CVD: Primary Care Intelligence Packs NHS Gloucestershire 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 Gloucestershire CCG are: NHS West Hampshire CCG NHS Somerset CCG NHS Wiltshire CCG NHS Southern Derbyshire CCG NHS Kernow CCG NHS East and North Hertfordshire CCG NHS Ipswich and East Suffolk CCG NHS Mid Essex CCG NHS Nene CCG NHS West Kent CCG

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

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

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

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

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

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

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

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

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

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

WELLINGTON ROAD SURGERY 7

EMERSONS GREEN MEDICAL CENTRE 9

LEAP VALLEY MEDICAL CENTRE 22

CHRISTCHURCH FAMILY MEDICAL CENTRE 21

CONISTON MEDICAL PRACTICE 17

FROME VALLEY MEDICAL CENTRE 31

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

THE WILLOW SURGERY 5

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

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

denominatorORCHARD MEDICAL plus CENTRE exceptions.

WEST WALK SURGERY

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

10 CVD: Primary Care Intelligence Packs CVD prevention

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

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

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

High systolic blood pressure

Dietary risks

High total cholesterol

High body-mass index

Tobacco smoke

High fasting plasma glucose

Low physical activity

Air pollution

Low glomerular filtration rate

Other environmental risks

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

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

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

NHS Nene CCG 19.3%

NHS Kernow CCG 18.0% • prevalence of 15.9% in NHS Gloucestershire CCG NHS Somerset CCG 17.7%

NHS Southern Derbyshire CCG 17.6%

NHS Ipswich and East Suffolk CCG 16.8%

NHS Gloucestershire CCG 15.9%

NHS East and North Hertfordshire CCG 15.8%

NHS Mid Essex CCG 15.7% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Wiltshire CCG 15.3% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS West Kent 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% 5% 10% 15% 20% 25% recorded as current smokers) divided by GP practice’s estimated number of patients 15+

13 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by GP practice

GP Practice CCG

GLOUCESTER HEALTH ACCESS CENTRE Y02519 35.2% GLOUCESTER CITY HEALTH CENTRE L84052 29.8% BARTONGATE SURGERY L84001 27.0% KINGSHOLM SURGERY L84081 25.1% ST.CATHERINE'S SURGERY L84058 24.0% SAINTBRIDGE SURGERY L84013 23.3% THE CORINTHIAN SURGERY L84056 22.9% FOREST HEALTH CARE L84028 22.7% ROSEBANK HEALTH L84050 21.8% DOCKHAM ROAD SURGERY L84046 21.4% • 83,995 people who are recorded as THE ROYAL WELL SURGERY L84049 20.1% LOCKING HILL SURGERY L84032 19.9% YORKLEIGH SURGERY(CT) L84022 19.9% smokers in NHS Gloucestershire PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 19.5% SEVERNBANK SURGERY L84085 19.5% ST.GEORGE'S SURGERY L84008 19.2% CCG ROYAL CRESCENT L84059 18.7% ACORN PRACTICE L84073 18.1% LONDON MEDICAL PRACTICE L84042 18.0% • GP practice range: 7.2% to 35.2% BROCKWORTH SURGERY L84084 17.9% HEATHVILLE MEDICAL PRACTICE L84026 17.8% STROUD HC L84039 17.5% COLEFORD FAMILY DOCTORS L84069 17.5% BRUNSTON PRACTICE L84071 17.3% CHURCH STREET PRACTICE L84023 17.3% ROWCROFT MEDICAL CENTRE L84007 17.2% YORKLEY HEALTH CENTRE(WG) L84021 17.2% MYTHE MEDICAL PRACTICE L84054 17.2% HADWEN MEDICAL PRACT. L84009 17.1% LYDNEY PRACTICE L84011 17.0% STROUD VALLEYS FAMILY PRACTICE L84077 16.8% CRESCENT BAKERY L84616 16.7% STONEHOUSE HEALTH CLINIC L84613 16.6% ST.PETER'S ROAD SURGERY L84017 16.3% BARNWOOD MEDICAL PRACTICE L84057 16.3% AVENUE SURGERY L84018 16.2% BLAKENEY SURGERY L84029 16.1% HIGH STREET MEDICAL CENTRE L84070 16.0% WALNUT TREE PRACTICE L84075 15.8% DRYBROOK SURGERY L84024 15.7% PHOENIX SURGERY L84012 15.2% MARYBROOK MEDICAL CENTRE L84044 15.1% QUEDGELEY MEDICAL CENTRE L84617 15.0% PRICES MILL SURGERY L84065 14.4% BERKELEY PLACE SURGERY L84030 14.2% REGENT STREET SURGERY L84080 14.1% PARK SURGERY(CV) L84010 14.1% MITCHELDEAN SURGERY L84045 14.0% CAM & ULEY FAMILY PRACTICE L84060 13.8% THE PORTLAND PRACTICE L84033 13.8% WHITE HOUSE SURGERY L84072 13.8% NEWNHAM SURGERY L84615 13.5% LECHLADE MEDICAL CENTRE L84055 13.4% UNDERWOOD SURGERY L84003 13.1% HOLTS HEALTH CENTRE L84037 12.8% STOW SURGERY L84031 12.8% ROMNEY HOUSE SURGERY L84020 12.7% CHURCHDOWN SURGERY L84047 12.6% HILARY COTTAGE SURGERY L84053 12.5% MANN COTTAGE SURGERY L84068 12.5% COLLEGE YARD & HIGHNAM L84606 12.1% COTSWOLD MEDICAL PRACTICE L84038 12.0% OVERTON PARK SURGERY L84041 12.0% WINCHCOMBE MEDICAL CENTRE L84004 11.6% CHIPPING CAMPDEN SURGERY L84043 11.6% CULVERHAY SURGERY L84027 11.5% FRITHWOOD SURGERY L84016 11.4% Note: This method is thought to be a reasonably LONGLEVENS SURGERY L84067 11.3% CHIPPING SURGERY L84051 11.2% HUCCLECOTE SURGERY L84014 10.8% robust method in estimating smoking prevalence SEVEN POSTS SURGERY L84036 10.7% FRAMPTON SURGERY L84078 10.6% for the majority of GP practices. However, CHELTENHAM ROAD SURGERY L84002 10.3% THE STOKE ROAD SURGERY, L84048 10.2% RENDCOMB SURGERY L84063 10.2% caution is advised for extreme estimates of SIXWAYS CLINIC L84015 9.9% STAUNTON & CORSE SURGERY L84006 8.9% MINCHINHAMPTON SURGERY L84005 8.7% smoking prevalence and those with high THE LECKHAMPTON SURGERY L84040 7.4% HOYLAND HOUSE L84025 7.2% numbers of smoking status not recorded and 0% 5% 10% 15% 20% 25% 30% 35% 40% 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 Gloucestershire CCG 0.58 • the ratio of those diagnosed with hypertension versus those expected to have hypertension is 0.58. This compares to 0.59 for England • this suggests that 58% 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 Nene CCG 0.60

NHS West Hampshire CCG 0.59

NHS Southern Derbyshire CCG 0.59

NHS Ipswich and East Suffolk CCG 0.59

NHS Kernow CCG 0.58

NHS West Kent CCG 0.58

NHS Mid Essex CCG 0.58

NHS East and North Hertfordshire CCG 0.58

NHS Gloucestershire CCG 0.58

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

COLEFORD FAMILY DOCTORS L84069 0.67 BRUNSTON PRACTICE L84071 0.66 LONDON MEDICAL PRACTICE L84042 0.64 ST.PETER'S ROAD SURGERY L84017 0.64 ACORN PRACTICE L84073 0.63 LYDNEY PRACTICE L84011 0.63 MANN COTTAGE SURGERY L84068 0.63 BARNWOOD MEDICAL PRACTICE L84057 0.62 STROUD HC L84039 0.62 CHURCH STREET PRACTICE L84023 0.62 LECHLADE MEDICAL CENTRE L84055 0.62 • it is estimated that there are 64,231 REGENT STREET SURGERY L84080 0.62 LONGLEVENS SURGERY L84067 0.61 WHITE HOUSE SURGERY L84072 0.61 people with undiagnosed FOREST HEALTH CARE L84028 0.61 COLLEGE YARD & HIGHNAM L84606 0.61 DRYBROOK SURGERY L84024 0.61 ROMNEY HOUSE SURGERY L84020 0.60 hypertension in NHS Gloucestershire ROSEBANK HEALTH L84050 0.60 WALNUT TREE PRACTICE L84075 0.60 HEATHVILLE MEDICAL PRACTICE L84026 0.60 CCG SEVERNBANK SURGERY L84085 0.59 HILARY COTTAGE SURGERY L84053 0.59 FRITHWOOD SURGERY L84016 0.59 STOW SURGERY L84031 0.59 • GP practice range of observed to CHIPPING CAMPDEN SURGERY L84043 0.59 NEWNHAM SURGERY L84615 0.58 SAINTBRIDGE SURGERY L84013 0.58 CHIPPING SURGERY L84051 0.58 expected hypertension prevalence GLOUCESTER CITY HEALTH CENTRE L84052 0.57 MYTHE MEDICAL PRACTICE L84054 0.57 PRICES MILL SURGERY L84065 0.57 0.43 to 0.67 THE CORINTHIAN SURGERY L84056 0.57 FRAMPTON SURGERY L84078 0.56 WINCHCOMBE MEDICAL CENTRE L84004 0.56 STONEHOUSE HEALTH CLINIC L84613 0.56 CHURCHDOWN SURGERY L84047 0.56 STAUNTON & CORSE SURGERY L84006 0.56 STROUD VALLEYS FAMILY PRACTICE L84077 0.56 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 0.55 THE STOKE ROAD SURGERY, L84048 0.55 PARK SURGERY(CV) L84010 0.55 AVENUE SURGERY L84018 0.55 SIXWAYS CLINIC L84015 0.55 CHELTENHAM ROAD SURGERY L84002 0.54 BLAKENEY SURGERY L84029 0.54 CRESCENT BAKERY L84616 0.53 HADWEN MEDICAL PRACT. L84009 0.53 MARYBROOK MEDICAL CENTRE L84044 0.52 BERKELEY PLACE SURGERY L84030 0.52 LOCKING HILL SURGERY L84032 0.52 HOLTS HEALTH CENTRE L84037 0.52 YORKLEY HEALTH CENTRE(WG) L84021 0.52 CAM & ULEY FAMILY PRACTICE L84060 0.52 ST.CATHERINE'S SURGERY L84058 0.52 MITCHELDEAN SURGERY L84045 0.51 THE PORTLAND PRACTICE L84033 0.51 SEVEN POSTS SURGERY L84036 0.51 THE ROYAL WELL SURGERY L84049 0.50 KINGSHOLM SURGERY L84081 0.50 THE LECKHAMPTON SURGERY L84040 0.50 HIGH STREET MEDICAL CENTRE L84070 0.50 ROYAL CRESCENT L84059 0.50 BROCKWORTH SURGERY L84084 0.50 COTSWOLD MEDICAL PRACTICE L84038 0.49 MINCHINHAMPTON SURGERY L84005 0.48 HOYLAND HOUSE L84025 0.48 ST.GEORGE'S SURGERY L84008 0.48 BARTONGATE SURGERY L84001 0.47 PHOENIX SURGERY L84012 0.47 HUCCLECOTE SURGERY L84014 0.47 UNDERWOOD SURGERY L84003 0.47 CULVERHAY SURGERY L84027 0.46 YORKLEIGH SURGERY(CT) L84022 0.46 QUEDGELEY MEDICAL CENTRE L84617 0.44 RENDCOMB SURGERY L84063 0.44 OVERTON PARK SURGERY L84041 0.44 ROWCROFT MEDICAL CENTRE L84007 0.43 DOCKHAM ROAD SURGERY L84046 0.43 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 Gloucestershire CCG 80.1% • 88,902 people with hypertension (diagnosed)* in NHS Gloucestershire CCG • 71,179 (80.1%) people whose blood pressure is <= 150/90 • 4,308 (4.8%) people who are excepted from optimal control • 13,415 (15.1%) 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 Nene CCG 80.9%

