Guidelines for General Practitioners in Scotland
The ‘Scottish Good Practice Statement on ME-CFS’ (SGPS) for General Practitioners was published on-line by NHS Scotland on the 1st of September and can be accessed at:
http://www.show.scot.nhs.uk/GoodPracticeStatementonME-CFSforGeneralPractitioners.aspx
This link gives access to the three SGPS documents:
· the Scottish Good Practice Statement in full;
· a shorter version, known as the ‘Quick Reference Guide’ (QRG);
· a Patient Guide.
The Quick Reference and Patient Guides relate to adults only, with coverage on the care of children and young people confined to the full SGPS document. Guidance on the care of severely affected patients is covered in a specific chapter in the full SGPS.
What do we make of the SGPS?
We are pleased to report that there have been some improvements in the published documents in comparison with the previous draft version, taking into account some of the critical responses to the draft. These include amendments to the chapter on the care of severely affected patients, in part reflecting the 25% ME Group’s comments on the draft.
The 25% ME Group welcomes the improvements made to the published SGPS. However, the guidance overall in its present form cannot be endorsed as there are some completely inappropriate elements - for example, a glibly positive assessment of the evidence from controlled trials of graded exercise and cognitive behavioural therapy for ‘CFS’. There is also a failure to note the possible biomedical contra-indications in respect of exercise.
We would be interested to have any feedback regarding how your GP has used the SGPS and whether or not you feel that it has been helpful in any way – or otherwise.
What Next?
The formation of a ‘virtual working group’ of clinicians and patients has been proposed. The purpose would be to review the content of guidance for GPs, with a view to updating the SGPS documents in the light of additional evidence – the forthcoming PACE trial publication and emerging XMRV research being cited as examples.
Questions about this proposal from patients at Cross Party Group focused on the composition of the group, and on which disorder – or disorders – would be covered. Patient representatives consistently expressed dissatisfaction with the approach to M.E. that has emerged from lumping this illness together with a broader group of fatiguing disorders. Concern was also expressed that, where patients and clinicians disagree, the views of clinicians ‘trump’ the views of patients.
Speaking to this item, Dr Gregor Purdie and Will Scott [Scottish Health Department] stressed that the proposal is at an early stage and that many aspects remain to be determined. For example, it was envisaged that clinician membership would include some - but not necessarily all - of those who had been involved in producing the SGPS, and that other clinicians could also be involved.
The composition of the relevant working groups and the names identity of the peer reviewers are listed at Appendix 5 of the full SGPS and are listed below. We would be interested to have your feedback regarding your experiences of clinicians who were on the various working and review groups:
Working Group
Dr Alan Carson, Consultant in Neuropsychiatry, NHS Lothian
Dr Kenneth Lawton, General Practitioner, Aberdeen, NHS Grampian and Chairman, RCGP Scotland
Dr Gregor Purdie, General Practitioner, Castle Douglas and Clinical Lead for ME, NHS Dumfries & Galloway
Prof Lewis Ritchie, General Practitioner, Peterhead, NHS Grampian and Mackenzie
Professor of General Practice, University of Aberdeen [Group Chair]
Will Scott, Scottish Government Health Directorates
Sir Peter Spencer, Chief Executive, Action for M.E.
Clinical Guidance Subgroup
Dr Alan Carson, Consultant in Neuropsychiatry, NHS Lothian [Subgroup Lead]
Dr Carl Counsell, Senior Lecturer in Medicine (Neurology), University of Aberdeen and Honorary Consultant Neurologist, NHS Grampian
Dr Kenneth Lawton, General Practitioner, Aberdeen, NHS Grampian and Chairman, RCGP Scotland
Dr Gregor Purdie, General Practitioner, Castle Douglas and Clinical Lead for ME, NHS Dumfries & Galloway
Dr David Watson, General Practitioner, Aberdeen, NHS Grampian
Health Professional Peer Reviewers of the Clinical Guidance
Dr Katy Auckland, Consultant in Paediatric and Adolescent Psychiatry, NHS Lothian
Professor D Nicholas Bateman, Professor of Clinical Toxicology, University of Edinburgh and Director of the National Poisons Information Service (NPIS), Edinburgh
Dr Jim Beattie, Consultant in Medical Paediatrics, NHS Greater Glasgow and Clyde
Professor Ian Bone, Honorary Senior Research Fellow (Neurology), School of Medical and Cardiovascular Studies, Western Infirmary Glasgow
Dr Tom Brown, Consultant in Liaison Psychiatry, NHS Greater Glasgow & Clyde
Dr Robert Dickie, General Practitioner, Stornoway, NHS Western Isles
Dr James Douglas, General Practitioner, Fort William, NHS Highland
Professor Peter Helms, Prof of Child Health, University of Aberdeen & Hon. Consultant in Paediatrics, NHS Grampian
Dr Patricia Jackson, Consultant in Community Child Health, NHS Lothian
Dr Catriona Kemp, General Practitioner, St Margaret’s Hope, NHS Orkney
Dr Derek King, Consultant in Haematology (Adult and Paediatric), NHS Grampian
Dr Brian Lennox, General Practitioner, Ayr, NHS Ayrshire & Arran
Dr Pauline Lockhart, Clinical Lecturer in Primary Care, University of Dundee and General Practitioner, NHS Tayside
Dr Paul MacIntyre, Consultant Cardiologist, NHS Greater Glasgow & Clyde
Professor Kenneth McColl, Professor of Gastroenterology, University of Glasgow and Honorary Consultant Gastroenterologist, NHS Greater Glasgow & Clyde
Dr Lucy Munro, General Practitioner, Grangemouth, NHS Forth Valley
Dr Jill Murie, General Practitioner, Forth, NHS Lanarkshire
Dr Tom Pullar, Consultant Physician and Rheumatologist, NHS Tayside
Dr R Andrew Seaton, Consultant in Infectious Diseases and General Medicine, NHS Greater Glasgow & Clyde
Dr Robert Simpson, Consultant in Paediatrics, NHS Dumfries and Galloway
Dr Shona Valentine, Associate Specialist in Community Child Health, NHS Lothian
Professor Alan (Mike) Wallace, Consultant Clinical Scientist, NHS Greater Glasgow & Clyde (deceased)
Professor David Weller, Mackenzie Professor of General Practice, University of Edinburgh and GP, NHS Lothian
Dr Derek Wooff, General Practitioner, Stranraer, NHS Dumfries & Galloway