CVD: Primary Care Intelligence Packs NHS Barnet 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 Barnet CCG are: NHS Sutton CCG NHS Bexley CCG NHS Hillingdon CCG NHS Milton Keynes CCG NHS Bromley CCG NHS Kingston CCG NHS Crawley CCG NHS Dartford, Gravesham and Swanley CCG NHS North West Surrey CCG NHS Chiltern 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 Crawley CCG 18.7%

NHS Milton Keynes CCG 18.0% • prevalence of 14.9% in NHS Barnet CCG NHS Dartford, Gravesham and Swanley CCG 17.2%

NHS Sutton CCG 16.6%

NHS Hillingdon CCG 16.3%

NHS Bexley CCG 16.1%

NHS Kingston CCG 15.3%

NHS Bromley CCG 15.2% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Barnet CCG 14.9% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS North West Surrey CCG 14.4% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS Chiltern CCG 13.9% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% recorded as current smokers) divided by GP practice’s estimated number of patients 15+

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

GP Practice CCG

PARKVIEW SURGERY E83028 21.0% THE EVERGLADE MEDICAL PRACTICE E83011 20.9% THE SURGERY E83041 20.6% DR MAKANJUOLA'S SURGERY E83042 20.1% DR AZIM & PARTNERS Y03664 19.3% GREENFIELD MEDICAL CENTRE E83006 19.2% STATION ROAD NEW BARNET SURGERY E83624 19.0% SQUIRES LANE MEDICAL PRACTICE E83007 18.7% • 48,657 people who are recorded as MULBERRY MEDICAL PRACTICE E83046 18.1% COLINDALE MEDICAL CENTRE LP E83637 17.8% smokers in NHS Barnet CCG THE VILLAGE SURGERY E83031 17.2% VALE DRIVE MEDICAL PRACTICE E83036 17.2% JAI MEDICAL CENTRE E83038 17.1% • GP practice range: 4.7% to 21.0% BALLARDS LANE SURGERY E83644 17.1% WOODLANDS MEDICAL PRACTICE Y00316 17.0% 188 THE PRACTICE E83027 16.9% HOLLY PARK CLINIC Y00105 16.8% THE PHOENIX PRACTICE E83653 16.7% TORRINGTON PARK GROUP PRACTICE E83021 16.6% FRIERN BARNET MEDICAL CENTRE E83045 16.6% LANGSTONE WAY SURGERY E83049 16.5% MULKIS HB-THE SURGERY E83034 16.4% ST. GEORGES MEDICAL CENTRE E83020 16.3% OAK LODGE MEDICAL CENTRE E83032 15.8% CRICKLEWOOD HEALTH CENTRE Y02986 15.7% THE HODFORD ROAD PRACTICE E83649 15.7% WATLING MEDICAL CENTRE E83018 15.3% HENDON WAY SURGERY Y03663 15.3% DR LF MILLER E83656 15.2% OAKLEIGH ROAD HEALTH CENTRE E83003 15.1% LICHFIELD GROVE SURGERY E83005 15.0% PENNINE DRIVE PRACTICE E83025 14.9% THE SPEEDWELL PRACTICE E83010 14.9% MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 14.9% WATFORD WAY CENTRE LIMITED E83633 14.7% LONGROVE SURGERY E83017 14.5% THE OLD COURT HOUSE SURGERY E83012 14.5% EBHC DR CJ PESKIN E83632 14.3% BRUNSWICK PARK MEDICAL CENTRE E83621 14.1% ROSEMARY SURGERY E83639 14.0% EAST FINCHLEY MEDICAL CENTRE E83050 13.8% GLOUCESTER ROAD SURGERY E83650 13.8% CORNWALL HOUSE SURGERY E83013 13.6% RAVENSCROFT MEDICAL CENTRE E83039 13.6% DR SP TALPAHEWA E83668 13.3% LANE END MEDICAL GROUP E83053 12.9% ADDINGTON MEDICAL CENTRE E83044 12.9% THE HILLVIEW SURGERY E83657 12.7% EBHC DR P WESTON E83629 12.6% MILLWAY MEDICAL PRACTICE E83016 12.5% SUPREME MEDICAL CENTRE E83026 12.1% WENTWORTH MEDICAL PRACTICE. E83035 12.1% Note: This method is thought to be a reasonably PHGH DOCTORS E83009 12.1% ST ANDREWS MEDICAL PRACTICE. E83024 12.0% robust method in estimating smoking prevalence EBHC DR D MONKMAN E83613 11.8% DERWENT CRESCENT MEDICAL CENTRE E83037 11.5% for the majority of GP practices. However, TEMPLE FORTUNE MEDICAL GROUP E83622 10.5% THE MOUNTFIELD SURGERY E83638 10.0% caution is advised for extreme estimates of PENSHURST GARDENS SURGERY E83030 9.7% HEATHFIELDE MEDICAL CENTRE E83008 8.8% smoking prevalence and those with high ADLER JS-THE SURGERY E83600 4.7% HAMID CARETAKING E83664 numbers of smoking status not recorded and 0% 5% 10% 15% 20% 25% 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 Enfield CCG 0.59

• the ratio of those diagnosed with NHS Barnet CCG 0.57 hypertension versus those expected to have hypertension is 0.57. This compares to 0.59 for England • this suggests that 57% of people with NHS Haringey CCG 0.55 hypertension have been diagnosed

NHS Camden CCG 0.54

NHS Islington CCG 0.50

Note: this slide shows Hypertension prevalence England 0.59 estimates created using data from QOF hypertension registers 2014/15 and Undiagnosed hypertension estimates for adults 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 16 years and older. 2014. Department of Primary Ratio Care & Public Health, Imperial College London

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

NHS Dartford, Gravesham and Swanley CCG 0.60

NHS Bexley CCG 0.59

NHS Bromley CCG 0.58

NHS Hillingdon CCG 0.58

NHS Chiltern CCG 0.58

NHS Milton Keynes CCG 0.57

NHS Crawley CCG 0.57

NHS Sutton CCG 0.57

NHS North West Surrey CCG 0.57

NHS Barnet CCG 0.57

NHS Kingston CCG 0.54

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

HAMID CARETAKING E83664 14.34 0.87 THE HILLVIEW SURGERY E83657 0.81 0.76 JAI MEDICAL CENTRE E83038 0.74 0.71 WENTWORTH MEDICAL PRACTICE. E83035 0.70 0.68 • it is estimated that there are 35,832 EBHC DR P WESTON E83629 0.68 0.66 PENSHURST GARDENS SURGERY E83030 0.65 people with undiagnosed 0.64 BRUNSWICK PARK MEDICAL CENTRE E83621 0.63 0.63 hypertension in NHS Barnet CCG 188 THE PRACTICE E83027 0.62 0.61 • GP practice range of observed to HOLLY PARK CLINIC Y00105 0.61 0.61 MILLWAY MEDICAL PRACTICE E83016 0.61 expected hypertension prevalence 0.60 DR LF MILLER E83656 0.59 0.58 0.33 to 14.34 EBHC DR CJ PESKIN E83632 0.58 0.58 ST ANDREWS MEDICAL PRACTICE. E83024 0.58 0.57 THE MOUNTFIELD SURGERY E83638 0.56 0.56 ADLER JS-THE SURGERY E83600 0.56 0.55 HEATHFIELDE MEDICAL CENTRE E83008 0.54 0.54 OAK LODGE MEDICAL CENTRE E83032 0.53 0.53 OAKLEIGH ROAD HEALTH CENTRE E83003 0.53 0.53 THE SURGERY E83041 0.53 0.53 WOODLANDS MEDICAL PRACTICE Y00316 0.52 0.52 SUPREME MEDICAL CENTRE E83026 0.52 0.50 THE PHOENIX PRACTICE E83653 0.49 0.48 MULKIS HB-THE SURGERY E83034 0.48 0.48 FRIERN BARNET MEDICAL CENTRE E83045 0.47 0.46 PHGH DOCTORS E83009 0.46 0.44 TEMPLE FORTUNE MEDICAL GROUP E83622 0.43 0.43 CORNWALL HOUSE SURGERY E83013 0.43 0.42 THE OLD COURT HOUSE SURGERY E83012 0.41 0.39 RAVENSCROFT MEDICAL CENTRE E83039 0.39 0.34 EAST FINCHLEY MEDICAL CENTRE E83050 0.33 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 Enfield CCG 78.5%

• 47,694 people with hypertension NHS Barnet CCG 77.9% (diagnosed)* in NHS Barnet CCG • 37,159 (77.9%) people whose blood pressure is <= 150/90 • 1,744 (3.7%) people who are NHS Camden CCG 76.9% excepted from optimal control • 8,791 (18.4%) additional people whose blood pressure is not <= NHS Islington CCG 76.7% 150/90

NHS Haringey CCG 74.7%

England 79.6%

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

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

NHS Bexley CCG 81.2%

NHS Chiltern CCG 80.0%

NHS Dartford, Gravesham and Swanley CCG 80.0%

NHS Hillingdon CCG 79.7%

NHS Crawley CCG 79.6%

NHS Kingston CCG 78.9%

NHS Sutton CCG 78.6%

NHS North West Surrey CCG 78.6%

NHS Barnet CCG 77.9%

NHS Milton Keynes CCG 77.7%

NHS Bromley CCG 77.3%

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

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

No treatment Exceptions reported

HAMID CARETAKING E83664 20 EAST FINCHLEY MEDICAL CENTRE E83050 193 DR AZIM & PARTNERS Y03664 274 THE SURGERY E83041 177 CRICKLEWOOD HEALTH CENTRE Y02986 31 LANGSTONE WAY SURGERY E83049 262 THE VILLAGE SURGERY E83031 183 PENSHURST GARDENS SURGERY E83030 294 • in total, including exceptions, there MULBERRY MEDICAL PRACTICE E83046 245 PARKVIEW SURGERY E83028 217 are 10,535 people whose blood MULKIS HB-THE SURGERY E83034 174 CORNWALL HOUSE SURGERY E83013 171 DR LF MILLER E83656 71 pressure is not <= 150/90 WOODLANDS MEDICAL PRACTICE Y00316 122 THE EVERGLADE MEDICAL PRACTICE E83011 251 DR SP TALPAHEWA E83668 103 • GP practice range: 9.2% to 83.3% BALLARDS LANE SURGERY E83644 90 PHGH DOCTORS E83009 268 THE SPEEDWELL PRACTICE E83010 343 WENTWORTH MEDICAL PRACTICE. E83035 326 HOLLY PARK CLINIC Y00105 125 WATLING MEDICAL CENTRE E83018 469 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 50 LONGROVE SURGERY E83017 349 OAKLEIGH ROAD HEALTH CENTRE E83003 253 FRIERN BARNET MEDICAL CENTRE E83045 173 LICHFIELD GROVE SURGERY E83005 124 DR MAKANJUOLA'S SURGERY E83042 58 188 THE PRACTICE E83027 207 THE HILLVIEW SURGERY E83657 73 MILLWAY MEDICAL PRACTICE E83016 495 GREENFIELD MEDICAL CENTRE E83006 158 ST ANDREWS MEDICAL PRACTICE. E83024 283 LANE END MEDICAL GROUP E83053 321 THE OLD COURT HOUSE SURGERY E83012 179 WATFORD WAY CENTRE LIMITED E83633 68 TORRINGTON PARK GROUP PRACTICE E83021 322 THE PHOENIX PRACTICE E83653 143 PENNINE DRIVE PRACTICE E83025 177 COLINDALE MEDICAL CENTRE LP E83637 114 TEMPLE FORTUNE MEDICAL GROUP E83622 123 ROSEMARY SURGERY E83639 110 ST. GEORGES MEDICAL CENTRE E83020 213 BRUNSWICK PARK MEDICAL CENTRE E83621 250 JAI MEDICAL CENTRE E83038 266 RAVENSCROFT MEDICAL CENTRE E83039 77 HENDON WAY SURGERY Y03663 152 THE MOUNTFIELD SURGERY E83638 99 OAK LODGE MEDICAL CENTRE E83032 322 THE HODFORD ROAD PRACTICE E83649 50 SQUIRES LANE MEDICAL PRACTICE E83007 136 STATION ROAD NEW BARNET SURGERY E83624 55 ADLER JS-THE SURGERY E83600 66 GLOUCESTER ROAD SURGERY E83650 53 SUPREME MEDICAL CENTRE E83026 72 VALE DRIVE MEDICAL PRACTICE E83036 68 DERWENT CRESCENT MEDICAL CENTRE E83037 100 ADDINGTON MEDICAL CENTRE E83044 103 HEATHFIELDE MEDICAL CENTRE E83008 119 EBHC DR CJ PESKIN E83632 61 EBHC DR D MONKMAN E83613 40 EBHC DR P WESTON E83629 44 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

