Thanet Area Health Needs Assessment July 2013

Thanet Area

Health Needs Assessment

July 2013

Contents

Demography and Geography ...... 3 In comparison to other CCGs in east Kent, Thanet has the highest proportion of people aged over 85 years old and the joint highest proportion of people aged over 65 years old...... 7 Inequalities in Health ...... 8 Risk Factors for Chronic Disease ...... 11 Smoking Prevalence ...... 11 Adult Obesity Prevalence ...... 12 Substance Misuse ...... 13 Chronic Disease Patterns ...... 16 Multi-Morbidity ...... 16 Cancer ...... 17 Diabetes ...... 19 Coronary Heart Disease (CHD) ...... 21 Stroke ...... 24 Chronic Obstructive Pulmonary Disease (COPD) ...... 26 Mental Health ...... 28 Dementia ...... 32 Activity ...... 34 Falls ...... 37 All age all cause mortality ...... 38 Health check data ...... 40 Screening ...... 41 Practice profile data – ...... 44

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Demography and Geography Thanet Clinical Commissioning Group (Thanet CCG) covers patients from 21 practices with a registered practice population of 140,157. The CCG area is co- terminus with that of the district council.

Using resident populations for the district of Thanet the population aged 65+ is predicted to increase by 68.1% from 2011 to 2031(from 22,600 to 38,000. This increase is greater in the 85+ group, being predicted to increase 142.3% during the same period (from 2,600 to 6,300).

It is important to recognise that patients resident in the CCG area cannot be presumed to be registered exclusively with Thanet primary care teams. Some residents of Cliffsend are registered with practices in Sandwich. Generally though, the vast majority of Thanet residents are registered with practices in Thanet.

Figure 1 - CCG areas within Kent

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Figure 2: Population pyramid for Thanet district

The population of children and young people is similar to the England average for boys (blue) and lower for girls (red) aged below 10, but has a higher than average for both boys and girls for 10 to 19 year olds. Thanet’s population exhibits a considerable smaller proportion of under 50s compared to the England profile, but has a higher percentage of over 55s. The largest section of the local population are aged 60 to 64. This will have an impact on health services because people over 60 will generally have greater health needs and service usage. Figures three to five show the different age distributions across different wards across Thanet.

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Figure 3: Thanet map

Figure 4 Thanet Ward Map

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Figure 5: Distribution of population aged 65 + years

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Figure 6 - Proportion of CCG registered practice populations aged 65+ and 85+ - September 2011

25.0%

20.0%

15.0%

10.0%

5.0%

0.0% South Kent and Ashford C4G Kent Swale Thanet Medway Coast 65+ 16.6% 18.5% 20.7% 16.2% 20.7% 17.9% 85+ 2.2% 2.8% 3.0% 1.8% 3.3% 2.5%

In comparison to other CCGs in east Kent, Thanet has the highest proportion of people aged over 85 years old and the joint highest proportion of people aged over 65 years old.

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Inequalities in Health

The Health and Social Care Act 2012 now places a new statutory duty on health services to reduce inequalities in health. Demonstrating this intention is also a requirement of CCGs for the purposes of authorisation by the NHS National Commissioning Board.

Inequalities in health is primarily a socio-economic relationship. The poorer people are, the greater the likelihood of early onset disability and chronic disease and shorter life span. In contrast, those who are of high status have expectations of a much greater disability free life span and of a good old age.

Figure 7: Life expectancy from birth

Source: Kent and Medway Public Health Observatory

Figure 7 shows that life expectancy between the best ward (Kingsgate 84.7) and the worst (Margate Central 72.7) is 12 years. The Thanet average is 79.2 years. Generally, there is an association between lower life expectancy estimates and higher levels of relative deprivation.

People with low socio-economic status have an increased risk of behaviours causing ill health. They are more likely to smoke, have a poor diet, are less likely to take part in social activities, and more likely to have poor mental health.

Addressing health inequalities as a strategic response requires CCGs to commit to partnership working with other statutory agencies whose capacity to address the wider determinants of health is core to their purpose. Accordingly Thanet CCG should support the actions of Public Health working with local authorities to address the root causes of disadvantage, whether through the Health Inequalities Action

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Plan through Thanet District Council’s Corporate Plan or through the work of Local Children’s Trusts.

In addition the BMA through the Presidency of Prof Sir Michael Marmot has identified a range of actions that doctors can do directly.

