CVD: Primary Care Intelligence Packs NHS Bromley 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 Bromley CCG are: NHS Basildon and Brentwood CCG NHS Havering CCG NHS North West Surrey CCG NHS Surrey Downs CCG NHS Chiltern CCG NHS Swindon CCG NHS South Gloucestershire CCG NHS Bexley CCG NHS Trafford CCG NHS Dartford, Gravesham and Swanley 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 Swindon CCG 17.8%
NHS Basildon and Brentwood CCG 17.3% • prevalence of 15.2% in NHS Bromley CCG NHS Dartford, Gravesham and Swanley CCG 17.2%
NHS Havering CCG 16.4%
NHS Bexley CCG 16.1%
NHS Trafford CCG 15.9%
NHS South Gloucestershire CCG 15.3%
NHS Bromley CCG 15.2% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS North West Surrey CCG 14.4% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Chiltern CCG 13.9% http://bmjopen.bmj.com/content/4/7/e005217.abs tract
NHS Surrey Downs CCG 12.4% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 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
PARK GROUP PRACTICE G84025 26.2% CROSS HALL SURGERY G84628 25.4% TRINITY MEDICAL CENTRE G84022 25.4% ROBIN HOOD SURGERY G84029 24.3% OAKFIELD SURGERY G84625 24.2% BROOMWOOD ROAD SURGERY G84019 24.1% • 42,548 people who are recorded as LINKS MEDICAL PRACTICE G84003 23.9% smokers in NHS Bromley CCG ST MARY CRAY PRACTICE G84013 23.8% DERRY DOWNS SURGERY G84005 22.8% • GP practice range: 8.7% to 26.2% POVEREST MEDICAL CENTRE G84007 19.8% GILLMANS ROAD SURGERY G84041 19.7% ANERLEY SURGERY G84624 18.5% WOODLANDS PRACTICE Y00542 18.3% BANK HOUSE SURGERY G84609 17.2% CATOR MEDICAL CENTRE Y02811 17.1% NORHEADS LANE SURGERY G84039 17.1% STOCK HILL SURGERY G84004 15.4% ST JAMES' PRACTICE G84028 15.3% LONDON LANE CLINIC G84016 15.1% CRESCENT SURGERY G84630 15.0% EDEN PARK SURGERY G84011 14.7% MANOR ROAD SURGERY G84008 14.7% BROMLEY COMMON PRACTICE G84024 14.6% SOUTHBOROUGH LANE SURGERY G84023 14.4% WICKHAM PARK SURGERY G84607 14.3% ELM HOUSE SURGERY G84027 14.2% WHITEHOUSE SURGERY G84621 13.9% KNOLL MEDICAL PRACTICE G84032 13.4% PICKHURST SURGERY G84033 13.3% HIGHLAND ROAD SURGERY G84604 13.1% DYSART SURGERY G84002 12.9% FAMILY SURGERY G84009 12.9% SOUTH VIEW PARTNERSHIP G84001 12.7% ADDINGTON ROAD SURGERY G84017 12.5% GREEN STREET GREEN MED CT G84627 12.5% SUNDRIDGE MEDICAL CENTRE G84629 12.1% CHISLEHURST MEDICAL PRACTICE G84010 12.0% BALLATER SURGERY G84040 11.9% Note: This method is thought to be a reasonably CHELSFIELD SURGERY G84020 11.6% robust method in estimating smoking prevalence CHARTERHOUSE SURGERY G84021 10.9% CORNERWAYS SURGERY G84018 10.9% for the majority of GP practices. However, FORGE CLOSE SURGERY G84030 10.6% caution is advised for extreme estimates of SUMMERCROFT SURGERY G84006 10.3% STATION ROAD SURGERY G84015 9.9% smoking prevalence and those with high TUDOR WAY SURGERY G84035 8.7% numbers of smoking status not recorded and 0% 5% 10% 15% 20% 25% 30% 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 Greenwich CCG 0.60
• the ratio of those diagnosed with NHS Bexley CCG 0.59 hypertension versus those expected to have hypertension is 0.58. This compares to 0.59 for England NHS Bromley CCG 0.58 • this suggests that 58% of people with hypertension have been diagnosed
NHS Lewisham CCG 0.56
NHS Southwark CCG 0.55
NHS Lambeth CCG 0.51
Note: this slide shows Hypertension prevalence England 0.59 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 Dartford, Gravesham and Swanley CCG 0.60
NHS Trafford CCG 0.60
NHS Basildon and Brentwood CCG 0.60
NHS Surrey Downs CCG 0.59
NHS Swindon CCG 0.59
NHS South Gloucestershire CCG 0.59
NHS Bexley CCG 0.59
NHS Bromley CCG 0.58
NHS Havering CCG 0.58
NHS Chiltern CCG 0.58
NHS North West Surrey CCG 0.57
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
NORHEADS LANE SURGERY G84039 0.74 ST MARY CRAY PRACTICE G84013 0.72 KNOLL MEDICAL PRACTICE G84032 0.71 DERRY DOWNS SURGERY G84005 0.69 WHITEHOUSE SURGERY G84621 0.69 WOODLANDS PRACTICE Y00542 0.69 • it is estimated that there are 32,954 FORGE CLOSE SURGERY G84030 0.68 CRESCENT SURGERY G84630 0.68 people with undiagnosed CHELSFIELD SURGERY G84020 0.66 TRINITY MEDICAL CENTRE G84022 0.65 hypertension in NHS Bromley CCG TUDOR WAY SURGERY G84035 0.64 STOCK HILL SURGERY G84004 0.64 • GP practice range of observed to ADDINGTON ROAD SURGERY G84017 0.62 PICKHURST SURGERY G84033 0.62 expected hypertension prevalence SUMMERCROFT SURGERY G84006 0.62 BROOMWOOD ROAD SURGERY G84019 0.62 0.41 to 0.74 ROBIN HOOD SURGERY G84029 0.61 CHARTERHOUSE SURGERY G84021 0.60 ST JAMES' PRACTICE G84028 0.59 CORNERWAYS SURGERY G84018 0.59 WICKHAM PARK SURGERY G84607 0.58 SUNDRIDGE MEDICAL CENTRE G84629 0.58 SOUTHBOROUGH LANE SURGERY G84023 0.57 STATION ROAD SURGERY G84015 0.56 LINKS MEDICAL PRACTICE G84003 0.56 BANK HOUSE SURGERY G84609 0.55 GREEN STREET GREEN MED CT G84627 0.55 CROSS HALL SURGERY G84628 0.55 FAMILY SURGERY G84009 0.54 GILLMANS ROAD SURGERY G84041 0.54 PARK GROUP PRACTICE G84025 0.54 HIGHLAND ROAD SURGERY G84604 0.54 OAKFIELD SURGERY G84625 0.54 LONDON LANE CLINIC G84016 0.54 POVEREST MEDICAL CENTRE G84007 0.51 ANERLEY SURGERY G84624 0.50 BROMLEY COMMON PRACTICE G84024 0.50 CHISLEHURST MEDICAL PRACTICE G84010 0.49 EDEN PARK SURGERY G84011 0.48 ELM HOUSE SURGERY G84027 0.48 SOUTH VIEW PARTNERSHIP G84001 0.46 BALLATER SURGERY G84040 0.44 CATOR MEDICAL CENTRE Y02811 0.43 MANOR ROAD SURGERY G84008 0.41 DYSART SURGERY G84002 0.41 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 Bexley CCG 81.2%
• 46,515 people with hypertension NHS Southwark CCG 79.4% (diagnosed)* in NHS Bromley CCG • 35,977 (77.3%) people whose blood pressure is <= 150/90 NHS Lambeth CCG 78.0% • 1,465 (3.1%) people who are excepted from optimal control • 9,073 (19.5%) additional people NHS Bromley CCG 77.3% whose blood pressure is not <= 150/90
NHS Greenwich CCG 76.0%
NHS Lewisham CCG 74.9%
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 Bexley CCG 81.2%
NHS Swindon CCG 80.5%
NHS Chiltern CCG 80.0%
NHS Dartford, Gravesham and Swanley CCG 80.0%
NHS Trafford CCG 79.7%
NHS Havering CCG 79.6%
NHS South Gloucestershire CCG 79.0%
NHS North West Surrey CCG 78.6%
NHS Basildon and Brentwood CCG 78.2%
NHS Bromley CCG 77.3%
NHS Surrey Downs CCG 75.3%
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