NHS Enfield CCG 75.3%

• 159 people with a new diagnosis* of NHS Islington CCG 74.5% hypertension with a CVD risk of 20% or higher in NHS Barnet CCG • 110 (69.2%) people who are currently treated with statins NHS Haringey CCG 74.3% • 46 (28.9%) people who are exempted from treatment with statins • 3 (1.9%) additional people who are NHS Barnet CCG 69.2% not currently treated with statins

NHS Camden CCG 62.5%

England 66.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% *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 Crawley CCG 75.0%

NHS Sutton CCG 74.7%

NHS Dartford, Gravesham and Swanley CCG 74.1%

NHS North West Surrey CCG 72.1%

NHS Hillingdon CCG 71.6%

NHS Bexley CCG 71.0%

NHS Kingston CCG 69.6%

NHS Barnet CCG 69.2%

NHS Milton Keynes CCG 68.2%

NHS Bromley CCG 66.0%

NHS Chiltern CCG 65.9%

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

RAVENSCROFT MEDICAL CENTRE E83039 1 CORNWALL HOUSE SURGERY E83013 2 WENTWORTH MEDICAL PRACTICE. E83035 2 DERWENT CRESCENT MEDICAL CENTRE E83037 2 THE HODFORD ROAD PRACTICE E83649 2 HEATHFIELDE MEDICAL CENTRE E83008 3 PENNINE DRIVE PRACTICE E83025 3 PENSHURST GARDENS SURGERY E83030 3 • in total, including exceptions, there LICHFIELD GROVE SURGERY E83005 2 TORRINGTON PARK GROUP PRACTICE E83021 3 are 49 people who are not treated BALLARDS LANE SURGERY E83644 1 THE PHOENIX PRACTICE E83653 1 HENDON WAY SURGERY Y03663 1 with statins THE SPEEDWELL PRACTICE E83010 2 BRUNSWICK PARK MEDICAL CENTRE E83621 2 MILLWAY MEDICAL PRACTICE E83016 4 • GP practice range: 0.0% to 100.0% LONGROVE SURGERY E83017 1 ST. GEORGES MEDICAL CENTRE E83020 2 ST ANDREWS MEDICAL PRACTICE. E83024 1 OAK LODGE MEDICAL CENTRE E83032 2 JAI MEDICAL CENTRE E83038 2 DR SP TALPAHEWA E83668 1 GREENFIELD MEDICAL CENTRE E83006 1 SQUIRES LANE MEDICAL PRACTICE E83007 1 FRIERN BARNET MEDICAL CENTRE E83045 1 LANE END MEDICAL GROUP E83053 1 WATLING MEDICAL CENTRE E83018 1 MULBERRY MEDICAL PRACTICE E83046 1 OAKLEIGH ROAD HEALTH CENTRE E83003 PHGH DOCTORS E83009 THE EVERGLADE MEDICAL PRACTICE E83011 THE OLD COURT HOUSE SURGERY E83012 188 THE PRACTICE E83027 PARKVIEW SURGERY E83028 THE VILLAGE SURGERY E83031 THE SURGERY E83041 ADDINGTON MEDICAL CENTRE E83044 LANGSTONE WAY SURGERY E83049 EAST FINCHLEY MEDICAL CENTRE E83050 EBHC DR D MONKMAN E83613 STATION ROAD NEW BARNET SURGERY E83624 EBHC DR P WESTON E83629 EBHC DR CJ PESKIN E83632 COLINDALE MEDICAL CENTRE LP E83637 THE MOUNTFIELD SURGERY E83638 ROSEMARY SURGERY E83639 GLOUCESTER ROAD SURGERY E83650 DR LF MILLER E83656 THE HILLVIEW SURGERY E83657 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 WOODLANDS MEDICAL PRACTICE Y00316 CRICKLEWOOD HEALTH CENTRE Y02986 DR AZIM & PARTNERS Y03664 HOLLY PARK CLINIC Y00105 HAMID CARETAKING E83664 WATFORD WAY CENTRE LIMITED E83633 TEMPLE FORTUNE MEDICAL GROUP E83622 ADLER JS-THE SURGERY E83600 DR MAKANJUOLA'S SURGERY E83042 VALE DRIVE MEDICAL PRACTICE E83036 MULKIS HB-THE SURGERY E83034 SUPREME MEDICAL CENTRE E83026 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 Camden CCG 0.66

• the ratio of those diagnosed with atrial NHS Islington CCG 0.62 fibrillation versus those expected to have atrial fibrillation is 0.61. This compares to 0.7 for England • this suggests that 61% of people with NHS Barnet CCG 0.61 atrial fibrillation have been diagnosed.

NHS Enfield CCG 0.57

NHS Haringey CCG 0.52

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

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

NHS Chiltern CCG 0.72

NHS Bromley CCG 0.70

NHS Dartford, Gravesham and Swanley CCG 0.68

NHS North West Surrey CCG 0.68

NHS Crawley CCG 0.67

NHS Bexley CCG 0.66

NHS Hillingdon CCG 0.64

NHS Milton Keynes CCG 0.64

NHS Sutton CCG 0.63

NHS Barnet CCG 0.61

NHS Kingston CCG 0.60

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

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

GP practice CCG

ADLER JS-THE SURGERY E83600 1.1 EBHC DR P WESTON E83629 1.0 GREENFIELD MEDICAL CENTRE E83006 0.8 MILLWAY MEDICAL PRACTICE E83016 0.8 LICHFIELD GROVE SURGERY E83005 0.7 SQUIRES LANE MEDICAL PRACTICE E83007 0.7 PHGH DOCTORS E83009 0.7 THE SPEEDWELL PRACTICE E83010 0.7 • it is estimated that there are 8,305 LONGROVE SURGERY E83017 0.7 ST ANDREWS MEDICAL PRACTICE. E83024 0.7 THE VILLAGE SURGERY E83031 0.7 people with undiagnosed atrial DERWENT CRESCENT MEDICAL CENTRE E83037 0.7 JAI MEDICAL CENTRE E83038 0.7 ADDINGTON MEDICAL CENTRE E83044 0.7 fibrillation in NHS Barnet CCG THE MOUNTFIELD SURGERY E83638 0.7 THE HODFORD ROAD PRACTICE E83649 0.7 DR AZIM & PARTNERS Y03664 0.7 • GP practice range of observed to OAKLEIGH ROAD HEALTH CENTRE E83003 0.6 HEATHFIELDE MEDICAL CENTRE E83008 0.6 expected atrial fibrillation prevalence THE OLD COURT HOUSE SURGERY E83012 0.6 CORNWALL HOUSE SURGERY E83013 0.6 WATLING MEDICAL CENTRE E83018 0.6 0.3 to 1.1 ST. GEORGES MEDICAL CENTRE E83020 0.6 TORRINGTON PARK GROUP PRACTICE E83021 0.6 PENNINE DRIVE PRACTICE E83025 0.6 188 THE PRACTICE E83027 0.6 PENSHURST GARDENS SURGERY E83030 0.6 OAK LODGE MEDICAL CENTRE E83032 0.6 VALE DRIVE MEDICAL PRACTICE E83036 0.6 DR MAKANJUOLA'S SURGERY E83042 0.6 FRIERN BARNET MEDICAL CENTRE E83045 0.6 LANGSTONE WAY SURGERY E83049 0.6 LANE END MEDICAL GROUP E83053 0.6 EBHC DR D MONKMAN E83613 0.6 TEMPLE FORTUNE MEDICAL GROUP E83622 0.6 BALLARDS LANE SURGERY E83644 0.6 THE PHOENIX PRACTICE E83653 0.6 THE EVERGLADE MEDICAL PRACTICE E83011 0.5 SUPREME MEDICAL CENTRE E83026 0.5 PARKVIEW SURGERY E83028 0.5 RAVENSCROFT MEDICAL CENTRE E83039 0.5 THE SURGERY E83041 0.5 MULBERRY MEDICAL PRACTICE E83046 0.5 EAST FINCHLEY MEDICAL CENTRE E83050 0.5 BRUNSWICK PARK MEDICAL CENTRE E83621 0.5 EBHC DR CJ PESKIN E83632 0.5 WATFORD WAY CENTRE LIMITED E83633 0.5 COLINDALE MEDICAL CENTRE LP E83637 0.5 GLOUCESTER ROAD SURGERY E83650 0.5 DR LF MILLER E83656 0.5 HOLLY PARK CLINIC Y00105 0.5 WOODLANDS MEDICAL PRACTICE Y00316 0.5 CRICKLEWOOD HEALTH CENTRE Y02986 0.5 HENDON WAY SURGERY Y03663 0.5 MULKIS HB-THE SURGERY E83034 0.4 WENTWORTH MEDICAL PRACTICE. E83035 0.4 STATION ROAD NEW BARNET SURGERY E83624 0.4 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 0.4 DR SP TALPAHEWA E83668 0.4 ROSEMARY SURGERY E83639 0.3 THE HILLVIEW SURGERY E83657 0.3 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio

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

NHS Enfield CCG 73.8% • 4,258 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS Barnet CCG NHS Barnet CCG 72.7% • 3,096 (72.7%) people treated with anti-coagulation therapy • 535 (12.6%) people who are NHS Haringey CCG 71.1% exceptions • 627 (14.7%) additional people with a recorded CHA2DS2-VASc score >= 2 NHS Camden CCG 70.5% who are not treated