NHS Southern Derbyshire CCG 80.6%

NHS Gloucestershire CCG 80.1%

NHS Ipswich and East Suffolk CCG 80.0%

NHS Kernow CCG 79.7%

NHS East and North Hertfordshire CCG 79.6%

NHS Wiltshire CCG 79.6%

NHS Mid Essex CCG 79.3%

NHS West Kent CCG 79.3%

NHS West Hampshire CCG 78.3%

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

GLOUCESTER HEALTH ACCESS CENTRE Y02519 117 ROYAL CRESCENT L84059 295 ROWCROFT MEDICAL CENTRE L84007 371 KINGSHOLM SURGERY L84081 193 CRESCENT BAKERY L84616 222 HIGH STREET MEDICAL CENTRE L84070 231 THE STOKE ROAD SURGERY, L84048 448 STROUD VALLEYS FAMILY PRACTICE L84077 210 HUCCLECOTE SURGERY L84014 326 GLOUCESTER CITY HEALTH CENTRE L84052 272 • in total, including exceptions, there SAINTBRIDGE SURGERY L84013 318 QUEDGELEY MEDICAL CENTRE L84617 129 LECHLADE MEDICAL CENTRE L84055 217 are 17,723 people whose blood CULVERHAY SURGERY L84027 204 ST.CATHERINE'S SURGERY L84058 326 BARNWOOD MEDICAL PRACTICE L84057 238 HILARY COTTAGE SURGERY L84053 307 pressure is not <= 150/90 ROSEBANK HEALTH L84050 718 BERKELEY PLACE SURGERY L84030 213 ST.PETER'S ROAD SURGERY L84017 275 • GP practice range: 8.8% to 32.1% RENDCOMB SURGERY L84063 105 UNDERWOOD SURGERY L84003 185 SEVERNBANK SURGERY L84085 170 HOYLAND HOUSE L84025 178 BROCKWORTH SURGERY L84084 262 OVERTON PARK SURGERY L84041 262 ST.GEORGE'S SURGERY L84008 277 NEWNHAM SURGERY L84615 120 LOCKING HILL SURGERY L84032 302 STOW SURGERY L84031 200 DOCKHAM ROAD SURGERY L84046 161 HEATHVILLE MEDICAL PRACTICE L84026 339 CHURCHDOWN SURGERY L84047 383 BRUNSTON PRACTICE L84071 222 COLLEGE YARD & HIGHNAM L84606 168 CHURCH STREET PRACTICE L84023 406 THE PORTLAND PRACTICE L84033 312 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 321 THE CORINTHIAN SURGERY L84056 222 THE LECKHAMPTON SURGERY L84040 353 MYTHE MEDICAL PRACTICE L84054 321 CAM & ULEY FAMILY PRACTICE L84060 292 SIXWAYS CLINIC L84015 300 WINCHCOMBE MEDICAL CENTRE L84004 227 HADWEN MEDICAL PRACT. L84009 406 FRITHWOOD SURGERY L84016 194 PRICES MILL SURGERY L84065 241 BARTONGATE SURGERY L84001 159 AVENUE SURGERY L84018 170 CHIPPING CAMPDEN SURGERY L84043 158 PHOENIX SURGERY L84012 256 STROUD HC L84039 230 LONGLEVENS SURGERY L84067 189 PARK SURGERY(CV) L84010 206 YORKLEIGH SURGERY(CT) L84022 181 LONDON MEDICAL PRACTICE L84042 164 THE ROYAL WELL SURGERY L84049 140 HOLTS HEALTH CENTRE L84037 263 STAUNTON & CORSE SURGERY L84006 149 YORKLEY HEALTH CENTRE(WG) L84021 184 WHITE HOUSE SURGERY L84072 129 MITCHELDEAN SURGERY L84045 146 LYDNEY PRACTICE L84011 195 COTSWOLD MEDICAL PRACTICE L84038 227 COLEFORD FAMILY DOCTORS L84069 223 WALNUT TREE PRACTICE L84075 110 CHELTENHAM ROAD SURGERY L84002 182 DRYBROOK SURGERY L84024 116 CHIPPING SURGERY L84051 176 ACORN PRACTICE L84073 90 REGENT STREET SURGERY L84080 90 MINCHINHAMPTON SURGERY L84005 164 MARYBROOK MEDICAL CENTRE L84044 105 ROMNEY HOUSE SURGERY L84020 170 FOREST HEALTH CARE L84028 171 BLAKENEY SURGERY L84029 62 MANN COTTAGE SURGERY L84068 86 SEVEN POSTS SURGERY L84036 161 STONEHOUSE HEALTH CLINIC L84613 48 FRAMPTON SURGERY L84078 64 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 Gloucestershire CCG 65.1% • 315 people with a new diagnosis* of hypertension with a CVD risk of 20% or higher in NHS Gloucestershire CCG • 205 (65.1%) people who are currently treated with statins • 101 (32.1%) people who are exempted from treatment with statins • 9 (2.9%) additional people who are not currently treated with statins

England 66.5%

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

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

NHS Nene CCG 69.5%

NHS East and North Hertfordshire CCG 65.4%

NHS Gloucestershire CCG 65.1%

NHS Mid Essex CCG 63.1%

NHS Ipswich and East Suffolk CCG 62.1%

NHS Kernow CCG 62.0%

NHS Southern Derbyshire CCG 61.5%

NHS West Kent CCG 60.3%

NHS Wiltshire CCG 59.7%

NHS West Hampshire CCG 55.9%

NHS Somerset CCG 55.1%

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

24 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and not treated with statins by GP practice

No treatment Exceptions reported

HADWEN MEDICAL PRACT. L84009 1 DOCKHAM ROAD SURGERY L84046 4 WHITE HOUSE SURGERY L84072 3 GLOUCESTER HEALTH ACCESS CENTRE Y02519 1 PHOENIX SURGERY L84012 2 CULVERHAY SURGERY L84027 2 ST.CATHERINE'S SURGERY L84058 2 MANN COTTAGE SURGERY L84068 2 COLEFORD FAMILY DOCTORS L84069 2 KINGSHOLM SURGERY L84081 2 • in total, including exceptions, there HIGH STREET MEDICAL CENTRE L84070 5 LOCKING HILL SURGERY L84032 3 FRAMPTON SURGERY L84078 3 are 110 people who are not treated MYTHE MEDICAL PRACTICE L84054 4 SEVERNBANK SURGERY L84085 4 SAINTBRIDGE SURGERY L84013 8 CHURCH STREET PRACTICE L84023 2 with statins BERKELEY PLACE SURGERY L84030 1 HOLTS HEALTH CENTRE L84037 2 MITCHELDEAN SURGERY L84045 1 • GP practice range: 0.0% to 100.0% PRICES MILL SURGERY L84065 6 BROCKWORTH SURGERY L84084 1 THE LECKHAMPTON SURGERY L84040 4 YORKLEY HEALTH CENTRE(WG) L84021 3 HILARY COTTAGE SURGERY L84053 3 BRUNSTON PRACTICE L84071 3 STOW SURGERY L84031 2 CAM & ULEY FAMILY PRACTICE L84060 2 HEATHVILLE MEDICAL PRACTICE L84026 3 UNDERWOOD SURGERY L84003 1 STAUNTON & CORSE SURGERY L84006 3 FOREST HEALTH CARE L84028 1 OVERTON PARK SURGERY L84041 1 MARYBROOK MEDICAL CENTRE L84044 1 CHURCHDOWN SURGERY L84047 1 THE STOKE ROAD SURGERY, L84048 1 LECHLADE MEDICAL CENTRE L84055 1 RENDCOMB SURGERY L84063 1 REGENT STREET SURGERY L84080 1 WINCHCOMBE MEDICAL CENTRE L84004 2 ROSEBANK HEALTH L84050 2 LONGLEVENS SURGERY L84067 7 PARK SURGERY(CV) L84010 1 CHIPPING CAMPDEN SURGERY L84043 1 ST.PETER'S ROAD SURGERY L84017 1 THE CORINTHIAN SURGERY L84056 1 MINCHINHAMPTON SURGERY L84005 1 QUEDGELEY MEDICAL CENTRE L84617 1 BARTONGATE SURGERY L84001 CHELTENHAM ROAD SURGERY L84002 ROWCROFT MEDICAL CENTRE L84007 ST.GEORGE'S SURGERY L84008 LYDNEY PRACTICE L84011 HUCCLECOTE SURGERY L84014 SIXWAYS CLINIC L84015 FRITHWOOD SURGERY L84016 AVENUE SURGERY L84018 ROMNEY HOUSE SURGERY L84020 YORKLEIGH SURGERY(CT) L84022 DRYBROOK SURGERY L84024 HOYLAND HOUSE L84025 THE PORTLAND PRACTICE L84033 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 SEVEN POSTS SURGERY L84036 COTSWOLD MEDICAL PRACTICE L84038 STROUD HC L84039 THE ROYAL WELL SURGERY L84049 CHIPPING SURGERY L84051 GLOUCESTER CITY HEALTH CENTRE L84052 ROYAL CRESCENT L84059 ACORN PRACTICE L84073 WALNUT TREE PRACTICE L84075 STROUD VALLEYS FAMILY PRACTICE L84077 COLLEGE YARD & HIGHNAM L84606 STONEHOUSE HEALTH CLINIC L84613 NEWNHAM SURGERY L84615 CRESCENT BAKERY L84616 BARNWOOD MEDICAL PRACTICE L84057 LONDON MEDICAL PRACTICE L84042 BLAKENEY SURGERY L84029 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 Gloucestershire CCG 0.74 • the ratio of those diagnosed with atrial fibrillation versus those expected to have atrial fibrillation is 0.74. This compares to 0.7 for England • this suggests that 74% 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 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 West Kent CCG 0.76

NHS Gloucestershire CCG 0.74

NHS Wiltshire CCG 0.73

NHS Ipswich and East Suffolk CCG 0.72

NHS Kernow CCG 0.72

NHS Nene CCG 0.70

NHS West Hampshire CCG 0.70

NHS Southern Derbyshire CCG 0.69

NHS East and North Hertfordshire CCG 0.68

NHS Mid Essex CCG 0.65

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

LYDNEY PRACTICE L84011 1.0 PARK SURGERY(CV) L84010 0.9 HILARY COTTAGE SURGERY L84053 0.9 LECHLADE MEDICAL CENTRE L84055 0.9 REGENT STREET SURGERY L84080 0.9 KINGSHOLM SURGERY L84081 0.9 CRESCENT BAKERY L84616 0.9 WINCHCOMBE MEDICAL CENTRE L84004 0.8 MINCHINHAMPTON SURGERY L84005 0.8 ST.PETER'S ROAD SURGERY L84017 0.8 ROMNEY HOUSE SURGERY L84020 0.8 • it is estimated that there are 18,129 CHURCH STREET PRACTICE L84023 0.8 BLAKENEY SURGERY L84029 0.8 STOW SURGERY L84031 0.8 people with undiagnosed atrial LOCKING HILL SURGERY L84032 0.8 THE PORTLAND PRACTICE L84033 0.8 COTSWOLD MEDICAL PRACTICE L84038 0.8 OVERTON PARK SURGERY L84041 0.8 fibrillation in NHS Gloucestershire CHIPPING CAMPDEN SURGERY L84043 0.8 DOCKHAM ROAD SURGERY L84046 0.8 CHURCHDOWN SURGERY L84047 0.8 THE STOKE ROAD SURGERY, L84048 0.8 CCG ROSEBANK HEALTH L84050 0.8 CHIPPING SURGERY L84051 0.8 THE CORINTHIAN SURGERY L84056 0.8 • GP practice range of observed to ST.CATHERINE'S SURGERY L84058 0.8 MANN COTTAGE SURGERY L84068 0.8 COLEFORD FAMILY DOCTORS L84069 0.8 BRUNSTON PRACTICE L84071 0.8 expected atrial fibrillation prevalence COLLEGE YARD & HIGHNAM L84606 0.8 GLOUCESTER HEALTH ACCESS CENTRE Y02519 0.8 BARTONGATE SURGERY L84001 0.7 UNDERWOOD SURGERY L84003 0.5 to 1 0.7 STAUNTON & CORSE SURGERY L84006 0.7 ROWCROFT MEDICAL CENTRE L84007 0.7 ST.GEORGE'S SURGERY L84008 0.7 PHOENIX SURGERY L84012 0.7 SAINTBRIDGE SURGERY L84013 0.7 SIXWAYS CLINIC L84015 0.7 FRITHWOOD SURGERY L84016 0.7 AVENUE SURGERY L84018 0.7 YORKLEY HEALTH CENTRE(WG) L84021 0.7 YORKLEIGH SURGERY(CT) L84022 0.7 HOYLAND HOUSE L84025 0.7 HEATHVILLE MEDICAL PRACTICE L84026 0.7 FOREST HEALTH CARE L84028 0.7 BERKELEY PLACE SURGERY L84030 0.7 SEVEN POSTS SURGERY L84036 0.7 HOLTS HEALTH CENTRE L84037 0.7 STROUD HC L84039 0.7 THE LECKHAMPTON SURGERY L84040 0.7 LONDON MEDICAL PRACTICE L84042 0.7 MARYBROOK MEDICAL CENTRE L84044 0.7 MITCHELDEAN SURGERY L84045 0.7 THE ROYAL WELL SURGERY L84049 0.7 GLOUCESTER CITY HEALTH CENTRE L84052 0.7 MYTHE MEDICAL PRACTICE L84054 0.7 BARNWOOD MEDICAL PRACTICE L84057 0.7 CAM & ULEY FAMILY PRACTICE L84060 0.7 RENDCOMB SURGERY L84063 0.7 PRICES MILL SURGERY L84065 0.7 LONGLEVENS SURGERY L84067 0.7 HIGH STREET MEDICAL CENTRE L84070 0.7 ACORN PRACTICE L84073 0.7 WALNUT TREE PRACTICE L84075 0.7 FRAMPTON SURGERY L84078 0.7 BROCKWORTH SURGERY L84084 0.7 SEVERNBANK SURGERY L84085 0.7 CHELTENHAM ROAD SURGERY L84002 0.6 HADWEN MEDICAL PRACT. L84009 0.6 HUCCLECOTE SURGERY L84014 0.6 DRYBROOK SURGERY L84024 0.6 CULVERHAY SURGERY L84027 0.6 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 0.6 ROYAL CRESCENT L84059 0.6 WHITE HOUSE SURGERY L84072 0.6 STROUD VALLEYS FAMILY PRACTICE L84077 0.6 STONEHOUSE HEALTH CLINIC L84613 0.6 QUEDGELEY MEDICAL CENTRE L84617 0.6 NEWNHAM SURGERY L84615 0.5 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

