Dartford, Gravesham and Swanley Clinical Commissioning Group

Dartford, Gravesham & Swanley Clinical Commissioning Group

Health & Demographic Profile

2014

Contributors;

Dr Su Xavier Consultant in Public Health Dartford, Gravesham & Swanley CCG

Jack Baxter Public Health Information Officer Kent & Medway Public Health Observatory

Contents Summary of Findings ...... Error! Bookmark not defined. Links to other useful documents/ plans ...... 3 Geography ...... 4 Demography ...... 8 Population Breakdowns ...... 8 Population Distribution Maps- ONS 2012 Mid-year estimates ...... 9 Population Projections ...... 17 Health Inequalities ...... 19 Indices of Multiple Deprivation (IMD) 2010 ...... 21 Children ...... 28 Life Expectancy from Birth ...... 28 Infant Mortality ...... 30 General Fertility Rate ...... 31 Low Birth Weight ...... 32 Breastfeeding ...... 33 Childrens Centres ...... 33 Child Wellbeing Index 2009 ...... 35 Immunisation & Vaccination ...... 37 National Child Measurement Programme (NCMP) ...... 41 Child and Adolescent Mental Health Services ...... 43 Sexual Health ...... 46 Older People ...... 48 Chronic Diseases ...... 49 Risk Factors for Chronic Diseases ...... 49 Smoking Prevalence ...... 49 Adult Obesity Prevalence ...... 50 Alcohol Misuse ...... 52 Local Alcohol Profiles for England ...... 53 Chronic Disease Patterns ...... 54 King’s Fund 10 Priorities for Commissioners ...... 54 Long Term Conditions ...... 55 Cancer Registrations ...... 55 Quality Outcomes Framework (QOF) ...... 58 Diabetes ...... 59 Coronary Heart Disease ...... 64 Stroke or Transient Ischaemic Attacks ...... 69 Hypertension ...... 74 Chronic Obstructive Pulmonary Disorder (COPD) ...... 78 Mental Health ...... 83 Dementia ...... 83 Mental Illness Needs Index 2000 ...... 86 Page | 2

Falls ...... 91 Hospital Activity: A&E Attendances and Admissions ...... 96 Dartford, Gravesham and Swanley A&E Admissions ...... 96 Emergency admission rates in DGS, 2012/13 ...... 110 Elective admission rates in DGS for older people, 2012/13 ...... 124 Outpatient attendance rates in DGS for older people, 2012/13 ...... 128

Links to other useful documents/ plans Healthy Lives, Healthy People: Our strategy for public health in England https://www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public- health-in-england Kent Joint Strategic Needs Assessment 13/14 Update http://www.kmpho.nhs.uk/jsna/ Kent Alcohol Strategy 2014-2016 http://www.kmpho.nhs.uk/EasysiteWeb/getresource.axd?AssetID=379439&type=full&servicetype=Att achment Dartford district council corporate plan http://committeedmz.dartford.gov.uk/documents/s42889/corporate%20plan%20update%20v4.pdf

Gravesham district council corporate plan http://www.gravesham.gov.uk/services/council-and-democracy/strategic-policy/corporate-plan-mid- term-review-2014/corporate-business-plan-2011-15

Sevenoaks district council corporate plan http://www.sevenoaks.gov.uk/__data/assets/pdf_file/0019/113707/Corporate-Plan.pdf

Dartford, Gravesham & Swanley CCG plans, reports and strategies http://www.dartfordgraveshamswanleyccg.nhs.uk/about-us/our-plans-reports-and-strategies/

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Geography Figure 1- Kent & Medway district authorities with CCG outlines.

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Figure 2- Electoral Wards within Dartford, Gravesham & Swanley CCG

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Figure 3- Approximate location of GP Practices in Dartford, Gravesham & Swanley CCG

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Table 1- Key to Figure 3

*Letter suffix (e.g. 2a) denotes a Branch practice of a partnership group (see below). Key to Map PracticeCode Practice Name Partnership Name LA 1 G82006 Dartford East Health Centre Dr Shimmins C J & Partners Dartford 2 The Shrubbery Gravesham G82021 The Shrubbery 2a The Shrubbery (Branch) Gravesham 3 G82028 The Cedars Surgery Dr Jones D I & Partners Sevenoaks 4 Pelham Medical Practice Gravesham G82032 Dr Moran S G & Partners 4a Pelham Medical Practice (Branch) Gravesham 5 G82044 The Gateway Medical Practice The Gateway Medical Practice Gravesham 6 G82048 Dr Fernandes N B & Partners Dr Fernandes N B & Partners Dartford 7 G82056 The Orchard Practice Dr Corbett D J R & Partners Dartford 8 G82062 Dr Shah S U D Dr Shah S U D Gravesham 9 Old Road West Surgery Gravesham G82067 Old Road West 9a Old Road West Surgery (Branch) Gravesham 10 G82073 Meopham Medical Centre Dr Mounty J P & Partners Gravesham 11 G82088 Devon Road Surgery Devon Road Surgery Dartford 12 G82096 The Forge Surgery Dr Karunaharan V M Gravesham 13 Jubilee Medical Group Dartford G82097 Jubilee Medical Group 13a Jubilee Medical Group (Branch) Sevenoaks 14 Swanscombe Health Centre Dartford G82122 Swanscombe Health 14a Bean Village Surgery (Branch) Dartford 15 G82124 West Kingsdown Medical Centre The Red Practice Sevenoaks 16 G82143 Lowfield Medical Centre Lowfield Medical Centre Dartford 17 G82156 Ivy Bower Surgery Ivy Bower Surgery Dartford 18 G82185 Redwood Practice Redwood Practice Dartford 19 G82197 Lamorna Surgery Dr Patel M M & Partner Gravesham 20 G82206 Dr Arora R P Dr Arora R P Dartford 21 G82212 Pilgrims Way Surgery Dr Patel B C & Partners Dartford 22 G82218 Farningham Surgery Farningham Surgery Sevenoaks 23 Elmdene Surgery Dartford G82221 Dr Langley S H & Partner 23a The New Surgery (Branch) Dartford 24 G82225 The Oaks Partnership The Oaks Sevenoaks 25 G82639 Maple Practice Maple Practice Dartford 26 G82647 Temple Hill Surgery Temple Hill Surgery Dartford 27 Dr Singh J & Partner Gravesham G82648 Dr Singh J & Partner 27a Dr Singh J & Partner (Branch) Gravesham 28 G82690 Chalk Surgery Dr Pillarisetti S C Gravesham 29 G82710 Bennett Way Surgery Bennett Way Surgery Dartford 30 G82722 Dr Muthappan A K Dr Muthappan A K Sevenoaks 31 G82780 Gravesend Medical Centre Gravesend Medical Centre Gravesham 32 G82808 Oakfield Health Centre Dr Vasudaven B & Partner Gravesham 33 Istead Rise Surgery Gravesham 33a G82809 Summerhouse Surgery (Branch) Downs Way Medical Practice Dartford 33b Shorne Village Surgery (Branch) Gravesham 34 Y02826 White Horse Surgery White Horse Surgery Gravesham 2 Practices have now merged in DGS CCG and 1 has closed; G82743 has merged with G82808 (as both are situated within Oakfield Health Centre) G82805 has merged with G82124 (as both are situated within West Kingsdown Medical Centre) G82122- Swanscombe Health practice has now closed. But the health centre has remained open. Page | 7

Demography Population Breakdowns

Figure 4-

The registered practice population for the Dartford Gravesham & Swanley CCG area closely reflects the pattern for Kent and Medway. The main difference is in the 25-39 age group which represent a much higher proportion compared to Kent whereas the 15-24s and 60+ age groups have a smaller proportional representation in comparison. Page | 8

Population Distribution Maps- ONS 2012 Mid-year estimates Figure 5- Population Distribution 0-4s

Top 5 highest wards 1 Northfleet North 2 Riverside 3 Swanscombe 4 Newtown 5 Northfleet South

Bottom 5 lowest wards 41 Higham 42 Istead Rise 43 Eynsford 44 Chalk 45 Crockenhill and Well Hill

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Figure 6- Population Distribution 0-19s

Top 5 highest wards 1 Riverside 2 Northfleet North 3 Northfleet South 4 Swanscombe 5 Singlewell

Bottom 5 lowest wards 41 Castle 42 Istead Rise 43 Crockenhill and Well Hill 44 Chalk 45 Eynsford

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Figure 7- Population Distribution 16-64s

Top 5 highest wards 1 Riverside 2 Northfleet North 3 Newtown 4 Northfleet South 5 Pelham

Bottom 5 lowest wards 41 Castle 42 Istead Rise 43 Chalk 44 Crockenhill and Well Hill 45 Eynsford

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Top 5 highest wards Bottom 5 lowest wards Figure 8- Population Distribution 65+ 1 Longfield, New Barn and Southfleet 41 Littlebrook

2 Hartley and Hodsoll Street 42 Crockenhill and Well Hill 3 Joydens Wood 43 Eynsford 4 Fawkham and West Kingsdown 44 Town 5 Painters Ash 45 Castle

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Figure 9- Population Distribution 85+

Top 5 highest wards 1 Longfield, New Barn & Southfleet 2 Pelham 3 Painters Ash 4 Hartley and Hodsoll Street 5 Wilmington

Bottom 5 lowest wards 41 Eynsford 42 Crockenhill and Well Hill 43 Town 44 Meopham South and Vigo 45 Castle

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Top 5 highest wards (people per hectare) Bottom 5 lowest wards (people per hectare) Figure 10- Population Density 1 Pelham (129.3) 41 Fawkham and West Kingsdown (5.4) 2 Whitehill (122.5) 42 Farningham, Horton Kirby and South Darenth (4.9) 3 Coldharbour (117.5) 43 Crockenhill and Well Hill (3.9) 4 Singlewell (113.6) 44 Eynsford (2.5) 5 Newtown (110.2) 45 Shorne, Cobham and Luddesdown (2.5)

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Figure 11- Proportion of CCG registered practice populations aged 65+ and 85+

The Dartford, Gravesham & Swanley CCG area has the lowest proportion of registered practice populations aged 65+ and the second lowest proportion of people aged 85+ in their population compared to the rest of Kent.

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Figure 12- Ethnicity in DGS CCG by Local Authority (Census Based)

Dartford LA Gravesham LA Sevenoaks LA Kent County England Broad Ethnic Group Population Population Population Population # of People # of People # of People # of People # of People Population % % % % % All Residents 97,365 100.00% 101,720 100.00% 114,893 100.00% 1,463,740 100.00% 56,075,912 100.00% White 81,233 83.43% 79,213 77.87% 105,488 91.81% 1,313,797 89.76% 45,665,773 81.44% Mixed/ Multiple Ethnicity 1,659 1.70% 1,550 1.52% 1,282 1.12% 16,783 1.15% 934,416 1.67% Asian/ Asian British 3,818 3.92% 8,891 8.74% 1,464 1.27% 29,901 2.04% 3,377,811 6.02% Black/ African/ Caribbean/ Black British 3,311 3.40% 2,682 2.64% 773 0.67% 14,816 1.01% 1,584,453 2.83% Other Ethnic Group 7,100 7.29% 9,064 8.91% 5,495 4.78% 83,758 5.72% 4,455,779 7.95% Gypsy or Irish Traveller 244 0.25% 320 0.31% 391 0.34% 4,685 0.32% 57,680 0.10%

These figures are all based on the 2011 Census and cover broad ethnic groups, unfortunately they were only published at a local authority level so we are currently unable to create or calculate any figure for the DGS CCG area. Dartford, Gravesham Kent and Medway Ethnic Group and Swanley CCG Number Percentage Number Percentage All Ethnic Minorities 46246 17.42% 198453 11.49% Asian 18144 6.83% 61229 3.54% Black 7223 2.72% 22879 1.32% Mixed 5130 1.93% 27283 1.58% Eastern European 1712 0.64% 7526 0.44% Other White 12857 4.84% 78469 4.54% Page | 16 Chinese 1229 0.46% 7323 0.42% Source: ONS, Census 2011 Population Projections *Caveat- These population projections have been assimilated by combining the KCC projected populations for Dartford, Gravesham and Swanley LOCAL AUTHORITIES- to calculate what proportion of the population of Sevenoaks is covered by Swanley we looked at the Electoral wards which covered both DGS CCG and Sevenoaks LA and then took the total of the overlapping wards and divided it into the total population for Sevenoaks to give us a percentage. We then applied this percentage to all the projected figures for Sevenoaks LA and added them to the figures for Dartford & Gravesham to give us a population projection which is as geographically & mathematically accurate as possible for the DGS area. **CCG population projections have since been published by ONS. Figure 13- Population projections - Males

The predicted trends for males aged 65+ and 85+ are what you’d expect as they’re showing a gradual increase in numbers over the next 16 years and a percentage increase of 39% and 108% respectively.

This is in contrast to 5-19 age bands who are expected to level off by the year 2030 with a 17% increase and the 0-4s who are expected to peak in 2022 and then begin a downward trend to end up with a percentage increase of a mere 2% by the year 2030, with a lower proportional representation of the entire population (2014=6.99%, 2030=6.18%)

Male Population Projection % of Total Population Age Predicted Difference from % Increase 2014 2018 2022 2026 2030 Group 2014-2030 (Thousands) from 2014

0-4 0.1 2% 6.99% 7.00% 6.78% 6.51% 6.18% 5-19 4.1 17% 19.07% 18.90% 19.30% 19.49% 19.48% 16-64 7.6 10% 63.25% 62.49% 61.87% 61.17% 60.36% 65+ 7.5 39% 15.70% 16.16% 16.69% 17.57% 18.95% 85+ 2.3 108% 1.68% 2.05% 2.37% 2.63% 3.04%

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Figure 14- Population projections - Females

There is a similar trend for females aged 65+ and 85+ this is likely to be the same in most geographies across the whole of England due to the “baby boom” which shortly followed World War II. (e.g. someone born on the 1st January 1946 (1-yr post war) would have turned 65 on 1st January 2011 and will turn 85 in 2031) this helps explain why the percentage increase and proportional representation of the total population are significantly higher in these age groups compared to the younger age bands, it is also connected to the fact people are living longer, healthier lives as well as fewer babies being born each year on year.

The females 0-4 and 5-19 age-bands tell the same story as that for the males only with a percentage increase of 1% and 19% respectively by the year 2030. The 0-4s are also expected to represent a smaller proportion of the total population by 2030 going from 6.6% in 2014 to 5.78% in 2030. Female Population Projection % of Total Population Age Predicted Difference from % Increase 2014 2018 2022 2026 2030 Group 2014-2030 (Thousands) from 2014 0-4 0.1 1% 6.60% 6.56% 6.35% 6.10% 5.78% 5-19 4.3 19% 17.53% 17.47% 17.95% 18.25% 18.19% 16-64 8.3 10% 62.22% 61.56% 61.06% 60.51% 59.76% 65+ 7.3 31% 18.31% 18.55% 18.83% 19.59% 20.87% 85+ 2.4 65% 2.90% 3.20% 3.49% 3.73% 4.17% Notes from Consultant: In addition to the significant increase in the over 65 year’s population, DGS will be affected by the planning proposals at Ebbsfleet whereby up to 11,000 homes are to be built over the next fifteen years. As this is likely to comprise young families and working age people this will impact on health and social care provision for the area. Work is being undertaken with borough councils to explore these impacts and estimate the future need for health and social care in the area.

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Health Inequalities

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, chronic disease and a shorter life span. In contrast, those who are of a higher status are expected to have a much greater disability-free life span and live a lot longer.

People with low socio-economic status are at greater risk of behaviours causing ill health. They will have higher smoking rates, a poorer diet; have less opportunity to take part in social activities and poorer mental health. Whilst it is undeniable that individual behaviour is a significant driver of ill health, it is wrong to attribute all causes of premature poor health and early death to personal behaviour. If such behaviour was eliminated, people with the lowest socio-economic status would certainly live longer, but would continue to die prematurely relative to the mainstream society.

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 Dartford, Gravesham & Swanley CCG must support the actions of Kents’ Public Health Team, working with local authorities to address the root causes of disadvantages in society, whether through the Kent Health Inequalities Strategy, through Dartford, Gravesham & Swanley Borough Council’s Corporate Plan or through the work of Local Children’s Trusts.

In addition the British Medical Association through the Presidency of Professor Sir Michael Marmot has identified a range of actions that doctors can implement 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; such as gypsy and traveller communities.

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

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Figure 15- Outline of the HINST Intervention Model

National Support Team)

h Inequalities

HINST (Healt

Bentley C (2007) Systematically Addressing InequalitiesHealth

Source: The direct actions that clinical services need to focus upon include:

A) Partnership, vision and strategy, leadership and engagement This requires ‘seamless’ partnership working between local authorities and CCGs. The CCG has a statutory duty to collaborate with social services. Public Health has a major leadership role but cannot deliver on its own. There is a need for a detailed strategy or action plan which shows how local inequality targets can be achieved. B) Systematic and scaled interventions by frontline services Primary care services will need to play a central role requiring organisational capacity to be addressed by some practices if they are to work more effectively on this agenda. There is a need for training systematically to ensure effective brief interventions, referral pathways, and performance monitoring which should at least cover smoking, alcohol problems and obesity. C) Systematic community engagement The CCG and local authorities should have joint systems for reaching vulnerable patients at highest risk who may be demotivated and not in meaningful contact with services. Such systems should be of sufficient scale to make a difference. A comprehensive engagement system is needed to interact not only with community groups but also with socially excluded individuals and families, e.g. through health trainers. D) Frontline service engagement with the community Many local areas have large portions of the population that are seldom seen, seldom heard. This can be addressed through the systematic use of practice registers and outreach staff to draw people in to services. Outreach strategies need to be targeted and scaled up appropriately in order to have impact across whole communities. The NHS workforce needs to be integrated effectively. The voluntary sector has great potential to bridge across from service into community provided that that sector is supported to develop its infrastructure to function at a strategic level.

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Indices of Multiple Deprivation (IMD) 2010 Figure 16- Deprivation- IMD Score Overall

Summary of IMD

The English Indices of Deprivation 2010 use 38 separate indicators, organised across seven distinct domains of deprivation which can be combined using appropriate weights, to calculate the Index of Multiple Deprivation 2010 (IMD 2010).

This is an overall measure of multiple deprivations experienced by people living in an area and is calculated for every Lower layer Super Output Area (LSOA) in England.

The IMD 2010 can be used to rank every LSOA in England according to their relative level of deprivation.

Source: https://www.gov.uk/government/uplo ads/system/uploads/attachment_dat a/file/6871/18712 08.pdf

This analysis describes the distribution of residents of the D.G.S. CCG area by reference to their socio-economic status. The majority of the deprived areas are found in the Joyce Green, Littlebrook, Northfleet, Bean & Darenth, Pelham, Riverside and Both Swanley wards. The least deprived wards are Hartley & Hodsoll Street, Istead Rise and Joydens Wood (except for1 LSOA which is in the 40% most deprived). Page | 21

Figure 17- Income Deprivation

Income Deprivation Domain

This domain measures the proportion of the population in an area experiencing deprivation related to low income. A combined count of income deprived individuals per LSOA is calculated by summing the following five indicators; Adults and children who are;  In income support families.  In income-based jobseekers allowance families.  In pension credit (Guarantee) families.  In child tax-credit families whose collective income is below 60% of the median before housing costs. -A nd Asylum seekers in England in receipt of subsistence support, accommodation support or both.

The wards which are the most deprived in terms of their income are very similar to those highlighted for their overall IMD Score. The main contrasts between the two are parts of the Crockenhill & Well Hill, Higham, Meopham South & Vigo and the two Swanley wards who are slightly more deprived in terms of their income. Whereas parts of the Bean & Darenth and Joyce Green wards are less deprived compared to their overall IMD score. Page | 22

Figure 18- Employment Domain

Employment Domain

This domain measures employment deprivation in an area conceptualised as involuntary exclusion of the working age population from the labour market.

