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High Impact Changes for Practice Teams

The above-named document is currently doing the general practice rounds and hopefully inspiring doctors and nurses to adopt a number of the suggested changes.(1) Despite numerous health reforms in recent years, general practice, for the main part, remains in a similar position to a previous, more traditional time, with GPs, nurses and managers working together with the aim of providing high-quality personal health services to a defined list of patients.

This document is designed to help achieve higher quality in the workplace. Case studies are provided with each of the nine changes to help bring increased authenticity and pragmatism to the document. The changes include: the promotion of patient self-care and self-management; the improved management of long-term conditions; improved access; the redesigning of roles; using data and information to drive improvement; improving care through patient feedback; avoiding unnecessary follow-ups; providing services closer to home; and making the best possible use of practice-based commissioning. This document is timely, given the reorganisation currently taking place in the English NHS and the new demands of the white paper Our Health, Our Care, Our Say.(2) The fact that the script is so simple adds to the quality and will help general practice staff concentrate on implementing measures that have a genuine impact on patients while chaos and confusion flourish in the NHS.

Another document with huge implications for general practice has recently been published. Equal Treatment: Closing the Gap,(3) carried out by the Disability Rights Commission (DRC), is a hefty piece of work written as the result of an investigation into the physical health inequalities experienced by people with learning disabilities and/or mental health problems.(3) The facts are alarming and demand quick, but intelligent, response from primary healthcare teams. The problems are profound and need to bring a renewed approach to the provision of primary healthcare to these two client groups. People with mental health problems also have to contend with higher rates of obesity, heart disease, high blood pressure, respiratory disease, diabetes, stroke and breast cancer than people without mental illness. People with learning disabilities tend to be more obese and despite suffering from high rates of practically every other chronic disease they receive less primary healthcare than the able-bodied within society. Alarmingly, people with schizophrenia are twice as likely to have bowel cancer than others. So, in brief, the story is this: people with learning disabilities and/or mental health problems are more physically ill but receive less care than other members of society. Despite the huge amount of energy currently being focused on improving general practice, there are special groups who continue to be missed out, and far more must be done to ensure that their needs are met.

More incentives are needed to ensure that we improve the care we give to those who need it most. Any discrimination, in terms of being removed from a GP's list on account of someone's learning disability or mental illness, must be identified and then acted upon. Special attention should be paid to care plans to ensure that they include regular physical health checks and progress should be tracked by monitoring trends in morbidity, mortality and patient experience. One easy way of providing new incentives would be through the development of a local enhanced service that ensures regular physical health checks for people with mental illness and/or learning disabilities.

While this DRC investigation may indicate that the impossible needs to be achieved, exploring ways in which each practice could achieve a level of progress would be a fine start and would bring wonderful benefits to some of the most vulnerable people living in our communities.


  1. NHS Institute for Innovation and Improvement. High impact for practice teams. London: DH; 2006.
  2. DH. Our health, our care, our say. London: DH; 2006.
  3. Disability Rights Commission. Equal treatment: closing the gap. London: DRC; 2006.