gp practice profile compiled by theresa lowry lehnen specialist nurse practitioner in conjunction...

GP PRACTICE PROFILE

GP PRACTICE PROFILE

FACCINI HOUSE SURGERY

64, MIDDLETON ROAD

SURREY

SM4 6RS

TELEPHONE: 0208 6464282

Data Compiled by

Theresa Lowry-Lehnen

Specialist Nurse PractitionerIn conjunction with Surrey University

January 2005

GENERAL PRACTITIONERS, NURSING & ADMINISTRATIVE STAFFG.Ps

Dr JK Sheikh

Dr I Zaidi

Dr ME Erskine

Nursing Staff

Specialist Nurse Practitioners:

Marie Edwards


Practice Nurse:

Louise Dennis

Practice Manager:

Beverley Moore

Lynne Murray (Assistant)

Receptionists:

Farrah Sheikh

Susan Richardson

Melonie Verrell

Secretary

Ann Symes

Health Visitors:

Tracey Holland

Linda Baines

Community Midwife:

Helen SimmonsRespiratory Specialist:

Jan WalkerFaccini House Surgery

Services Provided( Minor illness clinic: Daily 08.00 09.30

Nurse Practitioner lead

( Asthmatic clinic

( Diabetic clinic

( Hypertension clinic

( Smoking cessation clinic

( COPD clinic

( Well woman clinic

( Well man clinic

( Weight loss/Nutritional education clinic

( Minor surgery

( Travel vaccination clinic

( Childhood vaccination clinic

( Elderly health assessment

( Family planning (IUCD fitting )

( Ante natal clinic

( Health visitor clinic

( On site pharmacy

( Home visits

( Disabled access/Parking/Lifts

INTRODUCTION

While completing the BSc (Hons) Specialist Nurse Practitioner degree course at Surrey University, I am undertaking a Public Health module which requires me to carry out a health needs assessment profile, identifying a health need within a community from my practice area. To do this I am working in partnership with other specialist practitioners from various disciplines gathering data from a range of sources including demographic data, health of the population, health resources and environmental influences.

The objective of community profiling is to assess the health and social needs of a defined population in order to ensure a more effective and efficient use of resources (Hawtin et al 1995).

The following is a GP Practice profile of the practice population at the surgery where I am based. A practice profile is an organised attempt to examine the characteristics and health needs of the people registered with a General Practitioner practice. To do this I collated statistics from the GP surgery computerised records and from both the Health Visitor and District Nurses caseloads. I also consulted with and gathered information from the GPs and Nurses and other staff working at the surgery. Where certain information was not available or not up to date at the surgery I gained this from local organizations, the Sutton and Merton Primary Care Trust and statistics provided by the National Census 2001. This profile combined with both local and national statistical data and partnership working with my colleagues both at work and at the university has allowed me to identify a health need within a community (The St. Helier wards) in my practice area.

Practice Profile

Faccini House Surgery is based on the borders of Merton and Sutton. The practice forms part of the Sutton and Merton PCT, with 53% of patients living in the borough of Sutton and 47% residing in Merton.

The wards where the majority of the practice population live are:

WARDS AND DEPRIVATION SCORES

WARDS PRACTICE POPULATIONDEPRIVATION SCORE (ONS 2002)

St. Helier47%25.9

St. Helier North22%37.9

St. Helier South20%36.6

Rosehill 7%14.4

Sutton Common 4%11.2

St. Helier, St. Helier (North) and St. Helier (South) are among the top ten most deprived wards in the South Thames area. Both the St. Helier North and South wards are in the borough of Sutton, and the St. Helier ward is in the borough of Merton.

The practice population comprises 5630 patients of which:

Faccini House Surgery, Morden

Patients 5630

Male 2834 (50.3 %)

Female2796 (49.7 %)

The resident population of Sutton, as measured in the Census 2001, was 179,768 of which 48% were male and 51% female. The resident population of Merton, as measured in the Census 2001, was 187,908 of which 49% were male and 51% female.

