CVD: Primary Care Intelligence Packs NHS Dorset 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 Dorset CCG are: NHS Kernow CCG NHS Coastal West Sussex CCG NHS Somerset CCG NHS Northern, Eastern and Western Devon CCG NHS Gloucestershire CCG NHS West Hampshire CCG NHS Cumbria CCG NHS Cambridgeshire and Peterborough CCG NHS Wiltshire CCG NHS Southern Derbyshire CCG

The majority of data used in the packs is taken from the 2015/16 Quality and Outcomes Framework (QOF). Where this is not the case, this is indicated in the slide. All GP practices that were included in the 2015/16 QOF are included. Full source data are shown in the appendix.

For the majority of indicators, the additional number of people that would be treated if all practices were to achieve as well as the average of the top achieving practices is calculated. This is calculated by taking an average of the intervention rates (ie the denominator includes exceptions) for the best 50% of practices in the CCG and applying this rate to all practices in the CCG. Note, this number is not intended to be proof of a realisable improvement; rather it gives an indication of the magnitude of available opportunity.

6 CVD: Primary Care Intelligence Packs Why does variation matter?

A key observation about benchmarking data is The variation that exists between that it does not tell us why there is variation. Some of the demographically similar CCGs and variation may be explained by population or case mix and some may be unwarranted. We will not know unless we between practices illustrates the local investigate. potential to improve care and outcomes for our patients Benchmarking may not be conclusive. Its strength lies not in the answers it provides but in the questions it generates for CCGs and practices. Benchmarking is helpful because it highlights variation. For example: 1. How much variation is there in detection, management, Of course it has long been acknowledged that some exception reporting and outcomes? variation is inevitable in the healthcare and outcomes 2. How many people would benefit if average performers experienced by patients. improved to the level of the best performers? But John Wennberg, who has championed research 3. How many people would benefit if the lowest performers into clinical variation over four decades and who matched the achievement of the average? founded the pioneering Dartmouth Atlas of Health 4. What are better performers doing differently in the way Care, concluded that much variation is unwarranted – they provide services in order to achieve better outcomes? ie it cannot be explained on the basis of illness, 5. How can the CCG support low and average performers to medical evidence, or patient preference, but is help them match the achievement of the best? accounted for by the willingness and ability of doctors 6. How can we build clinical leadership to drive quality to offer treatment. improvement?

There are legitimate reasons for exception reporting. But ……. Excepting patients from indicators puts them at risk of not receiving optimal care and of having worse outcomes. It is also likely to increase health inequalities. The substantial variation seen in exception reporting for some indicators suggests that some practices are more effective than others at reaching their whole population. Benchmarking exception reporting 7 allows us to identify the practices that need support to implement the strategies adopted by low excepting practices. Cluster methodology: your most similar practices

Each practice has been grouped on the basis of demographic data into 15 national clusters. These demographic factors cover: • deprivation (practice level) • age profile (% < 5, % < 18, % 15-24, % 65+, % 75+, % 85+) • ethnicity (% population of white ethnicity) • practice population side

These demographic factors closely align with those used to calculate the “Similar 10 CCGs”. These demographic factors have been used to compare practices with similar populations to account for potential factors which may drive variation. Some local interpretation will need to be applied to the data contained within the packs as practices with significant outlying population characteristics e.g. university populations or care home practices will need further contextualisation. Further detailed information including full technical methodology and a full PDF report on each of the 15 practice clusters is available here: https://github.com/julianflowers/geopractice.

8 CVD: Primary Care Intelligence Packs Cluster methodology: calculating potential gains

The performance of every practice in the GP cluster contributes to the average of the top performing 50% of practices to form a benchmark.

5% 0% -5% -10% -15% -20%

WELLINGTON ROAD SURGERY 7

EMERSONS GREEN MEDICAL CENTRE 9

LEAP VALLEY MEDICAL CENTRE 22

CHRISTCHURCH FAMILY MEDICAL CENTRE 21

CONISTON MEDICAL PRACTICE 17

FROME VALLEY MEDICAL CENTRE 31

ST MARY STREET SURGERY 14 KINGSWOODRaw HEALTH difference CENTRE between the Potential opportunity if 15 Potential opportunity if the CONCORDpractice MEDICAL CENTRE value the practice value was 12 CCG value were to move KENNEDYand WAY the SURGERY average of the to move to the average 9 to the average of the top 5 highest or lowest 50% of of the highest 50% of performing closest CCGs similar cluster practices similar cluster practices BRADLEY STOKE SURGERY 3

THE WILLOW SURGERY 5

CLOSE FARM SURGERY 1 The difference between the benchmark and the selected practices is displayed on this chart. The benchmark will most likelyPILNING be SURGERY different for different practices as they are in different clusters, so1 the difference is the key measure here. IfCOURTSIDE the practice SURGERY performance is below the benchmark, the difference is applied1 to the denominator plus exceptionsALMONDSBURY to SURGERY demonstrate potential gains on a practice basis. The potential gains on a CCG basis are calculated

STOKEbased GIFFORD on MEDICAL the CENTREdifference between the top 5 performing closest CCGs and the selected CCG, applied to the

denominatorORCHARD MEDICAL plus CENTRE exceptions.

WEST WALK SURGERY

THORNBURY9 CVD: HEALTH PrimaryCENTRE - BURNEY Care Intelligence Packs CVD prevention

10 CVD: Primary Care Intelligence Packs CVD prevention

The size of the prevention problem “The NHS needs a radical upgrade • 2/3 of adults are obese or overweight in prevention if it is to be • 1/3 of adults are physically inactive sustainable” • average smoking prevalence is 17% but is much 5 year Forward View 2014 higher in some communities • in high risk conditions like atrial fibrillation, high blood pressure, diabetes and high ten year CVD risk score, This is because England faces an epidemic of largely up to half of all people do not receive preventive preventable non-communicable diseases, such as heart treatments that are known to be highly effective at disease and stroke, cancer, Type 2 diabetes and liver disease. preventing heart attacks and strokes

Dietary risks • around 90% of people with familial hypercholestero- Tobacco smoke High body-mass index laemia are undiagnosed and untreated despite their High systolic blood pressure Alcohol and drug use average 10 year reduction in life expectancy HIV/AIDS and tuberculosis High fasting plasma glucose Diarrhea, lower respiratory & other common infectious diseases High total cholesterol Neglected tropical diseases & malaria Maternal disorders Low glomerular filtration rate Neonatal disorders Nutritional deficiencies Low physical activity Other communicable, maternal, neonatal, & nutritional diseases Neoplasms Occupational risks Social prescribing and wellbeing hubs offer new Cardiovascular diseases Air pollution Chronic respiratory diseases Cirrhosis Low bone mineral density Digestive diseases models for supporting behaviour change while reducing Neurological disorders Child and maternal malnutrition Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases Sexual abuse and violence burden on general practice. Musculoskeletal disorders Other environmental risks Other non-communicable diseases Transport injuries Unsafe sex Unintentional injuries The NHS Health Check is a systematic approach to Self-harm and interpersonal violence Unsafe water/ sanitation/ handwashing Forces of nature, war, & legal intervention 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% identifying local people at high risk of CVD, offering Percent of total disability-adjusted life-years (DALYs) behaviour change support and early detection of the The Global Burden of Disease Study (next slide) shows us that high risk but often undiagnosed conditions such as the leading causes of premature mortality include diet, hypertension, atrial fibrillation, CKD, diabetes and pre- tobacco, obesity, raised blood pressure, physical inactivity and diabetes. raised cholesterol. The radical upgrade in prevention needs Question: What proportion of our local eligible population-level approaches. But it also needs interventions in population is receiving the NHS Health Check and how primary care for individuals with behavioural and clinical risk effective is the follow-up management of their clinical factors. risk factors in primary care?

11 11 CVD: Primary Care Intelligence Packs Global Burden of Disease Study 2015 Risk Factors for premature death and disability caused by CVD in England, expressed as a percentage of total disability-adjusted life-years

High systolic blood pressure

Dietary risks

High total cholesterol

High body-mass index

Tobacco smoke

High fasting plasma glucose

Low physical activity

Air pollution

Low glomerular filtration rate

Other environmental risks

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%

Percentage of total CVD disability-adjusted life-years (DALYs)

12 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by CCG Comparison with demographically similar CCGs

NHS Kernow CCG 18.0%

NHS Somerset CCG 17.7% • prevalence of 16.5% in NHS Dorset CCG NHS Southern Derbyshire CCG 17.6%

NHS Cambridgeshire and Peterborough CCG 17.5%

NHS Cumbria CCG 17.1%

NHS Northern, Eastern and Western Devon CCG 17.0%

NHS Coastal West Sussex CCG 16.8%

NHS Dorset CCG 16.5% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Gloucestershire CCG 15.9% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Wiltshire CCG 15.3% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS West Hampshire CCG 14.0% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 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

WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 48.0% PROVIDENCE SURGERY J81634 38.1% HOLDENHURST ROAD SURGERY J81024 31.7% BOSCOMBE MANOR MEDICAL CENTRE J81645 30.8% CRESCENT SURGERY J81624 30.2% HERBERT AVENUE J81632 28.6% KINSON ROAD MEDICAL CENTRE J81045 27.4% SHELLEY MANOR MEDICAL CENTRE J81021 24.6% ROYAL MANOR HEALTH CARE J81009 23.0% CARLISLE HOUSE SURGERY J81052 22.6% ALMA PARTNERSHIP J81003 22.0% THE PANTON PRACTICE J81072 21.8% • 110,800 people who are recorded as POOLE ROAD MEDICAL CENTRE J81004 21.7% DENMARK ROAD MEDICAL CENTRE J81625 21.6% MADEIRA MEDICAL CENTRE J81065 21.6% THE BRIDGES MEDICAL CTR. J81073 21.6% smokers in NHS Dorset CCG WOODLEA HOUSE SURGERY J81633 21.3% NORTHBOURNE SURGERY J81038 21.0% ABBOTSBURY ROAD SURGERY J81055 20.1% THE LANEHOUSE SURGERY J81090 19.9% • GP practice range: 7.3% to 48.0% THE ROSEMARY HEALTH CTR J81036 19.5% DURDELLS AVENUE SURGERY J81063 19.5% PARKSTONE HEALTH CENTRE J81012 19.4% THE BANKS & BEARWOOD MEDICAL CENTRE J81070 19.3% ROYAL CRESCENT SURGERY J81027 19.1% HEATHERVIEW MEDICAL CTR. J81044 18.9% THE ADAM PRACTICE J81006 18.8% THE DORCHESTER RD SURGERY J81613 18.7% THE BIRCHWOOD PRACTICE J81087 18.4% BEAUFORT ROAD SURGERY J81018 18.2% CANFORD HEATH GROUP PRACT J81013 18.0% LONGFLEET HOUSE SURGERY J81069 17.8% FORDINGTON SURGERY J81626 17.7% THE WELLBRIDGE PRACTICE J81025 17.4% DR NEWMAN J81648 17.1% WYKE REGIS MEDICAL PRACTICE J81051 17.0% MOORDOWN MEDICAL CENTRE J81039 17.0% BRIDPORT MEDICAL CENTRE J81005 17.0% THE BARN SURGERY J81043 16.9% ATRIUM HEALTH CENTRE J81068 16.7% CROSS ROAD SURGERY J81075 16.7% THE MEDICAL CENTRE (CORBIN AVE) J81621 16.7% ST ALBANS MEDICAL CENTRE J81062 16.6% POOLE TOWN SURGERY J81064 16.3% BLACKMORE VALE PARTNERSHIP J81620 16.2% FARMHOUSE SURGERY J81057 16.1% SWANAGE MEDICAL PRACTICE J81010 16.1% VILLAGE SURGERY J81042 15.9% LEYBOURNE SURGERY J81071 15.7% EAGLE HOUSE SURGERY J81031 15.3% THE ORCHARD SURGERY J81056 15.3% NEWLAND SURGERY J81032 15.2% GILLINGHAM MEDICAL PRACTICE J81081 15.2% JAMES FISHER MEDICAL CENTRE J81047 15.2% STOUR SURGERY J81066 15.1% WESTBOURNE MEDICAL CENTRE J81014 15.1% EVERGREEN OAK SURGERY J81086 14.9% STALBRIDGE SURGERY J81040 14.9% WHITECLIFF GROUP PRACTICE J81019 14.8% WAREHAM SURGERY J81011 14.7% SOUTHBOURNE PRACTICE J81059 14.6% MILTON ABBAS SURGERY J81035 14.6% CORFE CASTLE SURGERY J81612 14.3% BERE REGIS SURGERY J81020 14.2% THE TOLLERFORD PRACTICE J81076 13.9% BARTON HOUSE MED PRACTICE J81074 13.7% SANDFORD SURGERY J81631 13.6% BURTON & BRANSGORE MEDICAL CENTRE J81050 13.5% VILLAGE MEDICAL PRACTICE J81640 13.5% THE MARINE & OAKRIDGE PARTNERSHIP J81049 13.3% THE CRANBORNE PRACTICE J81058 12.9% GROVE SURGERY J81646 12.9% QUEENS AVENUE SURGERY J81016 12.5% MALTHOUSE MEADOWS SURGERY J81609 12.2% THE APPLES MEDICAL CENTRE J81029 12.2% THE PRINCE OF WALES SURGERY J81637 11.7% LYME REGIS MEDICAL CENTRE Y03661 11.5% PUDDLETOWN SURGERY J81616 11.5% POUNDBURY DOCTORS SURGERY J81082 11.2% WALFORD MILL MEDICAL CENTRE J81077 11.1% QUARTERJACK SURGERY J81034 10.9% WESSEX ROAD SURGERY J81048 10.8% Note: This method is thought to be a reasonably CERNE ABBAS SURGERY J81053 10.8% TALBOT MEDICAL CENTRE J81033 10.7% THE VERWOOD SURGERY J81030 10.4% robust method in estimating smoking prevalence BUTE HOUSE J81078 10.4% THE OLD DISPENSARY J81644 10.1% YETMINSTER MEDICAL CENTRE J81017 10.0% THE HADLEIGH PRACTICE J81041 9.9% for the majority of GP practices. However, PENNY'S HILL PRACTICE J81061 9.9% THE HARVEY PRACTICE J81046 9.6% CHARMOUTH MEDICAL PRACTICE J81628 9.6% caution is advised for extreme estimates of ORCHID HOUSE SURGERY J81002 9.5% LITTLEDOWN SURGERY J81067 9.5% HIGHCLIFFE MEDICAL CENTRE J81028 9.2% smoking prevalence and those with high WEST MOORS GROUP PRACTICE J81022 9.1% LILLIPUT SURGERY J81054 7.7% LYME BAY MEDICAL PRACTICE J81647 7.3% numbers of smoking status not recorded and 0% 10% 20% 30% 40% 50% 60% 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 Dorset CCG 0.59 • the ratio of those diagnosed with hypertension versus those expected to have hypertension is 0.59. This compares to 0.59 for England • this suggests that 59% of people with hypertension have been diagnosed

England 0.59

Note: this slide shows Hypertension prevalence estimates created using data from QOF hypertension registers 2014/15 and Undiagnosed hypertension estimates for adults 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 16 years and older. 2014. Department of Primary Ratio Care & Public Health, Imperial College London