NHS Islington CCG 66.4%

England 77.9%

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

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

NHS Chiltern CCG 84.9%

NHS Sutton CCG 82.3%

NHS Dartford, Gravesham and Swanley CCG 81.2%

NHS Milton Keynes CCG 79.2%

NHS North West Surrey CCG 77.1%

NHS Crawley CCG 77.1%

NHS Bromley CCG 76.7%

NHS Bexley CCG 75.8%

NHS Barnet CCG 72.7%

NHS Hillingdon CCG 72.2%

NHS Kingston CCG 71.6%

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

HAMID CARETAKING E83664 1 BALLARDS LANE SURGERY E83644 10 DR LF MILLER E83656 11 LICHFIELD GROVE SURGERY E83005 27 188 THE PRACTICE E83027 40 DERWENT CRESCENT MEDICAL CENTRE E83037 32 DR MAKANJUOLA'S SURGERY E83042 10 THE SPEEDWELL PRACTICE E83010 59 • in total, including exceptions, there OAK LODGE MEDICAL CENTRE E83032 47 COLINDALE MEDICAL CENTRE LP E83637 13 are 1,162 people with a recorded THE VILLAGE SURGERY E83031 23 RAVENSCROFT MEDICAL CENTRE E83039 13 ROSEMARY SURGERY E83639 5 CHA2DS2-VASc score >= 2 who are DR SP TALPAHEWA E83668 6 PHGH DOCTORS E83009 51 THE HODFORD ROAD PRACTICE E83649 12 not treated PARKVIEW SURGERY E83028 11 MULKIS HB-THE SURGERY E83034 11 • GP practice range: 0.0% to 100.0% HEATHFIELDE MEDICAL CENTRE E83008 29 HENDON WAY SURGERY Y03663 15 PENSHURST GARDENS SURGERY E83030 27 WENTWORTH MEDICAL PRACTICE. E83035 21 LONGROVE SURGERY E83017 47 ST ANDREWS MEDICAL PRACTICE. E83024 49 CORNWALL HOUSE SURGERY E83013 20 LANE END MEDICAL GROUP E83053 44 JAI MEDICAL CENTRE E83038 35 THE MOUNTFIELD SURGERY E83638 18 TEMPLE FORTUNE MEDICAL GROUP E83622 22 OAKLEIGH ROAD HEALTH CENTRE E83003 30 FRIERN BARNET MEDICAL CENTRE E83045 16 LANGSTONE WAY SURGERY E83049 14 HOLLY PARK CLINIC Y00105 7 WATLING MEDICAL CENTRE E83018 35 BRUNSWICK PARK MEDICAL CENTRE E83621 22 EAST FINCHLEY MEDICAL CENTRE E83050 14 PENNINE DRIVE PRACTICE E83025 21 TORRINGTON PARK GROUP PRACTICE E83021 37 SUPREME MEDICAL CENTRE E83026 11 MILLWAY MEDICAL PRACTICE E83016 56 ADLER JS-THE SURGERY E83600 16 THE PHOENIX PRACTICE E83653 16 WOODLANDS MEDICAL PRACTICE Y00316 7 EBHC DR CJ PESKIN E83632 10 THE OLD COURT HOUSE SURGERY E83012 21 VALE DRIVE MEDICAL PRACTICE E83036 8 ST. GEORGES MEDICAL CENTRE E83020 21 MULBERRY MEDICAL PRACTICE E83046 12 THE EVERGLADE MEDICAL PRACTICE E83011 7 DR AZIM & PARTNERS Y03664 10 GREENFIELD MEDICAL CENTRE E83006 13 THE HILLVIEW SURGERY E83657 2 ADDINGTON MEDICAL CENTRE E83044 20 SQUIRES LANE MEDICAL PRACTICE E83007 12 THE SURGERY E83041 4 WATFORD WAY CENTRE LIMITED E83633 3 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 1 GLOUCESTER ROAD SURGERY E83650 2 STATION ROAD NEW BARNET SURGERY E83624 1 EBHC DR P WESTON E83629 3 EBHC DR D MONKMAN E83613 1 CRICKLEWOOD HEALTH CENTRE Y02986 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

BALLARDS LANE SURGERY 7

DR LF MILLER 8

LICHFIELD GROVE SURGERY 18 • using the GP cluster method of 188 THE PRACTICE 26 calculating potential gains, if each DR MAKANJUOLA'S SURGERY 6 practice was to achieve as well as the DERWENT CRESCENT MEDICAL CENTRE 20 upper quartile of its national cluster, then an additional 483 people would THE SPEEDWELL PRACTICE 32 be treated COLINDALE MEDICAL CENTRE LP 7

OAK LODGE MEDICAL CENTRE 24

THE VILLAGE SURGERY 13

ST. GEORGES MEDICAL CENTRE 2

ADDINGTON MEDICAL CENTRE 1

THE SURGERY

WATFORD WAY CENTRE LIMITED

MAKANJI HH-WOODCROFT MEDICAL CENTRE

GLOUCESTER ROAD SURGERY

STATION ROAD NEW BARNET SURGERY

EBHC DR P WESTON

EBHC DR D MONKMAN

CRICKLEWOOD HEALTH CENTRE Details of this methodology are available on slide 9. Click here to view them.

34 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP

Below 150/90 Not below 150/90 Exceptions reported

NHS Camden CCG 85.6% • 5,111 people with a history of stroke or TIA* in NHS Barnet CCG • 4,242 (83%) people whose blood NHS Enfield CCG 83.9% pressure is <= 150 / 90 • 196 (3.8%) people who are exceptions NHS Barnet CCG 83.0% • 673 (13.2%) additional people whose blood pressure is not <= 150 / 90

NHS Islington CCG 82.0%

NHS Haringey CCG 78.9%

England 83.8%

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

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

NHS Chiltern CCG 86.1%

NHS Bexley CCG 85.3%

NHS Crawley CCG 84.1%

NHS Sutton CCG 83.6%

NHS Kingston CCG 83.4%

NHS Hillingdon CCG 83.3%

NHS North West Surrey CCG 83.1%

NHS Barnet CCG 83.0%

NHS Dartford, Gravesham and Swanley CCG 82.3%

NHS Bromley CCG 81.8%

NHS Milton Keynes CCG 81.7%

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

EAST FINCHLEY MEDICAL CENTRE E83050 35 DR AZIM & PARTNERS Y03664 16 DR SP TALPAHEWA E83668 9 BALLARDS LANE SURGERY E83644 6 LANGSTONE WAY SURGERY E83049 17 PENSHURST GARDENS SURGERY E83030 21 CORNWALL HOUSE SURGERY E83013 23 COLINDALE MEDICAL CENTRE LP E83637 13 • in total, including exceptions, there MULBERRY MEDICAL PRACTICE E83046 20 THE SPEEDWELL PRACTICE E83010 41 are 869 people whose blood pressure THE EVERGLADE MEDICAL PRACTICE E83011 17 OAKLEIGH ROAD HEALTH CENTRE E83003 29 DR LF MILLER E83656 3 is not <= 150 / 90 WATLING MEDICAL CENTRE E83018 33 BRUNSWICK PARK MEDICAL CENTRE E83621 21 HOLLY PARK CLINIC Y00105 11 • GP practice range: 0.0% to 48.6% LICHFIELD GROVE SURGERY E83005 14 THE OLD COURT HOUSE SURGERY E83012 23 MULKIS HB-THE SURGERY E83034 16 MILLWAY MEDICAL PRACTICE E83016 49 WENTWORTH MEDICAL PRACTICE. E83035 18 JAI MEDICAL CENTRE E83038 27 THE SURGERY E83041 8 WOODLANDS MEDICAL PRACTICE Y00316 9 LONGROVE SURGERY E83017 27 ST ANDREWS MEDICAL PRACTICE. E83024 36 ST. GEORGES MEDICAL CENTRE E83020 18 PHGH DOCTORS E83009 22 188 THE PRACTICE E83027 24 PARKVIEW SURGERY E83028 9 THE PHOENIX PRACTICE E83653 16 OAK LODGE MEDICAL CENTRE E83032 34 DR MAKANJUOLA'S SURGERY E83042 7 THE VILLAGE SURGERY E83031 9 TORRINGTON PARK GROUP PRACTICE E83021 27 ROSEMARY SURGERY E83639 5 TEMPLE FORTUNE MEDICAL GROUP E83622 15 EBHC DR CJ PESKIN E83632 9 LANE END MEDICAL GROUP E83053 25 SUPREME MEDICAL CENTRE E83026 6 WATFORD WAY CENTRE LIMITED E83633 3 THE HILLVIEW SURGERY E83657 2 SQUIRES LANE MEDICAL PRACTICE E83007 7 STATION ROAD NEW BARNET SURGERY E83624 2 FRIERN BARNET MEDICAL CENTRE E83045 8 THE MOUNTFIELD SURGERY E83638 8 PENNINE DRIVE PRACTICE E83025 11 EBHC DR P WESTON E83629 5 HENDON WAY SURGERY Y03663 5 RAVENSCROFT MEDICAL CENTRE E83039 5 HEATHFIELDE MEDICAL CENTRE E83008 9 ADLER JS-THE SURGERY E83600 6 GREENFIELD MEDICAL CENTRE E83006 6 ADDINGTON MEDICAL CENTRE E83044 10 THE HODFORD ROAD PRACTICE E83649 2 VALE DRIVE MEDICAL PRACTICE E83036 3 DERWENT CRESCENT MEDICAL CENTRE E83037 5 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 1 EBHC DR D MONKMAN E83613 2 GLOUCESTER ROAD SURGERY E83650 1 CRICKLEWOOD HEALTH CENTRE Y02986 HAMID CARETAKING E83664 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

NHS Camden CCG 92.1% • 3,190 people with a stroke shown to be non-haemorrhagic* in NHS Barnet CCG NHS Enfield CCG 91.2% • 2,842 (89.1%) people who are taking an anti-platetet agent or anti- coagulant NHS Barnet CCG 89.1% • 255 (8%) people who are exceptions • 93 (2.9%) additional people with no treatment NHS Islington CCG 89.1%

NHS Haringey CCG 88.3%

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 Crawley CCG 92.8%

NHS Bexley CCG 92.7%

NHS North West Surrey CCG 92.3%

NHS Chiltern CCG 92.3%

NHS Dartford, Gravesham and Swanley CCG 91.8%

NHS Milton Keynes CCG 91.7%

NHS Sutton CCG 91.5%

NHS Bromley CCG 91.4%

NHS Hillingdon CCG 90.8%

NHS Kingston CCG 89.6%

NHS Barnet CCG 89.1%

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

DR SP TALPAHEWA E83668 4 DR AZIM & PARTNERS Y03664 9 SUPREME MEDICAL CENTRE E83026 7 LICHFIELD GROVE SURGERY E83005 12 MULKIS HB-THE SURGERY E83034 15 WENTWORTH MEDICAL PRACTICE. E83035 10 TEMPLE FORTUNE MEDICAL GROUP E83622 13 WATFORD WAY CENTRE LIMITED E83633 2 • in total, including exceptions, there HENDON WAY SURGERY Y03663 5 CORNWALL HOUSE SURGERY E83013 9 are 348 people who are not taking an OAK LODGE MEDICAL CENTRE E83032 20 PENSHURST GARDENS SURGERY E83030 8 WOODLANDS MEDICAL PRACTICE Y00316 4 anti-platelet agent or anti-coagulant BRUNSWICK PARK MEDICAL CENTRE E83621 9 PENNINE DRIVE PRACTICE E83025 9 THE SPEEDWELL PRACTICE E83010 18 • GP practice range: 0.0% to 25.0% VALE DRIVE MEDICAL PRACTICE E83036 4 MULBERRY MEDICAL PRACTICE E83046 7 LANGSTONE WAY SURGERY E83049 5 SQUIRES LANE MEDICAL PRACTICE E83007 5 LONGROVE SURGERY E83017 12 ST ANDREWS MEDICAL PRACTICE. E83024 15 PHGH DOCTORS E83009 8 MILLWAY MEDICAL PRACTICE E83016 21 HOLLY PARK CLINIC Y00105 4 THE HODFORD ROAD PRACTICE E83649 2 THE VILLAGE SURGERY E83031 5 COLINDALE MEDICAL CENTRE LP E83637 3 HEATHFIELDE MEDICAL CENTRE E83008 7 WATLING MEDICAL CENTRE E83018 9 LANE END MEDICAL GROUP E83053 12 STATION ROAD NEW BARNET SURGERY E83624 1 TORRINGTON PARK GROUP PRACTICE E83021 10 THE OLD COURT HOUSE SURGERY E83012 9 DERWENT CRESCENT MEDICAL CENTRE E83037 4 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 1 THE EVERGLADE MEDICAL PRACTICE E83011 3 OAKLEIGH ROAD HEALTH CENTRE E83003 8 ST. GEORGES MEDICAL CENTRE E83020 6 188 THE PRACTICE E83027 5 ROSEMARY SURGERY E83639 1 THE PHOENIX PRACTICE E83653 5 FRIERN BARNET MEDICAL CENTRE E83045 3 JAI MEDICAL CENTRE E83038 5 THE SURGERY E83041 1 THE MOUNTFIELD SURGERY E83638 2 ADDINGTON MEDICAL CENTRE E83044 4 PARKVIEW SURGERY E83028 1 ADLER JS-THE SURGERY E83600 2 DR MAKANJUOLA'S SURGERY E83042 1 EBHC DR CJ PESKIN E83632 1 GREENFIELD MEDICAL CENTRE E83006 1 RAVENSCROFT MEDICAL CENTRE E83039 1 EAST FINCHLEY MEDICAL CENTRE E83050 EBHC DR D MONKMAN E83613 EBHC DR P WESTON E83629 BALLARDS LANE SURGERY E83644 GLOUCESTER ROAD SURGERY E83650 DR LF MILLER E83656 THE HILLVIEW SURGERY E83657 CRICKLEWOOD HEALTH CENTRE Y02986 HAMID CARETAKING E83664 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

