CVD: Primary Care Intelligence Packs NHS Camden 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 Camden CCG are: NHS Central London (Westminster) CCG NHS Islington CCG NHS Southampton CCG NHS Portsmouth CCG NHS Central Manchester CCG NHS Bristol CCG NHS Brighton and Hove CCG NHS South Manchester CCG NHS West London CCG NHS Nottingham City 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 South Manchester CCG 22.4%
NHS Nottingham City CCG 21.7% • prevalence of 17.8% in NHS Camden CCG NHS Brighton and Hove CCG 21.6%
NHS Portsmouth CCG 21.6%
NHS Southampton CCG 21.3%
NHS Bristol CCG 20.9%
NHS Islington CCG 20.6%
NHS Central Manchester CCG 20.0% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS West London CCG 18.7% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Camden CCG 17.8% http://bmjopen.bmj.com/content/4/7/e005217.abs tract
NHS Central London (Westminster) CCG 15.9% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 5% 10% 15% 20% 25% recorded as current smokers) divided by GP practice’s estimated number of patients 15+
13 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by GP practice
GP Practice CCG
CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 68.8% FOUR TREES SURGERY F83030 26.1% THE MATTHEWMAN PRACTICE F83677 25.8% SOMERS TOWN MEDICAL CENTRE F83683 23.4% • 39,338 people who are recorded as PRINCE OF WALES GROUP SURGERY F83018 23.2% AMPTHILL PRACTICE F83006 23.2% smokers in NHS Camden CCG CAVERSHAM GROUP PRACTICE F83022 23.0% • GP practice range: 7.9% to 68.8% BRONDESBURY MEDICAL CENTRE F83059 22.6% QUEENS CRESCENT PRACTICE F83632 22.5% BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 22.2% JAMES WIGG PRACTICE F83023 22.0% HOLBORN MEDICAL CENTRE F83058 20.4% KINGS CROSS SURGERY F83635 19.7% BRUNSWICK MEDICAL CENTRE UHPC F83048 19.5% THE REGENTS PARK PRACTICE F83025 19.4% GRAY'S INN ROAD MEDICAL CENTRE F83042 19.3% BROOKFIELD PARK SURGERY F83052 18.9% FORTUNE GREEN ROAD SURGERY F83050 18.5% ABBEY MEDICAL CENTRE F83019 18.3% MUSEUM PRACTICE F83061 18.3% THE BLOOMSBURY SURGERY F83044 18.2% WEST HAMPSTEAD MEDICAL CENTRE F83055 17.5% PARLIAMENT HILL SURGERY F83057 16.7% ADELAIDE MEDICAL CENTRE F83020 16.4% HAMPSTEAD GROUP PRACTICE F83017 16.3% PRIMROSE HILL SURGERY F83011 13.9% SWISS COTTAGE SURGERY F83665 13.6% ROSSLYN HILL SURGERY F83682 13.5% DALEHAM GARDENS HEALTH CENTRE F83633 12.6% Note: This method is thought to be a reasonably GOWER STREET PRACTICE F83005 12.6% robust method in estimating smoking prevalence CHOLMLEY GARDENS SURGERY F83615 11.9% for the majority of GP practices. However, PARK END SURGERY F83003 11.3% caution is advised for extreme estimates of KEATS GROUP PRACTICE F83623 8.6% smoking prevalence and those with high RIDGMOUNT PRACTICE F83043 7.9% numbers of smoking status not recorded and 0% 10% 20% 30% 40% 50% 60% 70% 80% 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 0.54. This compares to 0.59 for England • this suggests that 54% 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 Portsmouth CCG 0.56
NHS Nottingham City CCG 0.55
NHS South Manchester CCG 0.55
NHS Camden CCG 0.54
NHS Bristol CCG 0.54
NHS Southampton CCG 0.53
NHS Brighton and Hove CCG 0.52
NHS Central Manchester CCG 0.51
NHS Islington CCG 0.50
NHS West London CCG 0.49
NHS Central London (Westminster) CCG 0.48
0% 10% 20% 30% 40% 50% 60%
18 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by GP practice
GP practice CCG
FORTUNE GREEN ROAD SURGERY F83050 0.64 ABBEY MEDICAL CENTRE F83019 0.61 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 0.60 ROSSLYN HILL SURGERY F83682 0.60 SOMERS TOWN MEDICAL CENTRE F83683 0.60 • it is estimated that there are 20,016 PRINCE OF WALES GROUP SURGERY F83018 0.58 people with undiagnosed THE BLOOMSBURY SURGERY F83044 0.58 THE REGENTS PARK PRACTICE F83025 0.58 hypertension in NHS Camden CCG AMPTHILL PRACTICE F83006 0.56 • GP practice range of observed to BRONDESBURY MEDICAL CENTRE F83059 0.54 PRIMROSE HILL SURGERY F83011 0.54 expected hypertension prevalence KEATS GROUP PRACTICE F83623 0.53 0.14 to 0.64 BROOKFIELD PARK SURGERY F83052 0.52 JAMES WIGG PRACTICE F83023 0.51 FOUR TREES SURGERY F83030 0.51 HAMPSTEAD GROUP PRACTICE F83017 0.50 QUEENS CRESCENT PRACTICE F83632 0.48 BRUNSWICK MEDICAL CENTRE UHPC F83048 0.48 ADELAIDE MEDICAL CENTRE F83020 0.48 PARK END SURGERY F83003 0.46 WEST HAMPSTEAD MEDICAL CENTRE F83055 0.45 PARLIAMENT HILL SURGERY F83057 0.44 THE MATTHEWMAN PRACTICE F83677 0.43 CAVERSHAM GROUP PRACTICE F83022 0.42 GRAY'S INN ROAD MEDICAL CENTRE F83042 0.42 HOLBORN MEDICAL CENTRE F83058 0.42 SWISS COTTAGE SURGERY F83665 0.41 MUSEUM PRACTICE F83061 0.40 KINGS CROSS SURGERY F83635 0.40 CHOLMLEY GARDENS SURGERY F83615 0.38 DALEHAM GARDENS HEALTH CENTRE F83633 0.38 GOWER STREET PRACTICE F83005 0.27 RIDGMOUNT PRACTICE F83043 0.14 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%
• 23,452 people with hypertension NHS Barnet CCG 77.9% (diagnosed)* in NHS Camden CCG • 18,041 (76.9%) people whose blood pressure is <= 150/90 • 1,007 (4.3%) people who are NHS Camden CCG 76.9% excepted from optimal control • 4,404 (18.8%) 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 Nottingham City CCG 80.0%
NHS Portsmouth CCG 80.0%
NHS Bristol CCG 77.8%
NHS West London CCG 77.6%
NHS Camden CCG 76.9%
NHS Southampton CCG 76.8%
NHS Central Manchester CCG 76.8%
NHS Islington CCG 76.7%
NHS Central London (Westminster) CCG 75.3%
NHS South Manchester CCG 75.0%
NHS Brighton and Hove CCG 73.3%
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
CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 28 SOMERS TOWN MEDICAL CENTRE F83683 118 PRIMROSE HILL SURGERY F83011 236 CAVERSHAM GROUP PRACTICE F83022 368 • in total, including exceptions, there FORTUNE GREEN ROAD SURGERY F83050 124 AMPTHILL PRACTICE F83006 285 are 5,411 people whose blood GOWER STREET PRACTICE F83005 60 pressure is not <= 150/90 BRONDESBURY MEDICAL CENTRE F83059 452 JAMES WIGG PRACTICE F83023 513 • GP practice range: 12.2% to 41.8% HAMPSTEAD GROUP PRACTICE F83017 379 THE MATTHEWMAN PRACTICE F83677 40 CHOLMLEY GARDENS SURGERY F83615 140 SWISS COTTAGE SURGERY F83665 192 THE REGENTS PARK PRACTICE F83025 165 PRINCE OF WALES GROUP SURGERY F83018 266 KINGS CROSS SURGERY F83635 51 WEST HAMPSTEAD MEDICAL CENTRE F83055 217 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 118 HOLBORN MEDICAL CENTRE F83058 131 BROOKFIELD PARK SURGERY F83052 86 QUEENS CRESCENT PRACTICE F83632 78 GRAY'S INN ROAD MEDICAL CENTRE F83042 70 PARLIAMENT HILL SURGERY F83057 129 PARK END SURGERY F83003 155 FOUR TREES SURGERY F83030 48 KEATS GROUP PRACTICE F83623 215 ADELAIDE MEDICAL CENTRE F83020 226 BRUNSWICK MEDICAL CENTRE UHPC F83048 99 ROSSLYN HILL SURGERY F83682 36 ABBEY MEDICAL CENTRE F83019 215 THE BLOOMSBURY SURGERY F83044 78 DALEHAM GARDENS HEALTH CENTRE F83633 28 RIDGMOUNT PRACTICE F83043 20 MUSEUM PRACTICE F83061 45 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%
• 192 people with a new diagnosis* of NHS Islington CCG 74.5% hypertension with a CVD risk of 20% or higher in NHS Camden CCG • 120 (62.5%) people who are currently treated with statins NHS Haringey CCG 74.3% • 69 (35.9%) people who are exempted from treatment with statins • 3 (1.6%) 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 Central Manchester CCG 76.3%
NHS West London CCG 76.0%
NHS Islington CCG 74.5%
NHS Nottingham City CCG 74.1%
NHS Central London (Westminster) CCG 73.4%
NHS Southampton CCG 71.7%
NHS Portsmouth CCG 71.6%
NHS South Manchester CCG 70.4%
NHS Bristol CCG 68.1%
NHS Camden CCG 62.5%
NHS Brighton and Hove CCG 60.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
24 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and not treated with statins by GP practice
No treatment Exceptions reported
SOMERS TOWN MEDICAL CENTRE F83683 2 KEATS GROUP PRACTICE F83623 8 PRINCE OF WALES GROUP SURGERY F83018 6 WEST HAMPSTEAD MEDICAL CENTRE F83055 3 • in total, including exceptions, there JAMES WIGG PRACTICE F83023 14 HAMPSTEAD GROUP PRACTICE F83017 4 are 72 people who are not treated CAVERSHAM GROUP PRACTICE F83022 13 with statins RIDGMOUNT PRACTICE F83043 1 DALEHAM GARDENS HEALTH CENTRE F83633 1 • GP practice range: 0.0% to 100.0% PRIMROSE HILL SURGERY F83011 3 PARK END SURGERY F83003 1 BRUNSWICK MEDICAL CENTRE UHPC F83048 3 PARLIAMENT HILL SURGERY F83057 1 HOLBORN MEDICAL CENTRE F83058 1 SWISS COTTAGE SURGERY F83665 2 ADELAIDE MEDICAL CENTRE F83020 2 THE BLOOMSBURY SURGERY F83044 1 BRONDESBURY MEDICAL CENTRE F83059 4 MUSEUM PRACTICE F83061 1 AMPTHILL PRACTICE F83006 1 GOWER STREET PRACTICE F83005 ABBEY MEDICAL CENTRE F83019 THE REGENTS PARK PRACTICE F83025 FOUR TREES SURGERY F83030 GRAY'S INN ROAD MEDICAL CENTRE F83042 FORTUNE GREEN ROAD SURGERY F83050 BROOKFIELD PARK SURGERY F83052 CHOLMLEY GARDENS SURGERY F83615 QUEENS CRESCENT PRACTICE F83632 KINGS CROSS SURGERY F83635 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 ROSSLYN HILL SURGERY F83682 CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 THE MATTHEWMAN PRACTICE F83677 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 0.66. This compares to 0.7 for England • this suggests that 66% 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 Portsmouth CCG 0.74
NHS Bristol CCG 0.74
NHS South Manchester CCG 0.72
NHS Southampton CCG 0.68
NHS Brighton and Hove CCG 0.66
NHS Camden CCG 0.66
NHS Nottingham City CCG 0.65
NHS Central London (Westminster) CCG 0.65
NHS Islington CCG 0.62
NHS Central Manchester CCG 0.60
NHS West London CCG 0.58
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
QUEENS CRESCENT PRACTICE F83632 1.2 PRINCE OF WALES GROUP SURGERY F83018 0.9 PARK END SURGERY F83003 0.8 RIDGMOUNT PRACTICE F83043 0.8 PARLIAMENT HILL SURGERY F83057 0.8 • it is estimated that there are 3,680 GOWER STREET PRACTICE F83005 0.7 people with undiagnosed atrial AMPTHILL PRACTICE F83006 0.7 PRIMROSE HILL SURGERY F83011 0.7 fibrillation in NHS Camden CCG HAMPSTEAD GROUP PRACTICE F83017 0.7 • GP practice range of observed to ABBEY MEDICAL CENTRE F83019 0.7 ADELAIDE MEDICAL CENTRE F83020 0.7 expected atrial fibrillation prevalence CAVERSHAM GROUP PRACTICE F83022 0.7 0.3 to 1.2 THE REGENTS PARK PRACTICE F83025 0.7 THE BLOOMSBURY SURGERY F83044 0.7 WEST HAMPSTEAD MEDICAL CENTRE F83055 0.7 BRONDESBURY MEDICAL CENTRE F83059 0.7 KEATS GROUP PRACTICE F83623 0.7 JAMES WIGG PRACTICE F83023 0.6 GRAY'S INN ROAD MEDICAL CENTRE F83042 0.6 BRUNSWICK MEDICAL CENTRE UHPC F83048 0.6 FORTUNE GREEN ROAD SURGERY F83050 0.6 BROOKFIELD PARK SURGERY F83052 0.6 CHOLMLEY GARDENS SURGERY F83615 0.6 KINGS CROSS SURGERY F83635 0.6 SWISS COTTAGE SURGERY F83665 0.6 SOMERS TOWN MEDICAL CENTRE F83683 0.6 HOLBORN MEDICAL CENTRE F83058 0.5 DALEHAM GARDENS HEALTH CENTRE F83633 0.5 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 0.5 THE MATTHEWMAN PRACTICE F83677 0.5 ROSSLYN HILL SURGERY F83682 0.5 MUSEUM PRACTICE F83061 0.4 FOUR TREES SURGERY F83030 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% • 2,029 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS Camden CCG NHS Barnet CCG 72.7% • 1,430 (70.5%) people treated with anti-coagulation therapy • 333 (16.4%) people who are NHS Haringey CCG 71.1% exceptions • 266 (13.1%) 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 Bristol CCG 79.1%
NHS Central Manchester CCG 78.3%
NHS Southampton CCG 77.8%
NHS South Manchester CCG 77.4%
NHS Central London (Westminster) CCG 76.1%
NHS West London CCG 75.9%
NHS Portsmouth CCG 74.2%
NHS Nottingham City CCG 73.1%
NHS Camden CCG 70.5%
NHS Brighton and Hove CCG 70.4%
NHS Islington CCG 66.4%
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
CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 2 THE BLOOMSBURY SURGERY F83044 18 FOUR TREES SURGERY F83030 5 SOMERS TOWN MEDICAL CENTRE F83683 7 • in total, including exceptions, there HOLBORN MEDICAL CENTRE F83058 14 BRONDESBURY MEDICAL CENTRE F83059 44 are 599 people with a recorded QUEENS CRESCENT PRACTICE F83632 17 CHA2DS2-VASc score >= 2 who are HAMPSTEAD GROUP PRACTICE F83017 52 WEST HAMPSTEAD MEDICAL CENTRE F83055 31 not treated PARLIAMENT HILL SURGERY F83057 20 • GP practice range: 7.7% to 100.0% JAMES WIGG PRACTICE F83023 49 CHOLMLEY GARDENS SURGERY F83615 17 ABBEY MEDICAL CENTRE F83019 39 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 10 CAVERSHAM GROUP PRACTICE F83022 32 GRAY'S INN ROAD MEDICAL CENTRE F83042 8 BRUNSWICK MEDICAL CENTRE UHPC F83048 9 PRINCE OF WALES GROUP SURGERY F83018 28 KEATS GROUP PRACTICE F83623 30 ADELAIDE MEDICAL CENTRE F83020 32 BROOKFIELD PARK SURGERY F83052 8 PARK END SURGERY F83003 30 AMPTHILL PRACTICE F83006 22 DALEHAM GARDENS HEALTH CENTRE F83633 5 THE MATTHEWMAN PRACTICE F83677 3 RIDGMOUNT PRACTICE F83043 5 MUSEUM PRACTICE F83061 5 SWISS COTTAGE SURGERY F83665 14 THE REGENTS PARK PRACTICE F83025 14 PRIMROSE HILL SURGERY F83011 17 FORTUNE GREEN ROAD SURGERY F83050 6 GOWER STREET PRACTICE F83005 4 ROSSLYN HILL SURGERY F83682 1 KINGS CROSS SURGERY F83635 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
33 CVD: Primary Care Intelligence Packs In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by GP practice – opportunities compared to GP cluster
15% 10% 5% 0% -5% -10% -15% -20% -25% -30% -35% -40%
THE BLOOMSBURY SURGERY 12
FOUR TREES SURGERY 3
SOMERS TOWN MEDICAL CENTRE 5 • using the GP cluster method of HOLBORN MEDICAL CENTRE 8 calculating potential gains, if each BRONDESBURY MEDICAL CENTRE 25 practice was to achieve as well as the QUEENS CRESCENT PRACTICE 10 upper quartile of its national cluster, then an additional 268 people would WEST HAMPSTEAD MEDICAL CENTRE 17 be treated HAMPSTEAD GROUP PRACTICE 27
CHOLMLEY GARDENS SURGERY 9
PARLIAMENT HILL SURGERY 10
THE MATTHEWMAN PRACTICE 1
PRIMROSE HILL SURGERY 5
THE REGENTS PARK PRACTICE 4
MUSEUM PRACTICE 1
RIDGMOUNT PRACTICE 1
FORTUNE GREEN ROAD SURGERY 1
SWISS COTTAGE SURGERY 3
GOWER STREET PRACTICE 1
ROSSLYN HILL SURGERY
KINGS CROSS SURGERY Details of this methodology are available on slide 9. Click here to view them.
34 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP
Below 150/90 Not below 150/90 Exceptions reported
NHS Camden CCG 85.6% • 2,360 people with a history of stroke or TIA* in NHS Camden CCG • 2,019 (85.6%) people whose blood NHS Enfield CCG 83.9% pressure is <= 150 / 90 • 71 (3%) people who are exceptions • 270 (11.4%) additional people whose NHS Barnet CCG 83.0% 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 Camden CCG 85.6%
NHS Portsmouth CCG 84.4%
NHS Nottingham City CCG 84.4%
NHS Central London (Westminster) CCG 82.9%
NHS Southampton CCG 82.9%
NHS Islington CCG 82.0%
NHS Central Manchester CCG 82.0%
NHS Bristol CCG 81.9%
NHS West London CCG 81.3%
NHS South Manchester CCG 78.8%
NHS Brighton and Hove CCG 78.6%
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
SOMERS TOWN MEDICAL CENTRE F83683 12 CAVERSHAM GROUP PRACTICE F83022 33 THE MATTHEWMAN PRACTICE F83677 4 KINGS CROSS SURGERY F83635 5 • in total, including exceptions, there QUEENS CRESCENT PRACTICE F83632 8 PARLIAMENT HILL SURGERY F83057 11 are 341 people whose blood pressure FORTUNE GREEN ROAD SURGERY F83050 5 is not <= 150 / 90 WEST HAMPSTEAD MEDICAL CENTRE F83055 16 THE REGENTS PARK PRACTICE F83025 13 • GP practice range: 0.0% to 36.4% HAMPSTEAD GROUP PRACTICE F83017 34 GOWER STREET PRACTICE F83005 5 JAMES WIGG PRACTICE F83023 32 DALEHAM GARDENS HEALTH CENTRE F83633 5 CHOLMLEY GARDENS SURGERY F83615 8 PARK END SURGERY F83003 17 AMPTHILL PRACTICE F83006 13 HOLBORN MEDICAL CENTRE F83058 7 PRIMROSE HILL SURGERY F83011 10 ABBEY MEDICAL CENTRE F83019 18 PRINCE OF WALES GROUP SURGERY F83018 16 GRAY'S INN ROAD MEDICAL CENTRE F83042 4 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 5 BROOKFIELD PARK SURGERY F83052 3 ADELAIDE MEDICAL CENTRE F83020 16 THE BLOOMSBURY SURGERY F83044 5 BRONDESBURY MEDICAL CENTRE F83059 16 BRUNSWICK MEDICAL CENTRE UHPC F83048 4 FOUR TREES SURGERY F83030 2 SWISS COTTAGE SURGERY F83665 6 RIDGMOUNT PRACTICE F83043 1 ROSSLYN HILL SURGERY F83682 1 KEATS GROUP PRACTICE F83623 5 MUSEUM PRACTICE F83061 1 CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 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% • 1,214 people with a stroke shown to be non-haemorrhagic* in NHS Camden CCG NHS Enfield CCG 91.2% • 1,118 (92.1%) people who are taking an anti-platetet agent or anti- coagulant NHS Barnet CCG 89.1% • 81 (6.7%) people who are exceptions • 15 (1.2%) 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 Southampton CCG 92.3%
NHS Camden CCG 92.1%
NHS Central Manchester CCG 92.1%
NHS Nottingham City CCG 91.8%
NHS South Manchester CCG 91.0%
NHS Central London (Westminster) CCG 90.8%
NHS Bristol CCG 90.8%
NHS Portsmouth CCG 90.6%
NHS Brighton and Hove CCG 90.2%
NHS Islington CCG 89.1%
NHS West London CCG 87.3%
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
BROOKFIELD PARK SURGERY F83052 5 SOMERS TOWN MEDICAL CENTRE F83683 3 BRUNSWICK MEDICAL CENTRE UHPC F83048 4 HAMPSTEAD GROUP PRACTICE F83017 16 • in total, including exceptions, there DALEHAM GARDENS HEALTH CENTRE F83633 4 MUSEUM PRACTICE F83061 2 are 96 people who are not taking an THE BLOOMSBURY SURGERY F83044 4 anti-platelet agent or anti-coagulant PRINCE OF WALES GROUP SURGERY F83018 9 PARLIAMENT HILL SURGERY F83057 3 • GP practice range: 0.0% to 31.3% PARK END SURGERY F83003 7 KEATS GROUP PRACTICE F83623 6 HOLBORN MEDICAL CENTRE F83058 2 WEST HAMPSTEAD MEDICAL CENTRE F83055 3 THE REGENTS PARK PRACTICE F83025 2 GRAY'S INN ROAD MEDICAL CENTRE F83042 1 AMPTHILL PRACTICE F83006 2 ADELAIDE MEDICAL CENTRE F83020 4 QUEENS CRESCENT PRACTICE F83632 1 BRONDESBURY MEDICAL CENTRE F83059 4 PRIMROSE HILL SURGERY F83011 2 ABBEY MEDICAL CENTRE F83019 2 CHOLMLEY GARDENS SURGERY F83615 1 JAMES WIGG PRACTICE F83023 4 SWISS COTTAGE SURGERY F83665 2 CAVERSHAM GROUP PRACTICE F83022 2 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 1 GOWER STREET PRACTICE F83005 FOUR TREES SURGERY F83030 RIDGMOUNT PRACTICE F83043 FORTUNE GREEN ROAD SURGERY F83050 KINGS CROSS SURGERY F83635 THE MATTHEWMAN PRACTICE F83677 ROSSLYN HILL SURGERY F83682 CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 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 • 0.60 ratio of observed to expected diabetes prevalence in NHS Camden