A combined count of employment deprived individuals per LSOA is calculated by summing seven indicators.

Please follow the link on page 23 for a more detailed insight into how this is calculated.

As you would expect the quintiles for employment and income deprivation are very similar as the 2 are closely related. The areas with the worst relative deprivation are the LSOAs surrounding the central Dartford and Gravesham areas. The areas which are the least deprived mainly include the more rural areas and the LSOAs which make up the northern part of the Sevenoaks district (Except Farninghams’ LSOA)

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Figure 19- IDACI

Income Deprivation Affecting Children Index

In addition to the income deprivation index (Figure 17) there are two supplementary indices also produced;

 Income Deprivation Affecting Children Index  Income Deprivation Affecting Older People Index.

The IDACI represents the proportion of children aged 0-15 living in income deprived

households .

The picture for IDACI doesn’t really recognise any differences from the overall income deprivation score in terms of where the most deprived areas are for Dartford, Gravesham & Swanley CCG. It’s worth noting that the worst areas all tend to be within wards that have the highest numbers of 0- 19 year olds living within them, see figure 6.

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Figure 20- IDAOPI

Income Deprivation Affecting

Older People Index

The IDAOPI represents the proportion of older people aged 60 and over living in income deprived households respectively.

For a more in depth definition of any of these indicators please follow the link below.

Source: https://www.gov.uk/governmen t/uploads/system/uploads/attac hment_data/file/6871/1871208. pdf

The prime measure here is the extent to which there are sufficient concentrations of older people whose primary dependency is upon state pensions alone. The lack of income in later years is a useful proxy for identifying people at greater risk of early onset chronic disease. So from this map you can identify that the Pelham, Central and Coldharbour wards which have high numbers of people aged 65+ residing within them are in the 20% most deprived wards. Page | 25

Figure 21- Living Environment

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Living Environment Domain

This domain from the Index of Multiple Deprivation measures the physical and financial accessibility of housing and key local services. The indicators fall into two sub-domains: ‘geographical barriers’ which relate to the physical proximity of local services and ‘wider barriers’ which include issues relating to access to housing such as affordability. Seven indicators are combined to calculate this domain.

Wider barriers: • Household overcrowding – the proportion of households within an LSOA which are judged to have insufficient space to meet the household’s needs; • Homelessness – the rate of acceptances for housing assistance under the homelessness provisions of the 1996 Housing Act (at local authority district level); • Difficulty of access to owner-occupation (local authority district level) – proportion of households aged under 35 whose income means they are unable to afford to enter owner occupation.

Geographical barriers: • Road distance to a GP surgery; • Road distance to a supermarket or convenience store; • Road distance to a primary school’ • Road distance to a post office.

What therefore is being measured is the extent of spatial and service isolation and thus factors which may have some dilatory influence on positive mental health. This analysis offers a perspective that is counter to many of the other cartographic descriptions of deprivation but not all. Housing issues such as overcrowding and homelessness are both still found in all of the major centres of populations. On the other hand, the distance from location of basic services and amenities is also reflected in the extensive rural parts of the D.G.S. CCG area

Table 2- Practice Deprivation by IMD 2010 Between 40% Most 20% Most 40% Most 40% Least 20% Least Clinical Commissioning Group Deprived and 40% Deprived Deprived Deprived Deprived Least Deprived

NHS Ashford 2 10 4

NHS Canterbury and Coastal 10 12 1

NHS Dartford, Gravesham and Swanley 3 13 14 9

NHS South Kent Coast 1 11 11 10 NHS Swale 4 3 9 5 NHS Thanet 4 8 5 4 NHS West Kent 1 3 28 32 Kent 9 26 53 83 46 D.G.S. CCG has no practices in the in 20% most deprived wards on a national level, with 9 practices in the 20% least deprived wards for the whole of England.

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Children Life Expectancy from Birth Figure 22- Life Expectancy from birth by CCG in Kent

The DGS CCG area has a life expectancy of 80.7 years making it better than the England average by 0.6 years but just falling short of the average for Kent & Medway by 0.2 years.

*Life expectancy by ward on following page.

The highest life expectancy from birth is in Riverside ward at 86.4 years, this may be related to the fact that it has the largest working age population of all the wards in DGS CCG, there is a total of 18 wards with a significantly higher life expectancy from birth than the Kent & Medway average.

The ward with the lowest life expectancy is Castle at 73.0 years, nearly 8 years below the average for Kent and Medway.

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Figure 23- Life expectancy from birth by Ward in DGS CCG

Consultant notes: This marked difference in life expectancy for people born in Castle needs further exploration. The ward is relatively deprived but the considerable difference with other wards of similar deprivation warrants investigation for other contributing factors. Page | 29

Infant Mortality Figure 24- Infant Mortality Trend 2002-2012

The infant mortality trend for DGS CCG fluctuates between 2004 and 2008 but still shows a consistently lower trend in comparison to the Kent and England averages. Only two CCGs have a lower rate for infant mortality than DGS in the year 2012; Ashford (1.27) and Swale (1.42). Figure 25- Infant Mortality rate by CCG

The DGS area has the 3rd lowest rate for infant mortality in Kent & Medway CCGs, it’s also lower than the average rate for both England and Kent. Page | 30

General Fertility Rate Figure 26- GFR 2008-2012 by Electoral Ward

The general fertility rate for DGS CCG is slightly higher than that for Kent, the lowest fertility rates are in areas that have relatively low levels of deprivation (Heath, Longfield, New Barn & Southfleet, Hartley & Hodsoll Street). Respectively the wards with the higher rates of fertility tend to be- but not necessarily- in more deprived areas (Swanscombe, Northfleet North, Littlebrook) Figure 27- GFR 2008-2012 Map

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Low Birth Weight Figure 28- Percentage of low birth weight (<2500g) babies born by electoral ward 2010-2012.

The pattern of low birth weights in the DGS area appears to be at variance with the classic affiliation of relative deprivation and teenage parenthood; however this is represented in the Bean & Darenth, Town and Swanley St. Marys’ wards which are relatively deprived in comparison to the rest of the DGS CCG area. Figure 29- LBW Babies Born 2010-2012 Map

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Consultant notes on Low Birth Weight: Low birth weight is a measure of the proportion of all live born babies that weigh less than 2500g. Although helpful as an indicator within the CCG region, the measure cannot be used to compare wards as birth rates may vary from ward to ward. This data is published nationally but it would be helpful to consider calculating a rate to allow comparators. LBW is linked with teenage pregnancy, some ethnic groups and smoking so it would be helpful to further evaluate wards with regard to LBW and these characteristics. Breastfeeding Table 3- 6-8 Week breast feeding status 2012/13 Number of Number of Number of Number of Infants Prevalence Quarter Number of part infants not Area breastfed where of Breast % coverage 2012/13 Maternities breastfed breastfed infants status is feeding infants (artificial) unknown 1 897 204 107 513 73 34.7% 91.9% Dartford, 2 875 200 130 484 61 37.7% 93.0% Gravesham & 3 918 231 116 511 60 37.8% 93.5% Swanley CCG 4 759 164 105 395 95 35.4% 87.5% Year to Date 3449 799 458 1903 289 36.4% 91.6% 1 5550 1521 594 2928 507 38.1% 90.9% 2 5360 1475 656 2943 286 39.8% 94.7% Kent & 3 5544 1596 695 3023 230 41.3% 95.9% Medway 4 4985 1196 618 2525 646 36.4% 87.0% Year To Date 21439 5788 2563 11419 1669 39.0% 92.2% Source: Child Health Computer Table three shows a relatively consistent prevalence for breastfeeding in DGS CCG (Ranges between 34.7% - 37.8%) as is the same for the overall coverage percentage for the year with an average of 91.6%. Generally the prevalence and coverage rates are very similar to that for Kent & Medway. Consultant note: Although the rate of breastfeeding in DGS is similar to that of Kent it is still relatively low, given the enormous benefits conferred to both mother and baby through breast feeding. Work is being undertaken with KCC Public Health through a new infant feeding service to further develop and promote breastfeeding. Borough councils can support this through provision of breastfeeding friendly cafes and shops as well as amenable facilities to support mothers feeding in public places. Childrens Centres The monitoring of child health is in accordance with the national Healthy Child programme. This programme is conceived in two parts: birth to age five and five to 19. There is internationally-based evidence to show that over the life course, a person’s health is fundamentally influenced by influences in the first few months of life and a child’s early years (0-3). The delivery of this programme falls significantly to the role of the health visitor working in conjunction with a range of providers of children’s services. In recent years there has been a transformation of early year’s provision through the establishment of children’s centres with a view that primary childcare is not something which should be medicalised. The current policy of the Government is to re-build the profession of health visitors and expand their numbers. Locally the importance of health visitors has been consistently recognised and in the short term the delivery of the health visitor programme will fall to the NHS Commissioning Board and, at the completion of the programme (2015) the commissioning of these services will be transferred to local authorities re-confirming a historic position (pre-1974). Health visitor practise is seen to be crucial in the context of the role of children’s centres and thus health visitors will primarily be based in such centres. It is essential that there is effective liaison between health visitors, children’s centres and primary care teams and therefore a requirement that each practice has a named health visitor Page | 33

Figure 30- Approximate location of children’s’ centres

Key Name LA 1 Brent (YMCA) Dartford 2 Greenlands (Darenth) Dartford 3 Knockhall Dartford 4 Maypole Dartford 5 Oakfield Dartford 6 Swanscombe Dartford 7 Temple Hill Dartford 8 Bright Futures (Shears Green) Gravesham 9 Daisy Chains (Meopham) Gravesham 10 Kings Farm (Main Site) Gravesham 11 Little Gems (Lawn) Gravesham 12 Little Painters Gravesham 13 Little Pebbles (Chantry) Gravesham 14 Riverside Gravesham 15 New Ash Green Sevenoaks 16 Swanley Sevenoaks 17 West Kingsdown Sevenoaks Page | 34

Child Wellbeing Index 2009 Figure 31- Health & Disability Score

This is a mapped overall summary of children’s health drawn from a specific field of children’s indicators of wellbeing based on a variant of the Index of Multiple Deprivation as published in 2007. It covers for this purpose:

• All emergency admissions to hospital for children aged 0-18 as a proportion of all children aged 0-18 in each LSOA. (Source: Hospital Episode Statistics for England, 2005/6); • All outpatient hospital attendances for children aged 0-18 as a proportion of all children aged 0-18 in each LSOA. (Source: Hospital Episode Statistics for England, 2005/6); • The proportion of children aged 0-16 receiving Disabled Living Allowance. (Source: DWP, 2005).

Particular attention should be drawn to a greater proportion of children with poor health and disability found in the Singlewell, Princes, Riverside, Swanley (White Oak & St. Mary’s), Littlebrook and Coldharbour wards.

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Figure 32- Material Well-being Score – Child well-being Index 2009 This map describes material wellbeing for children as analysed by a variant of the Index of Multiple Deprivation 2007.

Particular note should be taken of Swanley White Oak and Swanley St. Marys, Joyce Green, Littlebrook, Stone, Swanscombe, Northfleet North, Northfleet, Coldharbour, Singlewell, Westcourt and Riverside Wards; most of which are in the northern parts of Dartford and Gravesham.

Children born into poverty are more likely to:

• Die in the first year of life; • Be born small, or born early, or both; • Be bottle fed; • Die from an accident in childhood; • Smoke and/ or have a parent who smokes; • Have poor nutrition; • Become a lone parent; • Have or father children younger; • Suffer from mental health problems; • Die in an accident; • Die younger.

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Key WHO Targets st Immunisation & Vaccination Figure 33- 2012/2013- Practice level vaccinations to 1 birthday 95% and above Up to 1st birthday 90.0%-94.99% DTap/IPV/Hib MenC Pneu <90% G code Practice Name Town LA No. of No. of No. of No. of Source: Child Health Computer children children % Uptake children % Uptake children % Uptake vaccinated vaccinated vaccinated

Dartford, Gravesham and Swanely CCG 3156 3103 98.3 3084 97.1 3094 98.0 G82006 Dartford East Health Centre (Dr Shimmins) Dartford Dartford 227 224 98.7 223 98.2 222 97.8 G82021 Shruberry Riverview Park Surgeries Northfleet Gravesham 139 137 98.6 136 97.8 137 98.6 G82028 Cedars Surgery Swanley Sevenoaks 108 105 97.2 104 96.3 105 97.2 G82032 Pelham Medical Practice Gravesend Gravesham 190 189 99.5 188 98.9 188 98.9 G82044 Gateway Medical Group Northfleet Gravesham 80 78 97.5 78 97.5 78 97.5 G82048 Horsmans Place Partnership Dartford Dartford 127 123 96.9 123 96.9 123 96.9 G82056 Orchard Practice, Dartford West Health Centre Dartford Dartford 95 93 97.9 93 97.9 94 98.9 G82062 Parrock Street Practice Gravesend Gravesham 42 41 97.6 41 97.6 41 97.6 G82067 Old Road West Surgery Gravesend Gravesham 154 153 99.4 152 98.7 152 98.7 G82073 Meopham Medical Practice Meopham Gravesham 76 75 98.7 75 98.7 75 98.7 G82088 Devon Road Surgery, South Darenth South Darenth Dartford 74 74 100.0 74 100.0 74 100.0 G82096 Forge Surgery Northfleet Gravesham 42 41 97.6 41 97.6 41 97.6 G82097 Jubilee Medical Group Longfield Dartford 151 150 99.3 149 98.7 150 99.3 G82122 Swanscombe Health Centre Swanscombe Dartford 226 224 99.1 221 97.8 224 99.1 G82124 West Kingsdown Medical Centre (Red) West Kingsdown Sevenoaks 7 7 100.0 7 100.0 7 100.0 G82143 Lowfield Medical Centre Dartford Dartford 58 58 100.0 58 100.0 58 100.0 G82156 Ivy Bower Surgery Greenhithe Dartford 45 43 95.6 42 93.3 42 93.3 G82185 Redwood Practice, Dartford West Health Centre Dartford Dartford 87 86 98.9 86 98.9 86 98.9 G82197 Lamorna Surgery Gravesend Gravesham 24 23 95.8 23 95.8 23 95.8 G82206 Joydens Wood Bexley Dartford 19 19 100.0 19 100.0 19 100.0 G82212 Dartford East Health Centre (Dr Patel) Dartford Dartford 65 64 98.5 63 96.9 63 96.9 G82218 Braeside Surgery Farningham Sevenoaks 43 43 100.0 43 100.0 43 100.0 G82221 Elmdene Surgery, Horns Cross Horns Cross Dartford 97 97 100.0 95 97.9 95 97.9 G82225 Oaks Surgery Swanley Sevenoaks 123 119 96.7 118 95.9 118 95.9 G82639 Maple Practice Dartford Dartford 47 45 95.7 44 93.6 46 97.9 G82647 Temple Hill Surgery Dartford Dartford 111 111 100.0 111 100.0 111 100.0 G82648 Rochester Road Surgery Gravesend Gravesham 41 40 97.6 39 95.1 40 97.6 G82690 Chalk Surgery Gravesend Gravesham 23 23 100.0 22 95.7 22 95.7 G82710 Bennett Way Lanes End Dartford 32 29 90.6 29 90.6 29 90.6 G82722 Hextable Surgery Hextable Sevenoaks 29 29 100.0 29 100.0 29 100.0 G82743 Oakfield Health Centre (Dr Vasudaven): 22 22 100.0 22 100.0 22 100.0 Gravesend Gravesham Merged with G82808 on 08/04/13 G82780 Gravesend Medical Centre Gravesend Gravesham 186 178 95.7 177 95.2 178 95.7 G82805 West Kingsdown Medical Centre (Yellow): 21 20 95.2 19 90.5 19 90.5 West Kingsdown Sevenoaks Merged with G82124 on 01/04/13 G82808 Oakfield Health Centre (Dr Harris) Gravesend Gravesham 68 67 98.5 67 98.5 67 98.5 G82809 Downs Way Medical Centre, Istead Rise Istead Rise Gravesham 111 109 98.2 109 98.2 109 98.2 Page | 37 Y02826 White Horse Surgery Northfleet Gravesham 166 164 98.8 164 98.8 164 98.8 Figure 34- 2012/2013 Practice level vaccinations to 2nd birthday Up to 2nd birthday primaries Up to 2nd birthday boosters Dtap/IPV/Hib MMR 1 MenC Pneu Hib/MenC Pneu

G code Practice Name Town LA No. of No. of No. of No. of No. of No. of No. of children children % Uptake children % Uptake children % Uptake children % Uptake children % Uptake children % Uptake vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated

Dartford, Gravesham and Swanely CCG 3058 3011 98.5 2947 96.4 2995 97.9 3006 98.3 2953 96.6 2950 96.5 G82006 Dartford East Health Centre (Dr Shimmins) Dartford Dartford 232 227 97.8 216 93.1 227 97.8 229 98.7 222 95.7 221 95.3 G82021 Shruberry Riverview Park Surgeries Northfleet Gravesham 156 156 100.0 153 98.1 156 100.0 156 100.0 155 99.4 155 99.4 G82028 Cedars Surgery Swanley Sevenoaks 112 109 97.3 105 93.8 108 96.4 109 97.3 104 92.9 105 93.8 G82032 Pelham Medical Practice Gravesend Gravesham 174 173 99.4 173 99.4 172 98.9 173 99.4 173 99.4 173 99.4 G82044 Gateway Medical Group Northfleet Gravesham 86 84 97.7 82 95.3 84 97.7 84 97.7 82 95.3 82 95.3 G82048 Horsmans Place Partnership Dartford Dartford 133 132 99.2 131 98.5 132 99.2 132 99.2 130 97.7 130 97.7 G82056 Orchard Practice, Dartford West Health Centre Dartford Dartford 81 78 96.3 78 96.3 78 96.3 78 96.3 77 95.1 77 95.1 G82062 Parrock Street Practice Gravesend Gravesham 26 26 100.0 26 100.0 26 100.0 26 100.0 26 100.0 25 96.2 G82067 Old Road West Surgery Gravesend Gravesham 117 116 99.1 113 96.6 114 97.4 115 98.3 112 95.7 113 96.6 G82073 Meopham Medical Practice Meopham Gravesham 85 85 100.0 82 96.5 85 100.0 85 100.0 84 98.8 84 98.8 G82088 Devon Road Surgery, South Darenth South Darenth Dartford 64 60 93.8 62 96.9 60 93.8 60 93.8 59 92.2 59 92.2 G82096 Forge Surgery Northfleet Gravesham 43 43 100.0 42 97.7 43 100.0 43 100.0 42 97.7 42 97.7 G82097 Jubilee Medical Group Longfield Dartford 140 138 98.6 135 96.4 138 98.6 139 99.3 136 97.1 136 97.1 G82122 Swanscombe Health Centre Swanscombe Dartford 237 236 99.6 231 97.5 235 99.2 235 99.2 235 99.2 235 99.2 G82124 West Kingsdown Medical Centre (Red) West Kingsdown Sevenoaks 12 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 12 100.0 G82143 Lowfield Medical Centre Dartford Dartford 58 57 98.3 55 94.8 56 96.6 57 98.3 56 96.6 57 98.3 G82156 Ivy Bower Surgery Greenhithe Dartford 29 29 100.0 27 93.1 29 100.0 29 100.0 28 96.6 28 96.6 G82185 Redwood Practice, Dartford West Health Centre Dartford Dartford 86 85 98.8 83 96.5 85 98.8 85 98.8 84 97.7 84 97.7 G82197 Lamorna Surgery Gravesend Gravesham 20 20 100.0 20 100.0 20 100.0 20 100.0 20 100.0 20 100.0 G82206 Joydens Wood Bexley Dartford 18 18 100.0 17 94.4 18 100.0 18 100.0 17 94.4 16 88.9 G82212 Dartford East Health Centre (Dr Patel) Dartford Dartford 63 62 98.4 62 98.4 62 98.4 62 98.4 62 98.4 62 98.4 G82218 Braeside Surgery Farningham Sevenoaks 62 61 98.4 53 85.5 61 98.4 61 98.4 55 88.7 55 88.7 G82221 Elmdene Surgery, Horns Cross Horns Cross Dartford 99 98 99.0 96 97.0 99 100.0 99 100.0 95 96.0 94 94.9 G82225 Oaks Surgery Swanley Sevenoaks 119 117 98.3 112 94.1 116 97.5 117 98.3 113 95.0 113 95.0 G82639 Maple Practice Dartford Dartford 35 34 97.1 33 94.3 34 97.1 34 97.1 34 97.1 34 97.1 G82647 Temple Hill Surgery Dartford Dartford 121 121 100.0 117 96.7 119 98.3 119 98.3 117 96.7 116 95.9 G82648 Rochester Road Surgery Gravesend Gravesham 41 39 95.1 39 95.1 39 95.1 39 95.1 39 95.1 39 95.1 G82690 Chalk Surgery Gravesend Gravesham 43 42 97.7 42 97.7 41 95.3 41 95.3 41 95.3 41 95.3 G82710 Bennett Way Lanes End Dartford 25 24 96.0 24 96.0 24 96.0 24 96.0 24 96.0 24 96.0 G82722 Hextable Surgery Hextable Sevenoaks 34 33 97.1 32 94.1 33 97.1 33 97.1 32 94.1 32 94.1 G82743 Oakfield Health Centre (Dr Vasudaven): Merged Gravesend Gravesham 33 33 100.0 33 100.0 33 100.0 33 100.0 33 100.0 33 100.0 with G82808 on 08/04/13 G82780 Gravesend Medical Centre Gravesend Gravesham 146 143 97.9 144 98.6 138 94.5 138 94.5 137 93.8 136 93.2 G82805 West Kingsdown Medical Centre (Yellow): West Kingsdown Sevenoaks 17 17 100.0 17 100.0 16 94.1 17 100.0 17 100.0 16 94.1 Merged with G82124 on 01/04/13

