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Microsoft word - ten years of change.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
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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