EDEN PARK SURGERY G84011 347 CATOR MEDICAL CENTRE Y02811 215 ELM HOUSE SURGERY G84027 626 CHARTERHOUSE SURGERY G84021 449 SOUTHBOROUGH LANE SURGERY G84023 512 MANOR ROAD SURGERY G84008 166 • in total, including exceptions, there SOUTH VIEW PARTNERSHIP G84001 415 PARK GROUP PRACTICE G84025 231 are 10,538 people whose blood ADDINGTON ROAD SURGERY G84017 432 CHELSFIELD SURGERY G84020 348 pressure is not <= 150/90 BROOMWOOD ROAD SURGERY G84019 387 • GP practice range: 9.0% to 38.5% DERRY DOWNS SURGERY G84005 244 KNOLL MEDICAL PRACTICE G84032 360 PICKHURST SURGERY G84033 253 GREEN STREET GREEN MED CT G84627 224 WHITEHOUSE SURGERY G84621 126 OAKFIELD SURGERY G84625 78 POVEREST MEDICAL CENTRE G84007 252 WOODLANDS PRACTICE Y00542 317 STOCK HILL SURGERY G84004 393 FORGE CLOSE SURGERY G84030 231 NORHEADS LANE SURGERY G84039 98 LONDON LANE CLINIC G84016 414 BROMLEY COMMON PRACTICE G84024 224 SUNDRIDGE MEDICAL CENTRE G84629 112 ROBIN HOOD SURGERY G84029 147 SUMMERCROFT SURGERY G84006 358 BANK HOUSE SURGERY G84609 81 WICKHAM PARK SURGERY G84607 140 LINKS MEDICAL PRACTICE G84003 264 CHISLEHURST MEDICAL PRACTICE G84010 355 STATION ROAD SURGERY G84015 327 TUDOR WAY SURGERY G84035 206 GILLMANS ROAD SURGERY G84041 59 CRESCENT SURGERY G84630 74 CORNERWAYS SURGERY G84018 228 ANERLEY SURGERY G84624 52 DYSART SURGERY G84002 163 FAMILY SURGERY G84009 94 BALLATER SURGERY G84040 149 CROSS HALL SURGERY G84628 50 TRINITY MEDICAL CENTRE G84022 114 ST JAMES' PRACTICE G84028 122 ST MARY CRAY PRACTICE G84013 54 HIGHLAND ROAD SURGERY G84604 47 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 Lewisham CCG 76.8%
• 141 people with a new diagnosis* of NHS Greenwich CCG 74.5% hypertension with a CVD risk of 20% or higher in NHS Bromley CCG • 93 (66%) people who are currently NHS Southwark CCG 72.7% treated with statins • 45 (31.9%) people who are exempted from treatment with statins NHS Bexley CCG 71.0% • 3 (2.1%) additional people who are not currently treated with statins
NHS Bromley CCG 66.0%
NHS Lambeth CCG 61.2%
England 66.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *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 Swindon CCG 76.8%
NHS Dartford, Gravesham and Swanley CCG 74.1%
NHS North West Surrey CCG 72.1%
NHS Trafford CCG 71.8%
NHS Bexley CCG 71.0%
NHS South Gloucestershire CCG 70.3%
NHS Havering CCG 69.8%
NHS Bromley CCG 66.0%
NHS Chiltern CCG 65.9%
NHS Surrey Downs CCG 63.4%
NHS Basildon and Brentwood CCG 61.6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
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
EDEN PARK SURGERY G84011 1 CHARTERHOUSE SURGERY G84021 4 STOCK HILL SURGERY G84004 4 FORGE CLOSE SURGERY G84030 2 TUDOR WAY SURGERY G84035 4 BALLATER SURGERY G84040 3 • in total, including exceptions, there SOUTH VIEW PARTNERSHIP G84001 2 LINKS MEDICAL PRACTICE G84003 2 are 48 people who are not treated CHELSFIELD SURGERY G84020 2 PARK GROUP PRACTICE G84025 1 with statins ELM HOUSE SURGERY G84027 2 • GP practice range: 0.0% to 100.0% ST JAMES' PRACTICE G84028 1 WOODLANDS PRACTICE Y00542 5 PICKHURST SURGERY G84033 3 DERRY DOWNS SURGERY G84005 1 CHISLEHURST MEDICAL PRACTICE G84010 1 BROOMWOOD ROAD SURGERY G84019 1 TRINITY MEDICAL CENTRE G84022 1 WHITEHOUSE SURGERY G84621 2 GREEN STREET GREEN MED CT G84627 1 ADDINGTON ROAD SURGERY G84017 1 SOUTHBOROUGH LANE SURGERY G84023 1 LONDON LANE CLINIC G84016 3 DYSART SURGERY G84002 SUMMERCROFT SURGERY G84006 POVEREST MEDICAL CENTRE G84007 MANOR ROAD SURGERY G84008 FAMILY SURGERY G84009 ST MARY CRAY PRACTICE G84013 STATION ROAD SURGERY G84015 CORNERWAYS SURGERY G84018 BROMLEY COMMON PRACTICE G84024 ROBIN HOOD SURGERY G84029 KNOLL MEDICAL PRACTICE G84032 NORHEADS LANE SURGERY G84039 GILLMANS ROAD SURGERY G84041 HIGHLAND ROAD SURGERY G84604 WICKHAM PARK SURGERY G84607 BANK HOUSE SURGERY G84609 OAKFIELD SURGERY G84625 CROSS HALL SURGERY G84628 SUNDRIDGE MEDICAL CENTRE G84629 CRESCENT SURGERY G84630 CATOR MEDICAL CENTRE Y02811 ANERLEY SURGERY G84624 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 Bromley CCG 0.70
• the ratio of those diagnosed with atrial NHS Bexley CCG 0.66 fibrillation versus those expected to have atrial fibrillation is 0.7. This compares to 0.7 for England NHS Greenwich CCG 0.60 • this suggests that 70% of people with atrial fibrillation have been diagnosed.
NHS Southwark CCG 0.55
NHS Lewisham CCG 0.53
NHS Lambeth CCG 0.52
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 Network estimates produced in 2017. The estimates were developed by applying age-sex England 0.70 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 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 South Gloucestershire CCG 0.76
NHS Trafford CCG 0.75
NHS Chiltern CCG 0.72
NHS Bromley CCG 0.70
NHS Swindon CCG 0.68
NHS Dartford, Gravesham and Swanley CCG 0.68
NHS North West Surrey CCG 0.68
NHS Surrey Downs CCG 0.67
NHS Basildon and Brentwood CCG 0.66
NHS Bexley CCG 0.66
NHS Havering CCG 0.61
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
29 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared with expected prevalence by GP practice
GP practice CCG
ANERLEY SURGERY G84624 3.0 BROOMWOOD ROAD SURGERY G84019 0.9 STATION ROAD SURGERY G84015 0.8 ADDINGTON ROAD SURGERY G84017 0.8 CORNERWAYS SURGERY G84018 0.8 CHELSFIELD SURGERY G84020 0.8 • it is estimated that there are 8,613 SOUTHBOROUGH LANE SURGERY G84023 0.8 BROMLEY COMMON PRACTICE G84024 0.8 people with undiagnosed atrial FORGE CLOSE SURGERY G84030 0.8 WOODLANDS PRACTICE Y00542 0.8 fibrillation in NHS Bromley CCG SOUTH VIEW PARTNERSHIP G84001 0.7 DYSART SURGERY G84002 0.7 • GP practice range of observed to STOCK HILL SURGERY G84004 0.7 DERRY DOWNS SURGERY G84005 0.7 expected atrial fibrillation prevalence SUMMERCROFT SURGERY G84006 0.7 FAMILY SURGERY G84009 0.7 0.4 to 3 CHISLEHURST MEDICAL PRACTICE G84010 0.7 EDEN PARK SURGERY G84011 0.7 LONDON LANE CLINIC G84016 0.7 CHARTERHOUSE SURGERY G84021 0.7 ELM HOUSE SURGERY G84027 0.7 KNOLL MEDICAL PRACTICE G84032 0.7 BALLATER SURGERY G84040 0.7 GILLMANS ROAD SURGERY G84041 0.7 WICKHAM PARK SURGERY G84607 0.7 WHITEHOUSE SURGERY G84621 0.7 OAKFIELD SURGERY G84625 0.7 LINKS MEDICAL PRACTICE G84003 0.6 POVEREST MEDICAL CENTRE G84007 0.6 MANOR ROAD SURGERY G84008 0.6 ST MARY CRAY PRACTICE G84013 0.6 TRINITY MEDICAL CENTRE G84022 0.6 PARK GROUP PRACTICE G84025 0.6 ST JAMES' PRACTICE G84028 0.6 TUDOR WAY SURGERY G84035 0.6 BANK HOUSE SURGERY G84609 0.6 GREEN STREET GREEN MED CT G84627 0.6 CROSS HALL SURGERY G84628 0.6 ROBIN HOOD SURGERY G84029 0.5 PICKHURST SURGERY G84033 0.5 NORHEADS LANE SURGERY G84039 0.5 SUNDRIDGE MEDICAL CENTRE G84629 0.5 CATOR MEDICAL CENTRE Y02811 0.5 HIGHLAND ROAD SURGERY G84604 0.4 CRESCENT SURGERY G84630 0.4 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 Bromley CCG 76.7% • 4,897 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS Lambeth CCG 76.3% NHS Bromley CCG • 3,756 (76.7%) people treated with anti-coagulation therapy NHS Bexley CCG 75.8% • 513 (10.5%) people who are exceptions • 628 (12.8%) additional people with a NHS Southwark CCG 75.2% recorded CHA2DS2-VASc score >= 2 who are not treated