Doctors can help by intervening with individual patients, their families and contacts, using clinical tools including social prescribing and brief interventions. They can work within communities, for example, by commissioning measures including health promotion and ill- health prevention that will affect changes to the social determinants and are effective in the whole community including those who are traditionally hard to reach.

Doctors can use evidence and influence to have a positive impact on health inequalities. Doctors can use their position and their expertise to advocate for change to areas outside traditional medical areas and to promote the generation of research, especially on the efficacy of prevention measures. Source: BMA Publications 2011

Figure 8: Indices of multiple deprivation across Thanet

The Indices of Multiple Deprivation are constructed using 36 variables across seven domains. These domains are income, barriers to housing, health and disability, crime, education, living environment and employment. Scores are present at lower super output areas (LSOAs). LSOAs areas are constructed using populations from communities or naturally bounded areas. The number of people in an LSOA is between 1,000 and 1,500 and they are aggregated together to form electoral wards. The number of LSOAs in an electoral ward can vary from one to five depending

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upon the original size of the electoral ward. Figure 8 shows that the most deprived areas are around central Margate, central Ramsgate, Cliftonville West, Millmead and Newington.

Figure 9: Thanet ward unemployment rates

There are vast differences in the unemployment rate across Thanet. In Cliftonville West, is 19.7% and the lowest is Kingsgate that has a rate of 1.5%. The average for the district is just under 6%.

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Risk Factors for Chronic Disease

Smoking Prevalence Figure 10: Smoking prevalence in Thanet

Smoking rates are highest around central Margate, Dane Valley, Cliftonville West, Newington and Central Ramsgate. The lowest rates are to be found in Kingsgate, Cliftonville East, Birchington, Bradstowe and Cliffsend and Pegwell. There is a strong association between deprivation and smoking prevalence rates.

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Adult Obesity Prevalence Figure 11

Modelled rates vary throughout Thanet and not strongly associated with deprivation. Cliftonville West has less than 20% and Cliffsend and Pegwell has between 30%- 35%.

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Substance Misuse

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Number of Admissions for Chronic alcoholic Liver Disease

Wards 2006/07 - 2012/13 Cliftonville West 143 Eastcliff 141 Margate Central 121 Central Harbour 82 Westbrook 73 Westgate-on-Sea 58 Salmestone 53 Dane Valley 49 Viking 44 Bradstowe 41 Thanet Villages 41 Newington 36 Beacon Road 30 Cliftonville East 30 Sir Moses Montefiore 28 Birchington South 24 St Peters 24 Northwood 17 Cliffsend and Pegwell 15 Garlinge 11 Nethercourt 10 Birchington North 4 Kingsgate 4

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Inpatient alcohol admission for wards in Thanet

Variance Variance 2006/07 2011/12 Sex 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 to to 2012/13 2012/14 Male 314 378 467 387 441 496 450 43.3% -9.3% Female 174 194 189 212 257 209 229 31.6% 9.6% People 488 572 656 599 698 705 679 39.1% -3.7% Under 18s 25 20 30 23 17 31 18 -28.0% -41.9%

Average Average 2008/09 - 2008/09 - Average Annual Annual Ward Name 2008/09 - 2012/13 2012/13 2012/13 Annual Population Rate Males Females Rate Males Rate Females Beacon Road 70 2.97 35 35 3.10 2.85 Birchington North 52 2.80 38 14 4.36 1.42 Birchington South 113 3.57 81 32 5.53 1.88 Bradstowe 81 4.13 48 33 5.29 3.14 Central Harbour 284 7.29 208 76 11.08 3.76 Cliffsend and Pegwell 58 2.38 42 16 3.53 1.28 Cliftonville East 80 2.52 48 32 3.21 1.90 Cliftonville West 492 12.06 355 137 18.05 6.49 Dane Valley 216 5.23 156 60 7.98 2.76 Eastcliff 310 8.15 200 110 10.95 5.56 Garlinge 80 3.35 50 30 4.37 2.42 Kingsgate 17 1.60 6 11 1.18 1.98 Margate Central 328 13.37 229 99 18.57 8.11 Nethercourt 43 1.93 25 18 2.33 1.56 Newington 141 5.49 84 57 6.83 4.26 Northwood 124 3.81 83 41 5.33 2.41 Salmestone 123 4.56 72 51 5.59 3.62 Sir Moses Montefiore 120 4.48 69 51 5.38 3.66 St Peters 78 2.17 48 30 2.89 1.55 Thanet Villages 95 2.80 58 37 3.45 2.16 Viking 101 2.90 68 33 4.02 1.84 Westbrook 170 8.15 124 46 11.97 4.38 Westgate-on-Sea 161 4.82 114 47 7.34 2.63

