Microsoft word - ten years of change[1].doc

The following is a brief snapshot of the changes within the Practice over the past 10 years. It has been an interesting exercise for us as a practice to produce this comparison and we hope you find it interesting. There is a commentary on all the data listed at the end of this document. Should you have any observations or comments the practice Consultation Rate
Actual Numbers and Percentage of Total Adult Population (Defined as admitting to an intake of more than 21u/week in Women & _____________________________________________________ Surgery Staffing – Total Hours Worked per Week It has been a fascinating exercise for the practice to compare the practice’s activity over a ten year period and to reflect on the many changes during that time. General practice has changed dramatically since 1997. The following represents a brief analysis of these changes. The new General Practice Contract has resulted in much more complex conditions being treated in local surgeries whilst at the same time GPs themselves have stopped providing care at nights and at weekends. Out of hours care is now provided by Primecare - a countywide service for which many local GPs work. Whilst the total practice population has remained quite constant there has been a marked aging of the practice as a whole with the number of children under the age of 5 reducing by 30% and births by 14% coupled with an increase of 12% in adults over 65. Deaths have also reduced quite dramatically by 53% though this probably represents a normal level of variation around a mean. The consultation rate for the practice as a whole has increased by 18% over 10 years and is probably related to an aging of the population, more complex care being delivered at the practice and a marked increase in certain diseases which will be highlighted below. The nursing staff at the surgery is now providing 68% more appointments than 10 years ago and the use of the telephone for simple consultations has increased dramatically. The number of home visits has reduced by 78% as access to transport has improved. At first glance it would appear that the number of medications prescribed by the practice has increased hugely this is largely due to a change to 28 day prescribing as recommended by the Government. That said it is clear that costs have risen hugely over the past 10 years and our drug spend now stands at over £600,000 - an increase of 105% in 10 years. Clearly, this would have been much greater had generic prescribing not increased from 27% to 83%. The groups of drugs used and, indeed, the specific drugs themselves, demonstrate the change from treating to preventing disease which has been the driving force in modern medicine Immunisation. Immunisation rates have yet to recover from the damage caused by the MMR scare. They are presently too low to prevent a measles outbreak. Clearly, there remains a cohort of children who will be vulnerable to measles in later life which, of itself, carries a substantial risk to them (ii) Cervical cytology uptake remains constantly high over the (iii) Hypertension. The number of people with high blood pressure has doubled over the decade. The aging of the practice population will have an influence as will our efforts to check the blood pressure of all the adult population of the practice. However, the increase in obesity (see below) will have been a major contributor to this huge increase in (iv) Asthma. The 27% drop in the total number of asthmatic can be explained in a number of ways. Firstly, the practice has sought to confirm the diagnosis of asthma in patients. Several were found to be suffering from COPD. Secondly, patients whose asthma had resolved in late childhood and did not require treatment were removed from the register. Lastly, there does seem to have been a true fall in the number of children suffering from asthma. (v) Diabetes Mellitus. Again the number has almost doubled. Similar factors will have been at play i.e. an ageing population, case finding by the practice and obesity. (vi) Epilepsy. There would appear to be a drop in the number of patients suffering with epilepsy. This may be due to the practice ensuring that the correct diagnosis was entered in (vii) Smoking. A gratifying drop of 4.2% is noted in the prevalence of smoking in the practice. The smoking cessation clinics provided at the practice and free nicotine replacement therapy will have aided this fall. (viii) Obesity. The number of obese people in the practice has increased by 277 in 10 years again reflecting national trends. (ix) Alcohol. The number of individuals who are prepared to admit to an intake that may be dangerous to their health has almost doubled in the case of men and has more than doubled in women over the last decade. This finding is in Whilst it is interesting to compare these statistics the absence of data for the intervening years makes claims about trends in referral patterns difficult to confirm except in those areas where the change has been substantial. Data for 1997 – 1998 & 1995 – 1996 exist and have been used in support of some of the claims made. The outstanding statistic in this area of analysis would seem to be the huge rise in the number of people attending A&E. Approximately a by hundred of these will be due to emergency admissions that are now admitted via casualty. Nevertheless, at first glance, it would appear that a large proportion of the increase in attendances by 117 is due to the changes in out-of-hours cover offered by GPs. However, data for the year 1997 – 1998 confirms that the number of patients attending A&E during that year was 538 – a statistic that is almost identical to the 543 for the Age Care, General Medicine, Neurology, Paediatrics and Urology referrals remain largely unchanged over the past 10 years. There have been significant drops in referrals to ENT, Ophthalmology and Rheumatology over the same period reflecting an increased ability on the part of GPs to investigate and manage conditions within these specialities. The fall in referrals to General Surgery is almost certainly due to the excellent diagnostic facilities now easily and rapidly available to GPs. This has enabled us to manage far more conditions within the practice than previously possible. Great credit is due to both the Radiology and Endoscopy departments for facilitating this development. The dramatic decline in referrals to both Dermatology and Gynaecology are a reflection of the expertise developed by doctors at the practice during the past decade where many of the functions of these departments are now undertaken at the surgery. Clearly, this is very much more convenient for patients. The decrease in referrals to the Mental Health unit is a reflection of the fact that simple psychotherapy or counselling is no longer provided by the unit. It does not indicate a reduction in the incidence of mental health problems. The increase in orthopaedic referrals does seem to be large but referral statistics for 1997 – 1998 indicate that 99 referrals were made in that year suggesting that the previous years referrals may have been The overall, referrals were 190(27%) less than 10 years ago and it is clear evidence of more conditions being managed at the practice. It is also interesting that Private referrals have fallen by 20(18%) but it is too small a decrease to categorically claim that an improvement in NHS services has resulted in a reduction in the need for Private Medicine. The enormous increase in the number of tasks the practice has been asked to accommodate over the past 10 years has inevitably required an increase in staffing levels by 62%. The increased level of complexity of care we deliver has also resulted in an increase in nursing provision at all

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