G82808 Oakfield Health Centre (Dr Harris) Gravesend Gravesham 69 69 100.0 69 100.0 69 100.0 69 100.0 68 98.6 68 98.6 G82809 Downs Way Medical Centre, Istead Rise Istead Rise Gravesham 101 99 98.0 98 97.0 98 97.0 99 98.0 98 97.0 99 98.0 Y02826 White Horse Surgery Northfleet Gravesham 141 135 95.7 133 94.3 135 95.7 136 96.5 134 95.0 134 95.0 Source: Child Health Computer Page | 38

Figure 35- 2012/2013 Practice level vaccinations to 5th birthday Up to 5th birthday primaries Up to 5th birthday boosters No. of Dtap/IPV/Hib MMR 1 MenC Pneu DTPP MMR 2 Hib/MenC Pneu children No. of % Uptake No. of % Uptake No. of % Uptake No. of % Uptake No. of % Uptake No. of % Uptake No. of % Uptake No. of % Uptake G code Practice Name Town LA children children children children children children children children vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated

Dartford, Gravesham and Swanely CCG 2929 2789 95.2 2792 95.3 2733 93.3 2752 94 2739 93.5 2660 90.8 2723 93 2612 89.1 G82006 Dartford East Health Centre (Dr Shimmins) Dartford Dartford 172 162 94.2 163 94.8 156 90.7 160 93.0 134 77.9 131 76.2 155 90.1 151 87.8 G82021 Shruberry Riverview Park Surgeries Northfleet Gravesham 150 145 96.7 148 98.7 141 94.0 144 96.0 148 98.7 147 98.0 143 95.3 138 92.0 G82028 Cedars Surgery Swanley Sevenoaks 97 96 99.0 92 94.8 93 95.9 94 96.9 91 93.8 89 91.8 91 93.8 85 87.6 G82032 Pelham Medical Practice Gravesend Gravesham 168 158 94.0 161 95.8 157 93.5 156 92.9 160 95.2 160 95.2 159 94.6 152 90.5 G82044 Gateway Medical Group Northfleet Gravesham 81 79 97.5 78 96.3 79 97.5 78 96.3 78 96.3 75 92.6 76 93.8 74 91.4 G82048 Horsmans Place Partnership Dartford Dartford 130 125 96.2 125 96.2 121 93.1 123 94.6 126 96.9 123 94.6 122 93.8 117 90.0 G82056 Orchard Practice, Dartford West Health Centre Dartford Dartford 100 98 98.0 93 93.0 93 93.0 94 94.0 96 96.0 93 93.0 94 94.0 88 88.0 G82062 Parrock Street Practice Gravesend Gravesham 29 29 100.0 29 100.0 28 96.6 29 100.0 28 96.6 28 96.6 29 100.0 29 100.0 G82067 Old Road West Surgery Gravesend Gravesham 145 143 98.6 143 98.6 143 98.6 141 97.2 144 99.3 143 98.6 143 98.6 140 96.6 G82073 Meopham Medical Practice Meopham Gravesham 103 101 98.1 100 97.1 101 98.1 101 98.1 101 98.1 95 92.2 101 98.1 96 93.2 G82088 Devon Road Surgery, South Darenth South Darenth Dartford 72 68 94.4 69 95.8 68 94.4 67 93.1 69 95.8 65 90.3 68 94.4 64 88.9 G82096 Forge Surgery Northfleet Gravesham 34 34 100.0 34 100.0 34 100.0 34 100.0 34 100.0 34 100.0 34 100.0 34 100.0 G82097 Jubilee Medical Group Longfield Dartford 146 138 94.5 137 93.8 138 94.5 136 93.2 140 95.9 132 90.4 136 93.2 131 89.7 G82122 Swanscombe Health Centre Swanscombe Dartford 202 192 95.0 196 97.0 190 94.1 190 94.1 196 97.0 193 95.5 186 92.1 186 92.1 G82124 West Kingsdown Medical Centre (Red) West Kingsdown Sevenoaks 6 6 100.0 6 100.0 6 100.0 6 100.0 6 100.0 6 100.0 6 100.0 6 100.0 G82143 Lowfield Medical Centre Dartford Dartford 58 55 94.8 55 94.8 54 93.1 54 93.1 55 94.8 52 89.7 50 86.2 48 82.8 G82156 Ivy Bower Surgery Greenhithe Dartford 27 23 85.2 25 92.6 23 85.2 24 88.9 25 92.6 23 85.2 23 85.2 22 81.5 G82185 Redwood Practice, Dartford West Health Centre Dartford Dartford 89 85 95.5 88 98.9 83 93.3 85 95.5 87 97.8 86 96.6 85 95.5 82 92.1 G82197 Lamorna Surgery Gravesend Gravesham 21 21 100.0 21 100.0 21 100.0 21 100.0 21 100.0 21 100.0 21 100.0 20 95.2 G82206 Joydens Wood Bexley Dartford 23 23 100.0 23 100.0 23 100.0 23 100.0 23 100.0 21 91.3 23 100.0 22 95.7 G82212 Dartford East Health Centre (Dr Patel) Dartford Dartford 54 49 90.7 49 90.7 49 90.7 49 90.7 50 92.6 49 90.7 48 88.9 48 88.9 G82218 Braeside Surgery Farningham Sevenoaks 61 57 93.4 57 93.4 57 93.4 56 91.8 58 95.1 55 90.2 56 91.8 50 82.0 G82221 Elmdene Surgery, Horns Cross Horns Cross Dartford 79 76 96.2 76 96.2 76 96.2 74 93.7 71 89.9 69 87.3 74 93.7 70 88.6 G82225 Oaks Surgery Swanley Sevenoaks 124 116 93.5 111 89.5 115 92.7 115 92.7 101 81.5 95 76.6 111 89.5 100 80.6 G82639 Maple Practice Dartford Dartford 38 37 97.4 36 94.7 37 97.4 37 97.4 38 100.0 36 94.7 35 92.1 33 86.8 G82647 Temple Hill Surgery Dartford Dartford 109 105 96.3 105 96.3 102 93.6 100 91.7 104 95.4 100 91.7 100 91.7 92 84.4 G82648 Rochester Road Surgery Gravesend Gravesham 55 52 94.5 52 94.5 50 90.9 51 92.7 52 94.5 52 94.5 49 89.1 49 89.1 G82690 Chalk Surgery Gravesend Gravesham 39 36 92.3 38 97.4 36 92.3 37 94.9 37 94.9 37 94.9 36 92.3 36 92.3 G82710 Bennett Way Lanes End Dartford 31 28 90.3 27 87.1 28 90.3 29 93.5 29 93.5 27 87.1 28 90.3 26 83.9 G82722 Hextable Surgery Hextable Sevenoaks 36 36 100.0 34 94.4 34 94.4 35 97.2 34 94.4 33 91.7 34 94.4 33 91.7 G82743 Oakfield Health Centre (Dr Vasudaven): Merged Gravesend Gravesham 27 26 96.3 24 88.9 26 96.3 26 96.3 27 100.0 24 88.9 26 96.3 24 88.9 with G82808 on 08/04/13 G82780 Gravesend Medical Centre Gravesend Gravesham 130 115 88.5 118 90.8 105 80.8 109 83.8 119 91.5 115 88.5 113 86.9 105 80.8 G82805 West Kingsdown Medical Centre (Yellow): West Kingsdown Sevenoaks 24 23 95.8 22 91.7 23 95.8 24 100.0 24 100.0 22 91.7 24 100.0 23 95.8 Merged with G82124 on 01/04/13

G82808 Oakfield Health Centre (Dr Harris) Gravesend Gravesham 54 51 94.4 53 98.1 51 94.4 52 96.3 52 96.3 50 92.6 51 94.4 50 92.6 G82809 Downs Way Medical Centre, Istead Rise Istead Rise Gravesham 112 108 96.4 108 96.4 107 95.5 109 97.3 106 94.6 103 92.0 108 96.4 102 91.1 Y02826 White Horse Surgery Northfleet Gravesham 103 93 90.3 96 93.2 85 82.5 89 86.4 75 72.8 76 73.8 85 82.5 86 83.5 Source: Child Health Computer Page | 39

National Childhood Immunisation Programme

The national Childhood Immunisation programme is an essential part of protecting children’s health. Low vaccine up-take puts children at risk. The right to be offered immunisation is enshrined in the NHS Constitution. Lower than acceptable levels of immunisation in east Kent were reviewed by a National Support Team in 2010 that made 29 detailed recommendations. The strategic aim is:

• To achieve herd immunity (95 %+) in the population through increased uptake of immunisation; • To ensure immunisation services are equitable and accessible; • To provide a high quality standardised immunisation service; • To ensure the implementation of NICE guidance relating to immunisation.

Overall D.G.S. CCG practices demonstrate very good uptake rates for the first 2 years of vaccinations, only Braeside surgery in Sevenoaks and Joydens Wood in Dartford are flagged as missing the 90% target rate set by WHO (World Health Organisation). However for the primaries and boosters leading up the child’s 5th birthday; D.G.S. practices show mixed rates which highlights the need to keep a focus on the implementation of effective immunisation after the child’s second birthday to help achieve optimal rates. Figure 36- Crude admission rates for deliberate and unintentional injury for 0-17 year olds

DGS CCG had the highest rates of admission for 0-17s due to unintentional and deliberate self-harm in the contract year 2012/ 2013, this is something that should be monitored over the next couple of years to ensure it’s not the beginning of an upward trend.

Consultant notes: These high rates in DGS have been reflected in the Swanley HNA and further breakdown of these data are being undertaken. Analysis of the cause of the injuries should highlight whether this is a child safeguarding issue for the area or the result of another cause such as high levels of road traffic accidents.

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National Child Measurement Programme (NCMP) Figure 36.5- NCMP Reception Year Obesity Prevalence 2012/13

There are areas with a high prevalence of obesity in DGS for Reception and year 6 children, Littlebrook, Joyce Green and Stone wards stands out for both of the year groups as well as Town and Swanley White Oak. Page | 41

Figure 36.51- NCMP Year 6 Obesity Prevalence 2012/13

Consultant note: Child obesity is a particular problem for DGS and worryingly, the data show that obesity rates are rising between Reception and Year 6. This implies that targeting children at primary school is a priority and despite the healthy schools programme, this alone is not yet demonstrating an impact on obesity reduction. Obesity is multifactorial and addressing nutrition, physical activity and emotional wellbeing are crucial. Page | 42

Child and Adolescent Mental Health Services Figure 37- Age-specific 0-18s CAMHS contact rates 2010/11 Data.

Overall DGS had a high rate of children and young people in contact with mental health services for the year 2010/2011 with an overall rate of 62 per 1,000 persons aged 0-18. The wards with the highest rates are Joyce Green, Northfleet North, Painters Ash, Shorne, Cobham & Luddesdown and Wilmington Wards.

The development of CAMHS began in 1995 when two key documents; ‘A Handbook on Child and Adolescent Mental Health’ and ‘Together We Stand’ laid the foundations for a four-tiered framework for the planning, commissioning and delivery of child and adolescents mental health services.

For more information please visit: (http://www.youngminds.org.uk/training_services/policy/policy_in_the_uk/camhs_policy_in_england)

The government published a mental health strategy in February 2011- ‘No Health Without Mental Health: a Cross-Government Outcomes Strategy for People of All Ages’

This strategy aims to improve mental health in all ages, and people from all backgrounds. It has six objectives:

1. More people will have good mental health 2. More people with mental health problems will recover 3. More people with mental health problems will have good physical health 4. More people will have a positive experience of care and support 5. Fewer people will suffer avoidable harm 6. Fewer people will experience stigma and discrimination

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Figure 38-

Figure 39- Graph of teenage conception rates by ward 2009-2011

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Figure 40- Teenage conception rates in Kent local authorities 2008/10-2010/12

The DGS CCG area has seen a welcome reduction in the rates of teenage pregnancy since the national programme commenced in1998. The national programme finished in 2011 but the Kent strategy is to reduce the rate of teenage conceptions in all districts to fewer than 40 per 1,000 young women under the age of 19 by 2015. Based on the current figures provided by ONS in the above chart, Shepway, Swale and Thanet are currently set to meet this target while the other local authorities had already achieved this by 2008 at least.

Successful reductions in teenage pregnancy rates are the result of a strategy that combines the availability of sexual health services with working on the wider determinants of good health – largely a partnership issue. Fundamentally the phenomenon of teenage pregnancy is a product of poor aspiration and self-regard amongst young people. The sustained downward trends in rates cannot be presumed to continue as the current national economic situation makes this a very difficult time for young people.

Consultant note: Although the downward trend in teenage conception rates is very encouraging there are still several wards across DGS that have high rates that need addressing. These pockets of inequality are often overlooked in the average rate calculated for the borough and therefore targeted work needs to be undertaken to tackle the issues in specific areas, for example Northfleet North , Swanscombe, Greenhithe and Swanley White Oak.

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Sexual Health The following charts have been created using data from the Sexual and Reproductive Health Profile data on the Public Health England website (http://fingertips.phe.org.uk/). Figure 41- Prevalence of diagnosed HIV among persons aged 15 to 59 years by district, 2012

Figure 42- % of HIV diagnoses with CD4 count below 350mm³

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Figure 43- Rate of diagnosed chlamydia for 15-24s, 2012

Collectively Dartford, Gravesham and Sevenoaks have the lowest rates of diagnosed chlamydia in Kent with all three districts producing a significantly better rate compared to England overall. Gravesham and Sevenoaks are also significantly better than the South East and Kent as a whole.

Here is a list of other sexual health indicators which are also available at district level from (www.fingertips.phe.org.uk):

 Rate of syphilis diagnoses per 100,000 population  Rate of gonorrhoea diagnoses per 100,000 population  Proportion of population aged 15 to 24 screened for chlamydia, measured separately in GUM and non-GUM settings (PHOF indicator 3.02ii)  Rate of first episode genital warts diagnoses per 100,000 population  Uptake of HIV testing among men who have sex with men (MSM) measured in GUM  Uptake of HIV testing among women measured in GUM  Uptake of HIV testing among men measured in GUM  Pelvic inflammatory disease (PID) admissions  Sexual offences (PHOF indicator) Consultant note on HIV: DGS has a higher than Kent average prevalence of people with HIV and in Dartford a higher percentage appears to have a late diagnosis. This may be related to the high levels of migration within DGS but it would be helpful to explore the possible reasons around this to ensure a greater proportion of patients are diagnosed early and can therefore benefit from early interventions.

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Older People As the population ages the need for health care increases as people are living longer and managing better with long term conditions. The proportion of the DGS population aged 65+ is 17% with 2.1% over the age of 85. These are both lower than the averages for Kent at 18.3% and 2.4% respectively. Figure 44- Life Expectancy at 65, 2008-2012

The population of DGS CCG who reach 65 years can expect to live a further 19.5 years compared to 19.9 years for Kent. DGS CCG has the third lowest life expectancy at 65+ of all CCGs for the years 2008-2012. There are 25 wards in the CCG with a life expectancy greater than that for Kent.

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Chronic Diseases Risk Factors for Chronic Diseases Smoking Prevalence Figure 45- Modelled smoking prevalence estimates in the DGS CCG area, 2006-2008

Figure 46- Smoking Prevalence by GP 2012/13 QOF data

*The crude prevalence estimates are calculated by dividing the actual number of known smokers from the QOF into the 16+ registered practice population size to give a percentage.

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Important note: The register figure does not represent all patients who smoke, but represents a count of patients noted as smoking within the last 15 months, who also have any combination of the following conditions: coronary heart disease, stroke/TIA, hypertension, diabetes, COPD, asthma. (A patient with more than one of these conditions is counted only once.) Approximately 30% of residents in D.G.S. are smokers compared to 22% of adults in the whole of England (figure taken from Health Survey for England 2012) For more accurate information on smoking and tobacco control there is a useful tool published by Public Health England to view areas by region/ PHE Centre and then broken down further by the following geographical levels:  Primary Care Trust  County/ Unitary Authority  District/ Unitary Authority level. This is available at: http://www.tobaccoprofiles.info/

Consultant note: Given that these smoking data reflect those patients with an underlying health problem for which smoking is often a risk factor there is a clear need to address smoking cessation in the area. Stopping smoking can greatly impact on a person’s risk of future events so targeting those smokers with a health condition is of importance. Equally, a general population approach to reducing numbers of people starting smoking, especially children, is paramount to reducing the overall impact of smoking on morbidity and mortality. Adult Obesity Prevalence Figure 47- Modelled adult obesity prevalence estimates in DGS CCG, 2006-2008

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These Lifestyle estimates are calculated by the office for national statistics at middle layer super output area level. Unfortunately the 2006-2008 data is still the most recent available in granular detail (i.e. not looking at local authorities as a whole). The active people survey provides more recent information at a district level. Figure 48- Active People Survey 2012, Prevalence of different weight classes in Kent districts

The Active People Survey is a large telephone survey of sport and active recreation commissioned by Sport England. In January 2012 questions on height and weight were added to provide data for the adult excess weight indicator in the Public Health Outcomes Framework. The APS collects self-reported height and weight from adults aged 16 and over. Height and weight data have been adjusted at individual level to correct for the reporting bias in self-report data. The new data provide robust prevalence estimates and will allow local areas to monitor annual trends in excess weight prevalence among their adult population. The APS data displays nearly 1 in 4 adults (24.5%) in Dartford are obese compared to 1 in 5 in Gravesham (21.8%) and Sevenoaks (19.7%). A similar figure is represented for Kent (21.2%) who as a county are collectively better than the overall figure for England (23%). Consultant note: Adult obesity is clearly a problem within DGS and given the significant health implications including diabetes, joint problems, hypertension etc and impact on health services relating to these, this issue needs to be prioritised. Interventions need to not only cover diet but address physical inactivity as well in order to enable sustained weight loss. A multi-agency approach to tackling obesity is required especially in light of the recent predictions of rapid increase in rates of obesity nationally. This has been recognised, along with child obesity, as a priority for the DGS Health and Well Being Board.