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Chronic Disease Patterns

Multi-Morbidity

An ageing population and increased prevalence of chronic diseases requires a service re-orientation away from the current emphasis on acute and episodic care, towards prevention, self-care, more consistent standards of primary care and care that is well co-ordinated and integrated. The King’s Fund has identified 10 priorities for action:

King’s Fund 10 Priorities for Commissioners

Active support for self-management Primary prevention Secondary prevention Managing ambulatory care sensitive conditions Improving the management of patients with both mental and physical health needs Care co-ordination through integrated health and social care teams Improving primary care management of end-of-life care Effective medicines management Managing elective activity – referral quality Managing emergency activity – urgent care

A common feature of all 10 priorities is the degree to which they are dependent upon a change within primary care services and the way in which such services relate to the rest of health and social care.

Clinical practise conventionally treats and thus measures individual diseases. Such an approach is increasingly challenged by the scale of service demands facing the NHS (and is also a world wide problem) through the concept of multi-morbidity. In essence patients with chronic conditions often have more than one such condition simultaneously. It is the challenge of managing the complexities of co-morbid and multi-morbid conditions that gives rise to complications, often leading to high cost, unplanned, unscheduled care.

A landmark Scottish study (Barnett et al 2012) has examined the distribution of multi-morbidity and of co-morbidity of physical and mental health disorders in relation to both age and socio-economic deprivation. In a cross sectional study data from 40 morbidities relating to 1,751,841 people registered with 314 medical practices in Scotland as of March 2007 was analysed according to the number of morbidities, disorder type (physical or mental), age, sex and socio-economic status. Multi-morbidity for the purpose of this study was defined as the presence of two or more disorders.

42.2% of all patients had one or more morbidity. 23.2% were multi-morbid. Although the prevalence of multi-morbidity increased substantially with age and was present in most people aged 65 and older, the absolute number of people with multi- morbidity was higher in those younger than 65 (210,500 v 194,196). Onset multi- morbidity occurred 10-15 years earlier in people living in the most deprived areas compared to the most affluent. The presence of a mental health disorder increased as the number of physical morbidities increased and was much greater in more

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deprived than in less deprived people. The authors recommend that generalist clinicians provide personalised, comprehensive continuity of care since the single disease framework on which most health care research and indeed medical education is based is profoundly challenged by this study.

An ageing population and increased prevalence of chronic disease requires a strong re-orientation away from the current emphasis on acute and episodic care, towards prevention, self-care and more consistent standards of primary care that are well co- ordinated and integrated. The King’s Fund (2011) has identified 10 priorities for action and most of these demand a change within primary care and in the way in which primary care relates to the rest of the health care system

Cancer Figure ?- Crude Cancer Registration Rates for the Period 2005-2009 for all Cancers

The Thanet rate for cancer mortality is slightly higher than the England rate. There is considerable variation at ward level.

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Figure ?- Crude Cancer Registration Rates for the Period 2005-2009 for all Cancers.

Source: Thames Cancer Registry, ONS Mid-Year Population Estimates

Figure ?- Crude Cancer Registration Rates for the Period 2005-2009 for all Cancers.

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Diabetes Figure ? - Diabetes QOF register 2010/11

7.0%

6.0%

5.0%

4.0%

3.0%

2.0%

1.0%

0.0% NHS NHS NHS NHS South Dartford, NHS Canterbury NHS West NHS Swale NHS Thanet Kent and Ashford Kent Coast Gravesham Medway England and Coastal Kent CCG CCG CCG Medway CCG CCG and Swanley CCG CCG CCG Diabetes (ages 17+) 5.5% 5.4% 6.2% 5.4% 4.9% 6.3% 6.6% 6.6% 5.7% 5.5%

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Coronary Heart Disease (CHD)