17 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs

NHS Somerset CCG 0.60

NHS Wiltshire CCG 0.60

NHS Coastal West Sussex CCG 0.60

NHS Northern, Eastern and Western Devon CCG 0.59

NHS Cumbria CCG 0.59

NHS West Hampshire CCG 0.59

NHS Dorset CCG 0.59

NHS Southern Derbyshire CCG 0.59

NHS Kernow CCG 0.58

NHS Gloucestershire CCG 0.58

NHS Cambridgeshire and Peterborough CCG 0.56

0% 10% 20% 30% 40% 50% 60% 70%

18 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by GP practice

GP practice CCG

0.71 SANDFORD SURGERY J81631 0.70 0.69 CORFE CASTLE SURGERY J81612 0.66 0.66 VILLAGE MEDICAL PRACTICE J81640 0.65 0.63 HERBERT AVENUE J81632 0.63 0.63 YETMINSTER MEDICAL CENTRE J81017 0.63 0.62 HEATHERVIEW MEDICAL CTR. J81044 0.62 0.62 • it is estimated that there are 83,374 MOORDOWN MEDICAL CENTRE J81039 0.62 0.62 THE VERWOOD SURGERY J81030 0.62 0.62 people with undiagnosed WAREHAM SURGERY J81011 0.61 0.61 PENNY'S HILL PRACTICE J81061 0.61 0.61 THE BRIDGES MEDICAL CTR. J81073 0.61 hypertension in NHS Dorset CCG 0.61 WALFORD MILL MEDICAL CENTRE J81077 0.60 0.60 THE HARVEY PRACTICE J81046 0.60 • GP practice range of observed to 0.59 ABBOTSBURY ROAD SURGERY J81055 0.59 0.59 SWANAGE MEDICAL PRACTICE J81010 0.59 expected hypertension prevalence 0.58 CANFORD HEATH GROUP PRACT J81013 0.58 0.58 THE BIRCHWOOD PRACTICE J81087 0.58 0.57 0.32 to 0.71 FORDINGTON SURGERY J81626 0.57 0.57 ATRIUM HEALTH CENTRE J81068 0.56 0.56 LONGFLEET HOUSE SURGERY J81069 0.56 0.56 WOODLEA HOUSE SURGERY J81633 0.56 0.56 THE LANEHOUSE SURGERY J81090 0.56 0.56 HIGHCLIFFE MEDICAL CENTRE J81028 0.55 0.55 KINSON ROAD MEDICAL CENTRE J81045 0.55 0.54 LITTLEDOWN SURGERY J81067 0.54 0.54 QUARTERJACK SURGERY J81034 0.54 0.54 BLACKMORE VALE PARTNERSHIP J81620 0.54 0.53 CROSS ROAD SURGERY J81075 0.53 0.53 POOLE TOWN SURGERY J81064 0.52 0.52 THE BARN SURGERY J81043 0.51 0.51 THE OLD DISPENSARY J81644 0.51 0.50 SOUTHBOURNE PRACTICE J81059 0.50 0.50 WHITECLIFF GROUP PRACTICE J81019 0.50 0.50 CARLISLE HOUSE SURGERY J81052 0.49 0.49 BARTON HOUSE MED PRACTICE J81074 0.49 0.49 POOLE ROAD MEDICAL CENTRE J81004 0.48 0.48 FARMHOUSE SURGERY J81057 0.48 0.48 BUTE HOUSE J81078 0.48 0.47 NORTHBOURNE SURGERY J81038 0.47 0.47 LILLIPUT SURGERY J81054 0.46 0.46 THE CRANBORNE PRACTICE J81058 0.46 0.45 WESTBOURNE MEDICAL CENTRE J81014 0.45 0.44 SHELLEY MANOR MEDICAL CENTRE J81021 0.43 0.42 JAMES FISHER MEDICAL CENTRE J81047 0.42 0.41 THE PANTON PRACTICE J81072 0.41 0.41 DR NEWMAN J81648 0.40 0.40 ALMA PARTNERSHIP J81003 0.39 0.34 CRESCENT SURGERY J81624 0.32 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 Dorset CCG 79.2% • 121,730 people with hypertension (diagnosed)* in NHS Dorset CCG • 96,374 (79.2%) people whose blood pressure is <= 150/90 • 7,076 (5.8%) people who are excepted from optimal control • 18,280 (15%) additional people whose blood pressure is not <= 150/90

England 79.6%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *Using QOF clinical indicator HYP006 denominator plus exceptions

20 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs

NHS Cumbria CCG 80.9%

NHS Southern Derbyshire CCG 80.6%

NHS Gloucestershire CCG 80.1%

NHS Kernow CCG 79.7%

NHS Wiltshire CCG 79.6%

NHS Northern, Eastern and Western Devon CCG 79.4%

NHS Dorset CCG 79.2%

NHS West Hampshire CCG 78.3%

NHS Cambridgeshire and Peterborough CCG 78.2%

NHS Coastal West Sussex CCG 76.1%

NHS Somerset CCG 74.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

21 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice

No treatment Exceptions reported

NORTHBOURNE SURGERY J81038 349 PROVIDENCE SURGERY J81634 320 DENMARK ROAD MEDICAL CENTRE J81625 311 ALMA PARTNERSHIP J81003 249 BURTON & BRANSGORE MEDICAL CENTRE J81050 545 JAMES FISHER MEDICAL CENTRE J81047 436 CRESCENT SURGERY J81624 86 WESTBOURNE MEDICAL CENTRE J81014 790 HOLDENHURST ROAD SURGERY J81024 261 BOSCOMBE MANOR MEDICAL CENTRE J81645 77 EVERGREEN OAK SURGERY J81086 173 SWANAGE MEDICAL PRACTICE J81010 610 • in total, including exceptions, there HERBERT AVENUE J81632 142 THE MARINE & OAKRIDGE PARTNERSHIP J81049 472 WEST MOORS GROUP PRACTICE J81022 314 THE PANTON PRACTICE J81072 334 are 25,356 people whose blood SHELLEY MANOR MEDICAL CENTRE J81021 373 THE OLD DISPENSARY J81644 136 MALTHOUSE MEADOWS SURGERY J81609 159 DURDELLS AVENUE SURGERY J81063 108 CHARMOUTH MEDICAL PRACTICE J81628 112 pressure is not <= 150/90 MADEIRA MEDICAL CENTRE J81065 270 YETMINSTER MEDICAL CENTRE J81017 163 THE DORCHESTER RD SURGERY J81613 203 QUEENS AVENUE SURGERY J81016 256 • GP practice range: 9.7% to 41.4% PARKSTONE HEALTH CENTRE J81012 297 ST ALBANS MEDICAL CENTRE J81062 311 KINSON ROAD MEDICAL CENTRE J81045 293 MILTON ABBAS SURGERY J81035 119 LONGFLEET HOUSE SURGERY J81069 166 THE WELLBRIDGE PRACTICE J81025 219 POOLE ROAD MEDICAL CENTRE J81004 279 THE BIRCHWOOD PRACTICE J81087 285 DR NEWMAN J81648 87 LILLIPUT SURGERY J81054 337 SOUTHBOURNE PRACTICE J81059 266 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 299 HIGHCLIFFE MEDICAL CENTRE J81028 523 THE ORCHARD SURGERY J81056 277 BRIDPORT MEDICAL CENTRE J81005 729 THE ADAM PRACTICE J81006 1098 ORCHID HOUSE SURGERY J81002 430 FORDINGTON SURGERY J81626 147 GROVE SURGERY J81646 166 POUNDBURY DOCTORS SURGERY J81082 180 HEATHERVIEW MEDICAL CTR. J81044 359 THE PRINCE OF WALES SURGERY J81637 208 BLACKMORE VALE PARTNERSHIP J81620 866 ROYAL CRESCENT SURGERY J81027 691 THE BRIDGES MEDICAL CTR. J81073 532 LITTLEDOWN SURGERY J81067 124 WOODLEA HOUSE SURGERY J81633 114 THE MEDICAL CENTRE (CORBIN AVE) J81621 215 THE CRANBORNE PRACTICE J81058 235 TALBOT MEDICAL CENTRE J81033 267 BEAUFORT ROAD SURGERY J81018 302 BUTE HOUSE J81078 166 VILLAGE SURGERY J81042 205 CANFORD HEATH GROUP PRACT J81013 323 BERE REGIS SURGERY J81020 118 ABBOTSBURY ROAD SURGERY J81055 289 THE HADLEIGH PRACTICE J81041 617 VILLAGE MEDICAL PRACTICE J81640 83 WALFORD MILL MEDICAL CENTRE J81077 197 POOLE TOWN SURGERY J81064 114 NEWLAND SURGERY J81032 211 THE TOLLERFORD PRACTICE J81076 170 CERNE ABBAS SURGERY J81053 125 ATRIUM HEALTH CENTRE J81068 223 WHITECLIFF GROUP PRACTICE J81019 398 STALBRIDGE SURGERY J81040 144 THE HARVEY PRACTICE J81046 340 LYME REGIS MEDICAL CENTRE Y03661 120 WESSEX ROAD SURGERY J81048 150 PENNY'S HILL PRACTICE J81061 290 QUARTERJACK SURGERY J81034 328 MOORDOWN MEDICAL CENTRE J81039 199 ROYAL MANOR HEALTH CARE J81009 312 LYME BAY MEDICAL PRACTICE J81647 59 THE ROSEMARY HEALTH CTR J81036 176 THE BARN SURGERY J81043 165 THE LANEHOUSE SURGERY J81090 73 STOUR SURGERY J81066 220 CROSS ROAD SURGERY J81075 109 WAREHAM SURGERY J81011 226 FARMHOUSE SURGERY J81057 142 BARTON HOUSE MED PRACTICE J81074 135 THE VERWOOD SURGERY J81030 191 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 5 LEYBOURNE SURGERY J81071 90 CARLISLE HOUSE SURGERY J81052 104 CORFE CASTLE SURGERY J81612 63 WYKE REGIS MEDICAL PRACTICE J81051 171 THE APPLES MEDICAL CENTRE J81029 122 GILLINGHAM MEDICAL PRACTICE J81081 252 EAGLE HOUSE SURGERY J81031 140 PUDDLETOWN SURGERY J81616 77 SANDFORD SURGERY J81631 44 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 Dorset CCG 56.6% • 447 people with a new diagnosis* of hypertension with a CVD risk of 20% or higher in NHS Dorset CCG • 253 (56.6%) people who are currently treated with statins • 185 (41.4%) people who are exempted from treatment with statins • 9 (2%) additional people who are not currently treated with statins

England 66.5%

0% 10% 20% 30% 40% 50% 60% 70% *Using the QOF clinical indicator CVD-PP001 denominator plus exceptions

23 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with demographically similar CCGs

NHS Gloucestershire CCG 65.1%

NHS Cumbria CCG 64.0%

NHS Northern, Eastern and Western Devon CCG 64.0%

NHS Kernow CCG 62.0%

NHS Southern Derbyshire CCG 61.5%

NHS Cambridgeshire and Peterborough CCG 61.2%

NHS Wiltshire CCG 59.7%

NHS Coastal West Sussex CCG 59.6%

NHS Dorset CCG 56.6%

NHS West Hampshire CCG 55.9%

NHS Somerset CCG 55.1%

0% 10% 20% 30% 40% 50% 60% 70%

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

THE LANEHOUSE SURGERY J81090 2 LYME REGIS MEDICAL CENTRE Y03661 8 PARKSTONE HEALTH CENTRE J81012 3 HIGHCLIFFE MEDICAL CENTRE J81028 3 DURDELLS AVENUE SURGERY J81063 3 STOUR SURGERY J81066 3 MALTHOUSE MEADOWS SURGERY J81609 3 WESTBOURNE MEDICAL CENTRE J81014 2 THE ROSEMARY HEALTH CTR J81036 4 THE BARN SURGERY J81043 2 THE MARINE & OAKRIDGE PARTNERSHIP J81049 4 THE ORCHARD SURGERY J81056 2 • in total, including exceptions, there MADEIRA MEDICAL CENTRE J81065 2 BARTON HOUSE MED PRACTICE J81074 2 BUTE HOUSE J81078 2 PUDDLETOWN SURGERY J81616 6 are 194 people who are not treated THE PRINCE OF WALES SURGERY J81637 2 THE HADLEIGH PRACTICE J81041 5 CANFORD HEATH GROUP PRACT J81013 3 THE HARVEY PRACTICE J81046 3 PROVIDENCE SURGERY J81634 3 with statins BURTON & BRANSGORE MEDICAL CENTRE J81050 18 QUARTERJACK SURGERY J81034 4 THE CRANBORNE PRACTICE J81058 4 DENMARK ROAD MEDICAL CENTRE J81625 4 • GP practice range: 0.0% to 100.0% ALMA PARTNERSHIP J81003 1 POOLE ROAD MEDICAL CENTRE J81004 1 BEAUFORT ROAD SURGERY J81018 1 THE APPLES MEDICAL CENTRE J81029 1 NEWLAND SURGERY J81032 2 NORTHBOURNE SURGERY J81038 1 MOORDOWN MEDICAL CENTRE J81039 1 HEATHERVIEW MEDICAL CTR. J81044 9 KINSON ROAD MEDICAL CENTRE J81045 2 WESSEX ROAD SURGERY J81048 1 ST ALBANS MEDICAL CENTRE J81062 1 THE PANTON PRACTICE J81072 2 GILLINGHAM MEDICAL PRACTICE J81081 2 THE DORCHESTER RD SURGERY J81613 1 DR NEWMAN J81648 1 BRIDPORT MEDICAL CENTRE J81005 6 WHITECLIFF GROUP PRACTICE J81019 4 THE BRIDGES MEDICAL CTR. J81073 4 WYKE REGIS MEDICAL PRACTICE J81051 3 BLACKMORE VALE PARTNERSHIP J81620 3 THE ADAM PRACTICE J81006 16 HOLDENHURST ROAD SURGERY J81024 2 CERNE ABBAS SURGERY J81053 2 LILLIPUT SURGERY J81054 2 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 2 THE BIRCHWOOD PRACTICE J81087 2 LYME BAY MEDICAL PRACTICE J81647 2 JAMES FISHER MEDICAL CENTRE J81047 3 QUEENS AVENUE SURGERY J81016 1 YETMINSTER MEDICAL CENTRE J81017 1 SHELLEY MANOR MEDICAL CENTRE J81021 2 VILLAGE SURGERY J81042 1 CARLISLE HOUSE SURGERY J81052 1 THE MEDICAL CENTRE (CORBIN AVE) J81621 1 PENNY'S HILL PRACTICE J81061 3 ROYAL MANOR HEALTH CARE J81009 1 SWANAGE MEDICAL PRACTICE J81010 2 THE VERWOOD SURGERY J81030 1 EAGLE HOUSE SURGERY J81031 2 WEST MOORS GROUP PRACTICE J81022 1 ATRIUM HEALTH CENTRE J81068 1 FORDINGTON SURGERY J81626 1 ORCHID HOUSE SURGERY J81002 WAREHAM SURGERY J81011 BERE REGIS SURGERY J81020 THE WELLBRIDGE PRACTICE J81025 ROYAL CRESCENT SURGERY J81027 TALBOT MEDICAL CENTRE J81033 MILTON ABBAS SURGERY J81035 STALBRIDGE SURGERY J81040 ABBOTSBURY ROAD SURGERY J81055 FARMHOUSE SURGERY J81057 SOUTHBOURNE PRACTICE J81059 POOLE TOWN SURGERY J81064 LITTLEDOWN SURGERY J81067 LONGFLEET HOUSE SURGERY J81069 LEYBOURNE SURGERY J81071 CROSS ROAD SURGERY J81075 THE TOLLERFORD PRACTICE J81076 WALFORD MILL MEDICAL CENTRE J81077 POUNDBURY DOCTORS SURGERY J81082 EVERGREEN OAK SURGERY J81086 CORFE CASTLE SURGERY J81612 CRESCENT SURGERY J81624 CHARMOUTH MEDICAL PRACTICE J81628 SANDFORD SURGERY J81631 HERBERT AVENUE J81632 WOODLEA HOUSE SURGERY J81633 THE OLD DISPENSARY J81644 BOSCOMBE MANOR MEDICAL CENTRE J81645 GROVE SURGERY J81646 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 VILLAGE MEDICAL PRACTICE J81640 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 Dorset CCG 0.77 • the ratio of those diagnosed with atrial fibrillation versus those expected to have atrial fibrillation is 0.77. This compares to 0.7 for England • this suggests that 77% of people with atrial fibrillation have been diagnosed.

Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 2015/16 to the estimated prevalence of atrial fibrillation, England 0.70 taken from National Cardiovascular Intelligence Network estimates produced in 2017. The estimates were developed by applying age-sex specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 NHS Digital. Estimates reported are adjusted for age and sex of the local population.