Practice Population age ranges

0 - 12991

13 - 18554

19 - 30883

31 - 501656

51 - 65614

65+922

ETHNICITYEthnicitySt. Helier (Merton)MertonLondonEngland

White83.8 %75 %71.2 %92.2 %

Asian7.7 %11.1 %12.1 %4.6 %

Black3.8 %7.8 %10.9 %2.1 %

Chinese (other)2.1 %3.0 %2.75 %0.9 %

Mixed2.5 %3.1 %3.2 %1.3 %

EthnicitySt. Helier (Sutton)SuttonLondonEngland

White90.6 %89.2 %71.2 %92.2 %

Asian3.0 %4.7 %12.1 %4.6 %

Black3.0 %2.6 %10.9 %2.1 %

Chinese (other)1.1 %1.4 %2.75 %0.9 %

Mixed2.2 %2.1 %3.2 %1.3 %

Source: Office of National Statistics 2002

CHRONIC DISEASES

PATIENTS WITH CHRONIC DISEASE WHO SMOKE

In compiling this profile, I looked at the number of our practice population diagnosed with the three main chronic diseases: Asthma, Diabetes and Coronary Heart Disease, followed by the number of these patients over the age of 13 who smoke.

St. Helier North and South wards have the highest level of chronic illness in Sutton, the former 16% and the latter 14%. The St. Helier ward at 17% has the highest level of chronic disease in Merton (Sutton and Merton PCT 2003a).CHRONIC ILLNESS PATIENTS

ASTHMADIABETESCORONARY HEART DISEASE

AGENUMBERAGENUMBERTOTAL183

0 12820 1213

13 249013 2425

25 44 12525 5074

45 646350+ 104

65 7425TOTAL189

75+14

TOTAL 399

The practice population also comprises a high number of smokers. Of the 4,085 patients aged over 18, a total of 1307, or 32%, are registered as smokers. This is a higher proportion than the national average of 26%, but close to the national proportion of those in routine or manual employment who smoke (31%) (DoH 2004a). Of 554 young people aged between 13 and 18 registered at the surgery, 55 smoke, that is 10%, slightly higher than the national average (9%) of 11 to 15 year-olds who smoke (DoH 2004a).

A comparison between smokers and those with chronic illnesses shows that a high proportion of chronic disease patients are smokers. Of the 399 asthmatic patients, 194 or 61% are registered as smokers. Of the 189 diabetic patients, 62 or 35.2% are smokers, and of the 183 coronary heart disease patients, 115 or 63% are smokers.CHRONIC ILLNESS AND SMOKING

DISEASETOTALSMOKERSPERCENTAGE

Asthma39919461.0 %

Diabetes189 6235.2 %

CHD18311563.0 %

KEY FACTS SMOKING (DoH 2004)

Smoking is the greatest cause of preventable illness and early death in the UK Smoking is the single biggest cause of health inequalities and is associated with poverty and social deprivation

Over 120,000 people die from smoking in the UK each year.

10,000,000 adults are smokers in England.

26% of adults smoke ( 25% of women, 27%of men)

9% of 11 15 year olds are smokers

Smoking causes a wide range of illnesses, including cancer, respiratory diseases and heart disease

Smoking costs the NHS between 1.4 and 1.7 billion pounds per year in England

70 % of smokers say they would like to stop.

GOVERNMENT TARGETS ON SMOKING (DoH 2004)

To reduce adult smoking rates from 26% in 2002 to 21% or less by 2010

To reduce the prevalence of smoking among routine and manual groups from 31% in 2002 to 26% or less by 2010

Smoking cessation to be embedded in all NHS social care pathways by 2006

The NHS to become a smoke free zone by 2006. Nurses to be targeted to quit smoking as part of a joint DoH and RCN campaign from 2005

Boost smoking cessation campaigns. Provide information, support, NRT and access to NHS support and stop smoking services

Restrict tobacco advertising

In 2005 2006, the Healthcare Commission will examine what PCTs are doing to reduce smoking in the local populations. Progress will be monitored against national standards and indicators

ALCOHOL

I hoped to find practice population statistics which would allow me to identify the number of people registered at our surgery who consume alcohol and especially those who drink above the government recommended guidelines. Unfortunately, our computer records were not fully updated with this information, and I was unable to gather correct statistics. However the following DoH 2004 statistics, highlight the serious health and social implications caused by alcohol misuse, and this would emphasise the importance of alcohol screening and intervention in a primary care setting.

