Practice Profiles Plus Transforming Cancer Services Team for London Selection Select Area: NHS Enfield CCG Select Year: 2015-16

What is Practice Profiles Plus? This profile provides a summary of the key diagnosis and referral indicators for your practice or CCG with regards to cancer. The profile enables comparisons to be made with other practices within a CCG, as well as with national figures, to allow for benchmarking and to highlight variations. Each indicator is accompanied by a description of key contextual or influencing factors and provides information on local and/or national resources and initiatives which practices can draw on to help improve cancer outcomes. For raw data methodology and further indicator definitions and

How should the profile be used? The purpose of the profile is to help practices reflect on their clinical practice and cancer service delivery, with a partic ular focus on symptom recognition and early diagnosis. It is not intended to be a measurement of performance. However, you may wish to review indicators which are significant outliers for your profile. As many indicators are influenced by factors such as age and deprivation, practices should review this profile in conjunction with their demographic profile. This profile presents crude rates which are not adjusted for demographic factors. A graph is provided for each indicator to visualise individual practices and how they are performing compared to the CCG, London and England averages. Significance compared to the CCG average is also being shown with colour coding. CCGs can also be visualised comparing how they are preforming to the London and England averages. Significance compared to the London average being shown by colour coding. There are five years of historic data available for each indicator as historical data may wish to be reviewed to assess data trends for each indicator over time. Whilst the data in this tool is presented at the CCG level, individual practices may find it useful to visit the source website to see their individual practice data concisely presented. Source: http://fingertips.phe.org.uk/profile/cancerservices

For further information regarding population size of each practice, and additional variables, for the most recent year please visit http://fingertips.phe.org.uk/profile/general-practice/data Contents Version April 2017 Tab Name Indicator Title Exec Summary Executive Summary 1. 2ww referral ratio Two-week wait referrals (Indirectly age-sex standardised referral ratio) 2. 2ww conversion Two-week referrals resulting in a diagnosis of cancer (Conversion rate: % of all 2ww referrals) 3. 2ww detection Number of new cancer cases treated (Detection rate: % of which resulted from a 2ww referral) 4. 2ww referrals all cancers Two-week wait referrals for suspected cancer (Number per 100,000 population) 3 & 4. time trend graphs Time trending for 2ww detection and 2ww referrals for all cancers 5. 2ww referrals breast Two-week wait referrals for suspected breast cancer (Number per 100,000 population) 6. 2ww referrals lower GI Two-week wait referrals for suspected lower GI cancers (Number per 100,000 population) 7. 2ww referrals lung Two-week wait referrals for suspected lung cancer (Number per 100,000 population) 8. 2ww referrals skin Two-week wait referrals for suspected skin cancer (Number per 100,000 population) 9. screening breast 36 mos Females, 50-70, screened for breast cancer in last 36 months (3 year coverage, %) 10. screening breast 6 mos Females, 50-70, screened for breast cancer within 6 months of invitation (Uptake, %) 11. screening cervical Females, 25-64, attending cervical screening within target period (3.5 or 5.5 year coverage, %) 12. screening bowel 30 mos Persons, 60-69, screened for bowel cancer in last 30 months (2.5 year coverage, %) 13. screening bowel 6 mos Persons, 60-69, screened for bowel cancer within 6 months of invitation (Uptake, %) 14. colonoscopy In-patient or day-case colonoscopy procedures (Number per 100,000 population) 15. sigmoidoscopy In-patient or day-case sigmoidoscopy procedures (Number per 100,000 population) 16. upper GI endoscopy In-patient or day-case upper GI endoscopy procedures (Number per 100,000 population) 17. emergency admissions Number of emergency admissions with cancer (Number per 100,000 population) 18. emergency presentations Number of emergency presentations (Number per 100,000 population) 19. other presentations Number of other presentations (Number per 100,000 population) Detection Rate Displays yearly detection rates by practice (2010/11 - 2015/16) Rolling Average Detection Rate Displays three year rolling averages of detection rates by practice (2010/11 - 2015/16) Index Table Displays name and practice code for each GP practice and selected context measures for each practice

Acknowledgments to the Public Health Intelligence Team, Islington for their initial document on which this tool is based. Acknowledgments to Jason Petit and Chipo Chirewa for their initial work on this tool. Authored by: Lucy Young, Mary Vu, Molly Loughran, Bethany Wickramasinghe, NCRAS-TCST Partnership.

Introduction Area: NHS Enfield CCG Executive Summary These measures contain some background information about the area population to provide context to the cancer measures. An index is provided at the back of the document containing information for each practice within a chosen CCG. Please note that this data is based on varied year formats and ranges due to data availability. For this reason, the year for each indicator must be selected individually. New Cancer Cases Select Financial Year: 2013-14 Measuring the rate of new cancer cases in each GP and CCG allows for a direct standardised comparison between GPs within a CCG and between CCGs in London. It also allows for comparison between the rates of new cancer cases in a 12 month period. As this is a crude measurement it does not take into account the variation in demographics between GP practices in a CCG, and between CCGs in London, that could affect the rate of new cancer cases including age and deprivation rates (1). Area London England New cancer cases (N) 1,214 31,707 290,133 New cancer cases (rate per 100,000 population) 386.8 349.8 515.4 Statistical difference from average Higher Higher Lower Quality and Outcomes Framework (QOF) Prevalence Select Financial Year: 2015-16 General practice has a key role in the referral and subsequent support of these patients and in ensuring that care is appropriately coordinated. Prevalence of cancer has found to be associated with a large range of demographics including age, deprivation and ethnicity. This is an important indicator to provide insight into how many people are currently living with cancer at both CCG and GP level. Variation in cancer prevalence between GPs within a CGG and between CCGs in London may be accounted for by variation in socio-economic characteristics as well as variation in cancer care and treatment. Extensive work has been carried out by the LWBC Team in TCST to improve the outcomes and quality of life in those living with and beyond cancer (2). Area London England QOF prevalent cases (N) 6,308 156,310 1,392,577 QOF prevalence (%) 1.9 1.7 2.4 Statistical difference from average - Higher Lower Age (% aged 65+ years) Select Calendar Year: 2016 The proportion of the population (%) aged 65 years or over is an important demographic to measure as increased age has been identified to be a risk factor in incidence for nearly all cancer types. It has also been found that those living with cancer (prevalent cases) increase with age, with the two largest age group proportions being 50-64 years and 75+ years (1). There is an important role for secondary prevention within this patient cohort, including providing support to individuals at risk of recurrence of cancer and new primary cancers. Area London England Age (% aged 65+ years) 12.8 11.0 17.2 Statistical difference from average - Higher Lower Deprivation score (IMD 2015) Data only available for: 2015 Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial. The English Indices of Deprivation attempt to measure a broader concept of multiple deprivation, made up of several distinct dimensions, or domains, of deprivation. A score is calculated based on a wide variety of factors thought to contribute to deprivation. The lower the score, the less deprived the area is considered to be. Research has found that for all major cancers, higher mortality and worse one-year survival are associated with more deprived areas. The only exception being to malignant melanoma, in which higher mortality is associated with the least deprived (2). Note, there is no summary data available for London. More information can be found at https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015. Area London England Deprivation score (IMD 2015) 27.0 N/A 21.8 1. National Cancer Intelligence Network (NCIN), What cancer statistics are available, and where can I find them? (2013). 2. National Cancer Survivorship Initiative Network (NCIN), Living with and beyond cancer: taking action to improve outcomes (2015). 3. National Cancer Intelligence Network (NCIN), Cancer and equality groups: key metrics. (2015).

Executive Summary Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Indirectly Age Standardised Two Week Wait Referral Ratio Two Week Wait Referral Ratio (indirectly age standardised) The number of Two Week Wait (2ww) referrals observed at the Please note that no data is available at the London NHS region level. practice, divided by the number expected based on the practice population age and the age-specific rates for England. F85002 149.1 F85003 73.8 F85004 93.7 F85010 56.8 F85011 105.6 Although there is no standard rate or number of 2ww referrals, F85015 45.8 F85016 91.3 practices should consider how their 2ww referral ratio compares to the F85020 161.7 England averages, in the context of the socio-demographic profile of F85023 68.7 F85024 70.6 the practice population and the underlying incidence of cancer in the F85025 138.8 F85027 108.0 local population. F85029 120.5 Practices which are significantly above or below the London or England F85032 125.4 F85033 119.9 average may wish to review this. Factors to consider are: F85035 130.1 • Practices serving very deprived populations with a high prevalence of F85036 100.9 F85039 82.1 cancer risk factors, such as smoking, might expect to have higher rates F85043 79.4 of 2ww referrals. F85044 175.4 F85048 92.8 • Practices serving populations with lower levels of cancer symptom F85053 97.6 awareness may have lower referral ratios and more cancers diagnosed F85055 121.1 F85058 58.0 through emergency presentation. F85072 79.4 F85076 208.4 • Practices should also consider this indicator alongside their F85625 125.2 conversion rate. A high conversion rate and a low 2ww referral ratio F85634 93.2 F85642 110.1 may indicate a high threshold of suspicion of cancer before a 2ww F85650 96.0 referral is made. F85652 103.7 F85654 140.1 F85663 81.4 F85666 52.8 F85676 56.7 F85678 57.7 F85681 35.2 F85682 90.2 F85684 143.4 F85686 124.0 F85687 184.3 F85700 51.4 F85701 69.9 F85703 151.2 F85707 92.3 Y00057 22.2 Y00612 51.0 Y03402 95.8 0 50 100 150 200 250 2ww referral ratio (referrals divided by number expected)

