Although Tower Hamlets has a young, transient and diverse population, health is poor and the borough ranks as one of the most deprived communities in the UK. The low life expectancy in Tower Hamlets means that it comes within the Government’s ‘spearhead’ areas with a target to reduce health inequalities by 10 per cent by 2010, as measured by infant mortality and life expectancy at birth.
Encompassing all the GP practices in Tower Hamlets, this project aims to reduce inequalities in how healthcare is delivered and ultimately in the health of the population.
The team plan to do this in two ways: first, by supporting GPs to identify and understand inequality in their practice and to provide a better and more equitable service. Secondly, the team intends to work with professionals and patients to develop self management programmes and to improve the public’s awareness of their right of access to healthcare services.
The project team have chosen to focus on the three disease areas which contribute most to poor health in Tower Hamlets. These are diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD). The project leads are Dr John Robson, Dr Sally Hull and Dr Kambiz Boomla.
“Our project will look at each of these disease areas in order to identify where the inequity lies,” Sally says. “For example, the incidence of Type 2 diabetes in the area is twice the national average, and coronary heart disease is 50 per cent higher. In the case of local men of Bangladeshi origin, it is almost double the national rate. COPD also has a very high prevalence in Tower Hamlets, even compared to surrounding localities.”
“We are going to hold a mirror up and show how individual practices are performing in relation to their peers," John comments. "Each practice will be given an equity report detailing their performance by age, sex and by ethnic group for the different disease areas.”
To develop this ‘mirror’, the project team will collect baseline data from GP practices. They will compare service provision both across the borough and against national guidelines. The team will then work with the practices to analyse the data and seek to understand how to improve their services. The methods will include education, facilitated support within practices and using IT systems to support case management.
Working with patient groups, the team will also develop a package of measures to help patients work in partnership with their GPs to manage their own condition more effectively.
Kambiz hopes that this will address the low expectations that some people in Tower Hamlets have about their health. “What we have to challenge is that sense of pessimism and lack of control – the ‘I’m going to die anyway’ attitude,” he says. “We want patients to access the services which are there for them and to change those services so that access becomes easier and more appropriate.”
The team hopes that this project will help those people most at risk of COPD, heart disease and diabetes in Tower Hamlets to access the right services and to receive appropriate treatment. Ultimately, they expect this to minimise the effect of these diseases in the long term and to improve life expectancy in the borough.
Lead organisation: The Clinical Effectiveness Group, Centre for Health Science, Queen Mary University of London
Partners: Tower Hamlets Primary Care Trust, Social Action for Health, City University London
Contact
Dr John Robson
10 April 2007