• 10,973 people with atrial fibrillation* NHS Gloucestershire CCG 82.0% with a CHA2DS2-VASc score >= 2 in NHS Gloucestershire CCG • 8,997 (82%) people treated with anti- coagulation therapy • 984 (9%) people who are exceptions • 992 (9%) 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 West Kent CCG 82.3%

NHS Gloucestershire CCG 82.0%

NHS Nene CCG 81.8%

NHS West Hampshire CCG 81.0%

NHS Kernow CCG 80.2%

NHS Wiltshire CCG 80.2%

NHS Ipswich and East Suffolk CCG 79.8%

NHS Somerset CCG 79.5%

NHS East and North Hertfordshire CCG 78.7%

NHS Mid Essex CCG 77.9%

NHS Southern Derbyshire CCG 76.0%

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

STROUD HC L84039 44 BROCKWORTH SURGERY L84084 38 ROWCROFT MEDICAL CENTRE L84007 51 MITCHELDEAN SURGERY L84045 34 LONDON MEDICAL PRACTICE L84042 27 NEWNHAM SURGERY L84615 13 OVERTON PARK SURGERY L84041 46 QUEDGELEY MEDICAL CENTRE L84617 10 BLAKENEY SURGERY L84029 16 GLOUCESTER CITY HEALTH CENTRE L84052 23 • in total, including exceptions, there STROUD VALLEYS FAMILY PRACTICE L84077 21 BRUNSTON PRACTICE L84071 28 CHURCH STREET PRACTICE L84023 53 are 1,976 people with a recorded YORKLEY HEALTH CENTRE(WG) L84021 30 HIGH STREET MEDICAL CENTRE L84070 21 CRESCENT BAKERY L84616 22 CHIPPING SURGERY L84051 31 CHA2DS2-VASc score >= 2 who are THE CORINTHIAN SURGERY L84056 30 MANN COTTAGE SURGERY L84068 21 WINCHCOMBE MEDICAL CENTRE L84004 43 not treated LYDNEY PRACTICE L84011 38 HOYLAND HOUSE L84025 28 ST.GEORGE'S SURGERY L84008 32 ROSEBANK HEALTH L84050 • GP practice range: 6.6% to 33.6% 54 CULVERHAY SURGERY L84027 21 HILARY COTTAGE SURGERY L84053 43 COLEFORD FAMILY DOCTORS L84069 37 SEVERNBANK SURGERY L84085 16 MINCHINHAMPTON SURGERY L84005 42 DRYBROOK SURGERY L84024 14 BERKELEY PLACE SURGERY L84030 19 WHITE HOUSE SURGERY L84072 17 SIXWAYS CLINIC L84015 38 REGENT STREET SURGERY L84080 17 THE PORTLAND PRACTICE L84033 32 THE ROYAL WELL SURGERY L84049 21 PHOENIX SURGERY L84012 37 COLLEGE YARD & HIGHNAM L84606 19 PARK SURGERY(CV) L84010 37 BARTONGATE SURGERY L84001 16 CHURCHDOWN SURGERY L84047 51 DOCKHAM ROAD SURGERY L84046 21 HEATHVILLE MEDICAL PRACTICE L84026 31 BARNWOOD MEDICAL PRACTICE L84057 18 COTSWOLD MEDICAL PRACTICE L84038 40 SAINTBRIDGE SURGERY L84013 17 LONGLEVENS SURGERY L84067 18 ST.PETER'S ROAD SURGERY L84017 6 ROMNEY HOUSE SURGERY L84020 30 STOW SURGERY L84031 23 KINGSHOLM SURGERY L84081 14 STAUNTON & CORSE SURGERY L84006 17 ROYAL CRESCENT L84059 15 PRICES MILL SURGERY L84065 25 HOLTS HEALTH CENTRE L84037 36 SEVEN POSTS SURGERY L84036 35 MYTHE MEDICAL PRACTICE L84054 31 YORKLEIGH SURGERY(CT) L84022 21 AVENUE SURGERY L84018 18 FRITHWOOD SURGERY L84016 19 THE STOKE ROAD SURGERY, L84048 35 THE LECKHAMPTON SURGERY L84040 42 HUCCLECOTE SURGERY L84014 24 LECHLADE MEDICAL CENTRE L84055 15 HADWEN MEDICAL PRACT. L84009 26 FRAMPTON SURGERY L84078 11 LOCKING HILL SURGERY L84032 24 ACORN PRACTICE L84073 7 ST.CATHERINE'S SURGERY L84058 21 WALNUT TREE PRACTICE L84075 8 STONEHOUSE HEALTH CLINIC L84613 6 UNDERWOOD SURGERY L84003 12 MARYBROOK MEDICAL CENTRE L84044 9 CHIPPING CAMPDEN SURGERY L84043 12 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 14 GLOUCESTER HEALTH ACCESS CENTRE Y02519 3 CAM & ULEY FAMILY PRACTICE L84060 17 FOREST HEALTH CARE L84028 10 RENDCOMB SURGERY L84063 5 CHELTENHAM ROAD SURGERY L84002 9 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

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

STROUD HC 24

BROCKWORTH SURGERY 16

MITCHELDEAN SURGERY 15 • using the GP cluster method of ROWCROFT MEDICAL CENTRE 21 calculating potential gains, if each QUEDGELEY MEDICAL CENTRE 5 practice was to achieve as well as the LONDON MEDICAL PRACTICE 12 upper quartile of its national cluster, then an additional 351 people would NEWNHAM SURGERY 6 be treated BLAKENEY SURGERY 6

OVERTON PARK SURGERY 16

GLOUCESTER CITY HEALTH CENTRE 8

GLOUCESTER HEALTH ACCESS CENTRE

HADWEN MEDICAL PRACT.

CHIPPING CAMPDEN SURGERY

ST.CATHERINE'S SURGERY

UNDERWOOD SURGERY

FOREST HEALTH CARE

RENDCOMB SURGERY

CHELTENHAM ROAD SURGERY

CAM & ULEY FAMILY PRACTICE

PARTNERS IN HEALTH, PAVILION FAMILY DRS 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

• 12,144 people with a history of stroke NHS Gloucestershire CCG 84.2% or TIA* in NHS Gloucestershire CCG • 10,231 (84.2%) people whose blood pressure is <= 150 / 90 • 667 (5.5%) people who are exceptions • 1,246 (10.3%) 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 Gloucestershire CCG 84.2%

NHS Ipswich and East Suffolk CCG 84.0%

NHS Nene CCG 83.8%

NHS East and North Hertfordshire CCG 83.4%

NHS Wiltshire CCG 83.2%

NHS Southern Derbyshire CCG 83.1%

NHS Kernow CCG 82.6%

NHS Mid Essex CCG 82.3%

NHS West Kent CCG 82.3%

NHS West Hampshire CCG 82.3%

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

THE STOKE ROAD SURGERY, L84048 79 STROUD VALLEYS FAMILY PRACTICE L84077 29 CULVERHAY SURGERY L84027 32 HIGH STREET MEDICAL CENTRE L84070 29 ROYAL CRESCENT L84059 31 KINGSHOLM SURGERY L84081 29 SAINTBRIDGE SURGERY L84013 34 CRESCENT BAKERY L84616 28 LECHLADE MEDICAL CENTRE L84055 17 ROWCROFT MEDICAL CENTRE L84007 42 • in total, including exceptions, there ST.PETER'S ROAD SURGERY L84017 39 GLOUCESTER HEALTH ACCESS CENTRE Y02519 12 HOYLAND HOUSE L84025 31 are 1,913 people whose blood PHOENIX SURGERY L84012 45 NEWNHAM SURGERY L84615 14 BROCKWORTH SURGERY L84084 34 RENDCOMB SURGERY L84063 13 pressure is not <= 150 / 90 GLOUCESTER CITY HEALTH CENTRE L84052 26 HILARY COTTAGE SURGERY L84053 37 BRUNSTON PRACTICE L84071 30 • GP practice range: 5.8% to 32.4% MITCHELDEAN SURGERY L84045 30 THE CORINTHIAN SURGERY L84056 27 BARNWOOD MEDICAL PRACTICE L84057 20 YORKLEY HEALTH CENTRE(WG) L84021 33 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 33 COLLEGE YARD & HIGHNAM L84606 21 YORKLEIGH SURGERY(CT) L84022 25 ROSEBANK HEALTH L84050 58 SEVERNBANK SURGERY L84085 17 AVENUE SURGERY L84018 19 CAM & ULEY FAMILY PRACTICE L84060 35 BERKELEY PLACE SURGERY L84030 16 STOW SURGERY L84031 20 PRICES MILL SURGERY L84065 27 WHITE HOUSE SURGERY L84072 15 WINCHCOMBE MEDICAL CENTRE L84004 29 THE PORTLAND PRACTICE L84033 37 CHIPPING CAMPDEN SURGERY L84043 21 CHURCHDOWN SURGERY L84047 40 THE LECKHAMPTON SURGERY L84040 45 DOCKHAM ROAD SURGERY L84046 23 OVERTON PARK SURGERY L84041 31 BARTONGATE SURGERY L84001 15 MYTHE MEDICAL PRACTICE L84054 38 HEATHVILLE MEDICAL PRACTICE L84026 28 UNDERWOOD SURGERY L84003 19 MINCHINHAMPTON SURGERY L84005 25 BLAKENEY SURGERY L84029 11 CHIPPING SURGERY L84051 22 REGENT STREET SURGERY L84080 12 LOCKING HILL SURGERY L84032 27 PARK SURGERY(CV) L84010 24 ST.CATHERINE'S SURGERY L84058 27 COTSWOLD MEDICAL PRACTICE L84038 28 SIXWAYS CLINIC L84015 29 LYDNEY PRACTICE L84011 21 DRYBROOK SURGERY L84024 13 ROMNEY HOUSE SURGERY L84020 20 COLEFORD FAMILY DOCTORS L84069 24 MANN COTTAGE SURGERY L84068 13 FOREST HEALTH CARE L84028 21 CHURCH STREET PRACTICE L84023 31 HADWEN MEDICAL PRACT. L84009 27 FRITHWOOD SURGERY L84016 14 MARYBROOK MEDICAL CENTRE L84044 10 HUCCLECOTE SURGERY L84014 19 LONGLEVENS SURGERY L84067 13 CHELTENHAM ROAD SURGERY L84002 19 ST.GEORGE'S SURGERY L84008 19 QUEDGELEY MEDICAL CENTRE L84617 6 FRAMPTON SURGERY L84078 8 THE ROYAL WELL SURGERY L84049 9 STAUNTON & CORSE SURGERY L84006 7 STROUD HC L84039 11 STONEHOUSE HEALTH CLINIC L84613 4 WALNUT TREE PRACTICE L84075 5 ACORN PRACTICE L84073 6 HOLTS HEALTH CENTRE L84037 14 SEVEN POSTS SURGERY L84036 13 LONDON MEDICAL PRACTICE L84042 8 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

• 8,530 people with a stroke shown to NHS Gloucestershire CCG 91.7% be non-haemorrhagic* in NHS Gloucestershire CCG • 7,822 (91.7%) people who are taking an anti-platetet agent or anti- coagulant • 518 (6.1%) people who are exceptions • 190 (2.2%) additional people with no treatment

