Agenda and draft minutes

Jinty Wilson (NCLCSN)

Lisa Redfern (AD Adults)

Eugenia Cronin (Joint Director of Public Health)

The Chair will consider the admission of any late items of urgent business.  (Late items will be considered under the agenda item where they appear.  New items will be dealth with at Item 5 below).

TPCT Stroke Report

A Member with a personal interest in a matter who attends a meeting of the authority at which the matter is considered must disclose to the meeting the existence and nature of that interest at the commencement of that consideration, or when the interest becomes apparent.

A Member with a personal interest in a matter also has a prejudicial interest in that matter if the interest is one which a member of the public, with knowledge of the relevant facts, would reasonably regard as so significant that it is likely to prejudice the Member’s judgement of the public interest and if this interest affects their finanicial position or the financial positions of a person or body as descibed in paragraph 8 of the Code of Conduct and/or of it relates to the determining of any approval, consent, licence, permission or registration in relation to them or any person or body described in paragraph 8 of the Code of Conduct.

Dr Manheim if the Chair of Haringey Carers Centre.

To hear from two local General Practioner’s (Dr. V. Manheim and

Dr. S. Pandya) and a Consultant Physician (Dr R. Luder).

Specifically in relation to the medical aspects of stroke prevention, both primary and secondary.

Dr Vivienne Manheim

General Practitioner, Morum House Medical Centre, Haringey

Haringey has a large non English speaking population and this is reflected at the Morum House Centre.

There is a high Turkish population in the area and therefore the practice has two translators.

Concern re transient population and in particular asylum seekers who may not want to become part of the system and therefore are consistently moving. This makes it very difficult to monitor people and ensure that they attend for follow up checks.

All patients are given an initial medical when they join the practice.  If any issues are found then the practice immediately tries to stabilise them.

Some blood pressure stabilising tablets have side effects which prevent people from taking them.

There is a need to get people to take responsibility for their own health and to gain an understanding of the risks that they are taking.

Every TIA and Stroke needs to be reported and monitored.  This is often a big issue.

There can be poor communication between hospitals and GPs regarding those who have had/suspected of having a stroke.  This is especially an issue with the private sector.

Are the private GPs that do not have a contract with the PCT monitored at all?  These are often used by those who do not want to be part of the ‘system’.  There are also language issues which leads those who do not speak English as a first language to go to a private Dr who speaks their language.

Noted that there are some people in the borough who have been resident in the UK for a number of years but who are not aware that they can access the health service for free.

Expert Patient Groups need to be encouraged as they are often very willing to be involved and to help.

Many patients are unwilling to accept that they may have a stroke.

Points of discussion

Query as to how easy it is for patients to access translation services.  Age Concern research has found that it is often not easy.

Some practices use Language Line to get translators.

There is a need to skill up practitioners so that they gain an understanding of their community profile and also to ensure they are all aware of the translating services available.

Not everyone who has a stroke or TIA is ready at that point to hear about the risks they may be taking and to have a conversation about the implications.

Dr Sejal Pandya

General Practitioner, JS Medical Practice, Haringey and member of the Professional Executive Committee (Haringey Teaching Primary Care Trust)

Dr Pandya’s practice has a weekly walking session which is a practice led initiative.  This now has a number of participants who attend on a regular basis.

There needs to be a national campaign on strokes, for example FAST.  This needs to be a campaign along the lines of the recent campaign on Heart Attacks.

Patient Participation Groups (PPGs) – consideration should be given to making  ...  view the full minutes text for item 23.

Dr Tamara Djuretic

Public Health Consultant, Haringey Teaching Primary Care Trust

Tamara presented a report on strokes, including mortality and morbidity data in Haringey.  Please see attached document.

The stroke pathway is complex.

Nationally and in particular in London there is under reporting on the Quality Outcomes Framework.

The West of the borough has lower hospital admission rates but higher mortality rates for stroke.  There are a number of possible reasons for this including the fact that people in the West may be less likely to present to a Dr – they may not know the underlying cause of symptoms they are experiencing.  They are also more likely to die at home.

Dr Luder noted that age is the highest risk factor for strokes, and that the West has a higher proportion of older people.

Stroke mortality across the borough is 50% higher than expected.  These are preventable deaths.

Noted that there is still work to be done in the area of strokes, particularly with regards to stroke registers. The London Health Observatory believes that only 60% of strokes/TIA are picked up in the borough.

Only a London basis Haringey can be considered to be doing ‘okay’ but there are large variances across practices.

Secondary prevention is being managed quite well in Haringey, but it is acknowledged that this is the tip of the ice berg.

Query as to the extent of under reporting – noted that this is at all levels of the stroke care pathway including those at risk of having a stroke.  There is currently no feel to what extent this under reporting is.

Issues include information not being registered properly or at all.  There is sometimes an issue with the IT literacy of some GPs, which may then rely on non-clinicians.  This may cause problems with recalling patients.

There are also issues around people simply not turning up when they have been recalled.

Importance of the concept that “stroke is a preventable condition” noted.

There are a number of variances across the borough in relation to the hypertensive register.  The possibility of looking at the age profile of each practice area and comparing this with the hypertensive register was discussed.  The TPCT have agreed to look at this.

The Vascular checks which will be rolled out in 2009 should improve primary prevention.

Points of discussion

Use of text messaging to remind people of their appointments.  Noted that if you send a patient a text they are highly likely to respond within 30 minutes, which is not the case with letters.   Query as to whether this could be considered for investment?

Noted that older people may not be likely to have a mobile phone.

Noted that blood pressure checks to do have to be carried out by a Dr, they can also be carried out by other health care professionals.  Query as to how many professionals go to the homes of people who are not able to get to practices.

There is a need to find a  ...  view the full minutes text for item 24.

TBC