CVD: Primary Care Intelligence Packs NHS Northern, Eastern and Western Devon CCG
June 2017 Version 1 Contents
1. Introduction 3
2. CVD prevention • The narrative 11 • The data 13 3. Hypertension • The narrative 16 • The data 17 4. Stroke • The narrative 27 • The data 28 5. Diabetes • The narrative 42 • The data 43 6. Kidney • The narrative 53 • The data 54 7. Heart • The narrative 65 • The data 66 8. Outcomes 82
9. Appendix 88 This document is valid only when viewed via the internet. If it is printed into hard copy or saved to another location, you must first check that the version number on your copy matches that of the one online. Printed copies are uncontrolled copies.
2 CVD: Primary Care Intelligence Packs Introduction
3 CVD: Primary Care Intelligence Packs This intelligence pack has been compiled by GPs and nurses and pharmacists in the Primary Care CVD Leadership Forum in collaboration with the National Cardiovascular Intelligence Network
Matt Kearney Sarit Ghosh Kathryn Griffith George Kassianos Jo Whitmore Matthew Fay Chris Harris Jan Procter-King Yassir Javaid Ivan Benett Ruth Chambers Ahmet Fuat Mike Kirby Peter Green Kamlesh Khunti Helen Williams Quincy Chuhka Sheila McCorkindale Nigel Rowell Ali Morgan Stephen Kirk Sally Christie Clare Hawley Paul Wright Bruce Taylor Mike Knapton John Robson Richard Mendelsohn Chris Arden David Fitzmaurice
4 CVD: Primary Care Intelligence Packs Local intelligence as a tool for clinicians and commissioners to improve outcomes for our patients Why should we use this CVD Intelligence Pack The high risk conditions for cardiovascular disease (CVD) - such as hypertension, atrial fibrillation, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease - are the low hanging fruit for prevention in the NHS because in each case late diagnosis and suboptimal treatment is common and there is substantial variation. High quality primary care is central to improving outcomes in CVD because primary care is where much prevention and most diagnosis and treatment is delivered. This cardiovascular intelligence pack is a powerful resource for stimulating local conversations about quality improvement in primary care. Across a number of vascular conditions, looking at prevention, diagnosis, care and outcomes, the data allows comparison between clinical commissioning groups (CCGs) and between practices. This is not about performance management because we know that variation can have more than one interpretation. But patients have a right to expect that we will ask challenging questions about how the best practices are achieving the best, what average or below average performers could do differently, and how they could be supported to perform as well as the best.
How to use the CVD intelligence pack The intelligence pack has several sections – CVD prevention, hypertension, stroke and atrial fibrillation (AF), diabetes, kidney disease, heart disease and heart failure. Each section has one slide of narrative that makes the case and asks some questions. This is followed by data for a number of indicators, each with benchmarked comparison between CCGs and between practices. Use the pack to identify where there is variation that needs exploring and to start asking challenging questions about where and how quality could be improved. We suggest you then develop a local action plan for quality improvement – this might include establishing communities of practice to build clinical leadership, systematic local audit to get a better understanding of the gaps in care and outcomes, and developing new models of care that mobilise the wider primary care team to reduce burden on general practice.
5 CVD: Primary Care Intelligence Packs Data and methods
This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic transformation plan (STP) and England. Where a CCG is in more than one STP, it has been allocated to the STP with the greatest geographical or population coverage. The slide pack also compares the CCG to its 10 most similar CCGs in terms of demography, ethnicity and deprivation. For information on the methodology used to calculate the 10 most similar CCGs please go to: http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/
The 10 most similar CCGs to NHS Northern, Eastern and Western Devon CCG are: NHS Dorset CCG NHS Cambridgeshire and Peterborough CCG NHS Oxfordshire CCG NHS Kernow CCG NHS Gloucestershire CCG NHS Somerset CCG NHS Cumbria CCG NHS Nene CCG NHS West Hampshire CCG NHS Southern Derbyshire CCG
The majority of data used in the packs is taken from the 2015/16 Quality and Outcomes Framework (QOF). Where this is not the case, this is indicated in the slide. All GP practices that were included in the 2015/16 QOF are included. Full source data are shown in the appendix.
For the majority of indicators, the additional number of people that would be treated if all practices were to achieve as well as the average of the top achieving practices is calculated. This is calculated by taking an average of the intervention rates (ie the denominator includes exceptions) for the best 50% of practices in the CCG and applying this rate to all practices in the CCG. Note, this number is not intended to be proof of a realisable improvement; rather it gives an indication of the magnitude of available opportunity.
6 CVD: Primary Care Intelligence Packs Why does variation matter?
A key observation about benchmarking data is The variation that exists between that it does not tell us why there is variation. Some of the demographically similar CCGs and variation may be explained by population or case mix and some may be unwarranted. We will not know unless we between practices illustrates the local investigate. potential to improve care and outcomes for our patients Benchmarking may not be conclusive. Its strength lies not in the answers it provides but in the questions it generates for CCGs and practices. Benchmarking is helpful because it highlights variation. For example: 1. How much variation is there in detection, management, Of course it has long been acknowledged that some exception reporting and outcomes? variation is inevitable in the healthcare and outcomes 2. How many people would benefit if average performers experienced by patients. improved to the level of the best performers? But John Wennberg, who has championed research 3. How many people would benefit if the lowest performers into clinical variation over four decades and who matched the achievement of the average? founded the pioneering Dartmouth Atlas of Health 4. What are better performers doing differently in the way Care, concluded that much variation is unwarranted – they provide services in order to achieve better outcomes? ie it cannot be explained on the basis of illness, 5. How can the CCG support low and average performers to medical evidence, or patient preference, but is help them match the achievement of the best? accounted for by the willingness and ability of doctors 6. How can we build clinical leadership to drive quality to offer treatment. improvement?
There are legitimate reasons for exception reporting. But ……. Excepting patients from indicators puts them at risk of not receiving optimal care and of having worse outcomes. It is also likely to increase health inequalities. The substantial variation seen in exception reporting for some indicators suggests that some practices are more effective than others at reaching their whole population. Benchmarking exception reporting 7 allows us to identify the practices that need support to implement the strategies adopted by low excepting practices. Cluster methodology: your most similar practices
Each practice has been grouped on the basis of demographic data into 15 national clusters. These demographic factors cover: • deprivation (practice level) • age profile (% < 5, % < 18, % 15-24, % 65+, % 75+, % 85+) • ethnicity (% population of white ethnicity) • practice population side
These demographic factors closely align with those used to calculate the “Similar 10 CCGs”. These demographic factors have been used to compare practices with similar populations to account for potential factors which may drive variation. Some local interpretation will need to be applied to the data contained within the packs as practices with significant outlying population characteristics e.g. university populations or care home practices will need further contextualisation. Further detailed information including full technical methodology and a full PDF report on each of the 15 practice clusters is available here: https://github.com/julianflowers/geopractice.
8 CVD: Primary Care Intelligence Packs Cluster methodology: calculating potential gains
The performance of every practice in the GP cluster contributes to the average of the top performing 50% of practices to form a benchmark.
5% 0% -5% -10% -15% -20%
WELLINGTON ROAD SURGERY 7
EMERSONS GREEN MEDICAL CENTRE 9
LEAP VALLEY MEDICAL CENTRE 22
CHRISTCHURCH FAMILY MEDICAL CENTRE 21
CONISTON MEDICAL PRACTICE 17
FROME VALLEY MEDICAL CENTRE 31
ST MARY STREET SURGERY 14 KINGSWOODRaw HEALTH difference CENTRE between the Potential opportunity if 15 Potential opportunity if the CONCORDpractice MEDICAL CENTRE value the practice value was 12 CCG value were to move KENNEDYand WAY the SURGERY average of the to move to the average 9 to the average of the top 5 highest or lowest 50% of of the highest 50% of performing closest CCGs similar cluster practices similar cluster practices BRADLEY STOKE SURGERY 3
THE WILLOW SURGERY 5
CLOSE FARM SURGERY 1 The difference between the benchmark and the selected practices is displayed on this chart. The benchmark will most likelyPILNING be SURGERY different for different practices as they are in different clusters, so1 the difference is the key measure here. IfCOURTSIDE the practice SURGERY performance is below the benchmark, the difference is applied1 to the denominator plus exceptionsALMONDSBURY to SURGERY demonstrate potential gains on a practice basis. The potential gains on a CCG basis are calculated
STOKEbased GIFFORD on MEDICAL the CENTREdifference between the top 5 performing closest CCGs and the selected CCG, applied to the
denominatorORCHARD MEDICAL plus CENTRE exceptions.
WEST WALK SURGERY
THORNBURY9 CVD: HEALTH PrimaryCENTRE - BURNEY Care Intelligence Packs CVD prevention
10 CVD: Primary Care Intelligence Packs CVD prevention
The size of the prevention problem “The NHS needs a radical upgrade • 2/3 of adults are obese or overweight in prevention if it is to be • 1/3 of adults are physically inactive sustainable” • average smoking prevalence is 17% but is much 5 year Forward View 2014 higher in some communities • in high risk conditions like atrial fibrillation, high blood pressure, diabetes and high ten year CVD risk score, This is because England faces an epidemic of largely up to half of all people do not receive preventive preventable non-communicable diseases, such as heart treatments that are known to be highly effective at disease and stroke, cancer, Type 2 diabetes and liver disease. preventing heart attacks and strokes
Dietary risks • around 90% of people with familial hypercholestero- Tobacco smoke High body-mass index laemia are undiagnosed and untreated despite their High systolic blood pressure Alcohol and drug use average 10 year reduction in life expectancy HIV/AIDS and tuberculosis High fasting plasma glucose Diarrhea, lower respiratory & other common infectious diseases High total cholesterol Neglected tropical diseases & malaria Maternal disorders Low glomerular filtration rate Neonatal disorders Nutritional deficiencies Low physical activity Other communicable, maternal, neonatal, & nutritional diseases Neoplasms Occupational risks Social prescribing and wellbeing hubs offer new Cardiovascular diseases Air pollution Chronic respiratory diseases Cirrhosis Low bone mineral density Digestive diseases models for supporting behaviour change while reducing Neurological disorders Child and maternal malnutrition Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases Sexual abuse and violence burden on general practice. Musculoskeletal disorders Other environmental risks Other non-communicable diseases Transport injuries Unsafe sex Unintentional injuries The NHS Health Check is a systematic approach to Self-harm and interpersonal violence Unsafe water/ sanitation/ handwashing Forces of nature, war, & legal intervention 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% identifying local people at high risk of CVD, offering Percent of total disability-adjusted life-years (DALYs) behaviour change support and early detection of the The Global Burden of Disease Study (next slide) shows us that high risk but often undiagnosed conditions such as the leading causes of premature mortality include diet, hypertension, atrial fibrillation, CKD, diabetes and pre- tobacco, obesity, raised blood pressure, physical inactivity and diabetes. raised cholesterol. The radical upgrade in prevention needs Question: What proportion of our local eligible population-level approaches. But it also needs interventions in population is receiving the NHS Health Check and how primary care for individuals with behavioural and clinical risk effective is the follow-up management of their clinical factors. risk factors in primary care?
11 11 CVD: Primary Care Intelligence Packs Global Burden of Disease Study 2015 Risk Factors for premature death and disability caused by CVD in England, expressed as a percentage of total disability-adjusted life-years
High systolic blood pressure
Dietary risks
High total cholesterol
High body-mass index
Tobacco smoke
High fasting plasma glucose
Low physical activity
Air pollution
Low glomerular filtration rate
Other environmental risks
0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%
Percentage of total CVD disability-adjusted life-years (DALYs)
12 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by CCG Comparison with demographically similar CCGs
NHS Nene CCG 19.3%
NHS Kernow CCG 18.0% • prevalence of 17% in NHS Northern, Eastern and Western Devon CCG NHS Somerset CCG 17.7%
NHS Southern Derbyshire CCG 17.6%
NHS Cambridgeshire and Peterborough CCG 17.5%
NHS Cumbria CCG 17.1%
NHS Northern, Eastern and Western Devon CCG 17.0%
NHS Dorset CCG 16.5% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Gloucestershire CCG 15.9% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Oxfordshire CCG 14.7% http://bmjopen.bmj.com/content/4/7/e005217.abs tract
NHS West Hampshire CCG 14.0% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 5% 10% 15% 20% 25% recorded as current smokers) divided by GP practice’s estimated number of patients 15+
13 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by GP practice
GP Practice CCG
CLOCK TOWER SURGERY L83673 73.6% FREEDOM HEALTH CENTRE L83643 42.0% ADELAIDE STREET SURGERY L83651 37.3% DEVONPORT HEALTH CENTRE L83624 33.3% NORTH ROAD WEST MED.CTR. L83030 33.2% ERNESETTLE PRIMARY CARE CENTRE L83006 32.0% ARMADA SURGERY L83080 31.7% WONFORD GREEN SURGERY L83655 31.2% BUDSHEAD MEDICAL PRACTICE L83113 29.8% OAKSIDE SURGERY L83015 29.1% STOKE SURGERY L83071 27.1% ST.LEVAN SURGERY L83646 26.7% ST NEOTS SURGERY L83028 26.5% SALTASH ROAD SURGERY L83626 26.0% FOXHAYES PRACTICE Y00568 25.9% • 130,373 people who are recorded as CHARD ROAD SURGERY L83037 25.3% WYCLIFFE SURGERY L83076 24.9% WEST HOE SURGERY L83112 23.9% WHIPTON SURGERY L83115 23.8% OCEAN HEALTH CENTRE L83074 23.6% smokers in NHS Northern, Eastern ST.BARNABAS SURGERY L83664 23.3% TOTHILL SURGERY L83123 23.3% FRIARY HOUSE SURGERY L83072 23.0% QUEEN'S MEDICAL CENTRE L83003 22.7% CROWNHILL SURGERY L83107 22.7% and Western Devon CCG SOUTHWAY SURGERY L83039 22.4% OKEMENT PRIMARY CARE CENTRE Y00304 22.4% WATERSIDE PRACTICE L83017 21.7% IMPERIAL SURGERY L83628 21.5% BOUTPORT MEDICAL CENTRE L83139 21.3% • GP practice range: 7.7% to 73.6% LISSON GROVE MEDICAL CTR. L83147 21.1% HYDE PARK SURGERY L83658 21.1% THE COMBE COASTAL PRACTICE L83096 21.0% SOUTHERNHAY HOUSE SURGERY L83058 21.0% ESTOVER SURGERY L83642 20.3% PATHFIELDS PRACTICE L83008 20.0% HALDON HOUSE SURGERY L83136 20.0% PARK VIEW SURGERY L83117 19.4% WOODA SURGERY L83106 19.2% CLARE HOUSE L83085 19.2% MOUNT PLEASANT HEALTH CENTRE L83066 19.2% BIDEFORD MEDICAL CENTRE L83083 18.9% NEW VALLEY PRACTICE L83127 18.9% BRANNAM MEDICAL CENTRE L83073 18.6% ELM SURGERY L83019 18.3% SOUTH LAWN MEDICAL PRACTICE L83084 17.8% ST LEONARDS PRACTICE L83042 17.8% LEYPARK SURGERY L83144 17.7% CASTLE PLACE PRACTICE L83052 17.7% HARTLAND SURGERY L83129 17.4% BRAMBLEHAIES SURGERY L83128 17.2% BEAUMONT VILLA SURGERY L83018 17.0% NORTHAM SURGERY L83050 17.0% ST THOMAS MEDICAL GROUP L83016 16.7% CRANBROOK MEDICAL PRACTICE Y04662 16.7% ISCA MEDICAL PRACTICE L83099 16.6% HATHERLEIGH MEDICAL CENTRE L83647 16.5% ROLLE MEDICAL PARTNERSHIP L83053 16.4% COLLEGE SURGERY PARTNERSHIP L83092 16.4% BARNFIELD HILL SURGERY L83024 16.3% LITCHDON MEDICAL CENTRE L83035 15.9% BARTON SURGERY L83125 15.8% CLAREMONT MEDICAL PRACTICE L83056 15.8% CASTLE GARDENS SURGERY L83105 15.8% EAST STREET SURGERY L83047 15.8% NORTH TAWTON MEDICAL PRACTICE Y04979 15.5% LYNTON HEALTH CENTRE L83068 15.5% HOLSWORTHY MEDICAL CENTRE L83069 15.3% NORTON BROOK MEDICAL CENTRE L83059 15.2% TORRINGTON HEALTH CENTRE L83026 15.2% SOUTH MOLTON HEALTH CENTRE L83137 15.0% ABBEY SURGERY L83101 14.9% OKEHAMPTON MEDICAL CENTRE L83087 14.7% HEAVITREE PRACTICE L83077 14.4% HONITON SURGERY L83002 14.3% WALLINGBROOK HEALTH CENTRE L83025 14.2% BRADWORTHY SURGERY L83012 14.2% BOW MEDICAL PRACTICE Y02633 14.2% HIGHLANDS HEALTH CENTRE L83644 14.2% SAMPFORD PEVERELL SURGERY L83616 14.2% CHIDDENBROOK SURGERY L83065 14.1% BAMPTON SURGERY L83009 13.9% TOWNSEND HOUSE MEDICAL CENTRE L83054 13.8% MORETONHAMPSTEAD HEALTH CENTRE L83049 13.8% HILL BARTON SURGERY L83143 13.7% AXMINSTER MEDICAL PRACTICE L83020 13.6% HONITON SURGERY - EVANS Y02121 13.6% KNOWLE HOUSE SURGERY L83089 13.6% REDFERN HEALTH CENTRE L83088 13.2% SHEBBEAR SURGERY L83121 13.0% IDE LANE SURGERY L83079 12.9% MID DEVON MEDICAL PRACTICE L83023 12.8% BEACON MEDICAL GROUP L83100 12.8% WESTBANK PRACTICE L83041 12.7% BLACKDOWN PRACTICE L83044 12.7% GLENSIDE MEDICAL CENTRE L83138 12.6% CAEN MEDICAL CENTRE L83097 12.4% PINHOE SURGERY L83040 12.3% TOPSHAM SURGERY L83036 12.2% CHAGFORD HEALTH CENTRE L83082 12.2% ROBOROUGH SURGERY L83048 12.1% SOUTH BRENT HEALTH CENTRE L83075 12.1% Note: This method is thought to be a reasonably LIFTON SURGERY L83608 12.1% TAVYSIDE HEALTH CENTRE L83038 12.0% PEVERELL PARK SURGERY L83648 11.9% RALEIGH SURGERY L83627 11.7% robust method in estimating smoking prevalence FREMINGTON MEDICAL CENTRE L83057 11.6% WOODBURY SURGERY L83116 11.5% YELVERTON SURGERY L83102 11.4% CHURCH VIEW SURGERY L83064 11.0% for the majority of GP practices. However, THE MANNAMEAD SURGERY L83061 10.9% YEALM MEDICAL CENTRE L83081 10.8% WYNDHAM HOUSE SURGERY L83134 10.8% SEATON & COLYTON MEDICAL PRACTICE L83007 10.7% BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 10.7% caution is advised for extreme estimates of MODBURY HEALTH CENTRE L83086 10.6% SID VALLEY PRACTICE L83067 10.5% BLACK TORRINGTON SURGERY L83663 10.2% DEAN CROSS SURGERY L83021 10.1% smoking prevalence and those with high COLERIDGE MEDICAL CENTRE L83095 9.9% CHERITON BISHOP SURGERY L83098 9.3% WEMBURY SURGERY L83639 7.7% numbers of smoking status not recorded and 0% 10% 20% 30% 40% 50% 60% 70% 80% exceptions.