28 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with demographically similar CCGs

NHS Somerset CCG 0.78

NHS Dorset CCG 0.77

NHS Gloucestershire CCG 0.74

NHS Northern, Eastern and Western Devon CCG 0.73

NHS Wiltshire CCG 0.73

NHS Coastal West Sussex CCG 0.72

NHS Kernow CCG 0.72

NHS Cumbria CCG 0.71

NHS West Hampshire CCG 0.70

NHS Southern Derbyshire CCG 0.69

NHS Cambridgeshire and Peterborough CCG 0.67

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

29 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared with expected prevalence by GP practice

GP practice CCG

1.1 NEWLAND SURGERY J81032 1.0 1.0 THE ADAM PRACTICE J81006 0.9 0.9 WHITECLIFF GROUP PRACTICE J81019 0.9 0.9 MILTON ABBAS SURGERY J81035 0.9 0.9 THE HARVEY PRACTICE J81046 0.9 0.9 LILLIPUT SURGERY J81054 0.9 0.9 • it is estimated that there are 26,146 CROSS ROAD SURGERY J81075 0.9 0.9 MALTHOUSE MEADOWS SURGERY J81609 0.9 0.8 people with undiagnosed atrial BRIDPORT MEDICAL CENTRE J81005 0.8 0.8 WAREHAM SURGERY J81011 0.8 0.8 BERE REGIS SURGERY J81020 0.8 fibrillation in NHS Dorset CCG 0.8 THE WELLBRIDGE PRACTICE J81025 0.8 0.8 HIGHCLIFFE MEDICAL CENTRE J81028 0.8 • GP practice range of observed to 0.8 MOORDOWN MEDICAL CENTRE J81039 0.8 0.8 THE HADLEIGH PRACTICE J81041 0.8 expected atrial fibrillation prevalence 0.8 JAMES FISHER MEDICAL CENTRE J81047 0.8 0.8 CERNE ABBAS SURGERY J81053 0.8 0.8 0.3 to 1.1 PENNY'S HILL PRACTICE J81061 0.8 0.8 POOLE TOWN SURGERY J81064 0.8 0.8 ATRIUM HEALTH CENTRE J81068 0.8 0.8 THE BIRCHWOOD PRACTICE J81087 0.8 0.8 BLACKMORE VALE PARTNERSHIP J81620 0.8 0.8 CHARMOUTH MEDICAL PRACTICE J81628 0.8 0.8 THE PRINCE OF WALES SURGERY J81637 0.8 0.8 ALMA PARTNERSHIP J81003 0.7 0.7 PARKSTONE HEALTH CENTRE J81012 0.7 0.7 WESTBOURNE MEDICAL CENTRE J81014 0.7 0.7 BEAUFORT ROAD SURGERY J81018 0.7 0.7 HOLDENHURST ROAD SURGERY J81024 0.7 0.7 THE VERWOOD SURGERY J81030 0.7 0.7 TALBOT MEDICAL CENTRE J81033 0.7 0.7 HEATHERVIEW MEDICAL CTR. J81044 0.7 0.7 WESSEX ROAD SURGERY J81048 0.7 0.7 CARLISLE HOUSE SURGERY J81052 0.7 0.7 ST ALBANS MEDICAL CENTRE J81062 0.7 0.7 LITTLEDOWN SURGERY J81067 0.7 0.7 LEYBOURNE SURGERY J81071 0.7 0.7 BARTON HOUSE MED PRACTICE J81074 0.7 0.7 GILLINGHAM MEDICAL PRACTICE J81081 0.7 0.7 EVERGREEN OAK SURGERY J81086 0.7 0.7 THE DORCHESTER RD SURGERY J81613 0.7 0.7 HERBERT AVENUE J81632 0.7 0.7 THE OLD DISPENSARY J81644 0.7 0.7 FARMHOUSE SURGERY J81057 0.6 0.6 THE PANTON PRACTICE J81072 0.6 0.6 CRESCENT SURGERY J81624 0.5 0.5 LYME BAY MEDICAL PRACTICE J81647 0.5 0.4 BOSCOMBE MANOR MEDICAL CENTRE J81645 0.3 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio

30 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by CCG Comparison with CCGs in the STP Optimal management No treatment Exceptions reported

• 16,562 people with atrial fibrillation* NHS Dorset CCG 75.5% with a CHA2DS2-VASc score >= 2 in NHS Dorset CCG • 12,507 (75.5%) people treated with anti-coagulation therapy • 1,817 (11%) people who are exceptions • 2,238 (13.5%) additional people with a recorded CHA2DS2-VASc score >= 2 who are not treated

England 77.9%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator AF007 denominator plus exceptions

31 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported

NHS Gloucestershire CCG 82.0%

NHS West Hampshire CCG 81.0%

NHS Northern, Eastern and Western Devon CCG 80.3%

NHS Kernow CCG 80.2%

NHS Wiltshire CCG 80.2%

NHS Somerset CCG 79.5%

NHS Southern Derbyshire CCG 76.0%

NHS Cambridgeshire and Peterborough CCG 75.7%

NHS Dorset CCG 75.5%

NHS Coastal West Sussex CCG 74.7%

NHS Cumbria CCG 73.7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

32 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by GP practice

No treatment Exceptions reported

HERBERT AVENUE J81632 19 LONGFLEET HOUSE SURGERY J81069 47 WESTBOURNE MEDICAL CENTRE J81014 148 ALMA PARTNERSHIP J81003 33 THE BIRCHWOOD PRACTICE J81087 45 ST ALBANS MEDICAL CENTRE J81062 63 PENNY'S HILL PRACTICE J81061 112 POOLE ROAD MEDICAL CENTRE J81004 70 ORCHID HOUSE SURGERY J81002 109 THE HARVEY PRACTICE J81046 103 SANDFORD SURGERY J81631 16 DR NEWMAN J81648 16 • in total, including exceptions, there BURTON & BRANSGORE MEDICAL CENTRE J81050 77 SOUTHBOURNE PRACTICE J81059 51 THE ADAM PRACTICE J81006 203 EVERGREEN OAK SURGERY J81086 27 are 4,055 people with a recorded HIGHCLIFFE MEDICAL CENTRE J81028 135 THE PANTON PRACTICE J81072 48 SHELLEY MANOR MEDICAL CENTRE J81021 51 VILLAGE SURGERY J81042 39 THE MARINE & OAKRIDGE PARTNERSHIP J81049 80 CHA2DS2-VASc score >= 2 who are KINSON ROAD MEDICAL CENTRE J81045 44 LYME BAY MEDICAL PRACTICE J81647 13 ATRIUM HEALTH CENTRE J81068 61 PROVIDENCE SURGERY J81634 5 not treated WALFORD MILL MEDICAL CENTRE J81077 39 THE OLD DISPENSARY J81644 18 GROVE SURGERY J81646 35 NORTHBOURNE SURGERY J81038 39 • GP practice range: 0.0% to 39.6% STOUR SURGERY J81066 62 BEAUFORT ROAD SURGERY J81018 58 JAMES FISHER MEDICAL CENTRE J81047 54 THE ROSEMARY HEALTH CTR J81036 50 FARMHOUSE SURGERY J81057 39 LITTLEDOWN SURGERY J81067 20 CANFORD HEATH GROUP PRACT J81013 26 PARKSTONE HEALTH CENTRE J81012 36 WOODLEA HOUSE SURGERY J81633 15 ABBOTSBURY ROAD SURGERY J81055 47 THE HADLEIGH PRACTICE J81041 130 WEST MOORS GROUP PRACTICE J81022 49 WAREHAM SURGERY J81011 53 LILLIPUT SURGERY J81054 77 DENMARK ROAD MEDICAL CENTRE J81625 18 POOLE TOWN SURGERY J81064 26 SWANAGE MEDICAL PRACTICE J81010 87 THE BRIDGES MEDICAL CTR. J81073 60 ROYAL CRESCENT SURGERY J81027 108 WESSEX ROAD SURGERY J81048 29 THE PRINCE OF WALES SURGERY J81637 29 THE BARN SURGERY J81043 44 FORDINGTON SURGERY J81626 22 MALTHOUSE MEADOWS SURGERY J81609 21 MOORDOWN MEDICAL CENTRE J81039 29 MADEIRA MEDICAL CENTRE J81065 23 HOLDENHURST ROAD SURGERY J81024 20 THE APPLES MEDICAL CENTRE J81029 33 HEATHERVIEW MEDICAL CTR. J81044 33 CARLISLE HOUSE SURGERY J81052 21 MILTON ABBAS SURGERY J81035 19 GILLINGHAM MEDICAL PRACTICE J81081 61 THE TOLLERFORD PRACTICE J81076 36 POUNDBURY DOCTORS SURGERY J81082 30 THE LANEHOUSE SURGERY J81090 17 STALBRIDGE SURGERY J81040 25 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 29 TALBOT MEDICAL CENTRE J81033 30 WYKE REGIS MEDICAL PRACTICE J81051 28 THE MEDICAL CENTRE (CORBIN AVE) J81621 20 THE CRANBORNE PRACTICE J81058 27 CORFE CASTLE SURGERY J81612 11 EAGLE HOUSE SURGERY J81031 24 QUARTERJACK SURGERY J81034 70 BLACKMORE VALE PARTNERSHIP J81620 95 CRESCENT SURGERY J81624 4 NEWLAND SURGERY J81032 34 THE DORCHESTER RD SURGERY J81613 15 CHARMOUTH MEDICAL PRACTICE J81628 14 DURDELLS AVENUE SURGERY J81063 11 YETMINSTER MEDICAL CENTRE J81017 12 ROYAL MANOR HEALTH CARE J81009 43 BRIDPORT MEDICAL CENTRE J81005 77 VILLAGE MEDICAL PRACTICE J81640 5 THE WELLBRIDGE PRACTICE J81025 19 CROSS ROAD SURGERY J81075 17 THE ORCHARD SURGERY J81056 29 CERNE ABBAS SURGERY J81053 15 LEYBOURNE SURGERY J81071 13 WHITECLIFF GROUP PRACTICE J81019 54 BOSCOMBE MANOR MEDICAL CENTRE J81645 2 QUEENS AVENUE SURGERY J81016 22 BUTE HOUSE J81078 19 THE VERWOOD SURGERY J81030 20 LYME REGIS MEDICAL CENTRE Y03661 10 BARTON HOUSE MED PRACTICE J81074 16 BERE REGIS SURGERY J81020 9 PUDDLETOWN SURGERY J81616 8 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 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% 5% 0% -5% -10% -15% -20% -25% -30%

HERBERT AVENUE 12

LONGFLEET HOUSE SURGERY 27

ALMA PARTNERSHIP 17 • using the GP cluster method of THE BIRCHWOOD PRACTICE 23 calculating potential gains, if each ST ALBANS MEDICAL CENTRE 31 practice was to achieve as well as the DR NEWMAN 8 upper quartile of its national cluster, then an additional 1,318 people would SANDFORD SURGERY 8 be treated WESTBOURNE MEDICAL CENTRE 69

SOUTHBOURNE PRACTICE 27

EVERGREEN OAK SURGERY 14

CHARMOUTH MEDICAL PRACTICE

QUEENS AVENUE SURGERY

WHITECLIFF GROUP PRACTICE

VILLAGE MEDICAL PRACTICE

LYME REGIS MEDICAL CENTRE

BERE REGIS SURGERY

PUDDLETOWN SURGERY

THE VERWOOD SURGERY

BUTE HOUSE

BARTON HOUSE MED PRACTICE 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

• 18,585 people with a history of stroke NHS Dorset CCG 82.3% or TIA* in NHS Dorset CCG • 15,291 (82.3%) people whose blood pressure is <= 150 / 90 • 1,237 (6.7%) people who are exceptions • 2,057 (11.1%) additional people whose blood pressure is not <= 150 / 90

England 83.8%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA003 denominator plus exceptions

35 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported

NHS Cumbria CCG 84.4%

NHS Gloucestershire CCG 84.2%

NHS Northern, Eastern and Western Devon CCG 83.4%

NHS Wiltshire CCG 83.2%

NHS Southern Derbyshire CCG 83.1%

NHS Kernow CCG 82.6%

NHS Dorset CCG 82.3%

NHS West Hampshire CCG 82.3%

NHS Cambridgeshire and Peterborough CCG 81.7%

NHS Coastal West Sussex CCG 79.7%

NHS Somerset CCG 77.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

36 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice

No treatment Exceptions reported

NORTHBOURNE SURGERY J81038 49 WESTBOURNE MEDICAL CENTRE J81014 153 BOSCOMBE MANOR MEDICAL CENTRE J81645 10 PROVIDENCE SURGERY J81634 44 BURTON & BRANSGORE MEDICAL CENTRE J81050 63 SHELLEY MANOR MEDICAL CENTRE J81021 75 DENMARK ROAD MEDICAL CENTRE J81625 38 DR NEWMAN J81648 19 ALMA PARTNERSHIP J81003 39 THE PANTON PRACTICE J81072 59 EVERGREEN OAK SURGERY J81086 25 WEST MOORS GROUP PRACTICE J81022 58 • in total, including exceptions, there HERBERT AVENUE J81632 21 CRESCENT SURGERY J81624 9 JAMES FISHER MEDICAL CENTRE J81047 63 QUEENS AVENUE SURGERY J81016 50 are 3,294 people whose blood HOLDENHURST ROAD SURGERY J81024 27 SWANAGE MEDICAL PRACTICE J81010 80 BRIDPORT MEDICAL CENTRE J81005 115 VILLAGE MEDICAL PRACTICE J81640 13 LONGFLEET HOUSE SURGERY J81069 29 pressure is not <= 150 / 90 THE CRANBORNE PRACTICE J81058 41 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 41 THE MARINE & OAKRIDGE PARTNERSHIP J81049 67 THE ORCHARD SURGERY J81056 42 • GP practice range: 0.0% to 33.6% THE PRINCE OF WALES SURGERY J81637 24 KINSON ROAD MEDICAL CENTRE J81045 38 TALBOT MEDICAL CENTRE J81033 49 HIGHCLIFFE MEDICAL CENTRE J81028 81 FORDINGTON SURGERY J81626 20 GROVE SURGERY J81646 24 YETMINSTER MEDICAL CENTRE J81017 15 MALTHOUSE MEADOWS SURGERY J81609 18 SOUTHBOURNE PRACTICE J81059 41 POOLE TOWN SURGERY J81064 21 DURDELLS AVENUE SURGERY J81063 13 CHARMOUTH MEDICAL PRACTICE J81628 18 ST ALBANS MEDICAL CENTRE J81062 36 PARKSTONE HEALTH CENTRE J81012 32 BEAUFORT ROAD SURGERY J81018 49 STALBRIDGE SURGERY J81040 19 PENNY'S HILL PRACTICE J81061 56 ROYAL CRESCENT SURGERY J81027 85 THE HARVEY PRACTICE J81046 57 HEATHERVIEW MEDICAL CTR. J81044 35 THE MEDICAL CENTRE (CORBIN AVE) J81621 22 ATRIUM HEALTH CENTRE J81068 37 MADEIRA MEDICAL CENTRE J81065 28 THE ADAM PRACTICE J81006 114 POOLE ROAD MEDICAL CENTRE J81004 38 BLACKMORE VALE PARTNERSHIP J81620 96 LILLIPUT SURGERY J81054 51 POUNDBURY DOCTORS SURGERY J81082 24 ORCHID HOUSE SURGERY J81002 48 WESSEX ROAD SURGERY J81048 21 ABBOTSBURY ROAD SURGERY J81055 33 WOODLEA HOUSE SURGERY J81633 13 FARMHOUSE SURGERY J81057 29 QUARTERJACK SURGERY J81034 51 THE WELLBRIDGE PRACTICE J81025 20 WALFORD MILL MEDICAL CENTRE J81077 20 THE HADLEIGH PRACTICE J81041 72 CANFORD HEATH GROUP PRACT J81013 32 CARLISLE HOUSE SURGERY J81052 20 THE ROSEMARY HEALTH CTR J81036 28 NEWLAND SURGERY J81032 20 THE BARN SURGERY J81043 30 BARTON HOUSE MED PRACTICE J81074 19 THE BRIDGES MEDICAL CTR. J81073 49 THE DORCHESTER RD SURGERY J81613 13 CORFE CASTLE SURGERY J81612 7 THE TOLLERFORD PRACTICE J81076 19 LITTLEDOWN SURGERY J81067 12 WHITECLIFF GROUP PRACTICE J81019 45 LYME BAY MEDICAL PRACTICE J81647 8 PUDDLETOWN SURGERY J81616 9 THE APPLES MEDICAL CENTRE J81029 15 ROYAL MANOR HEALTH CARE J81009 31 BUTE HOUSE J81078 13 MILTON ABBAS SURGERY J81035 7 WYKE REGIS MEDICAL PRACTICE J81051 21 MOORDOWN MEDICAL CENTRE J81039 17 WAREHAM SURGERY J81011 27 THE BIRCHWOOD PRACTICE J81087 17 VILLAGE SURGERY J81042 15 STOUR SURGERY J81066 26 LEYBOURNE SURGERY J81071 11 THE VERWOOD SURGERY J81030 22 CROSS ROAD SURGERY J81075 9 BERE REGIS SURGERY J81020 6 THE OLD DISPENSARY J81644 5 GILLINGHAM MEDICAL PRACTICE J81081 29 THE LANEHOUSE SURGERY J81090 6 EAGLE HOUSE SURGERY J81031 12 LYME REGIS MEDICAL CENTRE Y03661 5 CERNE ABBAS SURGERY J81053 7 SANDFORD SURGERY J81631 4 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 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

