Dudley Strategy for Tackling Health Inequalities 2010-15

Further analysis shows that for hypertension, asthma and dementia, the „missing‟patients are spread out across most GP practices. This suggests that Dudley-wideinitiatives will be needed in order to improve the detection of these diseases. Incontrast, for diabetes, CHD and strokes, there are „missing‟ patients in only a smallnumber of practices. This suggests that action needs to be targeted in thesepractices in order to improve detection.There is also variation across practices in respect of MMR, childhood immunisationand flu vaccinations.Prevalence and vaccination Indicators have been agreed as part of the revisedperformance management arrangements described above to ensure that all practicesachieve the PCT‟s minimum standards in these areas.4. Managing Long Term ConditionsThe Quality and Outcomes Framework (QOF) provides a useful way of assessinghow well primary care manages people with a long-term condition. In Dudley, GPpractices as a whole are in line with the national and regional averages for mostaspects of chronic disease management. Again, this masks some very high levels ofperformance as well as some practices where performance is below average.Although the QOF was originally set up to incentivise best clinical practice, and is nota contractual requirement, the clinical standards do support high quality chronicdisease management.Through improved performance management arrangements, GP practices who arenot achieving targets will be supported to improve their existing performance andwhere they consistently fail measures will be put in place to addressunderperformance (see section 1). Good practice will be identified and shared toimprove outcomes for patients in poorer performing practices.Table 2 gives examples of the numbers of people in Dudley with long-term conditionsthat are missing out on specific treatments or interventions, which are known toimprove health. For these patients, health outcomes are likely to be poorer than forpatients receiving the treatments. Treating these patients to QOF standards wouldmake a significant contribution to reducing health inequalities in Dudley.The number of people with hypertension, whose blood pressure is not managed tothe standard, is of particular note, since poor blood pressure control for this group isa risk factor for a number of other serious long-term conditions.181