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					  Southport and Formby GP Consortia – Key Health Needs (April 2011)




           Southport and Formby Practice Based
              Commissioning Confederation




                         Key Health Needs
                             Report A
                            April 2011




Prepared on behalf of the Commissioning
Confederation by NHS Sefton Department of Public
Health




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  Southport and Formby GP Consortia – Key Health Needs (April 2011)


Introduction
This report is the first in what will be a series of public health reports on health
status and needs of people living in Southport and Formby. This report
focuses on
 Health status
 Lifestyle factors influencing health
 Practice based strategies that can promote health improvement and
    reduce health inequalities
 Links to community based health promotion interventions

Forthcoming reports will identify opportunities for expanding public health
interventions in primary care; present the findings of the health equity audit of
maternity services and the annual report of the Director of Public Health.

This is a high level health status report and is therefore also intended to
stimulate discussion around priorities for future detailed analysis and action.

The aim of all public health reports is to provide the commissioning board with
a clear understanding of the social characteristics and health needs of the
population. This will inform the commissioning decisions taken to improve the
health of all residents in Southport and Formby and to reduce the significant
health inequalities which exist.

Summary
Southport and Formby GP Commissioning Consortia covers 121,000 patients
at 20 GP practices. Life expectancy is similar to the national average at 78.1
years for males and 82.4 for females. However, there are differences in life
expectancy within the Consortia of over 7 years for both sexes. Five main
lifestyle factors account for most (60%) of the gap in life expectancy within
Southport and Formby: Priority areas for intervention in Southport and
Formby are:
         Vascular checks for those at risk
         Smoking cessation services
         Social prescribing for mental health
         Alcohol screening and brief interventions
         Use of and referral to weight management services
         Increasing rates of breastfeeding
DH have identified ten major lessons that can help to reduce health
inequalities. These include getting the system and scale of interventions right,
strengthening primary care, raising the bar on achievement and utilising
population health intelligence.

Circulatory Diseases
 64 excess deaths in most deprived quintiles due to circulatory diseases
 Higher than average circulatory disease prevalence
 £5.7m spent on hospital admissions
 £4.7m spent on circulatory disease prescribing . Of this, £1.6m was spent
   on statins - £400,000 (25%) could be saved if prescribing was averagely
   efficient


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    Southport and Formby GP Consortia – Key Health Needs (April 2011)


    Universally applying certain drug treatments to hypertensive patients and
     patients with COPD could gain 1 year of life expectancy for both sexes
    Vascular Health Checks cost less than £40 each

Smoking and COPD
 18 excess deaths in most deprived areas due to smoking and COPD
 Around 20% of all deaths are smoking related
 Smoking prevalence (13%) is below average, but ranges from 7% to 21%
 COPD prevalence is above the England average; three practices have
  particularly high prevalence
 Southport and Formby spent over £2m on smoking related admissions and
  a further £2m on COPD prescribing
 58% of COPD hospital admissions were repeat admissions
 Sefton‟s Stop Smoking Services cost around £162 per quitter

Mental Health
 23 excess deaths in most deprived areas due to mental health conditions,
  but mental health is the biggest causes of ill health
 Mental health prevalence is above average and there is wide variation
  between practices. Mental well being is strongly related to deprivation
 50% of incapacity benefit claims are due to mental health (1,800 people)
 £14m spent on inpatient services and community services, with over 50%
  of admissions are repeat admissions
 Over £4m spent on prescribing. Of this, £650k on anti-depressants -
  £120k (18%) could be saved if prescribing was averagely efficient
 Citizens Advice Bureau in some GP practices (cost £265 per client, gain
  over £5,000 per client) and Creative Alternatives (an arts programme,
  £729 per client) are both proven to improve mental health and reduce
  prescription drug use

Alcohol
 10 excess deaths in most deprived areas due to alcohol
 1 in 5 residents drink at increasing or higher risk levels
 Drinking at increasing or higher risk levels is higher in less deprived areas
   and older residents; binge drinking is higher among younger residents
 £22m spent on hospital admissions (rising by £2.5m/year), which are
   highest in more deprived areas
 A brief intervention based LES is being rolled out in South Sefton aimed at
   higher risk drinkers that is predicted to save £87k/year

Obesity and Diabetes
 9 excess deaths in most deprived areas due to obesity and diabetes
 Over half of adults are overweight or obese
 Obesity is higher in deprived areas; overweight and obesity rises with age
 Diabetes prevalence is above average
 Overweight and obesity cost Sefton £85m/year
 A range of interventions are available. Active Sefton Weight Management
  Services are the most cost effective in Cheshire & Merseyside



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  Southport and Formby GP Consortia – Key Health Needs (April 2011)


As well as the five main causes of the gap in life expectancy between South
Sefton and England, five other areas were highlighted for exploration:

Children and Young People
 Around 90% of the 1,000 births each year are at Ormskirk. Births at
   Ormskirk from South Sefton has risen from 6% in 2000 to 30% in 2009
 There are less than 5 infant (u1) and less than 5 child (ages 1-17) deaths
   each year
 Rates of smoking in pregnancy and breastfeeding are worse than average
 Teenage conception rates have not fallen, with around 70 conceptions
   each year

International Workers
 In Southport, there could be as many as 2,000 international workers, 300
   school age children and 600 partners/other family members
 The main communities are from Poland, Portugal and Latvia
 13% of births in Southport and Formby are to non-British mothers – this
   rises to nearly 1/3 of births in Central Southport

Older People
 There are over 26,000 residents aged 65+ and this could increase by 10%
   within five years

GP Access and Urgent Care
 Phone access to GPs is below average
 There were 14,000 attendances at A&E, costing over £1m (£80 each)
 Nearly 40% of A&E attendances did not require any follow up treatment,
  with another 17% being referred back to their own GP

Insight and Behaviour Change
Five Mosaic groups account for 34% of Southport and Formby‟s population.
 Self reliant older families in suburban semis in industrial towns 9%
 Older people living in large houses in mature suburbs 8%
 Better off empty nesters in low density estates on town fringes 6%
 Transient singles, poorly supported by family and neighbours 5%
 Comfortably off suburban families weakly tied to their local community 5%

Further work is being undertaken to gain insight from GPs as to the future role
Public Health can play in improving health outcomes in the Consortia.



Southport and Formby GP Commissioning Consortia
1.1 This report aims to briefly outline the key health needs of the population
    of South Sefton and identify proven, cost effective interventions that will
    improve the health of the attending population. It identifies and is based
    around five lifestyle topics and also considers children and young people,
    GP access and urgent care and insight/behaviour change.