• 12,399 people with a stroke shown to NHS Dorset CCG 91.6% be non-haemorrhagic* in NHS Dorset CCG • 11,360 (91.6%) people who are taking an anti-platetet agent or anti- coagulant • 744 (6%) people who are exceptions • 295 (2.4%) additional people with no treatment

England 91.8%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA007 denominator plus exceptions

38 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported

NHS Northern, Eastern and Western Devon CCG 93.0%

NHS Kernow CCG 92.3%

NHS West Hampshire CCG 91.9%

NHS Wiltshire CCG 91.8%

NHS Gloucestershire CCG 91.7%

NHS Dorset CCG 91.6%

NHS Southern Derbyshire CCG 91.3%

NHS Cumbria CCG 91.1%

NHS Coastal West Sussex CCG 90.2%

NHS Cambridgeshire and Peterborough CCG 89.8%

NHS Somerset CCG 88.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

39 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who do not have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by GP practice

No treatment Exceptions reported

LYME REGIS MEDICAL CENTRE Y03661 18 CRESCENT SURGERY J81624 6 PROVIDENCE SURGERY J81634 23 LYME BAY MEDICAL PRACTICE J81647 12 MALTHOUSE MEADOWS SURGERY J81609 8 ATRIUM HEALTH CENTRE J81068 21 ROYAL MANOR HEALTH CARE J81009 25 THE WELLBRIDGE PRACTICE J81025 11 LONGFLEET HOUSE SURGERY J81069 12 VILLAGE MEDICAL PRACTICE J81640 6 POOLE ROAD MEDICAL CENTRE J81004 20 WESTBOURNE MEDICAL CENTRE J81014 33 • in total, including exceptions, there THE CRANBORNE PRACTICE J81058 17 MOORDOWN MEDICAL CENTRE J81039 12 NEWLAND SURGERY J81032 13 POUNDBURY DOCTORS SURGERY J81082 9 are 1,039 people who are not taking MILTON ABBAS SURGERY J81035 5 JAMES FISHER MEDICAL CENTRE J81047 20 THE ROSEMARY HEALTH CTR J81036 16 PARKSTONE HEALTH CENTRE J81012 14 BARTON HOUSE MED PRACTICE J81074 12 an anti-platelet agent or anti- THE TOLLERFORD PRACTICE J81076 10 LEYBOURNE SURGERY J81071 7 THE MEDICAL CENTRE (CORBIN AVE) J81621 10 BRIDPORT MEDICAL CENTRE J81005 35 coagulant THE BARN SURGERY J81043 17 SOUTHBOURNE PRACTICE J81059 14 CANFORD HEATH GROUP PRACT J81013 15 WESSEX ROAD SURGERY J81048 11 • GP practice range: 0.0% to 31.0% THE BANKS & BEARWOOD MEDICAL CENTRE J81070 9 FARMHOUSE SURGERY J81057 14 QUEENS AVENUE SURGERY J81016 13 ST ALBANS MEDICAL CENTRE J81062 11 ROYAL CRESCENT SURGERY J81027 27 NORTHBOURNE SURGERY J81038 9 CERNE ABBAS SURGERY J81053 5 THE BRIDGES MEDICAL CTR. J81073 26 THE PANTON PRACTICE J81072 12 PENNY'S HILL PRACTICE J81061 17 CARLISLE HOUSE SURGERY J81052 8 DENMARK ROAD MEDICAL CENTRE J81625 5 GILLINGHAM MEDICAL PRACTICE J81081 19 BLACKMORE VALE PARTNERSHIP J81620 31 THE MARINE & OAKRIDGE PARTNERSHIP J81049 16 SHELLEY MANOR MEDICAL CENTRE J81021 14 CROSS ROAD SURGERY J81075 4 WALFORD MILL MEDICAL CENTRE J81077 7 THE ADAM PRACTICE J81006 32 WHITECLIFF GROUP PRACTICE J81019 16 BUTE HOUSE J81078 5 THE HADLEIGH PRACTICE J81041 24 HEATHERVIEW MEDICAL CTR. J81044 10 DR NEWMAN J81648 3 PUDDLETOWN SURGERY J81616 4 GROVE SURGERY J81646 5 THE LANEHOUSE SURGERY J81090 3 ALMA PARTNERSHIP J81003 7 BURTON & BRANSGORE MEDICAL CENTRE J81050 10 STALBRIDGE SURGERY J81040 5 HIGHCLIFFE MEDICAL CENTRE J81028 22 QUARTERJACK SURGERY J81034 16 VILLAGE SURGERY J81042 8 ORCHID HOUSE SURGERY J81002 11 ABBOTSBURY ROAD SURGERY J81055 11 SWANAGE MEDICAL PRACTICE J81010 14 WEST MOORS GROUP PRACTICE J81022 11 THE HARVEY PRACTICE J81046 14 LILLIPUT SURGERY J81054 15 POOLE TOWN SURGERY J81064 4 MADEIRA MEDICAL CENTRE J81065 6 HERBERT AVENUE J81632 4 THE BIRCHWOOD PRACTICE J81087 5 STOUR SURGERY J81066 9 WAREHAM SURGERY J81011 8 THE PRINCE OF WALES SURGERY J81637 4 BERE REGIS SURGERY J81020 3 TALBOT MEDICAL CENTRE J81033 7 BEAUFORT ROAD SURGERY J81018 9 LITTLEDOWN SURGERY J81067 3 WYKE REGIS MEDICAL PRACTICE J81051 6 EVERGREEN OAK SURGERY J81086 3 THE APPLES MEDICAL CENTRE J81029 4 HOLDENHURST ROAD SURGERY J81024 4 THE DORCHESTER RD SURGERY J81613 4 CHARMOUTH MEDICAL PRACTICE J81628 3 YETMINSTER MEDICAL CENTRE J81017 2 THE VERWOOD SURGERY J81030 8 SANDFORD SURGERY J81631 2 DURDELLS AVENUE SURGERY J81063 2 FORDINGTON SURGERY J81626 2 THE OLD DISPENSARY J81644 1 WOODLEA HOUSE SURGERY J81633 2 THE ORCHARD SURGERY J81056 4 CORFE CASTLE SURGERY J81612 1 KINSON ROAD MEDICAL CENTRE J81045 3 EAGLE HOUSE SURGERY J81031 1 BOSCOMBE MANOR MEDICAL CENTRE J81645 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 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

• 0.69 ratio of observed to expected NHS Dorset CCG 0.69 diabetes prevalence in NHS Dorset CCG, compared to 0.77 in England

• this suggests 69% of people have been diagnosed

England 0.77 Note: This slide compares the prevalence of Diabetes recorded in QOF in 2015/16 to the expected prevalence of Diabetes in 2016 taken from the NCVIN diabetes prevalence model produced in 2015.

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

43 CVD: Primary Care Intelligence Packs Diabetes observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs

NHS Southern Derbyshire CCG 0.81

NHS Cumbria CCG 0.79

NHS Gloucestershire CCG 0.77

NHS Cambridgeshire and Peterborough CCG 0.77

NHS Coastal West Sussex CCG 0.76

NHS Northern, Eastern and Western Devon CCG 0.75

NHS Somerset CCG 0.74

NHS Wiltshire CCG 0.73

NHS Dorset CCG 0.69

NHS West Hampshire CCG 0.66

NHS Kernow CCG 0.65

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

44 CVD: Primary Care Intelligence Packs Diabetes prevalence by GP practice

GP practice CCG

POOLE TOWN SURGERY J81064 9.0% VILLAGE MEDICAL PRACTICE J81640 8.6% ORCHID HOUSE SURGERY J81002 8.2% THE LANEHOUSE SURGERY J81090 8.1% DURDELLS AVENUE SURGERY J81063 8.0% KINSON ROAD MEDICAL CENTRE J81045 7.9% PENNY'S HILL PRACTICE J81061 7.8% GILLINGHAM MEDICAL PRACTICE J81081 7.6% ROYAL MANOR HEALTH CARE J81009 7.5% CORFE CASTLE SURGERY J81612 7.5% SANDFORD SURGERY J81631 7.5% WAREHAM SURGERY J81011 7.5% • GP practice range of observed HERBERT AVENUE J81632 7.4% THE BRIDGES MEDICAL CTR. J81073 7.4% THE ADAM PRACTICE J81006 7.4% HIGHCLIFFE MEDICAL CENTRE J81028 7.4% SWANAGE MEDICAL PRACTICE J81010 7.4% diabetes 2.5% to 9.0% THE BARN SURGERY J81043 7.3% MADEIRA MEDICAL CENTRE J81065 7.2% STALBRIDGE SURGERY J81040 7.2% LEYBOURNE SURGERY J81071 7.2% • there are an estimated 18,054 people FARMHOUSE SURGERY J81057 7.2% WEST MOORS GROUP PRACTICE J81022 7.1% NORTHBOURNE SURGERY J81038 7.1% ABBOTSBURY ROAD SURGERY J81055 7.1% with undiagnosed diabetes in NHS THE ORCHARD SURGERY J81056 7.1% WYKE REGIS MEDICAL PRACTICE J81051 7.0% BURTON & BRANSGORE MEDICAL CENTRE J81050 6.9% CARLISLE HOUSE SURGERY J81052 6.8% Dorset CCG LONGFLEET HOUSE SURGERY J81069 6.8% WOODLEA HOUSE SURGERY J81633 6.8% THE ROSEMARY HEALTH CTR J81036 6.7% BERE REGIS SURGERY J81020 6.7% YETMINSTER MEDICAL CENTRE J81017 6.6% THE CRANBORNE PRACTICE J81058 6.5% THE VERWOOD SURGERY J81030 6.5% NEWLAND SURGERY J81032 6.5% CANFORD HEATH GROUP PRACT J81013 6.5% THE WELLBRIDGE PRACTICE J81025 6.5% THE BANKS & BEARWOOD MEDICAL CENTRE J81070 6.4% GROVE SURGERY J81646 6.4% THE HARVEY PRACTICE J81046 6.4% DR NEWMAN J81648 6.4% ROYAL CRESCENT SURGERY J81027 6.4% EAGLE HOUSE SURGERY J81031 6.3% HEATHERVIEW MEDICAL CTR. J81044 6.2% MOORDOWN MEDICAL CENTRE J81039 6.2% THE MARINE & OAKRIDGE PARTNERSHIP J81049 6.2% BLACKMORE VALE PARTNERSHIP J81620 6.2% THE HADLEIGH PRACTICE J81041 6.2% MILTON ABBAS SURGERY J81035 6.2% ATRIUM HEALTH CENTRE J81068 6.1% THE BIRCHWOOD PRACTICE J81087 6.1% POUNDBURY DOCTORS SURGERY J81082 6.0% CROSS ROAD SURGERY J81075 6.0% THE MEDICAL CENTRE (CORBIN AVE) J81621 6.0% WHITECLIFF GROUP PRACTICE J81019 6.0% WALFORD MILL MEDICAL CENTRE J81077 6.0% BRIDPORT MEDICAL CENTRE J81005 5.9% THE APPLES MEDICAL CENTRE J81029 5.8% FORDINGTON SURGERY J81626 5.8% JAMES FISHER MEDICAL CENTRE J81047 5.8% THE TOLLERFORD PRACTICE J81076 5.8% ST ALBANS MEDICAL CENTRE J81062 5.7% STOUR SURGERY J81066 5.7% CERNE ABBAS SURGERY J81053 5.7% QUARTERJACK SURGERY J81034 5.6% SOUTHBOURNE PRACTICE J81059 5.6% WESSEX ROAD SURGERY J81048 5.5% PUDDLETOWN SURGERY J81616 5.5% CHARMOUTH MEDICAL PRACTICE J81628 5.5% EVERGREEN OAK SURGERY J81086 5.5% THE DORCHESTER RD SURGERY J81613 5.4% LYME REGIS MEDICAL CENTRE Y03661 5.4% QUEENS AVENUE SURGERY J81016 5.4% MALTHOUSE MEADOWS SURGERY J81609 5.4% PARKSTONE HEALTH CENTRE J81012 5.3% WESTBOURNE MEDICAL CENTRE J81014 5.3% BARTON HOUSE MED PRACTICE J81074 5.2% LITTLEDOWN SURGERY J81067 5.2% THE PRINCE OF WALES SURGERY J81637 5.2% VILLAGE SURGERY J81042 5.1% BEAUFORT ROAD SURGERY J81018 5.1% BUTE HOUSE J81078 5.1% DENMARK ROAD MEDICAL CENTRE J81625 5.0% LYME BAY MEDICAL PRACTICE J81647 5.0% THE OLD DISPENSARY J81644 5.0% SHELLEY MANOR MEDICAL CENTRE J81021 5.0% CRESCENT SURGERY J81624 4.8% LILLIPUT SURGERY J81054 4.8% POOLE ROAD MEDICAL CENTRE J81004 4.6% ALMA PARTNERSHIP J81003 4.5% Note: The estimated number of undiagnosed PROVIDENCE SURGERY J81634 4.5% HOLDENHURST ROAD SURGERY J81024 4.4% TALBOT MEDICAL CENTRE J81033 3.6% THE PANTON PRACTICE J81072 3.6% people with diabetes has been calculated by BOSCOMBE MANOR MEDICAL CENTRE J81645 3.6% WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 2.5% multiplying the estimated prevalence rate to the 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 2015/16 QOF list size and subtracting the number of people on the diabetes register.

45 CVD: Primary Care Intelligence Packs Expected total prevalence of diabetes and non-diabetic hyperglycaemia

Diabetes prevalence Undiagnosed diabetes prevalence Expected non-diabetic hyperglycaemia prevalence

• the estimated total prevalence of diabetes in NHS Dorset CCG is 8.9% (diagnosed and undiagnosed) NHS Dorset CCG 6.1% 2.7% 12.1% • in addition, there are an estimated 12.1% of people in NHS Dorset CCG who are at increased risk of developing diabetes (i.e. with non- diabetic hyperglycaemia)

• this means that 20.9% of the population in NHS Dorset CCG are estimated to have diabetes, or at high risk of developing of diabetes

Note: Prevalence estimates of non-diabetic England 6.5% 1.9% 11.2% hyperglycaemia were developed using Health Survey for England (HSE) data. Five years of HSE data were combined, 2009- 2013. The estimates take into account the age, ethnic group and estimated body mass index of the population. 0% 5% 10% 15% 20% 25% These estimates were produced using the GP registered population.