NHS Barnet CCG 0.71 CCG, compared to 0.77 in England
• this suggests 60% 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 South Manchester CCG 0.80
NHS Portsmouth CCG 0.78
NHS Southampton CCG 0.76
NHS Nottingham City CCG 0.74
NHS Bristol CCG 0.71
NHS Central Manchester CCG 0.71
NHS Islington CCG 0.66
NHS Camden CCG 0.60
NHS Brighton and Hove CCG 0.60
NHS Central London (Westminster) CCG 0.57
NHS West London CCG 0.56
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
SOMERS TOWN MEDICAL CENTRE F83683 9.7% FOUR TREES SURGERY F83030 8.6% THE REGENTS PARK PRACTICE F83025 8.3% AMPTHILL PRACTICE F83006 7.0% • GP practice range of observed PRINCE OF WALES GROUP SURGERY F83018 6.2% THE BLOOMSBURY SURGERY F83044 6.2% diabetes 0.5% to 9.7% KINGS CROSS SURGERY F83635 5.9% • there are an estimated 5,750 people FORTUNE GREEN ROAD SURGERY F83050 5.7% BROOKFIELD PARK SURGERY F83052 5.7% with undiagnosed diabetes in NHS BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 5.6% Camden CCG ABBEY MEDICAL CENTRE F83019 5.5% QUEENS CRESCENT PRACTICE F83632 5.4% JAMES WIGG PRACTICE F83023 5.2% GRAY'S INN ROAD MEDICAL CENTRE F83042 5.1% CAVERSHAM GROUP PRACTICE F83022 4.8% BRUNSWICK MEDICAL CENTRE UHPC F83048 4.8% MUSEUM PRACTICE F83061 4.1% BRONDESBURY MEDICAL CENTRE F83059 4.1% HAMPSTEAD GROUP PRACTICE F83017 4.0% ROSSLYN HILL SURGERY F83682 3.8% CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 3.8% PRIMROSE HILL SURGERY F83011 3.7% ADELAIDE MEDICAL CENTRE F83020 3.7% DALEHAM GARDENS HEALTH CENTRE F83633 3.4% PARK END SURGERY F83003 3.4% THE MATTHEWMAN PRACTICE F83677 3.3% WEST HAMPSTEAD MEDICAL CENTRE F83055 2.9% KEATS GROUP PRACTICE F83623 2.9% CHOLMLEY GARDENS SURGERY F83615 2.8% PARLIAMENT HILL SURGERY F83057 2.8% SWISS COTTAGE SURGERY F83665 2.7% HOLBORN MEDICAL CENTRE F83058 2.3% Note: The estimated number of undiagnosed GOWER STREET PRACTICE F83005 1.1% people with diabetes has been calculated by RIDGMOUNT PRACTICE F83043 0.5% 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 Camden CCG is 6.7% (diagnosed and undiagnosed)
NHS Barnet CCG 6.1% 2.5% 11.3% • in addition, there are an estimated 8.2% of people in NHS Camden 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 14.9% of the population in NHS Camden 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 Camden CCG, 29 out of 36 practices (80.6%) participated in the NDA. Data is not available for the NHS Haringey CCG 37.0% remaining practices
NHS Enfield CCG 31.9% • 62.3% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS Camden 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
MUSEUM PRACTICE F83061 86.4% BRUNSWICK MEDICAL CENTRE UHPC F83048 81.0% ABBEY MEDICAL CENTRE F83019 80.9% • achievement - 8 care processes: in KEATS GROUP PRACTICE F83623 75.2% ADELAIDE MEDICAL CENTRE F83020 73.8% practices who provided data via the THE BLOOMSBURY SURGERY F83044 71.6% NDA, between 21.7% and 86.4% of PRINCE OF WALES GROUP SURGERY F83018 69.3% HOLBORN MEDICAL CENTRE F83058 68.8% patients received all 8 care processes JAMES WIGG PRACTICE F83023 67.7% BRONDESBURY MEDICAL CENTRE F83059 66.5% SWISS COTTAGE SURGERY F83665 65.8% • at least 2,659 people did not receive CAVERSHAM GROUP PRACTICE F83022 64.8% CHOLMLEY GARDENS SURGERY F83615 64.2% the eight care processes RIDGMOUNT PRACTICE F83043 62.7% FORTUNE GREEN ROAD SURGERY F83050 62.0% GRAY'S INN ROAD MEDICAL CENTRE F83042 61.1% QUEENS CRESCENT PRACTICE F83632 60.9% HAMPSTEAD GROUP PRACTICE F83017 55.3% BROOKFIELD PARK SURGERY F83052 54.9% BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 47.9% FOUR TREES SURGERY F83030 45.8% GOWER STREET PRACTICE F83005 44.9% WEST HAMPSTEAD MEDICAL CENTRE F83055 42.4% PARK END SURGERY F83003 37.3% KINGS CROSS SURGERY F83635 30.0% DALEHAM GARDENS HEALTH CENTRE F83633 26.6% SOMERS TOWN MEDICAL CENTRE F83683 21.7% CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 ROSSLYN HILL SURGERY F83682 THE MATTHEWMAN PRACTICE F83677 PARLIAMENT HILL SURGERY F83057 THE REGENTS PARK PRACTICE F83025 PRIMROSE HILL SURGERY F83011 AMPTHILL PRACTICE F83006 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%
• 42.4% of people with diabetes (of practices who participated in the NHS Barnet CCG 40.6% audit) met the three treatment targets in NHS Camden 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
ABBEY MEDICAL CENTRE F83019 56.3% BROOKFIELD PARK SURGERY F83052 54.5% HOLBORN MEDICAL CENTRE F83058 54.4% • achievement - 3 treatment targets: in THE BLOOMSBURY SURGERY F83044 53.9% GRAY'S INN ROAD MEDICAL CENTRE F83042 48.3% practices who provided data via the ADELAIDE MEDICAL CENTRE F83020 48.1% NDA, between 24.1% and 56.3% of BRUNSWICK MEDICAL CENTRE UHPC F83048 47.9% FORTUNE GREEN ROAD SURGERY F83050 47.6% patients achieved all 3 treatment CHOLMLEY GARDENS SURGERY F83615 46.8% targets SWISS COTTAGE SURGERY F83665 46.3% GOWER STREET PRACTICE F83005 45.1% • at least 3,626 people did not meet the BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 43.7% WEST HAMPSTEAD MEDICAL CENTRE F83055 42.7% three treatment targets JAMES WIGG PRACTICE F83023 41.9% HAMPSTEAD GROUP PRACTICE F83017 40.6% KEATS GROUP PRACTICE F83623 39.4% PARK END SURGERY F83003 39.1% PRINCE OF WALES GROUP SURGERY F83018 38.1% KINGS CROSS SURGERY F83635 38.1% SOMERS TOWN MEDICAL CENTRE F83683 37.6% RIDGMOUNT PRACTICE F83043 37.5% DALEHAM GARDENS HEALTH CENTRE F83633 37.5% MUSEUM PRACTICE F83061 36.4% BRONDESBURY MEDICAL CENTRE F83059 36.2% FOUR TREES SURGERY F83030 31.3% CAVERSHAM GROUP PRACTICE F83022 30.5% QUEENS CRESCENT PRACTICE F83632 24.1% CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 ROSSLYN HILL SURGERY F83682 THE MATTHEWMAN PRACTICE F83677 PARLIAMENT HILL SURGERY F83057 THE REGENTS PARK PRACTICE F83025 PRIMROSE HILL SURGERY F83011 AMPTHILL PRACTICE F83006 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