Lower No Difference Higher England Average

1. 2ww referral ratio Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Two Week Wait Referrals Resulting in Diagnosis of Cancer Two-week referrals resulting in a diagnosis of cancer (Conversion rate: as % of all 2WW referrals) The ‘conversion rate’, i.e., the proportion of Two Week Wait (2ww) referrals F85002 3.0 resulting in a diagnosis of cancer: the number of 2ww referrals resulting in a F85003 5.7 diagnosis of cancer in the year, divided by the total number of 2ww referrals F85004 4.8 in the year. F85010 6.7 F85011 3.8 A data quality issue has been identified for this indicator/measure: The F85015 7.1 number of patients per practice is often quite small so variation is inflated by F85016 4.8 chance considerably. Generally with small sample sizes, process indicators F85020 2.2 F85023 8.0 (e.g., rate of 2ww referrals) are considered to be more reliable than outcome F85024 7.5 indicators, such as this indicator. F85025 4.2 F85027 4.0 Area London England F85029 4.8 Number of cases (N) of 2ww referrals F85032 4.7 381 13,171 133,016 resulting in cancer diagnosis F85033 3.4 Average rate (%) 2ww referrals resulting in F85035 2.9 4.1 5.5 7.8 cancer diagnosis F85036 5.5 Expected area cases (N) given regional F85039 8.0 - 511 725 average F85043 9.1 F85044 4.4 Statistical significance compared to area - Lower Lower F85048 5.0 F85053 8.2 This indicator, together with the 2ww referral ratio, provides some insight F85055 2.9 F85058 11.6 into thresholds of suspicion of cancer within practices before making a 2ww F85072 5.0 referral, as well as the case-mix of cancers diagnosed in the practice. F85076 2.4 There is no standard for this indicator. Practices will want to consider how F85625 2.6 their conversion rate compares to the CCG average, and how the CCG average F85634 3.5 F85642 2.7 compares to that of London. Practices which are statistically different to the F85650 1.6 CCG average, or CCGs which are statistically different to the London average, F85652 0.8 may wish to review this. F85654 0.7 F85663 4.4 Factors which should be taken into consideration when reviewing this F85666 7.0 indicator are: F85676 4.2 • 2ww referral rate - a high conversion rate could be a reflection of low 2ww F85678 referral ratio and a high threshold of suspicion of cancer. F85681 5.0 F85682 3.2 • Cancer case-mix - the conversion rate varies by cancer type so it will depend F85684 5.3 on the case-mix of cancers in the practice. F85686 4.2 F85687 4.3 F85700 6.8 F85701 6.8 F85703 2.1 F85707 2.9 Y00057 15.8 Y00612 3.1 Y03402 3.3 0 5 10 15 20 25 30 35 40 Rate (%) 2ww referrals resulting in cancer diagnosis

Lower No Difference Higher England Average London Average CCG Average

2. 2ww conversion Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Proportion of New Cancer Cases Treated Number of new cancer cases treated (Detection rate: % of which resulted from a 2WW referral) Please note no comparison data are available against the London NHS region average. The proportion of new cancer cases treated who were referred through the Two Week Wait

(2ww) referral route. This is calculated as the number of new cancer cases treated in the year F85002 35.9 who were referred through the 2ww referral route, divided by the total number of patients F85003 30.0 registered at the practice who have a date of first treatment in the financial year on the Cancer F85004 38.6 Waiting Times system. F85010 43.8 F85011 40.0 Please see the Detection Rate Index Table and the Rolling Averages Detection Rate Index F85015 45.5 Table for detection rates at a practice level for the previous six years. F85016 34.6 A data quality issue has been identified for this indicator/measure: The number of patients per F85020 55.0 F85023 38.1 practice is often quite small so variation is inflated by chance considerably. Generally with small F85024 60.0 sample sizes, process indicators (e.g., rate of 2ww referrals) are considered to be more reliable F85025 54.8 than outcome indicators, such as this indicator. F85027 35.9 F85029 47.2 Area England F85032 42.9 F85033 36.1 Number new cancer cases (N) diagnosed through 2ww referral 429 136,050 F85035 44.8 F85036 71.4 Average proportion (%) of new cancer cases referred by 2ww 41.4 49.7 F85039 61.5 F85043 45.5 Expected area cases (N) given regional average - 515 F85044 38.1 F85048 31.6 Statistical significance compared to area - Lower F85053 71.4 F85055 36.8 F85058 46.2 F85072 37.5 This indicator provides a measure of the relative importance of the 2ww pathway compared to F85076 35.0 other routes to diagnosis. Research indicates that cancers diagnosed via a “managed referral” F85625 35.7 route have a higher relative survival than cancers diagnosed via an emergency route (1). F85634 25.0 Although there is no standard for this indicator practices which are statistically different to the F85642 50.0 F85650 21.4 CCG average, or CCGs which are statistically different to the London average, may wish to review F85652 9.1 this. Factors that influence the proportion of cancers diagnosed through this route include F85654 27.3 thresholds of suspicion of cancer as well as patient awareness and delays in presentation. F85663 36.8 Practices can be encouraged to undertake audit of all cancer diagnoses and discuss route to F85666 45.5 F85676 30.8 diagnosis at clinical meetings to identify local trends and approached to cancer diagnosis. F85678 20.0 F85681 28.6 F85682 36.4 Several resources are available to aid practices in making 2ww referrals: F85684 43.8 F85686 46.7 • NICE referral guidelines for suspected cancer (https://www.nice.org.uk/guidance/ng12) F85687 54.8 F85700 50.0 • Risk assessment tools for bowel, lung, prostate, ovarian and pancreatic cancers (2014)- F85701 50.0 (available at: www.qcancer.org) F85703 62.5 • Referral forms (available at: https://www.myhealth.london.nhs.uk/healthy-london/suspected- F85707 40.0 cancer-referrals). Y00057 25.0 Y00612 44.4 • BMJ Learning—Carcinoma of unknown primary origin: diagnosis and management: putting Y03402 41.9 NICE guidelines into practice (last updated 2010) (http://learning.bmj.com/learning/module- intro/.html?moduleId=10017700) 0 10 20 30 40 50 60 70 80 90 100 • Practices may also wish to consider if they can do more to promote awareness of cancer Proportion (%) of new cancer cases referred by 2ww symptoms and encourage earlier presentation amongst their registered population. Lower No Difference Higher England Average CCG Average 1. National Cancer Intelligence Network (NCIN), Routes to Diagnosis: Exploring Emergency Presentations (2013), http://www.ncin.org.uk/publications/data_briefings/routes_to_diagnosis_exploring_emergency_presentations

3. 2ww detection Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Two Week Wait Referrals for Suspected Cancer Two-week wait referrals for suspected cancer (Number per 100,000 population) The crude rate of referrals per 100,000 persons: the number of Two Week Wait (2ww) F85002 3483.2 referrals for suspected cancer (multiplied by 100,000), divided by the list size of the F85003 1912.5 practice in question. F85004 2475.2 F85010 1650.9 Area London England F85011 2775.8 Number (N) 9,366 238,678 1,711,263 F85015 1195.6 Rate per 100,000 population 2,873.4 2,538.9 2,975.1 F85016 3001.8 Statistical difference from F85020 4835.6 Higher Lower average - F85023 1433.9 F85024 1796.1 This indicator provides some insight into the thresholds of suspicion of cancer within both F85025 4123.3 practices and CCGs. This information may also provide insight into health seeking F85027 3352.2 F85029 3875.1 behaviours within the region. This data can be used to compare the number of cancer F85032 3663.0 cases at CCG level that were presented through different routes of diagnosis with those F85033 3744.3 diagnosed through 2ww referral. F85035 4031.7 Although there is no standard rate or number of 2ww referrals, CCGs and practices should F85036 2966.6 consider how their 2ww referral rate compares to the London and England averages, in F85039 1964.3 the context of the socio-demographic profile of the practice population and the F85043 1916.4 F85044 4478.3 underlying incidence of cancer in the local population. F85048 2353.8 Practices which are statistically different to the CCG average, or CCGs which are F85053 2938.5 statistically different to the London average, may wish to review this. Factors to consider F85055 3573.6 are: F85058 1566.6 • Practices serving very deprived populations with a high prevalence of cancer risk factors, F85072 2241.7 F85076 such as smoking, might expect to have higher rates of 2ww referrals. 5125.0 F85625 3793.3 • Practices serving populations with lower levels of cancer symptom awareness may have F85634 1795.3 lower referral rates and more cancers diagnosed through emergency presentation. F85642 2864.5 • Practices should also consider this indicator alongside their conversion rate. For F85650 2672.9 example, a high 2ww referral rate with a high conversion rate would be preferable to a F85652 2719.6 high referral rate and a low conversion rate. A high conversion rate and a low 2ww F85654 3755.6 F85663 2290.2 referral rate may indicate a high threshold of suspicion of cancer before a 2ww referral is F85666 1331.8 made. F85676 1362.6 F85678 1308.1 Several resources are available to aid practices in making 2ww referrals for suspected F85681 868.8 cancer: F85682 2023.4 • NICE referral guidelines for suspected cancer (www.nice.org.uk/guidance/ng12) F85684 3228.6 F85686 3655.8 • Referral forms for cancer (available at: https://www.myhealth.london.nhs.uk/healthy- F85687 5012.8 london/suspected-cancer-referrals). F85700 1165.3 F85701 1636.1 F85703 3036.5 F85707 1725.9 Y00057 407.2 Y00612 1077.8 Y03402 1926.0

0 1,000 2,000 3,000 4,000 5,000 6,000 Rate (per 100,000) 2ww referrals for suspected cancer

Lower No Difference Higher England Average London Average CCG Average

4. 2ww referrals all cancers Area: NHS Enfield CCG Trend Over Time for Proportion of New Cancer Cases Treated by Two Week Wait Referral Please note no comparison data are available against the London NHS region average.