14 CVD: Primary Care Intelligence Packs Hypertension
15 CVD: Primary Care Intelligence Packs Hypertension
The Missing Millions On average, each CCG in England has 26,000 residents with The Global Burden of Disease undiagnosed hypertension – these individuals are unaware of Study confirmed high blood pressure as their increased cardiovascular risk and are untreated. a leading cause of premature death and disability What questions should we ask in our CCG? 1. for each indicator how wide is the variation in achievement and exception reporting? 2. how many people would benefit if all practices performed High blood pressure is common and costly as well as the best? • it affects around a quarter of all adults 3. how can we support practices who are average or below • the NHS costs of hypertension are around £2bn average to perform as well as the best in: • social costs are probably considerably higher • detection of hypertension • management of hypertension What do we know? • at least half of all heart attacks and strokes are caused by high blood pressure and it is a major risk What might help? factor for chronic kidney disease and cognitive decline • support practices to share audit data and systematically • treatment is very effective – every 10mmHg reduction identify gaps and opportunities for improved detection and in systolic blood pressure lowers risk of heart attack management of hypertension and stroke by 20% • work with practices and local authorities to maximise • despite this 4 out of 10 adults with hypertension, over uptake and follow up in the NHS Health Check 5 and a half million people in England, remain • support access to self-test BP stations in waiting rooms undiagnosed and to ambulatory blood pressure monitoring. • and even when the condition is identified, treatment is • commission community pharmacists to offer blood often suboptimal, with blood pressure poorly pressure measurement, diagnosis and management controlled in about 1 out of 3 individuals support, including support for adherence to medication
16 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by CCG Comparison with CCGs in the STP
NHS South Devon And Torbay CCG 0.62 • the ratio of those diagnosed with hypertension versus those expected to have hypertension is 0.59. This compares to 0.59 for England • this suggests that 59% of people with NHS Northern, Eastern And Western Devon CCG 0.59 hypertension have been diagnosed
England 0.59 Note: this slide shows Hypertension prevalence estimates created using data from QOF hypertension registers 2014/15 and Undiagnosed hypertension estimates for adults 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 16 years and older. 2014. Department of Primary Ratio Care & Public Health, Imperial College London
17 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs
NHS Somerset CCG 0.60
NHS Nene CCG 0.60
NHS Northern, Eastern and Western Devon CCG 0.59
NHS Cumbria CCG 0.59
NHS West Hampshire CCG 0.59
NHS Dorset CCG 0.59
NHS Southern Derbyshire CCG 0.59
NHS Kernow CCG 0.58
NHS Gloucestershire CCG 0.58
NHS Oxfordshire CCG 0.57
NHS Cambridgeshire and Peterborough CCG 0.56
0% 10% 20% 30% 40% 50% 60% 70%
18 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by GP practice
GP practice CCG
ESTOVER SURGERY L83642 0.75 RALEIGH SURGERY L83627 0.73 SALTASH ROAD SURGERY L83626 0.69 CHARD ROAD SURGERY L83037 0.67 BEACON MEDICAL GROUP L83100 0.67 WYCLIFFE SURGERY L83076 0.66 CHURCH VIEW SURGERY L83064 0.65 HIGHLANDS HEALTH CENTRE L83644 0.65 LEYPARK SURGERY L83144 0.65 NORTH ROAD WEST MED.CTR. L83030 0.65 WOODBURY SURGERY L83116 0.63 OAKSIDE SURGERY L83015 0.63 TOTHILL SURGERY L83123 0.63 HARTLAND SURGERY L83129 0.62 TORRINGTON HEALTH CENTRE L83026 0.62 BLACK TORRINGTON SURGERY L83663 0.62 • it is estimated that there are 93,544 PATHFIELDS PRACTICE L83008 0.62 HALDON HOUSE SURGERY L83136 0.62 BOW MEDICAL PRACTICE Y02633 0.61 WEMBURY SURGERY L83639 0.61 COLERIDGE MEDICAL CENTRE L83095 0.61 people with undiagnosed SID VALLEY PRACTICE L83067 0.61 FOXHAYES PRACTICE Y00568 0.61 HEAVITREE PRACTICE L83077 0.61 SEATON & COLYTON MEDICAL PRACTICE L83007 0.61 ST.LEVAN SURGERY L83646 0.60 OCEAN HEALTH CENTRE L83074 0.60 hypertension in NHS Northern, NORTON BROOK MEDICAL CENTRE L83059 0.60 MID DEVON MEDICAL PRACTICE L83023 0.60 GLENSIDE MEDICAL CENTRE L83138 0.59 BAMPTON SURGERY L83009 0.59 WYNDHAM HOUSE SURGERY L83134 0.59 Eastern and Western Devon CCG ROBOROUGH SURGERY L83048 0.59 HILL BARTON SURGERY L83143 0.59 YEALM MEDICAL CENTRE L83081 0.58 SOUTH MOLTON HEALTH CENTRE L83137 0.58 ELM SURGERY L83019 0.58 • GP practice range of observed to CASTLE PLACE PRACTICE L83052 0.58 ABBEY SURGERY L83101 0.58 BRAMBLEHAIES SURGERY L83128 0.58 BARNFIELD HILL SURGERY L83024 0.57 AXMINSTER MEDICAL PRACTICE L83020 0.57 HOLSWORTHY MEDICAL CENTRE L83069 0.57 expected hypertension prevalence ERNESETTLE PRIMARY CARE CENTRE L83006 0.57 DEAN CROSS SURGERY L83021 0.57 SAMPFORD PEVERELL SURGERY L83616 0.57 CROWNHILL SURGERY L83107 0.57 THE MANNAMEAD SURGERY L83061 0.57 0.31 to 0.75 HONITON SURGERY - EVANS Y02121 0.57 YELVERTON SURGERY L83102 0.57 SOUTHWAY SURGERY L83039 0.56 COLLEGE SURGERY PARTNERSHIP L83092 0.56 LISSON GROVE MEDICAL CTR. L83147 0.56 BLACKDOWN PRACTICE L83044 0.56 FREMINGTON MEDICAL CENTRE L83057 0.56 TOWNSEND HOUSE MEDICAL CENTRE L83054 0.56 NEW VALLEY PRACTICE L83127 0.55 HONITON SURGERY L83002 0.55 FREEDOM HEALTH CENTRE L83643 0.55 CLAREMONT MEDICAL PRACTICE L83056 0.55 WESTBANK PRACTICE L83041 0.55 MOUNT PLEASANT HEALTH CENTRE L83066 0.55 KNOWLE HOUSE SURGERY L83089 0.55 DEVONPORT HEALTH CENTRE L83624 0.55 WEST HOE SURGERY L83112 0.55 ISCA MEDICAL PRACTICE L83099 0.55 IMPERIAL SURGERY L83628 0.54 SOUTH LAWN MEDICAL PRACTICE L83084 0.54 EAST STREET SURGERY L83047 0.54 LIFTON SURGERY L83608 0.54 THE COMBE COASTAL PRACTICE L83096 0.54 BRADWORTHY SURGERY L83012 0.53 MORETONHAMPSTEAD HEALTH CENTRE L83049 0.53 OKEHAMPTON MEDICAL CENTRE L83087 0.53 CASTLE GARDENS SURGERY L83105 0.52 TOPSHAM SURGERY L83036 0.52 HATHERLEIGH MEDICAL CENTRE L83647 0.52 SHEBBEAR SURGERY L83121 0.52 FRIARY HOUSE SURGERY L83072 0.52 MODBURY HEALTH CENTRE L83086 0.52 WALLINGBROOK HEALTH CENTRE L83025 0.52 IDE LANE SURGERY L83079 0.52 BUDSHEAD MEDICAL PRACTICE L83113 0.52 CAEN MEDICAL CENTRE L83097 0.51 NORTHAM SURGERY L83050 0.51 CLARE HOUSE L83085 0.51 BARTON SURGERY L83125 0.51 WONFORD GREEN SURGERY L83655 0.51 ST THOMAS MEDICAL GROUP L83016 0.51 ST NEOTS SURGERY L83028 0.51 STOKE SURGERY L83071 0.51 BOUTPORT MEDICAL CENTRE L83139 0.51 BIDEFORD MEDICAL CENTRE L83083 0.51 CHIDDENBROOK SURGERY L83065 0.51 TAVYSIDE HEALTH CENTRE L83038 0.50 ROLLE MEDICAL PARTNERSHIP L83053 0.50 ST.BARNABAS SURGERY L83664 0.50 ST LEONARDS PRACTICE L83042 0.49 CHERITON BISHOP SURGERY L83098 0.49 WATERSIDE PRACTICE L83017 0.49 SOUTHERNHAY HOUSE SURGERY L83058 0.49 LITCHDON MEDICAL CENTRE L83035 0.49 WOODA SURGERY L83106 0.49 BEAUMONT VILLA SURGERY L83018 0.49 REDFERN HEALTH CENTRE L83088 0.48 PINHOE SURGERY L83040 0.48 SOUTH BRENT HEALTH CENTRE L83075 0.48 QUEEN'S MEDICAL CENTRE L83003 0.48 ARMADA SURGERY L83080 0.47 LYNTON HEALTH CENTRE L83068 0.47 BRANNAM MEDICAL CENTRE L83073 0.46 CHAGFORD HEALTH CENTRE L83082 0.46 WHIPTON SURGERY L83115 0.45 PEVERELL PARK SURGERY L83648 0.44 HYDE PARK SURGERY L83658 0.42 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 0.41 ADELAIDE STREET SURGERY L83651 0.37 OKEMENT PRIMARY CARE CENTRE Y00304 0.31 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio
19 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP
NHS Northern, Eastern And Western Devon CCG 79.4% • 137,416 people with hypertension (diagnosed)* in NHS Northern, Eastern and Western Devon CCG • 109,061 (79.4%) people whose blood pressure is <= 150/90 NHS South Devon And Torbay CCG 77.1% • 7,234 (5.3%) people who are excepted from optimal control • 21,121 (15.4%) additional people whose blood pressure is not <= 150/90
England 79.6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *Using QOF clinical indicator HYP006 denominator plus exceptions
20 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs
NHS Cumbria CCG 80.9%
NHS Nene CCG 80.9%
NHS Southern Derbyshire CCG 80.6%
NHS Gloucestershire CCG 80.1%
NHS Oxfordshire CCG 79.8%
NHS Kernow CCG 79.7%
NHS Northern, Eastern and Western Devon CCG 79.4%
NHS Dorset CCG 79.2%
NHS West Hampshire CCG 78.3%
NHS Cambridgeshire and Peterborough CCG 78.2%
NHS Somerset CCG 74.8%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
21 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice
No treatment Exceptions reported
CLOCK TOWER SURGERY L83673 16 CRANBROOK MEDICAL PRACTICE Y04662 22 ADELAIDE STREET SURGERY L83651 110 WHIPTON SURGERY L83115 178 HIGHLANDS HEALTH CENTRE L83644 214 BEAUMONT VILLA SURGERY L83018 273 WEST HOE SURGERY L83112 238 ST THOMAS MEDICAL GROUP L83016 1057 NORTH ROAD WEST MED.CTR. L83030 390 HOLSWORTHY MEDICAL CENTRE L83069 578 ERNESETTLE PRIMARY CARE CENTRE L83006 433 CHARD ROAD SURGERY L83037 398 BEACON MEDICAL GROUP L83100 1387 RALEIGH SURGERY L83627 212 OKEMENT PRIMARY CARE CENTRE Y00304 19 ST LEONARDS PRACTICE L83042 • in total, including exceptions, there 286 ABBEY SURGERY L83101 659 CASTLE PLACE PRACTICE L83052 608 MOUNT PLEASANT HEALTH CENTRE L83066 553 CAEN MEDICAL CENTRE L83097 433 CLARE HOUSE L83085 373 are 28,355 people whose blood AXMINSTER MEDICAL PRACTICE L83020 551 ESTOVER SURGERY L83642 96 SHEBBEAR SURGERY L83121 69 OCEAN HEALTH CENTRE L83074 538 HATHERLEIGH MEDICAL CENTRE L83647 83 pressure is not <= 150/90 FREEDOM HEALTH CENTRE L83643 51 OAKSIDE SURGERY L83015 242 BOUTPORT MEDICAL CENTRE L83139 155 HYDE PARK SURGERY L83658 51 LIFTON SURGERY L83608 129 • GP practice range: 10.4% to 55.2% MODBURY HEALTH CENTRE L83086 156 FRIARY HOUSE SURGERY L83072 306 SALTASH ROAD SURGERY L83626 84 DEVONPORT HEALTH CENTRE L83624 179 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 267 CROWNHILL SURGERY L83107 122 HALDON HOUSE SURGERY L83136 245 FOXHAYES PRACTICE Y00568 79 LISSON GROVE MEDICAL CTR. L83147 257 TAVYSIDE HEALTH CENTRE L83038 296 COLERIDGE MEDICAL CENTRE L83095 627 SOUTH BRENT HEALTH CENTRE L83075 165 BRANNAM MEDICAL CENTRE L83073 419 OKEHAMPTON MEDICAL CENTRE L83087 462 BRAMBLEHAIES SURGERY L83128 220 SID VALLEY PRACTICE L83067 725 STOKE SURGERY L83071 182 ST.LEVAN SURGERY L83646 204 BLACKDOWN PRACTICE L83044 295 WONFORD GREEN SURGERY L83655 104 TORRINGTON HEALTH CENTRE L83026 196 THE MANNAMEAD SURGERY L83061 304 SOUTHERNHAY HOUSE SURGERY L83058 211 PINHOE SURGERY L83040 303 CLAREMONT MEDICAL PRACTICE L83056 383 EAST STREET SURGERY L83047 185 TOPSHAM SURGERY L83036 321 WATERSIDE PRACTICE L83017 285 BIDEFORD MEDICAL CENTRE L83083 440 LITCHDON MEDICAL CENTRE L83035 376 TOWNSEND HOUSE MEDICAL CENTRE L83054 255 QUEEN'S MEDICAL CENTRE L83003 169 ST.BARNABAS SURGERY L83664 49 ISCA MEDICAL PRACTICE L83099 148 WALLINGBROOK HEALTH CENTRE L83025 220 HEAVITREE PRACTICE L83077 188 BARNFIELD HILL SURGERY L83024 204 HONITON SURGERY L83002 404 ELM SURGERY L83019 161 CHAGFORD HEALTH CENTRE L83082 84 NORTH TAWTON MEDICAL PRACTICE Y04979 76 NORTON BROOK MEDICAL CENTRE L83059 351 BUDSHEAD MEDICAL PRACTICE L83113 148 MORETONHAMPSTEAD HEALTH CENTRE L83049 94 IMPERIAL SURGERY L83628 131 GLENSIDE MEDICAL CENTRE L83138 163 DEAN CROSS SURGERY L83021 295 HARTLAND SURGERY L83129 94 ROBOROUGH SURGERY L83048 331 ST NEOTS SURGERY L83028 222 HONITON SURGERY - EVANS Y02121 124 PEVERELL PARK SURGERY L83648 177 WOODA SURGERY L83106 220 SEATON & COLYTON MEDICAL PRACTICE L83007 274 NORTHAM SURGERY L83050 336 WYCLIFFE SURGERY L83076 150 NEW VALLEY PRACTICE L83127 210 WOODBURY SURGERY L83116 109 SOUTH LAWN MEDICAL PRACTICE L83084 158 THE COMBE COASTAL PRACTICE L83096 215 LEYPARK SURGERY L83144 59 WYNDHAM HOUSE SURGERY L83134 94 TOTHILL SURGERY L83123 51 BARTON SURGERY L83125 65 KNOWLE HOUSE SURGERY L83089 251 ROLLE MEDICAL PARTNERSHIP L83053 276 FREMINGTON MEDICAL CENTRE L83057 176 SOUTHWAY SURGERY L83039 109 WESTBANK PRACTICE L83041 182 SOUTH MOLTON HEALTH CENTRE L83137 133 BLACK TORRINGTON SURGERY L83663 68 PATHFIELDS PRACTICE L83008 235 MID DEVON MEDICAL PRACTICE L83023 127 CHERITON BISHOP SURGERY L83098 107 IDE LANE SURGERY L83079 159 BAMPTON SURGERY L83009 112 YELVERTON SURGERY L83102 167 HILL BARTON SURGERY L83143 69 COLLEGE SURGERY PARTNERSHIP L83092 311 BOW MEDICAL PRACTICE Y02633 64 LYNTON HEALTH CENTRE L83068 50 REDFERN HEALTH CENTRE L83088 95 CHIDDENBROOK SURGERY L83065 138 YEALM MEDICAL CENTRE L83081 125 BRADWORTHY SURGERY L83012 57 WEMBURY SURGERY L83639 56 CHURCH VIEW SURGERY L83064 261 SAMPFORD PEVERELL SURGERY L83616 37 CASTLE GARDENS SURGERY L83105 116 PARK VIEW SURGERY L83117 11 ARMADA SURGERY L83080 34 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
22 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with CCGs in the STP
NHS South Devon And Torbay CCG 66.7% • 444 people with a new diagnosis* of hypertension with a CVD risk of 20% or higher in NHS Northern, Eastern and Western Devon CCG • 284 (64%) people who are currently NHS Northern, Eastern And Western Devon CCG 64.0% treated with statins • 159 (35.8%) people who are exempted from treatment with statins • 1 (0.2%) additional people who are not currently treated with statins
England 66.5%
0% 10% 20% 30% 40% 50% 60% 70% *Using the QOF clinical indicator CVD-PP001 denominator plus exceptions
23 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with demographically similar CCGs
NHS Nene CCG 69.5%
NHS Gloucestershire CCG 65.1%
NHS Cumbria CCG 64.0%
NHS Northern, Eastern and Western Devon CCG 64.0%
NHS Kernow CCG 62.0%
NHS Southern Derbyshire CCG 61.5%
NHS Cambridgeshire and Peterborough CCG 61.2%
NHS Oxfordshire CCG 59.9%
NHS Dorset CCG 56.6%
NHS West Hampshire CCG 55.9%
NHS Somerset CCG 55.1%
0% 10% 20% 30% 40% 50% 60% 70% 80%
24 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and not treated with statins by GP practice
No treatment Exceptions reported
GLENSIDE MEDICAL CENTRE L83138 1 NORTH TAWTON MEDICAL PRACTICE Y04979 3 ST LEONARDS PRACTICE L83042 4 CLAREMONT MEDICAL PRACTICE L83056 4 BARNFIELD HILL SURGERY L83024 3 FREMINGTON MEDICAL CENTRE L83057 3 THE COMBE COASTAL PRACTICE L83096 6 SOUTH MOLTON HEALTH CENTRE L83137 3 HOLSWORTHY MEDICAL CENTRE L83069 4 HALDON HOUSE SURGERY L83136 4 BOW MEDICAL PRACTICE Y02633 2 BLACKDOWN PRACTICE L83044 7 HONITON SURGERY L83002 5 COLLEGE SURGERY PARTNERSHIP L83092 3 COLERIDGE MEDICAL CENTRE L83095 3 WHIPTON SURGERY L83115 • in total, including exceptions, there 3 OKEHAMPTON MEDICAL CENTRE L83087 4 SID VALLEY PRACTICE L83067 11 NORTON BROOK MEDICAL CENTRE L83059 7 BAMPTON SURGERY L83009 2 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 1 are 160 people who are not treated OAKSIDE SURGERY L83015 2 BEAUMONT VILLA SURGERY L83018 1 AXMINSTER MEDICAL PRACTICE L83020 2 DEAN CROSS SURGERY L83021 2 TOPSHAM SURGERY L83036 1 with statins EAST STREET SURGERY L83047 1 CASTLE PLACE PRACTICE L83052 1 MOUNT PLEASANT HEALTH CENTRE L83066 7 STOKE SURGERY L83071 1 ISCA MEDICAL PRACTICE L83099 2 • GP practice range: 0.0% to 100.0% ABBEY SURGERY L83101 3 WOODA SURGERY L83106 2 CROWNHILL SURGERY L83107 1 HARTLAND SURGERY L83129 1 RALEIGH SURGERY L83627 1 ROBOROUGH SURGERY L83048 4 PEVERELL PARK SURGERY L83648 3 TORRINGTON HEALTH CENTRE L83026 2 LITCHDON MEDICAL CENTRE L83035 2 ROLLE MEDICAL PARTNERSHIP L83053 2 BIDEFORD MEDICAL CENTRE L83083 2 REDFERN HEALTH CENTRE L83088 2 BUDSHEAD MEDICAL PRACTICE L83113 2 SEATON & COLYTON MEDICAL PRACTICE L83007 1 CHURCH VIEW SURGERY L83064 1 CHIDDENBROOK SURGERY L83065 1 SOUTH LAWN MEDICAL PRACTICE L83084 2 CAEN MEDICAL CENTRE L83097 2 BEACON MEDICAL GROUP L83100 4 WYNDHAM HOUSE SURGERY L83134 1 BOUTPORT MEDICAL CENTRE L83139 1 ST THOMAS MEDICAL GROUP L83016 2 CHARD ROAD SURGERY L83037 2 WESTBANK PRACTICE L83041 1 BRANNAM MEDICAL CENTRE L83073 1 HEAVITREE PRACTICE L83077 1 IDE LANE SURGERY L83079 1 WEST HOE SURGERY L83112 1 MORETONHAMPSTEAD HEALTH CENTRE L83049 1 TOWNSEND HOUSE MEDICAL CENTRE L83054 1 NEW VALLEY PRACTICE L83127 1 NORTH ROAD WEST MED.CTR. L83030 2 CLARE HOUSE L83085 1 LISSON GROVE MEDICAL CTR. L83147 1 SOUTHERNHAY HOUSE SURGERY L83058 1 ERNESETTLE PRIMARY CARE CENTRE L83006 PATHFIELDS PRACTICE L83008 BRADWORTHY SURGERY L83012 WATERSIDE PRACTICE L83017 ELM SURGERY L83019 MID DEVON MEDICAL PRACTICE L83023 WALLINGBROOK HEALTH CENTRE L83025 ST NEOTS SURGERY L83028 TAVYSIDE HEALTH CENTRE L83038 SOUTHWAY SURGERY L83039 PINHOE SURGERY L83040 NORTHAM SURGERY L83050 THE MANNAMEAD SURGERY L83061 LYNTON HEALTH CENTRE L83068 FRIARY HOUSE SURGERY L83072 OCEAN HEALTH CENTRE L83074 SOUTH BRENT HEALTH CENTRE L83075 WYCLIFFE SURGERY L83076 ARMADA SURGERY L83080 YEALM MEDICAL CENTRE L83081 CHAGFORD HEALTH CENTRE L83082 MODBURY HEALTH CENTRE L83086 KNOWLE HOUSE SURGERY L83089 CHERITON BISHOP SURGERY L83098 YELVERTON SURGERY L83102 CASTLE GARDENS SURGERY L83105 WOODBURY SURGERY L83116 BRAMBLEHAIES SURGERY L83128 HILL BARTON SURGERY L83143 LEYPARK SURGERY L83144 LIFTON SURGERY L83608 SAMPFORD PEVERELL SURGERY L83616 SALTASH ROAD SURGERY L83626 IMPERIAL SURGERY L83628 WEMBURY SURGERY L83639 ESTOVER SURGERY L83642 FREEDOM HEALTH CENTRE L83643 ST.LEVAN SURGERY L83646 ADELAIDE STREET SURGERY L83651 WONFORD GREEN SURGERY L83655 BLACK TORRINGTON SURGERY L83663 CLOCK TOWER SURGERY L83673 FOXHAYES PRACTICE Y00568 HONITON SURGERY - EVANS Y02121 CRANBROOK MEDICAL PRACTICE Y04662 OKEMENT PRIMARY CARE CENTRE Y00304 ST.BARNABAS SURGERY L83664 HYDE PARK SURGERY L83658 HATHERLEIGH MEDICAL CENTRE L83647 HIGHLANDS HEALTH CENTRE L83644 DEVONPORT HEALTH CENTRE L83624 BARTON SURGERY L83125 TOTHILL SURGERY L83123 SHEBBEAR SURGERY L83121 PARK VIEW SURGERY L83117 QUEEN'S MEDICAL CENTRE L83003 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
25 CVD: Primary Care Intelligence Packs Stroke
26 CVD: Primary Care Intelligence Packs Stroke prevention
What questions should we ask in our CCG? Only a half of people with known 1. for each indicator how wide is the variation in detection, treatment and exception reporting? AF who then suffer a stroke have been 2. how many people would benefit if all practices anticoagulated before their stroke. performed as well as the best? 3. how can we support practices who are average and below average to perform as well as the best in detection of atrial fibrillation and stroke prevention with anticoagulation. Stroke is one of the leading causes of premature death and disability. Stroke is What might help? devastating for individuals and families, and • increase opportunistic pulse checking especially in over 65s accounts for a substantial proportion of health • support practices to share audit data and systematically and social care expenditure. identify gaps and opportunities for improved detection and management of AF - eg GRASP-AF Atrial fibrillation increases the risk of stroke • promote systematic use of CHADS-VASC and HASBLED to by a factor of 5, and strokes caused by AF are ensure those at high risk are offered stroke prevention often more severe, with higher mortality and • promote systematic use of Warfarin Patient Safety Audit Tool greater disability. to ensure optimal time in therapeutic range for people on Anticoagulation reduces the risk of stroke in warfarin people with AF by two thirds. • develop local consensus statement on risk-benefit balance for Despite this, AF is underdiagnosed and under anticoagulants, including the newer treatments (NOACs) treated: up to a third of people with AF are • work with practices and local authorities to maximise uptake unaware they have the condition and even when and clinical follow up in the NHS Health Check diagnosed inadequate treatment is common – • commission community pharmacists to offer pulse checks, large numbers do not receive anticoagulants or anticoagulant monitoring, and support for adherence to have poor anticoagulant control. medication
27 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with CCGs in the STP
NHS South Devon And Torbay CCG 0.78 • the ratio of those diagnosed with atrial fibrillation versus those expected to have atrial fibrillation is 0.73. This compares to 0.7 for England • this suggests that 73% of people with NHS Northern, Eastern And Western Devon CCG 0.73 atrial fibrillation have been diagnosed.
Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 2015/16 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence England 0.70 Network estimates produced in 2017. The estimates were developed by applying age-sex specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 NHS Digital. Estimates reported are adjusted for age and sex of the local population.
28 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with demographically similar CCGs
NHS Somerset CCG 0.78
NHS Dorset CCG 0.77
NHS Gloucestershire CCG 0.74
NHS Northern, Eastern and Western Devon CCG 0.73
NHS Kernow CCG 0.72
NHS Cumbria CCG 0.71
NHS Nene CCG 0.70
NHS West Hampshire CCG 0.70
NHS Oxfordshire CCG 0.69
NHS Southern Derbyshire CCG 0.69
NHS Cambridgeshire and Peterborough CCG 0.67
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9
29 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared with expected prevalence by GP practice
GP practice CCG
ARMADA SURGERY L83080 1.1 DEVONPORT HEALTH CENTRE L83624 1.0 PATHFIELDS PRACTICE L83008 0.9 NORTH ROAD WEST MED.CTR. L83030 0.9 CHIDDENBROOK SURGERY L83065 0.9 WYCLIFFE SURGERY L83076 0.9 CROWNHILL SURGERY L83107 0.9 TOTHILL SURGERY L83123 0.9 SAMPFORD PEVERELL SURGERY L83616 0.9 FOXHAYES PRACTICE Y00568 0.9 NORTH TAWTON MEDICAL PRACTICE Y04979 0.9 BAMPTON SURGERY L83009 0.8 OAKSIDE SURGERY L83015 0.8 WALLINGBROOK HEALTH CENTRE L83025 0.8 TOPSHAM SURGERY L83036 0.8 PINHOE SURGERY L83040 0.8 • it is estimated that there are 27,827 WESTBANK PRACTICE L83041 0.8 BLACKDOWN PRACTICE L83044 0.8 ROBOROUGH SURGERY L83048 0.8 MORETONHAMPSTEAD HEALTH CENTRE L83049 0.8 ROLLE MEDICAL PARTNERSHIP L83053 0.8 people with undiagnosed atrial TOWNSEND HOUSE MEDICAL CENTRE L83054 0.8 NORTON BROOK MEDICAL CENTRE L83059 0.8 THE MANNAMEAD SURGERY L83061 0.8 CHURCH VIEW SURGERY L83064 0.8 SID VALLEY PRACTICE L83067 0.8 fibrillation in NHS Northern, Eastern LYNTON HEALTH CENTRE L83068 0.8 STOKE SURGERY L83071 0.8 BRANNAM MEDICAL CENTRE L83073 0.8 SOUTH BRENT HEALTH CENTRE L83075 0.8 IDE LANE SURGERY L83079 0.8 and Western Devon CCG BIDEFORD MEDICAL CENTRE L83083 0.8 SOUTH LAWN MEDICAL PRACTICE L83084 0.8 MODBURY HEALTH CENTRE L83086 0.8 REDFERN HEALTH CENTRE L83088 0.8 COLLEGE SURGERY PARTNERSHIP L83092 0.8 COLERIDGE MEDICAL CENTRE L83095 • GP practice range of observed to 0.8 CHERITON BISHOP SURGERY L83098 0.8 YELVERTON SURGERY L83102 0.8 WOODBURY SURGERY L83116 0.8 NEW VALLEY PRACTICE L83127 0.8 SOUTH MOLTON HEALTH CENTRE L83137 0.8 expected atrial fibrillation prevalence BOUTPORT MEDICAL CENTRE L83139 0.8 LISSON GROVE MEDICAL CTR. L83147 0.8 ADELAIDE STREET SURGERY L83651 0.8 BOW MEDICAL PRACTICE Y02633 0.8 SEATON & COLYTON MEDICAL PRACTICE L83007 0.7 0.3 to 1.1 ST THOMAS MEDICAL GROUP L83016 0.7 BEAUMONT VILLA SURGERY L83018 0.7 ELM SURGERY L83019 0.7 AXMINSTER MEDICAL PRACTICE L83020 0.7 DEAN CROSS SURGERY L83021 0.7 BARNFIELD HILL SURGERY L83024 0.7 TORRINGTON HEALTH CENTRE L83026 0.7 ST NEOTS SURGERY L83028 0.7 LITCHDON MEDICAL CENTRE L83035 0.7 TAVYSIDE HEALTH CENTRE L83038 0.7 SOUTHWAY SURGERY L83039 0.7 ST LEONARDS PRACTICE L83042 0.7 EAST STREET SURGERY L83047 0.7 NORTHAM SURGERY L83050 0.7 CASTLE PLACE PRACTICE L83052 0.7 CLAREMONT MEDICAL PRACTICE L83056 0.7 SOUTHERNHAY HOUSE SURGERY L83058 0.7 MOUNT PLEASANT HEALTH CENTRE L83066 0.7 HOLSWORTHY MEDICAL CENTRE L83069 0.7 FRIARY HOUSE SURGERY L83072 0.7 YEALM MEDICAL CENTRE L83081 0.7 CHAGFORD HEALTH CENTRE L83082 0.7 CLARE HOUSE L83085 0.7 KNOWLE HOUSE SURGERY L83089 0.7 ISCA MEDICAL PRACTICE L83099 0.7 BEACON MEDICAL GROUP L83100 0.7 ABBEY SURGERY L83101 0.7 WOODA SURGERY L83106 0.7 BARTON SURGERY L83125 0.7 BRAMBLEHAIES SURGERY L83128 0.7 HARTLAND SURGERY L83129 0.7 HALDON HOUSE SURGERY L83136 0.7 GLENSIDE MEDICAL CENTRE L83138 0.7 LEYPARK SURGERY L83144 0.7 RALEIGH SURGERY L83627 0.7 WEMBURY SURGERY L83639 0.7 ST.LEVAN SURGERY L83646 0.7 PEVERELL PARK SURGERY L83648 0.7 BLACK TORRINGTON SURGERY L83663 0.7 ST.BARNABAS SURGERY L83664 0.7 HONITON SURGERY L83002 0.6 QUEEN'S MEDICAL CENTRE L83003 0.6 ERNESETTLE PRIMARY CARE CENTRE L83006 0.6 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 0.6 BRADWORTHY SURGERY L83012 0.6 MID DEVON MEDICAL PRACTICE L83023 0.6 FREMINGTON MEDICAL CENTRE L83057 0.6 HEAVITREE PRACTICE L83077 0.6 OKEHAMPTON MEDICAL CENTRE L83087 0.6 CAEN MEDICAL CENTRE L83097 0.6 CASTLE GARDENS SURGERY L83105 0.6 WEST HOE SURGERY L83112 0.6 BUDSHEAD MEDICAL PRACTICE L83113 0.6 WHIPTON SURGERY L83115 0.6 WYNDHAM HOUSE SURGERY L83134 0.6 HILL BARTON SURGERY L83143 0.6 SALTASH ROAD SURGERY L83626 0.6 IMPERIAL SURGERY L83628 0.6 WONFORD GREEN SURGERY L83655 0.6 OCEAN HEALTH CENTRE L83074 0.5 LIFTON SURGERY L83608 0.5 FREEDOM HEALTH CENTRE L83643 0.5 HIGHLANDS HEALTH CENTRE L83644 0.5 HYDE PARK SURGERY L83658 0.5 ESTOVER SURGERY L83642 0.4 THE COMBE COASTAL PRACTICE L83096 0.3 HATHERLEIGH MEDICAL CENTRE L83647 0.3 CRANBROOK MEDICAL PRACTICE Y04662 0.3 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio
30 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by CCG Comparison with CCGs in the STP Optimal management No treatment Exceptions reported
NHS Northern, Eastern And Western Devon CCG 80.3% • 16,710 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS Northern, Eastern and Western Devon CCG • 13,411 (80.3%) people treated with anti-coagulation therapy NHS South Devon And Torbay CCG 79.9% • 1,587 (9.5%) people who are exceptions • 1,712 (10.2%) additional people with a recorded CHA2DS2-VASc score >= 2 who are not treated
England 77.9%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator AF007 denominator plus exceptions
31 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported
NHS Gloucestershire CCG 82.0%
NHS Nene CCG 81.8%
NHS West Hampshire CCG 81.0%
NHS Northern, Eastern and Western Devon CCG 80.3%
NHS Kernow CCG 80.2%
NHS Somerset CCG 79.5%
NHS Oxfordshire CCG 76.5%
NHS Southern Derbyshire CCG 76.0%
NHS Cambridgeshire and Peterborough CCG 75.7%
NHS Dorset CCG 75.5%
NHS Cumbria CCG 73.7%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
32 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by GP practice
No treatment Exceptions reported
BLACK TORRINGTON SURGERY L83663 21 BRANNAM MEDICAL CENTRE L83073 110 HATHERLEIGH MEDICAL CENTRE L83647 14 QUEEN'S MEDICAL CENTRE L83003 35 ADELAIDE STREET SURGERY L83651 10 FOXHAYES PRACTICE Y00568 13 BIDEFORD MEDICAL CENTRE L83083 101 LYNTON HEALTH CENTRE L83068 21 WHIPTON SURGERY L83115 18 CAEN MEDICAL CENTRE L83097 70 BARTON SURGERY L83125 17 BOUTPORT MEDICAL CENTRE L83139 25 EAST STREET SURGERY L83047 37 DEVONPORT HEALTH CENTRE L83624 25 LITCHDON MEDICAL CENTRE L83035 77 CHAGFORD HEALTH CENTRE L83082 • in total, including exceptions, there 17 THE MANNAMEAD SURGERY L83061 56 ERNESETTLE PRIMARY CARE CENTRE L83006 31 BLACKDOWN PRACTICE L83044 49 TORRINGTON HEALTH CENTRE L83026 29 BUDSHEAD MEDICAL PRACTICE L83113 17 are 3,299 people with a recorded FREMINGTON MEDICAL CENTRE L83057 43 WOODA SURGERY L83106 44 LIFTON SURGERY L83608 13 PEVERELL PARK SURGERY L83648 34 NORTHAM SURGERY L83050 76 CHA2DS2-VASc score >= 2 who are NORTH ROAD WEST MED.CTR. L83030 39 THE COMBE COASTAL PRACTICE L83096 33 LEYPARK SURGERY L83144 8 REDFERN HEALTH CENTRE L83088 32 HOLSWORTHY MEDICAL CENTRE L83069 52 not treated WALLINGBROOK HEALTH CENTRE L83025 39 HARTLAND SURGERY L83129 14 TOWNSEND HOUSE MEDICAL CENTRE L83054 55 SEATON & COLYTON MEDICAL PRACTICE L83007 43 BARNFIELD HILL SURGERY L83024 25 • GP practice range: 0.0% to 36.8% PINHOE SURGERY L83040 44 ARMADA SURGERY L83080 10 COLERIDGE MEDICAL CENTRE L83095 83 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 48 SID VALLEY PRACTICE L83067 121 BRAMBLEHAIES SURGERY L83128 23 CROWNHILL SURGERY L83107 12 WATERSIDE PRACTICE L83017 33 LISSON GROVE MEDICAL CTR. L83147 23 CHARD ROAD SURGERY L83037 32 ELM SURGERY L83019 17 WONFORD GREEN SURGERY L83655 7 CHIDDENBROOK SURGERY L83065 35 SOUTH LAWN MEDICAL PRACTICE L83084 23 IDE LANE SURGERY L83079 29 BEAUMONT VILLA SURGERY L83018 15 BEACON MEDICAL GROUP L83100 105 ST THOMAS MEDICAL GROUP L83016 67 TOPSHAM SURGERY L83036 42 MOUNT PLEASANT HEALTH CENTRE L83066 42 OCEAN HEALTH CENTRE L83074 39 SOUTH MOLTON HEALTH CENTRE L83137 25 CLARE HOUSE L83085 37 YELVERTON SURGERY L83102 32 PARK VIEW SURGERY L83117 2 ABBEY SURGERY L83101 58 HYDE PARK SURGERY L83658 3 OKEHAMPTON MEDICAL CENTRE L83087 41 WESTBANK PRACTICE L83041 30 AXMINSTER MEDICAL PRACTICE L83020 53 ST.LEVAN SURGERY L83646 9 WEST HOE SURGERY L83112 13 NORTON BROOK MEDICAL CENTRE L83059 43 HEAVITREE PRACTICE L83077 15 TOTHILL SURGERY L83123 6 FREEDOM HEALTH CENTRE L83643 1 PATHFIELDS PRACTICE L83008 33 IMPERIAL SURGERY L83628 11 HONITON SURGERY L83002 48 TAVYSIDE HEALTH CENTRE L83038 21 HONITON SURGERY - EVANS Y02121 16 CASTLE GARDENS SURGERY L83105 18 NORTH TAWTON MEDICAL PRACTICE Y04979 9 ROLLE MEDICAL PARTNERSHIP L83053 49 OAKSIDE SURGERY L83015 15 GLENSIDE MEDICAL CENTRE L83138 13 COLLEGE SURGERY PARTNERSHIP L83092 40 BRADWORTHY SURGERY L83012 7 ROBOROUGH SURGERY L83048 38 RALEIGH SURGERY L83627 12 STOKE SURGERY L83071 15 CASTLE PLACE PRACTICE L83052 38 SOUTH BRENT HEALTH CENTRE L83075 17 HALDON HOUSE SURGERY L83136 17 SOUTHERNHAY HOUSE SURGERY L83058 16 MORETONHAMPSTEAD HEALTH CENTRE L83049 11 NEW VALLEY PRACTICE L83127 18 ST NEOTS SURGERY L83028 20 FRIARY HOUSE SURGERY L83072 19 SOUTHWAY SURGERY L83039 9 ST LEONARDS PRACTICE L83042 16 BAMPTON SURGERY L83009 14 CLAREMONT MEDICAL PRACTICE L83056 30 WYCLIFFE SURGERY L83076 9 MODBURY HEALTH CENTRE L83086 12 YEALM MEDICAL CENTRE L83081 15 HIGHLANDS HEALTH CENTRE L83644 2 KNOWLE HOUSE SURGERY L83089 21 CHURCH VIEW SURGERY L83064 33 SAMPFORD PEVERELL SURGERY L83616 5 WOODBURY SURGERY L83116 10 SHEBBEAR SURGERY L83121 3 ST.BARNABAS SURGERY L83664 3 ISCA MEDICAL PRACTICE L83099 9 ESTOVER SURGERY L83642 2 BOW MEDICAL PRACTICE Y02633 5 WEMBURY SURGERY L83639 5 SALTASH ROAD SURGERY L83626 2 CHERITON BISHOP SURGERY L83098 9 HILL BARTON SURGERY L83143 3 DEAN CROSS SURGERY L83021 12 WYNDHAM HOUSE SURGERY L83134 4 MID DEVON MEDICAL PRACTICE L83023 4 CLOCK TOWER SURGERY L83673 OKEMENT PRIMARY CARE CENTRE Y00304 CRANBROOK MEDICAL PRACTICE Y04662 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
33 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by GP practice – opportunities compared to GP cluster
20% 15% 10% 5% 0% -5% -10% -15% -20% -25%
BLACK TORRINGTON SURGERY 12
HATHERLEIGH MEDICAL CENTRE 8
BRANNAM MEDICAL CENTRE 59 • using the GP cluster method of QUEEN'S MEDICAL CENTRE 20 calculating potential gains, if each FOXHAYES PRACTICE 7 practice was to achieve as well as the ADELAIDE STREET SURGERY 6 upper quartile of its national cluster, then an additional 701 people would LYNTON HEALTH CENTRE 11 be treated WHIPTON SURGERY 10
BIDEFORD MEDICAL CENTRE 50
BARTON SURGERY 9
BAMPTON SURGERY
BOW MEDICAL PRACTICE
WEMBURY SURGERY
CHERITON BISHOP SURGERY
SALTASH ROAD SURGERY
HILL BARTON SURGERY
WYNDHAM HOUSE SURGERY
MID DEVON MEDICAL PRACTICE
DEAN CROSS SURGERY
OKEMENT PRIMARY CARE CENTRE Details of this methodology are available on slide 9. Click here to view them.