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     Southport and Formby GP Consortia – Key Health Needs (April 2011)


1.2 Southport and Formby GPCC is defined as covering 9 electoral ward and
    20 GP practices. The area stretches from Crossens and Churchtown in
    the north to Formby and Ince Blundell in the south.

1.3 The resident population of Southport and Formby was 114,000,
    compared to a GP registered patient population of 121,210. Of those
    registered patients, 3,650 live outside Southport and Formby




Life Expectancy and Causes of Death
2.1 Life expectancy in Southport and Formby is 78.1 years for males and
    82.4 years for females – both similar to the England average and higher
    than South Sefton. NHS Sefton‟s Commissioning Strategic Plan1 sets
    goals to eradicate the historic and enduring gap between Sefton and
    England by 2014.

1
    See Jan 2010 link at http://www.sefton.nhs.uk/about-us/news-and-media/publications.asp


Email: Steven Ward, Public Health Intelligence, 0151 247 7256                 Page 5 of 27
                                   Southport and Formby GP Consortia – Key Health Needs (April 2011)


                                            Life Expectancy at Birth (2007-09)                          Males        Females
                                                   Southport and Formby                                 78.1           82.4
                                                       South Sefton                                     76.5           81.1
                                                          Sefton                                        77.3           81.6
                                                         England                                        78.3           82.3

2.2 Life expectancy has risen pretty much in line with the England average,
    but has risen about England average for females and dropped below
    England average for males.

2.3 There are around 1,500 deaths in Southport and Formby each year.
    Three main causes of death in Southport and Formby account for 75% of
    all deaths:
       Circulatory diseases (34%, around 490 deaths) and
       Cancers (26%, around 370 deaths)
       Respiratory diseases (14%, around 200 deaths).

2.4 Death is inevitable and everyone dies of something. It is also useful to
    consider the impact on daily living that a particular disease can have. For
    example, mental illness is a big contributor to years of healthy life lost2:
       Mental health 23%
       Cancer        16%
       Circulatory 16%
       Respiratory 8%


                                                          Life Expectancy at Birth (with 95% Confidence Intervals)
                                       England - Males                     England - Females                    Sefton - Males
                                       Sefton - Females                    Southport & Formby - Males           Southport & Formby - Females

                             86.0




                             82.0
Life Expectancy At Birth (Years)




                             78.0




                             74.0




                             70.0
                                      1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09




2
 Based on WHO Disability Adjusted Life Years model, applied to Southport and Formby
population


Email: Steven Ward, Public Health Intelligence, 0151 247 7256                                                                    Page 6 of 27
  Southport and Formby GP Consortia – Key Health Needs (April 2011)




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     Southport and Formby GP Consortia – Key Health Needs (April 2011)


Mortality by Lifestyle Factor
2.5 Southport and Formby can be split into five roughly equally sized groups
    (quintiles) using the Index of Multiple of Deprivation3. These quintiles can
    be used to analyse the difference in life expectancy between poorer and
    more affluent areas of Southport and Formby.

2.6 Males in the most deprived quintiles can expect to live up to 8 years less
    (74 years) than males in the least deprived quintiles (82 years). Similarly,
    females in the most deprived quintiles can expect to live up to 7 years less
    (79 years) than females in the least deprived quintile (86 years).

2.7 The least deprived quintile covers large parts of Formby, areas in Hillside
    and a pocket in Churchtown. The most deprived quintile covers Southport
    town centre, Blowick and pockets in Ainsdale and Kew. Given the spread
    of areas, it is likely that most GP practices will have patients from across
    the spectrum of deprivation.




3
    http://www.communities.gov.uk/publications/communities/indiciesdeprivation07


Email: Steven Ward, Public Health Intelligence, 0151 247 7256                 Page 8 of 27
                                   Southport and Formby GP Consortia – Key Health Needs (April 2011)


2.8 The internal gap in life expectancy within Southport and Formby can be
    categorised by lifestyle cause. Five lifestyle factors account for over 70%
    of the gap for males and over 55% of the gap for females (over 60% of all
    deaths).

                                   Life Expectancy Gap by Lifestyle                                 Male excess               Female excess
                                    Cause – Southport and Formby                                      deaths4                    deaths
                                          Circulatory diseases                                           23                        41
                                           Smoking & COPD                                                12                         7
                                             Mental Health                                               10                        13
                                                 Alcohol                                                 7                          4
                                          Obesity and Diabetes                                           3                          6

2.9 These gaps alter over time. For males, the gap due to alcohol has
    doubled and the gap due to smoking and COPD has increased, whilst the
    gap due to CVD has reduced. The gaps due to mental health and obesity
    and diabetes have remained similar.

                                                                     Life Expectancy Gap Modelling - MALES

                                       Alcohol      CVD    Mental health       Obesity & Diabetes     Smoking & COPD        Other +ve       LDiQ      MDiQ

                                       84.0                                                                                                    100%

                                       82.0                                                                                                    90%

                                       80.0                                                                                                    80%
    Life Expectancy at Birth (Years)




                                       78.0                                                                                                    70%

                                       76.0                                                                                                    60%




                                                                                                                                                        % of LE Gap
                                       74.0                                                                                                    50%

                                       72.0                                                                                                    40%

                                       70.0                                                                                                    30%

                                       68.0                                                                                                    20%

                                       66.0                                                                                                    10%

                                       64.0                                                                                                    0%
                                                 2001-03   2002-04         2003-05       2004-06      2005-07     2006-08         2007-09




4
 Excess deaths are calculated “gross” ie only disease categories where Southport and
Formby‟s most deprived quintile had more deaths than expected are included. There will be
some areas where Southport and Formby had less deaths than expected.


Email: Steven Ward, Public Health Intelligence, 0151 247 7256                                                                           Page 9 of 27
                                         Southport and Formby GP Consortia – Key Health Needs (April 2011)


                                                                                 Life Expectancy Gap Modelling - FEMALES

                                             Alcohol    CVD      Mental health      Obesity & Diabetes   Smoking & COPD   Other +ve   -ves   F LDiQ     F MDiQ

                                             88.0                                                                                                100%

                                             86.0

                                             84.0                                                                                                80%
          Life Expectancy at Birth (Years)




                                             82.0

                                             80.0                                                                                                60%




                                                                                                                                                           % of LE Gap
                                             78.0

                                             76.0                                                                                                40%

                                             74.0

                                             72.0                                                                                                20%

                                             70.0

                                             68.0                                                                                                0%
                                                       2001-03      2002-04          2003-05       2004-06     2005-07    2006-08      2007-09




         Circulatory Diseases
         3.1 Circulatory diseases (chapter I of ICD10) include any heart diseases,
             including heart disease and stroke. Compared to the least deprived
             quintile, Southport and Formby‟s most deprived quintile had 64 excess
             deaths due to circulatory diseases.