(5.9 million People in England drink above the governments recommended guidelines.

( 25 % of children aged 11-15 drink on average 10 units per week.

( Half of all violent crimes and 360,000 cases annually of domestic violence are alcohol related.

( Alcohol causes 150,000 hospital admissions annually.

( 70 % of A&E attendance is alcohol related.

( Up to 22,000 deaths annually are alcohol related.

( The loss to the economy is 2.4 billion annually

(DoH 2004)

The above statistics imply that alcohol is a major cause of violent crimes. In Merton, the number of violent crimes is 15.7 per 1000 population, compared to 11.4 per 1000 for England and Wales. In Sutton, the ratio is 11.5 : 1000 (Census 2001).

Mental Health

I was informed by the Practice manager that the following Mental health statistics are not accurate, as the computer records for some categories are at present not fully updated at Faccini House Surgery. This is being up dated at present.

I could only identify from computerised records that 15 patients suffer with severe mental health problems. The number of patients recorded with other mental health problems such as depression is: 82

The practice manager and GP believe that the real figures are much higher.

The following government statistics (2004) show that:

( Up to one in four consultations with a GP concern mental health issues.

( One in six adults at any one time has a mental health problem.

( As many as nine million people are affected.

( Work related stress affects one in five workers (approx. 5 million

people).

( 865,900 adults on incapacity benefit in England report their condition to

be mental ill health.

( One in ten children under the age of 16 have a mental health problem.

(DoH 2004)

CANCER

Computerized records show that 220 patients presently registered at this surgery are suffering from or have had Cancer. This is equal to 3.9 % of the practice population.

I was unable to find recent statistics for cancer in the St. Helier wards, however the Annual report of the Director of Public Health for Sutton and Merton states that the local Sutton and Merton rates for cancer, particularly breast and lung cancer are higher than the national average. In 1996 the mortality rate for all cancer patients in Sutton and Merton was 1385 of which 328 were Lung cancer and 124 were breast cancer (Merton Sutton and Wandsworth Health Authority 1996/1997).

TEENAGE PREGNANCY AND LONE PARENT HOUSEHOLDS

Our computerised records did not provide actual practice population statistics on either teenage pregnancy or lone parent households.

To obtain this local and Ward information I consulted the following;

( The Sutton and Merton Teenage Pregnancy Units

( The Census 2001

( The Office for National Statistics

LONE PARENT HOUSEHOLDS

St. Helier (Merton)MertonLondon

7.6 %6.0 %7.6 %

St. Helier (Sutton)SuttonLondon

11.8 %6.1 %7.6 %

(Census 2001)(ONS 2001)

TEENAGE PREGNANCY RATES 2002 (Ages 15-17)

St. Helier (Merton)MertonEngland

54.1 per 100040.5 per 100046.2 per 1000

(Merton Teenage Pregnancy Unit, ONS 2002)

St. Helier (Sutton)SuttonEngland

63.4 per 100035 per 100046.2 per 1000

(Sutton Teenage Pregnancy Unit, ONS 2002)

ELDERLY

The number of elderly (age 65+) patients registered at Faccini House surgery is 922.

The practice population number of elderly patients living alone is: 175

This correlates to 19% of our elderly practice population living alone.

The following ward data was obtained from the Census 2001.ELDERLY PATIENTS LIVING ALONESt. Helier (Sutton) 17.4 %

Sutton13.8 %

St. Helier (Merton)19.1 %

Merton12.8 %

England/Wales14.4 %

Source: Office of National Statistics 2002

The St. Helier wards which form the largest part of our practice population, have an above average local and national percentage of pensioners living alone.The district nurse and her team have at present 15 elderly patients from our surgery on their case loads who require home visits.

CHILDREN

There are 1,545 people under the age of 18 registered at Faccini House Surgery.

