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Reducing inequalities: a time for action, not talk!

With the recent publication of the WHO report on primary care, Donna Davenport asks what practices are doing to improve the services they provide to patients...

The World Health Organization (WHO) report, Primary Health Care: Now More Than Ever,(1) was published on 14 October 2008 and should make interesting reading for anyone working in primary care. It recognises the safe and effective care being delivered and the wealth of evidence demonstrating that patients value the relationship they have with care providers in the community. However, there is still a great deal of work to be done to make further improvements.
The report focuses on the continuing and widening health inequalities gap that has emerged over the past decade. We know that the numbers of people with long-term conditions are rising. Recent figures suggest there are almost 2.5 million people with diabetes in the UK, with many more undiagnosed, at a cost of £1 million an hour to the NHS. The long-term consequences of this are immense and the personal, social and financial implications are a major cause for concern.

The WHO report focuses on the need for urgent action and a return to a focus on preventive, rather than curative, measures. This is great news for nurses in primary care, an area of practice in which they have strived to deliver excellence, despite other demands and pressures in recent years. Prevention, screening and health promotion and education have never been more important.

We know from high-quality data available in general practice that there are areas of the population that do not access health care and we need to start to analyse the reasons for this, which we know will vary across the country. Mortality and morbidity statistics have greatly improved in more affluent areas but, sadly, in areas of deprivation there is a different picture, and the gap continues to widen.

Chapter 3 of the report focuses specifically on primary care and "putting people first". I am sure many of us have, at times, felt this has not been the case, particularly in the target-driven culture of the NHS. As we are seeing more and more services moved into primary care, it is clear that we need more resources to support this - not just financially, but to support the education and training that health care professionals need to deliver these new services.

The report says we need to reach out to patients and their families rather than wait for them to come to us and I have to agree with this. For too long we have talked about patients not turning up for their appointment (DNAs) - but what have we done to address this? Many practices put up a poster in the waiting room to show how many patients have not attended for their appointment in the previous month, but does this have the desired effect if the patients you wanted to see it haven't come to the practice anyway? How many patients are contacted directly to ask why they haven't attended? If we are going to work in partnership with patients then surely this is an essential first step rather than professionals merely complaining about non-attendance.

There may be real issues and concerns for patients and a prime example of this is cervical cytology. We know that in some areas coverage is really low, but are those areas taking a proactive approach to improving this? What are we doing to improve the health of those women, by detecting abnormalities earlier and therefore improving morbidity from cervical cancer? These are just some examples of where primary care can be more proactive. If you have found ways of addressing some of these issues and made significant improvements please let us know.

I would urge you all to read this important document and use it to plan how you will deliver services over the coming years. The future for primary care is challenging and exciting and we need to be creative and innovative in how we deliver services in the future, and not just do more of the same!

1. WHO (2008) Primary Health Care, Now More Than Ever. World Health Organization, Geneva