Year Area England LowerUpper CI CI 60.0 2010-11 43.2 43.7 50.0 2011-12 41.1 45.0

2012-13 39.3 46.3 40.0

2013-14 43.3 47.4 30.0 2014-15 36.5 48.4 2015-16 41.4 49.7 20.0

10.0 referred referred by2ww 0.0

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Proportion(%) ofnew cancercases Area England

Trend Over Time for Two Week Wait Referrals for Suspected Cancer

Year Area London England LowerUpper CI CI 3500.0 2010-11 1512.2 1372.8 1808.3 3000.0 2011-12 1573.2 1491.9 1977.7

2012-13 1784.7 1689.7 2165.0 2500.0

2013-14 1969.9 1931.6 2396.6 2000.0 2014-15 2516.3 2260 2707.7 2015-16 2873.4 2538.9 2975.1 1500.0 1000.0

suspectedcancer 500.0

0.0

Rate(per 100,000) 2ww referrals for 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

Area London England

3 & 4. time trend graphs Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Two Week Wait Referrals for Suspected Breast Cancer Two-week wait referrals for suspected breast cancer (Number per 100,000 population) The crude rate of referrals per 100,000 persons: the number of Two Week Wait F85002 554.7 (2ww) referrals for suspected breast cancer (multiplied by 100,000), divided by the F85003 241.8 list size of the practice in question. F85004 290.8 F85010 176.1 Area London England F85011 391.5 F85015 64.0 Number (N) 1,327 45,557 311,224 F85016 542.9 Rate per 100,000 population 407.1 484.6 541.1 F85020 1191.0 Statistical difference from F85023 211.8 Lower Lower average - F85024 269.4 F85025 477.4 F85027 291.9 Although there is no national standard for this indicator practices which are F85029 258.3 F85032 526.6 statistically different to the CCG average, or CCGs which are statistically different to F85033 373.2 the London average, may wish to review this. Factors to consider are: F85035 396.7 • Practices with a high proportion of patients over 65 years may expect a higher F85036 485.4 F85039 491.1 2ww referral rate due to the higher incidence of breast cancer in older women. F85043 290.4 • Practices serving populations with lower levels of breast cancer symptom F85044 500.0 awareness may have a lower referral rate and more cancers diagnosed through F85048 326.3 F85053 emergency presentation. 334.2 F85055 431.3 F85058 230.9 Several resources are available to aid practices in making 2ww referrals for F85072 366.2 F85076 546.4 suspected breast cancer: F85625 1176.1 F85634 440.9 • NICE referral guidelines for suspected cancer (www.nice.org.uk/guidance/ng12) F85642 505.5 F85650 487.9 • NICE guidance on familial breast cancer F85652 388.5 (https://www.nice.org.uk/guidance/CG164) F85654 651.0 • BMJ Learning ‘Suspected breast cancer: when you should refer’ F85663 385.1 F85666 257.0 (http://learning.bmj.com/learning/module-intro/.html?moduleId=5003318) F85676 416.4 (module ID - 5003318) F85678 133.5 F85681 130.3 F85682 298.2 • Referral forms for breast cancer (available at: F85684 466.2 https://www.myhealth.london.nhs.uk/healthy-london/suspected-cancer-referrals). F85686 228.5 F85687 806.3 F85700 344.3 F85701 332.1 F85703 521.9 F85707 150.1 Y00057 85.7 Y00612 232.1 Y03402 242.1 0 200 400 600 800 1,000 1,200 1,400 1,600 Rate (per 100,000) 2ww referrals for suspected breast cancer

Lower No Difference Higher England Average London Average CCG Average

5. 2ww referrals breast Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Two Week Wait Referrals for Suspected Lower GI Cancer Two-week wait referrals for suspected lower GI cancers (Number per 100,000 population) The crude rate of referrals per 100,000 persons: the number of Two Week Wait (2ww) F85002 603.6 referrals for suspected lower gastrointestinal (GI) cancer (multiplied by 100,000), F85003 285.8 divided by the list size of the practice in question. F85004 566.6 F85010 440.2 Area London England F85011 605.0 F85015 448.3 Number (N) 1,672 34,149 260,713 F85016 383.2 Rate per 100,000 population 513.0 363.2 453.3 F85020 643.2 F85023 Statistical difference from 228.1 Higher Higher F85024 314.3 average - F85025 789.9 F85027 592.1 F85029 782.8 Although there is no national standard for this indicator practices which are F85032 847.1 statistically different to the CCG average, or CCGs which are statistically different to F85033 715.8 F85035 621.9 the London average, may wish to review this. Factors to consider are: F85036 431.5 • Practices with a high proportion of patients over 65 years may expect a higher 2ww F85039 178.6 F85043 464.6 referral rate due to the increasing incidence of lower GI cancer with age. F85044 826.1 • Practices serving populations with lower levels of cancer symptom awareness may F85048 466.1 have a lower referral rate and more cancers diagnosed through emergency F85053 564.6 F85055 534.0 presentation. F85058 263.9 F85072 388.4 F85076 954.2 Several resources are available to aid practices in making 2ww referrals for suspected F85625 496.9 F85634 346.5 lower GI cancer: F85642 414.8 • Symptom checker tool for bowel cancer - (available at: F85650 254.6 http://www.nhs.uk/Tools/Pages/Bowel-cancer-self-assessment.aspx) F85652 582.8 F85654 475.7 • Small c bowel campaign (available at: http://www.smallc.org.uk/bowel/) F85663 506.7 • BMJ Learning http://learning.bmj.com/learning/module-intro/cancer- F85666 163.6 F85676 227.1 referral.html?moduleId=10053492) — module on ‘Quick tips: referral for suspected F85678 213.6 cancer’ (module ID - 10053492) F85681 130.3 F85682 362.1 • Referral forms for lower GI and colorectal cancers (available at: F85684 500.7 https://www.myhealth.london.nhs.uk/healthy-london/suspected-cancer-referrals). F85686 723.5 F85687 873.5 F85700 158.9 F85701 159.9 F85703 648.4 F85707 350.2 Y00057 21.4 Y00612 182.4 Y03402 410.5 0 200 400 600 800 1,000 1,200 Rate (per 100,000) 2ww referrals for suspected lower GI cancer

Lower No Difference Higher England Average London Average CCG Average

6. 2ww referrals lower GI Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Two Week Wait Referrals for Suspected Lung Cancer Two-week wait referrals for suspected lung cancer (Number per 100,000 population) The crude rate of referrals per 100,000 persons: the number of Two Week Wait (2ww) F85002 referrals for suspected lung cancer (multiplied by 100,000), then divided by the list size of 244.7 F85003 131.9 the practice in question. F85004 59.6 Area London England F85010 44.0 F85011 35.6 Number (N) 435 9,266 59,443 F85015 42.7 Rate per 100,000 population 133.5 98.6 103.3 F85016 95.8 Statistical difference from - Higher Higher F85020 214.4 average F85023 32.6 F85024 134.7 Although there is no national standard for this indicator practices which are statistically F85025 130.2 different to the CCG average, or CCGs which are statistically different to the London F85027 166.8 average, may wish to review this. Factors to consider are: F85029 164.4 • Practices with a high proportion of patients over 65 years may expect a higher 2ww F85032 114.5 referral rate due to the increasing incidence of lung cancer with age. F85033 238.6 • Practices serving populations with a high smoking prevalence may expect to have a F85035 139.4 F85036 53.9 higher rate of 2ww referrals. F85039 22.3 • Practices serving populations with lower levels of lung cancer symptom awareness may F85043 58.1 have a lower referral rate and more cancers diagnosed through emergency presentation. F85044 326.1 F85048 163.1 Several resources are available to aid practices in making 2ww referrals for suspected F85053 46.1 lung cancer: F85055 143.8 F85058 33.0 • Referral forms for lung cancer - (available at: F85072 99.9 https://www.myhealth.london.nhs.uk/healthy-london/suspected-cancer-referrals). F85076 292.4 F85625 198.8 • Risk assessment tools for lung cancer (smokers and non-smokers) - (available at: F85634 63.0 http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/national- F85642 233.3 awareness-and-early-diagnosis-initiative-naedi) F85650 254.6 F85652 107.9 • Cancer Research UK's Lung cancer campaign: Information for GPs - provides guidance and F85654 200.3 tips for referrers (http://www.cancerresearchuk.org/health-professional/early-diagnosis- F85663 121.6 activities/be-clear-on-cancer/lung-cancer-campaign/information-for-gps) F85666 F85676 • NHS's Clear on Cancer campaign on lung cancer symptoms (http://www.nhs.uk/be-clear- F85678 on-cancer/lung-cancer/symptoms) F85681 • NICE guidelines for lung cancer (2015) https://cks.nice.org.uk/lung-and-pleural-cancers- F85682 F85684 172.7 recognition-and-referral#!topicsummary F85686 152.3 F85687 389.7 F85700 79.4 F85701 49.2 F85703 158.2 F85707 Y00057 42.9 Y00612 16.6 Y03402 105.2

0 100 200 300 400 500 600 Rate (per 100,000) 2ww referrals for suspected lung cancer

Lower No Difference Higher England Average London Average CCG Average

7. 2ww referrals lung Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Two Week Wait Referrals for Suspected Skin Cancer Two-week wait referrals for suspected skin cancer (Number per 100,000 population)

The crude rate of referrals per 100,000 persons: the number of Two Week Wait (2ww) F85002 513.9 referrals for suspected skin cancer (multiplied by 100,000), divided by the list size of the F85003 329.7 F85004 246.0 practice in question. F85010 198.1 F85011 355.9 Area London England F85015 64.0 F85016 542.9 Number (N) 1,725 45,349 328,871 F85020 857.6 F85023 211.8 Rate per 100,000 population 529.2 482.4 571.8 F85024 269.4 F85025 1215.3 Statistical difference from average - Higher Lower F85027 800.5 F85029 1189.9 F85032 538.0 Although there is no national standard for this indicator practices which are statistically F85033 923.8 F85035 1200.9 different to the CCG average, or CCGs which are statistically different to the London F85036 458.5 F85039 178.6 average, may wish to review this. Factors to consider are: F85043 464.6 • Practices with a high proportion of patients over 65 years may expect a higher 2ww F85044 413.0 F85048 256.4 referral rate due to the higher incidence of skin cancer in this age range. F85053 645.3 • Practices serving populations with lower levels of skin cancer symptom awareness may F85055 554.5 F85058 148.4 have a lower referral rate and more cancers diagnosed through emergency presentation. F85072 532.7 F85076 831.1 F85625 281.6 Several resources are available to aid practices in making 2ww referrals for suspected F85634 63.0 skin cancer: F85642 648.1 • NICE referral guidelines for suspected cancer (http://cks.nice.org.uk/skin-cancers- F85650 254.6 F85652 863.4 recognition-and-referral#!topicsummary) F85654 500.8 F85663 283.7 • Referral forms for skin cancer (available at: F85666 186.9 F85676 151.4 https://www.myhealth.london.nhs.uk/healthy-london/suspected-cancer-referrals). F85678 427.1 F85681 86.9 • Pan-London Suspected Skin Cancer Referral Guide F85682 255.6 F85684 466.2 (https://www.myhealth.london.nhs.uk/nhsrefer/formlinks/guides/Pan%20London%20Sus F85686 952.0 F85687 779.5 pected%20Cancer%20Referral%20Guide%20Skin.pdf) F85700 211.9 • Doctors.net Skin Cancer Toolkit F85701 381.4 F85703 347.9 (http://www.doctors.net.uk/eclient/cruk/cruk_skin_toolkit_2014/) F85707 475.2 Y00057 85.7 • BMJ Learning--Basal cell carcinoma: diagnosis and treatment (archived) Y00612 149.2 (http://learning.bmj.com/learning/module-intro/basal-cell-carcinoma-diagnosis- Y03402 163.1 treatment.html?moduleId=5003142) 0 200 400 600 800 1,000 1,200 1,400 1,600 • BMJ Learning--Malignant melanomas: diagnosis and management Rate (per 100,000) 2ww referrals for suspected skin cancer (http://learning.bmj.com/learning/module-intro/malignant-melanomas-diagnosis- management.html?moduleId=5003313) (archived) Lower No Difference Higher England Average London Average CCG Average