         3.2 Southport and Formby had higher than average prevalence of circulatory
             diseases, but with two to three fold variation between practices – the
             highest practices having higher prevalence than the highest PCT.

      QOF Prevalence                                                                  CHD                Hypertension                 Stroke             Heart Failure
Southport and Formby Patients                                                         5,566                 19,072                    2,891                 1,074

    Southport and Formby                                                              4.6%                    15.7%                    2.4%                              0.9%
        South Sefton                                                                  4.5%                    15.7%                    2.0%                              1.3%
           Sefton                                                                     4.5%                    15.7%                    2.2%                              1.1%
            NW                                                                        4.1%                    13.8%                    1.9%                              0.8%
          England                                                                     3.4%                    13.4%                    1.7%                              0.7%

 Southport and Formby range                                                      2.7% to 5.8%            8.1% to 19.0%            1.0% to 7.3%           0.6% to 1.9%
        Highest PCT                                                                 5.2%                    16.7%                    2.4%                   1.1%




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     Southport and Formby GP Consortia – Key Health Needs (April 2011)


                                                                     Directly age-standardised mortality rate from all circulatory diseases per
                                                                      100,000 people under the age of 75 and progress towards local targets
                                                      England                 Sefton           Sefton 2010 target                    VS Trajectory (March 08)                   Southport & Formby Consortia

         Rate per 100,000 Population Aged Under 75   200

                                                     180

                                                     160

                                                     140

                                                     120

                                                     100

                                                      80

                                                      60

                                                      40

                                                      20

                                                       0
                                                           1995-97


                                                                        1996-98


                                                                                   1997-99


                                                                                             1998-00


                                                                                                       1999-01


                                                                                                                 2000-02


                                                                                                                           2001-03


                                                                                                                                        2002-04


                                                                                                                                                  2003-05


                                                                                                                                                            2004-06


                                                                                                                                                                      2005-07


                                                                                                                                                                                 2006-08


                                                                                                                                                                                           2007-09


                                                                                                                                                                                                     2008-10


                                                                                                                                                                                                               2009-11
3.3 In line with England, premature mortality (aged under 75) from circulatory
    diseases in Southport and Formby has fallen by nearly 50% since 1995.

3.4 Southport and Formby spent £5.7m on CVD hospital admissions, covering
    2,800 spells (average cost £2,000).

3.5 Southport and Formby also £4.7m on circulatory disease prescribing. Of
    this, £1.6m was spent on statins – by the National Audit Office measure5,
    this was less efficient than the England average. If Southport and Formby
    prescribing patterns were similar to the England average, Southport and
    Formby would only spend £1.2m on statins – a saving of £400,000 (25%).

3.6 Potential prescribing savings are calculated by comparing the cost per
    (age adjusted) prescribing unit (PU) for Southport and Formby with
    England as a whole. An above average cost per PU implies an area are
    prescribing more high cost drugs than average (after allowing for
    demography). The potential savings could be realised by switching
    patients to lower cost drugs. Note that as the comparison is with the
    England average, there is potential for greater savings than those shown.

3.7 DH Health Inequalities National Support Team6 have developed a tool that
    can be used to assess potential the contribution, and necessary scale of
    use, of selected evidence-based interventions to reduce the gap in life
    expectancy. The tool gives an indication of the impact on life expectancy
    that could be achieved if interventions were applied universally to those at
    risk.




5
    http://www.nao.org.uk/idoc.ashx?docId=50e7e400-f51d-44f2-9329-696571115a24&version=-1
6
    www.dh.gov.uk/HINST


Email: Steven Ward, Public Health Intelligence, 0151 247 7256 Page 11 of 27
                  Southport and Formby GP Consortia – Key Health Needs (April 2011)


      Southport and Formby                 Potential    Life       Life    Numbers Estimated
                                            Deaths   expectancy expectancy Needed Population
                                          Postponed gained – M gained – F to Treat  Eligible
  Extra treatments to hypertensives           61         0.5        0.4      403    24,673
    with no previous CVD events
 Statins to COPD patients to address         42          0.31               0.2                  37   1,538
              CVD risk
 Four treatments for all patients with       33          0.12              0.19               236     7,725
previous CVD event (partially treated)
 Four treatments for all patients with       21          0.11              0.10                  58   1,204
previous CVD event (now untreated)
              Four treatments: beta blocker, aspirin, ACE inhibitor, statin

              3.8 If all eligible patients received the circulatory disease interventions above,
                  these interventions alone could create a gain in life expectancy of over 1
                  year for males and 0.9 years for females.

              3.9 Nationally, the average cost of a circulatory disease health check is
                  around £25. From 2010-11, Southport and Formby are paying between
                  £26 and £38 per check. The estimated cost per quality adjusted life year
                  (QALY) is around £3,500. The gain is estimated to outweigh the cost
                  tenfold7.


              Smoking and COPD
              4.1 Compared to the least deprived quintile, Southport and Formby‟s most
                  deprived quintile had 18 excess deaths due to smoking and COPD.

              4.2 Adult smoking prevalence in Southport and Formby is 13% - slightly lower
                  than the Sefton average (15%) and this has fallen in recent years.
                  Smoking prevalence of 16% in Southport and Formby equals around
                  21,100 smokers (age 16+).

                     Smoking Prevalence            Southport        South Sefton          Sefton
                    (Lifestyle Survey data)       and Formby
                              2003                   20%                 25%               23%
                              2007                   17%                 19%               18%
                              2010                   13%                 16%               15%

              4.3 Smoking prevalence in Southport and Formby is below the England
                  average (21%). However, this relatively low smoking prevalence hides
                  some stark differences within Southport and Formby. Adult smoking
                  prevalence varies from 21% in Norwood to less than 7% in Harington and
                  Ravenmeols.

              4.4 Smoking is strongly related to deprivation, with higher prevalence in more
                  deprived areas. Younger people and males are more likely to smoke;
                  those aged 35-44 and in deprived areas are most likely to want to quit.