England 91.8%

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

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

NHS Nene CCG 93.2%

NHS West Kent CCG 92.3%

NHS Kernow CCG 92.3%

NHS East and North Hertfordshire CCG 91.9%

NHS West Hampshire CCG 91.9%

NHS Ipswich and East Suffolk CCG 91.8%

NHS Wiltshire CCG 91.8%

NHS Gloucestershire CCG 91.7%

NHS Southern Derbyshire CCG 91.3%

NHS Mid Essex CCG 90.4%

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

SEVERNBANK SURGERY L84085 14 HIGH STREET MEDICAL CENTRE L84070 12 BERKELEY PLACE SURGERY L84030 16 YORKLEIGH SURGERY(CT) L84022 19 CULVERHAY SURGERY L84027 14 ROWCROFT MEDICAL CENTRE L84007 18 WHITE HOUSE SURGERY L84072 11 BARTONGATE SURGERY L84001 14 CRESCENT BAKERY L84616 12 DRYBROOK SURGERY L84024 8 • in total, including exceptions, there BLAKENEY SURGERY L84029 8 SAINTBRIDGE SURGERY L84013 15 BRUNSTON PRACTICE L84071 9 are 708 people who are not taking an STONEHOUSE HEALTH CLINIC L84613 5 SIXWAYS CLINIC L84015 17 GLOUCESTER CITY HEALTH CENTRE L84052 8 AVENUE SURGERY L84018 9 anti-platelet agent or anti-coagulant STAUNTON & CORSE SURGERY L84006 7 STROUD VALLEYS FAMILY PRACTICE L84077 7 CHURCH STREET PRACTICE L84023 18 • GP practice range: 2.0% to 24.1% ROSEBANK HEALTH L84050 22 STROUD HC L84039 9 COLLEGE YARD & HIGHNAM L84606 8 PHOENIX SURGERY L84012 13 RENDCOMB SURGERY L84063 4 ST.PETER'S ROAD SURGERY L84017 11 CHIPPING CAMPDEN SURGERY L84043 12 STOW SURGERY L84031 9 LONGLEVENS SURGERY L84067 9 FRAMPTON SURGERY L84078 5 ROYAL CRESCENT L84059 7 MINCHINHAMPTON SURGERY L84005 10 OVERTON PARK SURGERY L84041 14 BROCKWORTH SURGERY L84084 13 CHIPPING SURGERY L84051 11 HOYLAND HOUSE L84025 7 UNDERWOOD SURGERY L84003 8 THE STOKE ROAD SURGERY, L84048 14 LOCKING HILL SURGERY L84032 10 COTSWOLD MEDICAL PRACTICE L84038 11 REGENT STREET SURGERY L84080 4 SEVEN POSTS SURGERY L84036 15 QUEDGELEY MEDICAL CENTRE L84617 4 LYDNEY PRACTICE L84011 9 HILARY COTTAGE SURGERY L84053 10 MYTHE MEDICAL PRACTICE L84054 15 ST.GEORGE'S SURGERY L84008 9 THE ROYAL WELL SURGERY L84049 5 CAM & ULEY FAMILY PRACTICE L84060 10 DOCKHAM ROAD SURGERY L84046 8 THE PORTLAND PRACTICE L84033 13 ROMNEY HOUSE SURGERY L84020 7 BARNWOOD MEDICAL PRACTICE L84057 5 YORKLEY HEALTH CENTRE(WG) L84021 7 KINGSHOLM SURGERY L84081 5 GLOUCESTER HEALTH ACCESS CENTRE Y02519 2 LECHLADE MEDICAL CENTRE L84055 2 PRICES MILL SURGERY L84065 7 PARK SURGERY(CV) L84010 8 FOREST HEALTH CARE L84028 7 MITCHELDEAN SURGERY L84045 6 THE LECKHAMPTON SURGERY L84040 12 NEWNHAM SURGERY L84615 2 CHURCHDOWN SURGERY L84047 8 HADWEN MEDICAL PRACT. L84009 10 MANN COTTAGE SURGERY L84068 4 WINCHCOMBE MEDICAL CENTRE L84004 8 HEATHVILLE MEDICAL PRACTICE L84026 8 HOLTS HEALTH CENTRE L84037 8 FRITHWOOD SURGERY L84016 4 MARYBROOK MEDICAL CENTRE L84044 3 LONDON MEDICAL PRACTICE L84042 4 ST.CATHERINE'S SURGERY L84058 7 THE CORINTHIAN SURGERY L84056 4 COLEFORD FAMILY DOCTORS L84069 6 HUCCLECOTE SURGERY L84014 5 CHELTENHAM ROAD SURGERY L84002 4 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 3 ACORN PRACTICE L84073 1 WALNUT TREE PRACTICE L84075 1 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

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

• this suggests 77% 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 Nene CCG 0.78

NHS Gloucestershire CCG 0.77

NHS Mid Essex CCG 0.77

NHS Somerset CCG 0.74

NHS East and North Hertfordshire CCG 0.73

NHS Wiltshire CCG 0.73

NHS West Kent CCG 0.72

NHS Ipswich and East Suffolk CCG 0.68

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

STONEHOUSE HEALTH CLINIC L84613 9.8% LONDON MEDICAL PRACTICE L84042 9.2% COLEFORD FAMILY DOCTORS L84069 9.2% BARTONGATE SURGERY L84001 9.1% BRUNSTON PRACTICE L84071 8.6% LYDNEY PRACTICE L84011 8.2% GLOUCESTER CITY HEALTH CENTRE L84052 8.2% MITCHELDEAN SURGERY L84045 8.1% DOCKHAM ROAD SURGERY L84046 8.0% HEATHVILLE MEDICAL PRACTICE L84026 7.9% • GP practice range of observed HUCCLECOTE SURGERY L84014 7.9% FOREST HEALTH CARE L84028 7.9% BARNWOOD MEDICAL PRACTICE L84057 7.9% COLLEGE YARD & HIGHNAM L84606 7.8% diabetes 3.4% to 9.8% SAINTBRIDGE SURGERY L84013 7.8% KINGSHOLM SURGERY L84081 7.7% BROCKWORTH SURGERY L84084 7.7% • there are an estimated 9,777 people DRYBROOK SURGERY L84024 7.6% MARYBROOK MEDICAL CENTRE L84044 7.6% BLAKENEY SURGERY L84029 7.5% with undiagnosed diabetes in NHS ST.PETER'S ROAD SURGERY L84017 7.5% SEVERNBANK SURGERY L84085 7.5% REGENT STREET SURGERY L84080 7.3% YORKLEY HEALTH CENTRE(WG) L84021 7.2% Gloucestershire CCG WALNUT TREE PRACTICE L84075 7.2% CHURCHDOWN SURGERY L84047 7.2% CHURCH STREET PRACTICE L84023 7.2% ACORN PRACTICE L84073 7.2% HADWEN MEDICAL PRACT. L84009 7.1% ROSEBANK HEALTH L84050 7.0% PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 6.9% CAM & ULEY FAMILY PRACTICE L84060 6.7% STOW SURGERY L84031 6.7% CHELTENHAM ROAD SURGERY L84002 6.6% MYTHE MEDICAL PRACTICE L84054 6.6% ST.CATHERINE'S SURGERY L84058 6.6% THE STOKE ROAD SURGERY, L84048 6.6% THE CORINTHIAN SURGERY L84056 6.5% ST.GEORGE'S SURGERY L84008 6.5% LOCKING HILL SURGERY L84032 6.5% WHITE HOUSE SURGERY L84072 6.4% HIGH STREET MEDICAL CENTRE L84070 6.3% PARK SURGERY(CV) L84010 6.3% COTSWOLD MEDICAL PRACTICE L84038 6.3% NEWNHAM SURGERY L84615 6.2% LECHLADE MEDICAL CENTRE L84055 6.2% HILARY COTTAGE SURGERY L84053 6.1% HOLTS HEALTH CENTRE L84037 6.1% AVENUE SURGERY L84018 6.0% CHIPPING CAMPDEN SURGERY L84043 5.9% FRAMPTON SURGERY L84078 5.9% SEVEN POSTS SURGERY L84036 5.9% QUEDGELEY MEDICAL CENTRE L84617 5.9% STROUD HC L84039 5.8% WINCHCOMBE MEDICAL CENTRE L84004 5.8% LONGLEVENS SURGERY L84067 5.7% THE ROYAL WELL SURGERY L84049 5.7% ROYAL CRESCENT L84059 5.6% YORKLEIGH SURGERY(CT) L84022 5.6% CHIPPING SURGERY L84051 5.6% CRESCENT BAKERY L84616 5.4% ROMNEY HOUSE SURGERY L84020 5.4% CULVERHAY SURGERY L84027 5.3% STROUD VALLEYS FAMILY PRACTICE L84077 5.2% PRICES MILL SURGERY L84065 5.2% THE PORTLAND PRACTICE L84033 5.1% FRITHWOOD SURGERY L84016 5.1% THE LECKHAMPTON SURGERY L84040 5.1% MANN COTTAGE SURGERY L84068 5.1% GLOUCESTER HEALTH ACCESS CENTRE Y02519 5.0% HOYLAND HOUSE L84025 4.9% STAUNTON & CORSE SURGERY L84006 4.9% MINCHINHAMPTON SURGERY L84005 4.9% BERKELEY PLACE SURGERY L84030 4.8% OVERTON PARK SURGERY L84041 4.8% Note: The estimated number of undiagnosed SIXWAYS CLINIC L84015 4.8% ROWCROFT MEDICAL CENTRE L84007 4.7% PHOENIX SURGERY L84012 4.7% people with diabetes has been calculated by RENDCOMB SURGERY L84063 4.2% UNDERWOOD SURGERY L84003 3.4% multiplying the estimated prevalence rate to the 0% 2% 4% 6% 8% 10% 12% 2015/16 QOF list size and subtracting the number of people on the diabetes register.

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

Diabetes prevalence Undiagnosed diabetes prevalence Expected non-diabetic hyperglycaemia prevalence

• the estimated total prevalence of diabetes in NHS Gloucestershire CCG is 8.3% (diagnosed and NHS Gloucestershire CCG 6.4% 1.9% 11.5% undiagnosed) • in addition, there are an estimated 11.5% of people in NHS Gloucestershire CCG who are at increased risk of developing diabetes (i.e. with non-diabetic hyperglycaemia) • this means that 19.8% of the population in NHS Gloucestershire 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 Gloucestershire CCG 58.7% targets are taken from the National Diabetes Audit (NDA) • overall practice participation in the 2015/16 audit was 81.4% in England

• in NHS Gloucestershire CCG, 74 out of 81 practices (91.4%) participated in the NDA. Data is not available for the remaining practices

• 58.7% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS Gloucestershire CCG, compared to England 52.6% 52.6% in England

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

BLAKENEY SURGERY L84029 83.8% STROUD HC L84039 81.7% PHOENIX SURGERY L84012 79.6% LYDNEY PRACTICE L84011 79.1% HOYLAND HOUSE L84025 78.9% FRAMPTON SURGERY L84078 77.7% WALNUT TREE PRACTICE L84075 77.3% • achievement - 8 care processes: in ACORN PRACTICE L84073 76.9% PARK SURGERY(CV) L84010 76.7% WINCHCOMBE MEDICAL CENTRE L84004 76.7% STOW SURGERY L84031 76.5% practices who provided data via the THE LECKHAMPTON SURGERY L84040 73.2% CHELTENHAM ROAD SURGERY L84002 72.7% HOLTS HEALTH CENTRE L84037 72.7% NDA, between 10.5% and 83.8% of HUCCLECOTE SURGERY L84014 72.6% MYTHE MEDICAL PRACTICE L84054 72.5% STROUD VALLEYS FAMILY PRACTICE L84077 72.4% HIGH STREET MEDICAL CENTRE L84070 71.3% patients received all 8 care processes CHIPPING CAMPDEN SURGERY L84043 71.0% HADWEN MEDICAL PRACT. L84009 70.7% SAINTBRIDGE SURGERY L84013 70.1% FOREST HEALTH CARE L84028 69.6% ST.PETER'S ROAD SURGERY L84017 69.5% THE CORINTHIAN SURGERY L84056 69.2% CHIPPING SURGERY L84051 68.9% ROWCROFT MEDICAL CENTRE L84007 67.6% • at least 12,565 people did not receive QUEDGELEY MEDICAL CENTRE L84617 64.5% THE STOKE ROAD SURGERY, L84048 64.3% LONGLEVENS SURGERY L84067 64.3% MITCHELDEAN SURGERY L84045 63.8% the eight care processes LONDON MEDICAL PRACTICE L84042 63.6% COTSWOLD MEDICAL PRACTICE L84038 63.4% YORKLEY HEALTH CENTRE(WG) L84021 63.1% UNDERWOOD SURGERY L84003 62.7% CHURCH STREET PRACTICE L84023 62.4% ST.GEORGE'S SURGERY L84008 62.0% AVENUE SURGERY L84018 61.4% ST.CATHERINE'S SURGERY L84058 61.3% HEATHVILLE MEDICAL PRACTICE L84026 60.9% CHURCHDOWN SURGERY L84047 59.3% REGENT STREET SURGERY L84080 58.6% THE PORTLAND PRACTICE L84033 58.6% MINCHINHAMPTON SURGERY L84005 58.4% PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 57.5% HILARY COTTAGE SURGERY L84053 57.3% BROCKWORTH SURGERY L84084 56.7% MARYBROOK MEDICAL CENTRE L84044 56.6% COLEFORD FAMILY DOCTORS L84069 55.4% OVERTON PARK SURGERY L84041 53.7% YORKLEIGH SURGERY(CT) L84022 52.2% LOCKING HILL SURGERY L84032 51.8% SEVERNBANK SURGERY L84085 51.6% ROSEBANK HEALTH L84050 51.6% SEVEN POSTS SURGERY L84036 48.3% GLOUCESTER CITY HEALTH CENTRE L84052 46.9% THE ROYAL WELL SURGERY L84049 46.3% DRYBROOK SURGERY L84024 45.5% DOCKHAM ROAD SURGERY L84046 42.7% ROYAL CRESCENT L84059 41.8% LECHLADE MEDICAL CENTRE L84055 40.4% SIXWAYS CLINIC L84015 39.9% CRESCENT BAKERY L84616 39.2% BRUNSTON PRACTICE L84071 39.1% PRICES MILL SURGERY L84065 36.3% BARNWOOD MEDICAL PRACTICE L84057 32.6% RENDCOMB SURGERY L84063 32.3% FRITHWOOD SURGERY L84016 29.4% BARTONGATE SURGERY L84001 26.4% MANN COTTAGE SURGERY L84068 25.6% BERKELEY PLACE SURGERY L84030 24.5% ROMNEY HOUSE SURGERY L84020 23.7% KINGSHOLM SURGERY L84081 13.6% WHITE HOUSE SURGERY L84072 10.5% GLOUCESTER HEALTH ACCESS CENTRE Y02519 NEWNHAM SURGERY L84615 STONEHOUSE HEALTH CLINIC L84613 COLLEGE YARD & HIGHNAM L84606 CAM & ULEY FAMILY PRACTICE L84060 CULVERHAY SURGERY L84027 STAUNTON & CORSE SURGERY L84006 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

