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Press releases Saturday 9 July 2005
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(1) NHS DIRECT MAY NOT HAVE CAPACITY TO MANAGE ALL OUT OF HOURS CALLS
(2) OVER THE COUNTER EMERGENCY CONTRACEPTION DOES NOT ENCOURAGE UNSAFE SEX
(3) NEW LEGISLATION MAY THREATEN THE FUTURE OF INDEPENDENT PUBLIC INQUIRIES
(4) UNPROVED HERBAL PRODUCTS NEED SEPARATE REGULATION
(1) NHS DIRECT MAY NOT HAVE CAPACITY TO MANAGE ALL OUT OF HOURS CALLS
(Effect of introduction of
integrated out of hours care in England: observational study)
http://bmj.com/cgi/content/full/331/7508/81
NHS Direct may not have sufficient capacity to manage out of hours care in England in the way the government envisaged, finds a study published in this week's BMJ.
In 2000, the government's review of out of hours care in England recommended that patients calling their general practitioner out of hours would be automatically diverted to NHS Direct for initial assessment by telephone. A national "exemplar programme" was established to enable providers to gain experience of developing integrated services.
The study set out to quantify the extent of integration achieved in this programme and its effect on the wider health system.
The analysis involved 31 English general practice cooperatives with NHS Direct partners (exemplars). Data were collected for a year before and after integration on out of hours calls to NHS Direct and cooperatives; new attendances at emergency departments, minor injuries units, and NHS walk-in centres; and 999 ambulance transports to hospital.
Most exemplars (68%) integrated all out of hours calls during the study period, but only nine (29%) achieved single call access for all patients (an automatic diversion of a call to NHS Direct from the practice or cooperative number). Most patients still needed to make at least two telephone calls to contact NHS Direct, and then waited to be called back by a nurse.
In one exemplar, more calls were handled by a local team of cooperative nurses before integration than by NHS Direct afterwards.
Overall, there was a small but significant downturn in demand for care. Calls to emergency ambulance services increased after integration, but this may have been due to patients dialing 999 rather than waiting for a return telephone call, suggest the authors.
These results suggest that there are limited efficiencies to be gained from routing all incoming calls through NHS Direct if the workload of general practice providers is insufficiently reduced.
NHS Direct may not have the capacity to manage all out of hours demand in the way the 2000 review of out of hours care in England envisaged, they conclude.
Contact:
Val Lattimer, Head of Health Services
Research Group, University of Southampton School of Nursing and Midwifery,
Southampton, UK
Email: v.a.lattimer@soton.ac.uk
(2) OVER THE COUNTER EMERGENCY CONTRACEPTION DOES NOT ENCOURAGE UNSAFE SEX
Online First
(Impact on contraceptive practice of making emergency hormonal contraception
available over the counter in Great Britain: repeated cross sectional surveys)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38519.440266.8F
Allowing emergency hormonal contraception to be sold over the counter in the United Kingdom has not increased its use or changed patterns of use, finds a study published online by the BMJ today.
These results suggest that the predicted rise in unsafe sex has been overstated, and supports the case for lifting the ban on over the counter sales in the United States and other countries.
Since January 2001, emergency hormonal contraception (EHC), commonly known as the 'morning-after pill' has been available without prescription across Britain to women aged 16 or over at a cost of £20-25.
Opponents claimed this would lead to "abuse" and encourage unsafe sex, particularly among teenagers, while supporters argued that easier access would help to reduce unwanted pregnancies.
Using national survey data, researchers examined use of EHC among British women aged 16 to 49 years to assess the impact of making it available over the counter.
The level of use of different contraceptives remained very similar before and after EHC was made available over the counter. No significant change occurred in the proportion of women using EHC (8.4% in 2000, 7.9% in 2001, and 7.2% in 2002) or having unprotected sex.
A change did, however, occur in where women obtained EHC. A smaller proportion obtained it from general practitioners and NHS clinics and a greater proportion bought it over the counter, but overall use remained the same.
No significant change occurred in the proportion of women using more regular methods of contraception, such as the oral contraceptive pill, or in the proportion of women using EHC more than once during a year.