Of these 1,340 are under the age of 16.

The practice Health Visitor Linda Blaine provided me with the following information from her caseloads.

There are 78 families with children under the age of 5, registered at Faccini House Surgery who belong to the Sure Start programme.

The total no of family records held are 332

There are 4 families without children under 5 years receiving health visiting services.

There are 22 families with children under 5 years who are considered a low level of vulnerability (Level 1). There are 6 families at level 2 whose needs are complex enough to require more than one agency.

There are 2 families at level 3 whose needs are complex and require a co-ordinated multi-agency assessment, service plan and review process.

There are 3 Families at level 4and 5 who have the highest level of vulnerability. Specialist assessment has confirmed the need for specific, sustained and intensive support.

The number of practice population births recorded for 2004 is: 95

The number of practice population low birth weight babies for 2004 is; 11

This means 11.6 % of the practice population births for 2004 were low birth weight

Low birth weight is associated with low socio-economic status(highest in births registered by the mother alone) smoking, maternal nutrition pre pregnancy, and energy intake during pregnancy (Sutton and Merton PCT 2003b).

The number of low birth weights for

St. Helier South ( 2002-2003)= 32

St. Helier North (2002-2003)= 44

St. Helier Merton (2002-2003) = 38

Rosehill (2002-2003) = 20

Sutton Common(2002-2003) = 19

(Sutton and Merton PCT 2003b)

GENERAL STATISTICS

To find out more information about the practice population not available on our computerised records, the following Ward statistics were obtained from the 2001 Census.

The St. Helier wards form the largest part of our practice population.

Limiting long term illness;

St. Helier (Merton)MertonSt. Helier (Sutton)SuttonEng/Wales

18.7 %13.8 %18.2 %14.8 %18.2 %

Unemployment


3.4 %3.3 %3.8 %2.6 %3.4 %

Providing unpaid care


8.8 %8.0 %8.5 %9.0 %10.0 %

No Qualifications


33.8 %19.9 %37.8 %23.3 %29.1 %

One person households


33.2 %32.1 %30.6 %33.1 %30.0 %

Households with dependent children


31.0 %28.6 %37.8 %30.0 %29.9 %

Lone parent households with dependent children


7.6 %6.0 %11.8 %6.1 %6.5 %

Owner occupied housing


59.7 %68.8 %51.8 %74.3 %68.9 %

Rented council accommodation


26.4 %9.2 %42.0 %10.9 %13.2 %

Without central heating


22.8 %10.2 %13.1 %7.1 %8.5 %

No car or van


35.8%30.1%35.1%23.3%26.8%

(Source: Office of National Statistics 2002)

THE AREA

Faccini House Surgery is situated in Middleton Road in Morden, on the borders of Merton and Sutton. The practice is situated on the St. Helier estate, which is one of the top ten most socially deprived areas in the South Thames region. Both Sutton and Merton are relatively affluent boroughs but the northern wards of St. Helier South and North(Sutton) and St. Helier(Merton) have high deprivation scores and lower health status (Sutton and Merton PCT 2002).

The practice is situated 1.5 km from Morden centre, 3 km from Sutton centre and 1 km from Rosehill. While Faccini House Surgery provides a very good service for its practice population, the area itself lacks many facilities and services. Accessing most services in the area would depend on travel by bus or car. The closest A&E department is at St. Helier Hospital approximately 2 km away. The nearest police and fire stations are in Sutton. The closest supermarkets are in Rosehill and Morden and would be difficult for the elderly or those with small children without transport to access. There are four primary schools and one high school in the immediate area, with lower educational achievements compared to other schools in more affluent areas of Merton and Sutton(Ofsted 2004). The area has a number of churches of various denominations. The nearest cafs are in Rosehill and Morden centre (Windshield Survey 2005).

The vast St. Helier estate was built in the post war years in the late 1930s. The houses are small redbrick council style terraced houses, each row backing on to another row of similar type houses. There is a mixed ethnic population but the majority are white. Many residents are in receipt of housing and other benefits. It has a lower than local and national level of owner occupied homes and a higher than local and national level of council rented accommodation. It has a large elderly population, a high level of pensioners living alone, a high incidence of young single mothers and a high rate of unemployment. Compared to local and national statistics it also has a high level of residents with no qualifications (Census 2001).