• 34.4% of people with diabetes (of NHS Gloucestershire CCG 34.4% practices who participated in the audit) met the three treatment targets in NHS Gloucestershire 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

ROMNEY HOUSE SURGERY L84020 48.2% COLEFORD FAMILY DOCTORS L84069 46.6% QUEDGELEY MEDICAL CENTRE L84617 46.2% THE ROYAL WELL SURGERY L84049 45.7% PHOENIX SURGERY L84012 45.6% OVERTON PARK SURGERY L84041 42.1% THE LECKHAMPTON SURGERY L84040 41.8% • achievement - 3 treatment targets: in LYDNEY PRACTICE L84011 41.8% COTSWOLD MEDICAL PRACTICE L84038 41.5% WALNUT TREE PRACTICE L84075 41.3% LOCKING HILL SURGERY L84032 40.8% practices who provided data via the ACORN PRACTICE L84073 40.7% BLAKENEY SURGERY L84029 40.3% MARYBROOK MEDICAL CENTRE L84044 39.9% NDA, between 21.5% and 48.2% of FOREST HEALTH CARE L84028 39.6% LONDON MEDICAL PRACTICE L84042 39.5% THE PORTLAND PRACTICE L84033 38.6% FRITHWOOD SURGERY L84016 38.5% patients achieved all 3 treatment UNDERWOOD SURGERY L84003 38.4% RENDCOMB SURGERY L84063 38.4% ST.GEORGE'S SURGERY L84008 38.3% targets SEVEN POSTS SURGERY L84036 38.2% MITCHELDEAN SURGERY L84045 38.2% STROUD HC L84039 37.8% CRESCENT BAKERY L84616 37.5% THE STOKE ROAD SURGERY, L84048 37.4% • at least 17,810 people did not meet PARK SURGERY(CV) L84010 37.1% CHIPPING SURGERY L84051 37.0% CHIPPING CAMPDEN SURGERY L84043 36.9% CHELTENHAM ROAD SURGERY L84002 36.9% the three treatment targets STOW SURGERY L84031 36.7% DRYBROOK SURGERY L84024 36.7% YORKLEY HEALTH CENTRE(WG) L84021 36.4% YORKLEIGH SURGERY(CT) L84022 36.3% LONGLEVENS SURGERY L84067 36.3% BERKELEY PLACE SURGERY L84030 35.5% PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 35.1% MINCHINHAMPTON SURGERY L84005 34.7% LECHLADE MEDICAL CENTRE L84055 34.6% HUCCLECOTE SURGERY L84014 34.5% HILARY COTTAGE SURGERY L84053 33.8% ROSEBANK HEALTH L84050 33.3% HOLTS HEALTH CENTRE L84037 33.2% MYTHE MEDICAL PRACTICE L84054 33.1% HADWEN MEDICAL PRACT. L84009 32.8% SAINTBRIDGE SURGERY L84013 32.6% PRICES MILL SURGERY L84065 32.5% MANN COTTAGE SURGERY L84068 32.4% THE CORINTHIAN SURGERY L84056 32.1% CHURCHDOWN SURGERY L84047 31.6% ROYAL CRESCENT L84059 31.2% WINCHCOMBE MEDICAL CENTRE L84004 30.9% CHURCH STREET PRACTICE L84023 30.8% WHITE HOUSE SURGERY L84072 29.8% FRAMPTON SURGERY L84078 29.5% BARTONGATE SURGERY L84001 29.2% BARNWOOD MEDICAL PRACTICE L84057 28.6% AVENUE SURGERY L84018 28.5% BROCKWORTH SURGERY L84084 28.1% ST.CATHERINE'S SURGERY L84058 27.9% SIXWAYS CLINIC L84015 27.6% DOCKHAM ROAD SURGERY L84046 26.6% SEVERNBANK SURGERY L84085 26.0% HEATHVILLE MEDICAL PRACTICE L84026 25.9% HOYLAND HOUSE L84025 25.9% BRUNSTON PRACTICE L84071 25.7% KINGSHOLM SURGERY L84081 25.3% HIGH STREET MEDICAL CENTRE L84070 25.3% STROUD VALLEYS FAMILY PRACTICE L84077 24.5% ST.PETER'S ROAD SURGERY L84017 24.1% ROWCROFT MEDICAL CENTRE L84007 24.1% GLOUCESTER CITY HEALTH CENTRE L84052 23.0% REGENT STREET SURGERY L84080 21.5% GLOUCESTER HEALTH ACCESS CENTRE Y02519 NEWNHAM SURGERY L84615 STONEHOUSE HEALTH CLINIC L84613 COLLEGE YARD & HIGHNAM L84606 CAM & ULEY FAMILY PRACTICE L84060 CULVERHAY SURGERY L84027 STAUNTON & CORSE SURGERY L84006 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

50 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16 - opportunities compared to GP cluster

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

REGENT STREET SURGERY 58

GLOUCESTER CITY HEALTH CENTRE 105

KINGSHOLM SURGERY 54 • using the GP cluster method of ST.PETER'S ROAD SURGERY 72 calculating potential gains, if each STROUD VALLEYS FAMILY PRACTICE 41 practice was to achieve as well as the HIGH STREET MEDICAL CENTRE 53 upper quartile of its national cluster, then an additional 2,831 people would ROWCROFT MEDICAL CENTRE 72 be treated BRUNSTON PRACTICE 76

SEVERNBANK SURGERY 47

DOCKHAM ROAD SURGERY 61

LYDNEY PRACTICE 16

LOCKING HILL SURGERY 16

COTSWOLD MEDICAL PRACTICE 12

THE LECKHAMPTON SURGERY 11

OVERTON PARK SURGERY 8

THE ROYAL WELL SURGERY 0

PHOENIX SURGERY

COLEFORD FAMILY DOCTORS

QUEDGELEY MEDICAL CENTRE

ROMNEY HOUSE 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 Gloucestershire CCG 0.98 • the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney disease is 0.98. This compares to 0.68 for England • this suggests that 98% 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 0.2 0.4 0.6 0.8 1.0 1.2 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 Ipswich and East Suffolk CCG 0.78

NHS Kernow CCG 0.72

NHS West Kent CCG 0.69

NHS Nene CCG 0.67

NHS Mid Essex CCG 0.66

NHS Somerset CCG 0.64

NHS Wiltshire CCG 0.61

NHS East and North Hertfordshire CCG 0.55

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

STONEHOUSE HEALTH CLINIC L84613 14.4% COLEFORD FAMILY DOCTORS L84069 12.3% MINCHINHAMPTON SURGERY L84005 11.1% BLAKENEY SURGERY L84029 10.3% MANN COTTAGE SURGERY L84068 10.2% LONDON MEDICAL PRACTICE L84042 10.1% CHIPPING SURGERY L84051 9.4% CHELTENHAM ROAD SURGERY L84002 9.2% LECHLADE MEDICAL CENTRE L84055 9.2% FOREST HEALTH CARE L84028 9.1% • it is estimated that there are 632 HUCCLECOTE SURGERY L84014 8.9% CHIPPING CAMPDEN SURGERY L84043 8.9% ACORN PRACTICE L84073 8.8% people with undiagnosed chronic COTSWOLD MEDICAL PRACTICE L84038 8.8% HILARY COTTAGE SURGERY L84053 8.8% LYDNEY PRACTICE L84011 8.7% NEWNHAM SURGERY L84615 8.7% kidney disease in NHS DRYBROOK SURGERY L84024 8.6% BARNWOOD MEDICAL PRACTICE L84057 8.5% CHURCH STREET PRACTICE L84023 8.4% Gloucestershire CCG SAINTBRIDGE SURGERY L84013 8.3% ST.CATHERINE'S SURGERY L84058 8.2% STROUD HC L84039 7.9% CRESCENT BAKERY L84616 7.8% • GP practice range of observed CKD: WINCHCOMBE MEDICAL CENTRE L84004 7.7% KINGSHOLM SURGERY L84081 7.7% THE LECKHAMPTON SURGERY L84040 7.7% 2.4% to 14.4% CULVERHAY SURGERY L84027 7.6% BROCKWORTH SURGERY L84084 7.5% HIGH STREET MEDICAL CENTRE L84070 7.5% HADWEN MEDICAL PRACT. L84009 7.1% STAUNTON & CORSE SURGERY L84006 7.1% SEVEN POSTS SURGERY L84036 7.1% MITCHELDEAN SURGERY L84045 7.0% THE ROYAL WELL SURGERY L84049 6.9% THE STOKE ROAD SURGERY, L84048 6.7% PARK SURGERY(CV) L84010 6.7% COLLEGE YARD & HIGHNAM L84606 6.7% CAM & ULEY FAMILY PRACTICE L84060 6.5% AVENUE SURGERY L84018 6.5% ROMNEY HOUSE SURGERY L84020 6.5% GLOUCESTER CITY HEALTH CENTRE L84052 6.4% WHITE HOUSE SURGERY L84072 6.4% PHOENIX SURGERY L84012 6.4% PRICES MILL SURGERY L84065 6.4% BRUNSTON PRACTICE L84071 6.3% ROSEBANK HEALTH L84050 6.3% LONGLEVENS SURGERY L84067 6.3% STROUD VALLEYS FAMILY PRACTICE L84077 6.3% FRITHWOOD SURGERY L84016 6.2% MARYBROOK MEDICAL CENTRE L84044 6.2% THE PORTLAND PRACTICE L84033 6.0% SEVERNBANK SURGERY L84085 6.0% FRAMPTON SURGERY L84078 6.0% BERKELEY PLACE SURGERY L84030 5.9% LOCKING HILL SURGERY L84032 5.8% DOCKHAM ROAD SURGERY L84046 5.8% RENDCOMB SURGERY L84063 5.8% YORKLEY HEALTH CENTRE(WG) L84021 5.7% OVERTON PARK SURGERY L84041 5.6% MYTHE MEDICAL PRACTICE L84054 5.6% STOW SURGERY L84031 5.3% HOYLAND HOUSE L84025 5.2% ST.PETER'S ROAD SURGERY L84017 5.1% BARTONGATE SURGERY L84001 5.1% SIXWAYS CLINIC L84015 4.9% YORKLEIGH SURGERY(CT) L84022 4.8% ST.GEORGE'S SURGERY L84008 4.7% HEATHVILLE MEDICAL PRACTICE L84026 4.7% REGENT STREET SURGERY L84080 4.4% CHURCHDOWN SURGERY L84047 4.3% Note: CCG estimates for the estimated THE CORINTHIAN SURGERY L84056 4.1% UNDERWOOD SURGERY L84003 4.1% number of people with CKD are based on ROWCROFT MEDICAL CENTRE L84007 3.8% WALNUT TREE PRACTICE L84075 3.8% HOLTS HEALTH CENTRE L84037 3.7% applying a proportion from a resident based QUEDGELEY MEDICAL CENTRE L84617 2.9% ROYAL CRESCENT L84059 2.8% PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 2.6% population estimate to a GP registered GLOUCESTER HEALTH ACCESS CENTRE Y02519 2.4% 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

• 32,786 people with CKD (diagnosed*) NHS Gloucestershire CCG 74.4% in NHS Gloucestershire CCG • 24,403 (74.4%) people whose blood pressure is <= 140 /85 • 3,100 (9.5%) people who are exceptions • 5,283 (16.1%) additional people whose blood pressure is not <= 140 / 85

