Tel: 01803 862671

Disease Management

Over the years general practice has changed and the services provided have increased in variety. Although our main function remains to provide help when you fall ill many of our services are aimed at catching diseases in their earliest and most treatable stages or preventing them altogether. For some of the more common and major diseases we have more structured programmes of care. These programmes are based on guidance from the NHS on the most effective way to manage these diseases.

Please choose a disease from below for further advice on management:

Coronary Heart Disease

Coronary heart disease (CHD) is the single commonest cause of premature death in the UK. The research evidence relating to the management of CHD is well established and if implemented can reduce the risk of death from CHD and improve the quality of life of patients. Some of our targets for good care in this area are to:

• Ensure all patients newly diagnosed with angina are referred for ‘exercise testing’ and / or specialist assessment
• Ensure that patients smoking status is recorded regularly and for people who do smoke ensure we offer advice and support to help them quit
• Ensure that patients blood pressure is measured regularly and with appropriate treatment to ensure blood pressure readings are kept within an acceptable range
• Ensure that patients have their cholesterol measured regularly and with appropriate treatment to ensure cholesterol levels are kept within an acceptable range
• Ensure patients are receiving appropriate medication including drugs that control your blood pressure and cholesterol levels
• Ensure patients have an influenza vaccination annually.

Apart from the care you routinely get from your doctor we run a clinic to which you will be invited at least annually to ensure that your disease remains well managed. The clinic is from 11.00am to 12.15pm on a Wednesday.

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Strokes

Stroke is the third most common cause of death in the developed world. One quarter of stroke deaths occur under the age of 65. There is evidence that appropriate diagnosis and management can improve outcomes for people who have had a stroke. Some of our targets for good care in this area are to:

• Ensure all patients who it is considered might have had a stroke have this diagnosis confirmed by CT or MRI scan
• Ensure that patients smoking status is recorded regularly and for people who do smoke ensure we offer advice and support to help them quit
• Ensure that patients blood pressure is measured regularly and with appropriate treatment to ensure blood pressure readings are kept within an acceptable range
• Ensure patients are receiving appropriate medication including drugs that control your blood pressure and cholesterol levels
• Ensure patients have an influenza vaccination annually.

Apart from the care you routinely get from your doctor we run a clinic to which you will be invited at least annually to ensure that your disease remains well managed. The clinics are combined for Stroke/Hypertension/Circulatory Diseases and run from 3.00pm to 5.15pm on Mondays, 8.30am to 10.45am on Tuesdays and 11.00am to 12.15pm and 1.30pm to 3.45pm on Wednesdays.

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Diabetes

Diabetes mellitus is one of the common endocrine diseases affecting all age groups with over one million people in the UK having the condition. Effective control of diabetes can reduce mortality and morbidity. This control can be achieved through regular monitoring of certain key facts and through appropriate treatment and changes to lifestyle. Some of our targets for good care in this area are to:

• Ensure that patients smoking status is recorded regularly and for people who do smoke ensure we offer advice and support to help them quit
• Ensure that patients blood pressure is measured regularly and with appropriate treatment to ensure blood pressure readings are kept within an acceptable range
• Ensure patients are receiving appropriate medication including drugs that control your blood pressure and cholesterol levels
• Ensure patients have an influenza vaccination annually
• Ensure that patients body mass index is recorded regularly
• Ensure that patients have eye checks regularly to prevent the disease causing damage to the retina
• Ensure that patients have regular blood and urine tests to establish that the disease is well controlled and not causing damage to your kidneys
• Ensure that patients have regular foot checks as patients with diabetes are at high risk of foot problems because of poor circulation or damage to nerve endings

Apart from the care you routinely get from your doctor we run a clinic to which you will be invited at least six monthly to ensure your disease is well managed. The clinic runs from 8.30am to 10.30am on Thursday morning and 11.00pm to 12.00pm on a Friday morning (not every week).