40 CVD: Primary Care Intelligence Packs Diabetes

41 CVD: Primary Care Intelligence Packs Diabetes prevention and management

Type 2 Diabetes in numbers Diabetes costs the NHS • diagnosed prevalence – 3.0 million £9.8 billion per year – and the • undiagnosed diabetes – 900,000 • non-diabetic hyperglycaemia (high risk of diabetes) – 5 million prevalence is rising What questions should we ask in our CCG? 1. for each indicator how wide is the variation in achievement and exception reporting? Type 2 diabetes is often preventable 2. how many people would benefit if all practices performed as well People at high risk of developing type 2 diabetes as the best? can be identified through the NHS Health Check, 3. how can we support practices who are average and below and the disease can be prevented or delayed in average to perform as well as the best in: many through intensive behaviour change support. • detection of diabetes • delivery of the 8 care processes and achievement of the 3 treatment targets Complications of diabetes are preventable • identification and management of Non-diabetic hyperglycaemia Diabetes is a major cause of premature death and disability and greatly increases the risk of heart disease and stroke, kidney failure, amputations and What might help blindness. 80% of NHS spending on diabetes goes • ensure universal participation by practices in the National on managing these complications, most of which Diabetes Audit (NDA) could be prevented. There are 8 essential care • benchmark practice level data from the NDA – and support processes, in addition to retinal screening, that practices to explore variation together substantially reduce complication rates. • increase support for patient education and shared Despite this, around a half of people with diabetes management do not receive all 8 care processes, and there is • maximise uptake of the NHS Health Check to aid detection of widespread variation between CCGs and practices diabetes and Non Diabetic Hyperglycaemia in levels of achievement • maximise uptake of the NHS Diabetes Prevention Programme

42 CVD: Primary Care Intelligence Packs Diabetes observed prevalence compared with expected prevalence by CCG Comparison with CCGs in the STP

NHS Enfield CCG 0.78 • 0.71 ratio of observed to expected diabetes prevalence in NHS Barnet

NHS Barnet CCG 0.71 CCG, compared to 0.77 in England

• this suggests 71% of people have NHS Islington CCG 0.66 been diagnosed

NHS Haringey CCG 0.65

NHS Camden CCG 0.60

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

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

NHS Crawley CCG 0.84

NHS Bexley CCG 0.84

NHS Hillingdon CCG 0.81

NHS Sutton CCG 0.81

NHS Dartford, Gravesham and Swanley CCG 0.78

NHS Milton Keynes CCG 0.77

NHS Kingston CCG 0.75

NHS North West Surrey CCG 0.75

NHS Chiltern CCG 0.72

NHS Barnet CCG 0.71

NHS Bromley CCG 0.67

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

GP practice CCG

ROSEMARY SURGERY E83639 10.6% BALLARDS LANE SURGERY E83644 10.2% WATFORD WAY CENTRE LIMITED E83633 9.3% WENTWORTH MEDICAL PRACTICE. E83035 9.2% JAI MEDICAL CENTRE E83038 9.1% PARKVIEW SURGERY E83028 8.7% HOLLY PARK CLINIC Y00105 8.5% THE EVERGLADE MEDICAL PRACTICE E83011 8.2% • GP practice range of observed SQUIRES LANE MEDICAL PRACTICE E83007 8.1% PENSHURST GARDENS SURGERY E83030 7.8% STATION ROAD NEW BARNET SURGERY E83624 diabetes 0.0% to 10.6% 7.6% MULBERRY MEDICAL PRACTICE E83046 7.5% BRUNSWICK PARK MEDICAL CENTRE E83621 7.4% • there are an estimated 7,923 people THE HILLVIEW SURGERY E83657 7.4% DR SP TALPAHEWA E83668 7.3% DR MAKANJUOLA'S SURGERY E83042 7.3% with undiagnosed diabetes in NHS FRIERN BARNET MEDICAL CENTRE E83045 7.2% MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 7.2% Barnet CCG EBHC DR D MONKMAN E83613 7.1% LANE END MEDICAL GROUP E83053 6.9% SUPREME MEDICAL CENTRE E83026 6.9% WATLING MEDICAL CENTRE E83018 6.9% EBHC DR CJ PESKIN E83632 6.9% THE PHOENIX PRACTICE E83653 6.6% DERWENT CRESCENT MEDICAL CENTRE E83037 6.4% HENDON WAY SURGERY Y03663 6.4% PENNINE DRIVE PRACTICE E83025 6.3% THE SURGERY E83041 6.2% OAK LODGE MEDICAL CENTRE E83032 6.2% EBHC DR P WESTON E83629 6.1% LANGSTONE WAY SURGERY E83049 6.1% MULKIS HB-THE SURGERY E83034 6.0% VALE DRIVE MEDICAL PRACTICE E83036 6.0% OAKLEIGH ROAD HEALTH CENTRE E83003 5.9% ADDINGTON MEDICAL CENTRE E83044 5.9% 188 THE PRACTICE E83027 5.8% THE SPEEDWELL PRACTICE E83010 5.8% ST ANDREWS MEDICAL PRACTICE. E83024 5.8% DR LF MILLER E83656 5.7% ADLER JS-THE SURGERY E83600 5.7% WOODLANDS MEDICAL PRACTICE Y00316 5.7% COLINDALE MEDICAL CENTRE LP E83637 5.6% TORRINGTON PARK GROUP PRACTICE E83021 5.5% GLOUCESTER ROAD SURGERY E83650 5.5% MILLWAY MEDICAL PRACTICE E83016 5.4% THE OLD COURT HOUSE SURGERY E83012 5.4% GREENFIELD MEDICAL CENTRE E83006 5.3% LONGROVE SURGERY E83017 5.2% CORNWALL HOUSE SURGERY E83013 5.1% HEATHFIELDE MEDICAL CENTRE E83008 5.0% ST. GEORGES MEDICAL CENTRE E83020 4.9% LICHFIELD GROVE SURGERY E83005 4.8% TEMPLE FORTUNE MEDICAL GROUP E83622 4.5% THE MOUNTFIELD SURGERY E83638 4.5% THE HODFORD ROAD PRACTICE E83649 4.3% THE VILLAGE SURGERY E83031 4.3% DR AZIM & PARTNERS Y03664 4.1% PHGH DOCTORS E83009 4.0% Note: The estimated number of undiagnosed EAST FINCHLEY MEDICAL CENTRE E83050 3.6% RAVENSCROFT MEDICAL CENTRE E83039 2.9% CRICKLEWOOD HEALTH CENTRE Y02986 2.1% people with diabetes has been calculated by HAMID CARETAKING E83664 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 NHS Enfield CCG 7.4% 2.1% 11.8% diabetes in NHS Barnet CCG is 8.6% (diagnosed and undiagnosed)

NHS Barnet CCG 6.1% 2.5% 11.3% • in addition, there are an estimated 11.3% of people in NHS Barnet CCG who are at increased risk of NHS Haringey CCG 6.2% 3.2% 10.4% developing diabetes (i.e. with non- diabetic hyperglycaemia)

NHS Islington CCG 5.1% 2.6% 8.9% • this means that 19.9% of the population in NHS Barnet CCG are estimated to have diabetes, or at high NHS Camden CCG 4.0% 2.6% 8.2% risk of developing of diabetes

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

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

NHS Camden CCG 62.3%

• data on care processes and treatment targets are taken from the National NHS Islington CCG 56.7% Diabetes Audit (NDA) • overall practice participation in the 2015/16 audit was 81.4% in England NHS Barnet CCG 39.8% • in NHS Barnet CCG, 56 out of 62 practices (90.3%) participated in the NDA. Data is not available for the NHS Haringey CCG 37.0% remaining practices

NHS Enfield CCG 31.9% • 39.8% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS Barnet CCG, compared to 52.6% in England

England 52.6%

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

47 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by GP practice, 2015/16

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

DR SP TALPAHEWA E83668 81.5% HEATHFIELDE MEDICAL CENTRE E83008 74.9% ADDINGTON MEDICAL CENTRE E83044 72.3% PENSHURST GARDENS SURGERY E83030 72.1% DERWENT CRESCENT MEDICAL CENTRE E83037 69.8% 188 THE PRACTICE E83027 69.2% • achievement - 8 care processes: in EBHC DR CJ PESKIN E83632 68.0% WATLING MEDICAL CENTRE E83018 67.9% practices who provided data via the EBHC DR P WESTON E83629 67.3% PHGH DOCTORS E83009 62.2% EBHC DR D MONKMAN E83613 61.2% NDA, between 2.4% and 81.5% of OAKLEIGH ROAD HEALTH CENTRE E83003 60.3% MILLWAY MEDICAL PRACTICE E83016 57.7% LANGSTONE WAY SURGERY E83049 55.7% patients received all 8 care processes SQUIRES LANE MEDICAL PRACTICE E83007 55.6% OAK LODGE MEDICAL CENTRE E83032 53.8% LICHFIELD GROVE SURGERY E83005 53.4% THE OLD COURT HOUSE SURGERY E83012 51.1% TEMPLE FORTUNE MEDICAL GROUP E83622 47.0% VALE DRIVE MEDICAL PRACTICE E83036 45.5% • at least 10,981 people did not receive WENTWORTH MEDICAL PRACTICE. E83035 42.9% ST ANDREWS MEDICAL PRACTICE. E83024 42.2% CORNWALL HOUSE SURGERY E83013 38.5% the eight care processes JAI MEDICAL CENTRE E83038 37.2% SUPREME MEDICAL CENTRE E83026 36.5% FRIERN BARNET MEDICAL CENTRE E83045 36.0% MULKIS HB-THE SURGERY E83034 35.6% THE SURGERY E83041 35.5% THE SPEEDWELL PRACTICE E83010 34.9% STATION ROAD NEW BARNET SURGERY E83624 32.8% GREENFIELD MEDICAL CENTRE E83006 31.1% WOODLANDS MEDICAL PRACTICE Y00316 29.7% PARKVIEW SURGERY E83028 29.5% MULBERRY MEDICAL PRACTICE E83046 27.2% COLINDALE MEDICAL CENTRE LP E83637 27.1% ST. GEORGES MEDICAL CENTRE E83020 25.3% LONGROVE SURGERY E83017 25.1% DR LF MILLER E83656 25.0% MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 24.8% TORRINGTON PARK GROUP PRACTICE E83021 23.6% WATFORD WAY CENTRE LIMITED E83633 19.0% LANE END MEDICAL GROUP E83053 18.7% PENNINE DRIVE PRACTICE E83025 18.4% DR MAKANJUOLA'S SURGERY E83042 17.7% THE PHOENIX PRACTICE E83653 16.8% CRICKLEWOOD HEALTH CENTRE Y02986 16.7% DR AZIM & PARTNERS Y03664 16.5% THE VILLAGE SURGERY E83031 16.1% HENDON WAY SURGERY Y03663 14.8% BRUNSWICK PARK MEDICAL CENTRE E83621 14.4% THE HILLVIEW SURGERY E83657 13.7% RAVENSCROFT MEDICAL CENTRE E83039 12.6% BALLARDS LANE SURGERY E83644 9.1% THE EVERGLADE MEDICAL PRACTICE E83011 5.3% ADLER JS-THE SURGERY E83600 4.8% THE MOUNTFIELD SURGERY E83638 2.4% HOLLY PARK CLINIC Y00105 HAMID CARETAKING E83664 GLOUCESTER ROAD SURGERY E83650 THE HODFORD ROAD PRACTICE E83649 ROSEMARY SURGERY E83639 EAST FINCHLEY MEDICAL CENTRE E83050 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