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Alcohol Misuse Figure 49- Age-standardised admission rates for alcohol specific admissions in D.G.S CCG by sex, 2006/07 – 2013/14, All ages

Figure 50- Age-standardised admission rates in DGS and Kent, 2006/07 – 2013/14, All Ages

Since 2006 there has been a steady increase in the rate of alcohol-specific admissions to hospital for all ages. In Dartford, Gravesham and Swanley CCG the rate is lower than Kent’s but not significantly; the steady upward trend highlights the need for closer monitoring in the coming years. There are at least twice as many Males admitted for an alcohol-specific condition compared to females both in Kent and the DGS area. Page | 52

Figure 51- Under 18’s alcohol-specific admission rates, 2006/07 – 2013/14

The trend for under 18 alcohol specific admissions tells a different story with rates of admission seeing a welcome reduction since the baseline of 2006/07.Although the rate for DGS has been fairly erratic since 2008/09 it’s still maintained a lower admission rate than the Kent average since 2006/07. Consultant note: Given the rapid rise in A&E admissions related to alcohol this is a priority that needs to be addressed within DGS. It has been proposed through the DGS HWB that a joint multi-agency alcohol strategy is developed in order to ensure a streamlined pathway for patients and tackle the increasing rates of drinking in the population. Local Alcohol Profiles for England A more detailed area profile focusing on indicators relating to alcohol is available for every local district in England, the main link for the South East section of the website is: http://www.lape.org.uk/LAProfile.aspx?reg=X25004AE You can then use the drop down box underneath where it says ‘Change Profile Area’ to select your preferred local authority. There is also the option to download the data as a PDF if required

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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 worldwide 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 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.

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The Dartford, Gravesham and Swanley CCG Board through its leadership need to enable:

 The systematic and pro-active management of chronic disease within primary care. This will improve health outcomes, manage down inappropriate use of hospital services but will also make a significant and positive contribution to reducing health inequalities;  The empowerment of patients. Patients are arguably the greatest untapped resource within the NHS. The active engagement of patients is a common thread throughout the 10 priorities identified by the King’s Fund;  A population-based approach to commissioning. This presents a dichotomy in relation to the primary care clinician’s role as advocate for the individual patient but also in shifting a focus from patients that present in practice to the wider population needs and disease patterns. The presentation of this needs assessment, keeping separate the population- based patterns from practice-based patterns of disease, is illustrative of the conceptual challenge of this task;  More integrated models of care. The aim is to improve the quality of care for patients and reduce waste, especially as CCGs are being tasked with providing leadership within the NHS at a time of financial constraint in which the burden of disease is growing, driven in part by demographic change, yet medical advances offer increasing opportunities to treat disease. Long Term Conditions Cancer Registrations

Figure 52- Crude cancer registration rates at ward level 2007-2011 for all cancers, All ages

Cancer registrations are collected by the Thames Cancer Registry Network and cover all ages. The registration rate in D.G.S. is 250 less per 100,000 than Kent overall and has 16 Wards with a higher rate than Kent for the period 2007-2011. The crude rate was calculated by dividing the total number of cancer registrations between 2007 and 2011 and dividing it into the total population figure for each ward using 2009 ONS mid-year resident population estimates. Page | 55

Figure 53- Crude cancer registration rates for Kent CCG’s, 2007-2011, All Ages

Figure 54- Crude cancer registration rates for West Kent’s Local Authorities, Under 75s

As a CCG D.G.S. have the second lowest registration rates in Kent. Overall Dartford, Gravesham and Sevenoaks local authorities have a marginally lower rate of cancer registrations compared to the Kent county total.

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Figure 55- Map of under 75s Mortality due to cancer 2009-2013 by Electoral Ward

There are some similarities between areas with the highest rates of mortality due to cancer and areas which are the 20% most deprived in DGS. This is particularly prominent in Joyce Green, Littlebrook, Stone and Singlewell wards however Eynsford and Brent wards are also amongst the wards with the highest rates of cancer mortality in DGS yet they have relatively low levels of deprivation. Consultant note: The variation in mortality rates across the CCG warrants investigation. As noted, this does not always reflect deprivation levels and another cause such as poor patient engagement with healthcare, late presentation or health professional late diagnosis should be explored.

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Quality Outcomes Framework (QOF) What is the QOF?

(Extracted from: http://www.nice.org.uk/aboutnice/qof/qof.jsp) Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients. The QOF contains groups of indicators, against which practices score points according to their level of achievement. NICE's role focuses on the clinical and public health domains in the QOF, which include a number of areas such as coronary heart disease and hypertension. The QOF gives an indication of the overall achievement of a practice through a points system. Practices aim to deliver high quality care across a range of areas, for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of the practice list size and prevalence. The results are published annually here: http://www.hscic.gov.uk/qof usually around October each year. Other useful link: QOF 2012/13 data explained: http://qof.hscic.gov.uk/ Disease Registers on QOF

Due to the nature of the QOF and the way patient data is collected and registered on the GP’s I.T system, you can’t fully rely on the prevalence data at any level being 100% accurate as it doesn’t account for those patients who are unaware they have the disease and therefore haven’t sought advice from their doctor. I.e. the patient is only recognised by the system once they have been to see their GP who has then subsequently diagnosed them with the condition and input it onto their system. It is for this reason that we use APHO Modelled estimates for prevalence of certain disease indicators on the QOF register which are found at: http://www.apho.org.uk/diseaseprevalencemodels to roughly estimate the number of people who are unidentified at practice or local authority level.

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Diabetes Figure 56- Prevalence of Diabetes in DGS Practices, QOF Register 2012/13

The recorded prevalence of diabetes varies between practices from 4.1% to 9.8%. The prevalence for the CCG is 6.1% which is roughly the same as England overall and places it third lowest of the eight CCGs in Kent and Medway. Figure 57- Prevalence of Diabetes in Kent CCGs, QOF Register 2012/13

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Figure 58- Modelled expected prevalence of Diabetes Vs Observed Prevalence

In 2012/13 there were 12,003 people registered as having diabetes on the GP Practice QOF Indicators. The expected number of diabetic patients was calculated at 13,152 using the ‘APHO prevalence modelling tool: define your own area in England’ which can be located at: http://www.yhpho.org.uk/default.aspx?RID=81090 using the PCIS registered populations as of 31/03/2013 to calculate the expected prevalence. This potentially leaves 1,149 patients living in DGS with diabetes who are undiagnosed. Figure 59- Correlation between diabetes and obesity prevalence QOF 2012/13 data

Please note the R² value is equal to 0.29 and while this does denote a positive correlation it should be made clear that it is a very mild positive correlation which holds very little significance. Page | 60

Figure 60- Elective and Emergency hospital admission rates for diabetes 2006/07-2013/14

The trend in elective and emergency admission rates for diabetes has seen a year on year increase since 2006/07 for Kent patients overall as well as being similarly represented by the DGS rates, prior to 2013/14 DGS had a lower elective admission rate compared to emergency admissions which suggests there could’ve been a better management of the condition at practice level to prevent there being a higher number of emergency admissions compared to elective admissions. Figure 61- Map of age-standardised emergency admission rates for diabetes 11/12 – 13/14

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The wards with the highest emergency admission rates for diabetes are Joyce Green (2214.8 per 100,000), Swanscombe (2189.4), Swanley St. Marys (1925.1), Town (1901.3) & Littlebrook (1863.2). Consultant note on diabetes: There are still a significant number of people in the DGS population with diabetes who have not yet been diagnosed or presented to healthcare. Given the increasing number of people developing diabetes at increasingly younger ages, this needs to be addressed in order to optimise treatment early, give lifestyle advice and hopefully delay the onset of longer term complications such as kidney disease, blindness, heart attack and amputation. Although the correlation between obesity and diabetes is not strong based on the data for DGS there is a clear medical correlation and hence addressing the underlying problem of obesity for the area has to be a priority if diabetes rates are to improve. DGS also has a large South Asian population who are known to be at higher risk of developing diabetes, also at a younger age that white people, and so this interventions targeting this population group need to be identified. Figure 62- Mean cost per hospital spell for diabetes 2009/10 – 2014/15

The mean cost per hospital spell for diabetes in DGS CCG presents a slight downward trend alongside Kent in the last 6 years however the average for Kent has remained slightly lower over this period.

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Figure 63- Total annual expenditure on hospital spells for diabetes 2009/10 – 2014/15

The total expenditure on hospital spells for diabetes in DGS CCG has seen an upward trend in the last 6 years, the total has increased by £386k in this time which accounts for an additional 375 spells in 2014/15 (1414) compared to 2009/10 (1039).

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Coronary Heart Disease Figure 64- Prevalence of Coronary Heart Disease in DGS Practices, QOF 2012/13

Figure 65- Prevalence of Coronary Heart Disease in Kent CCGs, QOF 2012/13

The prevalence of coronary heart disease varies between practices from 1.3% to 4.6%. The prevalence for the CCG is 3% which is slightly lower than the average for England and Kent and Medway. Page | 64

Figure 66- CHD: Expected prevalence (APHO 2011) Vs Observed prevalence (QOF 2012/13)

In 2012/13 there were 7,510 people recorded on the Coronary Heart Disease register at practices in DGS, this equates to 71.1% of the total expected number of patients with CHD according to the APHO 2011 modelled prevalence estimates for CHD. This leaves potentially 3,048 patients in DGS who are unaware they have the condition. Figure 67- Elective & Emergency admission rates for Coronary Heart Disease 2006/07-2013/14

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Both elective and emergency admission rates present an upward trend for coronary heart disease in Kent and DGS CCG. This is another condition that could be managed better at a practice level in order to identify patients who are at risk before they require an emergency admittance to hospital. Consultant note: A large number of people living with heart disease in DGS have not been diagnosed. Early treatment and interventions improve quality of life and improve life expectancy so it is important that the “missing millions” are identified. DGS has a higher percentage of people who are Black African and African-Caribbean compared to the rest of Kent and heart disease is known to be a higher risk in people from these ethnic backgrounds. Figure 68- Mean cost per hospital spell for Coronary Heart Disease 2009/10-2014/15

The mean cost per hospital spell for CHD has seen a steady decline over the last 6 years in both DGS and Kent overall, however DGS has remained slightly higher than Kent for this period.

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Figure 69- Total annual expenditure on hospital spells for CHD 2009/10-2014/15

The total expenditure spent on hospital spells for CHD has seen a gradual decrease over the last 6 years to a total of almost £1million, this is despite there being an additional 76 spells in 2014/15 (1,964) compared to 2009/10 (1,888)

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Figure 70- Age-standardised emergency admission rates for DGS CCG residents for acute myocardial infarction 2011/12-2013/14 by electoral ward

The wards with the highest emergency admission rates for acute myocardial infarction are Town (316.1 per 100,000), Swanscombe (270.1), Swanley St. Marys (256.3), Singlewell (248.3) and Northfleet North (227.7). Figure 71- Age-standardised emergency admission rates for DGS CCG residents for revascularisation 2011/12-2013/14 by electoral ward

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The highest emergency admission rates for revascularisation are found in Stone (85.6 per 100,000), Swanley St. Marys (73.6), Riverside (62.7), Pelham (61.3), Brent (56.3) and Central (54.5) wards. Stroke or Transient Ischaemic Attacks Figure 72- Prevalence of Stroke or Ischaemic Transient Attacks in GP practices, QOF 2012/13

Figure 73- Prevalence of Stroke & Ischaemic Transient Attacks by CCG, QOF 2012/13

The prevalence for Stroke or Ischaemic Transient Attacks ranges between practices from 0.57% to 2.53%. The CCG has a prevalence of 1.6% which is lower than the Kent and England average.

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Figure 74- Stroke: Expected prevalence (APHO 2011) Vs Observed prevalence (QOF 2012/13)

There were 3,890 patients registered on the Stroke or Transient Ischaemic Attack register in 2012/13 out of an expected estimate of 4,650 (83.7%). This leaves a potential total of 760 patients unidentified who may have the condition. Figure 75- Elective & Emergency hospital admission rates for Stroke 2006/07-2013/14

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The admission rates for Stroke in DGS and Kent have remained stagnant over the last 8 years with DGS’s emergency admission rate remaining lower than the value for Kent’s since 2007/08. Overall DGS present a slight downward trend whereas Kent is displaying a slight upward trend. As you would expect the elective admission rates are very low for this condition. Figure 76- Mean cost per hospital spell for Stroke 2009/10-2014/15

Mean costs of hospital spells due to a Stroke spiked in 2010/11 for both DGS and Kent, however DGS has remained higher than Kent for the duration of this period. DGS spend £400 - £500 more on Stroke patients compared to Kent overall.

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Figure 77- Total annual expenditure on hospital spells for Stoke 2009/10-2014/15

The total expenditure being spent on hospital spells for a stroke fluctuates around the £1.6million mark in DGS CCG over the last 6 years and presents a slightly upward trend if you were to project these forward. Figure 78- Age standardised emergency admission rates for Stroke 2011/12-2013/14

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The highest emergency admission rates for Stroke are found in Swanscombe (283.4 per 100,000), Pelham (250), Castle (221.6), Bean & Darenth (217.2) and West Hill (215.5) wards Figure 79- Age standardised mortality rates for under-75 circulatory disease 2009-2013

The highest rates of mortality due to circulatory conditions can be found in Castle ward in DGS, other wards with high rates of mortality are Joyce Green, Swanscombe, Newtown and Littlebrook. Similarities can be identified between high rates of mortality and deprivation, particularly those wards in the north of the CCG. The wards with the lowest rates are Chalk, Crockenhill and Well Hill, Heath, Higham and Hartley & Hodsoll Street.

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Hypertension Figure 80- Prevalence of Hypertension in GP practices QOF 2012/13

Figure 81- Prevalence of Hypertension by CCG, QOF 2012/13

The prevalence of hypertension in practices ranges from 7.6% to 19.6%. The CCG has a value of 14.8% for Hypertension which is higher than the average for Kent (14.3%) and England (13.7%). Page | 74

Figure 82- Hypertension: Expected (APHO 2011) Vs Observed prevalence (QOF 2012/13)

In 2012/13 there were 37,005 patients registered with Hypertension out of an estimated 59,284 according to the APHO prevalence estimates. This means 62.4% of the expected number of patients have been identified with 22,279 potentially unaware they have the condition. Figure 83- Elective and emergency admission rates for Hypertension 2006/07-2013/14

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Admission rates for Hypertension have shown a dramatic increase since 2006/07 for both Kent and DGS CCG. Since 2010/11 DGS has had higher rates than Kent for both elective and emergency admission rates. A higher elective admission rate compared to that for an emergency suggests that patients with hypertension are being identified and managed well in a primary care setting. Consultant note: A high proportion of the population in DGS have hypertension compared with the rest of Kent and a large number of these people are unaware that they suffer from this. As hypertension is strongly associated with the development of stroke, heart attack and diabetes, identifying and treating hypertension early has a significant impact on morbidity and mortality. Figure 84- Mean cost per hospital spell for hypertension 2009/10-2014/15

Mean costs for hospital spells due to Hypertension have seen a gradual decrease since 2009/10 in both Canterbury CCG and Kent overall, with Canterbury having a slightly higher average over this period.

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Figure 85- Total annual expenditure on hospital spells for hypertension 2009/10-2014/15

The total expenditure on hospital spells for hypertension has fluctuated between £5.6million and £6.8million over the last 6 years. Figure 86- Age standardised emergency admission rates for hypertension 2011/12-2013/14

The highest emergency admission rates for Hypertension are found in Joyce Green (4048.3 per 100,000), Swanscombe (3971.2), Northfleet North (3907.9), Riverside (3900) and Littlebrook (3717.3) wards. Page | 77

Chronic Obstructive Pulmonary Disorder (COPD) Figure 87- Prevalence of COPD in practices, QOF 2012/13

The prevalence of COPD in practices ranges from 0.4% to 4.1% in DGS, as a CCG they have the second lowest overall prevalence in Kent at 1.6%, Kent & Medway’s prevalence is similar to England at 1.75% and 1.74% respectively. Figure 88- Prevalence of COPD by CCG, QOF 2012/13

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Figure 89- COPD: Expected prevalence (APHO 2011) Vs Observed prevalence (QOF 2012/13)

In DGS there were 3,898 patients registered in 2012/13 as having COPD out of an estimated total of 7,466. With 52.2% of the expected number of patients identified this leaves 3,568 who could be living with the condition but are unaware.

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Figure 90- Elective and Emergency admission rates for COPD 2006/07-2013/14

There is an upward trend in admission rates for both elective and emergency admissions in Kent and DGS CCG. In order to try and reduce the number of emergency admissions there should be an initiative to raise awareness of the condition and its symptoms amongst the general population as the majority of people who develop these symptoms often disregard them as a ‘smokers cough’. Consultant note: Again there are people with COPD who have not yet been identified and worryingly, may continue to smoke if they currently do so. As stopping smoking has a big impact on the rate of progression of the disease, support to stop smoking in this group of patients is important. Figure 91- Mean cost per hospital spell for COPD 2009/10-2014/15

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Mean costs for hospital spells for COPD in DGS have been between £200 and £400 higher than Kent overall in the last six years. Figure 92- Total annual expenditure on hospital spell for COPD 2009/10-2014/15

The total expenditure spent on hospital spells for COPD in DGS has increased by just under £1.4million in the last 6 years, this is reflected in the number of spells between the baseline year (780) and the most recent (1,279) Figure 93- Age-standardised emergency admission rates for COPD 2011/12-2013/14

T he highest emergency admission rates for COPD are found in Swanley St. Mary’s (1606.3 per 100,000), Princes (1550.1) Swanley White Oak (1536.5), Littlebrook (1371.2), Swanscombe (1347.8) and Northfleet North (1273.4). Page | 81

Figure 94- Age standardised emergency admission rates for Asthma 2011/12-2013/14

The highest emergency admission rates for Asthma are found in Joyce Green (1203.2 per 100,000), Swanley St. Mary’s (1052.6), Swanley White Oak (899.3), Princes (855.4) and Westcourt (834.6). Figure 95- Age standardised mortality rates for all respiratory diseases 2009-2013

High rates of mortality due to respiratory conditions are found in Joyce Green, Stone, Westcourt, Princes and Brent wards, the lowest rates are found in Castle, Meopham South and Vigo, Riverview, Greenhithe, Istead Rise, Crockenhill and Well Hill and West Hill wards.

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Mental Health Dementia Figure 96- Prevalence of Dementia in practices, QOF 2012/13

Figure 97- Prevalence of Dementia by CCG, QOF 2012/13

The prevalence of Dementia in practices ranges from 0.12% to 1.49%, the prevalence in DGS is slightly lower than the score for Kent & Medway and England. Page | 83

Figure 98- Emergency admission rates for Dementia diagnoses 1-3, 2006/07-2013/14

The emergency admission rate for Dementia in DGS has been higher than that for Kent since 2006/07. However recent years figures suggest the rates have reached a plateau at CCG level. Figure 99- Mean cost per emergency hospital spell for Dementia diagnoses 1-3, 2009/10 – 2014/15

The mean cost per spell for dementia in DGS has remained higher than Kent over the last 6 years but follows the same pattern as Kent in the last 4 years. Both areas display an upward trend.

