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Recurrent strokes blamed on surgery opening hours

By Nigel Praities

As many as 500 recurrent strokes a year could be prevented by providing extended opening hours at GP surgeries, primary care researchers have claimed.

The controversial conclusions of a new study finding delays in stroke diagnosis out of normal surgery opening hours have been refuted by other GP experts.

Guidelines recommend patients with stroke or high risk transient ischaemic attacks – with an ABCD2 score of four or over – should be seen by a specialist within 24 hours.

But UK researchers found those having events outside surgery opening hours were waiting significantly longer to seek medical attention.

Their study looked at the time it took nearly 800 patients with TIA and minor stroke to access healthcare services at nine general practices in Oxfordshire, and found most patients contacted their registered GP, rather than seeking help from accident and emergency or out-of-hours GP services.

Patients experiencing an event out-of-hours during the week or at weekends waited an average of 25 hours before contacting their GP, compared with around four hours for those having an event in surgery hours.

The authors concluded that five recurrent strokes from their study could have been prevented if practices adopted 8am to 8pm opening hours and backed Government moves to extend opening hours, the equivalent of 500 nationally.

Dr Daniel Lasserson, a GP and clinical lecturer at the Department of Public Health and Primary Care at University of Oxford, said: ‘Current opening hours can increase the delay in assessment. Increased access to general practice out of hours could provide an opportunity for assessment and urgent referral.'

But Dr Helen Hosker, a GPSI in elderly people's care in Manchester, claimed GP hours were ‘irrelevant'.

‘It is about training. GPs, out-of hours providers, carers, district nurses and walk-in centres need to know the imperative is getting that patient to A&E,' she said.

Dr Damien Jenkinson, the national clinical lead for the NHS Stroke Improvement Programme, agreed that training was key, saying the Department of Health was about to launch a nationwide campaign to educate doctors about the symptoms of TIA and minor stroke.

‘There is a lack of awareness of TIA in primary care, although that is improving. Any patients with neurology need to be recognised, stratified and referred to the TIA clinic. The way to improve this is through better education,' he said.

Dr Jenkinson also revealed the Government was looking at launching an education programme for the public about TIA and stroke next year.

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