8. 2ww referrals skin Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Females, 50-70, Screened for Breast Cancer Females, 50-70, screened for breast cancer in last 36 months in Last 36 Months (3 Year Coverage, %) (3 year coverage, %) Three-year screening coverage (%): The number of females registered to the practice F85002 65.6 who were adequately screened in previous 36 months, divided by the number of F85003 71.1 eligible females on last day of the review period. F85004 73.9 F85010 69.0 70% National minimum standard for all Breast Cancer screening F85011 56.4 F85015 71.3 Area London England F85016 70.0 Number cases (N) 24,395 582,761 5,044,802 F85020 74.2 F85023 60.7 % eligible population screened 69.7 65.1 72.5 F85024 60.5 Difference from 70% national minimum standard (%) -0.3 -4.9 2.5 F85025 68.7 F85027 78.8 Statistical significance compared to area - Higher Lower F85029 72.2 F85032 70.7 Breast cancer screening is an important intervention for detecting breast cancer early. F85033 76.9 F85035 69.2 Screening saves about one life from breast cancer for every 200 women who are F85036 72.5 screened. This adds up to about 1,300 lives saved from breast cancer by screening each F85039 65.7 F85043 66.8 year in the UK (1). F85044 76.6 Inequalities exist in screening uptake with certain groups being less likely to attend, F85048 65.9 F85053 75.1 including: F85055 68.4 • women in the 50-54 age group F85058 72.7 • BME groups and Muslim women F85072 65.9 F85076 68.1 • women from a more deprived background F85625 74.2 F85634 54.6 F85642 60.4 The following initiatives can help improve breast cancer screening coverage and F85650 70.9 F85652 72.6 reduce inequalities: F85654 75.8 • List maintenance - ensure patient records are accurate and up-to-date, including F85663 77.5 F85666 61.3 addresses and telephone numbers. F85676 66.6 • Follow-up with women who did not attend their screening appointment. Evidence F85678 70.6 F85681 63.6 shows positive endorsement from a healthcare professional can increase screening F85682 59.9 uptake (2). F85684 69.9 F85686 76.2 • Use reminder flags on patient records for women who have missed their screening F85687 64.2 appointment to prompt a discussion with the patient regarding breast screening. F85700 47.8 F85701 59.2 F85703 61.8 • For more information regarding screening: F85707 72.9 Y00057 70.2 https://www.myhealth.london.nhs.uk/healthy-london/cancer-resources Y00612 66.4 Y03402 62.8 • Make use of easy read leaflets for women with learning disabilities. https://www.gov.uk/government/publications/breast-screening-information-for- 0 10 20 30 40 50 60 70 80 90 women-with-learning-disabilities % eligible population screened 1. Source: NHS, NHS Breast Screening: Helping you decide (2013) Lower No Difference Higher 2. Hewitson, P., Ward, A., Heneghan, C., Halloran, S. & Mant, D. (2011) Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial England Average London Average CCG Average

9. screening breast 36 mo nths Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Females, 50-70, Screened for Breast Cancer within Females, 50-70, screened for breast cancer within 6 months of invitation 6 Months of Invitation (Uptake, %) (Uptake, %)

One-year screening uptake (%): the number of females registered to the practice F85002 45.0 aged 50-70 invited for screening in the previous 12 months who were screened F85003 72.1 within 6 months of invitation, divided by the total number of females aged 50- F85004 72.8 F85010 75.0 70 invited for screening in the previous 12 months. F85011 38.9 F85015 69.9 70% National minimum standard for all Breast Cancer screening F85016 59.4 Area London England F85020 69.0 F85023 64.6 Number cases (N) 8,856 200,519 1,790,555 F85024 66.7 % eligible population screened 68.0 67.1 73.5 F85025 74.1 Difference from 70% national minimum F85027 48.4 -2.0 -2.9 3.5 standard (%) F85029 60.9 F85032 66.5 Statistical significance compared to area - Higher Lower F85033 51.1 The proportion of women who are screened within 6 months of invitation is an F85035 68.8 F85036 60.0 important metric to measure as it has been found that those that attend F85039 71.4 screening earlier are often associated with improved survival and better F85043 53.3 prognosis. F85044 40.0 Breast cancer screening is an important intervention for early detection of F85048 69.8 breast cancers. Screening saves about one life from breast cancer for every 200 F85053 74.7 F85055 75.7 women who are screened (1). This adds up to about 1,300 lives saved from F85058 45.8 breast cancer by screening each year in the UK. F85072 71.4 Inequalities exist in screening uptake with certain groups being less likely to F85076 67.4 attend, including: F85625 72.6 • women in the 50-54 age group F85634 63.2 F85642 52.2 • BME groups and Muslim women F85650 57.1 • women from a more deprived background F85652 41.7 The following initiatives can help improve time to breast cancer screening F85654 76.0 F85663 coverage and reduce inequalities: 63.6 F85666 33.3 • List maintenance - ensure patient records are accurate and up-to-date, F85676 47.8 including addresses and telephone numbers. F85678 50.0 • Follow-up with women who did not attend their screening appointment. F85681 69.1 Evidence shows positive endorsement from a healthcare professional can F85682 81.8 F85684 68.9 increase screening uptake (2). F85686 76.7 • Use reminder flags on patient records for women who have missed their F85687 64.0 screening appointment to prompt a discussion with the patient regarding breast F85700 48.8 screening. F85701 72.0 F85703 62.7 • For more information regarding screening: F85707 71.0 https://www.myhealth.london.nhs.uk/healthy-london/cancer-resources Y00057 70.2 Y00612 64.4 • Make use of easy read leaflets for women with learning disabilities. Y03402 37.7 https://www.gov.uk/government/publications/breast-screening-information-for- 0 10 20 30 40 50 60 70 80 90 100 women-with-learning-disabilities % eligible population screened 1. Source: NHS, NHS Breast Screening: Helping you decide (2013) 2. Hewitson, P., Ward, A., Heneghan, C., Halloran, S. & Mant, D. (2011) Primary care endorsement letter and Lower No Difference Higher England Average London Average CCG Average a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial

10. screening breast 6 months Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Females, 25-64, Attending Cervical Screening within Target Period Females, 25-64, attending cervical screening within target period (3.5 or 5.5 year coverage, %) (3.5 or 5.5 year coverage, %) The overall cervical screening coverage (%): the number of women registered at the F85002 71.1 practice who were adequately screened in the previous 42 months (if aged 24-49) or 66 F85003 72.3 months (if aged 50-64), divided by the number of eligible women on last day of review F85004 70.7 period. F85010 73.3 F85011 62.3 80% National minimum standard for Cervical Cancer screening coverage F85015 70.2 F85016 70.9 Area London England F85020 70.8 Number cases (N) 62,289 1,778,802 10,441,361 F85023 68.0 % eligible population screened 71.1 66.8 72.8 F85024 76.1 Difference from 80% national minimum standard F85025 75.8 -8.9 -13.2 -7.2 (%) F85027 75.4 F85029 75.9 Statistical significance compared to area - Higher Lower F85032 65.4 F85033 75.9 Cervical cancer screening reduces the incidence of cervical cancer. Evidence suggests F85035 75.6 F85036 69.1 that screening was associated with a 60% reduction of cancers in women aged 40, and an F85039 69.5 80% reduction in those aged 64 years (1). Screening was also found to be particularly F85043 70.5 effective in preventing advanced stage cancers. F85044 73.4 Inequalities exist in screening uptake with certain groups being less likely to attend, F85048 63.9 F85053 71.2 including: F85055 72.7 • women in the 25-34 year age group F85058 76.9 • BME groups F85072 71.7 • women from a more deprived background F85076 74.1 F85625 74.8 F85634 64.7 The following initiatives can help improve cervical cancer screening coverage and F85642 66.2 reduce inequalities: F85650 65.9 F85652 72.6 • List maintenance - ensure patient records are accurate and up-to-date, including F85654 72.6 addresses and telephone numbers. F85663 74.2 • Follow-up with women who did not attend their screening appointment. Evidence F85666 66.0 shows positive endorsement from a healthcare professional can increase screening F85676 74.8 F85678 63.3 uptake (2). F85681 72.8 • Use reminder flags on patient records for women who have missed their screening F85682 65.6 appointment to prompt a discussion with the patient regarding cervical screening. F85684 66.1 • Ensure women have access to cervical screening at times and locations that are F85686 74.6 F85687 75.1 convenient to them. F85700 63.5 F85701 66.7 • For more information regarding screening: F85703 66.4 https://www.myhealth.london.nhs.uk/healthy-london/cancer-resources F85707 69.5 Y00057 76.0 • Make use of easy read leaflets for people with learning disabilities Y00612 63.0 https://www.gov.uk/government/publications/cervical-screening-easy-read-guide Y03402 70.1 0 10 20 30 40 50 60 70 80 90 1. Sasieni, P., Castanon, A. and Cuzick, J., 2009. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. BMJ, 339, p.b2968. % eligible population screened

2. Hewitson, P., Ward, A., Heneghan, C., Halloran, S. & Mant, D. (2011) Primary care endorsement letter and a patient Lower No Difference Higher England Average London Average CCG Average leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial

11. screening cervical Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Persons, 60-69, Screened for Bowel Cancer Persons, 60-69, screened for bowel cancer in last 30 months in Last 30 Months (2.5 year coverage, %) (2.5 year coverage, %)