NHS Camden CCG 42.4%

• 40.6% of people with diabetes (of practices who participated in the NHS Barnet CCG 40.6% audit) met the three treatment targets in NHS Barnet CCG, compared to 39.0% in England

NHS Enfield CCG 40.3%

NHS Islington CCG 37.1%

NHS Haringey CCG 33.1%

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

EBHC DR CJ PESKIN E83632 60.5% ADLER JS-THE SURGERY E83600 60.1% EBHC DR P WESTON E83629 55.4% EBHC DR D MONKMAN E83613 54.7% HENDON WAY SURGERY Y03663 53.6% THE MOUNTFIELD SURGERY E83638 53.1% • achievement - 3 treatment targets: in DR MAKANJUOLA'S SURGERY E83042 53.0% HEATHFIELDE MEDICAL CENTRE E83008 52.8% practices who provided data via the DERWENT CRESCENT MEDICAL CENTRE E83037 52.2% RAVENSCROFT MEDICAL CENTRE E83039 51.5% PARKVIEW SURGERY E83028 48.2% NDA, between 26.1% and 60.5% of TEMPLE FORTUNE MEDICAL GROUP E83622 46.0% ADDINGTON MEDICAL CENTRE E83044 45.8% BALLARDS LANE SURGERY E83644 45.7% patients achieved all 3 treatment ST. GEORGES MEDICAL CENTRE E83020 45.4% SQUIRES LANE MEDICAL PRACTICE E83007 45.3% targets SUPREME MEDICAL CENTRE E83026 45.2% BRUNSWICK PARK MEDICAL CENTRE E83621 45.0% VALE DRIVE MEDICAL PRACTICE E83036 44.9% DR AZIM & PARTNERS Y03664 43.6% • at least 9,603 people did not meet the LANGSTONE WAY SURGERY E83049 43.5% LANE END MEDICAL GROUP E83053 43.3% GREENFIELD MEDICAL CENTRE E83006 42.7% three treatment targets THE PHOENIX PRACTICE E83653 42.3% PENNINE DRIVE PRACTICE E83025 42.3% OAK LODGE MEDICAL CENTRE E83032 42.1% WENTWORTH MEDICAL PRACTICE. E83035 41.8% STATION ROAD NEW BARNET SURGERY E83624 41.6% COLINDALE MEDICAL CENTRE LP E83637 41.0% LICHFIELD GROVE SURGERY E83005 40.4% MILLWAY MEDICAL PRACTICE E83016 40.0% FRIERN BARNET MEDICAL CENTRE E83045 39.9% JAI MEDICAL CENTRE E83038 39.8% DR SP TALPAHEWA E83668 39.7% THE OLD COURT HOUSE SURGERY E83012 39.2% WOODLANDS MEDICAL PRACTICE Y00316 39.1% ST ANDREWS MEDICAL PRACTICE. E83024 37.9% THE EVERGLADE MEDICAL PRACTICE E83011 36.8% THE SPEEDWELL PRACTICE E83010 36.1% OAKLEIGH ROAD HEALTH CENTRE E83003 35.7% THE VILLAGE SURGERY E83031 35.4% DR LF MILLER E83656 35.1% MULKIS HB-THE SURGERY E83034 34.3% WATLING MEDICAL CENTRE E83018 33.8% 188 THE PRACTICE E83027 33.4% WATFORD WAY CENTRE LIMITED E83633 32.7% PENSHURST GARDENS SURGERY E83030 32.0% CORNWALL HOUSE SURGERY E83013 31.4% THE HILLVIEW SURGERY E83657 31.3% MULBERRY MEDICAL PRACTICE E83046 30.8% LONGROVE SURGERY E83017 30.4% PHGH DOCTORS E83009 30.2% THE SURGERY E83041 29.5% TORRINGTON PARK GROUP PRACTICE E83021 29.5% MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 26.8% CRICKLEWOOD HEALTH CENTRE Y02986 26.1% HOLLY PARK CLINIC Y00105 HAMID CARETAKING E83664 GLOUCESTER ROAD SURGERY E83650 THE HODFORD ROAD PRACTICE E83649 ROSEMARY SURGERY E83639 EAST FINCHLEY MEDICAL CENTRE E83050 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

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

CRICKLEWOOD HEALTH CENTRE 4

MAKANJI HH-WOODCROFT MEDICAL CENTRE 22

THE SURGERY 29 • using the GP cluster method of PHGH DOCTORS 41 calculating potential gains, if each TORRINGTON PARK GROUP PRACTICE 69 practice was to achieve as well as the CORNWALL HOUSE SURGERY 30 upper quartile of its national cluster, then an additional 820 people would LONGROVE SURGERY 59 be treated THE HILLVIEW SURGERY 13

PENSHURST GARDENS SURGERY 48

MULBERRY MEDICAL PRACTICE 44

RAVENSCROFT MEDICAL CENTRE

DERWENT CRESCENT MEDICAL CENTRE

HEATHFIELDE MEDICAL CENTRE

DR MAKANJUOLA'S SURGERY

THE MOUNTFIELD SURGERY

EBHC DR D MONKMAN

HENDON WAY SURGERY

EBHC DR P WESTON

EBHC DR CJ PESKIN

ADLER JS-THE 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 Camden CCG 0.61

• the ratio of those diagnosed with NHS Enfield CCG 0.54 chronic kidney disease versus those expected to have chronic kidney disease is 0.53. This compares to NHS Barnet CCG 0.53 0.68 for England • this suggests that 53% of people with chronic kidney disease have been diagnosed NHS Islington CCG 0.51

NHS Haringey CCG 0.50

Note: This slide compares the prevalence of CKD recorded in QOF in 2015/16 to the expected prevalence of CKD produced by the University of Southampton in 2011. A small number of CCGs England 0.68 have a ratio greater than 1. It is unlikely that all people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.

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

NHS Crawley CCG 0.86

NHS Dartford, Gravesham and Swanley CCG 0.84

NHS Sutton CCG 0.62

NHS North West Surrey CCG 0.56

NHS Bromley CCG 0.55

NHS Bexley CCG 0.55

NHS Barnet CCG 0.53

NHS Milton Keynes CCG 0.52

NHS Chiltern CCG 0.51

NHS Hillingdon CCG 0.50

NHS Kingston CCG 0.42

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

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

GP practice CCG

HAMID CARETAKING E83664 14.3% DERWENT CRESCENT MEDICAL CENTRE E83037 6.3% MULBERRY MEDICAL PRACTICE E83046 5.1% PHGH DOCTORS E83009 4.6% PENSHURST GARDENS SURGERY E83030 4.4% ROSEMARY SURGERY E83639 4.3% EBHC DR CJ PESKIN E83632 4.3% LANE END MEDICAL GROUP E83053 4.2% • it is estimated that there are 7,999 EBHC DR P WESTON E83629 4.1% THE SPEEDWELL PRACTICE E83010 4.0% people with undiagnosed chronic DR MAKANJUOLA'S SURGERY E83042 3.8% PARKVIEW SURGERY E83028 3.8% JAI MEDICAL CENTRE E83038 3.8% kidney disease in NHS Barnet CCG MULKIS HB-THE SURGERY E83034 3.8% BALLARDS LANE SURGERY E83644 3.8% BRUNSWICK PARK MEDICAL CENTRE E83621 3.7% • GP practice range of observed CKD: GLOUCESTER ROAD SURGERY E83650 3.7% HEATHFIELDE MEDICAL CENTRE E83008 3.6% 0.4% to 14.3% WATLING MEDICAL CENTRE E83018 3.3% VALE DRIVE MEDICAL PRACTICE E83036 3.3% THE VILLAGE SURGERY E83031 3.3% HOLLY PARK CLINIC Y00105 3.3% LONGROVE SURGERY E83017 3.3% THE OLD COURT HOUSE SURGERY E83012 3.3% WENTWORTH MEDICAL PRACTICE. E83035 3.2% GREENFIELD MEDICAL CENTRE E83006 3.2% HENDON WAY SURGERY Y03663 3.2% LANGSTONE WAY SURGERY E83049 3.1% MILLWAY MEDICAL PRACTICE E83016 3.0% ADLER JS-THE SURGERY E83600 2.8% ADDINGTON MEDICAL CENTRE E83044 2.8% THE EVERGLADE MEDICAL PRACTICE E83011 2.8% LICHFIELD GROVE SURGERY E83005 2.7% TEMPLE FORTUNE MEDICAL GROUP E83622 2.7% OAKLEIGH ROAD HEALTH CENTRE E83003 2.7% ST ANDREWS MEDICAL PRACTICE. E83024 2.6% EBHC DR D MONKMAN E83613 2.6% WATFORD WAY CENTRE LIMITED E83633 2.6% PENNINE DRIVE PRACTICE E83025 2.5% FRIERN BARNET MEDICAL CENTRE E83045 2.5% DR LF MILLER E83656 2.5% THE SURGERY E83041 2.5% THE PHOENIX PRACTICE E83653 2.4% 188 THE PRACTICE E83027 2.4% ST. GEORGES MEDICAL CENTRE E83020 2.3% EAST FINCHLEY MEDICAL CENTRE E83050 2.3% STATION ROAD NEW BARNET SURGERY E83624 2.3% SUPREME MEDICAL CENTRE E83026 2.2% MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 2.1% TORRINGTON PARK GROUP PRACTICE E83021 2.0% OAK LODGE MEDICAL CENTRE E83032 2.0% COLINDALE MEDICAL CENTRE LP E83637 2.0% SQUIRES LANE MEDICAL PRACTICE E83007 1.9% CORNWALL HOUSE SURGERY E83013 1.8% THE HODFORD ROAD PRACTICE E83649 1.7% Note: CCG estimates for the estimated DR AZIM & PARTNERS Y03664 1.5% RAVENSCROFT MEDICAL CENTRE E83039 1.4% number of people with CKD are based on THE HILLVIEW SURGERY E83657 1.0% WOODLANDS MEDICAL PRACTICE Y00316 0.9% applying a proportion from a resident based THE MOUNTFIELD SURGERY E83638 0.6% CRICKLEWOOD HEALTH CENTRE Y02986 0.5% population estimate to a GP registered DR SP TALPAHEWA E83668 0.4% 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

NHS Islington CCG 76.0% • 8,901 people with CKD (diagnosed*) in NHS Barnet CCG • 6,608 (74.2%) people whose blood NHS Enfield CCG 75.3% pressure is <= 140 /85 • 646 (7.3%) people who are exceptions NHS Camden CCG 74.9% • 1,647 (18.5%) additional people whose blood pressure is not <= 140 / 85 NHS Barnet CCG 74.2%