The centralisation of facilities and services has resulted in this community lacking in local services to meet its population needs.

The Residents opinion

To find out what the local people felt about the area (St. Helier) and the services provided I gained the following information from the relevant section of the most recent Northern Wards Participatory Needs Assessment (1998).

In the executive summary of the Northern Wards Participatory Needs Assessment (Merton Sutton and Wandsworth 1998) the St Helier residents were concerned about the lack of facilities in the area for young people. This included poor provision of nurseries and after school clubs, with cost being a major issue especially for single mothers. With regard to older people, the need for day care, more nursing homes and social services was highlighted. Housing issues were raised, especially the poor provision for older people living alone, and the slow repairs to council houses.

With regard to health issues, the residents were concerned about long GP waiting times, and talk about the closure of St. Helier Hospital. Other concerns about St. Helier Hospital included long waiting lists and the early discharge of patients. Residents felt more resources were required for respite care, mental health, out of hours services, health visitors and social workers visiting the housebound.

With regards to leisure, lack of facilities for young people was a major concern, and was blamed by many residents for the increase in drugs and crime in the area. For adults, facilities were also considered poor, with the need to travel out of the area by limited public transport or expensive taxis.

With regards to transport, there were differences of opinion between car and non car owners. Those who owned cars found difficulty in parking and garages to rent on the St. Helier estate. Non car owners were concerned about the dangers from parked cars especially preventing prams and pushchairs getting through. Environmental issues raised were traffic pollution, graffiti, dog mess and the vandalism and destruction of public phones and bus shelters. Regarding safety and crime, residents both young and old said they felt unsafe on the streets at night. Much of the crime in the area is thought to be related to alcohol, under age drinking and drugs.

Long standing and older residents felt the area had a strong sense of community, helped by having a happy and stable network of family and friends. There was some hostility towards new residents who were regarded as having a reputation of being rough. As a consequence there was some conflict between generations, and differences were also seen to be aggravated by the high unemployment levels experienced in the area (Merton, Sutton and Wandsworth Health Authority 1998).

WHAT IS BEING DONE ?

Since this Northern Wards Participatory Needs Assessment (1998) there have been some improvements in the area. A new leisure centre has been built on Middleton Road and was opened to the public in 2002. There are traffic calming measures being put in place and some road and public transport improvements. Connexions, the governments support advice and personal development service for 13-19 year olds, has opened a local centre. The Sutton and Merton PCT have plans for one stop primary care centres and one of these will be a new Health centre in nearby Green Wrythe Lane, which promises to offer a variety of health services under one roof for the local people. The PCT is also involved in participatory well being needs assessments. For the elderly and needy there are cook and eat clubs, and exercise and falls prevention and health classes in the local area.

The Sutton and Merton Primary Care Trust was formed in April 2002. The overriding aims of the Sutton and Merton PCT are to improve local health services, the health of the population and to address health inequalities. It is one of the largest PCTs in the UK, and the only PCT covering two Local Authorities. In its Local Delivery Plan the Sutton and Merton PCT(2003a) envisages that working closely with the Boroughs of Sutton and Merton will enable a joint approach to address the issues in the deprived areas particularly in the wards to the north of Sutton, Roundshaw and in East Merton. These include St. Helier (Merton) and St. Helier North and South (Sutton).These areas have health problems such as high rates of coronary heart disease and cancer; a relatively high proportion of low and very low birth weight babies; smoking related disorders; and a high rate of teenage pregnancy.

The aims of the PCT include ; To shift services nearer to peoples homes particularly for the management of chronic illness, but also to coordinate with other local agencies both statutory and voluntary to enable the management of health need to become more local, and less hospital focused ; To improve the co-ordination of services for older people so that people receive the best care in or as close to their homes as possible ; To develop primary care particularly in the more deprived parts where investment has been low ; To ensure that Mental health services are improved, that services for children are directed by the needs of the child and to develop the ability of communities to improve their own health.

