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A grand day out at Aston University Health Centre

1 December 2005

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Angela Hegan
Practice Manager at the Health Centre for three years, having taken up post in August 2002. Previous background in both primary and secondary care in various management roles

Aston University Health Centre is a three PMS-doctor teaching practice situated within the main building at the University, providing medical services to students both at the University and other educational establishments in the Birmingham City Centre vicinity. The practice first formed in 1995 with a list size of 4,000; since then the list size has increased to 6,500, and it is expected to increase further in the future. Before becoming an open list in 1995, the Health Centre was a department of the University. Although we are now an independent practice, the Health Centre retains close links with the University.
As a practice we are unique, certainly in the West Midlands area, in that the majority of our patients are students. Our Age/Sex register always raises a smile during new employee inductions: currently we have 14 patients registered 0–4 years, 27 patients 5–16 years, 3,939 patients 17–24 years, 2,265 patients 25–34 years, 224 patients 35-44 years, 27 patients 45–54 years, five patients 55–64 years, one patient aged 65 years – and no over-75s at all!
As you can imagine, the Quality and Outcomes Framework (QOF) was somewhat of a nightmare, as we have no patients suffering from either of the big points earners, CHD and stroke. However, we earned maximum points for asthma, diabetes, epilepsy and hypothyroidism, narrowly missed out on top points for the remainder of the disease registers, and did extremely well in the other domains.

I prefer to use the term unique, rather than say we are not a normal practice (that conjures up visions of Quasimodo-esque reception staff and clinicians with excess body hair through every fault of their own!). The population we serve do not respond well to formality, and as a result we do not have any of the clinics you would expect from a “normal practice”.
Experience with DNA rates in previously assigned clinics for asthma and so on has taught us that this approach with young people simply does not work. All our screening is carried out using both a recall and an opportunistic system. Patients are booked in with clinicians to suit their timetables. We can offer early morning, late afternoon and lunchtime appointments, as we are open throughout the day. We send recall letters to targeted patients, but also follow this up with telephone invites. Again, our experience has shown that students prefer this personal approach, and that is actually backed up by our QOF achievement.

During main enrolment at the University at the end of September, the practice undertakes a mass registration of new patients, targeting all students who are enrolling on their course. Over a three-day period, we register approximately 390 patients daily, including undertaking new patient health checks and patient data entry.
For many patients this is their first time away from home, with all the ensuing anxiety that comes with that experience. Not only are they away from their family, but they also have to cope with living communally with strangers, trying to live within their means, and all this whilst trying to study and get the best grades they possibly can. The Health Centre staff are there to help them cope with this often-difficult transition, and we take an active role in University life, working closely with the Student Guild Executive supporting health promotion events.

There are frustrations being a university practice. Our average monthly DNA rate is usually around 150. We have difficulty in reaching our cytology target as many of our over-25 female patients are overseas students who either do not respond to recall or simply refuse to undergo the procedure. And every year we are sent a letter from our Primary Care Trust (PCT) berating us for not helping them to achieve the flu vaccination national targets for patients aged over 65, despite only having one patient over the age of 65 registered. It is discouraging to be criticised by the PCT for not achieving these targets and not receiving recognition for the work we undertake in sexual health, for instance.
However, the positive aspects of my role always outweigh the frustrations. The practice is very forward-thinking, and we have embraced practice-based commissioning as this gives us the opportunity to share our expertise, particularly in the fields of nurse triage, sexual health promotion and disease management. We are also planning to move in the near future to a purpose-built surgery, which will enable us to expand our practice list and the services we offer.
Perhaps the best part of being a university practice manager is that dealing with young people on a daily basis keeps you young – and that is no bad thing!