your foreskin.
Now you should be ready to collect the sample. Unscrew and set aside the red cap of the sample bottle. Then start passing urine and pass the sample bottle into the stream of urine, holding it there until the level of urine in the bottle reaches the red line.
Then screw the red cap back on the sample bottle, double-check that your name, date of birth and today’s date are on the bottle, wrap the foam insert around the sample bottle, place it into the transport tube, and screw the white cap onto the transport tube.
Once you have collected both samples in this way, place them in the blue postage paid mailing bag provided along with the completed request card, seal the mailing bag and simply put it in the post. Please ensure that you post it in a letterbox from which last collection for the day has not yet been made. It physically takes a few days for the laboratory to culture the sample. We aim to email you the report within 5 working days.
Why should I have a chickenpox or shingles vaccination?
Serious illness as a result of chickenpox in childhood is rare. It can be more problematic in adulthood, especially in pregnancy or in the context of other underlying health conditions. Most adults have been exposed to chickenpox and are therefore immune to it. However, the virus which caused chickenpox can be reactivated and cause shingles, usually later in life. Shingles can be unpleasant, and sometimes results in lasting discomfort.
Immunity as a result of chickenpox vaccination might wear off, such that it is better at preventing chickenpox in childhood (usually a relatively mild illness) than in adulthood. There is therefore some concern that having the chickenpox vaccination as a child might increase one’s risk of the more severe chickenpox illness as an adult. This has to be balanced against the benefits of reducing the risk of shingles.
Evidence suggests that 9 out of 10 children vaccinated with a single dose will develop immunity against chickenpox, but there is an even better immune response after two doses of the vaccine, so it is strongly recommended that two doses are given (4-6 weeks apart).
The vaccines
Vaccines to reduce the risk of shingles are available for adults. The NHS offers these to people aged 70 to 79. Zostavax (a “live” vaccine) is given as a single dose, while Shingrix is given as 2 separate doses 2 months apart.
Vaccines to prevent chickenpox are also available for those who have not already had chickenpox (usually, but not always, young children). They are usually given as 2 doses 4-8 weeks apart.
Are they safe for me?
Allergies
If you have ever had a severe allergic reaction to any ingredient of the vaccine, you might not be able to have it, or special precautions might be necessary (such as administering it in hospital). Depending upon the particular vaccine, ingredients might include the antibiotic neomycin, gelatin, and/or polysorbates.
Immune suppression and pregnancy
If your immune system is severely suppressed, or if you might be pregnant, Zostavax or either of the chickenpox vaccines might not be suitable for you. This is because they are ‘live’ vaccines which contain a tiny amount of the virus.
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!”
We aim to offer our patients an unhurried, high quality GP service, with continuity of care at its core, and allow them to make the choice about whether to access secondary care on the NHS or privately, and in all things to make meaningful choices about treatment options.
If you think about it, paying a fixed fee for any service for which demand is unpredictable is “betting against the house” – and the house is always going to win (or go out of business).
There are some private practices that offer an all-inclusive package for around £100 per month (over the age of 50). I would hope that a typical 50 year old would need to pay considerably less than £100/month in consultation fees, but we would expect to be there for them when they need us.
Most concierge-style services that we are aware of set a limit on the number of contacts in a year. Furthermore, many seek to attract the healthy and undertake assessments and tests that are not indicated, and therefore have significant potential to cause harm such as anxiety and complications of unnecessary treatment.
Further, such an arrangement necessarily encourages people to consult when they might not necessarily need to.
One of the challenges for NHS General Practice is that it is free at the point of delivery and therefore has had placed on it expectations (in terms of access, helping people who are not ill, etc) that it could never meet.
We want to form long term, adult-adult relationships with our patients, where we are no longer the gate-keepers, but can help to guide them through their options when they are ill.
Finally, consider how eager we will be to book each appointment if that is the only way we get paid! We certainly do not want to become embroiled in contractual disagreements about whether we are failing to offer appointments of sufficient length or readily enough, or whether our patients use of our service is “fair” – hardly a respectful interaction!
Our approach might not be for everyone. We consider it to be ethical where others might not always be. Our price list is at www.FormbyGP.com/pricing.
We do, however, offer Priority Club membership, benefits of each include a guarantee of access, waiving of our prescription fees, half price text consultations and access to our community forum. If this appeals, why not ask at your next appointment whether it could be right for you!
We are of course happy to prescribe most medication that you might need. In practice, we have a little more prescribing freedom than an NHS GP might.
We can prescribe controlled drugs if you are happy for us to share this information with other prescribers involved in your care, including your NHS GP.
Our prescriptions should be accepted by any pharmacy in the United Kingdom. Whenever possible, we will give you a paper prescription which you can take to the pharmacy of your choice. If that is not possible, we can send the prescription to you by email, which you can then show to the majority of pharmacies in the UK.
We make a charge for each item that we prescribe. We waive that charge for our Priority Club members. Our current prices can be reviewed at www.FormbyGP.com/pricing.
Regrettably, we are unable to issue NHS prescriptions.
Your pharmacy will charge you for dispensing your medication, even if you do not pay NHS prescription charges. They will usually not have to charge VAT. It is likely that prices will vary, so you might like to shop around before choosing a pharmacy.
We are often asked if we are able to access your NHS GP record. Because we are outside the NHS, we don’t automatically have access to it. However, this isn’t normally a problem: in many cases, we are happy to rely on information you provide us regarding your health conditions, medication, and allergies, and we will ask you about these before your appointment by means of our registration form.
Medical records storage – Fitzsimons General Hospital. Lebovich, Bill, creator, Public domain, via Wikimedia Commons
You have the right to receive your record in electronic format from your NHS GP if you ask for it electronically (a “Subject Access Request“). If you would like, you may then share it with us, either by emailing it to Clinical@FormbyGP.net, or uploading it from our registration form. Often, a summary of your record will suffice. Sometimes, however, we will need your full record, such as if you ask ask us to write certain reports. It can sometimes be helpful to know recent blood test results, to save us duplicating work privately; if you have online access, you will often be able to view your results there.
With your consent, we will usually keep your NHS GP and any other relevant professionals updated. If you would prefer us not to, that’s generally fine too, so long as you are happy for us not to prescribe any controlled drugs. If we feel that information-sharing is particularly important, such as in particularly complex cases, we may broach the subject with you again and explain why we would recommend information-sharing.
