Dalai Lama's Millennium message:
"....we should open our arms to change but never let go of our values..."
 

So what does this all mean for patients?

Accessibility of professional services

Improved health care

Currently there is a national trend whereby a few patients with a particular disease receive a higher proportion of NHS resources than the many. It is our intention to improve the care of certain priority diseases for the majority. Our emphasis will therefore be to tackle certain aspects of the disease in most people first and gradually extend these aspects.

Our first priority will be to reduce the waste of life due to deaths from heart attacks.

There are 100,000 deaths from heart disease every year in the UK. This is a loss of life equivalent to a jumbo jet crashing every day. It is our intention to reduce deaths from heart attacks in our practice population by half. That is a bold target but it will be achievable by a new approach.
Everybody on the team will be doing his or her bit. Office staff, the practice nursing team, health visitors, district nurses etc all have their role to play and the old boundaries will be dismantled.
For example, the office staff may take blood for laboratory testing and enter the results on the computer. It is also possible for them to use a computer programme to calculate the risk of heart disease.
Of course, the doctors will still be making the decisions regarding the results but a lot of the background work can be done for us. This leaves us with more time to discuss reduction of heart disease risk with those at high risk.

Those surviving a heart attack are at high risk of having a further attack (over 30% risk in 10 years) and may not be as lucky next time. So this is the group that will be tackled first with attention to modifiable risk including aspirin, cholesterol, statin & other drug prescribing etc. Our health visitor is trained in offering extensive advice to not only reduce the risk of a recurrence but also ensure that there is a better quality of life by dealing with the myths.

The next priority will be to progressively reduce the risk level being helped until all those with a risk of 15% or above have been assessed.

Linked to the aim of reducing heart attack deaths is smoking, high blood pressure and diabetes.
We do not agree that smokers should be denied access to heart disease care because “they bring it on themselves”.  However, it is true that the sum total of all we can do to reduce heart attack deaths is less than the benefit from stopping smoking. So long as the Government allows the prescription of drugs to assist smoking cessation, we will prescribe them for those well motivated to stop. As one third of those using such drugs are not smoking 1 year after giving up smoking, the savings in total NHS costs are enormous.

Dr Causer introduced well man clinics in 1981 and they still exist. However, we do not send out invitations anymore as studies have not showed a cost benefit. We have programmed our computer to show us that a patient attending a surgery has not had a blood pressure check in the last 5 years. We are also looking at a single invitation to a younger age group than the original clinics. The intention here is to try and identify individuals that may be at risk of developing high blood pressure later so we can advise on how to avoid this.

Those patients who already have high blood pressure will have their blood pressure progressively lowered to new standards in order to further reduce the risk of both strokes and heart attacks.

Diabetics are particularly at risk of heart disease and both blood sugar level AND blood pressure need to be well controlled. Those on insulin are usually followed up at hospital but it is our aim to share their care so that hospital visits are reduced. In the meantime, we will concentrate on those not on insulin and develop a list of standards that will be extended as the majority meet the first set of standards.

Anyone thinking they may be having a heart attack should always dial 999 as it is important for life saving equipment to be available as soon as possible. We have upgraded our emergency equipment at the Health Centre so that we can manage heart attacks occurring here whilst we wait for the ambulance to respond to our own 999 call.

Other changes

Out of hours services

Tired doctors are dangerous doctors. The NHS contracts with us to provide primary care services for our patients 24 hours a day 7 days a week. Clearly,  we were never expected to provide this care personally but we do make the arrangements for out of office hours cover.

As the demands have grown and medical care is more complex, we have to reduce the cover we provide personally. Doing a surgery after 48 hours on duty was not conducive to good concentration. For this reason, out of hours cover will be a combination of cover by ourselves and cover provided by a commercial deputising service which we are responsible for paying. The deputising service actually provides care for a small percentage of face to face contacts but the cover allows us to have a good night's sleep and work more efficiently for the majority of patient contacts. We had over 23,000 face to face patient contacts in 1999 and only 300 of these were by deputising.

In addition to paying for deputising, we also pay our share of the running costs of the Emergency Primary Care Centre at the Victoria hospital. Although this team is situated in the minor injuries unit, it is a separate service. The money we pay has helped to keep the Minor Injury unit going by allowing some cross cover. There is a possibility that the unit may be  closed as a result of the Health Authority review. We planned ahead for this possibility when we designed and paid for our extension at the Health Centre. The ground floor of the new facility can be closed off to allow a Primary Care Centre to operate out of hours.

Patient information

Studies show that very little of the information given by NHS professionals is remembered. Yet patients feel that they are not given enough information about their health. In order to reconcile these differences in perception we will provide more formal access to written and broadcast material.

Knowing why particular health care advice is given should result in more people following that advice. Knowing more about particular medical conditions should aid understanding and reduce anxiety about health matters.

The practice will identify useful information leaflets (writing our own if necessary), develop the information service on our website and has set up a patient loan library. The loan library will provide booklets, tapes and videos free of charge. A refundable deposit may be requested so that return of the items is more likely than under previous loan schemes.

The practice will also extend the information available via this website and the Minster Infotext system will be reintroduced to display a range of information available for those without Internet access.