The PCT envisage the provision of diagnosing and treating people where possible in the community and reserving hospital usage for the specialist and trauma services which require an acute setting. They plan to work across the interface between hospital and primary care, to achieve more support for older people, more outpatient and chronic illness services in primary care settings, including peoples homes. Access to out of hours GP services provided through the NHS Direct is being introduced across the region. The PCT has been working with GP practices and auditing the access requirement of the national target, to see a primary care professional within one working day and a GP within two working days.

The PCT recognise that smoking is a major contributor to ill health, and responsible for the socio-economic gradient in ill health. The target for Sutton and Merton is 5,442 smokers successfully quitting by March 2006. This will require concerted effort from the PCT, and Primary care together with all statutory and voluntary agencies, schools and local employers. To reduce smoking in the manual groups will need to address social and economic issues.

The PCT aims to work with GPs and other trusts to ensure the national plan targets for coronary heart disease are met, they also continue to work towards developing healthier lifestyles for young people and local communities and to reduce smoking.

The PCT takes the view of addressing health inequalities across the boroughs as one of its priorities. It is aware of the socio-economic issues which influence the health of many people, such as smoking, nutrition, drugs and alcohol, sexual health and teenage pregnancy. Smoking is a key target and being addressed through the smoking cessation services but more robust links need to be established to ensure services reach those most vulnerable and particularly at risk (Sutton and Merton PCT 2003).

SERVICES PROVIDED AT FACCINI HOUSE

Faccini House Surgery, provides a wide range of services for its practice population.

The practice Specialist NursePractitioners run a walk-in minor illness clinic each morning from Monday to Friday 8.30 am- 10.00am.

Housebound patients requiring a home visit, will be visited by the GP after 12.00 noon if they contact the surgery before 10.00 am.

GP and Nurse appointments are made on the day or from 4pm the previous evening. Some appointments are reserved each day for urgent problems which cannot wait. The Specialist Nurse Practitioners offer a variety of specialist services including; Asthma and COPD, Diabetes, Hypertension, Well Woman/Man and Family planning clinics. They also provide one to one smoking cessation counselling sessions, childhood and travel vaccination clinics and elderly health assessments. The GPs can also provide some minor surgery procedures and IUCD fitting.

There are two health visitors at Faccini House Surgery. Walk-in clinics are held every Monday between 11.00 and 1.00pm. They are also willing to do home visits or provide an appointment at the clinic at the patients convenience.

The community midwife holds a clinic at the practice each Friday morning, and the Sutton Respiratory Nurse Specialist also holds a clinic at Faccini House Surgery once every two weeks.

The Doctors and Nurses provide telephone health care advice on a range of health care issues. If not available at the time of call, the receptionist will arrange for a return call later that same day.

Faccini Surgery, has an on-site Pharmacy and staff are happy to deliver to housebound patients within the locality.

The surgery has full disabled access which includes disabled parking and access, lifts and washroom facilities.

The practice is also involved in the education and training of Medical Students and Practice Nurses.

CONCLUSION / EVALUATION

Faccini House Surgery provides a very good service for its practice population. The staff work very hard and are committed to providing their patients with the best possible care and services to meet their needs. The surgery is however situated in the St. Helier estate which is one of the top ten most socially deprived areas in the South Thames Region. The wards where the practice population live have high social deprivation scores: St. Helier South (36.6), St. Helier North (37.9), St. Helier(25.9) Rosehill (14.4) and Sutton Common (11.2). Such an area characteristically suffers with many health and social problems, and would require a multidisciplinary, multi-agency approach to both health and social care provision to meet the needs of its people.

In compiling this profile, I have identified many practice population health needs, which include;

( A high level of pensioners living alone = 19% ( 17.4% for St. Helier Sutton and 19.1% for St. Helier Merton compared to the national average of 14.4%)

The large number of lone pensioner household population, reflects the need for rehabilitation and home help services.

(Lone parent households and teenage pregnancy rates higher than both the local and national average.(St. Helier Merton 51.4per 1000, St. Helier Sutton 63.4 per1000,compared to 46.2 per 1000 across England, 40.5 in Merton, and 35 in Sutton).