34 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP
Below 150/90 Not below 150/90 Exceptions reported
NHS Northern, Eastern And Western Devon CCG 83.4% • 19,859 people with a history of stroke or TIA* in NHS Northern, Eastern and Western Devon CCG • 16,555 (83.4%) people whose blood pressure is <= 150 / 90 • 1,244 (6.3%) people who are NHS South Devon And Torbay CCG 80.6% exceptions • 2,060 (10.4%) additional people whose blood pressure is not <= 150 / 90
England 83.8%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA003 denominator plus exceptions
35 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported
NHS Cumbria CCG 84.4%
NHS Gloucestershire CCG 84.2%
NHS Oxfordshire CCG 83.9%
NHS Nene CCG 83.8%
NHS Northern, Eastern and Western Devon CCG 83.4%
NHS Southern Derbyshire CCG 83.1%
NHS Kernow CCG 82.6%
NHS Dorset CCG 82.3%
NHS West Hampshire CCG 82.3%
NHS Cambridgeshire and Peterborough CCG 81.7%
NHS Somerset CCG 77.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
36 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice
No treatment Exceptions reported
HIGHLANDS HEALTH CENTRE L83644 18 ADELAIDE STREET SURGERY L83651 15 HYDE PARK SURGERY L83658 16 WEST HOE SURGERY L83112 31 FREEDOM HEALTH CENTRE L83643 9 WHIPTON SURGERY L83115 25 SALTASH ROAD SURGERY L83626 9 LIFTON SURGERY L83608 17 ABBEY SURGERY L83101 93 CHAGFORD HEALTH CENTRE L83082 17 HOLSWORTHY MEDICAL CENTRE L83069 66 MOUNT PLEASANT HEALTH CENTRE L83066 64 FOXHAYES PRACTICE Y00568 12 ST THOMAS MEDICAL GROUP L83016 102 NORTH ROAD WEST MED.CTR. L83030 40 CHARD ROAD SURGERY L83037 • in total, including exceptions, there 37 OKEMENT PRIMARY CARE CENTRE Y00304 2 HATHERLEIGH MEDICAL CENTRE L83647 11 OAKSIDE SURGERY L83015 27 BOUTPORT MEDICAL CENTRE L83139 21 SOUTH BRENT HEALTH CENTRE L83075 24 are 3,304 people whose blood CAEN MEDICAL CENTRE L83097 64 RALEIGH SURGERY L83627 21 ST.LEVAN SURGERY L83646 19 COLERIDGE MEDICAL CENTRE L83095 83 TOTHILL SURGERY L83123 8 pressure is not <= 150 / 90 ST LEONARDS PRACTICE L83042 33 AXMINSTER MEDICAL PRACTICE L83020 56 BEAUMONT VILLA SURGERY L83018 21 WONFORD GREEN SURGERY L83655 16 CASTLE PLACE PRACTICE L83052 59 • GP practice range: 0.0% to 35.3% OKEHAMPTON MEDICAL CENTRE L83087 60 HALDON HOUSE SURGERY L83136 29 STOKE SURGERY L83071 22 DEVONPORT HEALTH CENTRE L83624 17 WOODA SURGERY L83106 41 SOUTHERNHAY HOUSE SURGERY L83058 31 WATERSIDE PRACTICE L83017 51 BEACON MEDICAL GROUP L83100 105 ERNESETTLE PRIMARY CARE CENTRE L83006 33 TAVYSIDE HEALTH CENTRE L83038 27 KNOWLE HOUSE SURGERY L83089 35 WYCLIFFE SURGERY L83076 20 LISSON GROVE MEDICAL CTR. L83147 24 CLARE HOUSE L83085 45 IMPERIAL SURGERY L83628 20 DEAN CROSS SURGERY L83021 41 ROBOROUGH SURGERY L83048 44 BARTON SURGERY L83125 13 SOUTH MOLTON HEALTH CENTRE L83137 28 FREMINGTON MEDICAL CENTRE L83057 37 PINHOE SURGERY L83040 33 SOUTH LAWN MEDICAL PRACTICE L83084 25 WYNDHAM HOUSE SURGERY L83134 14 GLENSIDE MEDICAL CENTRE L83138 17 SID VALLEY PRACTICE L83067 91 NEW VALLEY PRACTICE L83127 30 MORETONHAMPSTEAD HEALTH CENTRE L83049 12 HARTLAND SURGERY L83129 11 NORTH TAWTON MEDICAL PRACTICE Y04979 7 BRAMBLEHAIES SURGERY L83128 23 THE MANNAMEAD SURGERY L83061 40 CHERITON BISHOP SURGERY L83098 18 HEAVITREE PRACTICE L83077 19 OCEAN HEALTH CENTRE L83074 41 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 38 WOODBURY SURGERY L83116 11 YELVERTON SURGERY L83102 29 WEMBURY SURGERY L83639 10 BRANNAM MEDICAL CENTRE L83073 58 FRIARY HOUSE SURGERY L83072 27 SHEBBEAR SURGERY L83121 6 BIDEFORD MEDICAL CENTRE L83083 68 PEVERELL PARK SURGERY L83648 22 ISCA MEDICAL PRACTICE L83099 19 ELM SURGERY L83019 17 WALLINGBROOK HEALTH CENTRE L83025 24 NORTHAM SURGERY L83050 54 BRADWORTHY SURGERY L83012 10 CHIDDENBROOK SURGERY L83065 30 NORTON BROOK MEDICAL CENTRE L83059 39 ST.BARNABAS SURGERY L83664 8 MODBURY HEALTH CENTRE L83086 18 CLAREMONT MEDICAL PRACTICE L83056 41 LEYPARK SURGERY L83144 8 BLACKDOWN PRACTICE L83044 28 QUEEN'S MEDICAL CENTRE L83003 28 TORRINGTON HEALTH CENTRE L83026 21 EAST STREET SURGERY L83047 22 WESTBANK PRACTICE L83041 24 COLLEGE SURGERY PARTNERSHIP L83092 39 YEALM MEDICAL CENTRE L83081 18 CROWNHILL SURGERY L83107 8 HILL BARTON SURGERY L83143 7 LITCHDON MEDICAL CENTRE L83035 46 THE COMBE COASTAL PRACTICE L83096 26 IDE LANE SURGERY L83079 22 TOPSHAM SURGERY L83036 29 TOWNSEND HOUSE MEDICAL CENTRE L83054 28 ESTOVER SURGERY L83642 4 SEATON & COLYTON MEDICAL PRACTICE L83007 33 HONITON SURGERY - EVANS Y02121 12 PATHFIELDS PRACTICE L83008 23 ST NEOTS SURGERY L83028 20 BUDSHEAD MEDICAL PRACTICE L83113 10 MID DEVON MEDICAL PRACTICE L83023 12 HONITON SURGERY L83002 33 CHURCH VIEW SURGERY L83064 29 ROLLE MEDICAL PARTNERSHIP L83053 30 LYNTON HEALTH CENTRE L83068 7 BARNFIELD HILL SURGERY L83024 11 SOUTHWAY SURGERY L83039 10 BLACK TORRINGTON SURGERY L83663 8 BOW MEDICAL PRACTICE Y02633 5 SAMPFORD PEVERELL SURGERY L83616 4 REDFERN HEALTH CENTRE L83088 11 CASTLE GARDENS SURGERY L83105 11 BAMPTON SURGERY L83009 7 ARMADA SURGERY L83080 1 PARK VIEW SURGERY L83117 CLOCK TOWER SURGERY L83673 CRANBROOK MEDICAL PRACTICE Y04662 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
37 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with CCGs in the STP Below 150/90 Not below 150/90 Exceptions reported
NHS Northern, Eastern And Western Devon CCG 93.0% • 15,137 people with a stroke shown to be non-haemorrhagic* in NHS Northern, Eastern and Western Devon CCG • 14,073 (93%) people who are taking an anti-platetet agent or anti- NHS South Devon And Torbay CCG 92.0% coagulant • 791 (5.2%) people who are exceptions • 273 (1.8%) additional people with no treatment
England 91.8%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA007 denominator plus exceptions
38 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported
NHS Nene CCG 93.2%
NHS Northern, Eastern and Western Devon CCG 93.0%
NHS Kernow CCG 92.3%
NHS West Hampshire CCG 91.9%
NHS Gloucestershire CCG 91.7%
NHS Dorset CCG 91.6%
NHS Southern Derbyshire CCG 91.3%
NHS Cumbria CCG 91.1%
NHS Oxfordshire CCG 90.3%
NHS Cambridgeshire and Peterborough CCG 89.8%
NHS Somerset CCG 88.9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
39 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who do not have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by GP practice
No treatment Exceptions reported
OKEMENT PRIMARY CARE CENTRE Y00304 3 HATHERLEIGH MEDICAL CENTRE L83647 11 HIGHLANDS HEALTH CENTRE L83644 11 FREEDOM HEALTH CENTRE L83643 4 WHIPTON SURGERY L83115 11 STOKE SURGERY L83071 11 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 30 ERNESETTLE PRIMARY CARE CENTRE L83006 19 ARMADA SURGERY L83080 3 FOXHAYES PRACTICE Y00568 4 TOTHILL SURGERY L83123 3 AXMINSTER MEDICAL PRACTICE L83020 20 WONFORD GREEN SURGERY L83655 7 LIFTON SURGERY L83608 6 SAMPFORD PEVERELL SURGERY L83616 4 MODBURY HEALTH CENTRE L83086 • in total, including exceptions, there 10 YEALM MEDICAL CENTRE L83081 12 WOODA SURGERY L83106 18 CHURCH VIEW SURGERY L83064 16 BEAUMONT VILLA SURGERY L83018 7 ROLLE MEDICAL PARTNERSHIP L83053 24 are 1,064 people who are not taking ST THOMAS MEDICAL GROUP L83016 27 ABBEY SURGERY L83101 21 HYDE PARK SURGERY L83658 3 IDE LANE SURGERY L83079 12 WEMBURY SURGERY L83639 5 an anti-platelet agent or anti- CAEN MEDICAL CENTRE L83097 19 OCEAN HEALTH CENTRE L83074 18 PEVERELL PARK SURGERY L83648 7 QUEEN'S MEDICAL CENTRE L83003 12 PINHOE SURGERY L83040 14 coagulant BRANNAM MEDICAL CENTRE L83073 23 SHEBBEAR SURGERY L83121 2 HILL BARTON SURGERY L83143 3 BARTON SURGERY L83125 4 BEACON MEDICAL GROUP L83100 36 • GP practice range: 0.0% to 37.5% CHAGFORD HEALTH CENTRE L83082 5 BARNFIELD HILL SURGERY L83024 8 WOODBURY SURGERY L83116 5 LYNTON HEALTH CENTRE L83068 4 THE COMBE COASTAL PRACTICE L83096 15 NORTHAM SURGERY L83050 17 GLENSIDE MEDICAL CENTRE L83138 6 ESTOVER SURGERY L83642 2 IMPERIAL SURGERY L83628 7 ST LEONARDS PRACTICE L83042 9 SID VALLEY PRACTICE L83067 40 NORTON BROOK MEDICAL CENTRE L83059 17 SOUTH BRENT HEALTH CENTRE L83075 5 HOLSWORTHY MEDICAL CENTRE L83069 14 SOUTH MOLTON HEALTH CENTRE L83137 8 SOUTH LAWN MEDICAL PRACTICE L83084 7 CROWNHILL SURGERY L83107 3 COLERIDGE MEDICAL CENTRE L83095 22 SEATON & COLYTON MEDICAL PRACTICE L83007 18 KNOWLE HOUSE SURGERY L83089 11 LISSON GROVE MEDICAL CTR. L83147 7 WESTBANK PRACTICE L83041 10 THE MANNAMEAD SURGERY L83061 13 NORTH ROAD WEST MED.CTR. L83030 7 FRIARY HOUSE SURGERY L83072 7 HEAVITREE PRACTICE L83077 7 MORETONHAMPSTEAD HEALTH CENTRE L83049 4 YELVERTON SURGERY L83102 11 TOWNSEND HOUSE MEDICAL CENTRE L83054 11 WATERSIDE PRACTICE L83017 12 DEVONPORT HEALTH CENTRE L83624 4 ST.LEVAN SURGERY L83646 4 HONITON SURGERY - EVANS Y02121 6 TORRINGTON HEALTH CENTRE L83026 7 CASTLE PLACE PRACTICE L83052 13 TOPSHAM SURGERY L83036 12 CASTLE GARDENS SURGERY L83105 8 CLAREMONT MEDICAL PRACTICE L83056 13 MOUNT PLEASANT HEALTH CENTRE L83066 11 COLLEGE SURGERY PARTNERSHIP L83092 14 PATHFIELDS PRACTICE L83008 9 BRADWORTHY SURGERY L83012 3 CHARD ROAD SURGERY L83037 6 BUDSHEAD MEDICAL PRACTICE L83113 3 BLACKDOWN PRACTICE L83044 9 OKEHAMPTON MEDICAL CENTRE L83087 13 OAKSIDE SURGERY L83015 5 CHIDDENBROOK SURGERY L83065 10 FREMINGTON MEDICAL CENTRE L83057 9 HONITON SURGERY L83002 13 ELM SURGERY L83019 5 HALDON HOUSE SURGERY L83136 5 CLARE HOUSE L83085 9 BIDEFORD MEDICAL CENTRE L83083 17 BOUTPORT MEDICAL CENTRE L83139 3 DEAN CROSS SURGERY L83021 9 ST NEOTS SURGERY L83028 6 ROBOROUGH SURGERY L83048 8 EAST STREET SURGERY L83047 6 BOW MEDICAL PRACTICE Y02633 2 REDFERN HEALTH CENTRE L83088 5 NEW VALLEY PRACTICE L83127 6 ST.BARNABAS SURGERY L83664 2 RALEIGH SURGERY L83627 3 ISCA MEDICAL PRACTICE L83099 4 SALTASH ROAD SURGERY L83626 1 SOUTHERNHAY HOUSE SURGERY L83058 5 CHERITON BISHOP SURGERY L83098 4 BRAMBLEHAIES SURGERY L83128 5 HARTLAND SURGERY L83129 2 LITCHDON MEDICAL CENTRE L83035 10 WYCLIFFE SURGERY L83076 3 WALLINGBROOK HEALTH CENTRE L83025 4 ADELAIDE STREET SURGERY L83651 1 BAMPTON SURGERY L83009 3 BLACK TORRINGTON SURGERY L83663 2 MID DEVON MEDICAL PRACTICE L83023 3 LEYPARK SURGERY L83144 1 SOUTHWAY SURGERY L83039 2 WEST HOE SURGERY L83112 1 TAVYSIDE HEALTH CENTRE L83038 2 WYNDHAM HOUSE SURGERY L83134 1 PARK VIEW SURGERY L83117 CLOCK TOWER SURGERY L83673 CRANBROOK MEDICAL PRACTICE Y04662 NORTH TAWTON MEDICAL PRACTICE Y04979 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
40 CVD: Primary Care Intelligence Packs Diabetes
41 CVD: Primary Care Intelligence Packs Diabetes prevention and management
Type 2 Diabetes in numbers Diabetes costs the NHS • diagnosed prevalence – 3.0 million £9.8 billion per year – and the • undiagnosed diabetes – 900,000 • non-diabetic hyperglycaemia (high risk of diabetes) – 5 million prevalence is rising What questions should we ask in our CCG? 1. for each indicator how wide is the variation in achievement and exception reporting? Type 2 diabetes is often preventable 2. how many people would benefit if all practices performed as well People at high risk of developing type 2 diabetes as the best? can be identified through the NHS Health Check, 3. how can we support practices who are average and below and the disease can be prevented or delayed in average to perform as well as the best in: many through intensive behaviour change support. • detection of diabetes • delivery of the 8 care processes and achievement of the 3 treatment targets Complications of diabetes are preventable • identification and management of Non-diabetic hyperglycaemia Diabetes is a major cause of premature death and disability and greatly increases the risk of heart disease and stroke, kidney failure, amputations and What might help blindness. 80% of NHS spending on diabetes goes • ensure universal participation by practices in the National on managing these complications, most of which Diabetes Audit (NDA) could be prevented. There are 8 essential care • benchmark practice level data from the NDA – and support processes, in addition to retinal screening, that practices to explore variation together substantially reduce complication rates. • increase support for patient education and shared Despite this, around a half of people with diabetes management do not receive all 8 care processes, and there is • maximise uptake of the NHS Health Check to aid detection of widespread variation between CCGs and practices diabetes and Non Diabetic Hyperglycaemia in levels of achievement • maximise uptake of the NHS Diabetes Prevention Programme
42 CVD: Primary Care Intelligence Packs Diabetes observed prevalence compared with expected prevalence by CCG Comparison with CCGs in the STP
NHS Northern, Eastern And Western Devon CCG 0.75 • 0.75 ratio of observed to expected diabetes prevalence in NHS Northern, Eastern and Western Devon CCG, compared to 0.77 in England
• this suggests 75% of people have been diagnosed NHS South Devon And Torbay CCG 0.69
Note: This slide compares the prevalence of England 0.77 Diabetes recorded in QOF in 2015/16 to the expected prevalence of Diabetes in 2016 taken from the NCVIN diabetes prevalence model produced in 2015.
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9
43 CVD: Primary Care Intelligence Packs Diabetes observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs
NHS Southern Derbyshire CCG 0.81
NHS Cumbria CCG 0.79
NHS Nene CCG 0.78
NHS Gloucestershire CCG 0.77
NHS Cambridgeshire and Peterborough CCG 0.77
NHS Northern, Eastern and Western Devon CCG 0.75
NHS Somerset CCG 0.74
NHS Dorset CCG 0.69
NHS Oxfordshire CCG 0.69
NHS West Hampshire CCG 0.66
NHS Kernow CCG 0.65
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9
44 CVD: Primary Care Intelligence Packs Diabetes prevalence by GP practice
GP practice CCG
TOWNSEND HOUSE MEDICAL CENTRE L83054 9.7% SALTASH ROAD SURGERY L83626 9.6% HATHERLEIGH MEDICAL CENTRE L83647 9.1% LEYPARK SURGERY L83144 9.0% MID DEVON MEDICAL PRACTICE L83023 8.9% SAMPFORD PEVERELL SURGERY L83616 8.8% BLACK TORRINGTON SURGERY L83663 8.7% ST.BARNABAS SURGERY L83664 8.6% RALEIGH SURGERY L83627 8.6% WHIPTON SURGERY L83115 8.4% BAMPTON SURGERY L83009 8.4% HONITON SURGERY L83002 8.4% SID VALLEY PRACTICE L83067 8.4% OKEHAMPTON MEDICAL CENTRE L83087 8.3% SEATON & COLYTON MEDICAL PRACTICE L83007 8.3% IMPERIAL SURGERY L83628 • GP practice range of observed 8.3% FREMINGTON MEDICAL CENTRE L83057 8.2% HOLSWORTHY MEDICAL CENTRE L83069 8.2% ROLLE MEDICAL PARTNERSHIP L83053 8.1% HONITON SURGERY - EVANS Y02121 8.1% ELM SURGERY L83019 8.0% diabetes 2.0% to 9.7% BRANNAM MEDICAL CENTRE L83073 8.0% CHARD ROAD SURGERY L83037 7.9% ARMADA SURGERY L83080 7.8% CLARE HOUSE L83085 7.8% CROWNHILL SURGERY L83107 7.8% • there are an estimated 16,340 people DEVONPORT HEALTH CENTRE L83624 7.8% COLLEGE SURGERY PARTNERSHIP L83092 7.8% HALDON HOUSE SURGERY L83136 7.8% SOUTH LAWN MEDICAL PRACTICE L83084 7.7% EAST STREET SURGERY L83047 7.7% with undiagnosed diabetes in NHS OCEAN HEALTH CENTRE L83074 7.7% BUDSHEAD MEDICAL PRACTICE L83113 7.6% BRAMBLEHAIES SURGERY L83128 7.6% WONFORD GREEN SURGERY L83655 7.6% CHIDDENBROOK SURGERY L83065 7.5% Northern, Eastern and Western PATHFIELDS PRACTICE L83008 7.5% CASTLE GARDENS SURGERY L83105 7.5% NORTH TAWTON MEDICAL PRACTICE Y04979 7.4% WOODBURY SURGERY L83116 7.4% BRADWORTHY SURGERY L83012 7.3% NORTHAM SURGERY L83050 Devon CCG 7.3% AXMINSTER MEDICAL PRACTICE L83020 7.3% ROBOROUGH SURGERY L83048 7.3% ERNESETTLE PRIMARY CARE CENTRE L83006 7.3% WATERSIDE PRACTICE L83017 7.3% LITCHDON MEDICAL CENTRE L83035 7.3% SOUTH MOLTON HEALTH CENTRE L83137 7.2% ST NEOTS SURGERY L83028 7.2% ISCA MEDICAL PRACTICE L83099 7.1% TOTHILL SURGERY L83123 7.1% WYCLIFFE SURGERY L83076 7.1% CLAREMONT MEDICAL PRACTICE L83056 7.1% HARTLAND SURGERY L83129 7.1% TORRINGTON HEALTH CENTRE L83026 7.0% CHURCH VIEW SURGERY L83064 7.0% SOUTHERNHAY HOUSE SURGERY L83058 7.0% NORTH ROAD WEST MED.CTR. L83030 6.9% WYNDHAM HOUSE SURGERY L83134 6.9% BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 6.9% ESTOVER SURGERY L83642 6.9% CASTLE PLACE PRACTICE L83052 6.8% WESTBANK PRACTICE L83041 6.8% WOODA SURGERY L83106 6.7% CHERITON BISHOP SURGERY L83098 6.7% DEAN CROSS SURGERY L83021 6.7% OAKSIDE SURGERY L83015 6.7% BOUTPORT MEDICAL CENTRE L83139 6.7% COLERIDGE MEDICAL CENTRE L83095 6.6% QUEEN'S MEDICAL CENTRE L83003 6.6% IDE LANE SURGERY L83079 6.6% SOUTHWAY SURGERY L83039 6.5% FRIARY HOUSE SURGERY L83072 6.5% WEMBURY SURGERY L83639 6.5% WALLINGBROOK HEALTH CENTRE L83025 6.5% THE COMBE COASTAL PRACTICE L83096 6.5% MODBURY HEALTH CENTRE L83086 6.5% ST LEONARDS PRACTICE L83042 6.4% ABBEY SURGERY L83101 6.4% SHEBBEAR SURGERY L83121 6.4% MORETONHAMPSTEAD HEALTH CENTRE L83049 6.4% BIDEFORD MEDICAL CENTRE L83083 6.4% NEW VALLEY PRACTICE L83127 6.3% BLACKDOWN PRACTICE L83044 6.3% BARTON SURGERY L83125 6.3% ST.LEVAN SURGERY L83646 6.2% PINHOE SURGERY L83040 6.2% SOUTH BRENT HEALTH CENTRE L83075 6.2% HEAVITREE PRACTICE L83077 6.1% CAEN MEDICAL CENTRE L83097 6.1% NORTON BROOK MEDICAL CENTRE L83059 6.1% REDFERN HEALTH CENTRE L83088 6.1% HIGHLANDS HEALTH CENTRE L83644 6.1% THE MANNAMEAD SURGERY L83061 6.1% BOW MEDICAL PRACTICE Y02633 6.1% MOUNT PLEASANT HEALTH CENTRE L83066 6.0% BARNFIELD HILL SURGERY L83024 6.0% KNOWLE HOUSE SURGERY L83089 6.0% BEACON MEDICAL GROUP L83100 6.0% HILL BARTON SURGERY L83143 6.0% YELVERTON SURGERY L83102 5.9% LIFTON SURGERY L83608 5.9% TOPSHAM SURGERY L83036 5.8% PARK VIEW SURGERY L83117 5.7% LYNTON HEALTH CENTRE L83068 5.6% WEST HOE SURGERY L83112 5.6% TAVYSIDE HEALTH CENTRE L83038 5.5% CHAGFORD HEALTH CENTRE L83082 5.5% STOKE SURGERY L83071 5.5% LISSON GROVE MEDICAL CTR. L83147 5.4% ADELAIDE STREET SURGERY L83651 5.4% YEALM MEDICAL CENTRE L83081 5.3% FREEDOM HEALTH CENTRE L83643 5.2% GLENSIDE MEDICAL CENTRE L83138 4.9% OKEMENT PRIMARY CARE CENTRE Y00304 4.7% Note: The estimated number of undiagnosed FOXHAYES PRACTICE Y00568 4.6% HYDE PARK SURGERY L83658 4.5% ST THOMAS MEDICAL GROUP L83016 3.7% PEVERELL PARK SURGERY L83648 3.2% people with diabetes has been calculated by CLOCK TOWER SURGERY L83673 2.9% BEAUMONT VILLA SURGERY L83018 2.9% CRANBROOK MEDICAL PRACTICE Y04662 2.0% multiplying the estimated prevalence rate to the 0% 2% 4% 6% 8% 10% 12% 2015/16 QOF list size and subtracting the number of people on the diabetes register.