              7
              http://www.healthcheck.nhs.uk/Library/March_2010_Ebulletin_FAQs_Final.pdf


              Email: Steven Ward, Public Health Intelligence, 0151 247 7256 Page 12 of 27
    Southport and Formby GP Consortia – Key Health Needs (April 2011)


4.5 Around 20% of all deaths in Southport and Formby are in some way
    related to smoking or smoking related diseases.

4.6 Southport and Formby spent around £2.2m on smoking related hospital
    admissions in 2008-098. An average admission costs around £2,000.
    Southport and Formby also spent £140,000 on NRT.

4.7 Sefton‟s Stop Smoking Services cost around £162 per successful quitter –
    cheaper than the £224 England average. Quitting smoking using NRT
    costs around £750 per life year saved .

4.8 Southport and Formby has 2,166 patients on GP registers for COPD. This
    is a prevalence of 1.8% - above the England average.

                   QOF Prevalence (2009-10)               COPD
                     Southport and Formby                 1.8%
                         South Sefton                     2.8%
                            Sefton                        2.3%
                             NW                           2.1%
                           England                        1.6%

                  Southport and Formby range          1.3% to 3.2%

4.9 Within Southport and Formby, there are 3 practices with a COPD
    prevalence that puts them in the top 10 PCTs nationally.

4.10 In 2009-10 Southport and Formby had 240 hospital spells for COPD,
   costing £500,000. A COPD spells costs around £2,000. Over a three year
   period, 58% of COPD spells were repeat spells (ie one person having
   more than one admission). Potentially patients could be managed in the
   community to reduce hospital spells and costs.

4.11 Southport and Formby spent £2m on COPD prescribing (£1.4m of this
   on inhaled corticosteroids) and is slightly more efficient than average.


Mental Health
5.1 Compared to the least deprived quintile, Southport and Formby‟s most
    deprived quintile had 23 excess deaths due to mental health conditions.

5.2 Mental health prevalence is hard to assess as the term mental health
    covers a wide range of conditions. However, there are three GP QOF
    registers that cover a range of conditions. Depression is the largest
    register, with around 12,000 patients. All the registers are above average
    in Southport and Formby. However, there is wide variation amongst
    practices for all three registers


8
  http://www.lho.org.uk/LHO_Topics/Analytic_Tools/TobaccoControlProfiles Admissions
include various cancers, CHD, heart disease and COPD.


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                                   Southport and Formby GP Consortia – Key Health Needs (April 2011)


      QOF Prevalence                                                          Depression (18+)                        Mental Health (Psychoses)                               Dementia
Southport and Formby Patients                                                     11,831                                        1,141                                           881

    Southport and Formby                                                                 12.1%                                           0.94%                                  0.73%
        South Sefton                                                                     15.6%                                           1.03%                                  0.57%
           Sefton                                                                        14.0%                                           0.99%                                  0.64%
            NW                                                                           12.5%                                            0.9%                                   0.5%
          England                                                                        10.9%                                            0.8%                                   0.5%

 Southport and Formby range                                                       6.1% to 23.7%                                     0.5% to 5.5%                             0.2% to 10.8%

          5.3 In Southport and Formby, 1,800 people of working age (3%) were claiming
              incapacity benefit due to mental health conditions. This varies from 1.6%
              in Ravenmeols to 5.7% in Dukes. Mental health conditions account for
              over 50% of all incapacity benefit claims.

          5.4 The Sefton Lifestyle Survey 2010 used a 14 question scale to assess
              positive mental well being, rather than mental ill-health9. 26% of
              respondents from Southport and Formby assessed themselves as having
              low mental well being. Respondents aged 35-54 were most likely to have
              low mental well being – twice as likely as those aged 16-24. Respondents
              aged 16-24 and 65-74 were most likely to have high mental well being.
                                                           Sefton Lifetsyle Survey 2010: Mental Well Being Levels By Deprivation
                                                                               (with 95% confidence intervals)

                                                                           Most Deprived Quintile     Second    Third     Fourth    Least Deprived Quintile

                                                  100%

                                                  90%
              Percent of Respondents (Weighted)




                                                  80%

                                                  70%

                                                  60%

                                                  50%

                                                  40%

                                                  30%

                                                  20%

                                                  10%
                                                                                                                                             4%     4%        3%   4%   4%
                                                         37%   31%   28%   23%    20%               59%   65%   69%     73%   75%
                                                   0%
                                                                     Low                                    Moderate                                      High



          5.5 Mental well being is strongly related to deprivation. Respondents from the
              most deprived quintile are almost twice as likely to have low mental well
              being as respondents from the least deprived quintile.



          9
           Warwick Edinburgh Mental Well Being Scale, http://www.healthscotland.com/scotlands-
          health/population/Measuring-positive-mental-health.aspx


          Email: Steven Ward, Public Health Intelligence, 0151 247 7256 Page 14 of 27
     Southport and Formby GP Consortia – Key Health Needs (April 2011)


5.6 Southport and Formby spent approximately £4m on inpatient and secure
    mental health hospital services, with another £10m on community based
    services. Over a three year period, 56% of hospital spells were repeat
    admissions – 12 patients accounted for 105 admissions.

5.7 In addition, Southport and Formby spent £4.4m on drugs prescribing for
    mental health (not including social prescribing or alternative solutions). Of
    this, £650,000 was spent on anti-depressants – if Southport and Formby
    prescribed as efficiently as the England average, Southport and Formby
    could save £120,000 (18%).

5.8 Social prescribing is a mechanism for linking people with sources of
    support with in the community – Sefton has six social prescribing projects,
    two of which are outlined below.

5.9 Patients using the GP practice based Citizens Advice Bureau service (only
    available in some practices) showed statistically significant reductions in
    the number of GP appointments and prescriptions for hypnotics/
    anxiolytics. This CAB outreach service costs £265 per client per year, but
    gained £1700 per client in one off payments (44 patients across Sefton)
    and £3600 in ongoing annual payments (130 patients across Sefton).

5.10 Creative Alternatives (an arts programme) produced significant
   decreases in symptoms of depression and anxiety (65% of clients). 27%
   of clients reduced their medication (antidepressant or tranquiliser) and
   11% of clients stopped taking medication completely. 20% also stopped
   smoking. The cost of Creative Alternatives is £729 per client for a 6 month
   programme (24 sessions).


Alcohol
6.1 Compared to the least deprived quintile, Southport and Formby‟s most
    deprived quintile had 10 excess deaths due to alcohol related conditions.

