1. Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director www.lho.org.uk

2. What will this presentation cover? What basics do we need? What are we trying to achieve? Which inequalities are we looking at? What action can we take?

3. Primary Care – what basics do we need? Spearhead PCT? >30% ethnic minority population Under-served by GPs Under-served by non-medical primary care staff >10,000 residents not registered with a GP High numbers of avoidable admissions

4. Primary Care – what basics do we need?

5. Primary Care Quality – Admission rates for Asthma and Diabetes

6. What are we trying to achieve? The life expectancy inequalities target Starting with Local Authorities, by 2010 to reduce by at least 10% the gap in life expectancy between the fifth of areas with the “worst health and deprivation indicators” and the population as a whole (England). The areas covered by the target are known as the Spearhead Group. The baseline is 1995-97.

7. The spearhead group of Local Authorities Those In the worst 20% for 3 or more of the following indicators: –Male life expectancy –Female life expectancy –Cancer mortality in under 75s –Cardiovascular disease mortality in under 75s –Multiple deprivation score Covers 70 Local Authorities in England

8. The spearhead group (London)

9. Which inequalites? Tower Hamlets Health Profile

10. Tower Hamlets Health Profile

11. GP practice profiles – Tower Hamlets Diabetes

12. Exception rate for COPD indicators

13. What action can we take? The Health Inequalities intervention tool Planning tool to help PCTs and LAs with local delivery planning and commissioning to reduce inequalities in life expectancy Commissioned by Department of Health and produced by LHO and YHPHO for APHO

14. What does the tool do? Quantifies the current life expectancy gap at birth within local authority areas, and between spearhead local authorities and England Quantifies the diseases contributing to the life expectancy gap Models the effect of four high impact interventions on closing the life expectancy gap

15. Why use the tool? There are inequalities in life expectancy within all local areas – spearhead and non- spearhead Examples of life expectancy gap between Most Deprived Quintile and Local Authority as a whole in London: –Bromley (non-spearhead) – 4 year difference, 5% gap (males) –Lewisham (spearhead) – 3 year difference, 4.5% gap (males)

16. Understanding the gap Variations in the top four diseases which make up the within LA gap across the country Key diseases making up the gap in males in two London LA’s (Most Deprived Quintile compared to Least Deprived Quintile): Bromley (non-spearhead)% GapLewisham (spearhead)% Gap CHD (coronary heart disease)19CHD8 Lung cancer11Stroke9 COPD (chronic obstructive pulmonary disease) 8Other CVD9 Other CVD (cardiovascular disease) 7Other cancers8 TOTAL45%34%

17. If females in the most deprived quintile had the same mortality rate from stroke as females in the least deprived quintile, they would live 0.4 years longer

18. Applying evidence- based measures to show impact on the gap Interventions included: Increasing smoking quitters Improving blood pressure control in people without diagnosed CVD Improving blood cholesterol control in people without diagnosed CVD Reducing infant mortality Modelling of two scenarios: Applying the interventions across the LA as a whole Focusing the interventions in the MDQ(Most Deprived Quintile)

19. Applying the interventions in the Most Deprived Quintile (MDQ) Chart shows the reduction in the within area life expectancy gap in males in Lewisham if the following interventions are applied

20. Some Questions Clarity about which inequalities to address? Do local partners agree with me? What influence can my service/programme realistically have? Is there enough evidence to justify the directions taken? How can change be measured?

21. Want to know more? www.lho.org.uk Local health profiles: www.healthprofiles.info www.healthprofiles.info Health inequalities intervention tool: http://www.lho.org.uk/HEALTH_INEQUALI TIES/Health_Inequalities_Tool.aspx http://www.lho.org.uk/HEALTH_INEQUALI TIES/Health_Inequalities_Tool.aspx