Figure 2 - Coronary Heart Disease QOF register 2010/11

4.5%

4.0%

3.5%

3.0%

2.5%

2.0%

1.5%

1.0%

0.5%

0.0% NHS NHS Dartford, NHS NHS South NHS Canterbury Gravesham NHS West NHS Swale NHS Thanet Kent and Ashford Kent Coast Medway England and Coastal and Kent CCG CCG CCG Medway CCG CCG CCG CCG Swanley CCG Coronary Heart Disease 3.1% 3.3% 3.8% 3.0% 2.9% 2.8% 3.1% 3.9% 3.2% 3.4%

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Stroke

Figure ? - Stroke or transient ischemic attacks QOF register 2010/11

2.5%

2.0%

1.5%

1.0%

0.5%

0.0% Kent and Ashford C4G South Kent Swale Thanet Medway Stroke 1.7% 1.8% 2.0% 1.5% 2.1% 1.7%

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Figure ? - Expenditure on hospital admissions for stroke 2006/07-2010/11

£900,000

£800,000

£700,000

£600,000

£500,000

£400,000

£300,000 Annual expenditure (£) Annual expenditure £200,000

£100,000

£0 2006/07 2007/08 2008/09 2009/10 2010/11 Swale CCG £824,700 £809,092 £771,688 £683,836 £771,012

Source: SUS, KMPHO – Ordinary admissions only

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Chronic Obstructive Pulmonary Disease (COPD)

Figure 3 - COPD QOF register 2010/11

COPD

3.0%

2.5%

2.0%

1.5%

1.0%

0.5%

0.0% Kent and Ashford C4G South Kent Swale Thanet Medway COPD 1.5% 1.6% 2.0% 1.7% 2.5% 1.6%

Source: QOF Registers

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Mental Health

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Long term conditions and mental health: Co-morbidities

Many people with long term physical health conditions also have mental health problems. These can lead to significantly poorer health outcomes and reduced quality of life.

People with long term conditions and co-morbid mental health problems disproportionately live in deprived areas and have access to fewer resources of all kinds. The interaction between co-morbidities and deprivation makes a significant contribution to generating and maintaining inequalities.

Care for large numbers of people with long term conditions could be improved by better integrating mental health support with primary care and chronic disease management programmes, with closer working between mental health specialists and other professionals. Collaborative care arrangements between primary care and mental health specialists can improve outcomes with no or limited additional net costs. Innovative forms of liaison psychiatry demonstrate that providing better support for co-morbid mental health needs can reduce physical health care costs in acute hospitals.

The CCG should consider prioritising the integration of mental and physical health care more closely as a key part of its strategy to improve quality and productivity in health care.

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Dementia

Figure ? - Dementia QOF register by CCG 2010/11

0.60%

0.50%

0.40%

0.30%

0.20%

0.10%

0.00% Kent and Ashford C4G South Kent Swale Thanet Medway Dementia 0.39% 0.54% 0.56% 0.39% 0.54% 0.47%

Source: QOF Registers

Figure ? - Prevalence of dementia by practice 2010/11

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2015 - showing expected numbers at different levels of 2011 ascertainment On Poppi register Percentage Poppi At 2010/11 CCG estimates (QOF)* ascertained estimates QOF level 50% 60% 70% 80% 90% Ashford 1,502 476 31.7 1,700 539 850 1,020 1,190 1,360 1,530 Canterbury 2,145 1,151 53.7 2,375 1,274 1,188 1,425 1,663 1,900 2,138 DGS 2,183 1,159 53.1 2,416 1,283 1,208 1,450 1,691 1,933 2,174 South Kent Coast 3,348 1,089 32.5 3,664 1,192 1,832 2,198 2,565 2,931 3,298 Sw ale LC 1,474 411 27.9 1,682 469 841 1,009 1,177 1,346 1,514 Thanet 2,213 748 33.8 2,329 787 1,165 1,397 1,630 1,863 2,096 West Kent and Weald 6,436 2,139 33.2 7,176 2,385 3,588 4,306 5,023 5,741 6,458 Medw ay 2,454 1,093 44.5 2,749 1,224 1,375 1,649 1,924 2,199 2,474 Kent 19,301 7,173 37.2 21,342 7,932 10,671 12,805 14,939 17,074 19,208 Kent and Medw ay 21,755 8,266 38.0 24,091 9,154 12,046 14,455 16,864 19,273 21,682 Source: Poppi, QOF NB: There maybe a difference in definition between the national prevalence figures applied to local populations and the definition used for QOF Note: 2011 and 2015 Poppi estimates w ere assigned to CCGs according to the dominant local authority/ies