50 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16 - opportunities compared to GP cluster
15% 10% 5% 0% -5% -10% -15% -20% -25%
QUEENS CRESCENT PRACTICE 28
CAVERSHAM GROUP PRACTICE 65
FOUR TREES SURGERY 15 • using the GP cluster method of DALEHAM GARDENS HEALTH CENTRE 5 calculating potential gains, if each KINGS CROSS SURGERY 13 practice was to achieve as well as the PRINCE OF WALES GROUP SURGERY 28 upper quartile of its national cluster, then an additional 252 people would BRONDESBURY MEDICAL CENTRE 37 be treated PARK END SURGERY 10
MUSEUM PRACTICE 1
SOMERS TOWN MEDICAL CENTRE 11
GOWER STREET PRACTICE
FORTUNE GREEN ROAD SURGERY
BRUNSWICK MEDICAL CENTRE UHPC
ADELAIDE MEDICAL CENTRE
GRAY'S INN ROAD MEDICAL CENTRE
SWISS COTTAGE SURGERY
THE BLOOMSBURY SURGERY
BROOKFIELD PARK SURGERY
ABBEY MEDICAL CENTRE
HOLBORN MEDICAL CENTRE 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 0.61. This compares to NHS Barnet CCG 0.53 0.68 for England • this suggests that 61% 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 Bristol CCG 0.87
NHS Central Manchester CCG 0.78
NHS Nottingham City CCG 0.74
NHS Brighton and Hove CCG 0.66
NHS Southampton CCG 0.62
NHS Camden CCG 0.61
NHS South Manchester CCG 0.60
NHS Portsmouth CCG 0.60
NHS Islington CCG 0.51
NHS West London CCG 0.40
NHS Central London (Westminster) CCG 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
55 CVD: Primary Care Intelligence Packs CKD prevalence by GP practice, 2015/16
GP practice CCG
ROSSLYN HILL SURGERY F83682 4.4% BROOKFIELD PARK SURGERY F83052 4.3% FORTUNE GREEN ROAD SURGERY F83050 4.3% FOUR TREES SURGERY F83030 4.1% • it is estimated that there are 3,433 ABBEY MEDICAL CENTRE F83019 4.0% AMPTHILL PRACTICE F83006 3.8% people with undiagnosed chronic BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 3.7% kidney disease in NHS Camden CCG SOMERS TOWN MEDICAL CENTRE F83683 3.7% PARK END SURGERY F83003 3.7% • GP practice range of observed CKD: PRINCE OF WALES GROUP SURGERY F83018 3.5% 0.1% to 4.4% CHOLMLEY GARDENS SURGERY F83615 3.5% HAMPSTEAD GROUP PRACTICE F83017 3.3% ADELAIDE MEDICAL CENTRE F83020 3.2% THE REGENTS PARK PRACTICE F83025 3.1% PRIMROSE HILL SURGERY F83011 3.0% QUEENS CRESCENT PRACTICE F83632 3.0% KEATS GROUP PRACTICE F83623 2.9% THE BLOOMSBURY SURGERY F83044 2.8% BRONDESBURY MEDICAL CENTRE F83059 2.8% THE MATTHEWMAN PRACTICE F83677 2.7% PARLIAMENT HILL SURGERY F83057 2.5% BRUNSWICK MEDICAL CENTRE UHPC F83048 2.5% WEST HAMPSTEAD MEDICAL CENTRE F83055 2.4% JAMES WIGG PRACTICE F83023 2.3% SWISS COTTAGE SURGERY F83665 2.2% GRAY'S INN ROAD MEDICAL CENTRE F83042 2.2% CAVERSHAM GROUP PRACTICE F83022 2.1% DALEHAM GARDENS HEALTH CENTRE F83633 1.9% MUSEUM PRACTICE F83061 1.8% KINGS CROSS SURGERY F83635 1.4% Note: CCG estimates for the estimated CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 1.3% number of people with CKD are based on HOLBORN MEDICAL CENTRE F83058 1.1% applying a proportion from a resident based GOWER STREET PRACTICE F83005 0.5% RIDGMOUNT PRACTICE F83043 0.1% population estimate to a GP registered population. The characteristics of registered 0% 1% 1% 2% 2% 3% 3% 4% 4% 5% 5% 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% • 5,475 people with CKD (diagnosed*) in NHS Camden CCG • 4,100 (74.9%) people whose blood NHS Enfield CCG 75.3% pressure is <= 140 /85 • 520 (9.5%) people who are exceptions NHS Camden CCG 74.9% • 855 (15.6%) 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 Portsmouth CCG 78.8%
NHS Islington CCG 76.0%
NHS Camden CCG 74.9%
NHS Bristol CCG 74.4%
NHS Southampton CCG 74.0%
NHS Nottingham City CCG 73.7%
NHS West London CCG 73.3%
NHS Central London (Westminster) CCG 73.3%
NHS South Manchester CCG 72.5%
NHS Brighton and Hove CCG 72.3%
NHS Central Manchester CCG 71.2%
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
WESTFIELD MEDICAL CENTRE F83602 29 WEST END LANE MEDICAL PRACTICE F83049 18 SOMERS TOWN MEDICAL CENTRE F83683 34 PRINCE OF WALES ROAD PRACTICE (GROUP) F83018 83 AMPTHILL PRACTICE F83006 85 • in total, including exceptions, there PRINCE OF WALES ROAD PRACTICE (SINGLE) F83677 9 are 1,375 people whose blood DALEHAM GARDENS HEALTH CENTRE F83633 12 CAVERSHAM GROUP PRACTICE F83022 71 pressure is not <= 140 / 85 ADELAIDE MEDICAL CENTRE F83020 92 • GP practice range: 11.5% to 59.2% HAMPSTEAD GROUP PRACTICE F83017 112 FORTUNE GREEN PRACTICE F83050 21 PARLIAMENT HILL SURGERY F83057 38 THE REGENTS PARK PRACTICE F83025 37 JAMES WIGG GROUP PRACTICE F83023 102 CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 2 BRONDESBURY MEDICAL CENTRE F83059 106 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 30 CHOMLEY GARDENS SURGERY F83615 40 ABBEY MEDICAL CENTRE F83019 81 KINGS CROSS ROAD PRACTICE F83635 9 MUSEUM PRACTICE F83061 13 PARK END SURGERY F83003 46 SWISS COTTAGE SURGERY F83665 48 PRIMROSE HILL SURGERY F83011 35 WEST HAMPSTEAD MEDICAL CENTRE F83055 50 GOWER PLACE PRACTICE F83043 5 BROOKFIELD PARK SURGERY F83052 22 GOWER STREET PRACTICE F83005 7 QUEENS CRESCENT SURGERY F83632 14 KEATS GROUP PRACTICE F83623 44 HOLBORN MEDICAL CENTRE F83058 20 GRAY'S INN ROAD MEDICAL CENTRE F83042 16 FOUR TREES SURGERY F83030 11 BRUNSWICK MEDICAL CENTRE UHPC F83048 15 ROSSLYN HILL SURGERY F83682 7 THE BLOOMSBURY SURGERY F83044 11 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
59 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2014/15 – opportunities compared to GP cluster
10% 5% 0% -5% -10% -15% -20% -25%
SOMERS TOWN MEDICAL CENTRE 19
PRINCE OF WALES ROAD PRACTICE (GROUP) 45