45 CVD: Primary Care Intelligence Packs Expected total prevalence of diabetes and non-diabetic hyperglycaemia
Diabetes prevalence Undiagnosed diabetes prevalence Expected non-diabetic hyperglycaemia prevalence
• the estimated total prevalence of diabetes in NHS Northern, Eastern NHS South Devon And Torbay CCG 6.8% 3.1% 12.7% and Western Devon CCG is 8.9% (diagnosed and undiagnosed) • in addition, there are an estimated 11.7% of people in NHS Northern, Eastern and Western Devon CCG NHS Northern, Eastern And Western Devon CCG 6.7% 2.2% 11.7% who are at increased risk of developing diabetes (i.e. with non- diabetic hyperglycaemia) • this means that 20.5% of the population in NHS Northern, Eastern and Western Devon CCG are estimated to have diabetes, or at high risk of developing of diabetes
Note: Prevalence estimates of non-diabetic hyperglycaemia were developed using Health England 6.5% 1.9% 11.2% Survey for England (HSE) data. Five years of HSE data were combined, 2009- 2013. The estimates take into account the age, ethnic group and estimated body mass index of the population. 0% 5% 10% 15% 20% 25% These estimates were produced using the GP registered population.
46 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by CCG 2015/16
NHS Northern, Eastern And Western Devon CCG 56.9% • data on care processes and treatment targets are taken from the National Diabetes Audit (NDA) • overall practice participation in the 2015/16 audit was 81.4% in England
NHS South Devon And Torbay CCG 56.7% • in NHS Northern, Eastern and Western Devon CCG, 71 out of 118 practices (60.2%) participated in the NDA. Data is not available for the remaining practices
• 56.9% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS Northern, Eastern and Western Devon CCG, compared to 52.6% in England England 52.6%
0% 10% 20% 30% 40% 50% 60%
47 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by GP practice, 2015/16
GP practice Average of practices in the CCG who participated in the audit
FREMINGTON MEDICAL CENTRE L83057 84.9% CHIDDENBROOK SURGERY L83065 83.4% ROLLE MEDICAL PARTNERSHIP L83053 83.2% HARTLAND SURGERY L83129 82.0% CASTLE GARDENS SURGERY L83105 81.6% BARNFIELD HILL SURGERY L83024 81.6% PINHOE SURGERY L83040 81.2% SOUTH LAWN MEDICAL PRACTICE L83084 80.7% WYCLIFFE SURGERY L83076 77.6% WALLINGBROOK HEALTH CENTRE L83025 76.5% ROBOROUGH SURGERY L83048 75.9% IDE LANE SURGERY L83079 • achievement - 8 care processes: in 74.7% HEAVITREE PRACTICE L83077 72.0% TOTHILL SURGERY L83123 71.0% NEW VALLEY PRACTICE L83127 70.4% NORTHAM SURGERY L83050 69.3% SOUTHERNHAY HOUSE SURGERY L83058 69.2% practices who provided data via the BEAUMONT VILLA SURGERY L83018 69.2% MOUNT PLEASANT HEALTH CENTRE L83066 68.3% SOUTH MOLTON HEALTH CENTRE L83137 67.7% BOUTPORT MEDICAL CENTRE L83139 65.5% ST NEOTS SURGERY L83028 65.0% NDA, between 9.7% and 84.9% of SOUTH BRENT HEALTH CENTRE L83075 64.9% IMPERIAL SURGERY L83628 63.9% HONITON SURGERY L83002 63.8% RALEIGH SURGERY L83627 63.3% CHURCH VIEW SURGERY L83064 62.9% patients received all 8 care processes BIDEFORD MEDICAL CENTRE L83083 62.8% LITCHDON MEDICAL CENTRE L83035 62.5% QUEEN'S MEDICAL CENTRE L83003 62.0% AXMINSTER MEDICAL PRACTICE L83020 61.4% OKEHAMPTON MEDICAL CENTRE L83087 60.9% CAEN MEDICAL CENTRE L83097 59.7% DEVONPORT HEALTH CENTRE L83624 58.8% PEVERELL PARK SURGERY L83648 57.8% BUDSHEAD MEDICAL PRACTICE L83113 57.8% SEATON & COLYTON MEDICAL PRACTICE L83007 56.2% FRIARY HOUSE SURGERY L83072 55.7% EAST STREET SURGERY L83047 55.6% CHERITON BISHOP SURGERY L83098 54.7% • at least 13,960 people did not receive ST THOMAS MEDICAL GROUP L83016 54.3% TORRINGTON HEALTH CENTRE L83026 54.0% YELVERTON SURGERY L83102 53.4% THE COMBE COASTAL PRACTICE L83096 51.9% BEACON MEDICAL GROUP L83100 51.6% the eight care processes HILL BARTON SURGERY L83143 50.6% NORTON BROOK MEDICAL CENTRE L83059 50.1% ABBEY SURGERY L83101 46.9% TAVYSIDE HEALTH CENTRE L83038 46.6% BRANNAM MEDICAL CENTRE L83073 46.1% PATHFIELDS PRACTICE L83008 43.9% LYNTON HEALTH CENTRE L83068 43.7% BARTON SURGERY L83125 43.6% SALTASH ROAD SURGERY L83626 40.5% ERNESETTLE PRIMARY CARE CENTRE L83006 39.6% NORTH ROAD WEST MED.CTR. L83030 39.0% ST LEONARDS PRACTICE L83042 38.4% WONFORD GREEN SURGERY L83655 37.5% BLACK TORRINGTON SURGERY L83663 37.3% TOWNSEND HOUSE MEDICAL CENTRE L83054 36.7% WHIPTON SURGERY L83115 35.0% WEST HOE SURGERY L83112 30.6% ADELAIDE STREET SURGERY L83651 30.0% CHAGFORD HEALTH CENTRE L83082 29.7% CLAREMONT MEDICAL PRACTICE L83056 28.6% HATHERLEIGH MEDICAL CENTRE L83647 25.7% ISCA MEDICAL PRACTICE L83099 18.5% TOPSHAM SURGERY L83036 14.9% BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 9.7% NORTH TAWTON MEDICAL PRACTICE Y04979 CRANBROOK MEDICAL PRACTICE Y04662 BOW MEDICAL PRACTICE Y02633 HONITON SURGERY - EVANS Y02121 FOXHAYES PRACTICE Y00568 OKEMENT PRIMARY CARE CENTRE Y00304 CLOCK TOWER SURGERY L83673 ST.BARNABAS SURGERY L83664 HYDE PARK SURGERY L83658 ST.LEVAN SURGERY L83646 HIGHLANDS HEALTH CENTRE L83644 FREEDOM HEALTH CENTRE L83643 ESTOVER SURGERY L83642 WEMBURY SURGERY L83639 SAMPFORD PEVERELL SURGERY L83616 LIFTON SURGERY L83608 LISSON GROVE MEDICAL CTR. L83147 LEYPARK SURGERY L83144 GLENSIDE MEDICAL CENTRE L83138 HALDON HOUSE SURGERY L83136 WYNDHAM HOUSE SURGERY L83134 BRAMBLEHAIES SURGERY L83128 SHEBBEAR SURGERY L83121 PARK VIEW SURGERY L83117 WOODBURY SURGERY L83116 CROWNHILL SURGERY L83107 WOODA SURGERY L83106 COLERIDGE MEDICAL CENTRE L83095 COLLEGE SURGERY PARTNERSHIP L83092 KNOWLE HOUSE SURGERY L83089 REDFERN HEALTH CENTRE L83088 MODBURY HEALTH CENTRE L83086 CLARE HOUSE L83085 YEALM MEDICAL CENTRE L83081 ARMADA SURGERY L83080 OCEAN HEALTH CENTRE L83074 STOKE SURGERY L83071 HOLSWORTHY MEDICAL CENTRE L83069 SID VALLEY PRACTICE L83067 THE MANNAMEAD SURGERY L83061 CASTLE PLACE PRACTICE L83052 MORETONHAMPSTEAD HEALTH CENTRE L83049 BLACKDOWN PRACTICE L83044 WESTBANK PRACTICE L83041 SOUTHWAY SURGERY L83039 CHARD ROAD SURGERY L83037 MID DEVON MEDICAL PRACTICE L83023 DEAN CROSS SURGERY L83021 ELM SURGERY L83019 WATERSIDE PRACTICE L83017 OAKSIDE SURGERY L83015 BRADWORTHY SURGERY L83012 BAMPTON SURGERY L83009 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
48 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by CCG, 2015/16
NHS South Devon And Torbay CCG 36.0% • 35.2% of people with diabetes (of practices who participated in the audit) met the three treatment targets in NHS Northern, Eastern and Western Devon CCG, compared to 39.0% in England NHS Northern, Eastern And Western Devon CCG 35.2%
England 39.0%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
49 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16
GP practice Average of practices in the CCG who participated in the audit
CHIDDENBROOK SURGERY L83065 49.1% ROLLE MEDICAL PARTNERSHIP L83053 47.8% BLACK TORRINGTON SURGERY L83663 45.9% HONITON SURGERY L83002 45.3% TOTHILL SURGERY L83123 45.0% PINHOE SURGERY L83040 44.8% BEAUMONT VILLA SURGERY L83018 44.6% LYNTON HEALTH CENTRE L83068 44.4% SOUTH LAWN MEDICAL PRACTICE L83084 43.6% DEVONPORT HEALTH CENTRE L83624 42.7% NEW VALLEY PRACTICE L83127 42.0% CASTLE GARDENS SURGERY L83105 • achievement - 3 treatment targets: in 40.7% NORTON BROOK MEDICAL CENTRE L83059 39.9% CHURCH VIEW SURGERY L83064 39.7% HILL BARTON SURGERY L83143 39.3% IDE LANE SURGERY L83079 39.3% AXMINSTER MEDICAL PRACTICE L83020 39.3% practices who provided data via the CLAREMONT MEDICAL PRACTICE L83056 39.2% BARNFIELD HILL SURGERY L83024 39.0% PEVERELL PARK SURGERY L83648 38.8% CHERITON BISHOP SURGERY L83098 38.7% ROBOROUGH SURGERY L83048 38.6% NDA, between 16.0% and 49.1% of ISCA MEDICAL PRACTICE L83099 38.4% HATHERLEIGH MEDICAL CENTRE L83647 37.6% HEAVITREE PRACTICE L83077 37.3% PATHFIELDS PRACTICE L83008 37.2% LITCHDON MEDICAL CENTRE L83035 37.2% patients achieved all 3 treatment NORTHAM SURGERY L83050 37.1% SOUTH BRENT HEALTH CENTRE L83075 37.0% TORRINGTON HEALTH CENTRE L83026 36.6% FREMINGTON MEDICAL CENTRE L83057 36.4% OKEHAMPTON MEDICAL CENTRE L83087 35.6% targets WYCLIFFE SURGERY L83076 35.4% FRIARY HOUSE SURGERY L83072 35.3% BIDEFORD MEDICAL CENTRE L83083 35.1% BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 35.1% BEACON MEDICAL GROUP L83100 34.5% SALTASH ROAD SURGERY L83626 34.4% ST LEONARDS PRACTICE L83042 34.3% THE COMBE COASTAL PRACTICE L83096 33.8% RALEIGH SURGERY L83627 33.8% SOUTH MOLTON HEALTH CENTRE L83137 33.6% QUEEN'S MEDICAL CENTRE L83003 33.4% TOPSHAM SURGERY L83036 32.9% SEATON & COLYTON MEDICAL PRACTICE L83007 32.7% YELVERTON SURGERY L83102 32.7% TAVYSIDE HEALTH CENTRE L83038 32.7% WONFORD GREEN SURGERY L83655 31.9% NORTH ROAD WEST MED.CTR. L83030 31.2% BRANNAM MEDICAL CENTRE L83073 31.1% SOUTHERNHAY HOUSE SURGERY L83058 30.7% HARTLAND SURGERY L83129 30.2% BOUTPORT MEDICAL CENTRE L83139 30.1% BUDSHEAD MEDICAL PRACTICE L83113 29.9% CHAGFORD HEALTH CENTRE L83082 29.6% ABBEY SURGERY L83101 29.4% TOWNSEND HOUSE MEDICAL CENTRE L83054 28.9% ST NEOTS SURGERY L83028 28.4% ST THOMAS MEDICAL GROUP L83016 28.2% ERNESETTLE PRIMARY CARE CENTRE L83006 27.7% CAEN MEDICAL CENTRE L83097 26.8% MOUNT PLEASANT HEALTH CENTRE L83066 26.3% EAST STREET SURGERY L83047 26.0% WALLINGBROOK HEALTH CENTRE L83025 25.6% ADELAIDE STREET SURGERY L83651 24.5% IMPERIAL SURGERY L83628 23.0% WEST HOE SURGERY L83112 21.4% WHIPTON SURGERY L83115 17.0% BARTON SURGERY L83125 16.0% NORTH TAWTON MEDICAL PRACTICE Y04979 CRANBROOK MEDICAL PRACTICE Y04662 BOW MEDICAL PRACTICE Y02633 HONITON SURGERY - EVANS Y02121 FOXHAYES PRACTICE Y00568 OKEMENT PRIMARY CARE CENTRE Y00304 CLOCK TOWER SURGERY L83673 ST.BARNABAS SURGERY L83664 HYDE PARK SURGERY L83658 ST.LEVAN SURGERY L83646 HIGHLANDS HEALTH CENTRE L83644 FREEDOM HEALTH CENTRE L83643 ESTOVER SURGERY L83642 WEMBURY SURGERY L83639 SAMPFORD PEVERELL SURGERY L83616 LIFTON SURGERY L83608 LISSON GROVE MEDICAL CTR. L83147 LEYPARK SURGERY L83144 GLENSIDE MEDICAL CENTRE L83138 HALDON HOUSE SURGERY L83136 WYNDHAM HOUSE SURGERY L83134 BRAMBLEHAIES SURGERY L83128 SHEBBEAR SURGERY L83121 PARK VIEW SURGERY L83117 WOODBURY SURGERY L83116 CROWNHILL SURGERY L83107 WOODA SURGERY L83106 COLERIDGE MEDICAL CENTRE L83095 COLLEGE SURGERY PARTNERSHIP L83092 KNOWLE HOUSE SURGERY L83089 REDFERN HEALTH CENTRE L83088 MODBURY HEALTH CENTRE L83086 CLARE HOUSE L83085 YEALM MEDICAL CENTRE L83081 ARMADA SURGERY L83080 OCEAN HEALTH CENTRE L83074 STOKE SURGERY L83071 HOLSWORTHY MEDICAL CENTRE L83069 SID VALLEY PRACTICE L83067 THE MANNAMEAD SURGERY L83061 CASTLE PLACE PRACTICE L83052 MORETONHAMPSTEAD HEALTH CENTRE L83049 BLACKDOWN PRACTICE L83044 WESTBANK PRACTICE L83041 SOUTHWAY SURGERY L83039 CHARD ROAD SURGERY L83037 MID DEVON MEDICAL PRACTICE L83023 DEAN CROSS SURGERY L83021 ELM SURGERY L83019 WATERSIDE PRACTICE L83017 OAKSIDE SURGERY L83015 BRADWORTHY SURGERY L83012 BAMPTON SURGERY L83009 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
50 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16 - opportunities compared to GP cluster
10% 5% 0% -5% -10% -15% -20% -25% -30% -35%
BARTON SURGERY 28
WHIPTON SURGERY 67
WEST HOE SURGERY 51 • using the GP cluster method of IMPERIAL SURGERY 63 calculating potential gains, if each ADELAIDE STREET SURGERY 21 practice was to achieve as well as the WALLINGBROOK HEALTH CENTRE 62 upper quartile of its national cluster, then an additional 2,796 people would EAST STREET SURGERY 61 be treated MOUNT PLEASANT HEALTH CENTRE 113
ERNESETTLE PRIMARY CARE CENTRE 86
CAEN MEDICAL CENTRE 87
DEVONPORT HEALTH CENTRE 8
TOTHILL SURGERY 3
SOUTH LAWN MEDICAL PRACTICE 9
LYNTON HEALTH CENTRE 1
PINHOE SURGERY
BLACK TORRINGTON SURGERY
HONITON SURGERY
BEAUMONT VILLA SURGERY
CHIDDENBROOK SURGERY
ROLLE MEDICAL PARTNERSHIP Details of this methodology are available on slide 9. Click here to view them.
51 CVD: Primary Care Intelligence Packs Kidney
52 CVD: Primary Care Intelligence Packs Management of chronic kidney disease
Chronic Kidney Disease can progress to kidney failure and it Late diagnosis of CKD is common. substantially increases the risk Around a third of people with CKD are undiagnosed. More of heart attack and stroke. opportunistic testing and improved uptake of the NHS Health Check will increase detection rates.
Chronic Kidney Disease (CKD) is common. What questions should we ask in our CCG? It is one of the commonest co-morbidities and affects a third 1. for each indicator how wide is the variation in of people over 75. In 2010 it was estimated to cost the NHS achievement and exception reporting? around £1.5bn. Average length of stay in hospital tends to 2. how many people would benefit if all practices be longer and outcomes are considerably worse: performed as well as the best? approximately 7,000 excess strokes and 12,000 excess 3. how can we support practices who are average and heart attacks occur each year in people with CKD below average to perform as well as the best in: compared to those without. • detection of CKD Individuals with CKD are also at much higher risk of • more systematic delivery of evidence based care developing acute kidney injury when they have an intercurrent illness such as pneumonia What might help • Support practices to share audit data and systematically Evidence based guidance from NICE highlights CVD identify gaps and opportunities for improved detection risk reduction, good blood pressure control and and management of CKD. management of proteinuria as essential steps to reduce the • Promote uptake of and follow up from the NHS Health risk of cardiovascular events and progression to kidney Check to aid detection and management of CKD failure. Despite this there is often significant variation • Offer local training and education in the detection and between practices in achievement and exception reporting. management of CKD
53 CVD: Primary Care Intelligence Packs Chronic kidney disease (CKD) observed prevalence (2015/16) compared with expected prevalence (2011) by CCG Comparison with CCGs in the STP
NHS South Devon And Torbay CCG 0.69 • the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney disease is 0.67. This compares to 0.68 for England NHS Northern, Eastern And Western Devon CCG 0.67 • this suggests that 67% of people with chronic kidney disease have been diagnosed
Note: This slide compares the prevalence of CKD recorded in QOF in 2015/16 to the expected prevalence of CKD produced by the University of England 0.68 Southampton in 2011. A small number of CCGs have a ratio greater than 1. It is unlikely that all people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.
