Dudley Strategy for Tackling Health Inequalities 2010-15

There is great variation in performance between practices, with a number ofpractices consistent poor performers. Where practices differ significantly, this couldbe due to poor data recording, a need to improve case finding, higher exceptionreporting which would need investigating or alternatively a higher or lower actualprevalence in that GP practice population. These are important areas to concentrateon in order for the PCT to have an impact on reducing health inequalities in theborough.Exception ReportingException reporting is the process by which patients are excluded from chronicdisease registers for reasons such as failing to attend an appointment after 3reminders, or refusing treatment. Nationally GPs working in more deprived areastend to show higher exception reporting (CQC, 2009, p.17), but this was not the casein Dudley for any of the vascular disease registers.Exception reporting for all vascular disease registers was extremely varied acrossthe practices. Although the overall Dudley average was lower than the Englandaverage for all registers, there were a number of practices with very high exceptionlevels compared to other practices. It is important to review performance in this area,especially with the practice outliers to ensure that exclusion criteria are fair and arenot inadvertently contributing to health inequity.Management of Hypertension for Vascular Diseases in Primary CareThere is high variation in performance between practices for both the recording andcontrol of blood pressure across all vascular disease/ condition registers: CHD,stroke, diabetes, hypertension and Chronic Kidney Disease (CKD). The range ofperformance gaps are detailed in Table 2. The percentage gap represents thenumbers of patients that are not being treated at optimum level.Table 2: Range of performance gapDisease/condition registerQOF Clinical IndicatorPercentagegap rangeDudleyaverageCHD 5 (Bp record