2.5-year screening coverage (%): The number of persons registered to the F85002 46.5 F85003 52.3 practice who were adequately screened in the previous 30 months, divided by F85004 51.2 the number of eligible persons on last day of the review period. F85010 50.7 F85011 46.3 F85015 40.2 60% National minimum standard for overall Bowel screening coverage F85016 55.7 F85020 58.8 Area London England F85023 50.0 F85024 Number cases (N) 13,855 335,600 3,494,269 39.5 F85025 58.3 % eligible population screened 52.7 48.8 57.8 F85027 61.0 F85029 62.0 Difference from 60% national minimum -7.3 -11.2 -2.2 F85032 54.2 standard (%) F85033 59.5 F85035 58.4 Statistical significance compared to area - Higher Lower F85036 52.1 F85039 44.7 F85043 39.8 Bowel cancer screening can reduce deaths from bowel cancer by up to 15% (1). F85044 50.3 F85048 51.6 Inequalities exist in screening uptake with certain groups being less likely to F85053 58.9 F85055 55.4 attend, including: F85058 53.8 • BME groups and Muslim men and women F85072 53.3 F85076 52.5 • people from a more deprived background F85625 54.4 • men and women aged 60-65 years F85634 33.5 F85642 54.6 F85650 54.7 The following initiatives can help improve bowel cancer screening coverage F85652 52.3 F85654 51.6 and reduce inequalities: F85663 53.9 • List maintenance - ensure patient records are accurate and up-to-date, F85666 45.2 F85676 45.7 including addresses and telephone numbers. F85678 48.9 • Follow-up patients who did not return their screening kit. Evidence shows F85681 54.7 F85682 42.6 positive endorsement from a healthcare professional can increase screening F85684 49.4 uptake (2). F85686 51.4 F85687 51.0 • Use reminder flags on patient records for those who did not attend F85700 45.8 F85701 41.3 • For more information regarding screening: F85703 39.6 F85707 42.2 https://www.myhealth.london.nhs.uk/healthy-london/cancer-resources Y00057 50.5 Y00612 41.7 • Make use of easy read leaflets for people with learning disabilities Y03402 39.4 https://www.gov.uk/government/collections/bowel-cancer-screening- 0 10 20 30 40 50 60 70 commission-provide-inform % eligible population screened 1. Hewitson P, Glazsiou P, Towler B, et al. (2011). Screening for colorectal cancer using the faecal occult blood test: an update. The Cochrane Database of Systematic Reviews. [Online]. Lower No Difference Higher 2. Hewitson, P., Ward, A., Heneghan, C., Halloran, S. & Mant, D. (2011) Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial England Average London Average CCG Average

12. screening bowel 30 mos Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Persons, 60-69, Screened for Bowel Cancer Within Persons, 60-69, screened for bowel cancer within 6 months of invitation 6 Months of Invitation (Uptake, %) (Uptake, %)

Screening uptake (%): the number of persons aged 60-69 invited for screening in F85002 44.3 the previous 12 months who were adequately screened following an initial F85003 50.7 F85004 48.3 response within 6 months of invitation, divided by the total number of persons F85010 44.1 aged 60-69 invited for screening in the previous 12 months. F85011 40.3 F85015 38.0 F85016 52.1 60% National minimum standard for overall Bowel screening coverage F85020 58.5 F85023 43.2 Area London England F85024 41.9 Number cases (N) 6,854 159,968 1,682,289 F85025 54.9 F85027 57.1 % Eligible population screened 49.3 45.6 55.6 F85029 56.6 Difference from 60% national minimum standard F85032 52.0 -10.7 -14.4 -4.4 (%) F85033 54.6 F85035 53.8 Statistical significance compared to area - Higher Lower F85036 50.7 F85039 44.4 F85043 37.5 Bowel cancer screening can reduce deaths from bowel cancer by up to 15% (1). F85044 44.8 F85048 46.9 Inequalities exist in screening uptake with certain groups being less likely to F85053 56.0 attend, including: F85055 52.6 • BME groups and Muslim men and women F85058 51.6 F85072 46.7 • people from a more deprived background F85076 48.6 • men and women aged 60-65 years F85625 56.3 F85634 29.9 F85642 50.2 The following initiatives can help improve bowel cancer screening coverage and F85650 49.2 F85652 46.7 reduce inequalities: F85654 50.9 • List maintenance - ensure patient records are accurate and up-to-date, including F85663 50.2 F85666 38.7 addresses and telephone numbers. F85676 47.5 • Follow-up with patients who did not return their screening kit. Evidence shows F85678 46.8 positive endorsement from a healthcare professional can increase screening F85681 54.2 F85682 38.8 uptake (2). F85684 46.7 • Use reminder flags on patient records for those who did not attend screening. F85686 46.8 F85687 50.3 F85700 40.2 • For more information regarding screening: F85701 40.2 https://www.myhealth.london.nhs.uk/healthy-london/cancer-resources F85703 28.1 F85707 46.5 • Make use of easy read leaflets for people with learning disabilities Y00057 49.0 https://www.gov.uk/government/publications/bowel-cancer-screening-easy- Y00612 36.3 Y03402 39.1 guide. 1. Hewitson P, Glazsiou P, Towler B, et al. (2011). Screening for colorectal cancer using the faecal occult blood 0 10 20 30 40 50 60 70 test: an update. The Cochrane Database of Systematic Reviews. [Online]. % eligible population screened

2. Hewitson, P., Ward, A., Heneghan, C., Halloran, S. & Mant, D. (2011) Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial Lower No Difference Higher England Average London Average CCG Average

13. screening bowel 6 mos Area: NHS Enfield CCG Year: 2015-16 Area Comparison of In-Patient or Day-Case Colonoscopy Procedures (Number per 100,000 Population) In-patient or day-case colonoscopy procedures (Number per 100,000 population)

The crude rate per 100,000 persons of colonoscopies performed on persons registered at F85002 1231.7 the practice: the number of colonoscopies (in-patient and day-case) multiplied by 100,000, F85003 549.6 divided by the list size of the practice in question. F85004 760.5 F85010 770.4 These procedures were not filtered by the diagnostic field in the HES data so contain both F85011 391.5 patients subsequently diagnosed with cancer, those not subsequently diagnosed with cancer, F85015 704.5 and patients where there was no suspicion of cancer. Further, this includes procedure data for F85016 670.6 F85020 952.8 both primary and secondary care referrals. Procedures with Office of Population Census and F85023 374.8 Surveys Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) 3-digit codes F85024 583.7 of H22 are included. F85025 963.5 F85027 975.7 Area London England F85029 869.0 Number (N) 2,559 61,183 421,690 F85032 675.4 Colonoscopies performed (per 100,000 F85033 758.6 785.1 650.7 733.1 F85035 population) 900.7 F85036 782.1 Statistical difference from average - Higher Higher F85039 535.7 F85043 784.0 F85044 1108.7 Despite the rate of colonoscopy procedures also including those for which there is no F85048 489.4 suspicion of cancer, it is considered that the majority of colonoscopy procedures will be F85053 1048.6 F85055 1560.9 used for investigation of cancer. Comparing the number of colonoscopies between GPs F85058 742.1 within a CCG and comparing different CCGs to the London and England averages is F85072 721.3 important because it provides possible insight into the number of investigations for bowel F85076 1000.4 F85625 811.7 and colorectal cancer. F85634 629.9 F85642 687.0 Several resources are available to provide further information on the colonscopy procedure F85650 912.2 and colorectal cancer testing: F85652 841.8 • Cancer Research UK's guide to Bowel Cancer Tests F85654 1001.5 F85663 1053.9 (http://www.cancerresearchuk.org/about-cancer/type/bowel-cancer/diagnosis/bowel- F85666 747.7 cancer-tests#colonoscopy). F85676 757.0 F85678 507.2 • NHS Choice's guide to Diagnosing bowel cancer (http://www.nhs.uk/Conditions/Cancer- F85681 391.0 of-the-colon-rectum-or-bowel/Pages/Diagnosis.aspx). F85682 745.5 F85684 707.9 F85686 990.1 • The BMJ's guide to Colorectal screening for older adults F85687 967.6 (http://www.bmj.com/content/350/bmj.h2029). F85700 529.7 F85701 455.2 F85703 601.0 F85707 475.2 Y00057 300.0 Y00612 563.8 Y03402 642.0 0 500 1,000 1,500 2,000 2,500 Colonoscopies performed (per 100,000)

Lower No Difference Higher England Average London Average CCG Average

14. colonoscopy Area: NHS Enfield CCG Year: 2015-16 Area Comparison of In-Patient or Day-Case In-patient or day-case sigmoidoscopy procedures Sigmoidoscopy Procedures (Number per 100,000 population) (Number per 100,000 population) The crude rate per 100,000 persons of sigmoidoscopies performed on persons F85002 261.0 registered at the practice: the number of sigmoidoscopies (in-patient and day-case) F85003 340.7 F85004 484.6 multiplied by 100,000, divided by the list size of the practice in question. F85010 198.1 F85011 142.3 These procedures were not filtered by the diagnostic field in the HES data so contain both F85015 170.8 patients subsequently diagnosed with cancer, those not subsequently diagnosed with cancer, F85016 431.1 F85020 273.9 and patients where there was no suspicion of cancer. Further, this includes procedure data F85023 228.1 for both primary and secondary care referrals. Procedures with Office of Population Census F85024 134.7 F85025 477.4 and Surveys Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) 3- F85027 366.9 digit codes of H25 or H28 are included. F85029 430.6 F85032 423.5 F85033 293.7 Area London England F85035 418.2 Number (N) 1,083 34,829 274,734 F85036 809.1 F85039 223.2 Sigmoidoscopies performed (per 100,000 332.3 370.4 477.6 F85043 116.1 population) F85044 413.0 F85048 466.1 Statistical difference from average Lower Lower F85053 403.3 - F85055 328.6 F85058 280.3 F85072 377.3 Despite the rate of sigmoidoscopy procedures also including those for which there is F85076 523.3 no suspicion of cancer, it is considered that the majority of sigmoidoscopy procedures F85625 447.2 F85634 157.5 will be used for investigation of cancer. Comparing the number of sigmoidoscopies F85642 272.2 between GPs within a CCG and comparing different CCGs to the London and England F85650 254.6 F85652 366.9 averages is important because it provides possible insight into the number of F85654 300.5 F85663 364.8 investigations for bowel cancer. F85666 163.6 F85676 378.5 Several resources are available to provide further information on the sigmoidscopy F85678 106.8 F85681 347.5 procedure and bowel cancer testing: F85682 170.4 • Cancer Research UK's guide to bowel cancer tests F85684 224.4 F85686 457.0 (http://www.cancerresearchuk.org/about-cancer/type/bowel-cancer/diagnosis/bowel- F85687 524.1 F85700 158.9 cancer-tests#colonoscopy) F85701 282.9 • NHS Choice's guide to diagnosing bowel cancer F85703 332.1 F85707 200.1 (http://www.nhs.uk/Conditions/Cancer-of-the-colon-rectum-or- Y00057 171.5 bowel/Pages/Diagnosis.aspx). Y00612 165.8 Y03402 194.7 • The BMJ's guide to sigmoidoscopy screening for colorectal cancer (http://www.bmj.com/content/338/bmj.b2084). 0 200 400 600 800 1,000 1,200 1,400 Sigmoidoscopies performed (per 100,000)