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Figure 100- Total annual expenditure on hospital spells for dementia diagnoses 1-3, 2009/10- 2014/15

The total expenditure spent on hospital spells for Dementia has reduced by £60,000 over the last 6 years, however the total has fluctuated and presents high variance over this period.

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Mental Illness Needs Index 2000 In different types of areas, people are more or less likely to incur common mental illnesses. To some extent this can be predicted from characteristics of the population measured by the census or other types of survey. Mental health needs indices estimate by how much. A needs index of 0.8 suggests that there will be 20% less illness in an area than in the country as a whole, an index of 1.2 suggests 20% more Figure 101- Mental Illness Needs Index 2000

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Figure 102- Prevalence of Mental Illness in practices, QOF 2012/13

Figure 103- Prevalence of Mental Illness by CCG, QOF 2012/13

The prevalence of Mental Illness in practices ranges from 0.27% to 1.49%, DGS CCG is on a par with Kent & Medway at 0.73%, while England has a slightly higher prevalence at 0.84%.

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Figure 104- Adult (ages 15-64) mental illness patient contact rates, 2012-2013

Figure 105- Elderly (aged 65+) mental illness patient contact rates, 2012-2013

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Figure 106- Number of older people receiving enablement or active car, August 2013

Figure 107- Older people with a mental health problem living in residential or nursing homes

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Figure 108- Older people who receive domiciliary/ community support services care

Figure 109- Older people who are in receipt of day care

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Falls Figure 110- Emergency admission rates as a result of a fall, 2006/07-2013/14

Emergency hospital admission rates as a result of a fall display a slight upward trend at CCG and Kent level over the last 8 years, however since 2009/10 the rate in DGS has shown a downward trend. Figure 111- Mean cost per hospital spell due to a fall, 2009/10-2014/15

The mean cost per spell for a fall in DGS closely resembles the values for Kent with the exception of 2013/14, both areas present a downward trend. Page | 91

Figure 112- Total annual expenditure on hospital spells due to falls, 2009/10-2014/15

The total expenditure on hospital spells for Falls has fallen by just over £500,000 since the baseline of 2009/10 in DGS CCG. Figure 113- Age-standardised emergency admission rates due to a fall, 2011/12-2013/14

The highest rates of emergency admission as a result of a fall are found in Hextable (1598.9 per 100,000), Greenhithe (1475.1), Stone (1261.3), Town (1258.5) and Joyce Green (1136.7) wards. Page | 92

Figure 114- Age-standardised elective admission rates for 65+, 2011/12-2013/14

The highest elective admission rates for persons aged 65 and over are found in Wilmington (9531.7 per 100,000), Joyce Green (8617.7), Longfield, New Barn and Southfleet (7863.3) Farningham, Horton Kirkby & South Darenth (7633) and Central (7530) wards. Figure 115- Age-standardised emergency admission rates for 65+, 2011/12-1013/14

The highest emergency admission rates for persons aged 65 and over are found in Greenhithe (6415.7 per 100,000), Joyce Green (6058.7), Hextable (5828.2), Bean and Darenth (5670.9) wards. Page | 93

Figure 116- Age-standardised emergency admission rates due to fractured neck of femur, 2011/12-2013/14

The highest emergency admission results due to fractured neck of femur are found in Hextable (390.8 per 100,000), Greenhithe (380.6), Brent (275.3), Coldharbour (220.3) and Town (217.9) wards Figure 117- Age-standardised emergency admission rates due to hip or knee replacement, 2011/12-2013/14

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The highest emergency admission rates due to a hip or knee replacement are found in Swanley St. Mary’s (82.2 per 100,000), Northfleet South (56.6), Hextable (49.2), Wilmington (46.7) and Sutton-at- Hone and Hawley (40.6). Figure 118- Age-standardised mortality rates for all age, all cause 2009-2013

The highest rates for all age, all cause mortality are found in Brent, Northfleet North and Bean and Darenth wards. The wards with the lowest rates are Crockenhill and Well Hill, Riverview, Istead Rise, Joydens Wood, Heath and Ash.

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Hospital Activity: A&E Attendances and Admissions Dartford, Gravesham and Swanley A&E Admissions Figure 119- Accident & Emergency attendance rates for children aged 0-4 years.

There are high rates of A&E admissions in Ash, Farningham, Horton Kirby and South Darenth, Hextable, Chalk and Brent wards, the lowest rates are found in Heath Meopham North, Eynsford, Whitehall and Fawkham and West Kingsdown wards. For GP practices the highest rates are at Bennett Way Surgery, Dr Muthappan A K and Maple Practice. The lowest rate was found in Dr Asora R P’s practice.

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Ward Rates GP Practice Rates Ward Code Ward Name 0-4 GP Code GP Surgery 0-4 29UKGK Ash 342.5 G82710 Bennett Way Surgery 564.1 29UKGT Farningham, Horton Kirby and South Darenth 313.0 G82722 Dr Muthappan A K 367.7 29UKGY Hextable 298.9 G82639 Maple Practice 310.6 29UGFX Chalk 297.0 29UDGB Brent 295.9 G82225 The Oaks 291.9 29UKHJ Swanley Christchurch and Swanley Village 291.8 G82156 Ivy Bower Surgery 272.7 29UDGD Greenhithe 283.4 G82097 Jubilee Medical Group 266.6 29UDGH Littlebrook 280.1 G82143 Lowfield Medical Centre 261.9 29UDGQ Town 279.4 G82780 Gravesend Medical Centre 259.8 29UKHK Swanley St Mary's 276.5 Y02826 White Horse Surgery 246.6 29UDGR West Hill 275.2 G82021 The Shrubbery 244.1 29UGFY Coldharbour 269.5 G82006 Dr Shimmins C J & Partners 243.1 29UGGH Riverside 266.3 29UDGP Swanscombe 263.4 G82048 Horsman's Place Surgery 239.1 29UDGA Bean and Darenth 262.7 G82122 Swanscombe Health 237.6 29UKGN Crockenhill and Well Hill 256.1 G82212 Dr Patel B C & Partners 225.4 29UGGL Singlewell 252.9 G82056 The Orchard Practice 219.6 29UGGE Northfleet South 252.5 G82073 Dr Mounty J P & Partners 217.7 29UDGK Newtown 248.3 G82044 The Gateway Medical Practice 217.7 29UDGF Joyce Green 247.8 G82185 Redwood Practice 214.7 29UGGG Pelham 243.3 G82221 Dr Langley S H & Partner 214.4 29UDGS Wilmington 240.2 29UGGF Painters Ash 236.3 G82067 Old Road West 210.8 29UGGD Northfleet North 231.1 G82032 Dr Moran S G & Partners 206.5 29UKHL Swanley White Oak 229.6 G82808 Oakfields Health Centre 203.5 29UGGC Meopham South and Vigo 225.5 G82809 Downs Way Medical Practice 203.3 29UDGM Stone 215.6 G82028 Dr Jones D I & Partners 196.4 29UDGL Princes 202.4 G82647 Temple Hill Surgery 194.8 29UDGN Sutton-at-Hone and Hawley 200.0 G82088 Devon Road Surgery 181.6 29UGGJ Riverview 198.1 29UDGC Castle 197.2 G82096 The Forge Surgery 168.3 29UGGP Woodlands 192.5 G82690 Dr Pillarisetti S C 162.4 29UGGA Istead Rise 189.7 G82218 Farningham Surgery 156.4 29UGFW Central 181.8 G82648 Dr Singh J 146.0 29UGFZ Higham 180.6 G82197 Dr Patel M M & Partner 140.5 29UDGJ Longfield, New Barn and Southfleet 175.4 G82062 Dr Shah S U D 132.2 29UGGM Westcourt 173.4 G82124 West Kingsdown Medical Centre 122.8 29UGGK Shorne, Cobham and Luddesdown 165.6 G82206 Dr Arora R P 65.4 29UKGX Hartley and Hodsoll Street 162.6 29UDGG Joydens Wood 161.5 29UDGE Heath 159.6 29UGGB Meopham North 149.0 29UKGS Eynsford 135.9 29UGGN Whitehill 121.1 29UKGU Fawkham and West Kingsdown 119.3

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Figure 120- Accident & Emergency attendance rates for children aged 5-19 years

The highest A&E attendance rates for 5-19 year olds are found in Swanscombe, Littlebrook, Joyce Green, Brent and Castle wards, the lowest rates are located in Chalk, Joydens Wood, Shorne, Cobham and Luddesdown and Fawkham and West Kingsdown wards.

The GP practices with the highest rates are Lowfield Medical Centre, Swanscombe Health, Ivy Bower Surgery, Bennett Way Surgery and Maple Practice. The lowest rates are found in Dr Shah S U D, Dr Mounty J P & Partners and West Kingsdown Medical Centre.

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Ward Rates GP Practice Rates Ward Code Ward Name 5-19 GP Code Practice Name 5-19 29UDGP Swanscombe 167.1 G82143 Lowfield Medical Centre 169.8 29UDGH Littlebrook 139.2 G82122 Swanscombe Health 148.3 29UDGF Joyce Green 129.7 29UDGB Brent 127.4 G82156 Ivy Bower Surgery 144.4 29UDGC Castle 120.0 G82710 Bennett Way Surgery 115.8 29UGGH Riverside 112.9 G82639 Maple Practice 112.8 29UDGN Sutton-at-Hone and Hawley 111.8 G82212 Dr Patel B C & Partners 110.7 29UDGK Newtown 104.5 G82808 Oakfields Health Centre 108.2 29UKGX Hartley and Hodsoll Street 102.4 G82044 The Gateway Medical Practice 107.3 29UGGM Westcourt 102.2 29UDGA Bean and Darenth 100.5 G82021 The Shrubbery 107.3 29UGGL Singlewell 99.7 G82028 Dr Jones D I & Partners 105.9 29UGGG Pelham 96.7 G82096 The Forge Surgery 103.3 29UKHK Swanley St Mary's 93.4 G82048 Horsman's Place Surgery 99.5 29UKGK Ash 92.9 G82088 Devon Road Surgery 96.5 29UDGR West Hill 92.7 G82097 Jubilee Medical Group 93.4 29UGGN Whitehill 91.9 29UGGD Northfleet North 91.8 G82221 Dr Langley S H & Partner 92.6 29UDGQ Town 91.2 G82647 Temple Hill Surgery 92.1 29UKHL Swanley White Oak 89.5 Y02826 White Horse Surgery 91.8 29UGGF Painters Ash 89.2 G82006 Dr Shimmins C J & Partners 88.5 29UDGD Greenhithe 88.2 G82032 Dr Moran S G & Partners 87.6 29UGGE Northfleet South 87.3 29UDGE Heath 86.7 G82056 The Orchard Practice 86.3 29UDGM Stone 85.2 G82218 Farningham Surgery 76.2 29UDGS Wilmington 84.5 G82067 Old Road West 75.2 29UKGS Eynsford 83.0 G82690 Dr Pillarisetti S C 73.7 29UKGN Crockenhill and Well Hill 82.1 G82809 Downs Way Medical Practice 72.4 29UDGL Princes 81.7 G82197 Dr Patel M M & Partner 71.9 29UGFY Coldharbour 79.3 29UKHJ Swanley Christchurch and Swanley Village 74.9 G82722 Dr Muthappan A K 70.8 29UKGY Hextable 73.2 G82225 The Oaks 70.6 29UGGP Woodlands 71.7 G82780 Gravesend Medical Centre 69.0 29UGGB Meopham North 70.7 G82648 Dr Singh J 67.5 29UGGA Istead Rise 70.4 G82206 Dr Arora R P 65.7 29UGGJ Riverview 70.2 G82185 Redwood Practice 65.6 29UKGT Farningham, Horton Kirby and South Darenth 69.9 29UDGJ Longfield, New Barn and Southfleet 68.7 G82062 Dr Shah S U D 64.7 29UGGC Meopham South and Vigo 68.3 G82073 Dr Mounty J P & Partners 62.5 29UGFZ Higham 66.7 G82124 West Kingsdown Medical Centre 56.3 29UGFW Central 65.8 29UGFX Chalk 63.3 29UDGG Joydens Wood 62.3 29UGGK Shorne, Cobham and Luddesdown 50.3 29UKGU Fawkham and West Kingsdown 30.1

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Figure 121- Accident & Emergency attendance rates for people aged 20-44 years

Wards with the highest rates for people aged 20-44 are Swanley St Mary’s, Swanley White Oak, Coldharbour, Princes, Joyce Green and Northfleet North. Those with the lowest are Central, Whitehill, Crockenhil and Well Hill, Sutton-at-Hone and Hawley, Joydens Wood and Fawkham and West Kingsdown.

The practices with the highest rates are Dr Jones D I & Partners, The Gateway Medical Practice, Ivy Bower Surgery and The Forge Surgery. Those with the lowest are Dr Singh J, Redwood, Downs Way, Farningham and Dr Arora R P practices.

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Ward Rates GP Practice Rates Ward Code Ward Name 20-44 GP Code Practice Name 20-44 29UKHK Swanley St Mary's 356.1 G82028 Dr Jones D I & Partners 256.9 29UKHL Swanley White Oak 253.7 G82044 The Gateway Medical Practice 233.5 29UGFY Coldharbour 244.4 29UDGL Princes 229.4 G82156 Ivy Bower Surgery 229.5 29UDGF Joyce Green 229.1 G82096 The Forge Surgery 220.5 29UGGD Northfleet North 222.4 G82647 Temple Hill Surgery 216.2 29UGGC Meopham South and Vigo 207.1 G82225 The Oaks 211.6 29UGGL Singlewell 205.2 Y02826 White Horse Surgery 208.1 29UDGH Littlebrook 202.1 29UDGA Bean and Darenth 201.2 G82808 Oakfields Health Centre 202.7 29UGGM Westcourt 200.4 G82048 Horsman's Place Surgery 202.1 29UDGP Swanscombe 196.6 G82122 Swanscombe Health 201.9 29UDGB Brent 184.8 G82710 Bennett Way Surgery 201.3 29UGGE Northfleet South 184.1 G82221 Dr Langley S H & Partner 198.6 29UGFZ Higham 182.8 29UGGH Riverside 181.0 G82722 Dr Muthappan A K 198.3 29UKHJ Swanley Christchurch and Swanley Village 179.5 G82021 The Shrubbery 196.8 29UGGF Painters Ash 178.7 G82067 Old Road West 193.3 29UDGQ Town 177.8 G82690 Dr Pillarisetti S C 190.8 29UDGM Stone 177.5 G82212 Dr Patel B C & Partners 190.4 29UKGK Ash 176.3 29UKGS Eynsford 176.1 G82006 Dr Shimmins C J & Partners 190.3 29UGGG Pelham 174.1 G82073 Dr Mounty J P & Partners 183.2 29UKGY Hextable 171.6 G82143 Lowfield Medical Centre 181.8 29UGGB Meopham North 168.9 G82032 Dr Moran S G & Partners 178.3 29UDGD Greenhithe 168.6 G82639 Maple Practice 171.5 29UGGP Woodlands 167.7 29UKGX Hartley and Hodsoll Street 167.6 G82197 Dr Patel M M & Partner 167.8 29UDGJ Longfield, New Barn and Southfleet 164.7 G82780 Gravesend Medical Centre 156.6 29UDGS Wilmington 161.5 G82097 Jubilee Medical Group 154.8 29UGGJ Riverview 161.0 G82062 Dr Shah S U D 154.1 29UGFX Chalk 160.1 G82124 West Kingsdown Medical Centre 151.0 29UKGT Farningham, Horton Kirby and South Darenth 155.3 G82088 Devon Road Surgery 149.7 29UGGK Shorne, Cobham and Luddesdown 154.5 29UDGK Newtown 153.8 G82056 The Orchard Practice 148.7 29UDGE Heath 151.1 G82648 Dr Singh J 142.6 29UDGC Castle 151.1 G82185 Redwood Practice 135.8 29UGGA Istead Rise 150.3 G82809 Downs Way Medical Practice 132.4 29UDGR West Hill 149.0 G82218 Farningham Surgery 122.0 29UGFW Central 146.5 29UGGN Whitehill 146.4 G82206 Dr Arora R P 104.9 29UKGN Crockenhill and Well Hill 129.8 29UDGN Sutton-at-Hone and Hawley 123.3 29UDGG Joydens Wood 105.8 29UKGU Fawkham and West Kingsdown 85.1

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Figure 122- Accident & Emergency attendance rates for people aged 45-64 years

The highest ward rates for A&E attendances for people aged 45-64 are in Swanley White Oak, Swanley Christchurch and Swanley Village, Riverside, Princes and Joyce Green. The lowest rates are in Istead Rise, Woodlands, Wilmington, Joydens Wood, Meopham North and Fawkham and West Kingsdown wards.

The highest GP attendance rates are at Dr Singh J, Dr Muthappan A K and The Oaks practices. The lowest practices rates are in Redwood, Dr Mounty J P & Partners, Downs Way, Maple practice and Dr Arora R P.

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Ward Rates GP Practice Rates Ward Code Ward Name 45-64 GP Code Practice Name 45-64 29UKHL Swanley White Oak 385.2 G82648 Dr Singh J 509.3 29UKHJ Swanley Christchurch and Swanley Village381.3 G82722 Dr Muthappan A K 472.9 29UGGH Riverside 363.1 G82225 The Oaks 312.2 29UDGL Princes 345.8 G82647 Temple Hill Surgery 303.9 29UDGF Joyce Green 345.1 G82122 Swanscombe Health 296.3 29UDGP Swanscombe 331.0 G82143 Lowfield Medical Centre 289.4 29UDGJ Longfield, New Barn and Southfleet 309.1 G82690 Dr Pillarisetti S C 286.1 29UGGM Westcourt 304.5 G82032 Dr Moran S G & Partners 277.8 29UGGD Northfleet North 297.6 G82044 The Gateway Medical Practice 277.1 29UKHK Swanley St Mary's 289.0 G82710 Bennett Way Surgery 276.4 29UDGK Newtown 287.7 G82156 Ivy Bower Surgery 273.7 29UGGG Pelham 287.4 29UGFW Central 286.0 G82048 Horsman's Place Surgery 273.4 29UDGD Greenhithe 281.7 G82021 The Shrubbery 269.1 29UGFY Coldharbour 280.1 G82006 Dr Shimmins C J & Partners 261.0 29UDGH Littlebrook 279.0 G82062 Dr Shah S U D 257.2 29UDGR West Hill 266.6 G82028 Dr Jones D I & Partners 256.8 29UDGM Stone 258.3 Y02826 White Horse Surgery 249.6 29UDGA Bean and Darenth 258.3 G82056 The Orchard Practice 248.2 29UKGY Hextable 257.3 G82221 Dr Langley S H & Partner 247.7 29UKGS Eynsford 248.2 G82097 Jubilee Medical Group 244.9 29UDGB Brent 241.5 G82780 Gravesend Medical Centre 243.4 29UKGK Ash 240.3 G82808 Oakfields Health Centre 234.5 29UGFZ Higham 240.2 G82212 Dr Patel B C & Partners 233.2 29UGGK Shorne, Cobham and Luddesdown 239.2 G82218 Farningham Surgery 231.6 29UKGN Crockenhill and Well Hill 237.5 G82088 Devon Road Surgery 224.8 29UDGQ Town 236.2 G82096 The Forge Surgery 214.4 29UDGN Sutton-at-Hone and Hawley 234.7 G82124 West Kingsdown Medical Centre 207.2 29UGGE Northfleet South 231.9 G82197 Dr Patel M M & Partner 200.5 29UDGE Heath 230.2 G82067 Old Road West 188.9 29UGFX Chalk 221.0 G82185 Redwood Practice 186.9 29UGGL Singlewell 215.3 G82073 Dr Mounty J P & Partners 182.0 29UGGN Whitehill 215.0 29UGGJ Riverview 214.7 G82809 Downs Way Medical Practice 181.6 29UDGC Castle 214.3 G82639 Maple Practice 165.1 29UGGC Meopham South and Vigo 214.0 G82206 Dr Arora R P 159.2 29UKGT Farningham, Horton Kirby and South 212.3Darenth

29UGGF Painters Ash 202.8 29UKGX Hartley and Hodsoll Street 188.4 29UGGA Istead Rise 172.4 29UGGP Woodlands 172.4 29UDGS Wilmington 169.9 29UDGG Joydens Wood 159.5 29UGGB Meopham North 151.2 29UKGU Fawkham and West Kingsdown 116.2 Page | 103

Figure 123- Accident & Emergency attendance rates for people aged 65-84 years

The highest attendance rates at ward level are found in Joyce Green, Wilmington, Farningham, Horton Kirkby and South Darenth, West Hill and Central wards. The lowest are situated in Fawkham and West Kingsdown, Ash, Riverview, Joydens Wood and Chalk wards.