46 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by CCG 2015/16

• data on care processes and treatment NHS Dorset CCG 59.2% targets are taken from the National Diabetes Audit (NDA) • overall practice participation in the 2015/16 audit was 81.4% in England

• in NHS Dorset CCG, 68 out of 98 practices (69.4%) participated in the NDA. Data is not available for the remaining practices

• 59.2% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS Dorset CCG, compared to 52.6% in England England 52.6%

0% 10% 20% 30% 40% 50% 60% 70%

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

THE ORCHARD SURGERY J81056 81.9% SANDFORD SURGERY J81631 81.6% TALBOT MEDICAL CENTRE J81033 80.3% YETMINSTER MEDICAL CENTRE J81017 80.2% THE HADLEIGH PRACTICE J81041 78.6% CERNE ABBAS SURGERY J81053 76.8% THE CRANBORNE PRACTICE J81058 76.7% THE ADAM PRACTICE J81006 76.3% THE DORCHESTER RD SURGERY J81613 75.3% • achievement - 8 care processes: in PUDDLETOWN SURGERY J81616 75.0% BUTE HOUSE J81078 74.8% WHITECLIFF GROUP PRACTICE J81019 73.9% WEST MOORS GROUP PRACTICE J81022 73.5% practices who provided data via the THE APPLES MEDICAL CENTRE J81029 73.2% STOUR SURGERY J81066 72.6% CORFE CASTLE SURGERY J81612 72.3% ABBOTSBURY ROAD SURGERY J81055 72.1% NDA, between 14.3% and 81.9% of NEWLAND SURGERY J81032 70.1% THE BRIDGES MEDICAL CTR. J81073 69.6% HIGHCLIFFE MEDICAL CENTRE J81028 69.5% BLACKMORE VALE PARTNERSHIP J81620 68.7% THE ROSEMARY HEALTH CTR J81036 68.7% patients received all 8 care processes JAMES FISHER MEDICAL CENTRE J81047 67.6% THE TOLLERFORD PRACTICE J81076 66.4% WAREHAM SURGERY J81011 66.3% GILLINGHAM MEDICAL PRACTICE J81081 65.7% THE PRINCE OF WALES SURGERY J81637 65.7% THE MARINE & OAKRIDGE PARTNERSHIP J81049 64.8% STALBRIDGE SURGERY J81040 64.2% POOLE TOWN SURGERY J81064 64.2% ROYAL CRESCENT SURGERY J81027 63.5% CROSS ROAD SURGERY J81075 63.4% • at least 11,711 people did not receive LILLIPUT SURGERY J81054 63.4% VILLAGE SURGERY J81042 63.0% NORTHBOURNE SURGERY J81038 61.9% DENMARK ROAD MEDICAL CENTRE J81625 60.2% the eight care processes SOUTHBOURNE PRACTICE J81059 59.5% THE MEDICAL CENTRE (CORBIN AVE) J81621 57.8% BOSCOMBE MANOR MEDICAL CENTRE J81645 57.6% THE WELLBRIDGE PRACTICE J81025 56.6% BEAUFORT ROAD SURGERY J81018 56.3% MILTON ABBAS SURGERY J81035 53.3% LYME BAY MEDICAL PRACTICE J81647 51.8% MADEIRA MEDICAL CENTRE J81065 51.0% WESTBOURNE MEDICAL CENTRE J81014 50.6% BARTON HOUSE MED PRACTICE J81074 50.6% THE HARVEY PRACTICE J81046 50.1% WYKE REGIS MEDICAL PRACTICE J81051 49.7% CHARMOUTH MEDICAL PRACTICE J81628 48.6% SWANAGE MEDICAL PRACTICE J81010 48.1% THE LANEHOUSE SURGERY J81090 48.1% KINSON ROAD MEDICAL CENTRE J81045 47.2% FARMHOUSE SURGERY J81057 47.2% CARLISLE HOUSE SURGERY J81052 45.7% THE BANKS & BEARWOOD MEDICAL CENTRE J81070 45.5% BERE REGIS SURGERY J81020 43.2% BRIDPORT MEDICAL CENTRE J81005 42.4% BURTON & BRANSGORE MEDICAL CENTRE J81050 39.8% HOLDENHURST ROAD SURGERY J81024 35.4% MALTHOUSE MEADOWS SURGERY J81609 34.8% POUNDBURY DOCTORS SURGERY J81082 33.5% HERBERT AVENUE J81632 24.5% SHELLEY MANOR MEDICAL CENTRE J81021 24.5% THE BARN SURGERY J81043 23.5% LYME REGIS MEDICAL CENTRE Y03661 22.0% PROVIDENCE SURGERY J81634 21.3% PENNY'S HILL PRACTICE J81061 16.8% EVERGREEN OAK SURGERY J81086 14.3% WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 DR NEWMAN J81648 GROVE SURGERY J81646 THE OLD DISPENSARY J81644 VILLAGE MEDICAL PRACTICE J81640 WOODLEA HOUSE SURGERY J81633 FORDINGTON SURGERY J81626 CRESCENT SURGERY J81624 THE BIRCHWOOD PRACTICE J81087 WALFORD MILL MEDICAL CENTRE J81077 THE PANTON PRACTICE J81072 LEYBOURNE SURGERY J81071 LONGFLEET HOUSE SURGERY J81069 ATRIUM HEALTH CENTRE J81068 LITTLEDOWN SURGERY J81067 DURDELLS AVENUE SURGERY J81063 ST ALBANS MEDICAL CENTRE J81062 WESSEX ROAD SURGERY J81048 HEATHERVIEW MEDICAL CTR. J81044 MOORDOWN MEDICAL CENTRE J81039 QUARTERJACK SURGERY J81034 EAGLE HOUSE SURGERY J81031 THE VERWOOD SURGERY J81030 QUEENS AVENUE SURGERY J81016 CANFORD HEATH GROUP PRACT J81013 PARKSTONE HEALTH CENTRE J81012 ROYAL MANOR HEALTH CARE J81009 POOLE ROAD MEDICAL CENTRE J81004 ALMA PARTNERSHIP J81003 ORCHID HOUSE SURGERY J81002 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

• 34.6% of people with diabetes (of NHS Dorset CCG 34.6% practices who participated in the audit) met the three treatment targets in NHS Dorset CCG, compared to 39.0% in England

England 39.0%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

49 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16

GP practice Average of practices in the CCG who participated in the audit

STALBRIDGE SURGERY J81040 46.1% POOLE TOWN SURGERY J81064 44.1% THE CRANBORNE PRACTICE J81058 44.1% ABBOTSBURY ROAD SURGERY J81055 43.7% WHITECLIFF GROUP PRACTICE J81019 43.6% BERE REGIS SURGERY J81020 43.5% FARMHOUSE SURGERY J81057 43.1% CARLISLE HOUSE SURGERY J81052 42.8% BARTON HOUSE MED PRACTICE J81074 41.8% • achievement - 3 treatment targets: in GILLINGHAM MEDICAL PRACTICE J81081 41.7% CROSS ROAD SURGERY J81075 41.4% WYKE REGIS MEDICAL PRACTICE J81051 41.1% HIGHCLIFFE MEDICAL CENTRE J81028 41.1% practices who provided data via the STOUR SURGERY J81066 40.1% WAREHAM SURGERY J81011 40.0% LYME BAY MEDICAL PRACTICE J81647 40.0% THE ORCHARD SURGERY J81056 39.7% NDA, between 19.7% and 46.1% of THE BRIDGES MEDICAL CTR. J81073 39.5% THE HARVEY PRACTICE J81046 37.8% WEST MOORS GROUP PRACTICE J81022 37.7% THE ROSEMARY HEALTH CTR J81036 37.7% SANDFORD SURGERY J81631 37.2% patients achieved all 3 treatment THE TOLLERFORD PRACTICE J81076 37.1% BLACKMORE VALE PARTNERSHIP J81620 36.6% CORFE CASTLE SURGERY J81612 36.6% LILLIPUT SURGERY J81054 36.3% targets THE LANEHOUSE SURGERY J81090 36.2% SWANAGE MEDICAL PRACTICE J81010 35.8% PENNY'S HILL PRACTICE J81061 35.4% THE APPLES MEDICAL CENTRE J81029 34.9% CERNE ABBAS SURGERY J81053 34.8% THE MARINE & OAKRIDGE PARTNERSHIP J81049 34.2% • at least 16,855 people did not meet BEAUFORT ROAD SURGERY J81018 34.2% KINSON ROAD MEDICAL CENTRE J81045 34.1% THE ADAM PRACTICE J81006 34.1% THE WELLBRIDGE PRACTICE J81025 34.0% the three treatment targets THE BANKS & BEARWOOD MEDICAL CENTRE J81070 33.9% BUTE HOUSE J81078 33.8% THE BARN SURGERY J81043 33.4% ROYAL CRESCENT SURGERY J81027 33.1% MADEIRA MEDICAL CENTRE J81065 32.9% NEWLAND SURGERY J81032 32.9% MILTON ABBAS SURGERY J81035 32.8% YETMINSTER MEDICAL CENTRE J81017 32.7% SOUTHBOURNE PRACTICE J81059 32.6% PUDDLETOWN SURGERY J81616 32.5% THE HADLEIGH PRACTICE J81041 31.9% JAMES FISHER MEDICAL CENTRE J81047 31.6% THE PRINCE OF WALES SURGERY J81637 31.5% POUNDBURY DOCTORS SURGERY J81082 30.8% LYME REGIS MEDICAL CENTRE Y03661 30.6% EVERGREEN OAK SURGERY J81086 29.4% MALTHOUSE MEADOWS SURGERY J81609 28.7% CHARMOUTH MEDICAL PRACTICE J81628 27.8% BRIDPORT MEDICAL CENTRE J81005 27.2% TALBOT MEDICAL CENTRE J81033 27.1% WESTBOURNE MEDICAL CENTRE J81014 26.3% VILLAGE SURGERY J81042 26.1% HOLDENHURST ROAD SURGERY J81024 25.5% SHELLEY MANOR MEDICAL CENTRE J81021 25.3% THE MEDICAL CENTRE (CORBIN AVE) J81621 24.6% PROVIDENCE SURGERY J81634 24.3% NORTHBOURNE SURGERY J81038 23.7% THE DORCHESTER RD SURGERY J81613 23.4% BURTON & BRANSGORE MEDICAL CENTRE J81050 22.0% HERBERT AVENUE J81632 21.6% DENMARK ROAD MEDICAL CENTRE J81625 21.0% BOSCOMBE MANOR MEDICAL CENTRE J81645 19.7% WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 DR NEWMAN J81648 GROVE SURGERY J81646 THE OLD DISPENSARY J81644 VILLAGE MEDICAL PRACTICE J81640 WOODLEA HOUSE SURGERY J81633 FORDINGTON SURGERY J81626 CRESCENT SURGERY J81624 THE BIRCHWOOD PRACTICE J81087 WALFORD MILL MEDICAL CENTRE J81077 THE PANTON PRACTICE J81072 LEYBOURNE SURGERY J81071 LONGFLEET HOUSE SURGERY J81069 ATRIUM HEALTH CENTRE J81068 LITTLEDOWN SURGERY J81067 DURDELLS AVENUE SURGERY J81063 ST ALBANS MEDICAL CENTRE J81062 WESSEX ROAD SURGERY J81048 HEATHERVIEW MEDICAL CTR. J81044 MOORDOWN MEDICAL CENTRE J81039 QUARTERJACK SURGERY J81034 EAGLE HOUSE SURGERY J81031 THE VERWOOD SURGERY J81030 QUEENS AVENUE SURGERY J81016 CANFORD HEATH GROUP PRACT J81013 PARKSTONE HEALTH CENTRE J81012 ROYAL MANOR HEALTH CARE J81009 POOLE ROAD MEDICAL CENTRE J81004 ALMA PARTNERSHIP J81003 ORCHID HOUSE SURGERY J81002 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

5% 0% -5% -10% -15% -20% -25% -30%

BOSCOMBE MANOR MEDICAL CENTRE 20

DENMARK ROAD MEDICAL CENTRE 59

HERBERT AVENUE 44 • using the GP cluster method of BURTON & BRANSGORE MEDICAL CENTRE 93 calculating potential gains, if each SHELLEY MANOR MEDICAL CENTRE 86 practice was to achieve as well as the THE DORCHESTER RD SURGERY 46 upper quartile of its national cluster, then an additional 2,565 people would NORTHBOURNE SURGERY 54 be treated VILLAGE SURGERY 81

THE MEDICAL CENTRE (CORBIN AVE) 55

PROVIDENCE SURGERY 53

CARLISLE HOUSE SURGERY 8

GILLINGHAM MEDICAL PRACTICE 17

BARTON HOUSE MED PRACTICE 6

BERE REGIS SURGERY 3

FARMHOUSE SURGERY 3

WHITECLIFF GROUP PRACTICE 4

ABBOTSBURY ROAD SURGERY 2

THE CRANBORNE PRACTICE 1

POOLE TOWN SURGERY

STALBRIDGE 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 Dorset CCG 0.74 • the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney disease is 0.74. This compares to 0.68 for England • this suggests that 74% of people with chronic kidney disease have been diagnosed

Note: This slide compares the prevalence of CKD recorded in QOF in 2015/16 to the expected England 0.68 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 people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.

54 CVD: Primary Care Intelligence Packs Chronic kidney disease (CKD) observed prevalence (2015/16) compared with expected prevalence (2011) by CCG Comparison with demographically similar CCGs

NHS Gloucestershire CCG 0.98

NHS Southern Derbyshire CCG 0.81

NHS Dorset CCG 0.74

NHS Kernow CCG 0.72

NHS Cumbria CCG 0.71

NHS Northern, Eastern and Western Devon CCG 0.67

NHS Somerset CCG 0.64

NHS Wiltshire CCG 0.61

NHS Coastal West Sussex CCG 0.58

NHS Cambridgeshire and Peterborough CCG 0.51

NHS West Hampshire CCG 0.50

0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio

55 CVD: Primary Care Intelligence Packs CKD prevalence by GP practice, 2015/16

GP practice CCG

SANDFORD SURGERY J81631 13.4% THE HARVEY PRACTICE J81046 10.4% THE HADLEIGH PRACTICE J81041 10.3% SWANAGE MEDICAL PRACTICE J81010 10.1% WALFORD MILL MEDICAL CENTRE J81077 9.3% KINSON ROAD MEDICAL CENTRE J81045 8.4% LILLIPUT SURGERY J81054 8.2% THE ROSEMARY HEALTH CTR J81036 8.1% BRIDPORT MEDICAL CENTRE J81005 8.1% THE ADAM PRACTICE J81006 8.1% POOLE ROAD MEDICAL CENTRE J81004 8.0% MOORDOWN MEDICAL CENTRE J81039 7.9% • it is estimated that there are 13,203 THE MARINE & OAKRIDGE PARTNERSHIP J81049 7.9% ORCHID HOUSE SURGERY J81002 7.7% WAREHAM SURGERY J81011 7.7% PENNY'S HILL PRACTICE J81061 7.7% people with undiagnosed chronic YETMINSTER MEDICAL CENTRE J81017 7.3% THE ORCHARD SURGERY J81056 7.2% THE BRIDGES MEDICAL CTR. J81073 7.1% THE BIRCHWOOD PRACTICE J81087 7.0% BERE REGIS SURGERY J81020 6.9% kidney disease in NHS Dorset CCG LEYBOURNE SURGERY J81071 6.9% THE WELLBRIDGE PRACTICE J81025 6.9% NORTHBOURNE SURGERY J81038 6.9% STOUR SURGERY J81066 6.9% • GP practice range of observed CKD: WOODLEA HOUSE SURGERY J81633 6.7% WEST MOORS GROUP PRACTICE J81022 6.7% WESSEX ROAD SURGERY J81048 6.4% WESTBOURNE MEDICAL CENTRE J81014 6.4% 1.5% to 13.4% HIGHCLIFFE MEDICAL CENTRE J81028 6.4% THE APPLES MEDICAL CENTRE J81029 6.3% FORDINGTON SURGERY J81626 6.3% THE VERWOOD SURGERY J81030 6.2% WYKE REGIS MEDICAL PRACTICE J81051 6.2% STALBRIDGE SURGERY J81040 5.8% BLACKMORE VALE PARTNERSHIP J81620 5.8% ABBOTSBURY ROAD SURGERY J81055 5.8% THE DORCHESTER RD SURGERY J81613 5.7% HERBERT AVENUE J81632 5.7% PARKSTONE HEALTH CENTRE J81012 5.7% ST ALBANS MEDICAL CENTRE J81062 5.6% THE BARN SURGERY J81043 5.6% NEWLAND SURGERY J81032 5.5% WHITECLIFF GROUP PRACTICE J81019 5.5% SOUTHBOURNE PRACTICE J81059 5.5% MADEIRA MEDICAL CENTRE J81065 5.5% SHELLEY MANOR MEDICAL CENTRE J81021 5.4% CANFORD HEATH GROUP PRACT J81013 5.3% THE TOLLERFORD PRACTICE J81076 5.3% THE LANEHOUSE SURGERY J81090 5.3% DURDELLS AVENUE SURGERY J81063 5.1% THE PRINCE OF WALES SURGERY J81637 5.0% ROYAL MANOR HEALTH CARE J81009 5.0% ATRIUM HEALTH CENTRE J81068 5.0% GROVE SURGERY J81646 5.0% CORFE CASTLE SURGERY J81612 5.0% LONGFLEET HOUSE SURGERY J81069 4.9% BEAUFORT ROAD SURGERY J81018 4.9% DENMARK ROAD MEDICAL CENTRE J81625 4.9% CROSS ROAD SURGERY J81075 4.8% BURTON & BRANSGORE MEDICAL CENTRE J81050 4.8% MILTON ABBAS SURGERY J81035 4.7% THE MEDICAL CENTRE (CORBIN AVE) J81621 4.6% CARLISLE HOUSE SURGERY J81052 4.6% ROYAL CRESCENT SURGERY J81027 4.4% CHARMOUTH MEDICAL PRACTICE J81628 4.4% LITTLEDOWN SURGERY J81067 4.4% MALTHOUSE MEADOWS SURGERY J81609 4.3% POUNDBURY DOCTORS SURGERY J81082 4.2% QUARTERJACK SURGERY J81034 4.2% FARMHOUSE SURGERY J81057 4.1% THE BANKS & BEARWOOD MEDICAL CENTRE J81070 4.1% THE PANTON PRACTICE J81072 4.0% BARTON HOUSE MED PRACTICE J81074 4.0% JAMES FISHER MEDICAL CENTRE J81047 3.9% GILLINGHAM MEDICAL PRACTICE J81081 3.7% HEATHERVIEW MEDICAL CTR. J81044 3.7% LYME BAY MEDICAL PRACTICE J81647 3.7% BUTE HOUSE J81078 3.5% LYME REGIS MEDICAL CENTRE Y03661 3.5% POOLE TOWN SURGERY J81064 3.4% THE OLD DISPENSARY J81644 3.2% HOLDENHURST ROAD SURGERY J81024 3.0% EVERGREEN OAK SURGERY J81086 2.9% THE CRANBORNE PRACTICE J81058 2.9% ALMA PARTNERSHIP J81003 2.8% Note: CCG estimates for the estimated EAGLE HOUSE SURGERY J81031 2.8% PROVIDENCE SURGERY J81634 2.6% CERNE ABBAS SURGERY J81053 2.6% BOSCOMBE MANOR MEDICAL CENTRE J81645 2.5% number of people with CKD are based on CRESCENT SURGERY J81624 2.4% VILLAGE SURGERY J81042 2.2% WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 2.2% applying a proportion from a resident based VILLAGE MEDICAL PRACTICE J81640 2.1% TALBOT MEDICAL CENTRE J81033 1.8% DR NEWMAN J81648 1.7% PUDDLETOWN SURGERY J81616 1.6% population estimate to a GP registered QUEENS AVENUE SURGERY J81016 1.5% population. The characteristics of registered 0% 2% 4% 6% 8% 10% 12% 14% 16% 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

• 35,463 people with CKD (diagnosed*) NHS Dorset CCG 72.9% in NHS Dorset CCG • 25,847 (72.9%) people whose blood pressure is <= 140 /85 • 4,222 (11.9%) people who are exceptions • 5,394 (15.2%) additional people whose blood pressure is not <= 140 / 85

England 74.4%

*Using the QOF clinical indicator CKD002 denominator plus exceptions. Note: as the CKD002 indicator was removed from 0% 20% 40% 60% 80% 100% the QOF in 15/16 this is historic data taken from the 2014/15 QOF.