Lower No Difference Higher England Average London Average CCG Average

15. sigmoidoscopy Area: NHS Enfield CCG Year: 2015-16 Area Comparison of In-Patient or Day-Case In-patient or day-case upper GI endoscopy procedures Upper GI Endoscopy Procedures (Number per 100,000 population) (Number per 100,000 population)

The crude rate per 100,000 persons of endoscopies of the upper gastrointestinal tract F85002 1647.8 performed on persons registered at the practice: the number of endoscopies of the upper F85003 901.3 F85004 1207.8 gastrointestinal tract (in-patient and day-case) multiplied by 100,000, divided by the list size F85010 1210.7 of the practice in question. F85011 676.2 F85015 811.3 F85016 894.1 These procedures were not filtered by the diagnostic field in the HES data so contain both patients F85020 952.8 subsequently diagnosed with cancer, those not subsequently diagnosed with cancer, and patients F85023 635.5 where there was no suspicion of cancer. Further, this includes procedure data for both primary F85024 808.3 F85025 1284.7 and secondary care referrals. Procedures with Office of Population Census and Surveys F85027 1384.3 Classification of Surgical Operations and Procedures (4th revision) (OPCS-4) 3-digit codes of G16 F85029 1385.6 F85032 1408.0 and G45 are included. F85033 1180.8 F85035 1308.2 Area London England F85036 1186.6 Number (N) 3,805 104,161 749,164 F85039 1183.0 Upper GI endoscopies performed F85043 1248.5 1167.3 1107.9 1302.4 F85044 1673.9 (per 100,000 population) F85048 862.3 F85053 1290.6 - Higher Lower F85055 1869.0 Statistical difference from average F85058 1121.4 F85072 1154.1 Despite the rate of upper GI endoscopy procedures also including those for which there is F85076 1569.8 F85625 1159.5 no suspicion of cancer, it is considered that the majority of upper GI procedures will be F85634 913.4 used for investigation of cancer. Comparing the number of upper GI endoscopies between F85642 1114.7 F85650 1760.7 GPs within a CCG and comparing different CCGs to the London and England averages is F85652 971.3 important because it provides possible insight into the number of investigations for F85654 1377.1 F85663 1844.3 stomach cancer. F85666 817.8 F85676 1343.7 F85678 587.3 Several resources are available to provide further information on the upper GI endoscopy F85681 651.6 procedure and stomach cancer testing: F85682 958.5 F85684 1450.3 F85686 1599.4 • Cancer Research UK's guide to Endoscopy (http://www.cancerresearchuk.org/about- F85687 1478.3 cancer/cancers-in-general/tests/endoscopy). F85700 715.0 F85701 885.7 • NHS Choices' guide to Endoscopy F85703 695.9 F85707 600.3 (http://www.nhs.uk/conditions/Endoscopy/Pages/Introduction.aspx). Y00057 428.6 Y00612 862.2 Y03402 894.6 0 500 1,000 1,500 2,000 2,500 Upper GI endoscopies performed (per 100,000)

Lower No Difference Higher

England Average London Average CCG Average

16. upper GI endoscopy Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Number of Emergency Admissions with Cancer Number of emergency admissions with cancer (Number per 100,000 population) (Number per 100,000 Population) The crude rate per 100,000 persons of all emergency admissions with an invasive, in-situ, uncertain or unknown behaviour, or benign brain cancer (ICD-10 C00-C97, D00-D09, D33, and D37-48), F85002 783.1 present in any of the first three diagnostic fields (HES inpatient database) per patients on the F85003 406.7 practice register. F85004 671.0 F85010 770.4 A data quality issue has been identified for this indicator/measure: The number of patients per F85011 249.1 practice is often quite small so variation is inflated by chance considerably. Generally with small F85015 555.1 F85016 415.1 sample sizes, process indicators (e.g., rate of 2ww referrals) are considered to be more reliable F85020 488.3 than outcome indicators, such as this indicator. F85023 456.2 F85024 224.5 F85025 581.6 Area London England F85027 433.6 Number (N) 1,556 39,260 308,950 F85029 532.3 F85032 412.1 Rate per 100,000 population 477.4 418.3 537.8 F85033 361.0 Area statistical difference from F85035 482.5 Higher Lower average - F85036 377.6 F85039 401.8 F85043 1074.3 Certain cancers are more likely to be diagnosed through an emergency route, with over half (62%) F85044 543.5 of central nervous system (CNS) cancers in England diagnosed via all emergency routes, as are 39% F85048 209.7 F85053 449.4 of lung cancers - the third most common cancer in England. One year relative survival for cancers F85055 759.9 diagnosed through emergency presentation is significantly lower than all other routes to diagnosis F85058 676.1 F85072 432.8 (1). This data is intended to provide an insight into patients’ routes to diagnosis to CCGs and to F85076 369.4 encourage practices to consider how their own patients present with cancer. F85625 563.2 F85634 472.4 Note: Emergency routes include A&E, GP emergency referral, in-patient emergency admission, or F85642 285.2 F85650 445.5 other out-patient emergency referral (2). F85652 841.8 Further, it has been found that age, sex, deprivation, and tumour site also effect the method of F85654 701.1 F85663 425.6 presentation and is something that should be considered (3). F85666 280.4 F85676 473.1 F85678 427.1 F85681 477.8 Practices may wish to carry out an audit and/or significant event analysis (SEA) on patients F85682 362.1 diagnosed through an emergency route, to identify whether any practice level improvements could F85684 379.8 F85686 304.6 be made. F85687 470.4 The following resources are available to aid practices in undertaking audits and SEAs: F85700 423.7 F85701 418.3 F85703 458.6 • Royal College of GPs audit template and guidance (available at: http://www.rcgp.org.uk/clinical- F85707 200.1 Y00057 407.2 and-research/our-programmes/quality-improvement/significant-event-audit.aspx) Y00612 348.2 Y03402 410.5 1. Routes to Diagnosis: Exploring Emergency Presentations (2013), http://www.ncin.org.uk/publications/data_briefings/routes_to_diagnosis_exploring_emergency_presentations 0 200 400 600 800 1,000 1,200 1,400 1,600 Rate (per 100,000) emergency admissions with cancer 2. Hospital Episodes Survey (HES) Data Dictionary (2015). http://www.hscic.gov.uk/hesdatadictionary 3. Abel, G. A., et al. Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers. British Journal of Cancer; 112 (2015): S129-S136. Lower No Difference Higher England Average London Average CCG Average

17. emergency admissions Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Number of Emergency Presentations Number of emergency presentations (Number per 100,000 population) (Number per 100,000 population) The crude rate of persons diagnosed with cancer via an emergency route, divided by the number of persons in the practice list, expressed as a rate per 100,000 population. F85002 122.4 A data quality issue has been identified for this indicator/measure: The number of patients per F85003 65.9 F85004 89.5 practice is often quite small so variation is inflated by chance considerably. Generally with small F85010 66.0 sample sizes, process indicators (e.g., rate of 2ww referrals) are considered to be more reliable F85011 F85015 106.7 than outcome indicators, such as this indicator. F85016 79.8 F85020 47.6 Area London England F85023 48.9 Number (N) 228 6,090 51,164 F85024 89.8 F85025 104.2 Rate per 100,000 population 69.9 64.8 88.9 F85027 66.7 Area statistical difference from - No Difference Lower F85029 70.5 average F85032 34.3 Certain cancers are more likely to be diagnosed through an emergency route, with over half F85033 36.7 F85035 32.2 (62%) of central nervous system (CNS) cancers in England diagnosed via an emergency route, as F85036 27.0 are 39% of lung cancers - the third most common cancer in England. One year relative survival F85039 22.3 F85043 87.1 for cancers diagnosed through emergency presentation is significantly lower than all other F85044 130.4 routes to diagnosis (1). This data is intended to provide an insight into patients’ routes to F85048 139.8 diagnosis and to encourage practices and CCGs to consider how their own patients present with F85053 69.1 F85055 123.2 cancer. F85058 131.9 It is important to ascertain what proportion of new cancer cases are diagnosed by emergency F85072 77.7 F85076 77.0 route compared to other methods of diagnosis. F85625 165.6 Possible reasons for emergency presentation are as follows: F85634 94.5 • a person was diagnosed through an emergency route due to not attending a screening F85642 25.9 F85650 84.9 appointment F85652 86.3 • symptoms had previously been missed by a GP F85654 50.1 F85663 20.3 • severity of symptoms F85666 70.1 Note: Emergency routes include A&E, GP emergency referral, in-patient emergency admission, F85676 75.7 F85678 106.8 or other out-patient emergency referral (2). F85681 43.4 Further, it has been found that age, sex, deprivation, and tumour site also effect the method of F85682 63.9 presentation and is something that should be considered (3). F85684 51.8 F85686 76.2 Practices may wish to carry out an audit and/or significant event analysis (SEA) on patients F85687 67.2 F85700 79.4 diagnosed through an emergency route, to identify whether any practice level improvements F85701 73.8 could be made. F85703 63.3 The following resources are available to aid practices in undertaking audits and SEAs: F85707 Y00057 64.3 • Royal College of GPs audit template and guidance (available at: Y00612 33.2 http://www.rcgp.org.uk/clinical-and-research/our-programmes/quality- Y03402 47.4 improvement/significant-event-audit.aspx) 0 50 100 150 200 250 300 350 Rate (per 100,000) persons diagnosed with cancer via emergency route 1. Routes to Diagnosis: Exploring Emergency Presentations (2013), http://www.ncin.org.uk/publications/data_briefings/routes_to_diagnosis_exploring_emergency_presentations 2. Hospital Episodes Survey (HES) Data Dictionary (2015). http://www.hscic.gov.uk/hesdatadictionary Lower No Difference Higher 3. Abel, G. A., et al. Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer England Average London Average CCG Average cancers. British Journal of Cancer; 112 (2015): S129-S136.