The highest attendance rates broken down by GP practice are in West Kingsdown Medical Centre, Maple Practice, Dr Pillarisetti S C, Temple Hill and The Orchard Practice. The lowest rates are found in Dr Patel M M & Partner, Dr Langley S H & Partner and Dr Muthappan A K practices.

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Ward Rates GP Practice Rates Ward Code Ward Name 65-84 GP Code Practice Name 65-84 29UDGF Joyce Green 805.7 G82124 West Kingsdown Medical Centre 1007.3 29UDGS Wilmington 743.8 G82639 Maple Practice 683.5 29UKGT Farningham, Horton Kirby and South Darenth 668.4 29UDGR West Hill 657.1 G82690 Dr Pillarisetti S C 660.0 29UGFW Central 650.6 G82647 Temple Hill Surgery 659.4 29UDGE Heath 645.3 G82056 The Orchard Practice 625.8 29UKHK Swanley St Mary's 636.2 G82710 Bennett Way Surgery 606.3 29UDGB Brent 632.7 29UDGH Littlebrook 624.2 G82044 The Gateway Medical Practice 582.0 29UDGP Swanscombe 606.5 G82206 Dr Arora R P 553.8 29UDGQ Town 605.5 G82096 The Forge Surgery 545.8 29UDGA Bean and Darenth 605.3 G82062 Dr Shah S U D 544.1 29UGGD Northfleet North 602.2 G82048 Horsman's Place Surgery 542.3 29UGGK Shorne, Cobham and Luddesdown 592.6 29UGFZ Higham 583.2 G82067 Old Road West 541.0 29UDGJ Longfield, New Barn and Southfleet 578.3 G82032 Dr Moran S G & Partners 538.5 29UKGS Eynsford 571.0 G82218 Farningham Surgery 534.6 29UDGD Greenhithe 570.0 G82143 Lowfield Medical Centre 534.4 29UDGM Stone 568.1 G82006 Dr Shimmins C J & Partners 532.5 29UGFY Coldharbour 560.2 29UGGH Riverside 558.2 Y02826 White Horse Surgery 532.0 29UGGP Woodlands 555.8 G82225 The Oaks 531.3 29UGGF Painters Ash 552.1 G82028 Dr Jones D I & Partners 527.1 29UGGM Westcourt 549.0 G82088 Devon Road Surgery 525.6 29UGGE Northfleet South 536.9 G82156 Ivy Bower Surgery 521.6 29UKHL Swanley White Oak 531.0 29UGGL Singlewell 526.2 G82021 The Shrubbery 516.8 29UKGX Hartley and Hodsoll Street 524.3 G82212 Dr Patel B C & Partners 513.0 29UKHJ Swanley Christchurch and Swanley Village 523.2 G82122 Swanscombe Health 505.9 29UDGL Princes 517.0 G82808 Oakfields Health Centre 504.5 29UGGN Whitehill 514.2 G82073 Dr Mounty J P & Partners 487.2 29UKGN Crockenhill and Well Hill 513.5 29UKGY Hextable 508.3 G82097 Jubilee Medical Group 477.8 29UGGG Pelham 505.2 G82780 Gravesend Medical Centre 475.3 29UDGC Castle 500.0 G82648 Dr Singh J 460.7 29UGGB Meopham North 499.4 G82185 Redwood Practice 453.6 29UDGN Sutton-at-Hone and Hawley 488.1 G82809 Downs Way Medical Practice 443.5 29UGGA Istead Rise 485.7 29UGGC Meopham South and Vigo 485.7 G82197 Dr Patel M M & Partner 433.8 29UDGK Newtown 485.2 G82221 Dr Langley S H & Partner 418.1 29UKGU Fawkham and West Kingsdown 474.5 G82722 Dr Muthappan A K 388.9 29UKGK Ash 472.0 29UGGJ Riverview 468.3 29UDGG Joydens Wood 458.5 29UGFX Chalk 357.3

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Figure 124- Accident & Emergency attendance rates for people aged 85+ years

The highest attendance rates for persons aged 85 and over are found in Castle, Riverside, Hextable, Greenhithe, Painters Ash and Princes wards. The lowest rates can be found in Ash, Higham, West Hill, Meopham South and Vigo and Fawkham and West Kingsdown wards.

The practices with the highest rates are Ivy Bower, White Horse, Dr Moran S G & Partners and Dr Patel B C & Partners, those with the lowest rates are Maple, Redwood, West Kingsdown, Dr Shah S U D and Dr Singh J.

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Ward Rates GP Practice Rates Ward Code Ward Name 85+ GP Code Practice Name 85+ 29UDGC Castle 1600.0 G82156 Ivy Bower Surgery 1277.8 29UGGH Riverside 1490.7 29UKGY Hextable 1385.7 Y02826 White Horse Surgery 1250.0 29UDGD Greenhithe 1164.8 G82032 Dr Moran S G & Partners 1069.1 29UGGF Painters Ash 1089.6 G82212 Dr Patel B C & Partners 1016.7 29UDGL Princes 1060.2 G82647 Temple Hill Surgery 954.2 29UGFX Chalk 1051.7 29UKHJ Swanley Christchurch and Swanley Village 1015.2 G82028 Dr Jones D I & Partners 939.8 29UGGM Westcourt 1014.6 G82221 Dr Langley S H & Partner 937.5 29UGGN Whitehill 1000.0 G82044 The Gateway Medical Practice 921.5 29UKHL Swanley White Oak 987.4 G82197 Dr Patel M M & Partner 917.8 29UDGB Brent 929.9 G82710 Bennett Way Surgery 911.8 29UDGA Bean and Darenth 910.6 29UKGX Hartley and Hodsoll Street 910.0 G82722 Dr Muthappan A K 911.1 29UDGH Littlebrook 908.0 G82780 Gravesend Medical Centre 907.6 29UGGD Northfleet North 907.9 G82122 Swanscombe Health 907.2 29UGGB Meopham North 905.2 G82067 Old Road West 893.9 29UGFW Central 885.1 29UDGM Stone 883.0 G82048 Horsman's Place Surgery 887.6 29UGGG Pelham 871.7 G82021 The Shrubbery 881.4 29UDGN Sutton-at-Hone and Hawley 861.1 G82006 Dr Shimmins C J & Partners 829.5 29UDGS Wilmington 854.7 G82088 Devon Road Surgery 824.5 29UGGL Singlewell 846.8 29UKHK Swanley St Mary's 809.0 G82056 The Orchard Practice 815.3 29UDGJ Longfield, New Barn and Southfleet 790.0 G82808 Oakfields Health Centre 729.2 29UDGF Joyce Green 767.7 G82073 Dr Mounty J P & Partners 714.9 29UDGE Heath 762.3 G82096 The Forge Surgery 712.3 29UGGE Northfleet South 760.4 29UGGJ Riverview 755.1 G82225 The Oaks 711.2 29UDGQ Town 750.0 G82143 Lowfield Medical Centre 697.5 29UDGP Swanscombe 735.5 G82218 Farningham Surgery 692.3 29UGGP Woodlands 715.2 G82097 Jubilee Medical Group 674.6 29UGGA Istead Rise 714.3 29UKGS Eynsford 711.9 G82809 Downs Way Medical Practice 606.8 29UGFY Coldharbour 709.0 G82206 Dr Arora R P 523.8 29UDGK Newtown 697.7 G82690 Dr Pillarisetti S C 513.5 29UDGG Joydens Wood 648.3 G82639 Maple Practice 510.4 29UGGK Shorne, Cobham and Luddesdown 626.2 G82185 Redwood Practice 500.0 29UKGN Crockenhill and Well Hill 595.2 29UKGT Farningham, Horton Kirby and South Darenth 592.6 G82124 West Kingsdown Medical Centre 459.5 29UKGK Ash 579.7 G82062 Dr Shah S U D 457.1 29UGFZ Higham 572.6 G82648 Dr Singh J 146.7 29UDGR West Hill 487.0 29UGGC Meopham South and Vigo 391.3 29UKGU Fawkham and West Kingsdown 297.1

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Figure 125- Accident & Emergency attendance rates for people of all ages

For A&E attendance rates for people of all ages the highest ward rates are in Swanley St Mary’s, Swanley White Oak, Longfield, New Barn and Southfleet, Joyce Green and Wilmington. The lowest are in Newtown, Woodlands, Joydens Wood, Fawkham and West Kingsdown and Castle wards.

West Kingsdown Medical Centre has the highest attendance rates of GP practices, Dr Muthappan A K, Dr Jones D I & Partners and The Gateway Medical Practice also have high rates. Those with the lowest rates are White Horse Surgery, Downs Way Medical Practice, Gravesend Medical Centre, Redwood Practice and DR Arora R P.

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Ward Rates GP Practice Rates Ward Code Ward Name All Ages GP Code Practice Name All Ages 29UKHK Swanley St Mary's 328.9 G82124 West Kingsdown Medical Centre 379.2 29UKHL Swanley White Oak 326.5 G82722 Dr Muthappan A K 300.2 29UDGJ Longfield, New Barn and Southfleet 309.3 G82028 Dr Jones D I & Partners 295.7 29UDGF Joyce Green 301.9 G82044 The Gateway Medical Practice 290.0 29UDGS Wilmington 288.7 29UKHJ Swanley Christchurch and Swanley Village 288.6 G82156 Ivy Bower Surgery 286.1 29UDGB Brent 277.7 G82143 Lowfield Medical Centre 282.9 29UGGF Painters Ash 277.4 G82225 The Oaks 281.9 29UGFY Coldharbour 277.0 G82710 Bennett Way Surgery 281.2 29UKGS Eynsford 276.1 G82048 Horsman's Place Surgery 272.1 29UKGX Hartley and Hodsoll Street 274.1 G82021 The Shrubbery 269.7 29UGGK Shorne, Cobham and Luddesdown 273.5 G82122 Swanscombe Health 262.9 29UDGL Princes 273.3 G82032 Dr Moran S G & Partners 260.1 29UDGH Littlebrook 273.0 29UDGP Swanscombe 272.0 G82096 The Forge Surgery 257.0 29UGFZ Higham 268.7 G82647 Temple Hill Surgery 253.6 29UKGY Hextable 267.5 G82097 Jubilee Medical Group 253.4 29UDGA Bean and Darenth 266.2 G82056 The Orchard Practice 252.5 29UGGM Westcourt 264.3 G82690 Dr Pillarisetti S C 251.2 29UKGT Farningham, Horton Kirby and South Darenth 261.4 G82088 Devon Road Surgery 249.4 29UGGH Riverside 258.5 G82067 Old Road West 248.4 29UGGD Northfleet North 251.7 G82808 Oakfields Health Centre 243.3 29UKGN Crockenhill and Well Hill 249.1 29UGGG Pelham 248.1 G82648 Dr Singh J 243.0 29UGFW Central 245.3 G82639 Maple Practice 237.7 29UDGE Heath 243.5 G82218 Farningham Surgery 237.2 29UGGA Istead Rise 241.0 G82006 Dr Shimmins C J & Partners 236.2 29UGGL Singlewell 240.9 G82212 Dr Patel B C & Partners 234.9 29UGFX Chalk 238.2 G82073 Dr Mounty J P & Partners 232.6 29UDGR West Hill 237.6 G82062 Dr Shah S U D 229.8 29UDGD Greenhithe 235.4 G82197 Dr Patel M M & Partner 225.7 29UDGN Sutton-at-Hone and Hawley 233.6 29UDGM Stone 233.3 G82221 Dr Langley S H & Partner 220.9 29UGGB Meopham North 232.3 Y02826 White Horse Surgery 217.6 29UKGK Ash 231.6 G82809 Downs Way Medical Practice 216.9 29UGGC Meopham South and Vigo 226.9 G82780 Gravesend Medical Centre 200.1 29UGGJ Riverview 223.6 G82185 Redwood Practice 199.6 29UDGQ Town 220.3 G82206 Dr Arora R P 195.4 29UGGE Northfleet South 219.3 29UGGN Whitehill 219.0 29UDGK Newtown 218.0 29UGGP Woodlands 213.6 29UDGG Joydens Wood 195.9 29UKGU Fawkham and West Kingsdown 176.6 29UDGC Castle 174.5

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Emergency admission rates in DGS, 2012/13 Figure 126- Emergency admission rates for children aged 0-4 years

DGS CCG has 35 wards with an emergency admission rate for 0-4s higher than 65, the highest of which are Swanley St Mary’s, Greenhithe, Northfleet South, Hextable and Chalk wards. The lowest rates are in Heath, Eynsford, Hartley and Hodsoll Street, Fawkham and West Kingsdown and Higham wards.

The GP practices with the highest rates are Dr Muthappan A K, Ivy Bower, The Oaks, Bennett Way and White Horse, those with the lowest are Farningham, Dr Singh J, Dr Patel M M & Partner, West Kingsdown and Dr Arora R P practices. It should be noted that Dr Arora’s practice didn’t have a single emergency admission for emergency admissions to hospital for 0-4s.

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Ward Rates GP Practice Rates Ward Code Ward Name 0-4 GP Code GP Surgery 0-4 29UKHK Swanley St Mary's 167.2 G82722 Dr Muthappan A K 232.3 29UDGD Greenhithe 144.4 G82156 Ivy Bower Surgery 159.1 29UGGE Northfleet South 142.4 G82225 The Oaks 147.4 29UKGY Hextable 141.3 29UGFX Chalk 138.6 G82710 Bennett Way Surgery 134.6 29UKHJ Swanley Christchurch and Swanley Village 131.1 Y02826 White Horse Surgery 113.5 29UGGH Riverside 126.9 G82021 The Shrubbery 112.2 29UKGN Crockenhill and Well Hill 122.0 G82221 Dr Langley S H & Partner 102.7 29UGFY Coldharbour 120.6 G82044 The Gateway Medical Practice 102.7 29UGGL Singlewell 117.8 G82143 Lowfield Medical Centre 102.0 29UGGF Painters Ash 113.0 29UKHL Swanley White Oak 111.1 G82780 Gravesend Medical Centre 100.0 29UDGB Brent 109.7 G82096 The Forge Surgery 99.0 29UDGP Swanscombe 107.0 G82639 Maple Practice 97.9 29UDGK Newtown 103.3 G82122 Swanscombe Health 95.4 29UDGQ Town 101.6 G82006 Dr Shimmins C J & Partners 91.9 29UDGF Joyce Green 100.9 G82690 Dr Pillarisetti S C 91.4 29UDGC Castle 100.3 G82028 Dr Jones D I & Partners 90.9 29UDGM Stone 87.8 29UKGT Farningham, Horton Kirby and South Darenth 87.8 G82185 Redwood Practice 90.5 29UDGR West Hill 85.3 G82056 The Orchard Practice 89.1 29UDGH Littlebrook 84.0 G82212 Dr Patel B C & Partners 88.9 29UDGN Sutton-at-Hone and Hawley 82.6 G82073 Dr Mounty J P & Partners 86.2 29UDGL Princes 82.4 G82062 Dr Shah S U D 80.5 29UKGK Ash 80.0 G82097 Jubilee Medical Group 76.0 29UGFW Central 79.3 29UDGA Bean and Darenth 76.3 G82067 Old Road West 75.6 29UGGJ Riverview 75.5 G82032 Dr Moran S G & Partners 74.4 29UGGC Meopham South and Vigo 73.5 G82048 Horsman's Place Surgery 74.3 29UDGS Wilmington 72.6 G82088 Devon Road Surgery 72.0 29UGGD Northfleet North 71.9 G82809 Downs Way Medical Practice 66.1 29UDGJ Longfield, New Barn and Southfleet 70.2 G82647 Temple Hill Surgery 62.2 29UGGM Westcourt 69.4 G82808 Oakfields Health Centre 61.9 29UDGG Joydens Wood 68.0 29UGGG Pelham 65.1 G82218 Farningham Surgery 45.3 29UGGP Woodlands 64.2 G82648 Dr Singh J 39.8 29UGGK Shorne, Cobham and Luddesdown 61.3 G82197 Dr Patel M M & Partner 24.8 29UGGA Istead Rise 51.7 G82124 West Kingsdown Medical Centre 17.5 29UGGN Whitehill 50.8 G82206 Dr Arora R P 0.0 29UGGB Meopham North 48.1 29UDGE Heath 45.2 29UKGS Eynsford 38.8 29UKGX Hartley and Hodsoll Street 34.5 29UKGU Fawkham and West Kingsdown 32.1 29UGFZ Higham 19.4

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Figure 127- Emergency admission rates for children aged 5-19 years

For emergency admission rates for people aged 5-19 there are 24 wards with a rate of 20 or more, the highest of these are found in Painters Ash, Littlebrook, Eynsford, Whitehill and Swanley St Marys. Those with the lowest rates are Riverview, Farningham, Horton Kirkby and South Darenth, Istead Rise, Meopham North and Fawkham and West Kingsdown.

The GP practices with the highest admission rates are Lowfield Medical Centre, Dr Jones D I & Partners, Bennett Way Surgery, The Shrubbery and The Forge. The practices with the lowest rates are West Kingsdown, Redwood, Old Road West, Devon Road, Dr Muthappan A K and Dr Patel M M & Partner.