57 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less by CCG, 2014/15 Comparison with demographically similar CCGs Below 140/85 Not below 140/85 Exceptions reported

NHS Cumbria CCG 74.4%

NHS Gloucestershire CCG 74.4%

NHS Wiltshire CCG 73.3%

NHS Dorset CCG 72.9%

NHS Southern Derbyshire CCG 72.7%

NHS Kernow CCG 72.5%

NHS Cambridgeshire and Peterborough CCG 71.5%

NHS Northern, Eastern and Western Devon CCG 71.1%

NHS West Hampshire CCG 69.6%

NHS Coastal West Sussex CCG 68.6%

NHS Somerset CCG 67.3%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

58 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2014/15

Not below 140/85 Exceptions reported

BOSCOMBE MANOR MEDICAL CENTRE J81645 39 DENMARK ROAD MEDICAL CENTRE J81625 161 SHELLEY MANOR MEDICAL CENTRE J81021 213 NORTHBOURNE SURGERY J81038 134 BRIDPORT MEDICAL CENTRE J81005 297 WESTBOURNE MEDICAL CENTRE J81014 350 ORCHID HOUSE SURGERY J81002 240 THE BANKS MEDICAL PRACTICE J81070 89 WEST MOORS GROUP PRACTICE J81022 121 BURTON & BRANSGORE MEDICAL CENTRES J81050 136 WESSEX ROAD SURGERY J81048 90 DR J CLARK AND PARTNERS J81010 337 EVERGREEN OAK SURGERY J81086 42 • in total, including exceptions, there HERBERT AVENUE J81632 52 MADEIRA MEDICAL CENTRE J81065 134 THE WELLBRIDGE PRACTICE J81025 115 DR SAWYER & PTNS J81072 136 are 9,616 people whose blood PARKSTONE HEALTH CENTRE J81012 144 PROVIDENCE SURGERY J81634 63 NEWLAND SURGERY J81032 83 BUTE HOUSE SURGERY J81078 49 pressure is not <= 140 / 85 QUARTERJACK SURGERY J81034 127 HOLDENHURST ROAD SURGERY J81024 79 HEATHERVIEW MEDICAL CTR. J81044 95 JAMES FISHER MEDICAL CENTRE J81047 126 • GP practice range: 10.0% to 56.5% DR NEWMAN J81648 13 QUEENS AVENUE SURGERY J81016 25 HIGHCLIFFE MEDICAL CENTRE J81028 186 YETMINSTER HEALTH CENTRE J81017 68 CANFORD HEATH GROUP PRACTICE J81013 155 STOUR SURGERY J81066 164 MALTHOUSE MEADOWS SURGERY J81609 33 ORCHARD SURGERY J81056 132 LILLIPUT SURGERY J81054 194 THE DORCHESTER RD SURGERY J81613 68 THE ADAM PRACTICE J81006 547 THE PRINCE OF WALES SURGERY J81637 66 ROYAL MANOR HEALTH CARE J81009 150 THE MEDICAL CENTRE (CORBIN AVE) J81621 62 MILTON ABBAS SURGERY J81035 40 VILLAGE SURGERY J81042 53 POOLE TOWN SURGERY J81064 30 WOODLEA HOUSE SURGERY J81633 56 FORDINGTON SURGERY J81626 57 ROYAL CRESCENT SURGERY J81027 186 ABBEY VIEW MEDICAL CENTRE J81026 163 FARMHOUSE SURGERY J81057 59 PENNYS HILL PRACTICE J81061 157 ATRIUM HEALTH CENTRE J81068 80 WALFORD MILL MEDICAL CENTRE J81077 116 POOLE ROAD MEDICAL CENTRE J81004 162 WAREHAM HEALTH CENTRE J81011 115 TALBOT MEDICAL CENTRE J81033 75 THE HADLEIGH PRACTICE J81041 367 MARINE AND OAKRIDGE SURGERIES J81049 144 CORNWALL ROAD MED PRACT J81082 53 BLACKMORE VALE PARTNERSHIP J81620 145 ALMA PARTNERSHIP J81003 53 BRIDGES MEDICAL CENTRE J81073 165 CHARMOUTH MEDICAL PRACTICE J81628 22 BEAUFORT ROAD SURGERY J81018 103 MOORDOWN MEDICAL CENTRE J81039 116 CERNE ABBAS SURGERY J81053 19 SOUTHBOURNE PRACTICE J81059 84 THE BARN SURGERY J81043 76 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 2 BARTON HOUSE MEDICAL PRACTICE J81074 39 ST ALBANS MEDICAL CENTRE J81062 105 THE BIRCHWOOD PRACTICE J81087 46 BROADMAYNE SURGERY J81623 21 CROSS ROAD SURGERY J81075 42 CORFE CASTLE SURGERY J81612 20 LONGFLEET HOUSE SURGERY J81069 38 WYKE REGIS MEDICAL PRACTICE J81051 79 LITTLEDOWN SURGERY J81067 22 WHITE CLIFF MILL STREET SURGERY J81019 144 THE LANEHOUSE SURGERY J81090 28 CARLISLE HOUSE J81052 40 THE CRANBORNE PRACTICE J81058 45 THE VERWOOD SURGERY J81030 79 THE HARVEY PRACTICE J81046 175 THE APPLES MEDICAL CENTRE J81029 52 THE ROSEMARY HEALTH CTR J81036 84 GILLINGHAM MEDICAL PRACTICE J81081 61 MAIDEN NEWTON AND BEAMINSTER PRACTICE J81076 48 EAGLE HOUSE SURGERY J81031 31 DURDELLS AVENUE SURGERY J81063 21 KINSON ROAD SURGERY J81045 100 LYME BAY SURGERY J81647 13 SANDFORD SURGERY J81631 38 LEYBOURNE SURGERY J81071 35 GROVE SURGERY J81646 34 BERE REGIS PRACTICE J81020 30 VILLAGE MEDICAL PRACTICE J81640 5 ABBOTSBURY ROAD SURGERY J81055 68 THE OLD DISPENSARY J81644 9 STALBRIDGE SURGERY J81040 28 PUDDLETOWN SURGERY J81616 6 LYME REGIS MEDICAL CENTRE Y03661 12 CRESCENT SURGERY J81624 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

20% 10% 0% -10% -20% -30% -40% -50%

BOSCOMBE MANOR MEDICAL CENTRE 27

DENMARK ROAD MEDICAL CENTRE 107

SHELLEY MANOR MEDICAL CENTRE 134 • using the GP cluster method of NORTHBOURNE SURGERY 74 calculating potential gains, if each THE BANKS MEDICAL PRACTICE 46 practice was to achieve as well as the WESSEX ROAD SURGERY 45 upper quartile of its national cluster, then an additional 2,658 people would WESTBOURNE MEDICAL CENTRE 162 be treated BRIDPORT MEDICAL CENTRE 135

ORCHID HOUSE SURGERY 111

WEST MOORS GROUP PRACTICE 55

BERE REGIS PRACTICE

LYME BAY SURGERY

KINSON ROAD SURGERY

THE OLD DISPENSARY

STALBRIDGE SURGERY

VILLAGE MEDICAL PRACTICE

CRESCENT SURGERY

PUDDLETOWN SURGERY

ABBOTSBURY ROAD SURGERY

LYME REGIS MEDICAL CENTRE 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

• 35,459 people with CKD (diagnosed*) NHS Dorset CCG 73.1% in NHS Dorset CCG • 25,916 (73.1%) people who have a record of urine albumin:creatinine ratio test • 3,479 (9.8%) people who are exceptions • 6,064 (17.1%) additional people who have no record of urine albumin:creatinine ratio test

England 75.4%

*Using the QOF clinical indicator CKD004 denominator plus exceptions. Note: as the CKD004 indicator was removed from the QOF in 15/16 this is historic data 0% 20% 40% 60% 80% 100% taken from the 2014/15 QOF.

61 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with demographically similar CCGs Recorded Not recorded Exceptions reported

NHS Southern Derbyshire CCG 78.6%

NHS Kernow CCG 77.0%

NHS Cumbria CCG 76.9%

NHS Northern, Eastern and Western Devon CCG 75.8%

NHS Gloucestershire CCG 74.1%

NHS Wiltshire CCG 73.9%

NHS Cambridgeshire and Peterborough CCG 73.7%

NHS Dorset CCG 73.1%

NHS West Hampshire CCG 71.2%

NHS Coastal West Sussex CCG 67.4%

NHS Somerset CCG 61.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

62 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes do not have a record of a urine albumin: creatinine ratio test in the preceding 12 months by GP practice, 2014/15

Not recorded Exceptions reported

EVERGREEN OAK SURGERY J81086 113 BURTON & BRANSGORE MEDICAL CENTRES J81050 243 THE BARN SURGERY J81043 219 CORNWALL ROAD MED PRACT J81082 138 ORCHID HOUSE SURGERY J81002 384 BOSCOMBE MANOR MEDICAL CENTRE J81645 36 MILTON ABBAS SURGERY J81035 72 CRESCENT SURGERY J81624 24 BARTON HOUSE MEDICAL PRACTICE J81074 82 QUEENS AVENUE SURGERY J81016 39 HIGHCLIFFE MEDICAL CENTRE J81028 258 HEATHERVIEW MEDICAL CTR. J81044 127 PARKSTONE HEALTH CENTRE J81012 185 • in total, including exceptions, there THE LANEHOUSE SURGERY J81090 57 SHELLEY MANOR MEDICAL CENTRE J81021 184 MALTHOUSE MEADOWS SURGERY J81609 44 DR SAWYER & PTNS J81072 169 are 9,543 people who have no record NORTHBOURNE SURGERY J81038 129 BRIDGES MEDICAL CENTRE J81073 260 QUARTERJACK SURGERY J81034 153 WESTBOURNE MEDICAL CENTRE J81014 326 of urine albumin:creatinine ratio test THE MEDICAL CENTRE (CORBIN AVE) J81621 77 BEAUFORT ROAD SURGERY J81018 153 THE WELLBRIDGE PRACTICE J81025 125 CHARMOUTH MEDICAL PRACTICE J81628 32 • GP practice range: 0.0% to 95.0% CARLISLE HOUSE J81052 71 WEST MOORS GROUP PRACTICE J81022 108 WYKE REGIS MEDICAL PRACTICE J81051 129 ALMA PARTNERSHIP J81003 71 POOLE TOWN SURGERY J81064 35 PROVIDENCE SURGERY J81634 66 LYME REGIS MEDICAL CENTRE Y03661 37 VILLAGE SURGERY J81042 61 LONGFLEET HOUSE SURGERY J81069 58 MARINE AND OAKRIDGE SURGERIES J81049 184 HERBERT AVENUE J81632 45 DENMARK ROAD MEDICAL CENTRE J81625 94 WESSEX ROAD SURGERY J81048 71 ABBEY VIEW MEDICAL CENTRE J81026 175 FARMHOUSE SURGERY J81057 64 THE HADLEIGH PRACTICE J81041 415 ORCHARD SURGERY J81056 124 WALFORD MILL MEDICAL CENTRE J81077 123 GROVE SURGERY J81646 59 ATRIUM HEALTH CENTRE J81068 81 MADEIRA MEDICAL CENTRE J81065 108 BRIDPORT MEDICAL CENTRE J81005 189 PENNYS HILL PRACTICE J81061 152 KINSON ROAD SURGERY J81045 143 BERE REGIS PRACTICE J81020 51 WAREHAM HEALTH CENTRE J81011 111 SOUTHBOURNE PRACTICE J81059 88 YETMINSTER HEALTH CENTRE J81017 55 CANFORD HEATH GROUP PRACTICE J81013 125 CROSS ROAD SURGERY J81075 46 ROYAL CRESCENT SURGERY J81027 159 FORDINGTON SURGERY J81626 48 LILLIPUT SURGERY J81054 148 POOLE ROAD MEDICAL CENTRE J81004 140 THE BANKS MEDICAL PRACTICE J81070 51 ABBOTSBURY ROAD SURGERY J81055 105 WOODLEA HOUSE SURGERY J81633 43 THE DORCHESTER RD SURGERY J81613 50 DR J CLARK AND PARTNERS J81010 197 PUDDLETOWN SURGERY J81616 11 SANDFORD SURGERY J81631 47 HOLDENHURST ROAD SURGERY J81024 53 JAMES FISHER MEDICAL CENTRE J81047 84 STOUR SURGERY J81066 111 MAIDEN NEWTON AND BEAMINSTER PRACTICE J81076 54 THE ROSEMARY HEALTH CTR J81036 91 LYME BAY SURGERY J81647 15 CERNE ABBAS SURGERY J81053 16 GILLINGHAM MEDICAL PRACTICE J81081 65 THE APPLES MEDICAL CENTRE J81029 54 THE VERWOOD SURGERY J81030 80 THE PRINCE OF WALES SURGERY J81637 42 STALBRIDGE SURGERY J81040 39 ST ALBANS MEDICAL CENTRE J81062 80 DR NEWMAN J81648 7 LITTLEDOWN SURGERY J81067 17 THE ADAM PRACTICE J81006 291 TALBOT MEDICAL CENTRE J81033 44 BLACKMORE VALE PARTNERSHIP J81620 87 LEYBOURNE SURGERY J81071 33 NEWLAND SURGERY J81032 39 VILLAGE MEDICAL PRACTICE J81640 5 DURDELLS AVENUE SURGERY J81063 17 THE BIRCHWOOD PRACTICE J81087 29 THE HARVEY PRACTICE J81046 125 ROYAL MANOR HEALTH CARE J81009 71 WHITE CLIFF MILL STREET SURGERY J81019 96 CORFE CASTLE SURGERY J81612 12 THE CRANBORNE PRACTICE J81058 29 BUTE HOUSE SURGERY J81078 17 EAGLE HOUSE SURGERY J81031 17 MOORDOWN MEDICAL CENTRE J81039 46 BROADMAYNE SURGERY J81623 9 THE OLD DISPENSARY J81644 1 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 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 Dorset CCG 0.91% • prevalence of 0.91% in NHS Dorset CCG compared to 0.76% in England

England 0.76%

0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9% 1.0%

66 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with demographically similar CCGs