England 74.4%

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

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

NHS Nene CCG 75.5%

NHS Gloucestershire CCG 74.4%

NHS East and North Hertfordshire CCG 73.7%

NHS West Kent CCG 73.5%

NHS Wiltshire CCG 73.3%

NHS Southern Derbyshire CCG 72.7%

NHS Kernow CCG 72.5%

NHS Mid Essex CCG 72.0%

NHS Ipswich and East Suffolk CCG 72.0%

NHS West Hampshire CCG 69.6%

NHS Somerset CCG 67.3%

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

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

Not below 140/85 Exceptions reported

THE CULVERHAY SURGERY L84027 167 HOYLAND HOUSE L84025 70 THE LONDON ROAD MEDICAL PRACTICE L84042 166 DR SWINDELL & PARTNERS L84039 186 ROYAL CRESCENT SURGERY L84059 67 GLOUCESTER HEALTH ACCESS CENTRE Y02519 33 HILARY COTTAGE SURGERY L84053 144 ROWCROFT MEDICAL CENTRE L84007 122 NEWENT DOCTORS PRACTICE L84037 116 SIXWAYS CLINIC L84015 141 • in total, including exceptions, there ST CATHERINE'S SURGERY L84058 201 CRESCENT BAKERY SURGERY L84616 126 THE SPRINGBANK SURGERY Y02384 11 KINGSHOLM SURGERY L84081 85 are 8,383 people whose blood SAINTBRIDGE SURGERY L84013 155 HEATHVILLE ROAD MEDICAL PRACTICE L84026 120 HUCCLECOTE SURGERY L84014 206 pressure is not <= 140 / 85 GLOUCESTER CITY HEALTH CENTRE L84052 131 THE CORINTHIAN SURGERY L84056 83 BERKELEY PLACE SURGERY L84030 110 NEWNHAM SURGERY L84615 68 • GP practice range: 12.2% to 41.4% THE HIGH STREET MEDICAL CENTRE L84070 99 ROSEBANK SURGERY L84050 340 STROUD VALLEYS FAMILY PRACTICE L84077 67 LECHLADE MEDICAL CENTRE L84055 101 THE STOKE ROAD SURGERY L84048 164 UNDERWOOD SURGERY L84003 92 DOCKHAM ROAD SURGERY L84046 91 JESMOND HOUSE PRACTICE L84604 30 STOW SURGERY L84031 69 BARTONGATE SURGERY L84001 92 THE CHIPPING SURGERY L84051 171 DRYBROOK SURGERY L84024 82 LOCKING HILL SURGERY L84032 115 PRICES MILL SURGERY L84065 105 THE PORTLAND PRACTICE L84033 181 CAM AND ULEY FAMILY PRACTICE L84060 137 CHURCHDOWN SURGERY L84047 123 STONEHOUSE HEALTH CLINIC L84613 83 FRITHWOOD SURGERY L84016 81 REGENT STREET SURGERY L84080 35 WHITE HOUSE SURGERY L84072 60 ST LUKES MEDICAL CENTRE L84609 21 THE HADWEN MEDICAL PRACTICE L84009 240 BARNWOOD MEDICAL PRACTICE L84057 102 LONGLEVENS SURGERY L84067 87 THE PARK SURGERY L84010 98 THE AVENUE SURGERY L84018 88 THE LYDNEY PRACTICE L84011 113 MINCHINHAMPTON SURGERY L84005 159 COLEFORD FAMILY DOCTORS L84069 169 MYTHE MEDICAL PRACTICE L84054 101 MANN COTTAGE SURGERY L84068 77 WINCHCOMBE MEDICAL PRACTICE L84004 105 FRAMPTON SURGERY L84078 35 RENDCOMB SURGERY L84063 42 PARTNERS IN HEALTH-PAVILION FAMILY DOCTORS L84034 56 SEVERNBANK SURGERY L84085 50 LECHKAMPTON SURGERY L84040 155 BROCKWORTH SURGERY L84084 107 SEVENPOSTS SURGERY L84036 129 CHELTENHAM ROAD SURGERY L84002 139 OVERTON PARK SURGERY L84041 109 CHURCH STREET PRACTICE L84023 184 THE BRUNSTON AND LYDBROOK PRACTICE L84071 58 YORKLEIGH SURGERY L84022 49 MITCHELDEAN SURGERY L84045 77 FOREST HEALTH CARE L84028 107 COLLEGE YARD & HIGHNAM L84606 55 ROMNEY HOUSE L84020 71 ST GEORGE'S SURGERY L84008 76 STAUNTON AND CORSE SURGERY L84006 57 CAMPDEN SURGERY L84043 73 YORKLEY HEALTH CENTRE L84021 64 COTSWOLD MEDICAL PRACTICE L84038 128 ST PETER'S ROAD SURGERY L84017 55 ROYAL WELL SURGERY L84049 54 PHOENIX SURGERY L84012 117 BLAKENEY SURGERY L84029 44 ACORN PRACTICE L84073 41 MARYBROOK MEDICAL CENTRE L84044 31 QUEDGELEY MEDICAL CENTRE L84617 16 WALNUT TREE PRACTICE L84075 18 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

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

THE CULVERHAY SURGERY 94

THE LONDON ROAD MEDICAL PRACTICE 85

HOYLAND HOUSE 33 • using the GP cluster method of GLOUCESTER HEALTH ACCESS CENTRE 18 calculating potential gains, if each DR SWINDELL & PARTNERS 88 practice was to achieve as well as the ROYAL CRESCENT SURGERY 32 upper quartile of its national cluster, then an additional 2,082 people would SAINTBRIDGE SURGERY 73 be treated KINGSHOLM SURGERY 39

GLOUCESTER CITY HEALTH CENTRE 59

CRESCENT BAKERY SURGERY 53

ROYAL WELL SURGERY

ST GEORGE'S SURGERY

QUEDGELEY MEDICAL CENTRE

ROMNEY HOUSE

BLAKENEY SURGERY

ACORN PRACTICE

PHOENIX SURGERY

COTSWOLD MEDICAL PRACTICE

MARYBROOK MEDICAL CENTRE

WALNUT TREE PRACTICE Details of this methodology are available on slide 9. Click here to view them.

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

• 32,790 people with CKD (diagnosed*) NHS Gloucestershire CCG 74.1% in NHS Gloucestershire CCG • 24,282 (74.1%) people who have a record of urine albumin:creatinine ratio test • 2,404 (7.3%) people who are exceptions • 6,104 (18.6%) 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 West Kent CCG 75.7%

NHS Nene CCG 75.3%

NHS East and North Hertfordshire CCG 74.4%

NHS Gloucestershire CCG 74.1%

NHS Wiltshire CCG 73.9%

NHS Ipswich and East Suffolk CCG 71.5%

NHS West Hampshire CCG 71.2%

NHS Somerset CCG 61.5%

NHS Mid Essex CCG 61.3%

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

ROWCROFT MEDICAL CENTRE L84007 247 CHURCHDOWN SURGERY L84047 232 SIXWAYS CLINIC L84015 216 CRESCENT BAKERY SURGERY L84616 192 KINGSHOLM SURGERY L84081 131 HOYLAND HOUSE L84025 85 THE LONDON ROAD MEDICAL PRACTICE L84042 213 QUEDGELEY MEDICAL CENTRE L84617 53 NEWENT DOCTORS PRACTICE L84037 165 DR SWINDELL & PARTNERS L84039 237 • in total, including exceptions, there UNDERWOOD SURGERY L84003 140 BARTONGATE SURGERY L84001 140 GLOUCESTER HEALTH ACCESS CENTRE Y02519 39 HEATHVILLE ROAD MEDICAL PRACTICE L84026 152 are 8,508 people who have no record ROYAL CRESCENT SURGERY L84059 74 ROYAL WELL SURGERY L84049 115 MITCHELDEAN SURGERY L84045 136 of urine albumin:creatinine ratio test THE STOKE ROAD SURGERY L84048 204 SEVENPOSTS SURGERY L84036 212 MINCHINHAMPTON SURGERY L84005 235 JESMOND HOUSE PRACTICE L84604 36 • GP practice range: 9.8% to 66.8% GLOUCESTER CITY HEALTH CENTRE L84052 142 YORKLEIGH SURGERY L84022 78 HILARY COTTAGE SURGERY L84053 143 ST GEORGE'S SURGERY L84008 128 NEWNHAM SURGERY L84615 72 THE LYDNEY PRACTICE L84011 151 THE SPRINGBANK SURGERY Y02384 11 BERKELEY PLACE SURGERY L84030 105 YORKLEY HEALTH CENTRE L84021 100 ST CATHERINE'S SURGERY L84058 173 CAMPDEN SURGERY L84043 101 THE CULVERHAY SURGERY L84027 104 CAM AND ULEY FAMILY PRACTICE L84060 131 ROSEBANK SURGERY L84050 289 STOW SURGERY L84031 61 BARNWOOD MEDICAL PRACTICE L84057 102 REGENT STREET SURGERY L84080 33 FRAMPTON SURGERY L84078 37 SAINTBRIDGE SURGERY L84013 116 CHELTENHAM ROAD SURGERY L84002 152 THE HIGH STREET MEDICAL CENTRE L84070 76 PARTNERS IN HEALTH-PAVILION FAMILY DOCTORS L84034 58 HUCCLECOTE SURGERY L84014 148 THE HADWEN MEDICAL PRACTICE L84009 212 LOCKING HILL SURGERY L84032 94 ROMNEY HOUSE L84020 80 DRYBROOK SURGERY L84024 65 WHITE HOUSE SURGERY L84072 51 MYTHE MEDICAL PRACTICE L84054 93 LECHLADE MEDICAL CENTRE L84055 74 LECHKAMPTON SURGERY L84040 150 OVERTON PARK SURGERY L84041 108 LONGLEVENS SURGERY L84067 74 STAUNTON AND CORSE SURGERY L84006 57 SEVERNBANK SURGERY L84085 43 COTSWOLD MEDICAL PRACTICE L84038 130 CHURCH STREET PRACTICE L84023 160 WALNUT TREE PRACTICE L84075 26 MANN COTTAGE SURGERY L84068 57 WINCHCOMBE MEDICAL PRACTICE L84004 77 COLEFORD FAMILY DOCTORS L84069 119 BROCKWORTH SURGERY L84084 80 MARYBROOK MEDICAL CENTRE L84044 33 THE PORTLAND PRACTICE L84033 108 ST PETER'S ROAD SURGERY L84017 48 STROUD VALLEYS FAMILY PRACTICE L84077 35 BLAKENEY SURGERY L84029 43 PHOENIX SURGERY L84012 105 FOREST HEALTH CARE L84028 81 COLLEGE YARD & HIGHNAM L84606 42 THE PARK SURGERY L84010 59 PRICES MILL SURGERY L84065 58 RENDCOMB SURGERY L84063 28 STONEHOUSE HEALTH CLINIC L84613 45 THE CHIPPING SURGERY L84051 88 THE CORINTHIAN SURGERY L84056 38 FRITHWOOD SURGERY L84016 40 DOCKHAM ROAD SURGERY L84046 40 THE BRUNSTON AND LYDBROOK PRACTICE L84071 30 THE AVENUE SURGERY L84018 37 ACORN PRACTICE L84073 27 ST LUKES MEDICAL CENTRE L84609 8 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 Gloucestershire CCG 0.77% • prevalence of 0.77% in NHS Gloucestershire 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%