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Ward Rates GP Practice Rates

Ward Code Ward Name 5-19 GP Code Practice Name 5-19 29UGGF Painters Ash 40.1 G82143 Lowfield Medical Centre 52.0 29UDGH Littlebrook 33.7 29UKGS Eynsford 32.5 G82028 Dr Jones D I & Partners 38.9 29UGGN Whitehill 32.1 G82710 Bennett Way Surgery 35.6 29UKHK Swanley St Mary's 31.9 G82021 The Shrubbery 34.8 29UGGH Riverside 31.1 G82096 The Forge Surgery 32.7 29UDGF Joyce Green 30.3 G82212 Dr Patel B C & Partners 28.2 29UGGM Westcourt 28.6 29UDGB Brent 28.0 G82122 Swanscombe Health 25.6 29UDGK Newtown 27.4 G82218 Farningham Surgery 25.4 29UDGA Bean and Darenth 27.1 G82647 Temple Hill Surgery 25.2 29UGGL Singlewell 26.8 G82808 Oakfields Health Centre 24.8 29UDGP Swanscombe 25.5 29UKGX Hartley and Hodsoll Street 25.4 G82690 Dr Pillarisetti S C 24.6 29UKGK Ash 25.2 G82048 Horsman's Place Surgery 24.5 29UGGE Northfleet South 24.7 G82044 The Gateway Medical Practice 23.2 29UKHJ Swanley Christchurch and Swanley Village 23.1 G82032 Dr Moran S G & Partners 23.2 29UDGQ Town 22.8 Y02826 White Horse Surgery 23.2 29UDGM Stone 22.4 29UGFZ Higham 22.2 G82097 Jubilee Medical Group 22.8 29UDGC Castle 21.2 G82156 Ivy Bower Surgery 21.8 29UGGD Northfleet North 20.9 G82006 Dr Shimmins C J & Partners 21.0 29UDGS Wilmington 20.8 G82639 Maple Practice 20.8 29UKHL Swanley White Oak 20.1 29UDGJ Longfield, New Barn and Southfleet 19.9 G82648 Dr Singh J 20.4 29UGFY Coldharbour 17.5 G82780 Gravesend Medical Centre 15.6 29UDGR West Hill 17.0 G82056 The Orchard Practice 15.0 29UKGY Hextable 16.6 G82225 The Oaks 14.9 29UDGD Greenhithe 16.4 G82206 Dr Arora R P 14.6 29UGGG Pelham 16.1 29UDGL Princes 15.2 G82809 Downs Way Medical Practice 13.3 29UGFW Central 14.3 G82221 Dr Langley S H & Partner 12.9 29UDGE Heath 13.2 G82073 Dr Mounty J P & Partners 12.9 29UDGN Sutton-at-Hone and Hawley 13.0 G82062 Dr Shah S U D 11.5 29UGGP Woodlands 12.9 29UKGN Crockenhill and Well Hill 12.2 G82124 West Kingsdown Medical Centre 9.4 29UGFX Chalk 12.0 G82185 Redwood Practice 9.3 29UDGG Joydens Wood 9.9 G82067 Old Road West 8.2 29UGGK Shorne, Cobham and Luddesdown 9.5 G82088 Devon Road Surgery 6.9 29UGGC Meopham South and Vigo 9.3 G82722 Dr Muthappan A K 6.0 29UGGJ Riverview 8.3 29UKGT Farningham, Horton Kirby and South Darenth 7.8 G82197 Dr Patel M M & Partner 2.2 29UGGA Istead Rise 6.9 29UGGB Meopham North 6.8 29UKGU Fawkham and West Kingsdown 6.2

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Figure 128- Emergency admission rates for people aged 20-44 years

The highest admission rates for wards can be found in Swanley White Oak, Coldharbour, Joyce Green, Princes and Swanley St Mary’s wards, the lowest can be found in Istead Rise, Farningham, Horton Kirkby and South Darenth, Joydens Wood, Sutton-at-Hone and Hawley and Crockenhill and Well Hill wards.

The highest rates at GP level are found at Bennett Way, The Forge, Ivy Bower, Temple Hill and The Oaks. The lowest are at Dr Arora R P, Farningham Surgery, Downs Way, Redwood and Devon Road practices.

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Ward Rates GP Practice Rates

Ward Code Ward Name 20-44 GP Code Practice Name 20-44 29UKHL Swanley White Oak 62.5 G82710 Bennett Way Surgery 71.5 29UGFY Coldharbour 60.5 29UDGF Joyce Green 55.5 G82096 The Forge Surgery 52.8 29UDGL Princes 52.4 G82156 Ivy Bower Surgery 52.3 29UKHK Swanley St Mary's 51.4 G82647 Temple Hill Surgery 50.5 29UGGD Northfleet North 51.3 G82225 The Oaks 49.3 29UGGM Westcourt 48.6 G82808 Oakfields Health Centre 47.6 29UGGC Meopham South and Vigo 48.1 29UDGB Brent 45.2 Y02826 White Horse Surgery 46.0 29UGGH Riverside 44.6 G82048 Horsman's Place Surgery 44.9 29UDGA Bean and Darenth 44.2 G82032 Dr Moran S G & Partners 44.0 29UGGL Singlewell 43.4 G82639 Maple Practice 42.1 29UDGP Swanscombe 43.1 G82021 The Shrubbery 41.6 29UDGQ Town 41.9 29UGGB Meopham North 40.8 G82073 Dr Mounty J P & Partners 40.1 29UDGH Littlebrook 40.5 G82122 Swanscombe Health 39.0 29UKGS Eynsford 34.8 G82143 Lowfield Medical Centre 37.9 29UDGM Stone 32.8 G82124 West Kingsdown Medical Centre 37.1 29UDGC Castle 32.7 29UGGE Northfleet South 32.4 G82221 Dr Langley S H & Partner 36.3 29UGGK Shorne, Cobham and Luddesdown 31.7 G82006 Dr Shimmins C J & Partners 35.7 29UKGX Hartley and Hodsoll Street 31.0 G82067 Old Road West 34.2 29UGGN Whitehill 30.4 G82722 Dr Muthappan A K 34.2 29UDGS Wilmington 30.2 G82212 Dr Patel B C & Partners 33.8 29UGGG Pelham 30.0 29UGGJ Riverview 29.8 G82044 The Gateway Medical Practice 33.0 29UDGD Greenhithe 29.6 G82780 Gravesend Medical Centre 32.2 29UGGF Painters Ash 28.9 G82648 Dr Singh J 31.0 29UKGY Hextable 28.6 G82028 Dr Jones D I & Partners 30.9 29UGFW Central 27.6 G82062 Dr Shah S U D 28.0 29UGGP Woodlands 26.8 29UDGJ Longfield, New Barn and Southfleet 26.3 G82197 Dr Patel M M & Partner 27.7 29UDGK Newtown 25.7 G82690 Dr Pillarisetti S C 25.6 29UKGU Fawkham and West Kingsdown 23.8 G82056 The Orchard Practice 25.3 29UDGR West Hill 23.6 G82097 Jubilee Medical Group 23.3 29UKHJ Swanley Christchurch and Swanley Village 22.4 G82206 Dr Arora R P 22.5 29UGFZ Higham 21.7 29UGFX Chalk 20.5 G82218 Farningham Surgery 22.4 29UKGK Ash 20.4 G82809 Downs Way Medical Practice 21.5 29UDGE Heath 19.8 G82185 Redwood Practice 19.2 29UGGA Istead Rise 18.3 G82088 Devon Road Surgery 18.4 29UKGT Farningham, Horton Kirby and South Darenth 18.1

29UDGG Joydens Wood 17.7 29UDGN Sutton-at-Hone and Hawley 15.1 29UKGN Crockenhill and Well Hill 13.6

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Figure 129- Emergency admission rate for people aged 45-64 years

The highest emergency admission rates for persons aged 45-64 in DGS are found in Princes, Northfleet North, Joyce Green, Coldharbour and Riverside wards. The lowest rates are found in Fawkham and West Kingsdown, Wilmington, Joydens Wood, Castle and Meopham North wards.

The highest rates at GP level are Temple Hill, White Horse, The Gateway Medical Practice, Ivy Bower and Swanscombe Health surgery. The lowest rates are found in Farningham, Maple, Dr Mounty J P & Partners, Downs Way and Redwood Practice.

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Ward Rates GP Practice Rates Ward Code Ward Name 45-64 GP Code Practice Name 45-64 29UDGL Princes 86.5 G82647 Temple Hill Surgery 77.0 29UGGD Northfleet North 84.8 29UDGF Joyce Green 75.8 Y02826 White Horse Surgery 73.3 29UGFY Coldharbour 73.3 G82044 The Gateway Medical Practice 68.3 29UGGH Riverside 73.0 G82156 Ivy Bower Surgery 62.2 29UDGD Greenhithe 72.8 G82122 Swanscombe Health 60.6 29UKHL Swanley White Oak 61.6 G82690 Dr Pillarisetti S C 60.3 29UGGL Singlewell 60.3 29UDGP Swanscombe 58.7 G82021 The Shrubbery 59.1 29UKHK Swanley St Mary's 56.9 G82062 Dr Shah S U D 59.0 29UDGH Littlebrook 56.4 G82710 Bennett Way Surgery 57.0 29UGGM Westcourt 56.4 G82780 Gravesend Medical Centre 53.1 29UDGN Sutton-at-Hone and Hawley 53.6 29UGGF Painters Ash 52.6 G82808 Oakfields Health Centre 53.0 29UGFW Central 50.9 G82006 Dr Shimmins C J & Partners 51.1 29UDGA Bean and Darenth 49.0 G82032 Dr Moran S G & Partners 49.0 29UGGE Northfleet South 48.3 G82225 The Oaks 48.7 29UDGB Brent 47.7 29UDGK Newtown 46.5 G82648 Dr Singh J 48.5 29UGFX Chalk 44.8 G82722 Dr Muthappan A K 48.4 29UDGM Stone 44.6 G82124 West Kingsdown Medical Centre 48.3 29UGGG Pelham 43.4 G82056 The Orchard Practice 46.4 29UDGQ Town 39.9 G82048 Horsman's Place Surgery 45.8 29UDGJ Longfield, New Barn and Southfleet 39.2 29UGGK Shorne, Cobham and Luddesdown 38.6 G82088 Devon Road Surgery 45.7 29UKHJ Swanley Christchurch and Swanley Village 38.3 G82143 Lowfield Medical Centre 44.9 29UKGK Ash 36.8 G82212 Dr Patel B C & Partners 43.5 29UGGN Whitehill 35.4 G82067 Old Road West 42.5 29UKGY Hextable 34.5 29UGGJ Riverview 33.7 G82221 Dr Langley S H & Partner 39.9 29UGGC Meopham South and Vigo 33.6 G82028 Dr Jones D I & Partners 39.7 29UGGP Woodlands 29.6 G82096 The Forge Surgery 34.6 29UDGR West Hill 29.4 G82197 Dr Patel M M & Partner 31.9 29UKGS Eynsford 28.6 29UKGT Farningham, Horton Kirby and South Darenth 28.5 G82206 Dr Arora R P 30.3 29UGGA Istead Rise 27.0 G82097 Jubilee Medical Group 28.6 29UKGN Crockenhill and Well Hill 26.0 G82218 Farningham Surgery 27.0 29UGFZ Higham 25.6 G82639 Maple Practice 24.3 29UDGE Heath 25.1 G82073 Dr Mounty J P & Partners 24.2 29UKGX Hartley and Hodsoll Street 24.6 29UKGU Fawkham and West Kingsdown 21.5 G82809 Downs Way Medical Practice 22.5 29UDGS Wilmington 21.3 G82185 Redwood Practice 19.5 29UDGG Joydens Wood 18.5 29UDGC Castle 15.6 29UGGB Meopham North 11.8

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Figure 130- Emergency admission rates for people aged 65-84 years

The highest emergency admission rates are found in Joyce Green, Swanscombe, Grenhithe, Swanley St Mary’s and Brent wards. The lowest rates are found in Swanley Christchurch and Swanley Village, Riverview, Fawkham and West Kingsdown, Chalk and Meopham South and Vigo wards.

The highest GP rates are found in Temple Hill, Swanscombe Health, The Gateway, White Horse and Ivy Bower practices, the lowest rates are found in The Orchard Practice, Jubilee Medical Group, Redwood Practice, Dr Patel M M & Partners and Dr Mounty J P & Partners.

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Ward Rates GP Practice Rates Ward Code Ward Name 65-84 GP Code Practice Name 65-84 29UDGF Joyce Green 247.4 G82647 Temple Hill Surgery 313.4 29UDGP Swanscombe 223.0 G82122 Swanscombe Health 191.2 29UDGD Greenhithe 213.0 29UKHK Swanley St Mary's 209.3 G82044 The Gateway Medical Practice 177.9 29UDGB Brent 198.8 Y02826 White Horse Surgery 176.0 29UDGQ Town 195.7 G82156 Ivy Bower Surgery 175.9 29UDGH Littlebrook 188.9 G82710 Bennett Way Surgery 171.9 29UGGD Northfleet North 187.3 G82048 Horsman's Place Surgery 171.2 29UGGE Northfleet South 183.6 G82124 West Kingsdown Medical Centre 160.6 29UGGF Painters Ash 174.1 G82690 Dr Pillarisetti S C 157.1 29UGGH Riverside 170.4 29UGFY Coldharbour 165.1 G82780 Gravesend Medical Centre 155.5 29UGGL Singlewell 164.6 G82032 Dr Moran S G & Partners 154.9 29UGGG Pelham 162.3 G82639 Maple Practice 153.7 29UGFW Central 159.4 G82067 Old Road West 149.5 29UDGA Bean and Darenth 157.3 G82225 The Oaks 149.5 29UDGS Wilmington 156.5 G82096 The Forge Surgery 148.7 29UKHL Swanley White Oak 153.4 29UDGM Stone 147.8 G82212 Dr Patel B C & Partners 148.1 29UKGY Hextable 142.7 G82006 Dr Shimmins C J & Partners 136.2 29UDGL Princes 139.8 G82021 The Shrubbery 131.0 29UGGM Westcourt 137.8 G82808 Oakfields Health Centre 124.2 29UGGN Whitehill 136.8 G82088 Devon Road Surgery 123.6 29UDGK Newtown 135.7 G82648 Dr Singh J 120.8 29UDGN Sutton-at-Hone and Hawley 135.4 29UKGT Farningham, Horton Kirby and South Darenth 135.2 G82722 Dr Muthappan A K 120.0 29UDGR West Hill 133.3 G82028 Dr Jones D I & Partners 117.3 29UDGJ Longfield, New Barn and Southfleet 133.0 G82218 Farningham Surgery 116.3 29UGFZ Higham 130.3 G82143 Lowfield Medical Centre 115.5 29UKGS Eynsford 127.8 G82221 Dr Langley S H & Partner 110.5 29UDGE Heath 117.1 G82062 Dr Shah S U D 108.3 29UKGN Crockenhill and Well Hill 110.6 G82206 Dr Arora R P 107.6 29UGGP Woodlands 108.2 29UGGK Shorne, Cobham and Luddesdown 106.4 G82809 Downs Way Medical Practice 104.7 29UGGB Meopham North 102.4 G82056 The Orchard Practice 98.9 29UKGX Hartley and Hodsoll Street 100.7 G82097 Jubilee Medical Group 94.8 29UDGC Castle 100.0 G82185 Redwood Practice 90.6 29UKGK Ash 98.7 G82197 Dr Patel M M & Partner 89.0 29UGGA Istead Rise 98.6 G82073 Dr Mounty J P & Partners 79.6 29UDGG Joydens Wood 97.3 29UKHJ Swanley Christchurch and Swanley Village 89.5

29UGGJ Riverview 89.4 29UKGU Fawkham and West Kingsdown 88.3 29UGFX Chalk 76.0 29UGGC Meopham South and Vigo 67.7

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Figure 131- Emergency admission rates for people aged 85+ years

The wards with the highest emergency admission rates for people aged 85 and over are Castle, Hextable, Princes, Painters Ash and Greenhithe. The wards with the lowest rates are West Hill, Coldharbour, Farningham, Horton Kirkby and South Darenth, Fawkham and West Kingsdown and Meopham South and Vigo.

The practices with the highest rates are White Horse Surgery, Dr Patel B C & Partners, Dr Muthappan A K, Dr Langley S H & Partner and Dr Jones D I & Partners. Those with the lowest rates are Maple practice, Oakfields Health Centre, West Kingsdown, Dr Shah S U D and Dr Singh J.

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Ward Rates GP Practice Rates Ward Code Ward Name 85+ GP Code Practice Name 85+ 29UDGC Castle 1000.0 Y02826 White Horse Surgery 791.7 29UKGY Hextable 942.9 G82212 Dr Patel B C & Partners 750.0 29UDGL Princes 721.8 29UGGF Painters Ash 711.4 G82722 Dr Muthappan A K 711.1 29UDGD Greenhithe 703.3 G82221 Dr Langley S H & Partner 625.0 29UKHL Swanley White Oak 622.6 G82028 Dr Jones D I & Partners 615.7 29UDGA Bean and Darenth 585.4 G82122 Swanscombe Health 599.2 29UDGM Stone 585.1 G82710 Bennett Way Surgery 588.2 29UGGG Pelham 584.1 G82780 Gravesend Medical Centre 571.4 29UGGM Westcourt 562.0 29UDGH Littlebrook 551.7 G82048 Horsman's Place Surgery 534.1 29UGGD Northfleet North 539.5 G82044 The Gateway Medical Practice 528.8 29UKGX Hartley and Hodsoll Street 526.1 G82647 Temple Hill Surgery 526.7 29UDGB Brent 522.3 G82197 Dr Patel M M & Partner 520.5 29UDGS Wilmington 511.6 G82096 The Forge Surgery 506.8 29UKHK Swanley St Mary's 483.1 G82056 The Orchard Practice 503.2 29UGGB Meopham North 482.8 G82032 Dr Moran S G & Partners 492.5 29UDGP Swanscombe 479.3 29UDGQ Town 477.3 G82021 The Shrubbery 448.7 29UGGL Singlewell 475.8 G82088 Devon Road Surgery 446.8 29UDGN Sutton-at-Hone and Hawley 472.2 G82067 Old Road West 440.5 29UGFW Central 466.2 G82006 Dr Shimmins C J & Partners 437.5 29UGGN Whitehill 452.1 G82143 Lowfield Medical Centre 432.1 29UDGJ Longfield, New Barn and Southfleet 438.4 G82156 Ivy Bower Surgery 416.7 29UKHJ Swanley Christchurch and Swanley Village 409.1 29UGGJ Riverview 408.2 G82073 Dr Mounty J P & Partners 376.0 29UGGP Woodlands 386.1 G82097 Jubilee Medical Group 370.7 29UDGK Newtown 383.7 G82225 The Oaks 340.5 29UDGE Heath 377.0 G82218 Farningham Surgery 300.7 29UDGF Joyce Green 373.7 G82206 Dr Arora R P 285.7 29UGGH Riverside 370.4 G82690 Dr Pillarisetti S C 270.3 29UGGE Northfleet South 354.2 29UKGS Eynsford 339.0 G82185 Redwood Practice 258.2 29UKGN Crockenhill and Well Hill 309.5 G82809 Downs Way Medical Practice 257.6 29UDGG Joydens Wood 303.4 G82639 Maple Practice 250.0 29UGGA Istead Rise 297.6 G82808 Oakfields Health Centre 197.9 29UGFX Chalk 275.9 G82124 West Kingsdown Medical Centre 189.2 29UKGK Ash 275.4 G82062 Dr Shah S U D 185.7 29UGGK Shorne, Cobham and Luddesdown 271.0 29UGFZ Higham 256.4 G82648 Dr Singh J 80.0 29UDGR West Hill 226.1 29UGFY Coldharbour 223.9 29UKGT Farningham, Horton Kirby and South Darenth 207.4 29UKGU Fawkham and West Kingsdown 152.2 29UGGC Meopham South and Vigo 130.4

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Figure 132- Emergency admission rate for all ages

The wards with the highest rates are Painters Ash, Swanley White Oak, Swanley St Mary’s, Joyce Green and Brent wards. Those with the lowest are Heath, Meopham South and Vigo, Joydens Wood, Castle and Fawkham and West Kingsdown.

The highest rates amongst practices are Temple Hill Surgery, Bennett War, Ivy Bower, The Gateway Medical Practice and Horsman’s Place Surgery. The lowest rates are at Dr Mounty J P & Partners, Downs Way, Dr Singh J, Dr Arora R P and Redwood Practice.

