Like many observers of the National Health Service over the past few years, and like many people within it I suspect, I have become weary of the endless succession of changes that have been imposed on primary care – many of them no more than cost-cutting exercises dressed up as improved patient care. Weariness leads to wariness, so it was with some scepticism that I accepted an invitation recently to attend a cardio-vascular (CVD) patient information evening being run by our local practice, the Hillcrest Surgery in Acton, West London. My scepticism was entirely misplaced. It was a most excellent event.
Victoria Wells, the practice manager, tells me that it had been advertised for a month in advance on posters around the practice, in the practice newsletter, and at the bottom of the several hundred emails sent to patients each week acknowledging prescription requests. The practice nurses had also invited some patients personally. The practice had not written to those within particular patient groups, because this was the first such event they had held, and they were unable to forecast the uptake. In the event, a group of remarkably varied people filled the room.
It was clear from the outset that a great deal of thought and effort had been given to making the evening friendly, welcoming and informal. A light buffet went largely untouched, but water, soft drinks and the odd glass of wine helped to create a relaxed atmosphere and to encourage discussion.
We were given two presentations, one by Dr Vijay Tailor, a GP, and one by Rachel Oughton, a practice nurse. Both were remarkable for their comprehensiveness, for their expertise, for being delivered in plain English, and for the balance they struck between good-humoured professionalism and unhurried delivery, which encouraged questions and discussion.
Dr Tailor explained cardiovascular disease in some detail, the risk factors associated with it, ways in which people may keep their hearts and circulation healthy, and treatment options for established disease. Ms Oughton focused on cholesterol and diet. We were given handouts of the presentations as aides memoire and there was a range of detailed and well-produced leaflets on offer.
I maintain my “street cred” as patient editor of the BMJ, in part at least, by having had heart disease for fifteen years or so, and Type-2 diabetes for five. And I suppose that long association with the medical profession and the health voluntary sector in various capacities, and an active interest in maintaining my health, probably classifies me as an “informed patient.” Certainly, I went to this gathering wondering whether I would learn anything new. Equally certainly, I did. For me at least, the evening provided a very clear and detailed layman’s overview of CVD and served as a welcome reminder of a host of things I had part-remembered or forgotten. That it should have over-run by half an hour was scarcely surprising, given the high level of patient interest and discussion it generated.
In drawing the evening to a close, Dr Tailor posed us a question. He outlined a programme the practice is running to identify people at risk of CVD against criteria set by Ealing Primary Care Trust as part of its local enhanced service.
Initially the practice is seeking to attract people between 35 and 74 years of age who have never had a blood pressure (BP) reading or have not had one within the past five years. Those who respond will have their BP taken and their body mass index (and waist hip ratio if their BMI is 30 or more) noted along with their ethnicity. They will have urinalysis and be asked about smoking status and about family history of coronary heart disease and diabetes in first degree relatives. The practice will then run the risk scores and add them to a primary prevention register. (Patients whose blood pressures have been taken within the past five years will be included in the risk calculation, but the first step is to ensure that the practice has the data on all patients in the age range.)
The greatest challenge, of course, lies in persuading middle-aged men most of whom rarely see their doctors, to attend for risk assessment. How best, asked Dr Tailor, might the practice reach this notoriously hard-to-reach group? If any readers have solved this problem, or have any ideas as to how it might best be solved, I am sure the practice would be pleased to hear from them.
There can be no doubt that disease prevention through education and prophylactic treatment is a highly cost-effective use of health service resources. I do not know whether this patient information evening was held in response to some dictat from above or on the surgery’s own initiative; nor do I care. From this patient’s perspective at least, it was truly exemplary and very worthwhile.
Copies of Dr Tailor’s and Ms Oughton’s PowerPoint presentations may be obtained from the practice manager, Victoria Wells – Practice.Manager@gp-e85028.nhs.uk.
Peter Lapsley is patient editor, BMJ.