AMPTHILL PRACTICE 43 • using the GP cluster method of PRINCE OF WALES ROAD PRACTICE (SINGLE) 4 calculating potential gains, if each CAVERSHAM GROUP PRACTICE 32 practice was to achieve as well as the ADELAIDE MEDICAL CENTRE 41 upper quartile of its national cluster, then an additional 418 people would DALEHAM GARDENS HEALTH CENTRE 5 be treated FORTUNE GREEN PRACTICE 9
PARLIAMENT HILL SURGERY 16
THE REGENTS PARK PRACTICE 15
QUEENS CRESCENT SURGERY 2
GRAY'S INN ROAD MEDICAL CENTRE 2
GOWER STREET PRACTICE 1
SWISS COTTAGE SURGERY 4
HOLBORN MEDICAL CENTRE 2
FOUR TREES SURGERY
BRUNSWICK MEDICAL CENTRE UHPC
KEATS GROUP PRACTICE
ROSSLYN HILL SURGERY
THE BLOOMSBURY 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% • 5,458 people with CKD (diagnosed*) in NHS Camden CCG • 4,305 (78.9%) people who have a NHS Islington CCG 77.2% record of urine albumin:creatinine ratio test • 227 (4.2%) people who are NHS Barnet CCG 76.3% exceptions • 926 (17%) 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 Central Manchester CCG 79.8%
NHS Camden CCG 78.9%
NHS Islington CCG 77.2%
NHS Southampton CCG 77.1%
NHS Bristol CCG 76.8%
NHS Nottingham City CCG 76.2%
NHS Portsmouth CCG 75.3%
NHS Brighton and Hove CCG 73.8%
NHS Central London (Westminster) CCG 73.5%
NHS West London CCG 73.5%
NHS South Manchester CCG 71.9%
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
WEST END LANE MEDICAL PRACTICE F83049 32 PRINCE OF WALES ROAD PRACTICE (SINGLE) F83677 14 WESTFIELD MEDICAL CENTRE F83602 12 QUEENS CRESCENT SURGERY F83632 23 GOWER PLACE PRACTICE F83043 7 • in total, including exceptions, there ABBEY MEDICAL CENTRE F83019 90 are 1,153 people who have no record CAVERSHAM GROUP PRACTICE F83022 63 AMPTHILL PRACTICE F83006 67 of urine albumin:creatinine ratio test DALEHAM GARDENS HEALTH CENTRE F83633 10 • GP practice range: 0.0% to 91.4% FOUR TREES SURGERY F83030 18 CHOMLEY GARDENS SURGERY F83615 40 HAMPSTEAD GROUP PRACTICE F83017 96 GRAY'S INN ROAD MEDICAL CENTRE F83042 20 HOLBORN MEDICAL CENTRE F83058 24 JAMES WIGG GROUP PRACTICE F83023 86 PRINCE OF WALES ROAD PRACTICE (GROUP) F83018 52 GOWER STREET PRACTICE F83005 8 WEST HAMPSTEAD MEDICAL CENTRE F83055 49 ADELAIDE MEDICAL CENTRE F83020 66 BRONDESBURY MEDICAL CENTRE F83059 85 THE REGENTS PARK PRACTICE F83025 28 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 24 PARLIAMENT HILL SURGERY F83057 27 KEATS GROUP PRACTICE F83623 41 FORTUNE GREEN PRACTICE F83050 13 PRIMROSE HILL SURGERY F83011 27 BROOKFIELD PARK SURGERY F83052 18 SOMERS TOWN MEDICAL CENTRE F83683 15 KINGS CROSS ROAD PRACTICE F83635 6 SWISS COTTAGE SURGERY F83665 32 THE BLOOMSBURY SURGERY F83044 13 MUSEUM PRACTICE F83061 7 PARK END SURGERY F83003 23 BRUNSWICK MEDICAL CENTRE UHPC F83048 11 ROSSLYN HILL SURGERY F83682 6 CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 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 0.64% in NHS Camden 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 South Manchester CCG 0.65%
NHS Camden CCG 0.64%
NHS Bristol CCG 0.64%
NHS Portsmouth CCG 0.64%
NHS Southampton CCG 0.59%
NHS Central Manchester CCG 0.55%
NHS Nottingham City CCG 0.54%
NHS Brighton and Hove CCG 0.53%
NHS Islington CCG 0.49%
NHS Central London (Westminster) CCG 0.44%
NHS West London CCG 0.40%
0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7%
67 CVD: Primary Care Intelligence Packs Heart failure prevalence by GP practice
GP practice CCG
SOMERS TOWN MEDICAL CENTRE F83683 1.2% FOUR TREES SURGERY F83030 1.1% PRINCE OF WALES GROUP SURGERY F83018 1.1% BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 1.0% • 1,640 people with diagnosed heart AMPTHILL PRACTICE F83006 1.0% QUEENS CRESCENT PRACTICE F83632 0.9% failure in NHS Camden CCG HAMPSTEAD GROUP PRACTICE F83017 0.9% • GP practice range: 0.1% to 1.2% PARK END SURGERY F83003 0.8% KEATS GROUP PRACTICE F83623 0.8% ABBEY MEDICAL CENTRE F83019 0.8% THE REGENTS PARK PRACTICE F83025 0.8% PARLIAMENT HILL SURGERY F83057 0.7% BRONDESBURY MEDICAL CENTRE F83059 0.7% PRIMROSE HILL SURGERY F83011 0.7% ADELAIDE MEDICAL CENTRE F83020 0.7% MUSEUM PRACTICE F83061 0.7% BRUNSWICK MEDICAL CENTRE UHPC F83048 0.7% SWISS COTTAGE SURGERY F83665 0.6% ROSSLYN HILL SURGERY F83682 0.6% BROOKFIELD PARK SURGERY F83052 0.6% FORTUNE GREEN ROAD SURGERY F83050 0.6% HOLBORN MEDICAL CENTRE F83058 0.6% DALEHAM GARDENS HEALTH CENTRE F83633 0.6% JAMES WIGG PRACTICE F83023 0.5% CHOLMLEY GARDENS SURGERY F83615 0.5% CAVERSHAM GROUP PRACTICE F83022 0.5% WEST HAMPSTEAD MEDICAL CENTRE F83055 0.5% THE BLOOMSBURY SURGERY F83044 0.5% KINGS CROSS SURGERY F83635 0.5% THE MATTHEWMAN PRACTICE F83677 0.5% CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 0.4% GRAY'S INN ROAD MEDICAL CENTRE F83042 0.4% GOWER STREET PRACTICE F83005 0.2% RIDGMOUNT PRACTICE F83043 0.1% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4%
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% • 993 people with heart failure* with LVSD in NHS Camden CCG • 830 (83.6%) people treated with ACE- NHS Camden CCG 83.6% I or ARB • 160 (16.1%) people who are exceptions NHS Haringey CCG 83.3% • 3 (0.3%) 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 Nottingham City CCG 89.1%
NHS South Manchester CCG 86.9%
NHS Portsmouth CCG 86.6%
NHS Central Manchester CCG 86.3%
NHS Central London (Westminster) CCG 86.0%
NHS Bristol CCG 83.6%
NHS Camden CCG 83.6%
NHS Southampton CCG 83.0%
NHS West London CCG 82.7%
NHS Islington CCG 81.7%
NHS Brighton and Hove CCG 81.3%
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