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Hypertension

Hypertension is the clinical term for high blood pressure. Careful monitoring of people with high blood pressure and adjusting their medication where necessary is likely to reduce the risk of heart attack and stroke. Some of our targets for good care in this area are to:

Apart from the care you routinely get from your doctor we run a hypertension clinic to which you will be invited at least six monthly to ensure your disease is well managed. The clinic runs from 3.00pm to 5.15pm on Mondays, 8.30am to 10.45am on Tuesdays and 1.30pm to 3.45pm on Wednesdays.

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Chronic Obstructive Pulmonary Disease (COPD)

This is a general term which includes the conditions chronic bronchitis and emphysema. COPD is a common disabling condition with a high mortality. The most effective treatment is smoking cessation. Oxygen therapy has been shown to prolong life in the later stages of the disease and has also been shown to have a beneficial impact on exercise capacity and mental state. Some of our targets for good care in this area are to:

• Ensure that patients have their diagnosis confirmed with an appropriate test
• Ensure that patients smoking status is recorded regularly and for people who do smoke ensure we offer advice and support to help them quit
• Ensure that patients have their lung capacity recorded at least once every two years, a measurement that indicates how easy, or difficult, it is for someone to breath
• Ensure that patients receiving inhaled treatment have their inhaler technique checked once every two years
• Ensure patients have an influenza vaccination annually

Apart from the care you routinely get from your doctor we run a joint COPD / Asthma clinic to which you will be invited at least annually to ensure your disease is well managed. The clinic runs from 3.00pm to 6:00pm on Tuesdays and 5.00pm to 6.00pm on Mondays.

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Asthma

Asthma is a common condition which responds well to appropriate management. Some of our targets for good care in this area are to:

• Ensure that patients have their diagnosis confirmed by an appropriate test
• Ensure that patients smoking status is recorded regularly and for people who do smoke ensure we offer advice and support to help them quit
• Ensure patients have an asthma review annually
• Ensure patients have an influenza vaccination annually

Apart from the care you routinely get from your doctor we run a joint COPD / Asthma clinic to which you will be invited at least annually to ensure your disease is well managed. The clinic runs from 3.00pm to 6.00pm on Tuesdays and 5.00pm to 6.00pm on Mondays.

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Cancer

Most decisions regarding cancer care and much of the treatment takes place in hospitals. General practitioners however often have a key role in referring patients and subsequently providing support, ensuring that care is appropriately co-ordinated. Our main target in this area is to ensure that a review takes place soon after diagnosis in which the doctor will make an assessment of the patients need for support and arrangements for co-ordinating care with the hospital are confirmed. We do not hold a special clinic for this purpose: care is given through the booking of routine appointments with the doctor.

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Hypothyroidism

Hypothyroidism occurs when the thyroid gland does not make enough thyroxine, a body chemical that helps to keep the bodies functions working at the right pace. The treatment is to take thyroxine tablets each day. A low dose is prescribed at first and is gradually increased over a period of time. Blood tests are usually taken every now and then over several months, and the dose may be adjusted accordingly. The blood test measures TSH (see above). Once the blood TSH level is normal it means you are getting the correct amount of thyroxine from the tablets. It is then common practice to check the TSH blood level once a year. Our target for good care in this area is to ensure that these blood tests are done and the correct amount of medication continues to be taken. We do not hold a special clinic for this purpose: care is given through the booking of routine appointments with the doctor.

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Epilepsy

Epilepsy is the most common serious neurological condition, affecting about 5 to 10 per 1000 of the population at any one time. Few epilepsies are preventable, but much of the handicap that results could be prevented by appropriate clinical management. Some of our targets for good care in this area are to:

• Ensure patients over the age of 16 who receive drug treatment for epilepsy have a record of the frequency of their seizures recorded annually
• Ensure patients over the age of 16 who receive drug treatment for epilepsy have a medication review annually

We do not hold a special clinic for this purpose: care is given through the booking of routine appointments with the doctor.

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