54 CVD: Primary Care Intelligence Packs Chronic kidney disease (CKD) observed prevalence (2015/16) compared with expected prevalence (2011) by CCG Comparison with demographically similar CCGs
NHS Gloucestershire CCG 0.98
NHS Southern Derbyshire CCG 0.81
NHS Dorset CCG 0.74
NHS Kernow CCG 0.72
NHS Cumbria CCG 0.71
NHS Northern, Eastern and Western Devon CCG 0.67
NHS Nene CCG 0.67
NHS Somerset CCG 0.64
NHS Oxfordshire CCG 0.59
NHS Cambridgeshire and Peterborough CCG 0.51
NHS West Hampshire CCG 0.50
0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio
55 CVD: Primary Care Intelligence Packs CKD prevalence by GP practice, 2015/16
GP practice CCG
LIFTON SURGERY L83608 12.7% TOWNSEND HOUSE MEDICAL CENTRE L83054 10.8% ELM SURGERY L83019 10.1% BAMPTON SURGERY L83009 10.0% SEATON & COLYTON MEDICAL PRACTICE L83007 8.9% HONITON SURGERY L83002 8.3% NORTH TAWTON MEDICAL PRACTICE Y04979 8.2% HONITON SURGERY - EVANS Y02121 8.2% SID VALLEY PRACTICE L83067 8.0% ST.BARNABAS SURGERY L83664 7.5% SALTASH ROAD SURGERY L83626 7.3% FREMINGTON MEDICAL CENTRE L83057 7.3% DEAN CROSS SURGERY L83021 7.2% ROBOROUGH SURGERY L83048 7.1% PATHFIELDS PRACTICE L83008 7.1% NEW VALLEY PRACTICE L83127 • it is estimated that there are 17,094 6.9% LYNTON HEALTH CENTRE L83068 6.7% RALEIGH SURGERY L83627 6.7% LEYPARK SURGERY L83144 6.6% HALDON HOUSE SURGERY L83136 6.6% CHIDDENBROOK SURGERY L83065 people with undiagnosed chronic 6.6% NORTHAM SURGERY L83050 6.5% BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 6.5% WALLINGBROOK HEALTH CENTRE L83025 6.3% CLAREMONT MEDICAL PRACTICE L83056 6.3% SOUTH LAWN MEDICAL PRACTICE L83084 6.1% kidney disease in NHS Northern, WYCLIFFE SURGERY L83076 6.1% WHIPTON SURGERY L83115 6.0% ROLLE MEDICAL PARTNERSHIP L83053 6.0% SOUTH MOLTON HEALTH CENTRE L83137 5.9% REDFERN HEALTH CENTRE L83088 5.9% Eastern and Western Devon CCG AXMINSTER MEDICAL PRACTICE L83020 5.9% OCEAN HEALTH CENTRE L83074 5.9% HEAVITREE PRACTICE L83077 5.8% HATHERLEIGH MEDICAL CENTRE L83647 5.8% MID DEVON MEDICAL PRACTICE L83023 5.8% • GP practice range of observed CKD: COLERIDGE MEDICAL CENTRE L83095 5.8% NORTH ROAD WEST MED.CTR. L83030 5.7% WOODBURY SURGERY L83116 5.7% PARK VIEW SURGERY L83117 5.5% YEALM MEDICAL CENTRE L83081 5.5% 0.3% to 12.7% CHERITON BISHOP SURGERY L83098 5.4% ISCA MEDICAL PRACTICE L83099 5.4% COLLEGE SURGERY PARTNERSHIP L83092 5.3% CHARD ROAD SURGERY L83037 5.3% KNOWLE HOUSE SURGERY L83089 5.2% CROWNHILL SURGERY L83107 5.2% OKEHAMPTON MEDICAL CENTRE L83087 5.2% DEVONPORT HEALTH CENTRE L83624 5.0% CASTLE GARDENS SURGERY L83105 4.8% WEMBURY SURGERY L83639 4.8% WOODA SURGERY L83106 4.7% BRADWORTHY SURGERY L83012 4.7% SAMPFORD PEVERELL SURGERY L83616 4.7% BRAMBLEHAIES SURGERY L83128 4.7% OAKSIDE SURGERY L83015 4.7% CLARE HOUSE L83085 4.6% TORRINGTON HEALTH CENTRE L83026 4.6% NORTON BROOK MEDICAL CENTRE L83059 4.6% FOXHAYES PRACTICE Y00568 4.6% BOUTPORT MEDICAL CENTRE L83139 4.5% BEACON MEDICAL GROUP L83100 4.5% WESTBANK PRACTICE L83041 4.5% THE COMBE COASTAL PRACTICE L83096 4.4% BOW MEDICAL PRACTICE Y02633 4.4% WATERSIDE PRACTICE L83017 4.4% CHURCH VIEW SURGERY L83064 4.3% TOTHILL SURGERY L83123 4.3% HILL BARTON SURGERY L83143 4.3% IDE LANE SURGERY L83079 4.2% YELVERTON SURGERY L83102 4.2% IMPERIAL SURGERY L83628 4.1% SOUTH BRENT HEALTH CENTRE L83075 4.1% BIDEFORD MEDICAL CENTRE L83083 4.0% ST NEOTS SURGERY L83028 4.0% BLACKDOWN PRACTICE L83044 4.0% MOUNT PLEASANT HEALTH CENTRE L83066 4.0% HARTLAND SURGERY L83129 3.9% PINHOE SURGERY L83040 3.9% THE MANNAMEAD SURGERY L83061 3.9% MORETONHAMPSTEAD HEALTH CENTRE L83049 3.8% TOPSHAM SURGERY L83036 3.8% ST LEONARDS PRACTICE L83042 3.8% ESTOVER SURGERY L83642 3.7% CASTLE PLACE PRACTICE L83052 3.7% BARTON SURGERY L83125 3.7% BRANNAM MEDICAL CENTRE L83073 3.6% CAEN MEDICAL CENTRE L83097 3.6% FRIARY HOUSE SURGERY L83072 3.5% SOUTHWAY SURGERY L83039 3.5% HIGHLANDS HEALTH CENTRE L83644 3.5% LITCHDON MEDICAL CENTRE L83035 3.5% GLENSIDE MEDICAL CENTRE L83138 3.4% BLACK TORRINGTON SURGERY L83663 3.4% HOLSWORTHY MEDICAL CENTRE L83069 3.4% EAST STREET SURGERY L83047 3.4% WEST HOE SURGERY L83112 3.4% MODBURY HEALTH CENTRE L83086 3.4% ERNESETTLE PRIMARY CARE CENTRE L83006 3.4% QUEEN'S MEDICAL CENTRE L83003 3.3% BARNFIELD HILL SURGERY L83024 3.3% SHEBBEAR SURGERY L83121 3.2% HYDE PARK SURGERY L83658 3.0% ARMADA SURGERY L83080 3.0% FREEDOM HEALTH CENTRE L83643 2.8% TAVYSIDE HEALTH CENTRE L83038 2.8% SOUTHERNHAY HOUSE SURGERY L83058 2.8% Note: CCG estimates for the estimated ABBEY SURGERY L83101 2.8% WYNDHAM HOUSE SURGERY L83134 2.7% CHAGFORD HEALTH CENTRE L83082 2.6% ST.LEVAN SURGERY L83646 2.6% ST THOMAS MEDICAL GROUP L83016 2.5% number of people with CKD are based on OKEMENT PRIMARY CARE CENTRE Y00304 2.4% WONFORD GREEN SURGERY L83655 2.4% PEVERELL PARK SURGERY L83648 2.4% STOKE SURGERY L83071 2.3% applying a proportion from a resident based BEAUMONT VILLA SURGERY L83018 2.3% LISSON GROVE MEDICAL CTR. L83147 2.1% BUDSHEAD MEDICAL PRACTICE L83113 2.1% ADELAIDE STREET SURGERY L83651 2.0% population estimate to a GP registered CLOCK TOWER SURGERY L83673 0.9% CRANBROOK MEDICAL PRACTICE Y04662 0.3% population. The characteristics of registered 0% 2% 4% 6% 8% 10% 12% 14% and resident populations may vary in some CCGs, and local interpretation is required.
56 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less by CCG, 2014/15 Comparison with CCGs in the STP Below 140/85 Not below 140/85 Exceptions reported
NHS Northern, Eastern And Western Devon CCG 71.1% • 35,525 people with CKD (diagnosed*) in NHS Northern, Eastern and Western Devon CCG • 25,251 (71.1%) people whose blood pressure is <= 140 /85 • 4,135 (11.6%) people who are NHS South Devon And Torbay CCG 69.3% exceptions • 6,139 (17.3%) additional people whose blood pressure is not <= 140 / 85
England 74.4% *Using the QOF clinical indicator CKD002 denominator plus exceptions. Note: as the CKD002 indicator was removed from 0% 20% 40% 60% 80% 100% the QOF in 15/16 this is historic data taken from the 2014/15 QOF.
57 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less by CCG, 2014/15 Comparison with demographically similar CCGs Below 140/85 Not below 140/85 Exceptions reported
NHS Nene CCG 75.5%
NHS Oxfordshire CCG 74.5%
NHS Cumbria CCG 74.4%
NHS Gloucestershire CCG 74.4%
NHS Dorset CCG 72.9%
NHS Southern Derbyshire CCG 72.7%
NHS Kernow CCG 72.5%
NHS Cambridgeshire and Peterborough CCG 71.5%
NHS Northern, Eastern and Western Devon CCG 71.1%
NHS West Hampshire CCG 69.6%
NHS Somerset CCG 67.3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
58 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2014/15
Not below 140/85 Exceptions reported
CLOCK TOWER PRACTICE L83673 2 FRIARY HOUSE SURGERY L83072 166 THE WHIPTON SURGERY L83115 98 SALTASH ROAD SURGERY L83626 59 BARTON SURGERY L83125 41 ADELAIDE ST SURGERY L83651 20 THE MANNAMEAD SURGERY L83061 110 OAKSIDE SURGERY L83015 108 ST LEONARD'S PRACTICE L83042 114 NORTH TAWTON MEDICAL PRACTICE L83633 63 HOLSWORTHY HEALTH CENTRE L83069 126 QUEENS MEDICAL CENTRE L83003 81 TOWNSEND HOUSE MEDICAL CENTRE L83054 240 ST.THOMAS MEDICAL GROUP L83016 256 LIFTON SURGERY L83608 131 WALLINGBROOK HEALTH CENTRE L83025 160 • in total, including exceptions, there TAVYSIDE HEALTH CENTRE L83038 78 OKEMENT PRIMARY CARE CENTRE Y00304 24 STOKE SURGERY L83071 48 CHAGFORD HEALTH CENTRE L83082 28 ABBEY SURGERY. TAVISTOCK L83101 132 are 10,274 people whose blood WEST HOE SURGERY L83112 57 COLERIDGE MEDICAL CENTRE L83095 273 BLACKDOWN COUNTRY PRACTICE L83044 97 STIRLING ROAD SURGERY L83074 252 MOUNT PLEASANT HEALTH CENTRE L83066 177 pressure is not <= 140 / 85 ERNESETTLE PRIMARY CARE CENTRE L83006 102 HALDON HOUSE SURGERY L83136 117 HIGHLANDS HEALTH CENTRE L83644 38 NORTH ROAD WEST MEDICAL CENTRE L83030 92 ESTOVER SURGERY L83642 24 • GP practice range: 6.8% to 66.7% OKEHAMPTON MEDICAL CENTRE L83087 193 FREEDOM HEALTH CENTRE L83643 14 CAEN MEDICAL CENTRE L83097 123 CASTLE PLACE SURGERY L83052 164 MORETONHAMPSTEAD HEALTH CENTRE L83049 31 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 149 DEAN CROSS SURGERY L83021 194 HARTLAND SURGERY L83129 29 ELM SURGERY L83019 83 LISSON GROVE MEDICAL CENTRE L83147 51 LITCHDON MEDICAL CENTRE L83035 98 SEATON & COLYTON MEDICAL PRACTICE L83007 177 SOUTH MOLTON HEALTH CENTRE L83137 69 ROBOROUGH SURGERY L83048 199 AXMINSTER MEDICAL PRACTICE L83020 168 MODBURY HEALTH CENTRE L83086 40 EAST STREET SURGERY L83047 53 EXE VALLEY PRACTICE L83613 29 THE PINHOE SURGERY L83040 103 CLARE HOUSE L83085 111 CROWNHILL SURGERY L83107 36 HEAVITREE HEALTH CENTRE L83077 110 WYCLIFFE SURGERY L83076 79 BRANNAM MEDICAL CENTRE L83073 130 IMPERIAL SURGERY L83628 48 WONFORD GREEN SURGERY L83655 31 SOUTH BRENT HEALTH CENTRE L83075 54 WATERSIDE PRIMARY CARE L83017 112 TORRINGTON HEALTH CENTRE L83026 58 NORTHAM SURGERY L83050 185 BRAMBLEHAIES SURGERY L83128 68 RALEIGH SURGERY L83627 66 ISCA MEDICAL PRACTICE L83099 64 THE NEWCOMBES SURGERY L83127 112 CHARD ROAD SURGERY L83037 95 CLAREMONT MEDICAL PRACTICE L83056 176 FREMINGTON MEDICAL CENTRE L83057 107 BARNFIELD HILL SURGERY L83024 53 BIDEFORD MEDICAL CENTRE L83083 132 ST LEVAN SURGERY L83646 37 TOPSHAM SURGERY L83036 85 BLACKMORE HEALTH CENTRE L83067 272 PEVERELL PARK SURGERY L83648 74 SOUTHERNHAY HOUSE SURGERY L83058 48 BEACON MEDICAL GROUP L83100 303 YEALM MEDICAL CENTRE L83081 63 ST NEOTS SURGERY L83028 82 SOUTHWAY SURGERY L83039 35 THE NORTON BROOK MEDICAL CENTRE L83059 98 YELVERTON SURGERY L83102 62 CHURCH VIEW SURGERY L83064 103 BEECH HOUSE L83121 12 LEYPARK SURGERY L83144 30 ARMADA SURGERY L83080 16 WARWICK PRACTICE L83096 76 BOUTPORT MEDICAL CENTRE L83139 44 BEAUMONT VILLA SURGERY L83018 62 BLAKE HOUSE L83663 18 WOODBURY SURGERY L83116 41 CASTLE GARDENS SURGERY L83105 58 THE WOODA SURGERY L83106 79 TOTHILL SURGERY L83123 19 PATHFIELDS PRACTICE L83008 126 IDE LANE SURGERY L83079 55 KNOWLE HOUSE SURGERY L83089 105 BAMPTON SURGERY L83009 72 REDFERN HEALTH CENTRE L83088 53 HONITON SURGERY Y02121 58 HONITON SURGERY L83002 176 FOXHAYES PRACTICE Y00568 23 HILL BARTON SURGERY L83143 27 THE BUDSHEAD MEDICAL PRACTICE L83113 20 ROLLE MEDICAL PARTNERSHIP L83053 118 ST.BARNABAS SURGERY L83664 23 BOW MEDICAL PRACTICE Y02633 19 THE WESTBANK PRACTICE L83041 57 MID DEVON MEDICAL PRACTICE L83023 45 CHIDDENBROOK SURGERY L83065 71 GLENSIDE MEDICAL CENTRE L83138 35 WYNDHAM HOUSE SURGERY L83134 16 COLLEGE SURGERY PARTNERSHIP L83092 118 MARLBOROUGH STREET SURGERY L83624 41 BRADWORTHY SURGERY L83012 21 SUTHERLAND ROAD SURGERY L83109 17 CHERITON BISHOP SURGERY L83098 37 LYNTON HEALTH CENTRE L83068 23 WEMBURY SURGERY L83639 13 THE SOUTH LAWN MEDICAL PRACTICE L83084 51 HYDE PARK SURGERY L83658 10 HATHERLEIGH MEDICAL CENTRE L83647 11 PARK VIEW SURGERY L83117 3 SAMPFORD PEVERELL SURGERY L83616 5 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
59 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2014/15 – opportunities compared to GP cluster
15% 10% 5% 0% -5% -10% -15% -20% -25% -30% -35%
FRIARY HOUSE SURGERY 102
THE WHIPTON SURGERY 64
SALTASH ROAD SURGERY 38 • using the GP cluster method of BARTON SURGERY 24 calculating potential gains, if each ADELAIDE ST SURGERY 12 practice was to achieve as well as the OAKSIDE SURGERY 64 upper quartile of its national cluster, then an additional 3,300 people would QUEENS MEDICAL CENTRE 47 be treated OKEMENT PRIMARY CARE CENTRE 14
LIFTON SURGERY 71
WALLINGBROOK HEALTH CENTRE 86
HONITON SURGERY
CHERITON BISHOP SURGERY
ROLLE MEDICAL PARTNERSHIP
COLLEGE SURGERY PARTNERSHIP
LYNTON HEALTH CENTRE
WEMBURY SURGERY
HYDE PARK SURGERY
THE SOUTH LAWN MEDICAL PRACTICE
HATHERLEIGH MEDICAL CENTRE
SAMPFORD PEVERELL SURGERY Details of this methodology are available on slide 9. Click here to view them.
60 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with CCGs in the STP Recorded Not recorded Exceptions reported
NHS Northern, Eastern And Western Devon CCG 75.8% • 35,548 people with CKD (diagnosed*) in NHS Northern, Eastern and Western Devon CCG • 26,955 (75.8%) people who have a record of urine albumin:creatinine ratio test NHS South Devon And Torbay CCG 68.1% • 2,381 (6.7%) people who are exceptions • 6,212 (17.5%) additional people who have no record of urine albumin:creatinine ratio test
England 75.4% *Using the QOF clinical indicator CKD004 denominator plus exceptions. Note: as the CKD004 indicator was removed from the QOF in 15/16 this is historic data 0% 20% 40% 60% 80% 100% taken from the 2014/15 QOF.
61 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with demographically similar CCGs Recorded Not recorded Exceptions reported
NHS Southern Derbyshire CCG 78.6%
NHS Kernow CCG 77.0%
NHS Cumbria CCG 76.9%
NHS Oxfordshire CCG 76.8%
NHS Northern, Eastern and Western Devon CCG 75.8%
NHS Nene CCG 75.3%
NHS Gloucestershire CCG 74.1%
NHS Cambridgeshire and Peterborough CCG 73.7%
NHS Dorset CCG 73.1%
NHS West Hampshire CCG 71.2%
NHS Somerset CCG 61.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
62 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes do not have a record of a urine albumin: creatinine ratio test in the preceding 12 months by GP practice, 2014/15
Not recorded Exceptions reported
OAKSIDE SURGERY L83673 1 TAVYSIDE HEALTH CENTRE L83038 126 BEECH HOUSE L83121 30 FRIARY HOUSE SURGERY L83072 178 CASTLE PLACE SURGERY L83052 271 THE BUDSHEAD MEDICAL PRACTICE L83113 46 SALTASH ROAD SURGERY L83626 60 LIFTON SURGERY L83608 157 ST.THOMAS MEDICAL GROUP L83016 305 NORTH ROAD WEST MEDICAL CENTRE L83030 130 HIGHLANDS HEALTH CENTRE L83644 50 THE MANNAMEAD SURGERY L83061 114 IMPERIAL SURGERY L83628 68 FOXHAYES PRACTICE Y00568 45 HALDON HOUSE SURGERY L83136 133 SOUTH MOLTON HEALTH CENTRE L83137 94 • in total, including exceptions, there FREEDOM HEALTH CENTRE L83643 16 ST LEONARD'S PRACTICE L83042 104 DEAN CROSS SURGERY L83021 221 ADELAIDE ST SURGERY L83651 17 WONFORD GREEN SURGERY L83655 37 are 8,593 people who have no record CLOCK TOWER PRACTICE L83673 1 QUEENS MEDICAL CENTRE L83003 67 LITCHDON MEDICAL CENTRE L83035 100 CLARE HOUSE L83085 118 ABBEY SURGERY. TAVISTOCK L83101 110 of urine albumin:creatinine ratio test COLERIDGE MEDICAL CENTRE L83095 228 PEVERELL PARK SURGERY L83648 89 RALEIGH SURGERY L83627 71 YEALM MEDICAL CENTRE L83081 75 SOUTHWAY SURGERY L83039 42 • GP practice range: 0.0% to 70.2% BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 131 MORETONHAMPSTEAD HEALTH CENTRE L83049 27 EAST STREET SURGERY L83047 50 CROWNHILL SURGERY L83107 34 MOUNT PLEASANT HEALTH CENTRE L83066 138 EXE VALLEY PRACTICE L83613 27 ERNESETTLE PRIMARY CARE CENTRE L83006 79 SOUTH BRENT HEALTH CENTRE L83075 50 BEAUMONT VILLA SURGERY L83018 71 SOUTHERNHAY HOUSE SURGERY L83058 49 CLAREMONT MEDICAL PRACTICE L83056 166 STIRLING ROAD SURGERY L83074 174 AXMINSTER MEDICAL PRACTICE L83020 136 BEACON MEDICAL GROUP L83100 299 HOLSWORTHY HEALTH CENTRE L83069 77 STOKE SURGERY L83071 31 SEATON & COLYTON MEDICAL PRACTICE L83007 135 BOW MEDICAL PRACTICE Y02633 23 HEAVITREE HEALTH CENTRE L83077 86 ST.BARNABAS SURGERY L83664 27 WEST HOE SURGERY L83112 35 BARNFIELD HILL SURGERY L83024 45 WARWICK PRACTICE L83096 72 IDE LANE SURGERY L83079 56 BRAMBLEHAIES SURGERY L83128 54 BRANNAM MEDICAL CENTRE L83073 96 ST LEVAN SURGERY L83646 31 LISSON GROVE MEDICAL CENTRE L83147 34 OKEHAMPTON MEDICAL CENTRE L83087 121 THE WESTBANK PRACTICE L83041 63 LEYPARK SURGERY L83144 27 WYNDHAM HOUSE SURGERY L83134 18 ROBOROUGH SURGERY L83048 132 THE NEWCOMBES SURGERY L83127 85 MID DEVON MEDICAL PRACTICE L83023 49 REDFERN HEALTH CENTRE L83088 50 WATERSIDE PRIMARY CARE L83017 79 THE PINHOE SURGERY L83040 69 ISCA MEDICAL PRACTICE L83099 47 CASTLE GARDENS SURGERY L83105 51 HONITON SURGERY L83002 164 HILL BARTON SURGERY L83143 25 YELVERTON SURGERY L83102 49 WYCLIFFE SURGERY L83076 51 HONITON SURGERY Y02121 52 KNOWLE HOUSE SURGERY L83089 91 ST NEOTS SURGERY L83028 62 ESTOVER SURGERY L83642 13 MARLBOROUGH STREET SURGERY L83624 41 BLACKDOWN COUNTRY PRACTICE L83044 48 CHERITON BISHOP SURGERY L83098 39 TORRINGTON HEALTH CENTRE L83026 36 OKEMENT PRIMARY CARE CENTRE Y00304 11 BLAKE HOUSE L83663 14 THE NORTON BROOK MEDICAL CENTRE L83059 70 LYNTON HEALTH CENTRE L83068 25 HYDE PARK SURGERY L83658 13 ROLLE MEDICAL PARTNERSHIP L83053 97 CHURCH VIEW SURGERY L83064 70 SAMPFORD PEVERELL SURGERY L83616 12 TOTHILL SURGERY L83123 14 TOWNSEND HOUSE MEDICAL CENTRE L83054 98 CAEN MEDICAL CENTRE L83097 59 NORTH TAWTON MEDICAL PRACTICE L83633 25 CHARD ROAD SURGERY L83037 56 BLACKMORE HEALTH CENTRE L83067 172 CHAGFORD HEALTH CENTRE L83082 12 BARTON SURGERY L83125 15 COLLEGE SURGERY PARTNERSHIP L83092 100 CHIDDENBROOK SURGERY L83065 58 MODBURY HEALTH CENTRE L83086 20 BIDEFORD MEDICAL CENTRE L83083 76 BAMPTON SURGERY L83009 50 THE WHIPTON SURGERY L83115 31 BOUTPORT MEDICAL CENTRE L83139 28 THE SOUTH LAWN MEDICAL PRACTICE L83084 51 GLENSIDE MEDICAL CENTRE L83138 24 PATHFIELDS PRACTICE L83008 74 TOPSHAM SURGERY L83036 41 BRADWORTHY SURGERY L83012 14 NORTHAM SURGERY L83050 79 WEMBURY SURGERY L83639 10 WOODBURY SURGERY L83116 21 FREMINGTON MEDICAL CENTRE L83057 43 ELM SURGERY L83019 27 HATHERLEIGH MEDICAL CENTRE L83647 11 SUTHERLAND ROAD SURGERY L83109 10 THE WOODA SURGERY L83106 36 HARTLAND SURGERY L83129 9 WALLINGBROOK HEALTH CENTRE L83025 34 ARMADA SURGERY L83080 1 PARK VIEW SURGERY L83117 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