6.2 Over 20% of respondents to the Sefton Lifestyle Survey drank at
    increasing or higher risk levels10. These figures are similar for North and
    South Sefton and have risen from 16% in 2007.




10
   The recommended daily alcohol limits are 4 units for men and 3 units for women. Regularly
drinking more than these limits is classed as increasing risk (previously hazardous drinking,
between 22 and 50 units of alcohol per week for males, and between 15 and 35 units of
alcohol per week for females) or higher risk (previously harmful drinking, more than 50 units
of alcohol per week for males, and more than 35 units of alcohol per week for females)


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                                                            Southport and Formby GP Consortia – Key Health Needs (April 2011)


6.3 Levels of alcohol consumption do not follow the usual patterns of
    deprivation and age. Drinking at increasing or higher risk levels increases
    as deprivation decreases, with people living in the least deprived areas
    most likely to drink at increasing or higher risk levels.
                                                                               Sefton Lifestyle Survey 2010: Alcohol Drinking Over Lower Risk Levels by Deprivation
                                                                                                          (with 95% confidence intervals)
                                                                                              Most Deprived Quintile   Second      Third     Fourth      Least Deprived Quintile

                                     30.0


                                     25.0
Percent of Respondents (Weighted)




                                     20.0


                                     15.0


                                     10.0


                                                          5.0


                                                          0.0
                                                                                 Increasing Risk                               Higher Risk                           Increasing or Higher Risk
                                                                                                                Amount of Alcohol Drunk Last Week



                                                                               Sefton Lifestyle Survey 2010: Alcohol Drinking Over Lower Risk Levels by Age
                                                                                                      (with 95% confidence intervals)

                                                                                                      16-24    25-34   35-44     45-54     55-64      65-74   75+

                                                                        30.0


                                                                        25.0
                                    Percent of Respondents (Weighted)




                                                                        20.0


                                                                        15.0


                                                                        10.0


                                                                         5.0


                                                                         0.0
                                                                                   Increasing Risk                         Higher Risk                           Increasing or Higher Risk


                                                                                                               Amount of Alcohol drunk last week




6.4 Almost 1 in 4 people in the least deprived quintile drink at increasing or
    higher risk levels, compared to 1 in 6 in the most deprived quintile.

6.5 The 55-64 year age band is the age group most likely to drinking at
    increasing or higher risk levels. Drinking at increasing risk or higher risk
    levels rises from ages 25 to 64, is slightly higher in under 25s and lower in
    those aged 65+.




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     Southport and Formby GP Consortia – Key Health Needs (April 2011)


6.6 These findings can sometimes seem counter-intuitive. However, think
    about middle aged people in more affluent areas having a bottle of wine
    with dinner each night. An apparent social norm, but half a bottle of wine
    is 4-5 units so both men and women are in the increasing category if done
    4-5 nights per week.

6.7 Overall, 31% of respondents in Southport and Formby binge drink
    (compared to 36% in South Sefton). Binge drinking is most prevalence
    amongst younger residents, with 46% of under 35s binge drinking. Again,
    binge drinking increases with decreasing deprivation.

6.8 Southport and Formby spent £22m on alcohol related hospital admissions,
    covering around 11,000 admissions (average cost around £2,000 per
    admission). 30% of all hospital admissions are classed alcohol related in
    some way. The cost of alcohol related admissions is rising by around 11%
    per year, or £2.5m – this could be over £40m by 2015. This rise is mainly
    driven by the availability of cheap alcohol from shops and supermarkets.

6.9 Whilst drinking is higher in less deprived areas, most alcohol related
    hospital admissions come from more deprived areas. 30% of alcohol
    related admissions are for alcohol specific admissions (acute
    intoxification, dependence, self harm, complications of liver disease)11.

6.10 A LES is being rolled out in South Sefton that is predicted to prevent
   around 175 alcohol specific admissions using primary care brief
   interventions and treatment from the SATINS team. This is predicted to
   save £87,000 per year.

6.11 The DH Health Inequalities National Support Team12 tool estimates
   that for every 6% of higher risk drinkers that receive a brief intervention, 1
   death could be avoided. There are around 2,700 higher risk drinkers in
   Southport and Formby.


Obesity and Diabetes
7.1 Compared to the least deprived quintile, Southport and Formby‟s most
    deprived quintile had 9 excess deaths due to obesity and diabetes

7.2 According to the 2010 lifestyle survey, more than half of adults in
    Southport and Formby were overweight, obese or very obese. Over time
    there has been a steady rise in the proportion of respondents who are
    overweight or obese, with reductions in the underweight and ideal weight
    ranges.




11
   The remaining 70% are due to wider alcohol related conditions, including injuries and
accidents, cancers and heart disease. See technical guidance at
http://www.nwph.net/alcohol/lape/nationalindicator.htm
12
   www.dh.gov.uk/HINST, see Circulatory Diseases section for more information


Email: Steven Ward, Public Health Intelligence, 0151 247 7256 Page 17 of 27
              Southport and Formby GP Consortia – Key Health Needs (April 2011)


                          Under weight         Ideal weight       Over weight           Obese            Very Obese
      BMI (%)
                            (<18.5)             (18.5-24.9)        (25.0-29.9)        (30.0-39.9)           (>40)
Southport and Formby          1.7                  42.5               35.4               17.9                2.6
    South Sefton              3.6                  42.2               36.7               15.1                2.4
       Sefton                 2.5                  42.4               35.9               16.7                2.5
     England13                2.3                  36.4               38.3                            23.0

         7.3 The proportion of overweight respondents increases with age - more than
             two thirds of respondents aged 55-64 are classed as overweight, obese
             or very obese, compared to less than a third of under 25s.

         7.4 The proportion of respondents from the most deprived quintile classified
             as obese was significantly higher than the respondents from the other
             quintiles of Sefton.

         7.5 In Southport and Formby, around 1 in 12 children entering primary school
             are obese (8%). By the time they leave primary school, this has doubled,
             with more than 1 in 6 children are obese (18%)14.

         7.6 Diabetes prevalence is higher than average in Southport and Formby and
             there is two-fold variation between practices

                             QOF Prevalence                      Diabetes (Ages 18+)
                       Southport and Formby Patients                    5,723

                           Southport and Formby                            5.8%
                               South Sefton                                5.4%
                                  Sefton                                   5.6%
                                   NW                                      5.7%
                                 England                                   5.4%

                        Southport and Formby range                    3.8% to 7.5%

         7.7 Moderate obesity (BMI 30-35) is found to reduce life expectancy by an
             average of three years, while morbid obesity (BMI 40-50) reduces life
             expectancy by eight to ten years. This eight to ten year loss of life is
             equivalent to the effects of lifelong smoking. Obesity contributes to major
             killers such as cardiovascular disease and certain types of cancers; as
             well as a wide range of long term conditions such as type 2 diabetes,
             osteoarthritis, depression and infertility. Even a moderate 5-10% weight
             loss has a positive impact on many of these risks.