NHS Lewisham CCG 71.1%
NHS Greenwich CCG 70.4%
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 Chiltern CCG 84.9%
NHS Dartford, Gravesham and Swanley CCG 81.2%
NHS Surrey Downs CCG 81.0%
NHS South Gloucestershire CCG 79.7%
NHS Swindon CCG 78.9%
NHS Trafford CCG 77.6%
NHS North West Surrey CCG 77.1%
NHS Bromley CCG 76.7%
NHS Basildon and Brentwood CCG 76.6%
NHS Bexley CCG 75.8%
NHS Havering CCG 75.2%
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
OAKFIELD SURGERY G84625 9 TRINITY MEDICAL CENTRE G84022 25 CROSS HALL SURGERY G84628 10 SOUTHBOROUGH LANE SURGERY G84023 73 ANERLEY SURGERY G84624 5 LINKS MEDICAL PRACTICE G84003 34 • in total, including exceptions, there MANOR ROAD SURGERY G84008 19 CHISLEHURST MEDICAL PRACTICE G84010 77 are 1,141 people with a recorded PICKHURST SURGERY G84033 23 HIGHLAND ROAD SURGERY G84604 9 CHA2DS2-VASc score >= 2 who are LONDON LANE CLINIC G84016 56 not treated FORGE CLOSE SURGERY G84030 26 SUNDRIDGE MEDICAL CENTRE G84629 12 • GP practice range: 8.7% to 56.3% KNOLL MEDICAL PRACTICE G84032 44 ELM HOUSE SURGERY G84027 52 BALLATER SURGERY G84040 31 SOUTH VIEW PARTNERSHIP G84001 46 EDEN PARK SURGERY G84011 26 STATION ROAD SURGERY G84015 58 BROOMWOOD ROAD SURGERY G84019 40 ROBIN HOOD SURGERY G84029 13 WICKHAM PARK SURGERY G84607 19 CORNERWAYS SURGERY G84018 38 BANK HOUSE SURGERY G84609 11 BROMLEY COMMON PRACTICE G84024 30 ADDINGTON ROAD SURGERY G84017 40 TUDOR WAY SURGERY G84035 20 SUMMERCROFT SURGERY G84006 47 GREEN STREET GREEN MED CT G84627 20 WHITEHOUSE SURGERY G84621 12 NORHEADS LANE SURGERY G84039 5 DERRY DOWNS SURGERY G84005 19 FAMILY SURGERY G84009 16 STOCK HILL SURGERY G84004 34 GILLMANS ROAD SURGERY G84041 5 WOODLANDS PRACTICE Y00542 22 CHELSFIELD SURGERY G84020 25 CHARTERHOUSE SURGERY G84021 27 PARK GROUP PRACTICE G84025 1 POVEREST MEDICAL CENTRE G84007 17 DYSART SURGERY G84002 21 ST JAMES' PRACTICE G84028 15 CATOR MEDICAL CENTRE Y02811 4 ST MARY CRAY PRACTICE G84013 3 CRESCENT SURGERY G84630 2 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
10% 0% -10% -20% -30% -40% -50%
OAKFIELD SURGERY 7
TRINITY MEDICAL CENTRE 16
CROSS HALL SURGERY 6 • using the GP cluster method of ANERLEY SURGERY 3 calculating potential gains, if each SOUTHBOROUGH LANE SURGERY 36 practice was to achieve as well as the MANOR ROAD SURGERY 9 upper quartile of its national cluster, then an additional 355 people would LINKS MEDICAL PRACTICE 14 be treated PICKHURST SURGERY 10
HIGHLAND ROAD SURGERY 4
CHISLEHURST MEDICAL PRACTICE 31
CHELSFIELD SURGERY 4
STOCK HILL SURGERY 3
PARK GROUP PRACTICE 0
POVEREST MEDICAL CENTRE 1
CHARTERHOUSE SURGERY 0
ST JAMES' PRACTICE
DYSART SURGERY
CATOR MEDICAL CENTRE
ST MARY CRAY PRACTICE
CRESCENT SURGERY 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 Southwark CCG 86.4% • 5,094 people with a history of stroke or TIA* in NHS Bromley CCG NHS Bexley CCG 85.3% • 4,166 (81.8%) people whose blood pressure is <= 150 / 90 • 197 (3.9%) people who are NHS Lambeth CCG 85.2% exceptions • 731 (14.4%) additional people whose blood pressure is not <= 150 / 90 NHS Greenwich CCG 83.3%
NHS Bromley CCG 81.8%
NHS Lewisham CCG 80.8%
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 Chiltern CCG 86.1%
NHS Bexley CCG 85.3%
NHS Havering CCG 84.4%
NHS Trafford CCG 84.2%
NHS South Gloucestershire CCG 84.1%
NHS Swindon CCG 83.9%
NHS North West Surrey CCG 83.1%
NHS Dartford, Gravesham and Swanley CCG 82.3%
NHS Basildon and Brentwood CCG 81.9%
NHS Bromley CCG 81.8%
NHS Surrey Downs CCG 80.3%
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
MANOR ROAD SURGERY G84008 32 EDEN PARK SURGERY G84011 43 SOUTHBOROUGH LANE SURGERY G84023 75 WHITEHOUSE SURGERY G84621 13 ELM HOUSE SURGERY G84027 64 CHELSFIELD SURGERY G84020 30 • in total, including exceptions, there CHARTERHOUSE SURGERY G84021 36 DERRY DOWNS SURGERY G84005 28 are 928 people whose blood pressure BROOMWOOD ROAD SURGERY G84019 36 STOCK HILL SURGERY G84004 46 is not <= 150 / 90 PICKHURST SURGERY G84033 23 • GP practice range: 3.1% to 38.6% GREEN STREET GREEN MED CT G84627 15 KNOLL MEDICAL PRACTICE G84032 31 FAMILY SURGERY G84009 13 CATOR MEDICAL CENTRE Y02811 8 SOUTH VIEW PARTNERSHIP G84001 35 ADDINGTON ROAD SURGERY G84017 27 FORGE CLOSE SURGERY G84030 18 SUMMERCROFT SURGERY G84006 41 WICKHAM PARK SURGERY G84607 13 CORNERWAYS SURGERY G84018 21 TUDOR WAY SURGERY G84035 12 CHISLEHURST MEDICAL PRACTICE G84010 39 BALLATER SURGERY G84040 17 STATION ROAD SURGERY G84015 28 LINKS MEDICAL PRACTICE G84003 27 BROMLEY COMMON PRACTICE G84024 20 PARK GROUP PRACTICE G84025 9 LONDON LANE CLINIC G84016 30 TRINITY MEDICAL CENTRE G84022 11 NORHEADS LANE SURGERY G84039 4 POVEREST MEDICAL CENTRE G84007 16 ROBIN HOOD SURGERY G84029 8 OAKFIELD SURGERY G84625 4 CROSS HALL SURGERY G84628 4 ST MARY CRAY PRACTICE G84013 4 HIGHLAND ROAD SURGERY G84604 2 WOODLANDS PRACTICE Y00542 14 GILLMANS ROAD SURGERY G84041 2 ST JAMES' PRACTICE G84028 8 SUNDRIDGE MEDICAL CENTRE G84629 6 ANERLEY SURGERY G84624 1 DYSART SURGERY G84002 9 BANK HOUSE SURGERY G84609 4 CRESCENT SURGERY G84630 1 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 Bexley CCG 92.7% • 2,913 people with a stroke shown to be non-haemorrhagic* in NHS NHS Southwark CCG 92.5% Bromley CCG • 2,663 (91.4%) people who are taking an anti-platetet agent or anti- NHS Bromley CCG 91.4% coagulant • 155 (5.3%) people who are exceptions NHS Lewisham CCG 91.0% • 95 (3.3%) additional people with no treatment
NHS Greenwich CCG 90.9%
NHS Lambeth CCG 89.9%
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 Bexley CCG 92.7%
NHS Trafford CCG 92.4%
NHS South Gloucestershire CCG 92.4%
NHS North West Surrey CCG 92.3%
NHS Chiltern CCG 92.3%
NHS Dartford, Gravesham and Swanley CCG 91.8%
NHS Bromley CCG 91.4%
NHS Swindon CCG 91.2%
NHS Havering CCG 91.0%
NHS Basildon and Brentwood CCG 90.7%
NHS Surrey Downs CCG 89.9%
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