NHS Haringey CCG 71.7%

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 Bexley CCG 77.8%

NHS North West Surrey CCG 77.7%

NHS Hillingdon CCG 77.1%

NHS Chiltern CCG 75.9%

NHS Sutton CCG 75.6%

NHS Kingston CCG 75.4%

NHS Barnet CCG 74.2%

NHS Crawley CCG 73.5%

NHS Dartford, Gravesham and Swanley CCG 73.5%

NHS Bromley CCG 70.8%

NHS Milton Keynes CCG 68.5%

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

HAMDEN SQUARE E83664 4 CORNWALL HOUSE SURGERY E83013 57 I UKACHUKWU E83041 37 EAST FINCHLEY MEDICAL CENTRE E83050 53 MULBERRY MEDICAL PRACTICE E83046 105 BALLARDS LANE SURGERY E83644 21 THE VILLAGE SURGERY E83031 50 ISAACSON AND PARTNERS E83034 59 • in total, including exceptions, there WOODLANDS MEDICAL PRACTICE Y00316 13 DR LF MILLER E83656 14 PENSHURST GARDENS SURGERY E83030 71 are 2,293 people whose blood PARKVIEW SURGERY E83028 58 STATION ROAD NEW BARNET SURGERY E83624 13 TORRINGTON PARK GROUP PRACTICE E83021 69 pressure is not <= 140 / 85 LANGSTONE WAY SURGERY E83049 42 PHGH DOCTORS E83009 112 LONGROVE SURGERY E83017 82 • GP practice range: 0.0% to 57.1% ST. GEORGES MEDICAL CENTRE E83020 51 WATLING MEDICAL CENTRE E83018 119 TORRINGTON SPEEDWELL PRACTICE E83010 107 LICHFIELD GROVE SURGERY E83005 37 OAKLEIGH ROAD HEALTH CENTRE E83003 54 ST ANDREWS MEDICAL PRACTICE. E83024 58 MILLWAY MEDICAL PRACTICE E83016 103 LANE END MEDICAL GROUP E83053 78 VALE DRIVE MEDICAL PRACTICE E83036 27 PENNINE DRIVE PRACTICE E83025 30 188 THE PRACTICE E83027 34 SQUIRES LANE MEDICAL PRACTICE E83007 21 FRIERN BARNET MEDICAL CENTRE E83045 33 DR N. SIRISENA E83668 4 THE OLD COURT HOUSE SURGERY E83012 58 JAI MEDICAL CENTRE E83038 64 COLINDALE MEDICAL CENTRE LP E83637 24 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 9 DR AZIM & PARTNERS Y03664 12 TEAM HC BRUNSWICK PARK HTH CTR E83621 20 HOLLY PARK CLINIC Y00105 21 DERWENT CRESCENT MEDICAL CENTRE E83037 37 THE EVERGLADE MEDICAL PRACTICE E83011 29 OAK LODGE MEDICAL CENTRE E83032 51 THE HILLVIEW SURGERY E83657 3 OSIDGE MEDICAL PRACTICE E83645 17 RAVENSCROFT MEDICAL CENTRE E83039 16 CHERRY TREE SURGERY E83631 6 CRICKLEWOOD HEALTH CENTRE Y02986 2 HENDON WAY SURGERY Y03663 19 WATFORD WAY CENTRE LIMITED E83633 9 GLOUCESTER ROAD SURGERY E83650 9 ADDINGTON MEDICAL CENTRE E83044 36 ROSEMARY SURGERY E83639 23 THE PHOENIX PRACTICE E83653 23 ADLER JS-THE SURGERY E83600 15 SUPREME MEDICAL CENTRE E83026 12 EBHC DR CJ PESKIN E83632 24 THE HODFORD ROAD PRACTICE E83649 9 HARRIS M-THE SURGERY E83651 9 DR MAKANJUOLA'S SURGERY E83042 11 THE MOUNTFIELD SURGERY E83638 3 WENTWORTH MEDICAL PRACTICE E83035 30 GREENFIELD MEDICAL CENTRE E83006 23 EBHC DR D MONKMAN E83613 7 HEATHFIELDE MEDICAL CENTRE E83008 25 EBHC DR P WESTON E83629 11 BUCKMAN L-THE SURGERY E83622 6 DR V. AZIZ E83640 4 ROWBURY CA-THE SURGERY E83652 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% 0% -10% -20% -30% -40% -50%

CORNWALL HOUSE SURGERY 40

I UKACHUKWU 25

EAST FINCHLEY MEDICAL CENTRE 32 • using the GP cluster method of MULBERRY MEDICAL PRACTICE 64 calculating potential gains, if each BALLARDS LANE SURGERY 11 practice was to achieve as well as the ISAACSON AND PARTNERS 32 upper quartile of its national cluster, then an additional 731 people would WOODLANDS MEDICAL PRACTICE 7 be treated DR LF MILLER 8

THE VILLAGE SURGERY 25

PARKVIEW SURGERY 30

OAK LODGE MEDICAL CENTRE

GREENFIELD MEDICAL CENTRE

ADDINGTON MEDICAL CENTRE

DR MAKANJUOLA'S SURGERY

THE PHOENIX PRACTICE

EBHC DR D MONKMAN

HEATHFIELDE MEDICAL CENTRE

EBHC DR P WESTON

WENTWORTH MEDICAL PRACTICE

BUCKMAN L-THE SURGERY Details of this methodology are available on slide 9. Click here to view them.

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

NHS Camden CCG 78.9% • 8,911 people with CKD (diagnosed*) in NHS Barnet CCG • 6,798 (76.3%) people who have a NHS Islington CCG 77.2% record of urine albumin:creatinine ratio test • 396 (4.4%) people who are NHS Barnet CCG 76.3% exceptions • 1,717 (19.3%) additional people who have no record of urine NHS Haringey CCG 76.0% albumin:creatinine ratio test

NHS Enfield CCG 74.9%

*Using the QOF clinical indicator CKD004 England 75.4% denominator plus exceptions. Note: as the CKD004 indicator was removed from the QOF in 15/16 this is historic data 0% 20% 40% 60% 80% 100% taken from the 2014/15 QOF.

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

NHS Hillingdon CCG 78.6%

NHS Barnet CCG 76.3%

NHS Crawley CCG 76.1%

NHS Bexley CCG 76.0%

NHS North West Surrey CCG 74.6%

NHS Chiltern CCG 73.9%

NHS Sutton CCG 71.8%

NHS Kingston CCG 71.2%

NHS Bromley CCG 69.5%

NHS Dartford, Gravesham and Swanley CCG 66.9%

NHS Milton Keynes CCG 65.8%

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

THE VILLAGE SURGERY E83031 81 DR MAKANJUOLA'S SURGERY E83042 42 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 17 ISAACSON AND PARTNERS E83034 70 CORNWALL HOUSE SURGERY E83013 35 EAST FINCHLEY MEDICAL CENTRE E83050 44 ADDINGTON MEDICAL CENTRE E83044 69 PARKVIEW SURGERY E83028 58 • in total, including exceptions, there LANE END MEDICAL GROUP E83053 99 188 THE PRACTICE E83027 44 THE HILLVIEW SURGERY E83657 5 are 2,113 people who have no record PENSHURST GARDENS SURGERY E83030 64 STATION ROAD NEW BARNET SURGERY E83624 12 TORRINGTON SPEEDWELL PRACTICE E83010 103 of urine albumin:creatinine ratio test TORRINGTON PARK GROUP PRACTICE E83021 63 SUPREME MEDICAL CENTRE E83026 20 DR LF MILLER E83656 11 • GP practice range: 0.0% to 60.0% WOODLANDS MEDICAL PRACTICE Y00316 10 ST ANDREWS MEDICAL PRACTICE. E83024 59 DR AZIM & PARTNERS Y03664 14 LICHFIELD GROVE SURGERY E83005 34 WATLING MEDICAL CENTRE E83018 103 WENTWORTH MEDICAL PRACTICE E83035 51 ROSEMARY SURGERY E83639 32 THE EVERGLADE MEDICAL PRACTICE E83011 37 DR V. AZIZ E83640 14 LONGROVE SURGERY E83017 63 FRIERN BARNET MEDICAL CENTRE E83045 31 THE PHOENIX PRACTICE E83653 31 ST. GEORGES MEDICAL CENTRE E83020 39 BALLARDS LANE SURGERY E83644 12 TEAM HC BRUNSWICK PARK HTH CTR E83621 21 CHERRY TREE SURGERY E83631 7 MILLWAY MEDICAL PRACTICE E83016 80 HOLLY PARK CLINIC Y00105 22 DERWENT CRESCENT MEDICAL CENTRE E83037 39 OAK LODGE MEDICAL CENTRE E83032 54 VALE DRIVE MEDICAL PRACTICE E83036 21 WATFORD WAY CENTRE LIMITED E83633 10 LANGSTONE WAY SURGERY E83049 26 JAI MEDICAL CENTRE E83038 52 OAKLEIGH ROAD HEALTH CENTRE E83003 36 PENNINE DRIVE PRACTICE E83025 22 PHGH DOCTORS E83009 66 MULBERRY MEDICAL PRACTICE E83046 48 OSIDGE MEDICAL PRACTICE E83645 16 BUCKMAN L-THE SURGERY E83622 10 COLINDALE MEDICAL CENTRE LP E83637 17 HARRIS M-THE SURGERY E83651 10 THE OLD COURT HOUSE SURGERY E83012 35 ADLER JS-THE SURGERY E83600 13 SQUIRES LANE MEDICAL PRACTICE E83007 12 THE HODFORD ROAD PRACTICE E83649 8 GLOUCESTER ROAD SURGERY E83650 7 I UKACHUKWU E83041 11 EBHC DR CJ PESKIN E83632 19 HEATHFIELDE MEDICAL CENTRE E83008 26 HENDON WAY SURGERY Y03663 13 GREENFIELD MEDICAL CENTRE E83006 20 RAVENSCROFT MEDICAL CENTRE E83039 10 EBHC DR D MONKMAN E83613 6 THE MOUNTFIELD SURGERY E83638 2 CRICKLEWOOD HEALTH CENTRE Y02986 1 EBHC DR P WESTON E83629 6 ROWBURY CA-THE SURGERY E83652 HAMDEN SQUARE E83664 DR N. SIRISENA E83668 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 Camden CCG 0.64%

• prevalence of 0.51% in NHS Barnet NHS Enfield CCG 0.54% CCG compared to 0.76% in England