         7.8 The Foresight Report15 estimated that the wider costs of obesity to Sefton
             are £46m per year – this rises to £85m when considering overweight and


         13
            Health Survey for England, 2009
         14
            National Child Measurement Programme 2009-10 www.ic.nhs.uk/ncmp
         15
            http://www.bis.gov.uk/foresight/our-work/projects/published-projects/tackling-obesities


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        Southport and Formby GP Consortia – Key Health Needs (April 2011)


          obesity. The direct costs for Southport and Formby are £4.7m on hospital
          admissions and £1.5m on prescribing.

   7.9 Sefton‟s multi-agency Public Health Partnership has focused on tackling
       obesity via both food and physical activity. Actions have been developed
       across the life course and in different settings such as schools and
       community venues. Interventions have included:
       Free weight management courses „Choose 2 Lose‟ (including men only
         courses) are offered across Sefton by accredited leaders
       Free practical cookery courses
       Lifestyle card training for a range of front-line staff provides clear
         information and signposts to local services
       A localised Family Challenge to encourage families to lost weight,
         increase and physical activity and is currently being evaluated
       Active Sefton Weight Management programmes commissioned from
         Leisure Services provide weight management courses from GP
         referrals

   7.10 Active Sefton Weight Management Service operates at three levels –
       all levels provide a cost effective service compared to other services in
       Cheshire & Merseyside16.
 Active Sefton Weight Management             Total     Cost    Cheshire & Mersey
                 Service                     Cost     KG lost range (exc Sefton)
Level 1 – Early Intervention Programme £51,000         £16           £17-£269
    Level 2 – Weight Management            £200,000    £10           £20-£269
       Level 3 – Dietetic support           £14,000     £8          £20-£2,625

   7.11 The DH Health Inequalities National Support Team17 tool estimates
       that reducing blood sugars (HbA1c) 5 by one unit in everyone in
       Southport and Formby whose blood sugar is over 7.5 could save 40
       deaths per year.


   Children and Young People
   8.1 There are 22,100 residents aged under 18 in Southport and Formby –
       roughly equal to the number of over 67 year olds.

   8.2 This section highlights some key issues for children and young people in
       general. Specific issues (eg CAMHS, immunisations, child health
       promotion programme) are not covered here but can be provided in more
       detailed reports on request. Public Health are currently undertaking a
       health equity audit of maternity services which will provide valuable
       intelligence for future maternity service commissioning.

   8.3 There are around 1,000 births in Southport and Formby each year, with
       around 90% of births at Ormskirk. However, over the last decade, more
       women from South Sefton have also chosen to have their babies at

   16
        [draft data, reference awaited]
   17
        www.dh.gov.uk/HINST, see Circulatory Diseases section for more information


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  Southport and Formby GP Consortia – Key Health Needs (April 2011)


     Ormskirk (or previously Southport). In 2000, 6% of births from South
     Sefton were at Ormskirk – this rose to 30% in 2009. This is partly due to
     the closure of the maternity unit at Aintree hospital.

8.4 Whilst child and infant deaths are not a major contributor to the gap in life
    expectancy between Southport and Formby‟s most and least deprived
    quintiles, there are a number of important health issues to consider. On
    average there are less than 5 infant deaths (aged under 1) in Southport
    and Formby each year, with mortality rates similar to average, and less
    than five child deaths (ages 1-17 years).

8.5 Smoking in pregnancy is associated with a range of negative health
    outcomes for the child. Rates of smoking in pregnancy are above
    average in Southport and Formby.

                         Smoking in      Breastfeeding        Breastfeeding
                         Pregnancy          Initiation     Duration (6-8 wks)
Southport and Formby        14.4%             62.7%               34.7%
     South Sefton           18.8%             49.4%               22.5%
        Sefton              17.1%             55.4%               26.4%
         NW                 18.6%             63.0%               32.5%
       England              14.1%             72.7%               45.2%
 8.6 Breastfeeding provides protection against disease in childhood, but also
     in adulthood, principally obesity, heart disease, cancer, type II diabetes
     and hypertension – the main causes of the gap in life expectancy
     between Southport and Formby‟s most and least deprived quintiles.

8.7 Breastfeeding initiation and duration rates in Southport and Formby are
    lower than average. To boost breastfeeding rates, infant feeding co-
    ordinators have been recruited at Ormskirk Hospital and in Community
    Health Services to provide training and advice to staff and mothers.

8.8 Breastfeeding champions are working in general practice and across
    community services and a NICE approved breastfeeding peer mentor
    support programme has been commissioned. Partner agencies in Sefton
    are committed to achieving the UNICEF Baby Friendly Initiative.

8.9 Breastfeeding is the first line in preventing obesity in infancy and
    childhood - childhood obesity rates have been highlighted in the obesity
    section above.

8.10 There is strong evidence that teenage parents tend to have poorer
    ante-natal health; they are more likely to have low birth weight babies,
    who partly because of this and other health problems are more at risk of
    dying in infancy. Post pregnancy their own health and that of the child
    continues to be poorer.

8.11 Southport and Formby has historically had low numbers of teenage
    conceptions, with less than 70 conceptions per year. However, the rate



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   Southport and Formby GP Consortia – Key Health Needs (April 2011)


                                             has not reduced and is higher than it was a decade ago.                                            Teenage
                                             conceptions are strongly linked to deprivation.

                                                                               Teenage Conception Rates in Sefton

                                                     England        Sefton        Southport and Formby GPCC        South Sefton GPCC        Sefton Target

                                             50.0

                                             45.0
  Conceptions Per 1,000 Females Aged 15-17




                                             40.0

                                             35.0

                                             30.0

                                             25.0

                                             20.0

                                             15.0

                                             10.0

                                              5.0

                                              0.0
                                                    1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11




8.12 A variety of interventions aim to address the 3 main factors known to
    contribute to high conception rates: low expectations, lack of accurate
    knowledge about contraception, and mixed messages from the adult
    world. Many interventions began as pilot projects and are now
    mainstreamed and available to young people and their parents across
    Sefton. However, Sefton needs to maintain the downward trend in
    teenage pregnancy, particularly in the most disadvantaged wards during
    a time of NHS reorganisation, removal of national targets and reduced
    spending across all public services.