18. emergency presentations Area: NHS Enfield CCG Year: 2015-16 Area Comparison of Number of Other Presentations Number of other presentations (Number per 100,000 population) (Number per 100,000 population) The crude rate of persons diagnosed with cancer via a non-emergency route, divided by the number of persons in the practice list, expressed as a rate per 100,000 persons. F85002 244.7 F85003 494.6 A data quality issue has been identified for this indicator/measure: The number of patients per F85004 335.5 practice is often quite small so variation is inflated by chance considerably. Generally with small F85010 264.1 F85011 177.9 sample sizes, process indicators (e.g., rate of 2ww referrals) are considered to be more reliable F85015 128.1 F85016 287.4 than outcome indicators, such as this indicator. F85020 321.6 F85023 228.1 Area London England F85024 224.5 F85025 303.8 Number (N) 921 23,561 207,881 F85027 300.2 F85029 407.1 Rate per 100,000 population 282.6 250.6 361.4 F85032 366.3 Area statistical difference from F85033 379.3 - Higher Lower F85035 364.6 average F85036 404.5 F85039 223.2 F85043 290.4 F85044 326.1 Certain cancers are more likely to be diagnosed through an emergency route, with over half F85048 326.3 (62%) of central nervous system (CNS) cancers in England diagnosed via an emergency route, as F85053 311.1 F85055 287.5 are 39% of lung cancers - the third most common cancer in England. One year relative survival F85058 362.8 F85072 277.4 for cancers diagnosed through emergency presentation is significantly lower than all other routes F85076 277.0 to diagnosis (1). This data is intended to provide an insight into patients’ routes to diagnosis and F85625 397.5 F85634 252.0 to encourage practices and CCGs to consider how their own patients present with cancer. F85642 181.5 Possible non-emergency routes to diagnosis include: screen detected, 2ww, GP referral, in- F85650 254.6 F85652 215.8 patient elective, and other non-emergency presentations (2). F85654 325.5 F85663 344.5 Further, it has been found that age, sex, deprivation, and tumour site also effect the method of F85666 280.4 presentation and is something that should be considered (3). F85676 227.1 F85678 160.2 F85681 173.8 F85682 191.7 Practices may wish to carry out an audit and/or significant event analysis (SEA) on patients F85684 241.7 F85686 457.0 diagnosed through an emergency route (this metric is looking at non-emergency), to identify F85687 403.2 whether any practice level improvements could be made. F85700 158.9 F85701 258.3 The following resources are available to aid practices in undertaking audits and SEAs: F85703 94.9 F85707 200.1 Y00057 85.7 • Royal College of GPs audit template and guidance (available at: http://www.rcgp.org.uk/clinical- Y00612 116.1 Y03402 136.8 and-research/our-programmes/quality-improvement/significant-event-audit.aspx) 0 100 200 300 400 500 600 700 800 900 1. Routes to Diagnosis: Exploring Emergency Presentations (2013), Rate (per 100,000) persons diagnosed with cancer via non-emergency route http://www.ncin.org.uk/publications/data_briefings/routes_to_diagnosis_exploring_emergency_presentations 2. Hospital Episodes Survey (HES) Data Dictionary (2015). http://www.hscic.gov.uk/hesdatadictionary Lower No Difference Higher 3. Abel, G. A., et al. Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer England Average London Average CCG Average cancers. British Journal of Cancer; 112 (2015): S129-S136.

19. other presentations Detection Rates Index Table Note: This table is not available at the London level Source: http://fingertips.phe.org.uk/profile/cancerservices Area: NHS Enfield CCG Detection rate is the proportion of cancers detected via the 2 week wait pathway compared to the total number of cancers in that practice. This route is the preferred pathway to ensure rapid access to tests and treatments. Typically, it is around 45-50% in London. However, there is year on year variation in this figure at practice level and at CCG level. Practices demonstrating greater than expected variation in their data can seek reasons for this (sometimes relating to clinical practice or practice systems). In order to take into account natural, expected variation, data from multiple years has been tabulated. Low numbers of suspected cancer cases at a practice level can lead to large fluctuation in the detection rates. To account for this, three-year rolling averages have been calculated.

Practice Practice Name 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Average Code

England 43.7 45 46.3 47.4 48.4 49.7 46.75 NHS Enfield CCG 43.2 41.1 39.3 43.3 36.5 41.4 40.80 F85002 Forest Rd Group Practice 50 57.9 47.8 35.5 19.4 35.9 41.08 F85003 Riley House Surgery 25 22.9 45 27.3 45 30 32.53 F85004 Eagle House Surgery 45.8 59.1 38 44.1 33.3 38.6 43.15 F85010 Keats Surgery 33.3 38.1 16 9.1 21.1 43.8 26.90 F85011 Bowes Medical Centre 57.1 16.7 33.3 50 14.3 40 35.23 F85015 Dover House Surgery 41.7 55.6 40 66.7 33.3 45.5 47.13 F85016 Cockfosters Medical Ctre 25 24 25.7 43.5 52.9 34.6 34.28 F85020 The Woodberry Practice 42.9 39.3 42.3 50 25.7 55 42.53 F85023 The Ordnance Unity Centre For Health 50 46.7 50 22.2 38.1 41.40 F85024 Dean House Surgery 28.6 50 57.1 46.7 50 60 48.73 F85025 White Lodge Medical Practice 48.8 37.9 34.1 40.9 43.6 54.8 43.35 F85027 Carlton House Surgery 46.4 42.2 40.6 41.3 32 35.9 39.73 F85029 Abernethy House Surgery 55.9 60 56.7 47.4 39.1 47.2 51.05 F85032 Southgate 30.8 43.8 50 55.2 30 42.9 42.12 F85033 Winchmore Hill Practice 51.4 41 37.5 46.3 42.9 36.1 42.53 F85035 Highlands Practice 48.7 42.3 44.1 66.7 48.4 44.8 49.17 F85036 Willow House Surgery 66.7 76.9 50 77.8 43.8 71.4 64.43 F85039 Rainbow Practice 50 27.8 30 66.7 41.2 61.5 46.20 F85043 Boundary Court Surgery 50 7.7 27.3 33.3 50 45.5 35.63 F85044 The Bounces Road Surgery 33.3 38.5 22.2 53.3 31.6 38.1 36.17 F85048 Moorfield Road Health Ctr 33.3 20 33.3 30.8 58.3 31.6 34.55 F85053 Park Lodge Medical Centre 54.8 33.3 27.8 50 35.7 71.4 45.50 F85055 Connaught Surgery 38.1 43.8 56.3 38.9 46.7 36.8 43.43 F85058 Nightingale House Surgery 21.1 42.1 26.3 42.9 21.1 46.2 33.28 F85072 Grovelands Medical Centre 52.9 35 46.2 28 50 37.5 41.60 F85076 Freezywater Primary Care Centre 47.4 37 41.9 25.6 30.3 35 36.20 F85625 Bincote Surgery 30 40 45 41.2 48 35.7 39.98 F85634 East Enfield Practice 40 25 0 0 33.3 25 20.55 F85642 The North London Health Centre 38.1 50 41.2 65.2 30.4 50 45.82 F85650 Morecambe Surgery 38.5 26.3 33.3 36.4 22.2 21.4 29.68 F85652 Southbury Surgery 50 40 66.7 27.3 25 9.1 36.35 F85654 Brick Lane Surgery 65 36.4 50 41.7 50 27.3 45.07 F85663 Latymer Road Surgery 53.8 30 21.4 28.6 21.1 36.8 31.95 F85666 Dr Me Silver's Practice 35.7 35.3 60 42.9 36.4 45.5 42.63 F85676 Boundary House Surgery 25 33.3 55.6 63.6 40 30.8 41.38 F85678 Town Surgery 55.6 50 25 40 42.9 20 38.92 F85681 Green Street Surgery 42.9 60 33.3 57.1 25 28.6 41.15 F85682 Chalfont Road Surgery 40 20 45.5 28.6 33.3 36.4 33.97 F85684 Curzon Avenue Surgery 40 50 50 35 31.3 43.8 41.68 F85686 Trinity Avenue Surgery 50 55.6 36.4 28.6 53.3 46.7 45.10 F85687 Oakwood Medical Centre 50 57.1 30.4 42.9 30 54.8 44.20

Detection Rates Index Detection Rates Index Table Note: This table is not available at the London level Source: http://fingertips.phe.org.uk/profile/cancerservices Area: NHS Enfield CCG Detection rate is the proportion of cancers detected via the 2 week wait pathway compared to the total number of cancers in that practice. This route is the preferred pathway to ensure rapid access to tests and treatments. Typically, it is around 45-50% in London. However, there is year on year variation in this figure at practice level and at CCG level. Practices demonstrating greater than expected variation in their data can seek reasons for this (sometimes relating to clinical practice or practice systems). In order to take into account natural, expected variation, data from multiple years has been tabulated. Low numbers of suspected cancer cases at a practice level can lead to large fluctuation in the detection rates. To account for this, three-year rolling averages have been calculated.

Practice Practice Name 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 Average Code

F85700 Arnos Grove Medical Centr 62.5 0 20 40 33.3 50 34.30 F85701 Gillan House Surgery 43.5 35.3 80 39.1 53.8 50 50.28 F85703 Lincoln Road Med Practice 25 33.3 27.3 44.4 42.9 62.5 39.23 F85707 Enfield Island Surgery 0 50 20 16.7 0 40 21.12 Y00057 Angel Surgery 11.1 0 30.8 33.3 25 25 20.87 Y00612 Green Cedars Medical Centre 54.5 38.5 36.4 40 50 44.4 43.97 Y03402 Evergreen Primary Care Centre 30.6 66.7 32.6 41.9 42.95

Detection Rates Index Rolling Averages Detection Rates Index Table Note: This table is not available at the London level Source: http://fingertips.phe.org.uk/profile/cancerservices Area: NHS Enfield CCG Three-year rolling average detection rates have been presented at a practice level for a selected CCG, along with the average detection rate over the six years. Low numbers of suspected cancer cases at a practice level can lead to large fluctuation in the detection rates. To account for this, three-year rolling averages have been calculated.