MANOR ROAD SURGERY G84008 16 EDEN PARK SURGERY G84011 17 HIGHLAND ROAD SURGERY G84604 1 SOUTHBOROUGH LANE SURGERY G84023 21 SUNDRIDGE MEDICAL CENTRE G84629 3 ADDINGTON ROAD SURGERY G84017 12 • in total, including exceptions, there WHITEHOUSE SURGERY G84621 4 SOUTH VIEW PARTNERSHIP G84001 13 are 250 people who are not taking an DERRY DOWNS SURGERY G84005 10 STATION ROAD SURGERY G84015 15 anti-platelet agent or anti-coagulant FORGE CLOSE SURGERY G84030 7 • GP practice range: 0.0% to 31.4% CHISLEHURST MEDICAL PRACTICE G84010 21 FAMILY SURGERY G84009 5 LONDON LANE CLINIC G84016 14 KNOLL MEDICAL PRACTICE G84032 9 BALLATER SURGERY G84040 5 STOCK HILL SURGERY G84004 9 ROBIN HOOD SURGERY G84029 2 ELM HOUSE SURGERY G84027 10 CRESCENT SURGERY G84630 1 NORHEADS LANE SURGERY G84039 1 GREEN STREET GREEN MED CT G84627 2 DYSART SURGERY G84002 4 LINKS MEDICAL PRACTICE G84003 6 SUMMERCROFT SURGERY G84006 7 CHARTERHOUSE SURGERY G84021 5 WOODLANDS PRACTICE Y00542 4 PICKHURST SURGERY G84033 3 CATOR MEDICAL CENTRE Y02811 1 WICKHAM PARK SURGERY G84607 3 POVEREST MEDICAL CENTRE G84007 4 CHELSFIELD SURGERY G84020 3 OAKFIELD SURGERY G84625 1 CORNERWAYS SURGERY G84018 3 TRINITY MEDICAL CENTRE G84022 2 PARK GROUP PRACTICE G84025 1 BROMLEY COMMON PRACTICE G84024 2 BROOMWOOD ROAD SURGERY G84019 2 ST JAMES' PRACTICE G84028 1 ST MARY CRAY PRACTICE G84013 TUDOR WAY SURGERY G84035 GILLMANS ROAD SURGERY G84041 BANK HOUSE SURGERY G84609 ANERLEY SURGERY G84624 CROSS HALL SURGERY G84628 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 Bexley CCG 0.84 • 0.67 ratio of observed to expected diabetes prevalence in NHS Bromley NHS Greenwich CCG 0.80 CCG, compared to 0.77 in England
NHS Bromley CCG 0.67 • this suggests 67% of people have been diagnosed
NHS Lewisham CCG 0.66
NHS Southwark CCG 0.65
NHS Lambeth CCG 0.58
Note: This slide compares the prevalence of Diabetes recorded in QOF in 2015/16 to the expected prevalence of Diabetes in 2016 taken England 0.77 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 Swindon CCG 0.94
NHS Bexley CCG 0.84
NHS Trafford CCG 0.79
NHS Dartford, Gravesham and Swanley CCG 0.78
NHS South Gloucestershire CCG 0.78
NHS North West Surrey CCG 0.75
NHS Basildon and Brentwood CCG 0.75
NHS Havering CCG 0.73
NHS Chiltern CCG 0.72
NHS Surrey Downs CCG 0.67
NHS Bromley CCG 0.67
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
44 CVD: Primary Care Intelligence Packs Diabetes prevalence by GP practice
GP practice CCG
DERRY DOWNS SURGERY G84005 8.0% ROBIN HOOD SURGERY G84029 7.6% KNOLL MEDICAL PRACTICE G84032 7.4% BROOMWOOD ROAD SURGERY G84019 7.3% ANERLEY SURGERY G84624 7.3% TRINITY MEDICAL CENTRE G84022 7.2% • GP practice range of observed POVEREST MEDICAL CENTRE G84007 6.9% CROSS HALL SURGERY G84628 6.8% diabetes 3.5% to 8.0% HIGHLAND ROAD SURGERY G84604 6.4% CRESCENT SURGERY G84630 6.4% • there are an estimated 7,462 people BANK HOUSE SURGERY G84609 6.2% ST MARY CRAY PRACTICE G84013 6.1% with undiagnosed diabetes in NHS SOUTHBOROUGH LANE SURGERY G84023 6.1% PICKHURST SURGERY G84033 6.1% Bromley CCG PARK GROUP PRACTICE G84025 6.0% SUNDRIDGE MEDICAL CENTRE G84629 5.9% LINKS MEDICAL PRACTICE G84003 5.9% SUMMERCROFT SURGERY G84006 5.9% WHITEHOUSE SURGERY G84621 5.9% CHARTERHOUSE SURGERY G84021 5.8% NORHEADS LANE SURGERY G84039 5.7% GILLMANS ROAD SURGERY G84041 5.6% WICKHAM PARK SURGERY G84607 5.5% OAKFIELD SURGERY G84625 5.5% STATION ROAD SURGERY G84015 5.5% GREEN STREET GREEN MED CT G84627 5.5% FAMILY SURGERY G84009 5.4% ST JAMES' PRACTICE G84028 5.4% WOODLANDS PRACTICE Y00542 5.4% TUDOR WAY SURGERY G84035 5.4% LONDON LANE CLINIC G84016 5.3% STOCK HILL SURGERY G84004 5.3% CHELSFIELD SURGERY G84020 5.3% ADDINGTON ROAD SURGERY G84017 5.2% CHISLEHURST MEDICAL PRACTICE G84010 4.8% BROMLEY COMMON PRACTICE G84024 4.8% EDEN PARK SURGERY G84011 4.7% BALLATER SURGERY G84040 4.6% DYSART SURGERY G84002 4.6% CORNERWAYS SURGERY G84018 4.6% SOUTH VIEW PARTNERSHIP G84001 4.4% ELM HOUSE SURGERY G84027 4.4% Note: The estimated number of undiagnosed FORGE CLOSE SURGERY G84030 4.2% MANOR ROAD SURGERY G84008 3.9% people with diabetes has been calculated by CATOR MEDICAL CENTRE Y02811 3.5% multiplying the estimated prevalence rate to the 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 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 NHS Lewisham CCG 6.4% 3.3% 11.1% diabetes in NHS Bromley CCG is 8.2% (diagnosed and undiagnosed) NHS Bexley CCG 6.9% 1.3% 11.5% • in addition, there are an estimated 11.4% of people in NHS Bromley NHS Bromley CCG 5.5% 2.7% 11.4% CCG who are at increased risk of developing diabetes (i.e. with non- diabetic hyperglycaemia) NHS Southwark CCG 5.9% 3.2% 10.2%
• this means that 19.7% of the NHS Lambeth CCG 5.3% 3.8% 9.7% population in NHS Bromley CCG are estimated to have diabetes, or at high risk of developing of diabetes NHS Greenwich CCG 6.7% 1.7% 10.3%
Note: Prevalence estimates of non-diabetic hyperglycaemia were developed using Health Survey for England (HSE) data. Five years of England 6.5% 1.9% 11.2% 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 Bexley CCG 49.5%
• data on care processes and treatment NHS Greenwich CCG 43.3% targets are taken from the National Diabetes Audit (NDA) • overall practice participation in the NHS Lambeth CCG 43.1% 2015/16 audit was 81.4% in England
• in NHS Bromley CCG, 42 out of 45 NHS Bromley CCG 41.2% practices (93.3%) participated in the NDA. Data is not available for the remaining practices NHS Southwark CCG 39.7%
• 41.2% of people with diabetes (of NHS Lewisham CCG 33.7% practices who participated in the audit) had the eight recommended care processes in NHS Bromley 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
ST MARY CRAY PRACTICE G84013 79.6% WOODLANDS PRACTICE Y00542 78.6% LONDON LANE CLINIC G84016 75.5% CHISLEHURST MEDICAL PRACTICE G84010 66.6% • achievement - 8 care processes: in CORNERWAYS SURGERY G84018 66.1% STATION ROAD SURGERY G84015 63.9% practices who provided data via the SUMMERCROFT SURGERY G84006 59.5% STOCK HILL SURGERY G84004 57.8% NDA, between 4.0% and 79.6% of BROOMWOOD ROAD SURGERY G84019 57.4% GILLMANS ROAD SURGERY G84041 57.4% patients received all 8 care processes WHITEHOUSE SURGERY G84621 51.9% KNOLL MEDICAL PRACTICE G84032 48.6% POVEREST MEDICAL CENTRE G84007 48.2% BROMLEY COMMON PRACTICE G84024 45.3% BANK HOUSE SURGERY G84609 43.9% • at least 8,044 people did not receive ST JAMES' PRACTICE G84028 42.5% CATOR MEDICAL CENTRE Y02811 41.2% the eight care processes TUDOR WAY SURGERY G84035 41.2% WICKHAM PARK SURGERY G84607 41.0% SUNDRIDGE MEDICAL CENTRE G84629 38.6% ELM HOUSE SURGERY G84027 36.6% FAMILY SURGERY G84009 36.2% CRESCENT SURGERY G84630 33.9% LINKS MEDICAL PRACTICE G84003 32.8% ADDINGTON ROAD SURGERY G84017 31.5% BALLATER SURGERY G84040 29.9% SOUTHBOROUGH LANE SURGERY G84023 29.1% ROBIN HOOD SURGERY G84029 28.8% PARK GROUP PRACTICE G84025 28.3% GREEN STREET GREEN MED CT G84627 27.7% CHARTERHOUSE SURGERY G84021 27.2% DYSART SURGERY G84002 26.5% FORGE CLOSE SURGERY G84030 25.2% CHELSFIELD SURGERY G84020 25.0% HIGHLAND ROAD SURGERY G84604 23.3% MANOR ROAD SURGERY G84008 16.3% NORHEADS LANE SURGERY G84039 12.3% SOUTH VIEW PARTNERSHIP G84001 11.6% OAKFIELD SURGERY G84625 8.3% TRINITY MEDICAL CENTRE G84022 6.5% DERRY DOWNS SURGERY G84005 6.0% CROSS HALL SURGERY G84628 4.0% ANERLEY SURGERY G84624 PICKHURST SURGERY G84033 EDEN PARK SURGERY G84011 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 Bexley CCG 45.9%