NHS Barnet CCG 0.51%

NHS Haringey CCG 0.50%

NHS Islington CCG 0.49%

England 0.76%

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

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

NHS Bexley CCG 0.77%

NHS Bromley CCG 0.66%

NHS Crawley CCG 0.58%

NHS Dartford, Gravesham and Swanley CCG 0.58%

NHS Chiltern CCG 0.56%

NHS Sutton CCG 0.54%

NHS North West Surrey CCG 0.53%

NHS Milton Keynes CCG 0.52%

NHS Barnet CCG 0.51%

NHS Hillingdon CCG 0.49%

NHS Kingston CCG 0.45%

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

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

GP practice CCG

JAI MEDICAL CENTRE E83038 0.9% LONGROVE SURGERY E83017 0.9% DR LF MILLER E83656 0.8% BALLARDS LANE SURGERY E83644 0.8% ROSEMARY SURGERY E83639 0.8% SQUIRES LANE MEDICAL PRACTICE E83007 0.7% GREENFIELD MEDICAL CENTRE E83006 0.7% THE SPEEDWELL PRACTICE E83010 0.7% • 2,060 people with diagnosed heart PHGH DOCTORS E83009 0.7% DERWENT CRESCENT MEDICAL CENTRE E83037 0.7% failure in NHS Barnet CCG PENNINE DRIVE PRACTICE E83025 0.7% EBHC DR P WESTON E83629 0.6% ADLER JS-THE SURGERY E83600 0.6% • GP practice range: 0.0% to 0.9% ST ANDREWS MEDICAL PRACTICE. E83024 0.6% MULKIS HB-THE SURGERY E83034 0.6% THE SURGERY E83041 0.6% DR MAKANJUOLA'S SURGERY E83042 0.6% LANE END MEDICAL GROUP E83053 0.6% HEATHFIELDE MEDICAL CENTRE E83008 0.6% 188 THE PRACTICE E83027 0.6% THE EVERGLADE MEDICAL PRACTICE E83011 0.6% LANGSTONE WAY SURGERY E83049 0.6% TORRINGTON PARK GROUP PRACTICE E83021 0.5% BRUNSWICK PARK MEDICAL CENTRE E83621 0.5% THE PHOENIX PRACTICE E83653 0.5% WATFORD WAY CENTRE LIMITED E83633 0.5% WENTWORTH MEDICAL PRACTICE. E83035 0.5% SUPREME MEDICAL CENTRE E83026 0.5% MILLWAY MEDICAL PRACTICE E83016 0.5% TEMPLE FORTUNE MEDICAL GROUP E83622 0.5% THE HODFORD ROAD PRACTICE E83649 0.5% ADDINGTON MEDICAL CENTRE E83044 0.5% ST. GEORGES MEDICAL CENTRE E83020 0.4% PENSHURST GARDENS SURGERY E83030 0.4% THE VILLAGE SURGERY E83031 0.4% CORNWALL HOUSE SURGERY E83013 0.4% EBHC DR CJ PESKIN E83632 0.4% OAK LODGE MEDICAL CENTRE E83032 0.4% WATLING MEDICAL CENTRE E83018 0.4% DR AZIM & PARTNERS Y03664 0.4% MULBERRY MEDICAL PRACTICE E83046 0.4% HENDON WAY SURGERY Y03663 0.4% HOLLY PARK CLINIC Y00105 0.4% PARKVIEW SURGERY E83028 0.4% EBHC DR D MONKMAN E83613 0.4% THE MOUNTFIELD SURGERY E83638 0.4% LICHFIELD GROVE SURGERY E83005 0.4% FRIERN BARNET MEDICAL CENTRE E83045 0.4% EAST FINCHLEY MEDICAL CENTRE E83050 0.4% THE OLD COURT HOUSE SURGERY E83012 0.3% WOODLANDS MEDICAL PRACTICE Y00316 0.3% THE HILLVIEW SURGERY E83657 0.3% MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 0.3% DR SP TALPAHEWA E83668 0.3% STATION ROAD NEW BARNET SURGERY E83624 0.3% RAVENSCROFT MEDICAL CENTRE E83039 0.3% COLINDALE MEDICAL CENTRE LP E83637 0.3% OAKLEIGH ROAD HEALTH CENTRE E83003 0.2% VALE DRIVE MEDICAL PRACTICE E83036 0.2% GLOUCESTER ROAD SURGERY E83650 0.2% CRICKLEWOOD HEALTH CENTRE Y02986 0.1% HAMID CARETAKING E83664 0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9% 1.0%

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

NHS Enfield CCG 86.7% • 430 people with heart failure* with LVSD in NHS Barnet CCG • 343 (79.8%) people treated with ACE- NHS Camden CCG 83.6% I or ARB • 85 (19.8%) people who are exceptions NHS Haringey CCG 83.3% • 2 (0.5%) additional people who are not treated with ACE-I or ARB

NHS Islington CCG 81.7%

NHS Barnet CCG 79.8%

England 84.7%

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

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

NHS Bromley CCG 90.7%

NHS Crawley CCG 89.7%

NHS Kingston CCG 88.7%

NHS Sutton CCG 88.1%

NHS Bexley CCG 87.7%

NHS Chiltern CCG 87.7%

NHS Hillingdon CCG 87.6%

NHS Milton Keynes CCG 85.4%

NHS North West Surrey CCG 84.9%

NHS Dartford, Gravesham and Swanley CCG 84.6%

NHS Barnet CCG 79.8%

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

OAKLEIGH ROAD HEALTH CENTRE E83003 2 PENSHURST GARDENS SURGERY E83030 3 COLINDALE MEDICAL CENTRE LP E83637 3 DR LF MILLER E83656 1 ST. GEORGES MEDICAL CENTRE E83020 3 THE HODFORD ROAD PRACTICE E83649 4 HEATHFIELDE MEDICAL CENTRE E83008 1 WENTWORTH MEDICAL PRACTICE. E83035 3 • in total, including exceptions, there MULBERRY MEDICAL PRACTICE E83046 2 BALLARDS LANE SURGERY E83644 1 are 87 people who are not treated TORRINGTON PARK GROUP PRACTICE E83021 4 THE OLD COURT HOUSE SURGERY E83012 4 DERWENT CRESCENT MEDICAL CENTRE E83037 2 with ACE-I or ARB SQUIRES LANE MEDICAL PRACTICE E83007 3 OAK LODGE MEDICAL CENTRE E83032 3 SUPREME MEDICAL CENTRE E83026 2 • GP practice range: 0.0% to 66.7% EAST FINCHLEY MEDICAL CENTRE E83050 1 STATION ROAD NEW BARNET SURGERY E83624 1 ROSEMARY SURGERY E83639 1 HOLLY PARK CLINIC Y00105 1 DR AZIM & PARTNERS Y03664 4 WOODLANDS MEDICAL PRACTICE Y00316 2 MILLWAY MEDICAL PRACTICE E83016 6 ADLER JS-THE SURGERY E83600 3 THE PHOENIX PRACTICE E83653 3 PHGH DOCTORS E83009 1 PENNINE DRIVE PRACTICE E83025 1 ADDINGTON MEDICAL CENTRE E83044 1 FRIERN BARNET MEDICAL CENTRE E83045 3 BRUNSWICK PARK MEDICAL CENTRE E83621 5 GREENFIELD MEDICAL CENTRE E83006 1 THE SPEEDWELL PRACTICE E83010 1 ST ANDREWS MEDICAL PRACTICE. E83024 3 RAVENSCROFT MEDICAL CENTRE E83039 1 THE EVERGLADE MEDICAL PRACTICE E83011 3 LICHFIELD GROVE SURGERY E83005 1 CORNWALL HOUSE SURGERY E83013 1 TEMPLE FORTUNE MEDICAL GROUP E83622 1 JAI MEDICAL CENTRE E83038 1 LONGROVE SURGERY E83017 WATLING MEDICAL CENTRE E83018 188 THE PRACTICE E83027 PARKVIEW SURGERY E83028 THE VILLAGE SURGERY E83031 MULKIS HB-THE SURGERY E83034 VALE DRIVE MEDICAL PRACTICE E83036 THE SURGERY E83041 DR MAKANJUOLA'S SURGERY E83042 LANGSTONE WAY SURGERY E83049 LANE END MEDICAL GROUP E83053 EBHC DR D MONKMAN E83613 EBHC DR P WESTON E83629 EBHC DR CJ PESKIN E83632 THE MOUNTFIELD SURGERY E83638 GLOUCESTER ROAD SURGERY E83650 THE HILLVIEW SURGERY E83657 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 DR SP TALPAHEWA E83668 CRICKLEWOOD HEALTH CENTRE Y02986 HENDON WAY SURGERY Y03663 HAMID CARETAKING E83664 WATFORD WAY CENTRE LIMITED E83633 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

NHS Islington CCG 82.9% • 343 people with heart failure* with LVSD treated with ACE-I/ARB in NHS Barnet CCG NHS Haringey CCG 81.4% • 262 (76.4%) people treated with ACE- I/ARB and BB • 59 (17.2%) people who are NHS Enfield CCG 79.9% exceptions • 22 (6.4%) additional people who are not treated with ACE-I/ARB and BB NHS Camden CCG 77.2%

NHS Barnet CCG 76.4%

England 77.7%

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

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

NHS Bromley CCG 87.9%

NHS Dartford, Gravesham and Swanley CCG 83.0%

NHS North West Surrey CCG 82.9%

NHS Bexley CCG 81.3%

NHS Milton Keynes CCG 79.8%

NHS Crawley CCG 78.6%

NHS Chiltern CCG 77.3%

NHS Barnet CCG 76.4%

NHS Sutton CCG 75.0%

NHS Kingston CCG 74.0%

NHS Hillingdon CCG 72.6%

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

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

No treatment Exceptions reported

THE MOUNTFIELD SURGERY E83638 2 THE OLD COURT HOUSE SURGERY E83012 7 LICHFIELD GROVE SURGERY E83005 4 EAST FINCHLEY MEDICAL CENTRE E83050 2 HOLLY PARK CLINIC Y00105 2 HEATHFIELDE MEDICAL CENTRE E83008 1 CORNWALL HOUSE SURGERY E83013 3 PENSHURST GARDENS SURGERY E83030 1 • in total, including exceptions, there WATLING MEDICAL CENTRE E83018 4 THE HODFORD ROAD PRACTICE E83649 3 are 81 people who are not treated MILLWAY MEDICAL PRACTICE E83016 8 THE VILLAGE SURGERY E83031 1 WENTWORTH MEDICAL PRACTICE. E83035 2 with ACE-I or ARB VALE DRIVE MEDICAL PRACTICE E83036 1 LANE END MEDICAL GROUP E83053 1 STATION ROAD NEW BARNET SURGERY E83624 1 • GP practice range: 0.0% to 100.0% ROSEMARY SURGERY E83639 1 CRICKLEWOOD HEALTH CENTRE Y02986 1 FRIERN BARNET MEDICAL CENTRE E83045 4 JAI MEDICAL CENTRE E83038 2 WOODLANDS MEDICAL PRACTICE Y00316 2 PHGH DOCTORS E83009 1 ST. GEORGES MEDICAL CENTRE E83020 1 PENNINE DRIVE PRACTICE E83025 1 THE EVERGLADE MEDICAL PRACTICE E83011 4 BRUNSWICK PARK MEDICAL CENTRE E83621 5 THE SPEEDWELL PRACTICE E83010 1 DERWENT CRESCENT MEDICAL CENTRE E83037 1 RAVENSCROFT MEDICAL CENTRE E83039 1 ADLER JS-THE SURGERY E83600 2 SUPREME MEDICAL CENTRE E83026 1 TEMPLE FORTUNE MEDICAL GROUP E83622 1 DR AZIM & PARTNERS Y03664 2 LANGSTONE WAY SURGERY E83049 1 SQUIRES LANE MEDICAL PRACTICE E83007 1 OAK LODGE MEDICAL CENTRE E83032 1 TORRINGTON PARK GROUP PRACTICE E83021 1 LONGROVE SURGERY E83017 1 THE PHOENIX PRACTICE E83653 1 ST ANDREWS MEDICAL PRACTICE. E83024 1 OAKLEIGH ROAD HEALTH CENTRE E83003 GREENFIELD MEDICAL CENTRE E83006 188 THE PRACTICE E83027 PARKVIEW SURGERY E83028 MULKIS HB-THE SURGERY E83034 THE SURGERY E83041 DR MAKANJUOLA'S SURGERY E83042 ADDINGTON MEDICAL CENTRE E83044 MULBERRY MEDICAL PRACTICE E83046 EBHC DR D MONKMAN E83613 EBHC DR P WESTON E83629 EBHC DR CJ PESKIN E83632 COLINDALE MEDICAL CENTRE LP E83637 BALLARDS LANE SURGERY E83644 GLOUCESTER ROAD SURGERY E83650 DR LF MILLER E83656 THE HILLVIEW SURGERY E83657 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 DR SP TALPAHEWA E83668 HENDON WAY SURGERY Y03663 HAMID CARETAKING E83664 WATFORD WAY CENTRE LIMITED E83633 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

NHS Enfield CCG 89.0% • 10,108 people with coronary heart disease* in NHS Barnet CCG • 8,887 (87.9%) people whose blood NHS Camden CCG 88.5% pressure <= 150 / 90 • 321 (3.2%) people who are exceptions NHS Barnet CCG 87.9% • 900 (8.9%) additional people whose blood pressure is not <= 150 / 90