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Activity

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Falls

Fracture neck of femur

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All age all cause mortality

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Health check data

Invitations Completed Estimated GP /Actual % % Practice

Code Eligible Invited Completed

Jul-12 Jul-12

Apr-12 Oct-12 Apr-12 Oct-12

Jun-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Jun-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

Aug-12 Sep-12 May-12 Aug-12 Sep-12 Tier 1 Tier 2 May-12 Number G82105 Bethesda Medical Centre 802 281 100 164 0 101 55 0 39 86 30 64 80 83 20 25 34 31 34 5 27 30 17 12 28 18 829 97 34 G82666 Birchington Medical Centre 506 340 0 86 91 58 75 102 0 0 94 0 0 0 38 60 41 19 34 46 31 19 0 13 19 20 678 75 50 G82769 Cecil Square Surgery 171 67 25 20 23 46 0 11 2 14 30 0 0 0 5 8 6 22 0 5 9 3 6 0 0 3 110 156 61 G82674 Cliftonville Surgery 0 0 118 0 0 G82064 Dashwood House 173 142 0 41 0 0 0 73 0 0 0 0 59 0 0 9 5 0 0 0 0 8 9 40 45 26 384 45 37 G82126 East Cliff Medical Practice 462 157 101 21 0 79 0 0 61 90 60 50 0 0 13 37 2 14 15 1 5 11 13 25 11 10 892 52 18 G82810 Garlinge Surgery 171 85 0 0 0 18 153 0 0 0 0 0 0 0 0 18 36 12 3 6 7 2 1 218 78 39 G82107 Minster Surgery 529 206 65 27 0 0 20 24 0 0 60 0 0 333 21 22 20 20 24 19 19 9 5 2 16 29 513 103 40 G82650 Mocketts Wood Surgery 0 195 0 0 0 0 0 0 0 0 0 0 0 0 11 6 27 62 61 23 5 0 0 0 0 0 189 0 103 G82150 Newington Road Surgery 0 0 441 0 0 G82066 Northdown Surgery 447 353 0 0 125 0 0 82 135 0 0 0 105 0 36 39 55 62 38 25 53 31 12 0 1 1 576 78 61 G82210 Osborne Road Surgery 164 69 0 0 0 20 20 24 95 0 0 0 0 5 0 0 0 0 6 12 9 28 4 1 4 5 155 106 45 G82219 St Peter's Surgery 192 183 0 25 32 30 25 0 21 29 0 30 0 0 3 1 13 27 14 22 2 12 11 33 13 32 282 68 65 G82046 Summerhill Surgery 432 165 0 0 0 0 0 0 0 0 77 71 46 238 0 0 0 0 0 0 0 0 22 71 46 26 444 97 37 G82796 The Albion Road Surgery 0 0 137 0 0 G82630 The Broadway Practice 378 117 0 0 0 0 29 0 0 180 0 0 169 0 0 0 0 0 14 6 5 50 12 11 9 10 538 70 22 G82020 The Grange Medical Centre 402 232 94 15 54 119 7 0 0 49 0 38 0 26 21 32 29 38 27 7 0 13 1 0 0 64 669 60 35 G82052 The Limes 660 283 1 25 32 60 85 116 0 334 6 1 0 0 0 1 14 33 7 29 18 35 45 38 28 35 559 118 51 G82649 Union Row Surgery 0 0 132 0 0 G82079 Westgate Surgery 435 363 0 0 0 0 0 102 0 105 109 0 0 119 43 48 38 43 28 17 33 45 38 0 0 30 588 74 62 G82812 Wickham Surgery 0 0 134 0 0 Totals 5924 3238 386 424 357 531 469 534 353 887 466 254 459 804 211 288 284 371 320 253 228 297 201 253 222 310

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Screening

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Cervical Cytology Screening for Thanet CCG Patients - Jan 2007 to Dec 2012 (pooled data) by age band