• 42.0% of people with diabetes (of NHS Bromley CCG 42.0% practices who participated in the audit) met the three treatment targets in NHS Bromley CCG, compared to 39.0% in England NHS Greenwich CCG 39.9%
NHS Southwark CCG 37.0%
NHS Lambeth CCG 35.7%
NHS Lewisham CCG 35.5%
England 39.0%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
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
ST MARY CRAY PRACTICE G84013 57.0% NORHEADS LANE SURGERY G84039 56.3% ROBIN HOOD SURGERY G84029 55.8% TRINITY MEDICAL CENTRE G84022 55.0% • achievement - 3 treatment targets: in BANK HOUSE SURGERY G84609 53.2% HIGHLAND ROAD SURGERY G84604 52.3% practices who provided data via the WHITEHOUSE SURGERY G84621 51.4% ADDINGTON ROAD SURGERY G84017 49.7% NDA, between 23.9% and 57.0% of BALLATER SURGERY G84040 49.0% TUDOR WAY SURGERY G84035 48.7% patients achieved all 3 treatment CHISLEHURST MEDICAL PRACTICE G84010 48.6% ST JAMES' PRACTICE G84028 47.0% targets DYSART SURGERY G84002 46.7% WICKHAM PARK SURGERY G84607 45.5% SUMMERCROFT SURGERY G84006 45.3% • at least 6,941 people did not meet the OAKFIELD SURGERY G84625 45.2% ELM HOUSE SURGERY G84027 45.1% three treatment targets CORNERWAYS SURGERY G84018 44.9% CHELSFIELD SURGERY G84020 44.6% BROMLEY COMMON PRACTICE G84024 44.4% STATION ROAD SURGERY G84015 43.8% STOCK HILL SURGERY G84004 43.8% KNOLL MEDICAL PRACTICE G84032 43.6% MANOR ROAD SURGERY G84008 42.7% LONDON LANE CLINIC G84016 41.6% FORGE CLOSE SURGERY G84030 41.0% WOODLANDS PRACTICE Y00542 39.7% DERRY DOWNS SURGERY G84005 38.2% CHARTERHOUSE SURGERY G84021 37.9% PARK GROUP PRACTICE G84025 37.2% CROSS HALL SURGERY G84628 36.3% SOUTH VIEW PARTNERSHIP G84001 36.2% GILLMANS ROAD SURGERY G84041 36.2% SUNDRIDGE MEDICAL CENTRE G84629 36.0% FAMILY SURGERY G84009 35.7% BROOMWOOD ROAD SURGERY G84019 35.3% LINKS MEDICAL PRACTICE G84003 35.3% CRESCENT SURGERY G84630 30.4% GREEN STREET GREEN MED CT G84627 29.4% POVEREST MEDICAL CENTRE G84007 29.2% SOUTHBOROUGH LANE SURGERY G84023 28.7% CATOR MEDICAL CENTRE Y02811 23.9% ANERLEY SURGERY G84624 PICKHURST SURGERY G84033 EDEN PARK SURGERY G84011 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
15% 10% 5% 0% -5% -10% -15% -20% -25%
CATOR MEDICAL CENTRE 41
POVEREST MEDICAL CENTRE 65
GREEN STREET GREEN MED CT 43 • using the GP cluster method of SOUTHBOROUGH LANE SURGERY 62 calculating potential gains, if each CRESCENT SURGERY 18 practice was to achieve as well as the BROOMWOOD ROAD SURGERY 48 upper quartile of its national cluster, then an additional 521 people would SUNDRIDGE MEDICAL CENTRE 20 be treated FAMILY SURGERY 15
DERRY DOWNS SURGERY 28
SOUTH VIEW PARTNERSHIP 30
BALLATER SURGERY
ADDINGTON ROAD SURGERY
CHISLEHURST MEDICAL PRACTICE
WHITEHOUSE SURGERY
HIGHLAND ROAD SURGERY
BANK HOUSE SURGERY
ROBIN HOOD SURGERY
TRINITY MEDICAL CENTRE
ST MARY CRAY PRACTICE
NORHEADS LANE SURGERY 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 Greenwich CCG 0.67
NHS Southwark CCG 0.61 • the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney NHS Lambeth CCG 0.55 disease is 0.55. This compares to 0.68 for England • this suggests that 55% of people with NHS Bromley CCG 0.55 chronic kidney disease have been diagnosed
NHS Bexley CCG 0.55
NHS Lewisham CCG 0.49
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 Southampton in 2011. A small number of CCGs have a ratio greater than 1. It is unlikely that all England 0.68 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 Basildon and Brentwood CCG 0.89
NHS South Gloucestershire CCG 0.86
NHS Dartford, Gravesham and Swanley CCG 0.84
NHS Trafford CCG 0.68
NHS North West Surrey CCG 0.56
NHS Swindon CCG 0.56
NHS Bromley CCG 0.55
NHS Surrey Downs CCG 0.55
NHS Bexley CCG 0.55
NHS Chiltern CCG 0.51
NHS Havering CCG 0.48
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio
55 CVD: Primary Care Intelligence Packs CKD prevalence by GP practice, 2015/16
GP practice CCG
KNOLL MEDICAL PRACTICE G84032 7.7% WHITEHOUSE SURGERY G84621 6.6% SOUTHBOROUGH LANE SURGERY G84023 6.5% SUMMERCROFT SURGERY G84006 6.5% BROMLEY COMMON PRACTICE G84024 5.9% BROOMWOOD ROAD SURGERY G84019 5.3% • it is estimated that there are 7,724 WOODLANDS PRACTICE Y00542 5.3% CHELSFIELD SURGERY G84020 5.1% people with undiagnosed chronic BANK HOUSE SURGERY G84609 5.0% STOCK HILL SURGERY G84004 5.0% kidney disease in NHS Bromley CCG FAMILY SURGERY G84009 4.7% FORGE CLOSE SURGERY G84030 4.7% • GP practice range of observed CKD: NORHEADS LANE SURGERY G84039 4.6% 1.1% to 7.7% BALLATER SURGERY G84040 4.2% DYSART SURGERY G84002 4.0% ADDINGTON ROAD SURGERY G84017 3.9% CORNERWAYS SURGERY G84018 3.7% POVEREST MEDICAL CENTRE G84007 3.6% CHISLEHURST MEDICAL PRACTICE G84010 3.6% CHARTERHOUSE SURGERY G84021 3.5% DERRY DOWNS SURGERY G84005 3.5% ELM HOUSE SURGERY G84027 3.2% ST MARY CRAY PRACTICE G84013 3.1% TRINITY MEDICAL CENTRE G84022 3.1% CRESCENT SURGERY G84630 3.0% LINKS MEDICAL PRACTICE G84003 3.0% PICKHURST SURGERY G84033 2.9% GILLMANS ROAD SURGERY G84041 2.8% WICKHAM PARK SURGERY G84607 2.8% HIGHLAND ROAD SURGERY G84604 2.6% LONDON LANE CLINIC G84016 2.6% SOUTH VIEW PARTNERSHIP G84001 2.4% TUDOR WAY SURGERY G84035 2.4% ROBIN HOOD SURGERY G84029 2.2% CROSS HALL SURGERY G84628 2.1% STATION ROAD SURGERY G84015 2.0% SUNDRIDGE MEDICAL CENTRE G84629 2.0% OAKFIELD SURGERY G84625 1.7% MANOR ROAD SURGERY G84008 1.6% EDEN PARK SURGERY G84011 1.4% Note: CCG estimates for the estimated CATOR MEDICAL CENTRE Y02811 1.4% number of people with CKD are based on ST JAMES' PRACTICE G84028 1.3% ANERLEY SURGERY G84624 1.3% applying a proportion from a resident based PARK GROUP PRACTICE G84025 1.1% population estimate to a GP registered GREEN STREET GREEN MED CT G84627 1.1% population. The characteristics of registered 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 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 Bexley CCG 77.8% • 9,733 people with CKD (diagnosed*) in NHS Bromley CCG NHS Greenwich CCG 76.7% • 6,887 (70.8%) people whose blood pressure is <= 140 /85 • 657 (6.8%) people who are NHS Southwark CCG 75.2% exceptions • 2,189 (22.5%) additional people whose blood pressure is not <= 140 / NHS Lambeth CCG 74.6% 85