Practice 2010/11-2012/13 2011/12-2013/14 2012/13-2014/15 2013/14-2015/16 2010/11- 2015/16 Practice Name Code Average Average Average Average Average

England 45.00 46.23 47.37 48.50 46.75 NHS Enfield CCG 41.20 41.23 39.70 40.40 40.80 F85002 Forest Rd Group Practice 51.90 47.07 34.23 30.27 41.08 F85003 Riley House Surgery 30.97 31.73 39.10 34.10 32.53 F85004 Eagle House Surgery 47.63 47.07 38.47 38.67 43.15 F85010 Keats Surgery 29.13 21.07 15.40 24.67 26.90 F85011 Bowes Medical Centre 35.70 33.33 32.53 34.77 35.23 F85015 Dover House Surgery 45.77 54.10 46.67 48.50 47.13 F85016 Cockfosters Medical Ctre 24.90 31.07 40.70 43.67 34.28 F85020 The Woodberry Practice 41.50 43.87 39.33 43.57 42.53 F85023 The Ordnance Unity Centre For Health 48.35 48.35 36.10 36.77 41.40 F85024 Dean House Surgery 45.23 51.27 51.27 52.23 48.73 F85025 White Lodge Medical Practice 40.27 37.63 39.53 46.43 43.35 F85027 Carlton House Surgery 43.07 41.37 37.97 36.40 39.73 F85029 Abernethy House Surgery 57.53 54.70 47.73 44.57 51.05 F85032 Southgate 41.53 49.67 45.07 42.70 42.12 F85033 Winchmore Hill Practice 43.30 41.60 42.23 41.77 42.53 F85035 Highlands Practice 45.03 51.03 53.07 53.30 49.17 F85036 Willow House Surgery 64.53 68.23 57.20 64.33 64.43 F85039 Rainbow Practice 35.93 41.50 45.97 56.47 46.20 F85043 Boundary Court Surgery 28.33 22.77 36.87 42.93 35.63 F85044 The Bounces Road Surgery 31.33 38.00 35.70 41.00 36.17 F85048 Moorfield Road Health Ctr 28.87 28.03 40.80 40.23 34.55 F85053 Park Lodge Medical Centre 38.63 37.03 37.83 52.37 45.50 F85055 Connaught Surgery 46.07 46.33 47.30 40.80 43.43 F85058 Nightingale House Surgery 29.83 37.10 30.10 36.73 33.28 F85072 Grovelands Medical Centre 44.70 36.40 41.40 38.50 41.60 F85076 Freezywater Primary Care Centre 42.10 34.83 32.60 30.30 36.20 F85625 Bincote Surgery 38.33 42.07 44.73 41.63 39.98 F85634 East Enfield Practice 21.67 8.33 11.10 19.43 20.55 F85642 The North London Health Centre 43.10 52.13 45.60 48.53 45.82 F85650 Morecambe Surgery 32.70 32.00 30.63 26.67 29.68 F85652 Southbury Surgery 52.23 44.67 39.67 20.47 36.35 F85654 Brick Lane Surgery 50.47 42.70 47.23 39.67 45.07 F85663 Latymer Road Surgery 35.07 26.67 23.70 28.83 31.95 F85666 Dr Me Silver's Practice 43.67 46.07 46.43 41.60 42.63 F85676 Boundary House Surgery 37.97 50.83 53.07 44.80 41.38 F85678 Town Surgery 43.53 38.33 35.97 34.30 38.92 F85681 Green Street Surgery 45.40 50.13 38.47 36.90 41.15 F85682 Chalfont Road Surgery 35.17 31.37 35.80 32.77 33.97 F85684 Curzon Avenue Surgery 46.67 45.00 38.77 36.70 41.68

Detection Rates Index Rolling Averages Detection Rates Index Table Note: This table is not available at the London level Source: http://fingertips.phe.org.uk/profile/cancerservices Area: NHS Enfield CCG Three-year rolling average detection rates have been presented at a practice level for a selected CCG, along with the average detection rate over the six years. Low numbers of suspected cancer cases at a practice level can lead to large fluctuation in the detection rates. To account for this, three-year rolling averages have been calculated.

Practice 2010/11-2012/13 2011/12-2013/14 2012/13-2014/15 2013/14-2015/16 2010/11- 2015/16 Practice Name Code Average Average Average Average Average

F85686 Trinity Avenue Surgery 47.33 40.20 39.43 42.87 45.10 F85687 Oakwood Medical Centre 45.83 43.47 34.43 42.57 44.20 F85700 Arnos Grove Medical Centr 27.50 20.00 31.10 41.10 34.30 F85701 Gillan House Surgery 52.93 51.47 57.63 47.63 50.28 F85703 Lincoln Road Med Practice 28.53 35.00 38.20 49.93 39.23 F85707 Enfield Island Surgery 23.33 28.90 12.23 18.90 21.12 Y00057 Angel Surgery 13.97 21.37 29.70 27.77 20.87 Y00612 Green Cedars Medical Centre 43.13 38.30 42.13 44.80 43.97 Y03402 Evergreen Primary Care Centre 30.60 48.65 43.30 47.07 42.95

Detection Rates Index GP Practice Index Table Note: This table is not available at the London level Source: http://fingertips.phe.org.uk/profile/cancerservices For further information regarding population size of each practice, and additional variables, for the most recent year please visit http://fingertips.phe.org.uk/profile/general- practice/data Area: NHS Enfield CCG Quality and Proportion Practice specific New cancer cases Outcomes of deprivation Practice Code Practice Name (rate per 100,000 Framework (QOF) population score (IMD population) Prevalence (%) 65+ (%) Score) Most recent year available: 2013-14 2015-16 2016 2015 F85002 Forest Rd Group Practice 331.2 1.6 9.9 36.2 F85003 Riley House Surgery 393.2 1.2 12.7 37 F85004 Eagle House Surgery 342.5 2.2 12.6 34.7 F85010 Keats Surgery 455.4 2 15.3 33.5 F85011 Bowes Medical Centre 322.5 2.6 14.9 20.5 F85015 Dover House Surgery 242.2 1.7 12.1 38.4 F85016 Cockfosters Medical Ctre 360.1 2.8 20.9 12.2 F85020 The Woodberry Practice 504.7 2.1 15.8 15 F85023 The Ordnance Unity Centre For Health 176.8 1.2 7.4 36.2 F85024 Dean House Surgery 935 1.7 12.6 34.7 F85025 White Lodge Medical Practice 481.5 2.7 16.5 18.4 F85027 Carlton House Surgery 438.6 2.6 17.7 18.7 F85029 Abernethy House Surgery 553.8 3.3 19.6 17.6 F85032 Southgate 503.8 1.2 16.5 14.9 F85033 Winchmore Hill Practice 610.1 3.1 18.4 12.4 F85035 Highlands Practice 384.6 2.5 18.4 12.5 F85036 Willow House Surgery 560.3 3.5 15.5 22.3 F85039 Rainbow Practice 456.1 1.7 10.7 39.5 F85043 Boundary Court Surgery 468 1.5 10.3 43.5 F85044 The Bounces Road Surgery 453.5 1.8 11.9 36.7 F85048 Moorfield Road Health Ctr 312.1 2 12.5 36.3 F85053 Park Lodge Medical Centre 440.6 2.2 15 15.1 F85055 Connaught Surgery 493.5 2.3 16.3 19.8 F85058 Nightingale House Surgery 470.3 1.3 12.7 33.4 F85072 Grovelands Medical Centre 273.3 1.7 15.1 21.3 F85076 Freezywater Primary Care Centre 399.5 1.8 11.1 34.7 F85625 Bincote Surgery 407.5 2.6 15.9 15.3 F85634 East Enfield Practice 63.1 0.7 5.3 36.1 F85642 The North London Health Centre 414.9 1.8 11.3 19.1 F85650 Morecambe Surgery 390.2 2.1 15 30.5 F85652 Southbury Surgery 291.7 2.3 11.2 21.6 F85654 Brick Lane Surgery 324.4 2.4 13.4 34.2 F85663 Latymer Road Surgery 485.6 1.7 13.6 35.1 F85666 Dr Me Silver's Practice 220 2 11 41.6 F85676 Boundary House Surgery 249.4 1.1 10.5 34.2 F85678 Town Surgery 214.5 1.4 8.2 22.9 F85681 Green Street Surgery 392.7 1.2 12.4 35.1 F85682 Chalfont Road Surgery 131.2 1 6.9 39.1 F85684 Curzon Avenue Surgery 389.7 1.9 7.6 37 F85686 Trinity Avenue Surgery 599.6 1.7 15.5 21.5 F85687 Oakwood Medical Centre 413.6 2.7 14 16.7 F85700 Arnos Grove Medical Centr 290.4 1 8.9 23.6 F85701 Gillan House Surgery 374 1.8 9.9 20.6 F85703 Lincoln Road Med Practice 267 1.1 6.7 28.1 F85707 Enfield Island Surgery 118.8 0.9 3.9 35.3 Y00057 Angel Surgery 217.9 1 4.7 40.8 Y00612 Green Cedars Medical Centre 268 0.8 6.3 37.5 Y03402 Evergreen Primary Care Centre 268.1 1.1 6.7 41.5

Index Table GP Practice Index Table Note: This table is not available at the London level Source: http://fingertips.phe.org.uk/profile/cancerservices For further information regarding population size of each practice, and additional variables, for the most recent year please visit http://fingertips.phe.org.uk/profile/general- practice/data Area: NHS Enfield CCG Quality and Proportion Practice specific New cancer cases Outcomes of deprivation Practice Code Practice Name (rate per 100,000 Framework (QOF) population score (IMD population) Prevalence (%) 65+ (%) Score) Most recent year available: 2013-14 2015-16 2016 2015

Index Table