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

NHS Kernow CCG 1.03%

NHS Southern Derbyshire CCG 0.92%

NHS Somerset CCG 0.89%

NHS Ipswich and East Suffolk CCG 0.87%

NHS Wiltshire CCG 0.86%

NHS West Hampshire CCG 0.78%

NHS Gloucestershire CCG 0.77%

NHS Nene CCG 0.77%

NHS West Kent CCG 0.65%

NHS Mid Essex CCG 0.62%

NHS East and North Hertfordshire CCG 0.62%

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

LONDON MEDICAL PRACTICE L84042 1.7% ST.CATHERINE'S SURGERY L84058 1.4% ACORN PRACTICE L84073 1.3% STONEHOUSE HEALTH CLINIC L84613 1.3% YORKLEY HEALTH CENTRE(WG) L84021 1.3% DOCKHAM ROAD SURGERY L84046 1.2% BARNWOOD MEDICAL PRACTICE L84057 1.2% FOREST HEALTH CARE L84028 1.2% MANN COTTAGE SURGERY L84068 1.2% CHIPPING SURGERY L84051 1.2% • 4,870 people with diagnosed heart MINCHINHAMPTON SURGERY L84005 1.2% ST.PETER'S ROAD SURGERY L84017 1.1% YORKLEIGH SURGERY(CT) L84022 1.1% failure in NHS Gloucestershire CCG THE STOKE ROAD SURGERY, L84048 1.1% HILARY COTTAGE SURGERY L84053 1.1% LYDNEY PRACTICE L84011 1.1% THE LECKHAMPTON SURGERY L84040 1.0% • GP practice range: 0.4% to 1.7% WINCHCOMBE MEDICAL CENTRE L84004 1.0% MARYBROOK MEDICAL CENTRE L84044 1.0% MITCHELDEAN SURGERY L84045 1.0% HOYLAND HOUSE L84025 1.0% ROMNEY HOUSE SURGERY L84020 0.9% ST.GEORGE'S SURGERY L84008 0.9% BROCKWORTH SURGERY L84084 0.9% DRYBROOK SURGERY L84024 0.9% NEWNHAM SURGERY L84615 0.9% PRICES MILL SURGERY L84065 0.9% BRUNSTON PRACTICE L84071 0.9% SEVERNBANK SURGERY L84085 0.9% SEVEN POSTS SURGERY L84036 0.9% GLOUCESTER CITY HEALTH CENTRE L84052 0.9% WALNUT TREE PRACTICE L84075 0.8% FRITHWOOD SURGERY L84016 0.8% STROUD HC L84039 0.8% BLAKENEY SURGERY L84029 0.8% HIGH STREET MEDICAL CENTRE L84070 0.8% ROSEBANK HEALTH L84050 0.8% BARTONGATE SURGERY L84001 0.8% SAINTBRIDGE SURGERY L84013 0.8% PARK SURGERY(CV) L84010 0.8% CHIPPING CAMPDEN SURGERY L84043 0.8% CAM & ULEY FAMILY PRACTICE L84060 0.7% WHITE HOUSE SURGERY L84072 0.7% CHELTENHAM ROAD SURGERY L84002 0.7% COLEFORD FAMILY DOCTORS L84069 0.7% RENDCOMB SURGERY L84063 0.7% CHURCHDOWN SURGERY L84047 0.7% STOW SURGERY L84031 0.7% THE PORTLAND PRACTICE L84033 0.7% SIXWAYS CLINIC L84015 0.7% HOLTS HEALTH CENTRE L84037 0.6% MYTHE MEDICAL PRACTICE L84054 0.6% CRESCENT BAKERY L84616 0.6% AVENUE SURGERY L84018 0.6% HUCCLECOTE SURGERY L84014 0.6% THE CORINTHIAN SURGERY L84056 0.6% STROUD VALLEYS FAMILY PRACTICE L84077 0.6% REGENT STREET SURGERY L84080 0.6% FRAMPTON SURGERY L84078 0.6% HADWEN MEDICAL PRACT. L84009 0.6% KINGSHOLM SURGERY L84081 0.6% OVERTON PARK SURGERY L84041 0.6% ROYAL CRESCENT L84059 0.6% LONGLEVENS SURGERY L84067 0.5% QUEDGELEY MEDICAL CENTRE L84617 0.5% BERKELEY PLACE SURGERY L84030 0.5% LOCKING HILL SURGERY L84032 0.5% COLLEGE YARD & HIGHNAM L84606 0.5% PHOENIX SURGERY L84012 0.5% ROWCROFT MEDICAL CENTRE L84007 0.5% HEATHVILLE MEDICAL PRACTICE L84026 0.5% STAUNTON & CORSE SURGERY L84006 0.5% CULVERHAY SURGERY L84027 0.5% THE ROYAL WELL SURGERY L84049 0.4% COTSWOLD MEDICAL PRACTICE L84038 0.4% CHURCH STREET PRACTICE L84023 0.4% GLOUCESTER HEALTH ACCESS CENTRE Y02519 0.4% LECHLADE MEDICAL CENTRE L84055 0.4% UNDERWOOD SURGERY L84003 0.4% PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 0.4% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8%

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

• 2,205 people with heart failure* with NHS Gloucestershire CCG 85.4% LVSD in NHS Gloucestershire CCG • 1,883 (85.4%) people treated with ACE-I or ARB • 320 (14.5%) 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 East and North Hertfordshire CCG 87.4%

NHS West Kent CCG 86.3%

NHS Gloucestershire CCG 85.4%

NHS Wiltshire CCG 85.0%

NHS Nene CCG 84.1%

NHS West Hampshire CCG 84.0%

NHS Mid Essex CCG 82.9%

NHS Ipswich and East Suffolk CCG 81.9%

NHS Kernow CCG 81.0%

NHS Southern Derbyshire CCG 80.8%

NHS Somerset CCG 80.1%

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

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

No treatment Exceptions reported

LECHLADE MEDICAL CENTRE L84055 2 NEWNHAM SURGERY L84615 2 PARK SURGERY(CV) L84010 6 ROYAL CRESCENT L84059 2 STROUD VALLEYS FAMILY PRACTICE L84077 2 STAUNTON & CORSE SURGERY L84006 3 COTSWOLD MEDICAL PRACTICE L84038 4 MINCHINHAMPTON SURGERY L84005 14 DRYBROOK SURGERY L84024 6 HEATHVILLE MEDICAL PRACTICE L84026 2 • in total, including exceptions, there BRUNSTON PRACTICE L84071 2 ROMNEY HOUSE SURGERY L84020 12 BARNWOOD MEDICAL PRACTICE L84057 13 are 322 people who are not treated THE ROYAL WELL SURGERY L84049 4 UNDERWOOD SURGERY L84003 3 LONDON MEDICAL PRACTICE L84042 12 HUCCLECOTE SURGERY L84014 5 with ACE-I or ARB PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 5 GLOUCESTER CITY HEALTH CENTRE L84052 5 THE CORINTHIAN SURGERY L84056 4 • GP practice range: 0.0% to 50.0% WHITE HOUSE SURGERY L84072 2 THE PORTLAND PRACTICE L84033 10 YORKLEIGH SURGERY(CT) L84022 6 MARYBROOK MEDICAL CENTRE L84044 3 ROSEBANK HEALTH L84050 16 SEVEN POSTS SURGERY L84036 11 STROUD HC L84039 8 ST.CATHERINE'S SURGERY L84058 21 SIXWAYS CLINIC L84015 3 ST.PETER'S ROAD SURGERY L84017 2 BLAKENEY SURGERY L84029 2 CHIPPING CAMPDEN SURGERY L84043 3 FRITHWOOD SURGERY L84016 4 MITCHELDEAN SURGERY L84045 4 WINCHCOMBE MEDICAL CENTRE L84004 7 OVERTON PARK SURGERY L84041 2 MYTHE MEDICAL PRACTICE L84054 4 LYDNEY PRACTICE L84011 7 CHELTENHAM ROAD SURGERY L84002 4 ST.GEORGE'S SURGERY L84008 4 PRICES MILL SURGERY L84065 5 STOW SURGERY L84031 1 BROCKWORTH SURGERY L84084 8 HILARY COTTAGE SURGERY L84053 9 RENDCOMB SURGERY L84063 3 CHIPPING SURGERY L84051 8 FOREST HEALTH CARE L84028 10 DOCKHAM ROAD SURGERY L84046 6 COLEFORD FAMILY DOCTORS L84069 2 THE LECKHAMPTON SURGERY L84040 4 ROWCROFT MEDICAL CENTRE L84007 2 BERKELEY PLACE SURGERY L84030 3 LONGLEVENS SURGERY L84067 1 LOCKING HILL SURGERY L84032 3 CHURCHDOWN SURGERY L84047 7 PHOENIX SURGERY L84012 2 STONEHOUSE HEALTH CLINIC L84613 1 MANN COTTAGE SURGERY L84068 1 CHURCH STREET PRACTICE L84023 2 FRAMPTON SURGERY L84078 1 THE STOKE ROAD SURGERY, L84048 5 HADWEN MEDICAL PRACT. L84009 2 HOLTS HEALTH CENTRE L84037 2 SAINTBRIDGE SURGERY L84013 1 CAM & ULEY FAMILY PRACTICE L84060 1 YORKLEY HEALTH CENTRE(WG) L84021 1 BARTONGATE SURGERY L84001 AVENUE SURGERY L84018 HOYLAND HOUSE L84025 CULVERHAY SURGERY L84027 HIGH STREET MEDICAL CENTRE L84070 ACORN PRACTICE L84073 WALNUT TREE PRACTICE L84075 REGENT STREET SURGERY L84080 KINGSHOLM SURGERY L84081 SEVERNBANK SURGERY L84085 COLLEGE YARD & HIGHNAM L84606 CRESCENT BAKERY L84616 QUEDGELEY MEDICAL CENTRE L84617 GLOUCESTER HEALTH ACCESS CENTRE Y02519 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

• 1,878 people with heart failure* with NHS Gloucestershire CCG 75.9% LVSD treated with ACE-I/ARB in NHS Gloucestershire CCG • 1,426 (75.9%) people treated with ACE-I/ARB and BB • 318 (16.9%) people who are exceptions • 134 (7.1%) additional people who are not treated with ACE-I/ARB and BB

England 77.7%

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

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

NHS Nene CCG 78.7%

NHS West Kent CCG 77.9%

NHS West Hampshire CCG 77.4%

NHS Ipswich and East Suffolk CCG 77.4%

NHS East and North Hertfordshire CCG 76.8%

NHS Gloucestershire CCG 75.9%

NHS Kernow CCG 73.4%

NHS Mid Essex CCG 72.9%

NHS Somerset CCG 72.5%

NHS Southern Derbyshire CCG 72.2%

NHS Wiltshire CCG 71.5%

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

ST.PETER'S ROAD SURGERY L84017 5 STOW SURGERY L84031 3 HOYLAND HOUSE L84025 10 GLOUCESTER CITY HEALTH CENTRE L84052 8 HOLTS HEALTH CENTRE L84037 12 HILARY COTTAGE SURGERY L84053 19 HEATHVILLE MEDICAL PRACTICE L84026 2 BERKELEY PLACE SURGERY L84030 8 BRUNSTON PRACTICE L84071 2 KINGSHOLM SURGERY L84081 1 • in total, including exceptions, there SEVERNBANK SURGERY L84085 2 THE PORTLAND PRACTICE L84033 15 LONDON MEDICAL PRACTICE L84042 15 are 452 people who are not treated CHURCHDOWN SURGERY L84047 19 SEVEN POSTS SURGERY L84036 16 MANN COTTAGE SURGERY L84068 3 WINCHCOMBE MEDICAL CENTRE L84004 11 with ACE-I or ARB CAM & ULEY FAMILY PRACTICE L84060 7 CHURCH STREET PRACTICE L84023 6 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 6 • GP practice range: 0.0% to 50.0% MITCHELDEAN SURGERY L84045 6 STROUD HC L84039 11 DOCKHAM ROAD SURGERY L84046 11 ST.CATHERINE'S SURGERY L84058 29 MYTHE MEDICAL PRACTICE L84054 6 FRAMPTON SURGERY L84078 3 BROCKWORTH SURGERY L84084 13 ROWCROFT MEDICAL CENTRE L84007 4 SIXWAYS CLINIC L84015 4 RENDCOMB SURGERY L84063 5 THE LECKHAMPTON SURGERY L84040 7 MINCHINHAMPTON SURGERY L84005 10 STAUNTON & CORSE SURGERY L84006 2 YORKLEIGH SURGERY(CT) L84022 7 LONGLEVENS SURGERY L84067 2 GLOUCESTER HEALTH ACCESS CENTRE Y02519 1 LOCKING HILL SURGERY L84032 6 THE STOKE ROAD SURGERY, L84048 16 LYDNEY PRACTICE L84011 9 AVENUE SURGERY L84018 4 WALNUT TREE PRACTICE L84075 2 STONEHOUSE HEALTH CLINIC L84613 2 CRESCENT BAKERY L84616 2 ACORN PRACTICE L84073 6 UNDERWOOD SURGERY L84003 2 HADWEN MEDICAL PRACT. L84009 6 PARK SURGERY(CV) L84010 3 YORKLEY HEALTH CENTRE(WG) L84021 6 CHIPPING CAMPDEN SURGERY L84043 3 HIGH STREET MEDICAL CENTRE L84070 2 CHIPPING SURGERY L84051 10 HUCCLECOTE SURGERY L84014 4 ROMNEY HOUSE SURGERY L84020 7 QUEDGELEY MEDICAL CENTRE L84617 4 THE CORINTHIAN SURGERY L84056 3 CHELTENHAM ROAD SURGERY L84002 4 ST.GEORGE'S SURGERY L84008 4 ROSEBANK HEALTH L84050 13 PRICES MILL SURGERY L84065 5 FOREST HEALTH CARE L84028 11 DRYBROOK SURGERY L84024 3 BARTONGATE SURGERY L84001 2 THE ROYAL WELL SURGERY L84049 2 SAINTBRIDGE SURGERY L84013 3 BARNWOOD MEDICAL PRACTICE L84057 6 FRITHWOOD SURGERY L84016 3 PHOENIX SURGERY L84012 2 WHITE HOUSE SURGERY L84072 1 REGENT STREET SURGERY L84080 1 BLAKENEY SURGERY L84029 1 OVERTON PARK SURGERY L84041 1 COLEFORD FAMILY DOCTORS L84069 1 MARYBROOK MEDICAL CENTRE L84044 1 CULVERHAY SURGERY L84027 COTSWOLD MEDICAL PRACTICE L84038 LECHLADE MEDICAL CENTRE L84055 ROYAL CRESCENT L84059 STROUD VALLEYS FAMILY PRACTICE L84077 COLLEGE YARD & HIGHNAM L84606 NEWNHAM SURGERY L84615 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

