The project was delivered through the AT Medics Streatham Primary Care Network (PCN) in Lambeth, which consists of two practices, Edith Cavell Surgery and Streatham High Practice. The practices care for 45,000 patients, of which 3,100 were identified as suffering with hypertension. In 2021/22 across our Streatham PCN, blood pressure control in patients of white ethnicity was 67% and in patients of black ethnicity it was only 55%.
Key outcomes from the project include:
- Eradicating the 12% inequality gap for blood pressure control between our black and white patients in under 12 months
- blood pressure control for black patients in our PCN is now 21% higher than the Lambeth average.
- despite the high levels of deprivation in the communities we serve, our patients, regardless of ethnicity, now have the best blood pressure outcomes of any PCN in Southeast London.
“This project has delivered incredible results, and this is all down to the dedication of our amazing team, especially our administrators, healthcare assistants and pharmacists. The last 12 months have proved that we can not just reduce but actually eradicate health inequalities and raise the quality of care for everyone at the same time. I know the difference this will make to our local communities, and it really shows what is possible with a highly motivated multidisciplinary team.” Dr Tarek Radwan, GP Director
The aim of the project was to improve overall control of hypertension for all patients with a particular focus among patients of black African and black Caribbean descent. It is well documented nationally that blood pressure control amongst this community is significantly lower than for white patients.
The programme was led by a senior GP and PCN manager with centralised recall and pharmacist teams working alongside practice-based pharmacists and Health Care Assistants. The team’s work saw 98% of hypertensive patients checked and a blood pressure reading recorded in the last 12 months.
The overall results of the project are:
- AT Medics Streatham PCN has 20% better control than the next best Lambeth PCN for hypertensive patients under 80 years old
- Despite the high levels of deprivation in the communities we serve, our patients have the best blood pressure outcomes of any PCN in Southeast London
- 87% of all patients aged under 80 are now controlled, compared to 61% a year earlier.
- 95% of all patients aged 80 or more are now controlled, compared to 77% a year earlier.
For BAME patients the project has eradicated the 12% inequality gap for blood pressure control between our black and white patients in under 12 months.
- Blood pressure control in white ethnic patients over 80 years old = 87%
- Blood pressure control in black ethnic patients over 80 years old = 87.4%
- Blood pressure control for our black patients in our PCN is now 21% higher than the Lambeth average and 19% higher than the next best Lambeth PCN.
In addition, over 2000 NHS health checks were carried out by our HCA and nursing team in the last 12 months. This has contributed to over 300 patients being newly diagnosed with, and treated for, hypertension.
“It’s brilliant to see such fantastic results from this 12-month programme which show that using tailored approaches to access healthcare can improve overall diagnosis of high blood pressure and helps close the inequality gap in its treatment. We want there to be fewer strokes and for the people affected by stroke to have the treatment and support they need to recover, irrespective of their ethnicity. Programmes like this pave the way for the future and can help to tackle health inequalities.” Michelle Dalmacio, Stroke Association’s Associate Director for London