NHS Lewisham CCG 74.0%
NHS Bromley CCG 70.8%
*Using the QOF clinical indicator CKD002 England 74.4% 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 Havering CCG 77.8%
NHS Bexley CCG 77.8%
NHS North West Surrey CCG 77.7%
NHS South Gloucestershire CCG 76.6%
NHS Swindon CCG 76.3%
NHS Trafford CCG 76.2%
NHS Chiltern CCG 75.9%
NHS Dartford, Gravesham and Swanley CCG 73.5%
NHS Basildon and Brentwood CCG 73.3%
NHS Surrey Downs CCG 71.9%
NHS Bromley CCG 70.8%
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
SOUTHBOROUGH LANE SURGERY G84023 279 THE PARK GROUP PRACTICE G84025 32 EDEN PARK SURGERY G84011 39 WHITEHOUSE SURGERY G84621 72 CATOR MEDICAL CENTRE Y02811 29 CRESCENT SURGERY G84630 23 • in total, including exceptions, there ELM HOUSE SURGERY G84027 180 CHARTERHOUSE SURGERY G84021 91 are 2,846 people whose blood PICKHURST SURGERY G84033 60 GREEN ST GREEN MEDICAL CENTRE G84627 20 pressure is not <= 140 / 85 POVEREST MEDICAL CENTRE G84007 92 • GP practice range: 6.9% to 50.0% TRINITY MEDICAL CENTRE G84022 45 THE WOODLANDS PRACTICE Y00542 134 CHELSFIELD SURGERY G84020 108 BROOMWOOD SURGERY G84019 133 STOCK HILL SURGERY G84004 132 MANOR ROAD SURGERY G84008 24 FAMILY SURGERY G84009 48 STATION ROAD SURGERY G84015 68 DERRY DOWNS SURGERY G84005 42 THE SURGERY FORGE CLOSE G84030 67 SUMMERCROFT SURGERY G84006 178 BROMLEY COMMON PRACTICE G84024 112 KNOLL MEDICAL PRACTICE G84032 147 GILLMANS ROAD SURGERY G84041 14 THE CHISLEHURST MEDICAL PRACTICE G84010 106 THE LONDON LANE CLINIC G84016 76 LINKS MEDICAL PRACTICE G84003 53 ADDINGTON ROAD SURGERY G84017 66 SOUTH VIEW LODGE G84001 48 DYSART SURGERY G84002 74 10 HIGHLAND ROAD G84604 17 THE ROBIN HOOD SURGERY G84029 18 TUDOR WAY SURGERY G84035 26 CORNERWAYS SURGERY G84018 49 OAKFIELD SURGERY G84625 10 BALLATER G84040 51 WICKHAM PARK SURGERY G84607 18 CROSS HALL SURGERY G84628 9 BANK HOUSE G84609 18 14A NORHEADS LANE G84039 15 SUNDRIDGE MEDICAL CENTRE G84629 11 224 ANERLEY ROAD G84624 3 ST MARY CRAY PRACTICE G84013 4 ST JAMES' PRACTICE G84028 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%
THE PARK GROUP PRACTICE 21
SOUTHBOROUGH LANE SURGERY 159
EDEN PARK SURGERY 25 • using the GP cluster method of CATOR MEDICAL CENTRE 18 calculating potential gains, if each WHITEHOUSE SURGERY 39 practice was to achieve as well as the CRESCENT SURGERY 12 upper quartile of its national cluster, then an additional 998 people would POVEREST MEDICAL CENTRE 47 be treated TRINITY MEDICAL CENTRE 23
THE WOODLANDS PRACTICE 67
PICKHURST SURGERY 28
DYSART SURGERY 5
TUDOR WAY SURGERY 1
WICKHAM PARK SURGERY
14A NORHEADS LANE
SUNDRIDGE MEDICAL CENTRE
CORNERWAYS SURGERY
BANK HOUSE
224 ANERLEY ROAD
ST MARY CRAY PRACTICE
ST JAMES' PRACTICE 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 Southwark CCG 77.2% • 9,707 people with CKD (diagnosed*) in NHS Bromley CCG NHS Lambeth CCG 76.4% • 6,742 (69.5%) people who have a record of urine albumin:creatinine ratio test NHS Bexley CCG 76.0% • 387 (4%) people who are exceptions • 2,578 (26.6%) additional people who have no record of urine NHS Lewisham CCG 74.9% albumin:creatinine ratio test
NHS Greenwich CCG 70.6%
NHS Bromley CCG 69.5%
*Using the QOF clinical indicator CKD004 England 75.4% 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 South Gloucestershire CCG 80.2%
NHS Trafford CCG 78.2%
NHS Bexley CCG 76.0%
NHS Swindon CCG 75.3%
NHS North West Surrey CCG 74.6%
NHS Chiltern CCG 73.9%
NHS Havering CCG 70.4%
NHS Bromley CCG 69.5%
NHS Basildon and Brentwood CCG 67.5%
NHS Dartford, Gravesham and Swanley CCG 66.9%
NHS Surrey Downs CCG 66.6%
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
STATION ROAD SURGERY G84015 163 CHARTERHOUSE SURGERY G84021 165 10 HIGHLAND ROAD G84604 45 SOUTHBOROUGH LANE SURGERY G84023 269 TUDOR WAY SURGERY G84035 65 STOCK HILL SURGERY G84004 176 • in total, including exceptions, there CHELSFIELD SURGERY G84020 130 THE CHISLEHURST MEDICAL PRACTICE G84010 165 are 2,965 people who have no record EDEN PARK SURGERY G84011 32 FAMILY SURGERY G84009 57 of urine albumin:creatinine ratio test BROMLEY COMMON PRACTICE G84024 133 • GP practice range: 10.2% to 73.4% GILLMANS ROAD SURGERY G84041 18 OAKFIELD SURGERY G84625 18 WHITEHOUSE SURGERY G84621 57 SUNDRIDGE MEDICAL CENTRE G84629 25 DYSART SURGERY G84002 105 ADDINGTON ROAD SURGERY G84017 91 ST JAMES' PRACTICE G84028 22 THE PARK GROUP PRACTICE G84025 21 DERRY DOWNS SURGERY G84005 44 KNOLL MEDICAL PRACTICE G84032 153 PICKHURST SURGERY G84033 50 WICKHAM PARK SURGERY G84607 29 ELM HOUSE SURGERY G84027 134 CATOR MEDICAL CENTRE Y02811 20 SOUTH VIEW LODGE G84001 54 224 ANERLEY ROAD G84624 7 POVEREST MEDICAL CENTRE G84007 73 BALLATER G84040 71 MANOR ROAD SURGERY G84008 18 LINKS MEDICAL PRACTICE G84003 52 THE LONDON LANE CLINIC G84016 65 CROSS HALL SURGERY G84628 11 14A NORHEADS LANE G84039 22 THE ROBIN HOOD SURGERY G84029 19 CRESCENT SURGERY G84630 12 THE WOODLANDS PRACTICE Y00542 73 THE SURGERY FORGE CLOSE G84030 42 BROOMWOOD SURGERY G84019 73 GREEN ST GREEN MEDICAL CENTRE G84627 10 CORNERWAYS SURGERY G84018 42 SUMMERCROFT SURGERY G84006 97 TRINITY MEDICAL CENTRE G84022 18 ST MARY CRAY PRACTICE G84013 7 BANK HOUSE G84609 12 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 Bexley CCG 0.77%
• prevalence of 0.66% in NHS Bromley NHS Bromley CCG 0.66% CCG compared to 0.76% in England
NHS Greenwich CCG 0.61%
NHS Lewisham CCG 0.47%
NHS Southwark CCG 0.46%
NHS Lambeth CCG 0.41%
England 0.76%
0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9%
66 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with demographically similar CCGs
NHS Trafford CCG 0.87%
NHS Basildon and Brentwood CCG 0.77%
NHS Bexley CCG 0.77%
NHS South Gloucestershire CCG 0.70%
NHS Bromley CCG 0.66%
NHS Swindon CCG 0.61%
NHS Havering CCG 0.59%
NHS Dartford, Gravesham and Swanley CCG 0.58%
NHS Chiltern CCG 0.56%
NHS North West Surrey CCG 0.53%
NHS Surrey Downs CCG 0.52%
0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9% 1.0%