International Workers
8.13 In recent years, there have been growing communities of international
    workers in and around Southport. Whilst no definitive figures exist,
    sources indicate there could be as many as 2,000 international workers,
    300 school age children and 600 partners/other family members.

8.14 Trinity GP Practice was commissioned to address some of the primary
    care needs of the international worker community. The main
    communities are from Poland, Portugal and Latvia. There is no data
    available on the health status of these patients. However, in 2009 there
    were over 200 births to non-British born mothers – 13% of all births in
    Southport and Formby. This rises to nearly 1/3 of births in central
    Southport.

Older People
8.15 Southport and Formby already has a sizeable population of older
    people – much higher than South Sefton and overall, Sefton overall has
    the highest proportion of residents aged 65+ and 75+ of any metropolitan


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     Southport and Formby GP Consortia – Key Health Needs (April 2011)


                       borough. In Southport and Formby, there are over 26,000 residents aged
                       65+ (23%) and over 13,000 residents aged 75+ (12%).

8.16 Projections indicate there could be 10% more residents aged 65+
    within 5 years. Older people are more likely to have a range of long term
    conditions and make greater use of health services

GP Access and Urgent Care
9.1 As well as the main lifestyle diseases in Southport and Formby, issues of
    urgent care and access have been highlighted as concerns.

9.2 It is notoriously hard to measure patient perceived access to general
    practice. Sefton‟s GP Scorecard18 has tried to measure patient access
    via a number of indicators – all of which have proved unsatisfactory:
         3rd available appointment
         WTE GPs per 1,000 patients
         Half day closing
         Planned clinical capacity per 1,000 patients

                                                                       GP Patient Survey 2009-10
                                                                       Patient Access Questions
                                              Southport & Formby Consortia        South Sefton Consortia     Sefton     England
                               100.0%


                               90.0%
                                                                                                       84%
                                                                                                                            80%        80%
                               80.0%                                                                              77%


                               70.0%                                         67.9%
      Percent of Respondents




                                                       62.7%      61.8%
                                            60.3%
                               60.0%


                               50.0%


                               40.0%


                               30.0%


                               20.0%


                               10.0%


                                0.0%
                                        Very or fairly easy to get through on phone (Q5a)           Able to see a doctor within 2 weekdays (Q7)

9.3 Here, some key questions from the GP Patient Survey19 have been used
    that focus on patient ability to access the surgery.

9.4 Less than two-thirds of patients in Southport and Formby (60%) felt it was
    very or fairly easy to get through to their surgery on the phone – lower
    than South Sefton and lower than the England average (68%). However,
    the percentage of patients who were able to see a doctor within 2
    weekdays (84%) was higher than average (80%).


18
   http://nww.sefton.nhs.uk/useful-information/public-health-intelligence-information/public-
health-intelligence.asp
19
   Results by practice can be downloaded at www.gp-patient.co.uk


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  Southport and Formby GP Consortia – Key Health Needs (April 2011)


9.5 Overall satisfaction with the care received at the GP surgery is higher in
    Southport and Formby (61%) than South Sefton (56%), but both are
    higher than average.
                                            GP Patient Survey 2009-10
                                    Overall Satisfaction with GP Surgery (Q28)

                                              North PBC     South PBC      Sefton   England

100%

 90%

 80%

 70%
         61%
 60%           56%58% 55%

 50%

 40%                                    34% 34% 35%
                                  32%
 30%

 20%

 10%                                                       5% 5% 5% 6%
                                                                                    2% 3% 2% 3%               0% 1% 1% 1%
 0%
           Very satisfied          Fairly satisfied       Neither satisfied nor     Fairly dissatisfied       Very dissatisfied
                                                              dissatisfied




9.6 In 2009-10 Southport and Formby patients had nearly 14,000
    attendances at A&E departments, costing over £1m. Nearly 40% of these
    attendances required no further treatment (£400k), with nearly 17% being
    referred back to their GP (£200k). The rate of A&E attendances is 2.5
    times higher in South Sefton than Southport and Formby. Even within
    Southport and Formby, there is a four-fold variation between practices in
    the rate of attendances at A&E departments.

                                 Attendances at A&E Deparments
                            Southport and Formby GP Consortia, 2009-10
                                                 Other, 600, 5%

                  Discharged to GP for
                  follow up treatment,
                       2,346, 17%


                                                                                                   Discharged - did not
                                                                                                     require follow up
                                                                                                  treatment, 5,189, 38%




           Referred to other
       professional, 1,821, 14%




                                                Admitted to hospital,
                                                   3,565, 26%




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               Southport and Formby GP Consortia – Key Health Needs (April 2011)


             Insight and Behaviour Change
             10.1 Insight tools are based on segmenting the population into small groups,
                  stereotyping the population using a range of data to create as
                  homogenous groups as possible. Segmentation is categorising the
                  population so that you can intervene to greatest effect. This allows us to
                  understand why people do what they do and how we can help them
                  change their behaviour.

             10.2 There are a number of tools that can be used gain insight into the
                  behaviour of patients and how to aid behaviour change. Most
                  segmentation tools are based on where a person lives. The underlying
                  assumption is that, in general, people of similar habits/thoughts/lifestyles
                  tend to live in similar neighbourhoods - where you are says something
                  about who you are.

             10.3 Mosaic is a segmentation tool that takes over 400 variables and
                  segments the population into 69 groups. Five groups account for 34%
                  of Southport and Formby‟s adult population and are detailed below.

