Deprivation and Healtha GP perspective

Petra Sambale

Possilpark Health Centre

Glasgow

Psambale@btinternet.com

Deprivation and Health

89% of patients belong to the most deprived quintile

Deprivation and Health

And you? Where do you meet my patients and what is

your experience?

Deprivation and Health GP

Your experience:

Deprivation and health GP

A surgery 1 year old with bronchiolitis 30 year old with otitis, pmh of om,

mastoiditis,CIN2 and deafness, should wear hearing aid, too embarassed, mother died 2005, carer for younger brother and 8 year old child, under investigation for Noonan syndrome, autosomal genetic inheritance, short stature, heart problems, delayed puberty

Deprivation and GP

A surgery 51 year old lady: iron def anaemia,

hepatosplenomegaly, granulomatous enteritis, pruritus, restless legs, non alcoholic fatty liver disease, obesity, Diabetes Type 2, depression, diabetic neuropathy, polyarthopathy, OA knee, hypercholesterolaemia, gastritis, aortic incompetence, gallstones, asthma, works in supported accommodation for young people

Deprivation and GP

A surgery 51 year female: in tears, sobbing, Saturday

night incidence at work where a young girl with substance abuse had knife and was followed by a gang of boys who wanted to fight her and had entered premises

Deprivation and GP

A surgery 51 year old female

What does this woman need?

Deprivation and GP

A surgery 27 year old man, lives with parents, has 2 sisters,

parents are kinship carers of 3 grandchildren, pmh of depression, asthma, self harm and death of sister in 1989

30 year old, mother of 2, with urti and unprotected intercourse, pmh headache, domestic violence, hairline fracture mastoid 2009, persistent headache and left drift heel toe gait and romberg

GP and deprivation

A surgery 54 year old lady with epigastric pain, ashtma,

hypercholesteraemia, obesity, weight loss, hypertension, corrosive gastritis, on ppi’s, breath test negative

GP and deprivation

A surgery 45 year old lady phoned earlier to ask if sister

can come instead of her, as daughter at 37 weeks pregnancy in hospital with reduced fetal movements and anaemia, needs letter for appeal for ESA, PMH: obesity, depression

GP and deprivation

A surgery 40 year old female, PMH: anal carcinoma 2010,

chemotherapy, radiotherapy, acute coronary syndrome 3/11, peripheral neuropathy, premature menopause (radiotherapy), DNAs fu, smear overdue, requires vaginal stretch, bone densitometry, family history….

GP and deprivation

A surgery Emergency appointment not booked 27 year old female pmh sex abuse, self

harming, serious overdoses, lifelink support, ear pain, headache, and police asked her if she wanted report incident that happened in past

GP and deprivation

A surgery 40 year old male: depression, not been out since

last seen me 8 weeks ago, had dnaed one appt, anxious, nervous, pmh: 92 death of sister, 92 death of mother, opioid dependency, 98 death of father, off heroin for 8 weeks,(dealer from upstairs moved out), changed antidepressant

GP and deprivation

A surgery 50 year old female, cervical smear 87 severe

dyskariosis, depression 2001, self harm, CVA 2006, carpal tunnel, hyperchoesterolaemia, lymphocytosis, nov 11 with shortness of breath, lymphocytosis, dry mouth, diagnosed diabetes, discussed understanding, asking if needs injections, www diabetes uk given, daughters support, giving up smoking, also knee pain, physio review then follow knee pathway

GP and deprivation

After the surgery docman (hospital letters), practice nurse meeting with discussion of cases, chronic disease management, telephone calls, medication review

GP and deprivation

A medication review: Dihydrocodeine, fenofexadine, amlodipine,

aspirin, BFZ, Clenil, domperidone, humulin, omeprazole, pravastatin, ramipril, salbutamol, urea cream,

Link diagnosis, check in chronic disease monitoring, check concordance

GP and deprivation

Interface with secondary care What are the issues:

GP and deprivation

Interface with secondary care What are the issues and what can we do better?

GP and deprivation

“ There is not a single boring day” Learn to stay healthy Multimorbidity keeps you up to date Be prepared to take leadership Continuity of Care and Time are paramount

Deprivation and GP

Breast screeing Uptake 49.5% Wos: 72% Scoltland 75.7%

Deprivation and GP

QOF prevalence data Copd 99th centile Epilepsy 99th centile Heart failure 99th centile Mental health 97th centile Stroke/TIA 99th centile Dementia 97th centile Depression 98th centile