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Ward Rates GP Practice Rates

Ward Code Ward Name All Ages GP Code Practice Name All Ages 29UGGF Painters Ash 93.5 G82647 Temple Hill Surgery 83.4 29UKHL Swanley White Oak 88.2 G82710 Bennett Way Surgery 82.7 29UKHK Swanley St Mary's 87.5 29UDGF Joyce Green 85.0 G82156 Ivy Bower Surgery 80.0 29UDGB Brent 80.0 G82044 The Gateway Medical Practice 79.3 29UDGL Princes 78.5 G82048 Horsman's Place Surgery 74.1 29UGFY Coldharbour 77.3 G82096 The Forge Surgery 73.7 29UDGH Littlebrook 72.5 G82122 Swanscombe Health 73.2 29UDGP Swanscombe 72.5 G82021 The Shrubbery 72.8 29UGGL Singlewell 72.3 29UDGS Wilmington 71.4 G82225 The Oaks 72.6 29UGGD Northfleet North 70.4 G82124 West Kingsdown Medical Centre 71.0 29UDGD Greenhithe 69.9 G82032 Dr Moran S G & Partners 70.4 29UDGA Bean and Darenth 69.8 G82143 Lowfield Medical Centre 69.7 29UGGM Westcourt 69.8 G82028 Dr Jones D I & Partners 68.3 29UGGH Riverside 69.6 G82067 Old Road West 64.2 29UDGJ Longfield, New Barn and Southfleet 69.3 29UKGY Hextable 69.2 Y02826 White Horse Surgery 63.8 29UGGG Pelham 63.7 G82722 Dr Muthappan A K 62.3 29UKGX Hartley and Hodsoll Street 62.6 G82212 Dr Patel B C & Partners 60.5 29UGGE Northfleet South 60.9 G82808 Oakfields Health Centre 58.9 29UKGS Eynsford 60.7 G82088 Devon Road Surgery 58.3 29UDGN Sutton-at-Hone and Hawley 60.1 G82690 Dr Pillarisetti S C 58.1 29UGFW Central 59.3 29UDGQ Town 58.3 G82006 Dr Shimmins C J & Partners 56.8 29UDGM Stone 57.8 G82639 Maple Practice 55.9 29UGGN Whitehill 55.5 G82780 Gravesend Medical Centre 54.9 29UGGK Shorne, Cobham and Luddesdown 54.1 G82056 The Orchard Practice 52.9 29UGFX Chalk 51.3 G82062 Dr Shah S U D 52.6 29UGFZ Higham 51.1 29UDGK Newtown 50.6 G82221 Dr Langley S H & Partner 52.1 29UGGB Meopham North 50.6 G82097 Jubilee Medical Group 50.7 29UKGN Crockenhill and Well Hill 48.6 G82218 Farningham Surgery 49.0 29UKHJ Swanley Christchurch and Swanley Village 48.2 G82197 Dr Patel M M & Partner 48.7 29UKGT Farningham, Horton Kirby and South Darenth 47.4 G82073 Dr Mounty J P & Partners 48.4 29UGGA Istead Rise 46.7 G82809 Downs Way Medical Practice 46.1 29UGGP Woodlands 46.1 29UGGJ Riverview 44.1 G82648 Dr Singh J 44.4 29UDGR West Hill 43.8 G82206 Dr Arora R P 41.6 29UKGK Ash 42.5 G82185 Redwood Practice 37.9 29UDGE Heath 42.0 29UGGC Meopham South and Vigo 40.8 29UDGG Joydens Wood 40.6 29UDGC Castle 39.0 29UKGU Fawkham and West Kingsdown 37.5

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Elective admission rates in DGS for older people, 2012/13 Figure 133- Elective admission rates for people aged 65-84 years

For Elective admission rates for people aged 65-84 the highest are found in Joyce Green, West Hill, Farningham, Horton Kirkby and South Darenth, Heath and Shorne, Cobham and Luddesdown wards. The lowest ward rates are in Pelham, Northfleet South, Istead Rise, Wilmington and Chalk wards. The GP practices with the highest rates are Maple practice, Dr Arora R P, Dr Pillarisetti S C, Farningham surgery and Dr Patel B & Partners. The lowest are at Gravesend Medical Centre, Dr Patel M M & Partners, Swanscombe Health, Dr Langley S H & Partners and Dr Muthappan A K.

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Ward Rates GP Practice Rates

Ward Code Ward Name 65-84 GP Code Practice Name 65-84 29UDGF Joyce Green 456.0 G82639 Maple Practice 451.8 29UDGR West Hill 419.0 G82206 Dr Arora R P 351.7 29UKGT Farningham, Horton Kirby and South Darenth 404.3 29UDGE Heath 375.7 G82690 Dr Pillarisetti S C 325.7 29UGGK Shorne, Cobham and Luddesdown 328.7 G82218 Farningham Surgery 307.9 29UDGH Littlebrook 324.4 G82212 Dr Patel B C & Partners 287.0 29UGFW Central 321.2 G82067 Old Road West 281.8 29UDGC Castle 312.5 Y02826 White Horse Surgery 280.0 29UDGG Joydens Wood 312.2 29UGGN Whitehill 311.3 G82021 The Shrubbery 276.4 29UGGD Northfleet North 305.0 G82808 Oakfields Health Centre 275.8 29UGGL Singlewell 297.7 G82056 The Orchard Practice 272.9 29UKGN Crockenhill and Well Hill 297.3 G82096 The Forge Surgery 270.9 29UGGP Woodlands 294.6 G82143 Lowfield Medical Centre 263.7 29UGGM Westcourt 292.8 29UDGJ Longfield, New Barn and Southfleet 286.6 G82124 West Kingsdown Medical Centre 260.3 29UDGM Stone 279.7 G82088 Devon Road Surgery 260.1 29UGFY Coldharbour 273.1 G82156 Ivy Bower Surgery 259.3 29UKHK Swanley St Mary's 270.8 G82185 Redwood Practice 256.9 29UKGS Eynsford 269.9 G82073 Dr Mounty J P & Partners 253.6 29UKGU Fawkham and West Kingsdown 264.3 29UKHJ Swanley Christchurch and Swanley Village 261.1 G82028 Dr Jones D I & Partners 251.8 29UGGB Meopham North 259.4 G82032 Dr Moran S G & Partners 247.7 29UKGX Hartley and Hodsoll Street 259.2 G82006 Dr Shimmins C J & Partners 245.0 29UDGB Brent 246.6 G82044 The Gateway Medical Practice 240.1 29UDGP Swanscombe 245.7 G82710 Bennett Way Surgery 239.8 29UGGF Painters Ash 245.0 29UDGN Sutton-at-Hone and Hawley 244.0 G82062 Dr Shah S U D 239.3 29UGGC Meopham South and Vigo 237.6 G82097 Jubilee Medical Group 236.4 29UGGJ Riverview 237.3 G82225 The Oaks 226.0 29UDGA Bean and Darenth 230.3 G82048 Horsman's Place Surgery 223.4 29UKGK Ash 229.3 G82647 Temple Hill Surgery 218.0 29UDGD Greenhithe 229.2 29UDGL Princes 226.6 G82809 Downs Way Medical Practice 194.6 29UGFZ Higham 221.9 G82648 Dr Singh J 188.2 29UDGK Newtown 221.5 G82780 Gravesend Medical Centre 185.8 29UKHL Swanley White Oak 221.2 G82197 Dr Patel M M & Partner 180.4 29UKGY Hextable 218.8 G82122 Swanscombe Health 173.8 29UGGH Riverside 218.8 29UDGQ Town 214.1 G82221 Dr Langley S H & Partner 171.6 29UGGG Pelham 214.0 G82722 Dr Muthappan A K 140.0 29UGGE Northfleet South 208.6 29UGGA Istead Rise 199.5 29UDGS Wilmington 181.4 29UGFX Chalk 162.2

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Figure 134- Elective admission rates for people aged 85+ years

The wards with the highest rates for Elective admissions in the 85+ are Riverside, Chalk, Westcourt, Swanley Christchurch and Swanley Village and Sutton-at-Hone and Hawley. The lowest rates are found in Stone, Littlebrook, Bean and Darenth, Riverview and Northfleet North wards. The highest GP practice rates are found in Ivy Bower, Dr Moran S G & Partners, Oakfields Health Centre, Old Road West and Devon Road Surgery. The lowest rates are at Dr Shah S U D, Redwood, The Forge, Dr Singh J and Dr Langley S H & Partners practices.

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Ward Rates GP Practice Rates Ward Code Ward Name 85+ GP Code Practice Name 85+ 29UGGH Riverside 1074.1 G82156 Ivy Bower Surgery 555.6 29UGFX Chalk 741.4 G82032 Dr Moran S G & Partners 438.4 29UGGM Westcourt 350.4 29UKHJ Swanley Christchurch and Swanley Village 348.5 G82808 Oakfields Health Centre 375.0 29UDGN Sutton-at-Hone and Hawley 305.6 G82067 Old Road West 260.5 29UKHL Swanley White Oak 220.1 G82088 Devon Road Surgery 218.1 29UGFZ Higham 213.7 G82006 Dr Shimmins C J & Partners 210.2 29UDGF Joyce Green 212.1 G82021 The Shrubbery 208.3 29UDGD Greenhithe 208.8 G82048 Horsman's Place Surgery 168.7 29UDGG Joydens Wood 206.9 29UGGB Meopham North 206.9 G82212 Dr Patel B C & Partners 166.7 29UGGN Whitehill 205.5 Y02826 White Horse Surgery 166.7 29UKGS Eynsford 203.4 G82218 Farningham Surgery 160.8 29UDGC Castle 200.0 G82225 The Oaks 159.5 29UGFW Central 195.9 G82028 Dr Jones D I & Partners 157.4 29UKGU Fawkham and West Kingsdown 195.7 G82809 Downs Way Medical Practice 155.9 29UDGB Brent 191.1 29UGGE Northfleet South 177.1 G82690 Dr Pillarisetti S C 135.1 29UGGF Painters Ash 174.1 G82124 West Kingsdown Medical Centre 135.1 29UGGA Istead Rise 154.8 G82780 Gravesend Medical Centre 134.5 29UDGK Newtown 151.2 G82056 The Orchard Practice 133.8 29UKGT Farningham, Horton Kirby and South Darenth 148.1 G82044 The Gateway Medical Practice 130.9 29UDGE Heath 147.5 G82206 Dr Arora R P 119.0 29UKGY Hextable 142.9 29UGFY Coldharbour 141.8 G82710 Bennett Way Surgery 117.6 29UDGR West Hill 139.1 G82143 Lowfield Medical Centre 117.3 29UKHK Swanley St Mary's 134.8 G82073 Dr Mounty J P & Partners 115.7 29UGGP Woodlands 132.9 G82639 Maple Practice 114.6 29UDGS Wilmington 127.9 G82722 Dr Muthappan A K 111.1 29UGGL Singlewell 121.0 G82647 Temple Hill Surgery 99.2 29UDGL Princes 120.3 29UGGG Pelham 119.5 G82097 Jubilee Medical Group 97.0 29UGGK Shorne, Cobham and Luddesdown 112.1 G82197 Dr Patel M M & Partner 82.2 29UDGJ Longfield, New Barn and Southfleet 109.6 G82122 Swanscombe Health 63.3 29UGGC Meopham South and Vigo 108.7 G82062 Dr Shah S U D 57.1 29UDGP Swanscombe 107.4 G82185 Redwood Practice 54.9 29UKGX Hartley and Hodsoll Street 99.5 G82096 The Forge Surgery 41.1 29UKGN Crockenhill and Well Hill 95.2 29UDGQ Town 90.9 G82648 Dr Singh J 40.0 29UKGK Ash 87.0 G82221 Dr Langley S H & Partner 20.8 29UDGM Stone 85.1 29UDGH Littlebrook 80.5 29UDGA Bean and Darenth 48.8 29UGGJ Riverview 40.8 29UGGD Northfleet North 39.5

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Outpatient attendance rates in DGS for older people, 2012/13 Figure 135- First outpatient attendance rates for people aged 65-84 years

Outpatient attendance rates for people aged 65-84 are highest in Joyce Green, Wilmington, Farningham, Horton Kirkby and South Darenth, West Hill and Central wards. The lowest are found in Fawkham and West Kingsdown, Ash, Riverview, Joydens Wood and Chalk wards. The highest practice rates are found at West Kingsdown Medical Centre, Maple practice, Temple Hill Surgery, Dr Pillarisetti S C and The Orchard Practice. The lowest are found at Redwood, Downs Way Medical Practice, Dr Patel M M & Partner, Dr Langley S H & Partner and Dr Muthappan A K practices.

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Ward Rates GP Practice Rates Ward Code Ward Name 65-84 GP Code Practice Name 65-84 29UDGF Joyce Green 803.7 G82124 West Kingsdown Medical Centre 1007.3 29UDGS Wilmington 743.8 29UKGT Farningham, Horton Kirby and South Darenth 665.8 G82639 Maple Practice 683.5 29UDGR West Hill 654.4 G82647 Temple Hill Surgery 659.4 29UGFW Central 649.5 G82690 Dr Pillarisetti S C 654.3 29UDGE Heath 645.3 G82056 The Orchard Practice 624.2 29UKHK Swanley St Mary's 636.2 G82710 Bennett Way Surgery 606.3 29UDGB Brent 632.7 29UDGH Littlebrook 624.2 G82044 The Gateway Medical Practice 581.2 29UDGQ Town 605.5 G82206 Dr Arora R P 553.8 29UDGA Bean and Darenth 605.3 G82096 The Forge Surgery 545.8 29UDGP Swanscombe 605.1 G82048 Horsman's Place Surgery 541.1 29UGGD Northfleet North 602.2 G82062 Dr Shah S U D 536.5 29UGGK Shorne, Cobham and Luddesdown 592.6 29UGFZ Higham 583.2 G82032 Dr Moran S G & Partners 536.4 29UDGD Greenhithe 570.0 G82143 Lowfield Medical Centre 534.4 29UDGJ Longfield, New Barn and Southfleet 569.7 G82067 Old Road West 534.2 29UKGS Eynsford 568.2 G82218 Farningham Surgery 533.6 29UDGM Stone 568.1 29UGGH Riverside 558.2 G82006 Dr Shimmins C J & Partners 531.8 29UGFY Coldharbour 555.6 G82225 The Oaks 530.1 29UGGP Woodlands 552.4 G82028 Dr Jones D I & Partners 526.5 29UGGF Painters Ash 552.1 G82088 Devon Road Surgery 523.8 29UGGM Westcourt 549.0 G82156 Ivy Bower Surgery 521.6 29UGGE Northfleet South 536.9 29UKHL Swanley White Oak 528.0 Y02826 White Horse Surgery 520.0 29UKGX Hartley and Hodsoll Street 524.3 G82021 The Shrubbery 516.0 29UKHJ Swanley Christchurch and Swanley Village 523.2 G82212 Dr Patel B C & Partners 513.0 29UDGL Princes 514.2 G82808 Oakfields Health Centre 504.5 29UGGN Whitehill 514.2 G82122 Swanscombe Health 504.5 29UKGN Crockenhill and Well Hill 513.5 29UKGY Hextable 508.3 G82073 Dr Mounty J P & Partners 486.1 29UGGG Pelham 505.2 G82097 Jubilee Medical Group 475.9 29UDGC Castle 500.0 G82780 Gravesend Medical Centre 474.1 29UGGB Meopham North 499.4 G82648 Dr Singh J 460.7 29UGGL Singlewell 488.5 29UDGN Sutton-at-Hone and Hawley 488.1 G82185 Redwood Practice 453.6 29UGGA Istead Rise 485.7 G82809 Downs Way Medical Practice 438.1 29UGGC Meopham South and Vigo 485.7 G82197 Dr Patel M M & Partner 424.7 29UDGK Newtown 485.2 G82221 Dr Langley S H & Partner 418.1 29UKGU Fawkham and West Kingsdown 474.5 G82722 Dr Muthappan A K 388.9 29UKGK Ash 472.0

29UGGJ Riverview 468.3

29UDGG Joydens Wood 458.5 29UGFX Chalk 357.3

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Figure 136- Outpatient first attendance rates for people aged 85+ years

The highest rates for outpatient appointments are found in Castle, Riverside, Hextable, Greenhithe, Painters Ash, Princes and Chalk wards. The lowest are found in Ash, Higham, West Hill, Meopham South and Vigo and Fawkham and West Kingsdown wards The highest GP practice rates are found in Ivy Bower, White Horse, Dr Moran S G & Partner, Dr Patel B C & Partners and Temple Hill. The lowest rates are found in Maple, Redwood, West Kingsdown, Dr Shah S U D and Dr Singh J practices.

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Ward Rates GP Practice Rates Ward Code Ward Name 85+ GP Code Practice Name 85+ 29UDGC Castle 1600.0 G82156 Ivy Bower Surgery 1277.8 29UGGH Riverside 1490.7 Y02826 White Horse Surgery 1250.0 29UKGY Hextable 1385.7 G82032 Dr Moran S G & Partners 1066.1 29UDGD Greenhithe 1164.8 29UGGF Painters Ash 1089.6 G82212 Dr Patel B C & Partners 1016.7 29UDGL Princes 1060.2 G82647 Temple Hill Surgery 954.2 29UGFX Chalk 1051.7 G82028 Dr Jones D I & Partners 939.8 29UKHJ Swanley Christchurch and Swanley Village 1015.2 G82221 Dr Langley S H & Partner 937.5 29UGGM Westcourt 1014.6 G82197 Dr Patel M M & Partner 917.8 29UGGN Whitehill 1000.0 G82710 Bennett Way Surgery 911.8 29UKHL Swanley White Oak 987.4 G82722 Dr Muthappan A K 911.1 29UDGB Brent 929.9 29UDGA Bean and Darenth 910.6 G82780 Gravesend Medical Centre 907.6 29UKGX Hartley and Hodsoll Street 910.0 G82122 Swanscombe Health 907.2 29UDGH Littlebrook 908.0 G82044 The Gateway Medical Practice 890.1 29UGGD Northfleet North 907.9 G82048 Horsman's Place Surgery 887.6 29UGGB Meopham North 905.2 G82067 Old Road West 868.2 29UGFW Central 885.1 G82021 The Shrubbery 859.0 29UDGM Stone 883.0 G82006 Dr Shimmins C J & Partners 829.5 29UGGG Pelham 871.7 29UDGN Sutton-at-Hone and Hawley 861.1 G82088 Devon Road Surgery 824.5 29UDGS Wilmington 854.7 G82056 The Orchard Practice 815.3 29UKHK Swanley St Mary's 809.0 G82808 Oakfields Health Centre 718.8 29UDGJ Longfield, New Barn and Southfleet 790.0 G82096 The Forge Surgery 712.3 29UDGF Joyce Green 767.7 G82225 The Oaks 711.2 29UDGE Heath 762.3 G82073 Dr Mounty J P & Partners 710.7 29UGGE Northfleet South 760.4 G82143 Lowfield Medical Centre 697.5 29UGGJ Riverview 755.1 G82218 Farningham Surgery 692.3 29UDGQ Town 750.0 29UDGP Swanscombe 735.5 G82097 Jubilee Medical Group 674.6 29UGGP Woodlands 715.2 G82809 Downs Way Medical Practice 606.8 29UKGS Eynsford 711.9 G82206 Dr Arora R P 523.8 29UGFY Coldharbour 709.0 G82690 Dr Pillarisetti S C 513.5 29UGGA Istead Rise 702.4 G82639 Maple Practice 510.4 29UDGK Newtown 697.7 G82185 Redwood Practice 500.0 29UGGL Singlewell 661.3 G82124 West Kingsdown Medical Centre 459.5 29UDGG Joydens Wood 648.3 29UGGK Shorne, Cobham and Luddesdown 626.2 G82062 Dr Shah S U D 457.1 29UKGN Crockenhill and Well Hill 595.2 G82648 Dr Singh J 146.7 29UKGT Farningham, Horton Kirby and South Darenth 592.6 29UKGK Ash 579.7 29UGFZ Higham 572.6 29UDGR West Hill 487.0 29UGGC Meopham South and Vigo 391.3 29UKGU Fawkham and West Kingsdown 297.1

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