67 CVD: Primary Care Intelligence Packs Heart failure prevalence by GP practice
GP practice CCG
WHITEHOUSE SURGERY G84621 1.1% BANK HOUSE SURGERY G84609 1.1% BROMLEY COMMON PRACTICE G84024 1.0% BROOMWOOD ROAD SURGERY G84019 1.0% KNOLL MEDICAL PRACTICE G84032 0.9% SOUTHBOROUGH LANE SURGERY G84023 0.9% • 2,251 people with diagnosed heart WICKHAM PARK SURGERY G84607 0.9% SUMMERCROFT SURGERY G84006 0.9% failure in NHS Bromley CCG TUDOR WAY SURGERY G84035 0.8% LONDON LANE CLINIC G84016 0.8% • GP practice range: 0.2% to 1.1% TRINITY MEDICAL CENTRE G84022 0.8% STOCK HILL SURGERY G84004 0.8% ST MARY CRAY PRACTICE G84013 0.7% ROBIN HOOD SURGERY G84029 0.7% PICKHURST SURGERY G84033 0.7% LINKS MEDICAL PRACTICE G84003 0.7% HIGHLAND ROAD SURGERY G84604 0.7% CHARTERHOUSE SURGERY G84021 0.7% POVEREST MEDICAL CENTRE G84007 0.7% WOODLANDS PRACTICE Y00542 0.7% DERRY DOWNS SURGERY G84005 0.7% ADDINGTON ROAD SURGERY G84017 0.7% CHISLEHURST MEDICAL PRACTICE G84010 0.7% CORNERWAYS SURGERY G84018 0.7% CROSS HALL SURGERY G84628 0.6% FAMILY SURGERY G84009 0.6% CHELSFIELD SURGERY G84020 0.6% DYSART SURGERY G84002 0.6% FORGE CLOSE SURGERY G84030 0.6% STATION ROAD SURGERY G84015 0.6% NORHEADS LANE SURGERY G84039 0.6% ELM HOUSE SURGERY G84027 0.5% OAKFIELD SURGERY G84625 0.5% ST JAMES' PRACTICE G84028 0.5% CRESCENT SURGERY G84630 0.5% SUNDRIDGE MEDICAL CENTRE G84629 0.5% SOUTH VIEW PARTNERSHIP G84001 0.5% EDEN PARK SURGERY G84011 0.4% BALLATER SURGERY G84040 0.4% GILLMANS ROAD SURGERY G84041 0.4% PARK GROUP PRACTICE G84025 0.4% MANOR ROAD SURGERY G84008 0.4% GREEN STREET GREEN MED CT G84627 0.3% ANERLEY SURGERY G84624 0.2% CATOR MEDICAL CENTRE Y02811 0.2% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%
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 Lewisham CCG 92.0% • 786 people with heart failure* with LVSD in NHS Bromley CCG NHS Bromley CCG 90.7% • 713 (90.7%) people treated with ACE- I or ARB • 70 (8.9%) people who are exceptions NHS Greenwich CCG 89.4% • 3 (0.4%) additional people who are not treated with ACE-I or ARB
NHS Bexley CCG 87.7%
NHS Southwark CCG 87.6%
NHS Lambeth CCG 86.6%
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 Bromley CCG 90.7%
NHS Havering CCG 88.9%
NHS Bexley CCG 87.7%
NHS Chiltern CCG 87.7%
NHS Basildon and Brentwood CCG 86.9%
NHS Swindon CCG 85.3%
NHS South Gloucestershire CCG 85.3%
NHS North West Surrey CCG 84.9%
NHS Trafford CCG 84.8%
NHS Dartford, Gravesham and Swanley CCG 84.6%
NHS Surrey Downs CCG 82.1%
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
SUNDRIDGE MEDICAL CENTRE G84629 1 POVEREST MEDICAL CENTRE G84007 5 ADDINGTON ROAD SURGERY G84017 7 PARK GROUP PRACTICE G84025 2 CHISLEHURST MEDICAL PRACTICE G84010 3 FORGE CLOSE SURGERY G84030 1 • in total, including exceptions, there BANK HOUSE SURGERY G84609 1 CATOR MEDICAL CENTRE Y02811 1 are 73 people who are not treated SOUTHBOROUGH LANE SURGERY G84023 3 WICKHAM PARK SURGERY G84607 3 with ACE-I or ARB WOODLANDS PRACTICE Y00542 6 • GP practice range: 0.0% to 33.3% MANOR ROAD SURGERY G84008 1 KNOLL MEDICAL PRACTICE G84032 2 CORNERWAYS SURGERY G84018 5 CHELSFIELD SURGERY G84020 3 DERRY DOWNS SURGERY G84005 2 ROBIN HOOD SURGERY G84029 1 LINKS MEDICAL PRACTICE G84003 3 SUMMERCROFT SURGERY G84006 2 SOUTH VIEW PARTNERSHIP G84001 2 TUDOR WAY SURGERY G84035 1 STATION ROAD SURGERY G84015 4 BALLATER SURGERY G84040 1 STOCK HILL SURGERY G84004 4 BROMLEY COMMON PRACTICE G84024 3 ELM HOUSE SURGERY G84027 2 DYSART SURGERY G84002 1 WHITEHOUSE SURGERY G84621 1 LONDON LANE CLINIC G84016 2 FAMILY SURGERY G84009 EDEN PARK SURGERY G84011 ST MARY CRAY PRACTICE G84013 BROOMWOOD ROAD SURGERY G84019 CHARTERHOUSE SURGERY G84021 TRINITY MEDICAL CENTRE G84022 ST JAMES' PRACTICE G84028 PICKHURST SURGERY G84033 NORHEADS LANE SURGERY G84039 GILLMANS ROAD SURGERY G84041 HIGHLAND ROAD SURGERY G84604 ANERLEY SURGERY G84624 OAKFIELD SURGERY G84625 GREEN STREET GREEN MED CT G84627 CROSS HALL SURGERY G84628 CRESCENT SURGERY G84630 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 Lewisham CCG 88.8% • 712 people with heart failure* with LVSD treated with ACE-I/ARB in NHS NHS Southwark CCG 88.7% Bromley CCG • 626 (87.9%) people treated with ACE- I/ARB and BB NHS Bromley CCG 87.9% • 65 (9.1%) people who are exceptions • 21 (2.9%) additional people who are not treated with ACE-I/ARB and BB NHS Lambeth CCG 86.5%
NHS Greenwich CCG 82.0%
NHS Bexley CCG 81.3%
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 Bromley CCG 87.9%
NHS Trafford CCG 83.0%
NHS Dartford, Gravesham and Swanley CCG 83.0%
NHS North West Surrey CCG 82.9%
NHS Basildon and Brentwood CCG 82.3%
NHS South Gloucestershire CCG 81.3%
NHS Bexley CCG 81.3%
NHS Havering CCG 81.1%
NHS Chiltern CCG 77.3%
NHS Swindon CCG 71.2%
NHS Surrey Downs CCG 71.2%
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
DERRY DOWNS SURGERY G84005 5 CHELSFIELD SURGERY G84020 7 BALLATER SURGERY G84040 4 TUDOR WAY SURGERY G84035 3 WHITEHOUSE SURGERY G84621 7 KNOLL MEDICAL PRACTICE G84032 3 • in total, including exceptions, there CATOR MEDICAL CENTRE Y02811 1 WICKHAM PARK SURGERY G84607 4 are 86 people who are not treated SOUTH VIEW PARTNERSHIP G84001 4 PICKHURST SURGERY G84033 2 with ACE-I or ARB DYSART SURGERY G84002 3 • GP practice range: 0.0% to 38.5% LINKS MEDICAL PRACTICE G84003 4 MANOR ROAD SURGERY G84008 1 CHISLEHURST MEDICAL PRACTICE G84010 2 NORHEADS LANE SURGERY G84039 1 CORNERWAYS SURGERY G84018 5 FAMILY SURGERY G84009 3 OAKFIELD SURGERY G84625 1 ST MARY CRAY PRACTICE G84013 1 HIGHLAND ROAD SURGERY G84604 1 CHARTERHOUSE SURGERY G84021 3 BROMLEY COMMON PRACTICE G84024 4 WOODLANDS PRACTICE Y00542 3 POVEREST MEDICAL CENTRE G84007 1 SOUTHBOROUGH LANE SURGERY G84023 1 ELM HOUSE SURGERY G84027 2 STATION ROAD SURGERY G84015 3 STOCK HILL SURGERY G84004 3 SUMMERCROFT SURGERY G84006 1 ADDINGTON ROAD SURGERY G84017 1 LONDON LANE CLINIC G84016 2 EDEN PARK SURGERY G84011 BROOMWOOD ROAD SURGERY G84019 TRINITY MEDICAL CENTRE G84022 PARK GROUP PRACTICE G84025 ST JAMES' PRACTICE G84028 ROBIN HOOD SURGERY G84029 FORGE CLOSE SURGERY G84030 GILLMANS ROAD SURGERY G84041 BANK HOUSE SURGERY G84609 ANERLEY SURGERY G84624 GREEN STREET GREEN MED CT G84627 CROSS HALL SURGERY G84628 SUNDRIDGE MEDICAL CENTRE G84629 CRESCENT SURGERY G84630 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 Southwark CCG 90.7% • 9,845 people with coronary heart disease* in NHS Bromley CCG NHS Bexley CCG 90.0% • 8,600 (87.4%) people whose blood pressure <= 150 / 90 • 298 (3%) people who are exceptions NHS Lambeth CCG 89.0% • 947 (9.6%) additional people whose blood pressure is not <= 150 / 90
