Select Committee on Health Minutes of Evidence




  A 62 year old man presents with cough and blood stained sputum. The general practitioner requests a chest X-ray which shows a large, inoperable cancer of the bronchus. The GP sees the man with the result and arranges an urgent referral. At a significant event discussion this case is discussed. There is no record in the notes (paper or computer) of the man's smoking—he smokes 30 cigarettes per day—but he had been invited twice to a well person check. The practice considers what help it might have offered this patient and agrees that its smoking cessation support is fragmented. One nurse agrees to look into best practice. She returns with information that leads to a special clinic for smoking cessation with access to a hypnotherapist. A special smoking campaign for teenagers is designed and implemented. The recording of smoking habits is given a high priority and over the next year improves greatly.


  A young man is admitted with an acute, severe asthmatic attack and survives, but only after cardio-pulmonary resuscitation. The practice discusses the case and decides that the acute care was efficient and effective. However, it becomes clear that the man had not been using his inhalers regularly, was an episodic smoker and lived in a damp house provided by the local housing association. The patient had not been reviewed recently by a doctor or nurse and there is no record of smoking advice or support being given. There is a long discussion of the possible contribution made to this by the man's poor English. The practice decides to do three things: one nurse and one general practitioner are to set up an asthma service, which will include special advice and support for smokers. A regular audit will look at the outcomes of this service and a patient survey will be used to determine the best time to hold asthma clinics. The practice also decides to hold discussions with the housing association. They readily admit that their houses are damp and may contribute to ill health. An investment programme to upgrade the houses is discussed and implemented over a two-year period. The last action is to hold discussions with community leaders and the health authority to develop an effective interpretation service for those patients with poor or non-existent English. This led to an interpretation service using community volunteers.


  Following the death of a toddler on a "quiet" back street, the practice decides to campaign for traffic calming. In doing so it recognises that it cannot prevent another death or injury by clinical care, only through social action. In discussions with the local authority and the health authority, agreement is reached on making one road a "no through" area, and placing traffic humps on one other street. At the suggestion of the health authority, the practice agrees to take part in a campaign to increase the installation of smoke alarms by placing posters in the waiting room, and including smoke alarms in discussions at child checks, ante-natal clinics, well person checks and visits to the elderly. The Primary Care Group invites all the other local practices to joint in this campaign.


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