NHS Islington CCG 87.2%

NHS Haringey CCG 85.7%

England 88.2%

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

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

NHS Bexley CCG 90.0%

NHS Chiltern CCG 90.0%

NHS Dartford, Gravesham and Swanley CCG 89.1%

NHS Hillingdon CCG 89.1%

NHS North West Surrey CCG 88.5%

NHS Milton Keynes CCG 88.4%

NHS Sutton CCG 87.9%

NHS Barnet CCG 87.9%

NHS Kingston CCG 87.7%

NHS Crawley CCG 87.6%

NHS Bromley CCG 87.4%

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

HAMID CARETAKING E83664 4 EAST FINCHLEY MEDICAL CENTRE E83050 23 PENSHURST GARDENS SURGERY E83030 51 THE VILLAGE SURGERY E83031 29 CORNWALL HOUSE SURGERY E83013 34 THE SURGERY E83041 16 DR AZIM & PARTNERS Y03664 23 OAKLEIGH ROAD HEALTH CENTRE E83003 48 • in total, including exceptions, there MULBERRY MEDICAL PRACTICE E83046 30 DR LF MILLER E83656 11 are 1,221 people whose blood MULKIS HB-THE SURGERY E83034 24 WATLING MEDICAL CENTRE E83018 59 ROSEMARY SURGERY E83639 18 pressure is not <= 150 / 90 PHGH DOCTORS E83009 45 LANGSTONE WAY SURGERY E83049 21 DR MAKANJUOLA'S SURGERY E83042 11 • GP practice range: 1.6% to 100.0% THE HILLVIEW SURGERY E83657 6 CRICKLEWOOD HEALTH CENTRE Y02986 1 BALLARDS LANE SURGERY E83644 9 LANE END MEDICAL GROUP E83053 57 ST. GEORGES MEDICAL CENTRE E83020 30 JAI MEDICAL CENTRE E83038 41 188 THE PRACTICE E83027 29 WENTWORTH MEDICAL PRACTICE. E83035 35 DR SP TALPAHEWA E83668 8 THE EVERGLADE MEDICAL PRACTICE E83011 20 TORRINGTON PARK GROUP PRACTICE E83021 48 MILLWAY MEDICAL PRACTICE E83016 62 STATION ROAD NEW BARNET SURGERY E83624 5 THE SPEEDWELL PRACTICE E83010 39 WOODLANDS MEDICAL PRACTICE Y00316 10 ST ANDREWS MEDICAL PRACTICE. E83024 32 THE MOUNTFIELD SURGERY E83638 13 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 4 LICHFIELD GROVE SURGERY E83005 12 PARKVIEW SURGERY E83028 11 TEMPLE FORTUNE MEDICAL GROUP E83622 15 LONGROVE SURGERY E83017 30 PENNINE DRIVE PRACTICE E83025 20 COLINDALE MEDICAL CENTRE LP E83637 11 HOLLY PARK CLINIC Y00105 8 OAK LODGE MEDICAL CENTRE E83032 33 HEATHFIELDE MEDICAL CENTRE E83008 20 DERWENT CRESCENT MEDICAL CENTRE E83037 14 SQUIRES LANE MEDICAL PRACTICE E83007 14 HENDON WAY SURGERY Y03663 12 GREENFIELD MEDICAL CENTRE E83006 14 THE OLD COURT HOUSE SURGERY E83012 15 THE HODFORD ROAD PRACTICE E83649 5 FRIERN BARNET MEDICAL CENTRE E83045 15 BRUNSWICK PARK MEDICAL CENTRE E83621 19 SUPREME MEDICAL CENTRE E83026 9 WATFORD WAY CENTRE LIMITED E83633 4 RAVENSCROFT MEDICAL CENTRE E83039 7 GLOUCESTER ROAD SURGERY E83650 3 ADLER JS-THE SURGERY E83600 5 THE PHOENIX PRACTICE E83653 8 ADDINGTON MEDICAL CENTRE E83044 10 EBHC DR CJ PESKIN E83632 4 VALE DRIVE MEDICAL PRACTICE E83036 3 EBHC DR D MONKMAN E83613 3 EBHC DR P WESTON E83629 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

EAST FINCHLEY MEDICAL CENTRE 18

CORNWALL HOUSE SURGERY 24

PENSHURST GARDENS SURGERY 35 • using the GP cluster method of THE VILLAGE SURGERY 20 calculating potential gains, if each THE SURGERY 11 practice was to achieve as well as the DR AZIM & PARTNERS 16 upper quartile of its national cluster, then an additional 502 people would OAKLEIGH ROAD HEALTH CENTRE 32 be treated MULBERRY MEDICAL PRACTICE 20

DR LF MILLER 7

MULKIS HB-THE SURGERY 15

RAVENSCROFT MEDICAL CENTRE

SUPREME MEDICAL CENTRE

ADLER JS-THE SURGERY

GLOUCESTER ROAD SURGERY

EBHC DR CJ PESKIN

EBHC DR D MONKMAN

VALE DRIVE MEDICAL PRACTICE

THE PHOENIX PRACTICE

ADDINGTON MEDICAL CENTRE

EBHC DR P WESTON Details of this methodology are available on slide 9. Click here to view them.

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

NHS Enfield CCG 92.9% • 10,095 people with coronary heart disease* in NHS Barnet CCG • 9,166 (90.8%) people who are taking NHS Camden CCG 92.6% aspirin, an alternative anti-platelet therapy, or an anti-coagulant • 510 (5.1%) people who are NHS Islington CCG 92.0% exceptions • 419 (4.2%) additional people who are not taking aspirin, an alternative anti- NHS Haringey CCG 91.4% platelet therapy, or an anti-coagulant

NHS Barnet CCG 90.8%

England 91.8%

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

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

NHS Hillingdon CCG 93.5%

NHS Chiltern CCG 93.1%

NHS Bromley CCG 93.0%

NHS Kingston CCG 92.9%

NHS North West Surrey CCG 92.9%

NHS Dartford, Gravesham and Swanley CCG 92.7%

NHS Bexley CCG 92.2%

NHS Crawley CCG 91.6%

NHS Sutton CCG 91.4%

NHS Barnet CCG 90.8%

NHS Milton Keynes CCG 89.4%

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

HAMID CARETAKING E83664 2 MULKIS HB-THE SURGERY E83034 28 DR AZIM & PARTNERS Y03664 19 PHGH DOCTORS E83009 46 THE SPEEDWELL PRACTICE E83010 54 THE HILLVIEW SURGERY E83657 6 CRICKLEWOOD HEALTH CENTRE Y02986 1 DERWENT CRESCENT MEDICAL CENTRE E83037 22 • in total, including exceptions, there LICHFIELD GROVE SURGERY E83005 17 LANE END MEDICAL GROUP E83053 56 are 929 people are not taking aspirin, HEATHFIELDE MEDICAL CENTRE E83008 30 188 THE PRACTICE E83027 26 ROSEMARY SURGERY E83639 13 an alternative anti-platelet therapy, or TEMPLE FORTUNE MEDICAL GROUP E83622 18 WATLING MEDICAL CENTRE E83018 39 SUPREME MEDICAL CENTRE E83026 15 an anti-coagulant MULBERRY MEDICAL PRACTICE E83046 18 MILLWAY MEDICAL PRACTICE E83016 54 • GP practice range: 1.6% to 50.0% WOODLANDS MEDICAL PRACTICE Y00316 10 TORRINGTON PARK GROUP PRACTICE E83021 40 OAK LODGE MEDICAL CENTRE E83032 39 WATFORD WAY CENTRE LIMITED E83633 7 PENSHURST GARDENS SURGERY E83030 24 MAKANJI HH-WOODCROFT MEDICAL CENTRE E83658 4 DR LF MILLER E83656 6 DR SP TALPAHEWA E83668 6 SQUIRES LANE MEDICAL PRACTICE E83007 15 GLOUCESTER ROAD SURGERY E83650 5 JAI MEDICAL CENTRE E83038 27 ST ANDREWS MEDICAL PRACTICE. E83024 26 WENTWORTH MEDICAL PRACTICE. E83035 23 BRUNSWICK PARK MEDICAL CENTRE E83621 22 LANGSTONE WAY SURGERY E83049 11 CORNWALL HOUSE SURGERY E83013 13 VALE DRIVE MEDICAL PRACTICE E83036 6 HENDON WAY SURGERY Y03663 11 THE OLD COURT HOUSE SURGERY E83012 14 GREENFIELD MEDICAL CENTRE E83006 12 PARKVIEW SURGERY E83028 8 LONGROVE SURGERY E83017 22 ST. GEORGES MEDICAL CENTRE E83020 14 PENNINE DRIVE PRACTICE E83025 13 THE VILLAGE SURGERY E83031 8 THE PHOENIX PRACTICE E83653 10 ADLER JS-THE SURGERY E83600 6 THE EVERGLADE MEDICAL PRACTICE E83011 8 THE SURGERY E83041 4 FRIERN BARNET MEDICAL CENTRE E83045 10 EAST FINCHLEY MEDICAL CENTRE E83050 3 OAKLEIGH ROAD HEALTH CENTRE E83003 9 EBHC DR D MONKMAN E83613 3 COLINDALE MEDICAL CENTRE LP E83637 4 THE HODFORD ROAD PRACTICE E83649 2 DR MAKANJUOLA'S SURGERY E83042 2 ADDINGTON MEDICAL CENTRE E83044 6 RAVENSCROFT MEDICAL CENTRE E83039 3 STATION ROAD NEW BARNET SURGERY E83624 1 HOLLY PARK CLINIC Y00105 2 EBHC DR CJ PESKIN E83632 2 THE MOUNTFIELD SURGERY E83638 2 EBHC DR P WESTON E83629 1 BALLARDS LANE SURGERY E83644 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

81 CVD: Primary Care Intelligence Packs Some data on outcomes for people with cardiovascular disease

82 CVD: Primary Care Intelligence Packs Hospital admissions for coronary heart disease for all ages 2002/03 – 2015/16

NHS Barnet CCG England 900

800 • in NHS Barnet CCG, the hospital admission rate for coronary heart 700 disease in 2015/16 was 415.6 (1,183) compared to 527.9 for England

600

500

400

300 Age Age standardised (per rate 100,000) 200

100

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

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

NHS Barnet CCG England 300

• in NHS Barnet CCG, the hospital 250 admission rate for stroke in 2015/16 was 197.3 (582) compared to 172.8 for England

200

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 Barnet CCG England

156.1% Angina 136.8% • The risk of a stroke was 76.3% higher and the risk of a heart attack was 131.1% 131.1% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 251.5% higher. 140.4% Heart failure 150.0%

76.3% Stroke 81.3%

251.5% Major amputation 445.8%

1074.1% Minor amputation 753.5%

329.1% RRT 293.0%

0% 200% 400% 600% 800% 1000% 1200% 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 Barnet CCG England 90

80 • in NHS Barnet CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 33.8, 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 Barnet CCG England 30

• in NHS Barnet CCG, the early 25 mortality rate for stroke in 2013-15 was 11.9, compared to 13.6 for England

20

15

10 Age Age standardised (per rate 100,000)

5

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

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

87 CVD: Primary Care Intelligence Packs Appendix Data sources

• Quality and Outcomes Framework (QOF), 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved

• Non-diabetic hyperglycaemia prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/nhs-diabetes- prevention-programme-non-diabetic-hyperglycaemia

• Diabetes prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/diabetes-prevalence-estimates-for- local-populations

• CKD Prevalence model, G.Aitken, University of Southampton , 2014 https://www.gov.uk/government/publications/ckd- prevalence-estimates-for-local-and-regional-populations

• Hypertension prevalence estimates for local CCG populations. Created using data from: QOF hypertension registers 2014/15 and; Undiagnosed hypertension estimates for adults 16 years and older. 2014. Department of Primary Care & Public Health, Imperial College London https://www.gov.uk/government/publications/hypertension-prevalence-estimates-for-local-populations

• NHS Stop smoking services Copyright © 2014, NHS Digital

• Norberg J, Bäckström S , Jansson J-H, Johansson L. Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clin Epidemiol 2013 ; 5 475 – 81.

• National Diabetes Audit, 2013/14 and 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved

• Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved

• Office for National Statistics (ONS) mortality data 2002 – 2015, Copyright © 2017, Re-used with the permission of the Office for National Statistics. All rights reserved

88 CVD: Primary Care Intelligence Packs About Public Health England

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© 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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