NHS Cumbria CCG 1.13%

NHS Kernow CCG 1.03%

NHS Southern Derbyshire CCG 0.92%

NHS Dorset CCG 0.91%

NHS Somerset CCG 0.89%

NHS Coastal West Sussex CCG 0.88%

NHS Northern, Eastern and Western Devon CCG 0.88%

NHS Wiltshire CCG 0.86%

NHS West Hampshire CCG 0.78%

NHS Gloucestershire CCG 0.77%

NHS Cambridgeshire and Peterborough CCG 0.61%

0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%

67 CVD: Primary Care Intelligence Packs Heart failure prevalence by GP practice

GP practice CCG

MOORDOWN MEDICAL CENTRE J81039 2.4% THE VERWOOD SURGERY J81030 1.8% STALBRIDGE SURGERY J81040 1.7% WEST MOORS GROUP PRACTICE J81022 1.7% THE ADAM PRACTICE J81006 1.5% WESTBOURNE MEDICAL CENTRE J81014 1.5% LEYBOURNE SURGERY J81071 1.5% POOLE ROAD MEDICAL CENTRE J81004 1.4% HIGHCLIFFE MEDICAL CENTRE J81028 1.4% BEAUFORT ROAD SURGERY J81018 1.4% MALTHOUSE MEADOWS SURGERY J81609 1.4% CHARMOUTH MEDICAL PRACTICE J81628 1.4% • 7,151 people with diagnosed heart PENNY'S HILL PRACTICE J81061 1.3% LONGFLEET HOUSE SURGERY J81069 1.3% NORTHBOURNE SURGERY J81038 1.2% POOLE TOWN SURGERY J81064 1.2% failure in NHS Dorset CCG THE HADLEIGH PRACTICE J81041 1.2% THE HARVEY PRACTICE J81046 1.2% CORFE CASTLE SURGERY J81612 1.1% SWANAGE MEDICAL PRACTICE J81010 1.1% KINSON ROAD MEDICAL CENTRE J81045 1.1% • GP practice range: 0.3% to 2.4% LYME BAY MEDICAL PRACTICE J81647 1.1% BRIDPORT MEDICAL CENTRE J81005 1.0% GROVE SURGERY J81646 1.0% THE ORCHARD SURGERY J81056 1.0% ROYAL CRESCENT SURGERY J81027 1.0% WAREHAM SURGERY J81011 1.0% HERBERT AVENUE J81632 1.0% ATRIUM HEALTH CENTRE J81068 1.0% SOUTHBOURNE PRACTICE J81059 0.9% THE BARN SURGERY J81043 0.9% THE MARINE & OAKRIDGE PARTNERSHIP J81049 0.9% ST ALBANS MEDICAL CENTRE J81062 0.9% LILLIPUT SURGERY J81054 0.9% LITTLEDOWN SURGERY J81067 0.9% BERE REGIS SURGERY J81020 0.9% GILLINGHAM MEDICAL PRACTICE J81081 0.9% POUNDBURY DOCTORS SURGERY J81082 0.9% NEWLAND SURGERY J81032 0.9% BLACKMORE VALE PARTNERSHIP J81620 0.9% CROSS ROAD SURGERY J81075 0.9% THE BRIDGES MEDICAL CTR. J81073 0.9% THE ROSEMARY HEALTH CTR J81036 0.9% ROYAL MANOR HEALTH CARE J81009 0.9% QUARTERJACK SURGERY J81034 0.9% WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 0.9% FARMHOUSE SURGERY J81057 0.9% ORCHID HOUSE SURGERY J81002 0.9% THE TOLLERFORD PRACTICE J81076 0.8% FORDINGTON SURGERY J81626 0.8% MILTON ABBAS SURGERY J81035 0.8% THE MEDICAL CENTRE (CORBIN AVE) J81621 0.8% WESSEX ROAD SURGERY J81048 0.8% THE LANEHOUSE SURGERY J81090 0.8% SHELLEY MANOR MEDICAL CENTRE J81021 0.8% DURDELLS AVENUE SURGERY J81063 0.8% WYKE REGIS MEDICAL PRACTICE J81051 0.8% EAGLE HOUSE SURGERY J81031 0.8% WOODLEA HOUSE SURGERY J81633 0.8% VILLAGE MEDICAL PRACTICE J81640 0.8% BUTE HOUSE J81078 0.8% CERNE ABBAS SURGERY J81053 0.8% CARLISLE HOUSE SURGERY J81052 0.7% BURTON & BRANSGORE MEDICAL CENTRE J81050 0.7% STOUR SURGERY J81066 0.7% MADEIRA MEDICAL CENTRE J81065 0.7% THE APPLES MEDICAL CENTRE J81029 0.7% THE OLD DISPENSARY J81644 0.7% THE DORCHESTER RD SURGERY J81613 0.7% WHITECLIFF GROUP PRACTICE J81019 0.7% EVERGREEN OAK SURGERY J81086 0.7% JAMES FISHER MEDICAL CENTRE J81047 0.7% THE BIRCHWOOD PRACTICE J81087 0.7% THE CRANBORNE PRACTICE J81058 0.6% THE WELLBRIDGE PRACTICE J81025 0.6% THE PRINCE OF WALES SURGERY J81637 0.6% VILLAGE SURGERY J81042 0.6% QUEENS AVENUE SURGERY J81016 0.6% HOLDENHURST ROAD SURGERY J81024 0.6% YETMINSTER MEDICAL CENTRE J81017 0.6% CRESCENT SURGERY J81624 0.6% DR NEWMAN J81648 0.6% PARKSTONE HEALTH CENTRE J81012 0.6% SANDFORD SURGERY J81631 0.5% BARTON HOUSE MED PRACTICE J81074 0.5% ALMA PARTNERSHIP J81003 0.5% HEATHERVIEW MEDICAL CTR. J81044 0.5% PROVIDENCE SURGERY J81634 0.5% THE PANTON PRACTICE J81072 0.5% ABBOTSBURY ROAD SURGERY J81055 0.5% CANFORD HEATH GROUP PRACT J81013 0.5% DENMARK ROAD MEDICAL CENTRE J81625 0.5% LYME REGIS MEDICAL CENTRE Y03661 0.5% THE BANKS & BEARWOOD MEDICAL CENTRE J81070 0.5% WALFORD MILL MEDICAL CENTRE J81077 0.4% PUDDLETOWN SURGERY J81616 0.4% TALBOT MEDICAL CENTRE J81033 0.4% BOSCOMBE MANOR MEDICAL CENTRE J81645 0.3% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0%

68 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with CCGs in the STP Treatment No treatment Exceptions reported

• 2,234 people with heart failure* with NHS Dorset CCG 80.8% LVSD in NHS Dorset CCG • 1,805 (80.8%) people treated with ACE-I or ARB • 427 (19.1%) people who are exceptions • 2 (0.1%) additional people who are not treated with ACE-I or ARB

England 84.7%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF003 denominator plus exceptions

69 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported

NHS Cumbria CCG 86.5%

NHS Gloucestershire CCG 85.4%

NHS Wiltshire CCG 85.0%

NHS West Hampshire CCG 84.0%

NHS Northern, Eastern and Western Devon CCG 82.6%

NHS Kernow CCG 81.0%

NHS Southern Derbyshire CCG 80.8%

NHS Dorset CCG 80.8%

NHS Somerset CCG 80.1%

NHS Cambridgeshire and Peterborough CCG 80.1%

NHS Coastal West Sussex CCG 79.4%

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

PARKSTONE HEALTH CENTRE J81012 2 BERE REGIS SURGERY J81020 2 THE LANEHOUSE SURGERY J81090 2 FORDINGTON SURGERY J81626 4 POOLE ROAD MEDICAL CENTRE J81004 14 THE PANTON PRACTICE J81072 4 SWANAGE MEDICAL PRACTICE J81010 26 BEAUFORT ROAD SURGERY J81018 6 THE MARINE & OAKRIDGE PARTNERSHIP J81049 5 BURTON & BRANSGORE MEDICAL CENTRE J81050 1 DURDELLS AVENUE SURGERY J81063 1 WOODLEA HOUSE SURGERY J81633 3 • in total, including exceptions, there PROVIDENCE SURGERY J81634 3 WESSEX ROAD SURGERY J81048 8 NORTHBOURNE SURGERY J81038 10 YETMINSTER MEDICAL CENTRE J81017 2 are 429 people who are not treated SHELLEY MANOR MEDICAL CENTRE J81021 8 SOUTHBOURNE PRACTICE J81059 14 THE MEDICAL CENTRE (CORBIN AVE) J81621 2 THE BARN SURGERY J81043 5 WAREHAM SURGERY J81011 2 with ACE-I or ARB QUEENS AVENUE SURGERY J81016 1 LILLIPUT SURGERY J81054 9 THE CRANBORNE PRACTICE J81058 4 GROVE SURGERY J81646 2 • GP practice range: 0.0% to 50.0% PENNY'S HILL PRACTICE J81061 8 HERBERT AVENUE J81632 6 DENMARK ROAD MEDICAL CENTRE J81625 5 LITTLEDOWN SURGERY J81067 4 QUARTERJACK SURGERY J81034 7 THE ADAM PRACTICE J81006 86 JAMES FISHER MEDICAL CENTRE J81047 8 WESTBOURNE MEDICAL CENTRE J81014 26 KINSON ROAD MEDICAL CENTRE J81045 8 THE HADLEIGH PRACTICE J81041 10 MILTON ABBAS SURGERY J81035 1 THE ROSEMARY HEALTH CTR J81036 1 HEATHERVIEW MEDICAL CTR. J81044 1 POOLE TOWN SURGERY J81064 2 THE TOLLERFORD PRACTICE J81076 1 EVERGREEN OAK SURGERY J81086 2 CORFE CASTLE SURGERY J81612 1 ST ALBANS MEDICAL CENTRE J81062 4 ABBOTSBURY ROAD SURGERY J81055 6 POUNDBURY DOCTORS SURGERY J81082 3 WEST MOORS GROUP PRACTICE J81022 5 WHITECLIFF GROUP PRACTICE J81019 3 MADEIRA MEDICAL CENTRE J81065 3 THE APPLES MEDICAL CENTRE J81029 1 WALFORD MILL MEDICAL CENTRE J81077 1 BOSCOMBE MANOR MEDICAL CENTRE J81645 1 THE VERWOOD SURGERY J81030 5 THE HARVEY PRACTICE J81046 3 TALBOT MEDICAL CENTRE J81033 1 THE ORCHARD SURGERY J81056 4 CHARMOUTH MEDICAL PRACTICE J81628 1 DR NEWMAN J81648 1 BRIDPORT MEDICAL CENTRE J81005 12 CANFORD HEATH GROUP PRACT J81013 1 HOLDENHURST ROAD SURGERY J81024 1 STOUR SURGERY J81066 2 ATRIUM HEALTH CENTRE J81068 1 THE BRIDGES MEDICAL CTR. J81073 1 BARTON HOUSE MED PRACTICE J81074 1 BUTE HOUSE J81078 2 VILLAGE SURGERY J81042 4 ROYAL CRESCENT SURGERY J81027 8 WYKE REGIS MEDICAL PRACTICE J81051 5 HIGHCLIFFE MEDICAL CENTRE J81028 4 BLACKMORE VALE PARTNERSHIP J81620 4 MOORDOWN MEDICAL CENTRE J81039 15 CERNE ABBAS SURGERY J81053 2 GILLINGHAM MEDICAL PRACTICE J81081 2 EAGLE HOUSE SURGERY J81031 3 FARMHOUSE SURGERY J81057 1 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 1 ORCHID HOUSE SURGERY J81002 ALMA PARTNERSHIP J81003 ROYAL MANOR HEALTH CARE J81009 THE WELLBRIDGE PRACTICE J81025 NEWLAND SURGERY J81032 STALBRIDGE SURGERY J81040 CARLISLE HOUSE SURGERY J81052 LONGFLEET HOUSE SURGERY J81069 LEYBOURNE SURGERY J81071 CROSS ROAD SURGERY J81075 THE BIRCHWOOD PRACTICE J81087 MALTHOUSE MEADOWS SURGERY J81609 THE DORCHESTER RD SURGERY J81613 PUDDLETOWN SURGERY J81616 CRESCENT SURGERY J81624 SANDFORD SURGERY J81631 THE PRINCE OF WALES SURGERY J81637 THE OLD DISPENSARY J81644 LYME BAY MEDICAL PRACTICE J81647 LYME REGIS MEDICAL CENTRE Y03661 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 VILLAGE MEDICAL PRACTICE J81640 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

• 1,805 people with heart failure* with NHS Dorset CCG 76.5% LVSD treated with ACE-I/ARB in NHS Dorset CCG • 1,381 (76.5%) people treated with ACE-I/ARB and BB • 304 (16.8%) people who are exceptions • 120 (6.6%) additional people who are not treated with ACE-I/ARB and BB

England 77.7%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF004 denominator plus exceptions

72 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported

NHS Cumbria CCG 77.4%

NHS West Hampshire CCG 77.4%

NHS Dorset CCG 76.5%

NHS Gloucestershire CCG 75.9%

NHS Coastal West Sussex CCG 73.8%

NHS Kernow CCG 73.4%

NHS Somerset CCG 72.5%

NHS Southern Derbyshire CCG 72.2%

NHS Northern, Eastern and Western Devon CCG 71.9%

NHS Wiltshire CCG 71.5%

NHS Cambridgeshire and Peterborough CCG 69.4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

73 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB and BB by GP practice

No treatment Exceptions reported

THE MEDICAL CENTRE (CORBIN AVE) J81621 3 ALMA PARTNERSHIP J81003 1 THE ROSEMARY HEALTH CTR J81036 2 THE MARINE & OAKRIDGE PARTNERSHIP J81049 5 PUDDLETOWN SURGERY J81616 1 SHELLEY MANOR MEDICAL CENTRE J81021 9 CANFORD HEATH GROUP PRACT J81013 3 THE PRINCE OF WALES SURGERY J81637 3 HERBERT AVENUE J81632 8 THE CRANBORNE PRACTICE J81058 5 THE APPLES MEDICAL CENTRE J81029 2 PENNY'S HILL PRACTICE J81061 10 • in total, including exceptions, there THE ORCHARD SURGERY J81056 9 BLACKMORE VALE PARTNERSHIP J81620 12 BUTE HOUSE J81078 5 ROYAL MANOR HEALTH CARE J81009 1 are 424 people who are not treated BEAUFORT ROAD SURGERY J81018 4 BERE REGIS SURGERY J81020 1 QUARTERJACK SURGERY J81034 8 THE LANEHOUSE SURGERY J81090 1 CHARMOUTH MEDICAL PRACTICE J81628 2 with ACE-I or ARB DR NEWMAN J81648 2 KINSON ROAD MEDICAL CENTRE J81045 9 THE HARVEY PRACTICE J81046 5 WESSEX ROAD SURGERY J81048 5 • GP practice range: 0.0% to 60.0% THE ADAM PRACTICE J81006 88 HOLDENHURST ROAD SURGERY J81024 2 BARTON HOUSE MED PRACTICE J81074 2 MOORDOWN MEDICAL CENTRE J81039 36 VILLAGE SURGERY J81042 8 CERNE ABBAS SURGERY J81053 5 NORTHBOURNE SURGERY J81038 6 WESTBOURNE MEDICAL CENTRE J81014 25 LILLIPUT SURGERY J81054 7 HEATHERVIEW MEDICAL CTR. J81044 1 DENMARK ROAD MEDICAL CENTRE J81625 4 SANDFORD SURGERY J81631 1 JAMES FISHER MEDICAL CENTRE J81047 7 SWANAGE MEDICAL PRACTICE J81010 12 LITTLEDOWN SURGERY J81067 3 SOUTHBOURNE PRACTICE J81059 8 POOLE ROAD MEDICAL CENTRE J81004 5 STOUR SURGERY J81066 3 YETMINSTER MEDICAL CENTRE J81017 1 WALFORD MILL MEDICAL CENTRE J81077 1 BOSCOMBE MANOR MEDICAL CENTRE J81645 1 ABBOTSBURY ROAD SURGERY J81055 5 BRIDPORT MEDICAL CENTRE J81005 16 CARLISLE HOUSE SURGERY J81052 3 THE HADLEIGH PRACTICE J81041 7 ROYAL CRESCENT SURGERY J81027 11 WYKE REGIS MEDICAL PRACTICE J81051 7 LEYBOURNE SURGERY J81071 1 FORDINGTON SURGERY J81626 1 GROVE SURGERY J81646 1 HIGHCLIFFE MEDICAL CENTRE J81028 5 MADEIRA MEDICAL CENTRE J81065 2 ATRIUM HEALTH CENTRE J81068 1 THE PANTON PRACTICE J81072 1 THE BRIDGES MEDICAL CTR. J81073 1 WEST MOORS GROUP PRACTICE J81022 3 GILLINGHAM MEDICAL PRACTICE J81081 3 NEWLAND SURGERY J81032 1 POOLE TOWN SURGERY J81064 1 EVERGREEN OAK SURGERY J81086 1 ST ALBANS MEDICAL CENTRE J81062 2 EAGLE HOUSE SURGERY J81031 3 FARMHOUSE SURGERY J81057 1 THE BARN SURGERY J81043 1 POUNDBURY DOCTORS SURGERY J81082 1 WHITECLIFF GROUP PRACTICE J81019 1 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 1 THE VERWOOD SURGERY J81030 1 ORCHID HOUSE SURGERY J81002 WAREHAM SURGERY J81011 PARKSTONE HEALTH CENTRE J81012 QUEENS AVENUE SURGERY J81016 THE WELLBRIDGE PRACTICE J81025 TALBOT MEDICAL CENTRE J81033 MILTON ABBAS SURGERY J81035 STALBRIDGE SURGERY J81040 BURTON & BRANSGORE MEDICAL CENTRE J81050 DURDELLS AVENUE SURGERY J81063 LONGFLEET HOUSE SURGERY J81069 CROSS ROAD SURGERY J81075 THE TOLLERFORD PRACTICE J81076 THE BIRCHWOOD PRACTICE J81087 MALTHOUSE MEADOWS SURGERY J81609 CORFE CASTLE SURGERY J81612 THE DORCHESTER RD SURGERY J81613 CRESCENT SURGERY J81624 WOODLEA HOUSE SURGERY J81633 PROVIDENCE SURGERY J81634 THE OLD DISPENSARY J81644 LYME BAY MEDICAL PRACTICE J81647 LYME REGIS MEDICAL CENTRE Y03661 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 VILLAGE MEDICAL PRACTICE J81640 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

