The Darzi report identifies the following priorities for primary care in the NHS: 1) Better access through new GP health centers, extended GP hours including weekends, and linking payments to attracting patients. 2) Tackling inequalities by improving access in underserved areas. 3) More choice by making it easier to switch GPs and opening services to non-NHS providers.

1. Observations on @
‘Our NHS Our Future’ – the Darzi
report
Richard Hobbs
Professor & Head of Primary Care and General Practice
Primary Care Clinical Sciences Building
University of Birmingham, United Kingdom

2. What does Darzi feel are priorities for primary
care in the NHS?
Better Access
Tackling inequalities
More Choice

3. Changing patterns of death worldwide:
1990-2020
Chronic diseases
and injuries
60
Infectious, maternal,
40 perinatal and nutritional
Millions of conditions
deaths
20
0
1990 2020 1990 2020
Global Burden of Disease Project, 1996

4. Leading causes of death and disability
(disability adjusted life years)
1990 2020
Rank Cause % Rank Cause %
1 Lower respiratory infections 8.2 1 Ischaemic heart disease 5.9
2 Diarrhoeal diseases 7.2 2 Major depression 5.7
3 Perinatal conditions 6.7 3 Road traffic accidents 5.1
4 Major depression 3.7 4 Cerebrovascular disease 4.4
5 Ischaemic heart disease 3.4 5 COPD 4.2
6 Cerebrovascular disease 2.8 6 Lower respiratory infections 3.1
7 Tuberculosis 2.8 7 Tuberculosis 3.0
8 Measles 2.7 8 War 3.0
9 Road traffic accidents 2.5 9 Diarrhoeal diseases 2.7
10 Congenital abnormalities 2.4 10 HIV 2.6
Global Burden of Disease Project, 1996

5. Potentially Modifiable Risk Factors
and MI : INTERHEART Study
15152 Cases 14820 Controls in 262 Centres in 52 Countries on 6 Continents
9 RFs acounted for 90% of MI in men and 94% in women
3
Odds 2
Ratio
1
0
Ap
D
BP
St
Fr
Sm
Ph
O
Al
M
be
oB
re
co
/V
ys
60
ok
ss
eg
si
ho
/ Ap
Ac
in
ty
l
g
o
t.
A1
40
PAR
(%) 20
0
-20
Yusuf S. Lancet 2004

6. Changes in Management of Coronary
Heart Disease 1998-2003-2005
90 84
80 72
70
60
47
50
40
30
20
10
0
BP 150/90 or less
1998 2003 2005

7. Comparison of QOF achievement across
cardiovascular domains
Total points achieved as % of points available
(England, cardiovascular domain)
100
98
96
04/05
94
05/06
92
06/07
90
88
86
CHD LVD/ HF Hypertension Stroke

8. QOF HF tougher thresholds for payments
Payment stages in 2004/05 & 2005/06:
LVD2 and LVD3: 25-90%
Payment stages in 2006/07:
HF2 – 40-90%
HF3 – 40-80%

10. Quality of chronic disease care in the UK between
1998 and 2003
90
85
O verall sco re (m ax 100)
80
Angina
75
Diabetes
70
Asthma
65
60
55
50
1997 1998 1999 2000 2001 2002 2003 2004
Campbell et al. Improvements in quality of clinical care in English GP 1998-2003. BMJ 2005; 331: 11

11. Quality of care between 2003 and 2005, following
the introduction of QOF financial incentives
100
90
O v e ra ll s c o re
Angina
80
Diabetes
Asthma
70
60
50
1996 1998 2000 2002 2004 2006
Campbell et al. Improvements in clinical quality in English primary care before and after the introduction of a
for performance scheme. (New England Journal of Medicine, in pr

12. Number of cervical smears & directly age standardised
rate of in situ cervical cancer, England, 1965-95

13. Age standardised incidence of invasive cervical cancer
& coverage of screening, England, 1971-95

14. What does Darzi feel are priorities for primary
care in the NHS?
Access’
‘Our primary care system coordinates care for patients in a way few other countries
match
– 150 new GP-led health centres in areas of low GP/patient
ratios
– Half of all GPs will open at weekends or on one or two
evenings a week
– Increased proportion of NHS payments made to GP
practices will be linked to ‘success in attracting patients’
– More ability to make appointments beyond 48 hours
Choice
– Enable patients to switch GPs more easily
– Open GP services to voluntary sector and private providers.
No need to register with some providers
‘Our registered GP list system is renowned internationally’

15. What does Darzi feel are priorities for
hospitals?
More personal care in hospitals
– Privacy
– Dignity
– Elderly
Safety
– MRSA & C Difficile
Training of staff