NHS Bromley CCG 87.4%
NHS Greenwich CCG 86.8%
NHS Lewisham CCG 86.2%
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 Bexley CCG 90.0%
NHS Chiltern CCG 90.0%
NHS Dartford, Gravesham and Swanley CCG 89.1%
NHS Havering CCG 88.6%
NHS North West Surrey CCG 88.5%
NHS Trafford CCG 88.4%
NHS Swindon CCG 88.0%
NHS South Gloucestershire CCG 87.8%
NHS Bromley CCG 87.4%
NHS Basildon and Brentwood CCG 86.9%
NHS Surrey Downs CCG 84.8%
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
MANOR ROAD SURGERY G84008 32 SOUTHBOROUGH LANE SURGERY G84023 92 EDEN PARK SURGERY G84011 50 CHARTERHOUSE SURGERY G84021 65 ADDINGTON ROAD SURGERY G84017 60 CATOR MEDICAL CENTRE Y02811 18 • in total, including exceptions, there FORGE CLOSE SURGERY G84030 33 GREEN STREET GREEN MED CT G84627 40 are 1,245 people whose blood STOCK HILL SURGERY G84004 66 SOUTH VIEW PARTNERSHIP G84001 56 pressure is not <= 150 / 90 ELM HOUSE SURGERY G84027 63 • GP practice range: 0.0% to 27.1% WHITEHOUSE SURGERY G84621 14 PICKHURST SURGERY G84033 35 CHELSFIELD SURGERY G84020 34 KNOLL MEDICAL PRACTICE G84032 39 BROOMWOOD ROAD SURGERY G84019 49 SUMMERCROFT SURGERY G84006 56 DERRY DOWNS SURGERY G84005 27 HIGHLAND ROAD SURGERY G84604 12 LINKS MEDICAL PRACTICE G84003 38 TUDOR WAY SURGERY G84035 24 WOODLANDS PRACTICE Y00542 25 WICKHAM PARK SURGERY G84607 15 CHISLEHURST MEDICAL PRACTICE G84010 46 POVEREST MEDICAL CENTRE G84007 24 PARK GROUP PRACTICE G84025 11 LONDON LANE CLINIC G84016 37 TRINITY MEDICAL CENTRE G84022 11 OAKFIELD SURGERY G84625 5 BROMLEY COMMON PRACTICE G84024 23 GILLMANS ROAD SURGERY G84041 5 FAMILY SURGERY G84009 12 DYSART SURGERY G84002 18 BANK HOUSE SURGERY G84609 7 NORHEADS LANE SURGERY G84039 5 STATION ROAD SURGERY G84015 27 ROBIN HOOD SURGERY G84029 12 ST JAMES' PRACTICE G84028 15 SUNDRIDGE MEDICAL CENTRE G84629 9 CROSS HALL SURGERY G84628 3 BALLATER SURGERY G84040 13 ST MARY CRAY PRACTICE G84013 4 CRESCENT SURGERY G84630 4 CORNERWAYS SURGERY G84018 11 ANERLEY SURGERY G84624 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%
MANOR ROAD SURGERY 24
EDEN PARK SURGERY 37
SOUTHBOROUGH LANE SURGERY 60 • using the GP cluster method of CATOR MEDICAL CENTRE 12 calculating potential gains, if each ADDINGTON ROAD SURGERY 38 practice was to achieve as well as the CHARTERHOUSE SURGERY 38 upper quartile of its national cluster, then an additional 523 people would FORGE CLOSE SURGERY 20 be treated GREEN STREET GREEN MED CT 24
STOCK HILL SURGERY 33
SOUTH VIEW PARTNERSHIP 28
ROBIN HOOD SURGERY
ST JAMES' PRACTICE
CROSS HALL SURGERY
BALLATER SURGERY
DYSART SURGERY
STATION ROAD SURGERY
ST MARY CRAY PRACTICE
CRESCENT SURGERY
CORNERWAYS SURGERY
ANERLEY SURGERY 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 Bromley CCG 93.0% • 9,846 people with coronary heart disease* in NHS Bromley CCG NHS Southwark CCG 92.6% • 9,158 (93%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant NHS Bexley CCG 92.2% • 323 (3.3%) people who are exceptions • 365 (3.7%) additional people who are NHS Lewisham CCG 91.9% not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant
NHS Greenwich CCG 91.4%
NHS Lambeth CCG 90.8%
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 Chiltern CCG 93.1%
NHS Bromley CCG 93.0%
NHS North West Surrey CCG 92.9%
NHS South Gloucestershire CCG 92.8%
NHS Dartford, Gravesham and Swanley CCG 92.7%
NHS Trafford CCG 92.6%
NHS Havering CCG 92.5%
NHS Bexley CCG 92.2%
NHS Swindon CCG 90.9%
NHS Surrey Downs CCG 90.8%
NHS Basildon and Brentwood CCG 90.3%
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
MANOR ROAD SURGERY G84008 19 OAKFIELD SURGERY G84625 9 EDEN PARK SURGERY G84011 28 SOUTHBOROUGH LANE SURGERY G84023 45 PICKHURST SURGERY G84033 28 ADDINGTON ROAD SURGERY G84017 37 • in total, including exceptions, there FORGE CLOSE SURGERY G84030 20 HIGHLAND ROAD SURGERY G84604 11 are 688 people are not taking aspirin, KNOLL MEDICAL PRACTICE G84032 31 WICKHAM PARK SURGERY G84607 15 an alternative anti-platelet therapy, or TUDOR WAY SURGERY G84035 19 an anti-coagulant PARK GROUP PRACTICE G84025 11 SOUTH VIEW PARTNERSHIP G84001 29 • GP practice range: 1.0% to 16.1% LINKS MEDICAL PRACTICE G84003 25 CATOR MEDICAL CENTRE Y02811 7 CHISLEHURST MEDICAL PRACTICE G84010 35 CHELSFIELD SURGERY G84020 17 POVEREST MEDICAL CENTRE G84007 18 BALLATER SURGERY G84040 16 GREEN STREET GREEN MED CT G84627 15 ROBIN HOOD SURGERY G84029 12 WHITEHOUSE SURGERY G84621 6 BROMLEY COMMON PRACTICE G84024 17 STOCK HILL SURGERY G84004 23 SUMMERCROFT SURGERY G84006 25 ELM HOUSE SURGERY G84027 22 ST JAMES' PRACTICE G84028 13 DYSART SURGERY G84002 14 TRINITY MEDICAL CENTRE G84022 7 LONDON LANE CLINIC G84016 23 DERRY DOWNS SURGERY G84005 10 CHARTERHOUSE SURGERY G84021 15 CRESCENT SURGERY G84630 4 CROSS HALL SURGERY G84628 2 FAMILY SURGERY G84009 6 CORNERWAYS SURGERY G84018 10 ST MARY CRAY PRACTICE G84013 3 STATION ROAD SURGERY G84015 15 WOODLANDS PRACTICE Y00542 9 GILLMANS ROAD SURGERY G84041 2 NORHEADS LANE SURGERY G84039 2 ANERLEY SURGERY G84624 1 SUNDRIDGE MEDICAL CENTRE G84629 3 BROOMWOOD ROAD SURGERY G84019 8 BANK HOUSE SURGERY G84609 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 Bromley CCG England 800
700 • in NHS Bromley CCG, the hospital admission rate for coronary heart disease in 2015/16 was 482.2 (1,418) 600 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 Bromley CCG England 200
180 • in NHS Bromley CCG, the hospital admission rate for stroke in 2015/16 160 was 138.6 (422) compared to 172.8 for England 140
120
100
80
60 Age standardised standardised Age (per rate 100,000)
40
20
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 Bromley CCG England
117.0% Angina 136.8% • The risk of a stroke was 86.8% higher and the risk of a heart attack was 118.5% 118.5% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 157.5% higher. 129.7% Heart failure 150.0%
86.8% Stroke 81.3%
157.5% Major amputation 445.8%
901.6% Minor amputation 753.5%
262.6% RRT 293.0%
0% 100% 200% 300% 400% 500% 600% 700% 800% 900% 1000% 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 Bromley CCG England 90
80 • in NHS Bromley CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 32.1, 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 Bromley CCG England 30
• in NHS Bromley CCG, the early 25 mortality rate for stroke in 2013-15 was 10.7, 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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