• 20,232 people with coronary heart NHS Gloucestershire CCG 88.2% disease* in NHS Gloucestershire CCG • 17,848 (88.2%) people whose blood pressure <= 150 / 90 • 1,139 (5.6%) people who are exceptions • 1,245 (6.2%) 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 Nene CCG 88.9%

NHS Kernow CCG 88.5%

NHS East and North Hertfordshire CCG 88.3%

NHS Gloucestershire CCG 88.2%

NHS West Kent CCG 88.1%

NHS Ipswich and East Suffolk CCG 87.7%

NHS Southern Derbyshire CCG 87.6%

NHS Wiltshire CCG 87.6%

NHS Mid Essex CCG 87.0%

NHS West Hampshire CCG 86.8%

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

ROWCROFT MEDICAL CENTRE L84007 82 CRESCENT BAKERY L84616 42 HIGH STREET MEDICAL CENTRE L84070 50 ROYAL CRESCENT L84059 44 KINGSHOLM SURGERY L84081 33 GLOUCESTER HEALTH ACCESS CENTRE Y02519 22 STROUD VALLEYS FAMILY PRACTICE L84077 36 BROCKWORTH SURGERY L84084 58 SAINTBRIDGE SURGERY L84013 49 BARNWOOD MEDICAL PRACTICE L84057 36 • in total, including exceptions, there ST.CATHERINE'S SURGERY L84058 47 LECHLADE MEDICAL CENTRE L84055 23 ROSEBANK HEALTH L84050 96 are 2,384 people whose blood GLOUCESTER CITY HEALTH CENTRE L84052 41 ST.PETER'S ROAD SURGERY L84017 33 WHITE HOUSE SURGERY L84072 27 CULVERHAY SURGERY L84027 27 pressure is not <= 150 / 90 AVENUE SURGERY L84018 23 HILARY COTTAGE SURGERY L84053 37 YORKLEIGH SURGERY(CT) L84022 34 • GP practice range: 2.1% to 26.7% PARK SURGERY(CV) L84010 45 LOCKING HILL SURGERY L84032 48 SIXWAYS CLINIC L84015 56 BERKELEY PLACE SURGERY L84030 22 WINCHCOMBE MEDICAL CENTRE L84004 35 DOCKHAM ROAD SURGERY L84046 36 BRUNSTON PRACTICE L84071 27 PRICES MILL SURGERY L84065 35 UNDERWOOD SURGERY L84003 22 THE PORTLAND PRACTICE L84033 50 HEATHVILLE MEDICAL PRACTICE L84026 43 HOYLAND HOUSE L84025 21 MITCHELDEAN SURGERY L84045 26 REGENT STREET SURGERY L84080 20 THE STOKE ROAD SURGERY, L84048 47 ST.GEORGE'S SURGERY L84008 38 LONGLEVENS SURGERY L84067 24 MYTHE MEDICAL PRACTICE L84054 43 QUEDGELEY MEDICAL CENTRE L84617 12 FOREST HEALTH CARE L84028 33 COTSWOLD MEDICAL PRACTICE L84038 35 PHOENIX SURGERY L84012 34 THE LECKHAMPTON SURGERY L84040 47 NEWNHAM SURGERY L84615 11 STOW SURGERY L84031 23 CHIPPING CAMPDEN SURGERY L84043 20 THE CORINTHIAN SURGERY L84056 25 COLEFORD FAMILY DOCTORS L84069 30 LONDON MEDICAL PRACTICE L84042 22 CAM & ULEY FAMILY PRACTICE L84060 35 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 31 HADWEN MEDICAL PRACT. L84009 43 YORKLEY HEALTH CENTRE(WG) L84021 28 LYDNEY PRACTICE L84011 25 OVERTON PARK SURGERY L84041 26 RENDCOMB SURGERY L84063 10 HUCCLECOTE SURGERY L84014 31 BARTONGATE SURGERY L84001 18 CHELTENHAM ROAD SURGERY L84002 26 COLLEGE YARD & HIGHNAM L84606 14 CHURCH STREET PRACTICE L84023 40 CHURCHDOWN SURGERY L84047 42 HOLTS HEALTH CENTRE L84037 31 STROUD HC L84039 21 THE ROYAL WELL SURGERY L84049 15 FRITHWOOD SURGERY L84016 18 SEVERNBANK SURGERY L84085 11 STAUNTON & CORSE SURGERY L84006 13 WALNUT TREE PRACTICE L84075 14 ROMNEY HOUSE SURGERY L84020 17 MANN COTTAGE SURGERY L84068 11 BLAKENEY SURGERY L84029 9 MINCHINHAMPTON SURGERY L84005 19 CHIPPING SURGERY L84051 19 DRYBROOK SURGERY L84024 11 MARYBROOK MEDICAL CENTRE L84044 11 STONEHOUSE HEALTH CLINIC L84613 6 ACORN PRACTICE L84073 7 FRAMPTON SURGERY L84078 4 SEVEN POSTS SURGERY L84036 8 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%

ROWCROFT MEDICAL CENTRE 56

CRESCENT BAKERY 30

HIGH STREET MEDICAL CENTRE 36 • using the GP cluster method of ROYAL CRESCENT 31 calculating potential gains, if each GLOUCESTER HEALTH ACCESS CENTRE 16 practice was to achieve as well as the KINGSHOLM SURGERY 23 upper quartile of its national cluster, then an additional 855 people would STROUD VALLEYS FAMILY PRACTICE 24 be treated SAINTBRIDGE SURGERY 33

BROCKWORTH SURGERY 35

BARNWOOD MEDICAL PRACTICE 21

HOLTS HEALTH CENTRE

MINCHINHAMPTON SURGERY

CHIPPING SURGERY

DRYBROOK SURGERY

ROMNEY HOUSE SURGERY

MARYBROOK MEDICAL CENTRE

STONEHOUSE HEALTH CLINIC

ACORN PRACTICE

FRAMPTON SURGERY

SEVEN POSTS SURGERY Details of this methodology are available on slide 9. Click here to view them.

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

• 20,231 people with coronary heart NHS Gloucestershire CCG 91.5% disease* in NHS Gloucestershire CCG • 18,521 (91.5%) people who are taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant • 1,027 (5.1%) people who are exceptions • 683 (3.4%) additional people who are not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant

England 91.8%

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

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

NHS West Kent CCG 92.8%

NHS Kernow CCG 92.6%

NHS Nene CCG 92.6%

NHS West Hampshire CCG 92.6%

NHS East and North Hertfordshire CCG 92.2%

NHS Gloucestershire CCG 91.5%

NHS Wiltshire CCG 90.8%

NHS Southern Derbyshire CCG 90.6%

NHS Ipswich and East Suffolk CCG 90.5%

NHS Mid Essex CCG 90.0%

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

SIXWAYS CLINIC L84015 78 BERKELEY PLACE SURGERY L84030 28 WHITE HOUSE SURGERY L84072 30 ROWCROFT MEDICAL CENTRE L84007 49 THE STOKE ROAD SURGERY, L84048 63 ST.PETER'S ROAD SURGERY L84017 34 GLOUCESTER HEALTH ACCESS CENTRE Y02519 14 HIGH STREET MEDICAL CENTRE L84070 30 ROYAL CRESCENT L84059 27 BARTONGATE SURGERY L84001 26 • in total, including exceptions, there OVERTON PARK SURGERY L84041 35 LECHLADE MEDICAL CENTRE L84055 17 MINCHINHAMPTON SURGERY L84005 33 are 1,710 people are not taking CRESCENT BAKERY L84616 20 REGENT STREET SURGERY L84080 20 GLOUCESTER CITY HEALTH CENTRE L84052 30 SEVERNBANK SURGERY L84085 17 aspirin, an alternative anti-platelet COLLEGE YARD & HIGHNAM L84606 18 KINGSHOLM SURGERY L84081 16 YORKLEIGH SURGERY(CT) L84022 27 therapy, or an anti-coagulant CHIPPING CAMPDEN SURGERY L84043 21 STROUD HC L84039 29 CULVERHAY SURGERY L84027 20 DOCKHAM ROAD SURGERY L84046 • GP practice range: 2.3% to 18.9% 30 ROSEBANK HEALTH L84050 62 MYTHE MEDICAL PRACTICE L84054 40 CHURCH STREET PRACTICE L84023 46 UNDERWOOD SURGERY L84003 18 STONEHOUSE HEALTH CLINIC L84613 11 SEVEN POSTS SURGERY L84036 38 BROCKWORTH SURGERY L84084 27 STROUD VALLEYS FAMILY PRACTICE L84077 16 MARYBROOK MEDICAL CENTRE L84044 17 THE PORTLAND PRACTICE L84033 37 PARK SURGERY(CV) L84010 28 ST.GEORGE'S SURGERY L84008 28 DRYBROOK SURGERY L84024 14 FRITHWOOD SURGERY L84016 19 STOW SURGERY L84031 17 SAINTBRIDGE SURGERY L84013 19 RENDCOMB SURGERY L84063 8 HOYLAND HOUSE L84025 13 CHIPPING SURGERY L84051 20 LOCKING HILL SURGERY L84032 25 MANN COTTAGE SURGERY L84068 11 BRUNSTON PRACTICE L84071 15 STAUNTON & CORSE SURGERY L84006 12 HILARY COTTAGE SURGERY L84053 18 COTSWOLD MEDICAL PRACTICE L84038 22 HOLTS HEALTH CENTRE L84037 25 AVENUE SURGERY L84018 11 PHOENIX SURGERY L84012 21 MITCHELDEAN SURGERY L84045 14 CAM & ULEY FAMILY PRACTICE L84060 22 THE ROYAL WELL SURGERY L84049 12 COLEFORD FAMILY DOCTORS L84069 18 LYDNEY PRACTICE L84011 16 HADWEN MEDICAL PRACT. L84009 26 PARTNERS IN HEALTH, PAVILION FAMILY DRS L84034 18 WINCHCOMBE MEDICAL CENTRE L84004 15 PRICES MILL SURGERY L84065 15 BARNWOOD MEDICAL PRACTICE L84057 11 THE LECKHAMPTON SURGERY L84040 23 CHELTENHAM ROAD SURGERY L84002 15 THE CORINTHIAN SURGERY L84056 12 ST.CATHERINE'S SURGERY L84058 14 NEWNHAM SURGERY L84615 5 CHURCHDOWN SURGERY L84047 23 LONGLEVENS SURGERY L84067 10 BLAKENEY SURGERY L84029 6 ROMNEY HOUSE SURGERY L84020 11 YORKLEY HEALTH CENTRE(WG) L84021 13 HUCCLECOTE SURGERY L84014 14 HEATHVILLE MEDICAL PRACTICE L84026 15 FOREST HEALTH CARE L84028 11 FRAMPTON SURGERY L84078 3 LONDON MEDICAL PRACTICE L84042 7 QUEDGELEY MEDICAL CENTRE L84617 3 WALNUT TREE PRACTICE L84075 5 ACORN PRACTICE L84073 3 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 Gloucestershire CCG England 800

700 • in NHS Gloucestershire CCG, the hospital admission rate for coronary heart disease in 2015/16 was 420.5 600 (2,693) compared to 527.9 for England

500

400

300

Age Age standardised (per rate 100,000) 200

100

0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved

83 CVD: Primary Care Intelligence Packs Hospital admissions for stroke for all ages 2002/03 – 2015/16

NHS Gloucestershire CCG England 250

• in NHS Gloucestershire CCG, the hospital admission rate for stroke in 200 2015/16 was 134.6 (874) compared to 172.8 for England

150

100 Age standardised standardised Age (per rate 100,000)

50

0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved

84 CVD: Primary Care Intelligence Packs Additional risk of complications for people with diabetes, three year follow up, 2013/14

NHS Gloucestershire CCG England

158.4% Angina 136.8% • The risk of a stroke was 85.9% higher and the risk of a heart attack was 119.2% 119.2% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 499.8% higher. 143.4% Heart failure 150.0%

85.9% Stroke 81.3%

499.8% Major amputation 445.8%

1369.0% Minor amputation 753.5%

224.7% RRT 293.0%

0% 200% 400% 600% 800% 1000% 1200% 1400% 1600% 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 Gloucestershire CCG England 90

80 • in NHS Gloucestershire CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 37.7, 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 Gloucestershire CCG England 30

• in NHS Gloucestershire CCG, the 25 early mortality rate for stroke in 2013- 15 was 13.3, 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

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health, and are a distinct delivery organisation with operational autonomy to advise and support government, local authorities and the NHS in a professionally independent manner.

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© Crown copyright 2017 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

Published June 2017 Gateway number 2017095

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