Percentage screened by age band Thanet CCG Practices Practice Name 25-29 25-64 30-34 35-39 40-44 45-49 50-54 50-64 55-59 60-64 All Ages G82796 THE ALBION ROAD SURGERY 87.10 92.75 97.67 97.78 98.15 93.33 90.16 89.22 92.31 85.19 92.37 G82674 CLIFTONVILLE SURGERY 82.93 89.32 82.50 87.50 91.53 95.92 91.04 90.18 95.45 84.62 89.10 G82219 ST PETER'S SURGERY 81.73 87.36 89.47 90.38 91.60 92.45 90.70 84.00 84.21 76.11 86.80 G82107 MINSTER SURGERY 74.29 85.92 90.10 88.56 87.76 90.27 87.10 83.97 85.91 78.90 85.28 G82810 GARLINGE SURGERY 73.40 85.07 89.77 89.81 86.30 90.08 86.84 82.49 80.23 77.19 84.12 G82210 OSBORNE ROAD SURGERY 71.93 83.91 83.64 79.41 84.52 91.55 91.67 86.10 77.19 86.96 83.69 G82650 MOCKETTS WOOD SURGERY 71.70 83.02 84.82 81.75 92.19 88.17 86.43 80.87 73.95 81.17 82.41 G82079 WESTGATE SURGERY 76.21 81.45 86.32 86.19 83.14 83.73 83.61 79.01 76.40 76.08 81.21 G82649 UNION ROW SURGERY 71.29 81.72 84.72 80.25 87.91 93.51 90.28 78.23 71.74 58.62 79.83 G82020 THE GRANGE PRACTICE 71.14 79.09 84.18 82.18 80.66 83.24 82.74 76.89 75.10 71.53 78.68 G82126 EAST CLIFF MEDICAL PRACTICE 69.61 78.74 80.53 83.55 86.41 85.92 78.24 73.59 73.65 68.03 77.83 G82812 WICKHAM SURGERY 74.07 78.20 83.33 82.00 89.83 71.43 86.27 74.64 65.12 70.45 77.53 G82150 NEWINGTON ROAD SURGERY 69.75 77.90 79.61 81.73 83.60 83.33 81.77 75.15 68.98 73.50 77.53 G82666 BIRCHINGTON MEDICAL CENTRE 72.54 76.63 80.86 83.89 82.64 79.46 73.33 71.86 70.04 72.27 76.35 G82630 THE BROADWAY PRACTICE 61.18 77.04 75.93 87.73 86.34 82.00 79.38 73.14 71.26 67.68 76.17 G82046 SUMMERHILL SURGERY 65.17 75.84 80.21 79.37 81.95 77.03 79.10 74.14 70.27 71.23 75.43 G82105 BETHESDA MEDICAL CENTRE 66.94 75.39 73.64 78.70 80.00 81.03 76.70 74.63 74.19 72.41 75.36 G82064 DASHWOOD HOUSE 61.98 75.21 79.84 78.11 81.96 82.04 78.19 72.57 72.30 64.57 74.68 G82052 THE LIMES 60.15 73.73 78.19 80.07 78.11 77.38 79.25 72.61 72.22 65.00 73.67 G82066 NORTHDOWN SURGERY 64.56 73.57 77.88 77.21 77.85 77.19 79.18 70.89 67.06 66.06 73.15 G82769 CECIL SQUARE SURGERY 51.25 69.23 66.22 80.60 78.08 76.06 77.08 67.24 58.62 61.54 68.59 Thanet CCG Average 70.42 80.05 82.35 83.66 85.26 84.53 83.29 77.69 75.06 72.81 79.51

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Breast Screening Coverage - Thanet CCG Patient - April 2009 to March 2012 (pooled data)

Practice Name Percentage Screened in 3 year period to March 2012 BIRCHINGTON MEDICAL 81.09 CENTRE MINSTER SURGERY 80.00 ST PETER'S SURGERY 79.76 WESTGATE SURGERY 78.87 THE GRANGE PRACTICE 78.75 SUMMERHILL SURGERY 78.40 OSBORNE ROAD 78.23 SURGERY THE BROADWAY 77.73 PRACTICE CLIFTONVILLE SURGERY 77.18 EAST CLIFF MEDICAL 76.90 PRACTICE MOCKETTS WOOD 76.06 SURGERY NORTHDOWN SURGERY 75.93 THE ALBION ROAD 75.71 SURGERY GARLINGE SURGERY 75.70 DASHWOOD HOUSE 75.15 BETHESDA MEDICAL 73.35 CENTRE NEWINGTON ROAD 72.52 SURGERY THE LIMES 72.33 WICKHAM SURGERY 69.80 UNION ROW SURGERY 67.54 CECIL SQUARE 59.86 SURGERY 77.88

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Practice profile data –

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