Agenda item

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 in compulsory for Strokes to be covered as part of their work.

 

Health professionals need to try and get out into Community centres to raise awareness of the risks of stroke and to monitor blood pressure etc.

 

The awareness of health professionals in the field of strokes also needs to be raised.

 

Tottenham Green Leisure Centre has a GP referral scheme for those with a Body Mass Index of 30 or above.  This would cover those people at risk of stroke. 

Consideration should be given to rolling out the scheme further across the borough.

Leisure Prescriptions.

Discussion around the possibility of introducing Leisure prescription for strokes.  This scheme could include incentivised weight loss goals for example, extended discount at leisure centres.  Dr Pandya’s surgery could consider piloting this.  Would need to consider costs.

Noted that from an acute perspective it would be very useful to know what projects are happening across the borough that they could direct people towards.

 

Need to reinforce the link between healthy lifestyles/exercise and health for example having visible presence of health professionals in leisure centres.

 

Points of discussion

Robert Edmonds, Age Concern Haringey, is currently talking to the TPCT about the use of voluntary sector personal trainers.

 

Dr Robert Luder

Consultant Physician, North Middlesex Hospital Trust

 

Secondary prevention arena.

 

Believes that there is a need for awareness raising campaigns.

 

There are currently a lot of changes going on throughout the whole Stroke pathway.  Including the reconfiguration of services in the acute sector.

The North Middlesex Hospital has but a bid into NHS London to have a Hyper Acute Unit (which would include thrombolysis), an Acute Unit and a TIA service.  There is full organisational support for these bids. (Noted that if the North Middlesex hospital do not win the above bids they will still be provided somewhere else in London and still available for Haringey patients). 

The outcomes of the bids will be known by January 2009 and the majority of services will then be expected to be up and running by approximately October 2009.

 

The costs associated with achieving the above would not be huge overall and comparatively.  It would include recruiting one or two extra consultants, MRA scanning is already available, medication costs and carotid surgery costs.

 

Costs would become savings in the longer term.  There would be increased life expectancy, decreased morbidity and a better quality of life.

 

Key elements of stroke care are seeing people fast, diagnosing them fast and putting them on the correct treatment fast.  If you do this well and systematically then there is a high impact on the outcomes of strokes.  A study in Oxford reported an 80% improvement in the outcomes of stroke patients.

 

It is also important to start aspirin, cholesterol lowering drugs and Blood Pressure drugs immediately after diagnosis and by working closely with primary care services.

 

Once people have had a scare they are generally likely to take it seriously and see their GP.

 

The North Middlesex Hospital is currently looking at electronic systems to enable them to communicate with GPs, for example letting them know when they have seen someone in the acute setting.

Electronic discharge prescriptions are currently part of their IT Strategy.

Ideal would be a system whereby GPs could look up the results from tests carried out in the acute setting rather than having to re-run tests themselves.

 

Points of discussion

Discussion surrounding the relationship between the acute sector and GPs, for example surrounding what happens after diagnosis.

Dr Luder often lectures for GPs and attends group meetings.

There are forms in place to refer TIA patients to their GPs after referral.  This form will be amended should the North Middlesex win their bids.