63 CVD: Primary Care Intelligence Packs Heart
64 CVD: Primary Care Intelligence Packs Management of Heart Disease
Premature death and disability in people with What questions should we ask in our CCG? CHD can be reduced significantly by systematic 1. for each indicator how wide is the variation in evidence based management in primary care achievement and exception reporting? 2. how many people would benefit if all practices performed as well as the best? 3. how can we support practices who are Coronary Heart Disease is one of the principal causes of average and below average to perform as premature death and disability. The key elements of management for well as the best in: an individual who has already had a heart attack or angina are • more systematic delivery of evidence symptom control and secondary prevention of further cardiovascular based care for people with CHD events and premature mortality. There is robust evidence to support the • improved detection and management use of anti-platelet treatment, statins, beta-blockers and angiotensin of heart failure converting enzyme inhibitors or angiotensin receptor blockers. There is also robust evidence to support good control of blood pressure. Each of these interventions is incentivised in QOF but variation in achievement What might help and exception reporting at practice level shows that there is often 1. roll out of GRASP-Heart Failure audit tool considerable potential for improving management and outcomes. that identifies people with heart failure who are undiagnosed or under treated 2. education for health professionals to Heart failure is a common and an important complication of promote evidence based management of coronary heart disease and other conditions. Appropriate treatment CHD and high quality measurement of including up-titration of ace inhibitors and beta blockers in heart failure blood pressure due to LVSD can significantly improve symptom control and quality of 3. ensure access to rapid access diagnostic life, and improve outcomes for patients. Despite this, around a quarter clinics and specialist support for of people with heart failure are undetected and untreated. And amongst management of angina and heart failure those who are diagnosed, there is significant variation in the quality of 4. ensure access to cardiac rehab for care. individuals with CHD and heart failure
65 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with CCGs in the STP
NHS Northern, Eastern And Western Devon CCG 0.88% • prevalence of 0.88% in NHS Northern, Eastern and Western Devon CCG compared to 0.76% in England
NHS South Devon And Torbay CCG 0.81%
England 0.76%
0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9% 1.0%
66 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with demographically similar CCGs
NHS Cumbria CCG 1.13%
NHS Kernow CCG 1.03%
NHS Southern Derbyshire CCG 0.92%
NHS Dorset CCG 0.91%
NHS Somerset CCG 0.89%
NHS Northern, Eastern and Western Devon CCG 0.88%
NHS West Hampshire CCG 0.78%
NHS Gloucestershire CCG 0.77%
NHS Nene CCG 0.77%
NHS Oxfordshire CCG 0.63%
NHS Cambridgeshire and Peterborough CCG 0.61%
0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%
67 CVD: Primary Care Intelligence Packs Heart failure prevalence by GP practice
GP practice CCG
BLACK TORRINGTON SURGERY L83663 1.8% AXMINSTER MEDICAL PRACTICE L83020 1.7% TOWNSEND HOUSE MEDICAL CENTRE L83054 1.7% MID DEVON MEDICAL PRACTICE L83023 1.6% SEATON & COLYTON MEDICAL PRACTICE L83007 1.4% SOUTHERNHAY HOUSE SURGERY L83058 1.3% CHURCH VIEW SURGERY L83064 1.3% CHIDDENBROOK SURGERY L83065 1.3% ABBEY SURGERY L83101 1.3% PATHFIELDS PRACTICE L83008 1.2% LEYPARK SURGERY L83144 1.2% LYNTON HEALTH CENTRE L83068 1.2% ROBOROUGH SURGERY L83048 1.2% BAMPTON SURGERY L83009 1.2% NORTHAM SURGERY L83050 1.2% ROLLE MEDICAL PARTNERSHIP L83053 • 7,975 people with diagnosed heart 1.2% SHEBBEAR SURGERY L83121 1.2% CROWNHILL SURGERY L83107 1.2% NORTH ROAD WEST MED.CTR. L83030 1.2% WALLINGBROOK HEALTH CENTRE L83025 1.2% CHARD ROAD SURGERY L83037 failure in NHS Northern, Eastern and 1.2% OKEHAMPTON MEDICAL CENTRE L83087 1.2% TORRINGTON HEALTH CENTRE L83026 1.1% HONITON SURGERY - EVANS Y02121 1.1% WOODBURY SURGERY L83116 1.1% SOUTH MOLTON HEALTH CENTRE L83137 1.1% Western Devon CCG FREEDOM HEALTH CENTRE L83643 1.1% NORTON BROOK MEDICAL CENTRE L83059 1.1% BOUTPORT MEDICAL CENTRE L83139 1.1% HARTLAND SURGERY L83129 1.1% MODBURY HEALTH CENTRE L83086 1.1% • GP practice range: 0.0% to 1.8% EAST STREET SURGERY L83047 1.1% ST NEOTS SURGERY L83028 1.0% WEST HOE SURGERY L83112 1.0% BIDEFORD MEDICAL CENTRE L83083 1.0% BLACKDOWN PRACTICE L83044 1.0% RALEIGH SURGERY L83627 1.0% HALDON HOUSE SURGERY L83136 1.0% GLENSIDE MEDICAL CENTRE L83138 1.0% COLERIDGE MEDICAL CENTRE L83095 1.0% ARMADA SURGERY L83080 1.0% BRADWORTHY SURGERY L83012 1.0% FRIARY HOUSE SURGERY L83072 0.9% THE MANNAMEAD SURGERY L83061 0.9% MORETONHAMPSTEAD HEALTH CENTRE L83049 0.9% WOODA SURGERY L83106 0.9% OCEAN HEALTH CENTRE L83074 0.9% LIFTON SURGERY L83608 0.9% BOW MEDICAL PRACTICE Y02633 0.9% LITCHDON MEDICAL CENTRE L83035 0.9% CLAREMONT MEDICAL PRACTICE L83056 0.9% ELM SURGERY L83019 0.9% ST.BARNABAS SURGERY L83664 0.9% SOUTH LAWN MEDICAL PRACTICE L83084 0.9% YELVERTON SURGERY L83102 0.9% WATERSIDE PRACTICE L83017 0.9% ST.LEVAN SURGERY L83646 0.9% WEMBURY SURGERY L83639 0.9% SOUTHWAY SURGERY L83039 0.8% HOLSWORTHY MEDICAL CENTRE L83069 0.8% CLARE HOUSE L83085 0.8% REDFERN HEALTH CENTRE L83088 0.8% YEALM MEDICAL CENTRE L83081 0.8% BRANNAM MEDICAL CENTRE L83073 0.8% TOTHILL SURGERY L83123 0.8% CHERITON BISHOP SURGERY L83098 0.8% SID VALLEY PRACTICE L83067 0.8% QUEEN'S MEDICAL CENTRE L83003 0.8% THE COMBE COASTAL PRACTICE L83096 0.8% DEVONPORT HEALTH CENTRE L83624 0.8% ISCA MEDICAL PRACTICE L83099 0.8% CASTLE GARDENS SURGERY L83105 0.8% WHIPTON SURGERY L83115 0.8% TOPSHAM SURGERY L83036 0.8% IDE LANE SURGERY L83079 0.8% KNOWLE HOUSE SURGERY L83089 0.8% OAKSIDE SURGERY L83015 0.8% NORTH TAWTON MEDICAL PRACTICE Y04979 0.8% MOUNT PLEASANT HEALTH CENTRE L83066 0.8% BARTON SURGERY L83125 0.8% WYCLIFFE SURGERY L83076 0.7% WYNDHAM HOUSE SURGERY L83134 0.7% BEACON MEDICAL GROUP L83100 0.7% NEW VALLEY PRACTICE L83127 0.7% LISSON GROVE MEDICAL CTR. L83147 0.7% IMPERIAL SURGERY L83628 0.7% CASTLE PLACE PRACTICE L83052 0.7% HIGHLANDS HEALTH CENTRE L83644 0.7% ADELAIDE STREET SURGERY L83651 0.7% HONITON SURGERY L83002 0.7% FREMINGTON MEDICAL CENTRE L83057 0.7% PINHOE SURGERY L83040 0.7% ST THOMAS MEDICAL GROUP L83016 0.7% DEAN CROSS SURGERY L83021 0.7% ERNESETTLE PRIMARY CARE CENTRE L83006 0.7% BARNFIELD HILL SURGERY L83024 0.7% COLLEGE SURGERY PARTNERSHIP L83092 0.7% STOKE SURGERY L83071 0.6% ST LEONARDS PRACTICE L83042 0.6% CAEN MEDICAL CENTRE L83097 0.6% BRAMBLEHAIES SURGERY L83128 0.6% WESTBANK PRACTICE L83041 0.6% HATHERLEIGH MEDICAL CENTRE L83647 0.6% BEAUMONT VILLA SURGERY L83018 0.6% SALTASH ROAD SURGERY L83626 0.6% BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 0.6% HEAVITREE PRACTICE L83077 0.6% SOUTH BRENT HEALTH CENTRE L83075 0.5% WONFORD GREEN SURGERY L83655 0.5% FOXHAYES PRACTICE Y00568 0.5% HILL BARTON SURGERY L83143 0.5% SAMPFORD PEVERELL SURGERY L83616 0.5% ESTOVER SURGERY L83642 0.5% CHAGFORD HEALTH CENTRE L83082 0.5% TAVYSIDE HEALTH CENTRE L83038 0.5% BUDSHEAD MEDICAL PRACTICE L83113 0.5% PEVERELL PARK SURGERY L83648 0.4% HYDE PARK SURGERY L83658 0.4% PARK VIEW SURGERY L83117 0.3% OKEMENT PRIMARY CARE CENTRE Y00304 0.2% CLOCK TOWER SURGERY L83673 0.2% CRANBROOK MEDICAL PRACTICE Y04662 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8% 2.0%
68 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with CCGs in the STP Treatment No treatment Exceptions reported
NHS Northern, Eastern And Western Devon CCG 82.6% • 2,383 people with heart failure* with LVSD in NHS Northern, Eastern and Western Devon CCG • 1,968 (82.6%) people treated with ACE-I or ARB • 405 (17%) people who are exceptions NHS South Devon And Torbay CCG 81.9% • 10 (0.4%) additional people who are not treated with ACE-I or ARB
England 84.7%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF003 denominator plus exceptions
69 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported
NHS Cumbria CCG 86.5%
NHS Gloucestershire CCG 85.4%
NHS Nene CCG 84.1%
NHS West Hampshire CCG 84.0%
NHS Oxfordshire CCG 82.9%
NHS Northern, Eastern and Western Devon CCG 82.6%
NHS Kernow CCG 81.0%
NHS Southern Derbyshire CCG 80.8%
NHS Dorset CCG 80.8%
NHS Somerset CCG 80.1%
NHS Cambridgeshire and Peterborough CCG 80.1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
70 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB by GP practice
No treatment Exceptions reported
CLOCK TOWER SURGERY L83673 1 SHEBBEAR SURGERY L83121 1 BIDEFORD MEDICAL CENTRE L83083 2 HIGHLANDS HEALTH CENTRE L83644 4 ERNESETTLE PRIMARY CARE CENTRE L83006 3 TORRINGTON HEALTH CENTRE L83026 2 TOPSHAM SURGERY L83036 6 BRANNAM MEDICAL CENTRE L83073 3 IDE LANE SURGERY L83079 2 COLERIDGE MEDICAL CENTRE L83095 10 CAEN MEDICAL CENTRE L83097 3 HILL BARTON SURGERY L83143 1 BLACK TORRINGTON SURGERY L83663 2 TOWNSEND HOUSE MEDICAL CENTRE L83054 3 MODBURY HEALTH CENTRE L83086 3 FREEDOM HEALTH CENTRE L83643 • in total, including exceptions, there 2 DEAN CROSS SURGERY L83021 9 BAMPTON SURGERY L83009 5 QUEEN'S MEDICAL CENTRE L83003 3 AXMINSTER MEDICAL PRACTICE L83020 15 OKEHAMPTON MEDICAL CENTRE L83087 26 are 415 people who are not treated SOUTHWAY SURGERY L83039 1 HEAVITREE PRACTICE L83077 1 ISCA MEDICAL PRACTICE L83099 1 WEMBURY SURGERY L83639 3 ST.LEVAN SURGERY L83646 2 with ACE-I or ARB LITCHDON MEDICAL CENTRE L83035 6 NORTH ROAD WEST MED.CTR. L83030 10 THE COMBE COASTAL PRACTICE L83096 7 ROBOROUGH SURGERY L83048 12 REDFERN HEALTH CENTRE L83088 3 • GP practice range: 0.0% to 100.0% STOKE SURGERY L83071 5 ST NEOTS SURGERY L83028 18 BLACKDOWN PRACTICE L83044 2 FRIARY HOUSE SURGERY L83072 4 BARTON SURGERY L83125 2 PEVERELL PARK SURGERY L83648 2 GLENSIDE MEDICAL CENTRE L83138 10 OAKSIDE SURGERY L83015 3 CLAREMONT MEDICAL PRACTICE L83056 9 PATHFIELDS PRACTICE L83008 13 WALLINGBROOK HEALTH CENTRE L83025 10 BRADWORTHY SURGERY L83012 1 WYCLIFFE SURGERY L83076 1 SOUTH LAWN MEDICAL PRACTICE L83084 7 ABBEY SURGERY L83101 7 LISSON GROVE MEDICAL CTR. L83147 1 NORTH TAWTON MEDICAL PRACTICE Y04979 1 COLLEGE SURGERY PARTNERSHIP L83092 5 HONITON SURGERY L83002 14 NORTON BROOK MEDICAL CENTRE L83059 8 SEATON & COLYTON MEDICAL PRACTICE L83007 8 ST LEONARDS PRACTICE L83042 4 SOUTHERNHAY HOUSE SURGERY L83058 12 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 1 CHARD ROAD SURGERY L83037 1 MORETONHAMPSTEAD HEALTH CENTRE L83049 1 CHURCH VIEW SURGERY L83064 8 BOUTPORT MEDICAL CENTRE L83139 1 BUDSHEAD MEDICAL PRACTICE L83113 4 YEALM MEDICAL CENTRE L83081 3 BEACON MEDICAL GROUP L83100 12 WATERSIDE PRACTICE L83017 4 CASTLE PLACE PRACTICE L83052 2 THE MANNAMEAD SURGERY L83061 2 OCEAN HEALTH CENTRE L83074 4 WOODBURY SURGERY L83116 4 NEW VALLEY PRACTICE L83127 2 WEST HOE SURGERY L83112 4 NORTHAM SURGERY L83050 8 MOUNT PLEASANT HEALTH CENTRE L83066 1 SOUTH BRENT HEALTH CENTRE L83075 1 CLARE HOUSE L83085 2 WHIPTON SURGERY L83115 2 TOTHILL SURGERY L83123 2 SOUTH MOLTON HEALTH CENTRE L83137 3 HYDE PARK SURGERY L83658 1 FOXHAYES PRACTICE Y00568 1 CHIDDENBROOK SURGERY L83065 8 CASTLE GARDENS SURGERY L83105 1 CROWNHILL SURGERY L83107 1 ST THOMAS MEDICAL GROUP L83016 7 SID VALLEY PRACTICE L83067 1 HALDON HOUSE SURGERY L83136 1 DEVONPORT HEALTH CENTRE L83624 1 BRAMBLEHAIES SURGERY L83128 2 BOW MEDICAL PRACTICE Y02633 2 ELM SURGERY L83019 2 YELVERTON SURGERY L83102 4 KNOWLE HOUSE SURGERY L83089 1 EAST STREET SURGERY L83047 1 LIFTON SURGERY L83608 1 HONITON SURGERY - EVANS Y02121 2 WOODA SURGERY L83106 2 BEAUMONT VILLA SURGERY L83018 3 ROLLE MEDICAL PARTNERSHIP L83053 2 MID DEVON MEDICAL PRACTICE L83023 BARNFIELD HILL SURGERY L83024 TAVYSIDE HEALTH CENTRE L83038 PINHOE SURGERY L83040 WESTBANK PRACTICE L83041 FREMINGTON MEDICAL CENTRE L83057 LYNTON HEALTH CENTRE L83068 HOLSWORTHY MEDICAL CENTRE L83069 ARMADA SURGERY L83080 CHAGFORD HEALTH CENTRE L83082 CHERITON BISHOP SURGERY L83098 PARK VIEW SURGERY L83117 HARTLAND SURGERY L83129 WYNDHAM HOUSE SURGERY L83134 LEYPARK SURGERY L83144 SAMPFORD PEVERELL SURGERY L83616 SALTASH ROAD SURGERY L83626 RALEIGH SURGERY L83627 IMPERIAL SURGERY L83628 HATHERLEIGH MEDICAL CENTRE L83647 ADELAIDE STREET SURGERY L83651 WONFORD GREEN SURGERY L83655 ST.BARNABAS SURGERY L83664 CRANBROOK MEDICAL PRACTICE Y04662 OKEMENT PRIMARY CARE CENTRE Y00304 ESTOVER SURGERY L83642 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
71 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with CCGs in the STP Treatment No treatment Exceptions reported
NHS Northern, Eastern And Western Devon CCG 71.9% • 1,955 people with heart failure* with LVSD treated with ACE-I/ARB in NHS Northern, Eastern and Western Devon CCG • 1,405 (71.9%) people treated with ACE-I/ARB and BB NHS South Devon And Torbay CCG 65.0% • 412 (21.1%) people who are exceptions • 138 (7.1%) additional people who are not treated with ACE-I/ARB and BB
England 77.7%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF004 denominator plus exceptions
72 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported
NHS Nene CCG 78.7%
NHS Cumbria CCG 77.4%
NHS West Hampshire CCG 77.4%
NHS Dorset CCG 76.5%
NHS Gloucestershire CCG 75.9%
NHS Kernow CCG 73.4%
NHS Somerset CCG 72.5%
NHS Southern Derbyshire CCG 72.2%
NHS Northern, Eastern and Western Devon CCG 71.9%
NHS Oxfordshire CCG 71.1%
NHS Cambridgeshire and Peterborough CCG 69.4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
73 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB and BB by GP practice
No treatment Exceptions reported
HIGHLANDS HEALTH CENTRE L83644 5 HYDE PARK SURGERY L83658 5 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 4 LITCHDON MEDICAL CENTRE L83035 13 HEAVITREE PRACTICE L83077 2 CHAGFORD HEALTH CENTRE L83082 2 CAEN MEDICAL CENTRE L83097 4 WYNDHAM HOUSE SURGERY L83134 2 ERNESETTLE PRIMARY CARE CENTRE L83006 3 LEYPARK SURGERY L83144 4 QUEEN'S MEDICAL CENTRE L83003 4 SOUTH BRENT HEALTH CENTRE L83075 3 HALDON HOUSE SURGERY L83136 4 SOUTH MOLTON HEALTH CENTRE L83137 9 BLACK TORRINGTON SURGERY L83663 2 FOXHAYES PRACTICE Y00568 • in total, including exceptions, there 3 CASTLE PLACE PRACTICE L83052 5 THE MANNAMEAD SURGERY L83061 5 ROLLE MEDICAL PARTNERSHIP L83053 24 WEMBURY SURGERY L83639 4 YEALM MEDICAL CENTRE L83081 7 are 550 people who are not treated COLLEGE SURGERY PARTNERSHIP L83092 9 PEVERELL PARK SURGERY L83648 3 SEATON & COLYTON MEDICAL PRACTICE L83007 15 MORETONHAMPSTEAD HEALTH CENTRE L83049 2 BOUTPORT MEDICAL CENTRE L83139 2 with ACE-I or ARB FREEDOM HEALTH CENTRE L83643 2 THE COMBE COASTAL PRACTICE L83096 9 AXMINSTER MEDICAL PRACTICE L83020 16 OKEHAMPTON MEDICAL CENTRE L83087 29 OAKSIDE SURGERY L83015 4 • GP practice range: 0.0% to 83.3% ARMADA SURGERY L83080 4 WOODA SURGERY L83106 9 COLERIDGE MEDICAL CENTRE L83095 7 WEST HOE SURGERY L83112 8 BARNFIELD HILL SURGERY L83024 3 TOPSHAM SURGERY L83036 4 NORTHAM SURGERY L83050 16 FREMINGTON MEDICAL CENTRE L83057 1 MOUNT PLEASANT HEALTH CENTRE L83066 2 CLARE HOUSE L83085 4 ISCA MEDICAL PRACTICE L83099 1 WHIPTON SURGERY L83115 4 SOUTHERNHAY HOUSE SURGERY L83058 19 ST THOMAS MEDICAL GROUP L83016 18 GLENSIDE MEDICAL CENTRE L83138 11 PATHFIELDS PRACTICE L83008 14 FRIARY HOUSE SURGERY L83072 4 SOUTH LAWN MEDICAL PRACTICE L83084 8 MODBURY HEALTH CENTRE L83086 2 WATERSIDE PRACTICE L83017 6 WALLINGBROOK HEALTH CENTRE L83025 10 ST NEOTS SURGERY L83028 16 BRADWORTHY SURGERY L83012 1 BEAUMONT VILLA SURGERY L83018 10 TORRINGTON HEALTH CENTRE L83026 1 NORTH ROAD WEST MED.CTR. L83030 8 CHIDDENBROOK SURGERY L83065 14 SID VALLEY PRACTICE L83067 2 HOLSWORTHY MEDICAL CENTRE L83069 1 WYCLIFFE SURGERY L83076 1 IDE LANE SURGERY L83079 1 TOTHILL SURGERY L83123 3 NORTH TAWTON MEDICAL PRACTICE Y04979 1 YELVERTON SURGERY L83102 9 HONITON SURGERY L83002 14 STOKE SURGERY L83071 4 BRAMBLEHAIES SURGERY L83128 4 BEACON MEDICAL GROUP L83100 15 WESTBANK PRACTICE L83041 3 ELM SURGERY L83019 4 ST LEONARDS PRACTICE L83042 4 ABBEY SURGERY L83101 6 CLAREMONT MEDICAL PRACTICE L83056 7 NORTON BROOK MEDICAL CENTRE L83059 7 CHURCH VIEW SURGERY L83064 8 KNOWLE HOUSE SURGERY L83089 2 EAST STREET SURGERY L83047 2 NEW VALLEY PRACTICE L83127 2 LIFTON SURGERY L83608 2 BRANNAM MEDICAL CENTRE L83073 1 BAMPTON SURGERY L83009 2 ROBOROUGH SURGERY L83048 6 PINHOE SURGERY L83040 2 BLACKDOWN PRACTICE L83044 1 TOWNSEND HOUSE MEDICAL CENTRE L83054 1 CASTLE GARDENS SURGERY L83105 1 CROWNHILL SURGERY L83107 1 BUDSHEAD MEDICAL PRACTICE L83113 3 BARTON SURGERY L83125 1 IMPERIAL SURGERY L83628 1 MID DEVON MEDICAL PRACTICE L83023 3 OCEAN HEALTH CENTRE L83074 3 DEAN CROSS SURGERY L83021 3 BOW MEDICAL PRACTICE Y02633 2 CHERITON BISHOP SURGERY L83098 1 RALEIGH SURGERY L83627 1 TAVYSIDE HEALTH CENTRE L83038 1 REDFERN HEALTH CENTRE L83088 1 HONITON SURGERY - EVANS Y02121 2 WOODBURY SURGERY L83116 1 CHARD ROAD SURGERY L83037 SOUTHWAY SURGERY L83039 LYNTON HEALTH CENTRE L83068 BIDEFORD MEDICAL CENTRE L83083 PARK VIEW SURGERY L83117 SHEBBEAR SURGERY L83121 HARTLAND SURGERY L83129 HILL BARTON SURGERY L83143 LISSON GROVE MEDICAL CTR. L83147 SAMPFORD PEVERELL SURGERY L83616 DEVONPORT HEALTH CENTRE L83624 SALTASH ROAD SURGERY L83626 ST.LEVAN SURGERY L83646 HATHERLEIGH MEDICAL CENTRE L83647 ADELAIDE STREET SURGERY L83651 WONFORD GREEN SURGERY L83655 ST.BARNABAS SURGERY L83664 CRANBROOK MEDICAL PRACTICE Y04662 OKEMENT PRIMARY CARE CENTRE Y00304 CLOCK TOWER SURGERY L83673 ESTOVER SURGERY L83642 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
