Sax Quacks               Drs Havard, Evans, Murphy, Hamblyn, Dunn, Oates & Richards Your Health Summary Care Record The NHS in England is changing the way your health records are stored and managed.  Today, records are kept in all the places where you receive care. These places can usually only share information  from your records by letter, email, fax or phone. At times, this can slow down treatment and sometimes  information can be hard to access.  By making more health records electronic, there will be quicker ways to get important information  to NHS healthcare staff treating you, including in an emergency.   The Summary Care Record is an electronic record which will give healthcare staff faster, easier  access to essential information about you, to help provide you with safe treatment when you need  care in an emergency or when your GP practice is closed.  SCR’s are not currently being used in Suffolk. For more information please visit www.nhscarerecords.nhs.uk  Preventing strokes in the community Preventative medicine is a large part of the GP's role and explaining the importance of this to patients is a daily  event. In stroke, we know that blood pressure control is crucial and diabetes, smoking and obesity are other  important factors which can load the dice and affect the risk of stroke in an individual. Of course age and family  history are fixed risks that can mean the variable ones become even more important.  Less newsworthy is the fact that about 30,000 of the 110,000 strokes that occurred last year happened in patients  who had a heart condition called Atrial Fibrillation (AF). This is quite common (1.4% of the population but 10% of  the over 80s) and it causes an irregular pulse that makes the formation of tiny clots in the heart more likely. In fact  patients with AF are four times more likely that those with normal rhythms to have a stroke. AF usually causes  absolutely no symptoms at all and so part of the challenge is to find these patients and then try to reduce their risk  of stroke. Finding new patients with AF GPs and Nurses can do their own screening on everyone  who attends the Surgery. But taking a pulse and finding if  it is irregular is something that anyone can do. If there is  any doubt then the pulse can be checked by a Nurse or a  Doctor and if necessary a confirmatory ECG can be done.  We know from work elsewhere that there are about 60%  more patients with AF than we are aware of and we want  to identify and help them. Treatment The best treatment in most cases is to use warfarin (the  clot-stopper) and sometimes to control the heart rate.  Warfarin is very effective but it does have drawbacks.  Firstly it makes bruising and bleeding more likely because  it slows down natural clotting. In some patients there is a  balance of risk that suggests avoiding warfarin is the right  thing to do - but these cases are relatively rare. There is  no doubt that these are 'rock and hard place' decisions  because in 1000 patients we know that six will have bleeds  (with occasional fatalities) and yet 30 will have strokes. As  GPs, our dilemma is that our warfarin treatment could  rarely cause death and yet not treating is generally much  more likely to cause death or disability - and yet this might  be seen by the public as 'natural'. A frequent compromise  is the prescription of Aspirin which may save 12 strokes  but the contention is that we should warfarinise more  patients. Why not warfarinise more patients with AF?  The decision here weighs up a lot of factors.  The risk of  falls and subsequent bleeds, difficulty in getting the  warfarin dose blood tests and uncertainty about whether patients will take the warfarin reliably are reasons quoted  frequently by GPs. Occasionally the risks of treatment are given more emphasis than the risks of not treating  although sometimes it is clearly right not to treat.  Plan  Patients and their relatives need to be aware of this balance so that mature decisions can be made. We now have a  computer programme that can predict the annual risk of stroke while the patient is sitting in the Consulting Room.  We know patients are more concerned about stroke than heart attack so this will be powerful personal information  that will influence the decision that the patient and GP take together. Furthermore the patient information is also  checked by a local Cardiologist who gives an emailed response within a day based on the information supplied.  This is a new move which will support both GPs and patients in difficult decisions. In Primary Care we need to  make the blood testing easier and have this done in the home by someone who specialises in just warfarin. He or  she can then help patients be clear about dosages possibly even using a portable machine in the home.