Lone parent households are associated with poverty and social deprivation (Blackburn 1991). This theory is supported by Whitehead (1988) who also suggests that poverty and ill health are interrelated.

High incidence of low birth weight babies.

Low birth weight is associated with low socio-economic status (highest in births registered by mother alone), smoking, maternal nutrition pre pregnancy and energy intake during pregnancy (Sutton and Merton PCT 2003b).

( A high number of practice population patients who smoke compared to the national average. (32% vs 26%)

Smoking is the single biggest cause of health inequalities and is associated with poverty and social deprivation (DoH 2004).

( A high incidence of chronic disease patients (Asthma, Diabetes and Coronary Heart Disease ) registered at Faccini House Surgery who smoke. ( Asthma = 61%, Diabetes = 35.2% and CHD = 63%)

St. Helier North and South has the highest level of chronic illness in Sutton, the former 16% and the latter 14%. The St. Helier ward at 17% has the highest level of chronic disease in Merton (Sutton and Merton PCT 2003a).My purpose in compiling this profile was to identify a health need within a community from my practice area. The community I have chosen are the St. Helier and St Helier North and South Wards practice population registered at Faccini House Surgery, where I am presently based while undertaking the Specialist Nurse Practitioner Degree course. Through compiling this profile I have found many health needs within our practice population which require intervention. I have however identified the high incidence of smoking within our practice population and especially among the chronic disease patients as the most serious health need requiring intervention.

Liberating the Talents(DoH 2002) highlights three main core functions for nurses in primary care. As well as being a point of first contact for patients and taking a lead role in chronic disease and minor illness management, they also have a responsibility to deliver health protection and promotion programmes. The health need identified relates to the core functions of both chronic disease management and health promotion and intervention. One of the most urgent health promotion interventions required for this practice population should therefore aim to reduce the number of smokers, especially among the identified high-risk groups.


Specialist Nurse Practitioner January 2005

REFERENCES

Blackburn C 1991 Poverty and Health: Working with families Open University press

Department of Health 2002 Liberating the talents HMSO, London

Department of Health 2004 Choosing health: making healthy choices easier HMSO, London

Faccini House Surgery 2004 Health Visitor Caseload 2004 Middleton Rd, Morden SM4 6RS

Faccini House Surgery 2005 ( Statistics 2005 from the practice computerized records) Middleton Rd, Morden SM4 6RS

Hawtin M, Hughes G, Percy-Smith J 1994 Community profiling: auditing social needs Open University Press, Milton Keynes

Merton, Sutton and Wandsworth Health Authority 1996/97 Annual Report of the Director of Public Health: Tipping the scales towards a healthier lifestyle. Merton, Sutton and Wandsworth Health Authority, London

Merton, Sutton and Wandsworth Health Authority 1998 Northern wards participatory needs assessment. Executive summary Merton, Sutton and Wandsworth Health Authority, London

Merton Teenage Pregnancy Unit 2004 Briefing paper on teenage pregnancy in the London Borough of Merton Sutton and Merton Primary Care Trust, London

Office of National Statistics 2002 Census 2001 HMSO, London

Ofsted 2004 Statistics (online) Available from: www. ofsted.gov.uk (Accessed on 18 January 2005)

Sutton and Merton Primary Care Trust 2002 GLA Scrutiny of Access to Primary Care in London Sutton and Merton Primary Care Trust, London

Sutton and Merton Primary Care Trust 2003a Public Health Annual Report 2002-2003 Sutton and Merton Primary Care Trust, London

Sutton and Merton Primary Care Trust 2003b Local Delivery Plan 2003-2006 For Public Use Sutton and Merton Primary Care Trust, London

Sutton Teenage Pregnancy Unit 2002 Under 18 conception rates 1998-2002 Sutton and Merton Primary Care Trust, London

Whitehead M 1998 The Health Divide: Health Education Council, London

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gp practice profile compiled by theresa lowry lehnen specialist nurse practitioner in conjunction...

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