74 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP Below 150/90 Not below 150/90 Exceptions reported
NHS Northern, Eastern And Western Devon CCG 87.6% • 34,816 people with coronary heart disease* in NHS Northern, Eastern and Western Devon CCG • 30,512 (87.6%) people whose blood pressure <= 150 / 90 • 1,868 (5.4%) people who are NHS South Devon And Torbay CCG 85.6% exceptions • 2,436 (7%) additional people whose blood pressure is not <= 150 / 90
England 88.2%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD002 denominator plus exceptions
75 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported
NHS Cumbria CCG 89.2%
NHS Nene CCG 88.9%
NHS Kernow CCG 88.5%
NHS Oxfordshire CCG 88.5%
NHS Gloucestershire CCG 88.2%
NHS Northern, Eastern and Western Devon CCG 87.6%
NHS Southern Derbyshire CCG 87.6%
NHS Dorset CCG 87.1%
NHS West Hampshire CCG 86.8%
NHS Cambridgeshire and Peterborough CCG 86.2%
NHS Somerset CCG 82.4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
76 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice
Not below 150/90 Exceptions reported
CRANBROOK MEDICAL PRACTICE Y04662 2 ADELAIDE STREET SURGERY L83651 30 CLOCK TOWER SURGERY L83673 2 WHIPTON SURGERY L83115 48 HIGHLANDS HEALTH CENTRE L83644 29 ERNESETTLE PRIMARY CARE CENTRE L83006 82 NORTH ROAD WEST MED.CTR. L83030 67 LISSON GROVE MEDICAL CTR. L83147 53 ST THOMAS MEDICAL GROUP L83016 166 ESTOVER SURGERY L83642 21 WEST HOE SURGERY L83112 36 HOLSWORTHY MEDICAL CENTRE L83069 101 FREEDOM HEALTH CENTRE L83643 10 FRIARY HOUSE SURGERY L83072 76 ST LEONARDS PRACTICE L83042 42 CHARD ROAD SURGERY L83037 • in total, including exceptions, there 66 WONFORD GREEN SURGERY L83655 19 BEAUMONT VILLA SURGERY L83018 35 MOUNT PLEASANT HEALTH CENTRE L83066 79 RALEIGH SURGERY L83627 29 DEVONPORT HEALTH CENTRE L83624 36 are 4,304 people whose blood ABBEY SURGERY L83101 99 SOUTHERNHAY HOUSE SURGERY L83058 40 AXMINSTER MEDICAL PRACTICE L83020 80 CAEN MEDICAL CENTRE L83097 76 ST.LEVAN SURGERY L83646 32 pressure is not <= 150 / 90 CASTLE PLACE PRACTICE L83052 77 BRANNAM MEDICAL CENTRE L83073 93 OKEHAMPTON MEDICAL CENTRE L83087 73 CLARE HOUSE L83085 55 CROWNHILL SURGERY L83107 23 • GP practice range: 3.6% to 40.0% BIDEFORD MEDICAL CENTRE L83083 105 HATHERLEIGH MEDICAL CENTRE L83647 13 SOUTH BRENT HEALTH CENTRE L83075 25 STOKE SURGERY L83071 32 COLERIDGE MEDICAL CENTRE L83095 90 PEVERELL PARK SURGERY L83648 40 BOUTPORT MEDICAL CENTRE L83139 26 OCEAN HEALTH CENTRE L83074 75 HALDON HOUSE SURGERY L83136 38 MODBURY HEALTH CENTRE L83086 24 LITCHDON MEDICAL CENTRE L83035 86 QUEEN'S MEDICAL CENTRE L83003 42 HARTLAND SURGERY L83129 17 NORTHAM SURGERY L83050 80 HEAVITREE PRACTICE L83077 25 BRAMBLEHAIES SURGERY L83128 25 BLACKDOWN PRACTICE L83044 38 SALTASH ROAD SURGERY L83626 10 BOW MEDICAL PRACTICE Y02633 9 WOODA SURGERY L83106 51 LIFTON SURGERY L83608 16 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 42 NEW VALLEY PRACTICE L83127 35 ELM SURGERY L83019 34 BEACON MEDICAL GROUP L83100 145 DEAN CROSS SURGERY L83021 51 OAKSIDE SURGERY L83015 27 BARTON SURGERY L83125 15 SHEBBEAR SURGERY L83121 10 WATERSIDE PRACTICE L83017 55 THE MANNAMEAD SURGERY L83061 45 CLAREMONT MEDICAL PRACTICE L83056 53 TOWNSEND HOUSE MEDICAL CENTRE L83054 39 WALLINGBROOK HEALTH CENTRE L83025 34 EAST STREET SURGERY L83047 28 PINHOE SURGERY L83040 30 NORTON BROOK MEDICAL CENTRE L83059 42 IMPERIAL SURGERY L83628 16 FOXHAYES PRACTICE Y00568 8 MORETONHAMPSTEAD HEALTH CENTRE L83049 10 ISCA MEDICAL PRACTICE L83099 20 ROBOROUGH SURGERY L83048 48 GLENSIDE MEDICAL CENTRE L83138 24 IDE LANE SURGERY L83079 31 THE COMBE COASTAL PRACTICE L83096 38 SEATON & COLYTON MEDICAL PRACTICE L83007 41 WEMBURY SURGERY L83639 10 ST.BARNABAS SURGERY L83664 10 TOPSHAM SURGERY L83036 37 KNOWLE HOUSE SURGERY L83089 40 NORTH TAWTON MEDICAL PRACTICE Y04979 7 WYCLIFFE SURGERY L83076 19 SID VALLEY PRACTICE L83067 74 SOUTH LAWN MEDICAL PRACTICE L83084 24 CHIDDENBROOK SURGERY L83065 26 SOUTH MOLTON HEALTH CENTRE L83137 23 HONITON SURGERY L83002 44 CHAGFORD HEALTH CENTRE L83082 10 WESTBANK PRACTICE L83041 27 BLACK TORRINGTON SURGERY L83663 11 YEALM MEDICAL CENTRE L83081 21 PATHFIELDS PRACTICE L83008 37 LEYPARK SURGERY L83144 9 ROLLE MEDICAL PARTNERSHIP L83053 40 YELVERTON SURGERY L83102 25 TOTHILL SURGERY L83123 6 FREMINGTON MEDICAL CENTRE L83057 30 CASTLE GARDENS SURGERY L83105 23 TORRINGTON HEALTH CENTRE L83026 19 SOUTHWAY SURGERY L83039 18 WYNDHAM HOUSE SURGERY L83134 10 BARNFIELD HILL SURGERY L83024 15 COLLEGE SURGERY PARTNERSHIP L83092 40 MID DEVON MEDICAL PRACTICE L83023 16 OKEMENT PRIMARY CARE CENTRE Y00304 1 CHERITON BISHOP SURGERY L83098 13 ST NEOTS SURGERY L83028 28 HONITON SURGERY - EVANS Y02121 12 BUDSHEAD MEDICAL PRACTICE L83113 14 BRADWORTHY SURGERY L83012 7 TAVYSIDE HEALTH CENTRE L83038 20 HILL BARTON SURGERY L83143 6 HYDE PARK SURGERY L83658 3 ARMADA SURGERY L83080 7 BAMPTON SURGERY L83009 7 CHURCH VIEW SURGERY L83064 26 SAMPFORD PEVERELL SURGERY L83616 3 LYNTON HEALTH CENTRE L83068 5 REDFERN HEALTH CENTRE L83088 8 WOODBURY SURGERY L83116 7 PARK VIEW SURGERY L83117 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
77 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice – opportunities compared to GP cluster
10% 5% 0% -5% -10% -15% -20% -25% -30%
ADELAIDE STREET SURGERY 24
WHIPTON SURGERY 37
HIGHLANDS HEALTH CENTRE 21 • using the GP cluster method of ERNESETTLE PRIMARY CARE CENTRE 56 calculating potential gains, if each NORTH ROAD WEST MED.CTR. 45 practice was to achieve as well as the ESTOVER SURGERY 14 upper quartile of its national cluster, then an additional 1,615 people would WEST HOE SURGERY 24 be treated FREEDOM HEALTH CENTRE 7
LISSON GROVE MEDICAL CTR. 32
BEAUMONT VILLA SURGERY 23
FREMINGTON MEDICAL CENTRE
COLLEGE SURGERY PARTNERSHIP
ARMADA SURGERY
SAMPFORD PEVERELL SURGERY
TAVYSIDE HEALTH CENTRE
LYNTON HEALTH CENTRE
WOODBURY SURGERY
BAMPTON SURGERY
CHURCH VIEW SURGERY
REDFERN HEALTH CENTRE Details of this methodology are available on slide 9. Click here to view them.
78 CVD: Primary Care Intelligence Packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with CCGs in the STP Optimal management No treatment Exceptions reported
NHS Northern, Eastern And Western Devon CCG 92.0% • 34,801 people with coronary heart disease* in NHS Northern, Eastern and Western Devon CCG • 32,031 (92%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant NHS South Devon And Torbay CCG 90.9% • 1,580 (4.5%) people who are exceptions • 1,190 (3.4%) additional people who are not taking aspirin, an alternative anti-platelet therapy, or an anti- coagulant
England 91.8%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD005 denominator plus exceptions
79 CVD: Primary Care Intelligence Packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported
NHS Kernow CCG 92.6%
NHS Nene CCG 92.6%
NHS West Hampshire CCG 92.6%
NHS Oxfordshire CCG 92.1%
NHS Northern, Eastern and Western Devon CCG 92.0%
NHS Cumbria CCG 91.9%
NHS Dorset CCG 91.6%
NHS Gloucestershire CCG 91.5%
NHS Southern Derbyshire CCG 90.6%
NHS Cambridgeshire and Peterborough CCG 90.5%
NHS Somerset CCG 88.9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
80 CVD: Primary Care Intelligence Packs Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice
No treatment Exceptions reported
CLOCK TOWER SURGERY L83673 2 HATHERLEIGH MEDICAL CENTRE L83647 21 HIGHLANDS HEALTH CENTRE L83644 26 CRANBROOK MEDICAL PRACTICE Y04662 1 ERNESETTLE PRIMARY CARE CENTRE L83006 63 TOTHILL SURGERY L83123 12 AXMINSTER MEDICAL PRACTICE L83020 76 SHEBBEAR SURGERY L83121 13 BUDLEIGH SALTERTON MEDICAL PRACTICE L83011 50 OKEMENT PRIMARY CARE CENTRE Y00304 2 BEAUMONT VILLA SURGERY L83018 27 WHIPTON SURGERY L83115 23 LYNTON HEALTH CENTRE L83068 14 BRAMBLEHAIES SURGERY L83128 26 PEVERELL PARK SURGERY L83648 36 HYDE PARK SURGERY L83658 • in total, including exceptions, there 6 RALEIGH SURGERY L83627 20 QUEEN'S MEDICAL CENTRE L83003 37 TOWNSEND HOUSE MEDICAL CENTRE L83054 40 WALLINGBROOK HEALTH CENTRE L83025 35 ISCA MEDICAL PRACTICE L83099 21 are 2,770 people are not taking MOUNT PLEASANT HEALTH CENTRE L83066 49 WYNDHAM HOUSE SURGERY L83134 14 HALDON HOUSE SURGERY L83136 29 SEATON & COLYTON MEDICAL PRACTICE L83007 41 OCEAN HEALTH CENTRE L83074 55 aspirin, an alternative anti-platelet ARMADA SURGERY L83080 12 IMPERIAL SURGERY L83628 15 WATERSIDE PRACTICE L83017 46 TOPSHAM SURGERY L83036 35 LISSON GROVE MEDICAL CTR. L83147 24 therapy, or an anti-coagulant BOUTPORT MEDICAL CENTRE L83139 18 THE COMBE COASTAL PRACTICE L83096 35 BARTON SURGERY L83125 12 SOUTHERNHAY HOUSE SURGERY L83058 22 IDE LANE SURGERY L83079 27 • GP practice range: 1.0% to 33.3% STOKE SURGERY L83071 20 BRANNAM MEDICAL CENTRE L83073 55 ST THOMAS MEDICAL GROUP L83016 70 THE MANNAMEAD SURGERY L83061 35 ST NEOTS SURGERY L83028 35 HONITON SURGERY - EVANS Y02121 15 HEAVITREE PRACTICE L83077 17 WOODA SURGERY L83106 35 BRADWORTHY SURGERY L83012 9 CAEN MEDICAL CENTRE L83097 41 ELM SURGERY L83019 23 DEVONPORT HEALTH CENTRE L83624 18 WONFORD GREEN SURGERY L83655 9 MORETONHAMPSTEAD HEALTH CENTRE L83049 8 BIDEFORD MEDICAL CENTRE L83083 60 HOLSWORTHY MEDICAL CENTRE L83069 41 WOODBURY SURGERY L83116 13 COLLEGE SURGERY PARTNERSHIP L83092 44 EAST STREET SURGERY L83047 21 COLERIDGE MEDICAL CENTRE L83095 50 ESTOVER SURGERY L83642 8 ABBEY SURGERY L83101 47 MODBURY HEALTH CENTRE L83086 14 CASTLE PLACE PRACTICE L83052 40 FRIARY HOUSE SURGERY L83072 31 ROLLE MEDICAL PARTNERSHIP L83053 36 CROWNHILL SURGERY L83107 12 HONITON SURGERY L83002 37 SID VALLEY PRACTICE L83067 58 SOUTH BRENT HEALTH CENTRE L83075 13 DEAN CROSS SURGERY L83021 31 CLAREMONT MEDICAL PRACTICE L83056 35 CLARE HOUSE L83085 28 GLENSIDE MEDICAL CENTRE L83138 17 PATHFIELDS PRACTICE L83008 31 CHARD ROAD SURGERY L83037 27 PARK VIEW SURGERY L83117 2 LITCHDON MEDICAL CENTRE L83035 46 ADELAIDE STREET SURGERY L83651 6 BEACON MEDICAL GROUP L83100 82 CHURCH VIEW SURGERY L83064 36 PINHOE SURGERY L83040 19 FOXHAYES PRACTICE Y00568 5 BLACK TORRINGTON SURGERY L83663 8 NORTHAM SURGERY L83050 39 ST.LEVAN SURGERY L83646 13 OAKSIDE SURGERY L83015 14 WESTBANK PRACTICE L83041 19 SALTASH ROAD SURGERY L83626 5 HARTLAND SURGERY L83129 8 CHAGFORD HEALTH CENTRE L83082 7 BUDSHEAD MEDICAL PRACTICE L83113 13 CHIDDENBROOK SURGERY L83065 17 REDFERN HEALTH CENTRE L83088 11 NORTON BROOK MEDICAL CENTRE L83059 24 OKEHAMPTON MEDICAL CENTRE L83087 30 ST LEONARDS PRACTICE L83042 14 FREEDOM HEALTH CENTRE L83643 3 ROBOROUGH SURGERY L83048 26 SOUTH MOLTON HEALTH CENTRE L83137 14 YELVERTON SURGERY L83102 17 BOW MEDICAL PRACTICE Y02633 4 CHERITON BISHOP SURGERY L83098 10 LIFTON SURGERY L83608 7 KNOWLE HOUSE SURGERY L83089 22 BLACKDOWN PRACTICE L83044 16 TORRINGTON HEALTH CENTRE L83026 13 CASTLE GARDENS SURGERY L83105 15 NEW VALLEY PRACTICE L83127 14 FREMINGTON MEDICAL CENTRE L83057 19 LEYPARK SURGERY L83144 5 NORTH ROAD WEST MED.CTR. L83030 15 YEALM MEDICAL CENTRE L83081 11 BARNFIELD HILL SURGERY L83024 9 BAMPTON SURGERY L83009 6 NORTH TAWTON MEDICAL PRACTICE Y04979 3 WEMBURY SURGERY L83639 4 WYCLIFFE SURGERY L83076 8 SOUTH LAWN MEDICAL PRACTICE L83084 9 SOUTHWAY SURGERY L83039 8 MID DEVON MEDICAL PRACTICE L83023 7 SAMPFORD PEVERELL SURGERY L83616 2 ST.BARNABAS SURGERY L83664 3 WEST HOE SURGERY L83112 5 TAVYSIDE HEALTH CENTRE L83038 7 HILL BARTON SURGERY L83143 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
81 CVD: Primary Care Intelligence Packs Some data on outcomes for people with cardiovascular disease
82 CVD: Primary Care Intelligence Packs Hospital admissions for coronary heart disease for all ages 2002/03 – 2015/16
NHS Northern, Eastern and Western Devon CCG England 800
700 • in NHS Northern, Eastern and Western Devon CCG, the hospital admission rate for coronary heart 600 disease in 2015/16 was 476 (4,566) compared to 527.9 for England
500
400
300
Age Age standardised (per rate 100,000) 200
100
0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved
83 CVD: Primary Care Intelligence Packs Hospital admissions for stroke for all ages 2002/03 – 2015/16
NHS Northern, Eastern and Western Devon CCG England 250
• in NHS Northern, Eastern and Western Devon CCG, the hospital 200 admission rate for stroke in 2015/16 was 167.8 (1,679) compared to 172.8 for England
150
100 Age standardised standardised Age (per rate 100,000)
50
0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved
84 CVD: Primary Care Intelligence Packs Additional risk of complications for people with diabetes, three year follow up, 2013/14
NHS Northern, Eastern and Western Devon CCG England
139.6% Angina 136.8% • The risk of a stroke was 80% higher and the risk of a heart attack was 118.4% 118.4% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 638.5% higher. 141.7% Heart failure 150.0%
80.0% Stroke 81.3%
638.5% Major amputation 445.8%
733.0% Minor amputation 753.5%
284.3% RRT 293.0%
0% 100% 200% 300% 400% 500% 600% 700% 800% Note: This slide uses data from the National Diabetes Audit (NDA)
85 CVD: Primary Care Intelligence Packs Deaths from coronary heart disease, under 75s
NHS Northern, Eastern and Western Devon CCG England 90
80 • in NHS Northern, Eastern and Western Devon CCG, the early 70 mortality rate for coronary heart disease in 2013-15 was 34.2, compared to 40.6 for England 60
50
40
30 Age Age standardised (per rate 1000,000) 20
10
0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Source: Office for National Statistics (ONS) mortality data 2002 - 2015
86 CVD: Primary Care Intelligence Packs Deaths from stroke, under 75s
NHS Northern, Eastern and Western Devon CCG England 30
• in NHS Northern, Eastern and 25 Western Devon CCG, the early mortality rate for stroke in 2013-15 was 11.5, compared to 13.6 for England 20
15
10 Age Age standardised (per rate 100,000)
5
0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Source: Office for National Statistics (ONS) mortality data 2002 - 2015
87 CVD: Primary Care Intelligence Packs Appendix Data sources
• Quality and Outcomes Framework (QOF), 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved
• Non-diabetic hyperglycaemia prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/nhs-diabetes- prevention-programme-non-diabetic-hyperglycaemia
• Diabetes prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/diabetes-prevalence-estimates-for- local-populations
• CKD Prevalence model, G.Aitken, University of Southampton , 2014 https://www.gov.uk/government/publications/ckd- prevalence-estimates-for-local-and-regional-populations
• Hypertension prevalence estimates for local CCG populations. Created using data from: QOF hypertension registers 2014/15 and; Undiagnosed hypertension estimates for adults 16 years and older. 2014. Department of Primary Care & Public Health, Imperial College London https://www.gov.uk/government/publications/hypertension-prevalence-estimates-for-local-populations
• NHS Stop smoking services Copyright © 2014, NHS Digital
• Norberg J, Bäckström S , Jansson J-H, Johansson L. Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clin Epidemiol 2013 ; 5 475 – 81.
• National Diabetes Audit, 2013/14 and 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved
• Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved
• Office for National Statistics (ONS) mortality data 2002 – 2015, Copyright © 2017, Re-used with the permission of the Office for National Statistics. All rights reserved
88 CVD: Primary Care Intelligence Packs About Public Health England
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Published June 2017 Gateway number 2017095
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