• 32,662 people with coronary heart NHS Dorset CCG 87.1% disease* in NHS Dorset CCG • 28,456 (87.1%) people whose blood pressure <= 150 / 90 • 2,265 (6.9%) people who are exceptions • 1,941 (5.9%) additional people whose blood pressure is not <= 150 / 90

England 88.2%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD002 denominator plus exceptions

75 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported

NHS Cumbria CCG 89.2%

NHS Kernow CCG 88.5%

NHS Gloucestershire CCG 88.2%

NHS Northern, Eastern and Western Devon CCG 87.6%

NHS Southern Derbyshire CCG 87.6%

NHS Wiltshire CCG 87.6%

NHS Dorset CCG 87.1%

NHS West Hampshire CCG 86.8%

NHS Cambridgeshire and Peterborough CCG 86.2%

NHS Coastal West Sussex CCG 84.3%

NHS Somerset CCG 82.4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

76 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice

Not below 150/90 Exceptions reported

BOSCOMBE MANOR MEDICAL CENTRE J81645 16 DENMARK ROAD MEDICAL CENTRE J81625 67 ALMA PARTNERSHIP J81003 62 PROVIDENCE SURGERY J81634 64 NORTHBOURNE SURGERY J81038 66 WESTBOURNE MEDICAL CENTRE J81014 187 CRESCENT SURGERY J81624 16 BURTON & BRANSGORE MEDICAL CENTRE J81050 104 THE OLD DISPENSARY J81644 25 THE PANTON PRACTICE J81072 74 HOLDENHURST ROAD SURGERY J81024 44 SWANAGE MEDICAL PRACTICE J81010 129 • in total, including exceptions, there BRIDPORT MEDICAL CENTRE J81005 182 SHELLEY MANOR MEDICAL CENTRE J81021 78 WEST MOORS GROUP PRACTICE J81022 65 THE PRINCE OF WALES SURGERY J81637 42 are 4,206 people whose blood EVERGREEN OAK SURGERY J81086 30 HERBERT AVENUE J81632 20 JAMES FISHER MEDICAL CENTRE J81047 74 POOLE ROAD MEDICAL CENTRE J81004 64 MALTHOUSE MEADOWS SURGERY J81609 23 pressure is not <= 150 / 90 DURDELLS AVENUE SURGERY J81063 22 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 2 YETMINSTER MEDICAL CENTRE J81017 21 THE BRIDGES MEDICAL CTR. J81073 103 • GP practice range: 3.0% to 32.7% THE MARINE & OAKRIDGE PARTNERSHIP J81049 72 QUEENS AVENUE SURGERY J81016 43 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 47 CHARMOUTH MEDICAL PRACTICE J81628 16 FORDINGTON SURGERY J81626 24 THE MEDICAL CENTRE (CORBIN AVE) J81621 36 HIGHCLIFFE MEDICAL CENTRE J81028 103 VILLAGE MEDICAL PRACTICE J81640 21 MILTON ABBAS SURGERY J81035 21 THE WELLBRIDGE PRACTICE J81025 31 BLACKMORE VALE PARTNERSHIP J81620 116 ST ALBANS MEDICAL CENTRE J81062 51 THE HADLEIGH PRACTICE J81041 112 BUTE HOUSE J81078 31 ATRIUM HEALTH CENTRE J81068 40 FARMHOUSE SURGERY J81057 40 ORCHID HOUSE SURGERY J81002 71 TALBOT MEDICAL CENTRE J81033 46 POOLE TOWN SURGERY J81064 22 THE ORCHARD SURGERY J81056 41 MADEIRA MEDICAL CENTRE J81065 34 PENNY'S HILL PRACTICE J81061 75 THE ADAM PRACTICE J81006 153 PARKSTONE HEALTH CENTRE J81012 42 QUARTERJACK SURGERY J81034 65 STOUR SURGERY J81066 45 HEATHERVIEW MEDICAL CTR. J81044 35 THE DORCHESTER RD SURGERY J81613 21 NEWLAND SURGERY J81032 25 ROYAL CRESCENT SURGERY J81027 99 WESSEX ROAD SURGERY J81048 26 KINSON ROAD MEDICAL CENTRE J81045 43 WOODLEA HOUSE SURGERY J81633 16 BERE REGIS SURGERY J81020 19 POUNDBURY DOCTORS SURGERY J81082 28 DR NEWMAN J81648 12 GROVE SURGERY J81646 26 WALFORD MILL MEDICAL CENTRE J81077 25 THE BARN SURGERY J81043 33 THE LANEHOUSE SURGERY J81090 14 THE BIRCHWOOD PRACTICE J81087 37 THE CRANBORNE PRACTICE J81058 39 WAREHAM SURGERY J81011 39 ROYAL MANOR HEALTH CARE J81009 48 LITTLEDOWN SURGERY J81067 15 VILLAGE SURGERY J81042 23 THE HARVEY PRACTICE J81046 47 CROSS ROAD SURGERY J81075 17 CARLISLE HOUSE SURGERY J81052 27 THE VERWOOD SURGERY J81030 35 CERNE ABBAS SURGERY J81053 14 LILLIPUT SURGERY J81054 38 GILLINGHAM MEDICAL PRACTICE J81081 50 ABBOTSBURY ROAD SURGERY J81055 31 SOUTHBOURNE PRACTICE J81059 25 THE TOLLERFORD PRACTICE J81076 21 THE ROSEMARY HEALTH CTR J81036 26 LEYBOURNE SURGERY J81071 14 CANFORD HEATH GROUP PRACT J81013 30 MOORDOWN MEDICAL CENTRE J81039 22 BEAUFORT ROAD SURGERY J81018 33 LONGFLEET HOUSE SURGERY J81069 14 BARTON HOUSE MED PRACTICE J81074 20 WHITECLIFF GROUP PRACTICE J81019 44 PUDDLETOWN SURGERY J81616 9 CORFE CASTLE SURGERY J81612 7 EAGLE HOUSE SURGERY J81031 19 LYME REGIS MEDICAL CENTRE Y03661 11 LYME BAY MEDICAL PRACTICE J81647 7 STALBRIDGE SURGERY J81040 11 WYKE REGIS MEDICAL PRACTICE J81051 21 THE APPLES MEDICAL CENTRE J81029 9 SANDFORD SURGERY J81631 3 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

77 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice – opportunities compared to GP cluster

10% 5% 0% -5% -10% -15% -20% -25% -30%

BOSCOMBE MANOR MEDICAL CENTRE 13

DENMARK ROAD MEDICAL CENTRE 53

PROVIDENCE SURGERY 49 • using the GP cluster method of ALMA PARTNERSHIP 44 calculating potential gains, if each NORTHBOURNE SURGERY 48 practice was to achieve as well as the WESTBOURNE MEDICAL CENTRE 123 upper quartile of its national cluster, then an additional 1,656 people would CRESCENT SURGERY 11 be treated THE OLD DISPENSARY 17

BURTON & BRANSGORE MEDICAL CENTRE 64

HOLDENHURST ROAD SURGERY 30

BARTON HOUSE MED PRACTICE

LYME REGIS MEDICAL CENTRE

BEAUFORT ROAD SURGERY

STALBRIDGE SURGERY

WHITECLIFF GROUP PRACTICE

EAGLE HOUSE SURGERY

LYME BAY MEDICAL PRACTICE

WYKE REGIS MEDICAL PRACTICE

SANDFORD SURGERY

THE APPLES MEDICAL CENTRE Details of this methodology are available on slide 9. Click here to view them.

78 CVD: Primary Care Intelligence Packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with CCGs in the STP Optimal management No treatment Exceptions reported

• 32,662 people with coronary heart NHS Dorset CCG 91.6% disease* in NHS Dorset CCG • 29,934 (91.6%) people who are taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant • 1,697 (5.2%) people who are exceptions • 1,031 (3.2%) additional people who are not taking aspirin, an alternative anti-platelet therapy, or an anti- coagulant

England 91.8%

0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD005 denominator plus exceptions

79 CVD: Primary Care Intelligence Packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported

NHS Kernow CCG 92.6%

NHS West Hampshire CCG 92.6%

NHS Northern, Eastern and Western Devon CCG 92.0%

NHS Cumbria CCG 91.9%

NHS Dorset CCG 91.6%

NHS Gloucestershire CCG 91.5%

NHS Wiltshire CCG 90.8%

NHS Southern Derbyshire CCG 90.6%

NHS Cambridgeshire and Peterborough CCG 90.5%

NHS Coastal West Sussex CCG 89.8%

NHS Somerset CCG 88.9%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

80 CVD: Primary Care Intelligence Packs Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice

No treatment Exceptions reported

BOSCOMBE MANOR MEDICAL CENTRE J81645 11 PROVIDENCE SURGERY J81634 46 VILLAGE MEDICAL PRACTICE J81640 28 DR NEWMAN J81648 20 WEYMOUTH COMMUNITY HEALTH CENTRE Y02650 2 THE LANEHOUSE SURGERY J81090 21 THE MEDICAL CENTRE (CORBIN AVE) J81621 38 LYME BAY MEDICAL PRACTICE J81647 16 ORCHID HOUSE SURGERY J81002 75 SHELLEY MANOR MEDICAL CENTRE J81021 51 CRESCENT SURGERY J81624 9 PARKSTONE HEALTH CENTRE J81012 44 • in total, including exceptions, there MILTON ABBAS SURGERY J81035 19 MALTHOUSE MEADOWS SURGERY J81609 17 POOLE ROAD MEDICAL CENTRE J81004 45 BLACKMORE VALE PARTNERSHIP J81620 104 are 2,728 people are not taking LONGFLEET HOUSE SURGERY J81069 22 THE HADLEIGH PRACTICE J81041 96 THE OLD DISPENSARY J81644 13 THE TOLLERFORD PRACTICE J81076 29 POUNDBURY DOCTORS SURGERY J81082 29 aspirin, an alternative anti-platelet DENMARK ROAD MEDICAL CENTRE J81625 24 LYME REGIS MEDICAL CENTRE Y03661 20 BARTON HOUSE MED PRACTICE J81074 29 BRIDPORT MEDICAL CENTRE J81005 101 therapy, or an anti-coagulant WESTBOURNE MEDICAL CENTRE J81014 83 ATRIUM HEALTH CENTRE J81068 33 BUTE HOUSE J81078 25 HERBERT AVENUE J81632 11 • GP practice range: 1.9% to 22.4% SWANAGE MEDICAL PRACTICE J81010 67 ROYAL MANOR HEALTH CARE J81009 53 STOUR SURGERY J81066 39 THE PRINCE OF WALES SURGERY J81637 22 BURTON & BRANSGORE MEDICAL CENTRE J81050 46 ROYAL CRESCENT SURGERY J81027 86 WESSEX ROAD SURGERY J81048 22 JAMES FISHER MEDICAL CENTRE J81047 39 LILLIPUT SURGERY J81054 39 CARLISLE HOUSE SURGERY J81052 27 LEYBOURNE SURGERY J81071 15 THE BIRCHWOOD PRACTICE J81087 31 THE WELLBRIDGE PRACTICE J81025 19 HEATHERVIEW MEDICAL CTR. J81044 26 THE BRIDGES MEDICAL CTR. J81073 56 THE HARVEY PRACTICE J81046 43 NEWLAND SURGERY J81032 18 HOLDENHURST ROAD SURGERY J81024 18 ST ALBANS MEDICAL CENTRE J81062 31 SOUTHBOURNE PRACTICE J81059 24 THE ORCHARD SURGERY J81056 26 WHITECLIFF GROUP PRACTICE J81019 48 FARMHOUSE SURGERY J81057 24 THE BARN SURGERY J81043 25 STALBRIDGE SURGERY J81040 14 CERNE ABBAS SURGERY J81053 12 EVERGREEN OAK SURGERY J81086 12 BERE REGIS SURGERY J81020 13 POOLE TOWN SURGERY J81064 13 MADEIRA MEDICAL CENTRE J81065 20 FORDINGTON SURGERY J81626 12 SANDFORD SURGERY J81631 7 THE ROSEMARY HEALTH CTR J81036 23 NORTHBOURNE SURGERY J81038 17 CANFORD HEATH GROUP PRACT J81013 26 THE ADAM PRACTICE J81006 84 HIGHCLIFFE MEDICAL CENTRE J81028 47 DURDELLS AVENUE SURGERY J81063 9 CHARMOUTH MEDICAL PRACTICE J81628 7 PENNY'S HILL PRACTICE J81061 39 VILLAGE SURGERY J81042 16 THE MARINE & OAKRIDGE PARTNERSHIP J81049 30 QUARTERJACK SURGERY J81034 35 THE PANTON PRACTICE J81072 23 WALFORD MILL MEDICAL CENTRE J81077 15 PUDDLETOWN SURGERY J81616 8 GILLINGHAM MEDICAL PRACTICE J81081 35 THE BANKS & BEARWOOD MEDICAL CENTRE J81070 19 THE DORCHESTER RD SURGERY J81613 11 WEST MOORS GROUP PRACTICE J81022 20 THE CRANBORNE PRACTICE J81058 22 THE APPLES MEDICAL CENTRE J81029 12 GROVE SURGERY J81646 14 LITTLEDOWN SURGERY J81067 9 BEAUFORT ROAD SURGERY J81018 24 CORFE CASTLE SURGERY J81612 6 ABBOTSBURY ROAD SURGERY J81055 20 CROSS ROAD SURGERY J81075 10 MOORDOWN MEDICAL CENTRE J81039 15 EAGLE HOUSE SURGERY J81031 16 YETMINSTER MEDICAL CENTRE J81017 7 WAREHAM SURGERY J81011 20 TALBOT MEDICAL CENTRE J81033 18 KINSON ROAD MEDICAL CENTRE J81045 17 WYKE REGIS MEDICAL PRACTICE J81051 14 THE VERWOOD SURGERY J81030 14 WOODLEA HOUSE SURGERY J81633 5 QUEENS AVENUE SURGERY J81016 9 ALMA PARTNERSHIP J81003 4 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 Dorset CCG England 900

800 • in NHS Dorset CCG, the hospital admission rate for coronary heart 700 disease in 2015/16 was 735.5 (6,533) compared to 527.9 for England

600

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 Dorset CCG England 200

180 • in NHS Dorset CCG, the hospital admission rate for stroke in 2015/16 160 was 173 (1,644) 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 Dorset CCG England

132.1% Angina 136.8% • The risk of a stroke was 87.6% higher and the risk of a heart attack was 98.5% 98.5% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 750.1% higher. 156.6% Heart failure 150.0%

87.6% Stroke 81.3%

750.1% Major amputation 445.8%

832.9% Minor amputation 753.5%

319.6% RRT 293.0%

0% 100% 200% 300% 400% 500% 600% 700% 800% 900% 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 Dorset CCG England 90

80 • in NHS Dorset CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 30.2, compared to 40.6 for England

60

50

40

30 Age Age standardised (per rate 1000,000) 20

10

0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Source: Office for National Statistics (ONS) mortality data 2002 - 2015

86 CVD: Primary Care Intelligence Packs Deaths from stroke, under 75s

NHS Dorset CCG England 30

• in NHS Dorset CCG, the early 25 mortality rate for stroke in 2013-15 was 11.8, 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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