                          Mosaic Type                      Adult Population        % of population
           E19 Self reliant older families in suburban           8,200                   9%
                   semis in industrial towns
           D14 Older people living in large houses in             7,600                    8%
                         mature suburbs
              B05 Better off empty nesters in low                 5,800                    6%
                density estates on town fringes
            G33 Transient singles, poorly supported               5,100                    5%
                   by family and neighbours
             E17 Comfortably off suburban families                5,100                    5%
              weakly tied to their local community

Segment                       Brief Description
Hedonistic Immortals          Motivated by risk and enjoyment. Feel that anything enjoyable (smoking,
(12% of Southport and         drinking) can‟t be bad for you. Lack of concern for their health. Intend to lead
Formby)                       healthy lifestyles – later
Living for Today              Take a short term, fatalistic view of life and health. Don‟t acknowledge
(18% of Southport and         consequences of health choices Value their health but believe that leading a
Formby)                       healthy lifestyle doesn‟t sound like much fun, and think it would be difficult
Unconfident Fatalists         Fairly negative about most things. Don‟t feel in control of their health. Likely to
(21% of Southport and         depressed and demotivated. Acknowledge unhealthy behaviours but don‟t feel
Formby)                       able to change. Need help to take small realistic steps
Health Conscious Realists     Motivated and feel in control of their health. Take a long term view and realistic
(37% of Southport and         of their health. Not risk takers, but will take opportunities to improve health
Formby)
Balanced Compensators         Generally positive and like to feel and look good. Take some risks but generally
(12% of Southport and         not with their health. Compensate unhealthy activities with healthy. Need to be
Formby)                       made aware of long term health risks

             10.4 Healthy Foundations is an attitudinal segmentation tool developed by
                  the Department of Health. It is not based on where respondents live
                  (postcode) but their attitudes. A respondent‟s segment can only be


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     Southport and Formby GP Consortia – Key Health Needs (April 2011)


         determined by answering 19 questions regarding their attitudes to their
         health.

10.5 Healthy Foundations segments respondents into five groups. The
     segments are not equally distributed within Southport and Formby.

GP Insight
10.6 Members of the public health team are undertaking a piece of work to
     explore how public health and general practice can work together to
     improve health outcomes in South Sefton.

10.7 This qualitative piece of work involves interviewing members of staff
     from a sample of GP practices across South Sefton.

10.8 This is a period of significant change for both public health and primary
     care. The work will explore the understanding of public health within
     general practice; identify the public health work that is currently being
     carried out within primary care; help identify public health priorities for
     practice populations; explore whether the NHS reforms will affect the
     relationship between general practice and public health.

10.9 The overall aim is to build relationships between primary care and public
     health and identify how public health can best support primary care in
     improving public health outcomes for their practice populations.

Priority Actions
11.1 The Department of Health toolkit on addressing health inequalities20
    concludes that the greatest impact on reducing health inequalities will be
    made through targeting cost effective interventions at areas of poorest
    health.

11.2 The authors identified 10 major lessons that can help to reduce health
    inequalities. Some will seem obvious, but others may require a new
    approach to commissioning locally. Three pertain to the importance of
    leadership and partnership work. The following seven relate more
    specifically to primary care

11.3 Get system and scale right. The scale of interventions should reflect
    the size of the problem. Consider levels of overweight and obesity. This
    needs an “industrial scale” intervention. There should be systematic,
    focused action plans detailing the whole trail, through to targets and
    outcomes.

11.4 Adjust workforce. Industrial scale interventions will require a review of
    skill mix to ensure cost effective, sustainable systems. Using obesity as
    an example, scarce professional resources need to focus on individuals
    with complex needs, whilst lay and peer support can work at community
    and group level.

20
     http://www.dh.gov.uk/en/Publichealth/NationalSupportTeams/HealthInequalities/index.htm


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11.5 Strengthen primary care. Ongoing practice support is needed to
    ensure management of specific priorities, i.e. CVD, diabetes and COPD.

11.6 Find the missing thousands. Be proactive in finding those with
    existing disease or at high risk but accessing services sub-optimally or
    not at all. Public health can support practices identify gaps between
    expected and actual numbers.

11.7 Capitalise on community engagement. Liaise with local authority,
    third sector and health colleagues who have existing infrastructures that
    can help develop engagement and subsequent appropriate health
    behaviour, e.g. parent forums, equality partnerships, older people‟s forum
    etc.

11.8 Raise the bar on target achievement. Make sure there are incentives
    to reach those patients who are “harder to reach” or who have more
    complex problems and or greater need. One option is to develop stronger
    QOF exemption strategy to ensure vulnerable patients are not removed
    from the target registers before any effort has been made to engage with
    them.

11.9 Utilise population health intelligence. Public health intelligence can
    work with practices, practice cluster or consortia as a whole to provide
    specific intelligence that is relevant and in real time.

11.10 Proven and cost effective interventions for the five lifestyle areas that
    need to be addressed in Southport and Formby should include:
       Smoking cessation services
       Vascular checks for those at risk
       Alcohol screening and brief interventions
       Use of and referral to weight management services
       Social prescribing for mental health
       Increasing rates of breastfeeding

11.11 Interventions in one area can have positive benefits to improving health
    in other priority areas. For example smoking cessation, as well as
    improving the health of parents and grandparents, will also reduce the
    negative impact of passive smoking on children. One of the key
    interventions needed in any obesity prevention and treatment programme
    is the promotion of breastfeeding. A reduction in passive smoking and
    increase in breastfeeding will help reduce infant mortality.

11.12 This report confirms the conclusions of previous public health annual
    reports21, joint strategic needs assessment22 and PCT commissioning
    plans23. Five lifestyle factors remain key areas for priority investment.

21
     http://www.sefton.nhs.uk/about-us/news-and-media/publications/Public_Health_Annual_Reports.asp
22
     Dec 2010 link at http://www.sefton.nhs.uk/about-us/news-and-media/publications.asp
23
     Jan 2010 link at http://www.sefton.nhs.uk/about-us/news-and-media/publications.asp


Email: Steven Ward, Public Health Intelligence, 0151 247 7256 Page 26 of 27
             Southport and Formby GP Consortia – Key Health Needs (April 2011)


           Next Steps
           12.1 The board is asked to note this report and
                  Ensure that commissioning decisions reflect the health needs and
                    characteristics of the Sefton population
                  Where appropriate, identify areas for more detailed analysis and
                    action, e.g. equity of access to primary care




           Appendix: Links to other GP based data and tools
           There are an increasing number of online tools that allow users to view
           profiles of data for GP practices. Other resources may exist and all links
           correct as at 17 March 2011.

Tool                   Details
GP Practice Profiles   Combines QOF, demographics, estimated prevalence and GP Patient
                       Survey data. Covers five main disease areas (CVD, diabetes, MH,
                       respiratory disease and other conditions). Can build own comparison areas
QOF results            Fully searchable QOF results for every practice in England
GP Patient Survey      Downloadable results for all practices in each PCT
Results
GP Cancer profiles     Comparative information at GP level. Practice demographics, breast,
                       cervical and bowel screening, cancer waiting times, cancer presentation and
                       diagnostics. [login required, but available to GP practices on application]
NHS comparators        Benchmarked secondary care data (some QOF and prescribing data)
                       [login required, but available to all on application]




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