BROOKFIELD PARK SURGERY F83052 5 MUSEUM PRACTICE F83061 5 DALEHAM GARDENS HEALTH CENTRE F83633 2 CHOLMLEY GARDENS SURGERY F83615 7 • in total, including exceptions, there ADELAIDE MEDICAL CENTRE F83020 11 THE REGENTS PARK PRACTICE F83025 6 are 163 people who are not treated PARK END SURGERY F83003 7 with ACE-I or ARB WEST HAMPSTEAD MEDICAL CENTRE F83055 7 KEATS GROUP PRACTICE F83623 12 • GP practice range: 0.0% to 33.3% BRUNSWICK MEDICAL CENTRE UHPC F83048 4 HOLBORN MEDICAL CENTRE F83058 6 FOUR TREES SURGERY F83030 2 AMPTHILL PRACTICE F83006 7 CAVERSHAM GROUP PRACTICE F83022 9 BRONDESBURY MEDICAL CENTRE F83059 14 SOMERS TOWN MEDICAL CENTRE F83683 4 PRINCE OF WALES GROUP SURGERY F83018 9 PARLIAMENT HILL SURGERY F83057 5 PRIMROSE HILL SURGERY F83011 4 HAMPSTEAD GROUP PRACTICE F83017 12 JAMES WIGG PRACTICE F83023 8 SWISS COTTAGE SURGERY F83665 5 QUEENS CRESCENT PRACTICE F83632 2 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 3 ROSSLYN HILL SURGERY F83682 1 ABBEY MEDICAL CENTRE F83019 5 THE BLOOMSBURY SURGERY F83044 1 GOWER STREET PRACTICE F83005 GRAY'S INN ROAD MEDICAL CENTRE F83042 RIDGMOUNT PRACTICE F83043 FORTUNE GREEN ROAD SURGERY F83050 KINGS CROSS SURGERY F83635 THE MATTHEWMAN PRACTICE F83677 CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 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% • 830 people with heart failure* with LVSD treated with ACE-I/ARB in NHS Camden CCG NHS Haringey CCG 81.4% • 641 (77.2%) people treated with ACE- I/ARB and BB • 162 (19.5%) people who are NHS Enfield CCG 79.9% exceptions • 27 (3.3%) 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 South Manchester CCG 88.4%
NHS Central Manchester CCG 87.1%
NHS Portsmouth CCG 85.5%
NHS Islington CCG 82.9%
NHS Bristol CCG 81.2%
NHS Southampton CCG 78.6%
NHS Camden CCG 77.2%
NHS Brighton and Hove CCG 75.6%
NHS West London CCG 73.4%
NHS Nottingham City CCG 71.9%
NHS Central London (Westminster) CCG 71.7%
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
RIDGMOUNT PRACTICE F83043 2 KEATS GROUP PRACTICE F83623 20 KINGS CROSS SURGERY F83635 2 PRIMROSE HILL SURGERY F83011 8 • in total, including exceptions, there FOUR TREES SURGERY F83030 3 PARLIAMENT HILL SURGERY F83057 9 are 189 people who are not treated MUSEUM PRACTICE F83061 3 with ACE-I or ARB SWISS COTTAGE SURGERY F83665 11 THE MATTHEWMAN PRACTICE F83677 2 • GP practice range: 0.0% to 50.0% SOMERS TOWN MEDICAL CENTRE F83683 6 ADELAIDE MEDICAL CENTRE F83020 10 BRONDESBURY MEDICAL CENTRE F83059 19 HAMPSTEAD GROUP PRACTICE F83017 18 PARK END SURGERY F83003 6 THE BLOOMSBURY SURGERY F83044 3 WEST HAMPSTEAD MEDICAL CENTRE F83055 6 JAMES WIGG PRACTICE F83023 11 ABBEY MEDICAL CENTRE F83019 9 BROOKFIELD PARK SURGERY F83052 2 DALEHAM GARDENS HEALTH CENTRE F83633 1 BRUNSWICK MEDICAL CENTRE UHPC F83048 3 HOLBORN MEDICAL CENTRE F83058 4 CHOLMLEY GARDENS SURGERY F83615 3 AMPTHILL PRACTICE F83006 5 THE REGENTS PARK PRACTICE F83025 3 PRINCE OF WALES GROUP SURGERY F83018 7 CAVERSHAM GROUP PRACTICE F83022 6 QUEENS CRESCENT PRACTICE F83632 2 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 3 FORTUNE GREEN ROAD SURGERY F83050 1 GOWER STREET PRACTICE F83005 1 GRAY'S INN ROAD MEDICAL CENTRE F83042 ROSSLYN HILL SURGERY F83682 CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 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% • 3,944 people with coronary heart disease* in NHS Camden CCG • 3,490 (88.5%) people whose blood NHS Camden CCG 88.5% pressure <= 150 / 90 • 127 (3.2%) people who are exceptions NHS Barnet CCG 87.9% • 327 (8.3%) 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 Portsmouth CCG 88.5%
NHS Southampton CCG 88.5%
NHS Camden CCG 88.5%
NHS Nottingham City CCG 88.0%
NHS Central Manchester CCG 87.8%
NHS Islington CCG 87.2%
NHS Bristol CCG 86.9%
NHS West London CCG 86.5%
NHS Central London (Westminster) CCG 86.3%
NHS South Manchester CCG 83.5%
NHS Brighton and Hove CCG 83.0%
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
CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 4 SOMERS TOWN MEDICAL CENTRE F83683 23 PRIMROSE HILL SURGERY F83011 20 WEST HAMPSTEAD MEDICAL CENTRE F83055 32 • in total, including exceptions, there KINGS CROSS SURGERY F83635 8 PRINCE OF WALES GROUP SURGERY F83018 30 are 454 people whose blood pressure AMPTHILL PRACTICE F83006 26 is not <= 150 / 90 JAMES WIGG PRACTICE F83023 43 QUEENS CRESCENT PRACTICE F83632 8 • GP practice range: 0.0% to 33.3% FORTUNE GREEN ROAD SURGERY F83050 11 CAVERSHAM GROUP PRACTICE F83022 28 PARK END SURGERY F83003 18 CHOLMLEY GARDENS SURGERY F83615 13 SWISS COTTAGE SURGERY F83665 16 BRONDESBURY MEDICAL CENTRE F83059 31 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 8 HAMPSTEAD GROUP PRACTICE F83017 27 FOUR TREES SURGERY F83030 5 THE REGENTS PARK PRACTICE F83025 13 GRAY'S INN ROAD MEDICAL CENTRE F83042 6 ADELAIDE MEDICAL CENTRE F83020 18 KEATS GROUP PRACTICE F83623 17 ABBEY MEDICAL CENTRE F83019 16 PARLIAMENT HILL SURGERY F83057 7 THE BLOOMSBURY SURGERY F83044 5 DALEHAM GARDENS HEALTH CENTRE F83633 3 HOLBORN MEDICAL CENTRE F83058 5 BROOKFIELD PARK SURGERY F83052 4 MUSEUM PRACTICE F83061 3 THE MATTHEWMAN PRACTICE F83677 1 BRUNSWICK MEDICAL CENTRE UHPC F83048 3 GOWER STREET PRACTICE F83005 1 ROSSLYN HILL SURGERY F83682 1 RIDGMOUNT PRACTICE F83043 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%
SOMERS TOWN MEDICAL CENTRE 18
PRIMROSE HILL SURGERY 13
WEST HAMPSTEAD MEDICAL CENTRE 21 • using the GP cluster method of KINGS CROSS SURGERY 5 calculating potential gains, if each PRINCE OF WALES GROUP SURGERY 18 practice was to achieve as well as the AMPTHILL PRACTICE 15 upper quartile of its national cluster, then an additional 193 people would QUEENS CRESCENT PRACTICE 5 be treated FORTUNE GREEN ROAD SURGERY 6
CAVERSHAM GROUP PRACTICE 15
CHOLMLEY GARDENS SURGERY 6
HOLBORN MEDICAL CENTRE 0
BROOKFIELD PARK SURGERY
KEATS GROUP PRACTICE
DALEHAM GARDENS HEALTH CENTRE
MUSEUM PRACTICE
THE MATTHEWMAN PRACTICE
BRUNSWICK MEDICAL CENTRE UHPC
GOWER STREET PRACTICE
ROSSLYN HILL SURGERY
RIDGMOUNT PRACTICE 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% • 3,944 people with coronary heart disease* in NHS Camden CCG • 3,653 (92.6%) people who are taking NHS Camden CCG 92.6% aspirin, an alternative anti-platelet therapy, or an anti-coagulant • 176 (4.5%) people who are NHS Islington CCG 92.0% exceptions • 115 (2.9%) 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 Central Manchester CCG 93.4%
