The NHS at 60

All letters are subject to editing and may be shortened. Letters should be sent to the BJGP office by e-mail in the first instance, addressed to [email protected] (please include your postal address). Alternatively, they may be sent by post as an MS Word or plain text version on CD or DVD. We regret that we cannot notify authors regarding publication. Letters not published in the Journal may be posted online on our Discussion Forum. For instructions Le tte rs please visit: http://www.rcgp.org.uk/bjgp-discuss The NHS at 60 We started with the intent of replicating a Cardiovascular model of care from our Edgbaston practice to find that, not only were we regarded as disease risk of In support of Watt’s editorial calling for over-idealistic by our new local colleagues, measures to correct health inequalities in but that the patients were wrong-footed by homeless deprived areas, 1 we have experienced that our more patient-centred approach, and the inverse care law 2 is alive and patients sometimes antagonistic to our insistence flourishing. on, for example, face-to-face medication Two years ago we were awarded an In response to the article by Holt et al ,1 in review. Alternative Provider Medical Services the July issue, the use of practice-based We are proud of how far we have come contract by Heart of Birmingham Teaching software would increase our efficiency in on a shoe string. The shutters now go up Primary Care Trust (HOBtPCT), to provide identifying individuals at risk of and the doors open for the duration of our care to the patients of a retiring GP in cardiovascular disease (CVD). This study contractually agreed hours. Prescribing, Nechells, Birmingham. This inner-city focuses on the older age group of QOF scores, and other quality indicators suburb has operated for decades as a 50 –74 years. A recent study done by the have improved, although we are conduit for ingress into the city by Stockport PCT examining the CVD risk disappointed by the limitations of existing progressive waves of immigrants. Hence, factor screening in the homeless measures in discriminating true quality. we serve a variety of patients including population demonstrates that only a small And, although we are improving primary Irish, Pakistani, African –Caribbean number of homeless individuals fell within care in Nechells, we remain frustrated by (including significant numbers of refugees) the age range of screening (35 –70 years), our sense of how much more we could and Eastern European, many of whose but all of them were successfully screened achieve, were resources fairly allocated to primary language is not English. to some degree. It also shows that they where the need is greater. In our other practice, through a PMS had more risk factors, the age of the contract 4 miles away in the Edgbaston individuals attending was younger, and Locality, South Birmingham PCT, we serve Maurice Conlon they had more high-risk lifestyle a comparatively mid-range socioeconomic Ridgacre Medical Centres, behaviours. Even though only a small population where nearly all the patients 83 Ridgacre Road, Quinton, Birmingham. number was taken into account in this speak English. E-mail: [email protected] study, it emphasised why this group of In Nechells we crudely estimate the individuals needs to be targeted for future Steve Brinksman workload required to achieve similar quality health care. A proposed GP-led health Ridgacre Medical Centres, Birmingham. of service to be about 130% of that in centre by Lord Darzi in the area providing Edgbaston. However, our income per 0800 –2000 hours care daily would allow Vanessa Manley them to be registered with a GP and patient in Nechells in the first year was Ridgacre Medical Centres, Birmingham. 55% of that in Edgbaston, taking into therefore provide these patients with supportive and accessible health care. account basic contract, Quality and Philip Saunders Outcomes Framework (QOF) and additional Ridgacre Medical Centres, Birmingham. More upstream health prevention and services. After 1 year we negotiated an health promotion could be offered in this uplift to 85%. Martyn Hull centre as well as drug and alcohol This letter is not a side swipe at Ridgacre Medical Centres, Birmingham. treatment services. HOBtPCT, who are responsible for provision of NHS services in a difficult area, Lynette Houghton Janet Maxwell but an illustration of the inequities that can Ridgacre Medical Centres, Birmingham. Consultant in Public Health, Stockport Primary exist invisibly, becoming apparent when Care Trust. REFERENCES E-mail: [email protected] people cross out of their usual divide, as 1. Watt G. The NHS at 60: time to end the fairy tale. Br J Gen Pract 2008; 58(552): 459 –460. we have. Financially, our winning the Jason Lie Nechells contract has been challenging (to 2. Hart JG. The inverse care law. Lancet 1971; 1(7697): 405 –412. Foundation Year 2 Doctor in General Practice say the least). & Public Health, Stockport NHS Foundation Professionally, it has been a revelation. DOI: 10.3399/bjgp08X341977 Trust & PCT. 648 British Journal of General Practice, September 2008.

Load more