Making emergency hormonal contraception available over the counter does not seem to have led to an increase in its use, to an increase in unprotected sex, or to a decrease in the use of more reliable methods of contraception, say the authors. Despite some weakness, this study has important policy implications.
Contacts:
Cicely Marston, Lecturer in Social
Science and Public Health, Department of Primary Care and Social Medicine,
Imperial College Faculty of Medicine, London, UK
Email: c.marston@imperial.ac.uk
or
Tony Stephenson, Press Officer, Imperial
College Faculty of Medicine, London, UK
Email: at.stephenson@imperial.ac.uk
(3) NEW LEGISLATION MAY THREATEN THE FUTURE OF INDEPENDENT PUBLIC INQUIRIES
(Personal View: Are public
inquiries losing their independence?)
http://bmj.com/cgi/content/full/331/7508/117
The independence of public inquiries may be under threat following new legislation introduced by the UK government earlier this year, warns a researcher in this week's BMJ.
Public inquiries have played an important role in the NHS in recent years, writes Professor Kieran Walshe. Yet, just before the UK elections in May 2005, the Inquiries Act 2005 slipped almost unnoticed onto the statute book, replacing the outdated Tribunals of Inquiry (Evidence) Act of 1921.
This Act gives government ministers unprecedented powers over the initiation, conduct, funding, staffing and direction of public inquiries.
For instance, ministers now set up inquiries by order rather than resolution, ministers appoint the inquiry chair and panel, and can add to or change appointments at any time. They write the inquiry terms of reference and have the power to suspend inquiries, or terminate them early. They also control inquiry funding and publication of inquiry reports.
Overall, these changes seem designed to reduce the independence of future public inquiries, and to provide the government with a host of mechanisms for controlling inquiries at every step, writes the author. This is considerable departure from past practice.
As a result, he believes that inquiries are likely to be more cautious and narrowly focused affairs. Stakeholders are less likely to trust in the impartiality of inquiries, and so it is less likely that inquiries will produce cathartic exposure and closure for people who were involved or affected.
"The most fundamental and important characteristic of public enquiries in the United Kingdom has been their independence," he says.
"It remains to be seen whether this government, by taking so many new legislative powers to control and direct public inquiries, has stripped them of the independence and impartiality that was so central to their purpose."
Contact:
Kieran Walshe, Professor of Health
Policy and Management, Manchester Business School, University of Manchester,
UK
Email: kieran.walshe@man.ac.uk
(4) UNPROVED HERBAL PRODUCTS NEED SEPARATE REGULATION
(Editorial: Regulating herbal
medicines in the UK)
http://bmj.com/cgi/content/full/331/7508/62
The UK needs a separate regulatory body to distinguish unproved herbal products from more rational treatments, say experts in this week's BMJ.
There are some herbal medicines of demonstrable efficacy, write Drs Robin Ferner and Keith Beard. For example, a recent study found a standard extract of St John's wort was as effective as the antidepressant drug paroxetine.
For most herbal treatments, however, good trials of efficacy are lacking, and conducting them would be expensive.
Without evidence of efficacy, it is hard to judge the safety of herbal medicines. Quality of manufacture is also a serious problem, as the concentrations of compounds in unstandardised herbal products can vary several hundredfold.
The United States Food and Drug Administration (FDA) regards herbal medicines as dietary supplements, which must not bear claims that cannot be backed up by scientific evidence.
In contrast, the European Union is introducing a simple registration procedure for herbal products that have been used for many years, while the UK is considering a Herbal Medicines Advisory Committee to advise ministers directly on the regulation of herbal medicines. This raises concern over why products that make medicinal claims should be judged on plausible traditions rather than scientific analysis.
"Herbal products for which there are reliable data could be granted standard marketing authorisations. If the rest were judged by a separate body, and by different criteria, we could certainly distinguish rational therapies based on good evidence of efficacy and safety from products that lack those attributes," say the authors.
"Advocates of the use of unproved herbal products would then be able to take separate and full responsibility for them."
Contact: Robin Ferner, Director,
West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham,
UK
Email: r.e.ferner@bham.ac.uk
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