NHS Camden CCG 92.6%
NHS Southampton CCG 92.6%
NHS Islington CCG 92.0%
NHS Bristol CCG 91.8%
NHS Nottingham City CCG 91.3%
NHS South Manchester CCG 90.5%
NHS Portsmouth CCG 89.5%
NHS Brighton and Hove CCG 89.4%
NHS Central London (Westminster) CCG 89.1%
NHS West London CCG 88.4%
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
CAMDEN HEALTH IMPROVEMENT PRACTICE Y02674 4 WEST HAMPSTEAD MEDICAL CENTRE F83055 39 HAMPSTEAD GROUP PRACTICE F83017 34 THE MATTHEWMAN PRACTICE F83677 3 • in total, including exceptions, there QUEENS CRESCENT PRACTICE F83632 7 PRIMROSE HILL SURGERY F83011 13 are 291 people are not taking aspirin, PARK END SURGERY F83003 15 an alternative anti-platelet therapy, or DALEHAM GARDENS HEALTH CENTRE F83633 5 THE BLOOMSBURY SURGERY F83044 7 an anti-coagulant MUSEUM PRACTICE F83061 7 • GP practice range: 0.0% to 33.3% AMPTHILL PRACTICE F83006 16 SOMERS TOWN MEDICAL CENTRE F83683 7 ADELAIDE MEDICAL CENTRE F83020 18 KEATS GROUP PRACTICE F83623 17 ABBEY MEDICAL CENTRE F83019 16 PRINCE OF WALES GROUP SURGERY F83018 13 JAMES WIGG PRACTICE F83023 19 FOUR TREES SURGERY F83030 3 BROOKFIELD PARK SURGERY F83052 4 CHOLMLEY GARDENS SURGERY F83615 6 KINGS CROSS SURGERY F83635 3 GRAY'S INN ROAD MEDICAL CENTRE F83042 4 RIDGMOUNT PRACTICE F83043 1 HOLBORN MEDICAL CENTRE F83058 4 THE REGENTS PARK PRACTICE F83025 6 PARLIAMENT HILL SURGERY F83057 3 ROSSLYN HILL SURGERY F83682 1 CAVERSHAM GROUP PRACTICE F83022 6 BELSIZE PRIORY MEDICAL PRACTICE (GROUP) F83658 2 BRUNSWICK MEDICAL CENTRE UHPC F83048 2 SWISS COTTAGE SURGERY F83665 3 FORTUNE GREEN ROAD SURGERY F83050 1 BRONDESBURY MEDICAL CENTRE F83059 2 GOWER STREET PRACTICE F83005 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 Camden CCG England 800
700 • in NHS Camden CCG, the hospital admission rate for coronary heart disease in 2015/16 was 321.7 (503) 600 compared to 527.9 for England
500
400
300
Age Age standardised (per rate 100,000) 200
100
0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved
83 CVD: Primary Care Intelligence Packs Hospital admissions for stroke for all ages 2002/03 – 2015/16
NHS Camden CCG England 250
• in NHS Camden CCG, the hospital admission rate for stroke in 2015/16 200 was 184 (278) compared to 172.8 for England
150
100 Age standardised standardised Age (per rate 100,000)
50
0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/132013/142014/152015/16 Source: Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved
84 CVD: Primary Care Intelligence Packs Additional risk of complications for people with diabetes, three year follow up, 2013/14
NHS Camden CCG England
231.9% Angina 136.8% • The risk of a stroke was 187.9% higher and the risk of a heart attack 277.1% was 277.1% higher compared to Heart Attack 108.6% people without diabetes. The risk of a major amputation was 822% higher. 237.8% Heart failure 150.0%
187.9% Stroke 81.3%
822.0% Major amputation 445.8%
1459.9% Minor amputation 753.5%
542.8% RRT 293.0%
0% 200% 400% 600% 800% 1000% 1200% 1400% 1600% Note: This slide uses data from the National Diabetes Audit (NDA)
85 CVD: Primary Care Intelligence Packs Deaths from coronary heart disease, under 75s
NHS Camden CCG England 100
90 • in NHS Camden CCG, the early mortality rate for coronary heart 80 disease in 2013-15 was 31.2, compared to 40.6 for England 70
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 Camden CCG England 30
• in NHS Camden CCG, the early 25 mortality rate for stroke in 2013-15 was 13, compared to 13.6 for England
20
15
10 Age Age standardised (per rate 100,000)
5
0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15
Source: Office for National Statistics (ONS) mortality data 2002 - 2015
87 CVD: Primary Care Intelligence Packs Appendix Data sources
• Quality and Outcomes Framework (QOF), 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved
• Non-diabetic hyperglycaemia prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/nhs-diabetes- prevention-programme-non-diabetic-hyperglycaemia
• Diabetes prevalence estimates, NCVIN, PHE: https://www.gov.uk/government/publications/diabetes-prevalence-estimates-for- local-populations
• CKD Prevalence model, G.Aitken, University of Southampton , 2014 https://www.gov.uk/government/publications/ckd- prevalence-estimates-for-local-and-regional-populations
• Hypertension prevalence estimates for local CCG populations. Created using data from: QOF hypertension registers 2014/15 and; Undiagnosed hypertension estimates for adults 16 years and older. 2014. Department of Primary Care & Public Health, Imperial College London https://www.gov.uk/government/publications/hypertension-prevalence-estimates-for-local-populations
• NHS Stop smoking services Copyright © 2014, NHS Digital
• Norberg J, Bäckström S , Jansson J-H, Johansson L. Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clin Epidemiol 2013 ; 5 475 – 81.
• National Diabetes Audit, 2013/14 and 2015/16, Copyright © 2016, re-used with the permission of NHS Digital. All rights reserved
• Hospital Episode Statistics (HES), 2002/03 - 2015/16, Copyright © 2017, Re‐used with the permission of NHS Digital. All rights reserved
• Office for National Statistics (ONS) mortality data 2002 – 2015, Copyright © 2017, Re-used with the permission of the Office for National Statistics. All rights reserved
88 CVD: Primary Care Intelligence Packs About Public Health England
Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health, and are a distinct delivery organisation with operational autonomy to advise and support government, local authorities and the NHS in a professionally independent manner.
Public Health England Wellington House 133-155 Waterloo Road London SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland
© 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
89