CVD: Primary Care Intelligence Packs CCG: NHS Kernow CCG
April 2016 Version 1.0 Contents
1. Introduction 3
2. CVD prevention • The narrative 9 • The data 11 3. Hypertension • The narrative 18 • The data 19 4. Stroke • The narrative 30 • The data 31 5. Diabetes • The narrative 44 • The data 45 6. Kidney • The narrative 52 • The data 53 7. Heart • The narrative 63 • The data 64 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 Every year in England there are around 150,000 premature deaths. A quarter of premature deaths are due to cardiovascular disease. Two thirds of premature deaths could be avoided through improved prevention, earlier detection and better treatment. High quality primary care is crucial for 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 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 and what average or below average achievers 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 AF, diabetes, kidney and 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, use of audit tools to get a better understanding of the gaps in care and outcomes, agreeing local protocols and consensus approaches, assessing training and education needs, and exploring new ways of delivering care.
5 CVD: Primary Care Intelligence Packs Data and methods
This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic clinical network (SCN) and England. Where a CCG is in more than one SCN, it has been allocated to the SCN 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 Kernow CCG are: NHS Somerset CCG NHS Cumbria CCG NHS Coastal West Sussex CCG NHS Gloucestershire CCG NHS Dorset CCG NHS West Hampshire CCG NHS Northumberland CCG NHS East Riding of Yorkshire CCG NHS North East Essex CCG NHS Ipswich and East Suffolk CCG
The majority of data used in the packs are taken from the 2014/15 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 2014/15 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 (i.e. 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 The variation that exists between is that it does not tell us why there is variation. Some of demographically similar CCGs and the variation may be explained by population or case mix and some may be unwarranted – we will not know between practices illustrates the unless we investigate. local 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 exception reporting and outcomes? some variation is inevitable in the healthcare and 2. How many people would benefit if average performers outcomes experienced by patients. improved to the level of the best performers? But John Wennberg, who has championed 3. How many people would benefit if the lowest performers research into clinical variation over four decades matched the achievement of the average? and who founded the pioneering Dartmouth Atlas 4. What are better performers doing differently in the way of Health Care, concluded that much variation is they provide services in order to achieve better outcomes? unwarranted – i.e. it cannot be explained on the 5. How can the CCG support low and average performers to basis of illness, medical evidence, or patient help them match the achievement of the best? preference but is accounted for by the willingness 6. How can we build clinical leadership to drive quality and ability of doctors 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 allows us to identify the practices that need support to implement the strategies adopted by low excepting practices. CVD Prevention
8 CVD: Primary Care Intelligence Packs CVD Prevention
“The NHS needs a radical upgrade in prevention if it is to be The size of the prevention problem sustainable” • 2/3 of people are obese or overweight 5 year Forward View 2014 • 1/3 of people are physically inactive • 20% of people smoke but this rises to over 50% in some communities • Evidence based interventions are effective in This is because England faces an epidemic of largely tackling these behavioural risk factors preventable non-communicable diseases, such as heart disease and stroke, cancer, Type 2 diabetes and liver disease. • Thousands of people in every CCG have undiagnosed or undertreated physiological
Dietary risks risk factors such as hypertension, atrial Tobacco smoke High body-mass index fibrillation, chronic kidney disease, diabetes High systolic blood pressure Alcohol and drug use HIV/AIDS and tuberculosis and non-diabetic hyperglycaemia 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 Cardiovascular diseases Air pollution Chronic respiratory diseases Cirrhosis Low bone mineral density Digestive diseases Neurological disorders Child and maternal malnutrition Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases The NHS Health Check is a systematic Sexual abuse and violence Musculoskeletal disorders Other environmental risks Other non-communicable diseases Transport injuries Unsafe sex Unintentional injuries approach to identifying local people at high risk Self-harm and interpersonal violence Unsafe water/ sanitation/ handwashing Forces of nature, war, & legal intervention of CVD, offering behaviour change support and 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% Percent of total disability-adjusted life-years (DALYs) early detection of hypertension, CKD, diabetes The Global Burden of Disease Study (next slide) shows us that and pre-diabetes. Modelling suggests that high the leading causes of premature mortality include diet, tobacco, uptake will lead to substantial reductions in obesity, raised blood pressure, physical inactivity and raised premature mortality. cholesterol. The radical upgrade in prevention needs Question: What proportion of our local eligible population-level approaches. But it also needs ongoing population is receiving the NHS Health Check behaviour change support and medical treatment for individuals and how effective is their follow-up management during their frequent contacts with primary care. of risk factors in primary care? Global Burden of Disease Study 2013 Leading causes of premature death and disability in England Expressed as a percentage of disability-adjusted life-years
Dietary risks Tobacco smoke High body-mass index High systolic blood pressure Alcohol and drug use 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 Cardiovascular diseases Air pollution Chronic respiratory diseases Cirrhosis Low bone mineral density Digestive diseases Neurological disorders Child and maternal malnutrition Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases Sexual abuse and violence Musculoskeletal disorders Other environmental risks Other non-communicable diseases Transport injuries Unsafe sex Unintentional injuries 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%
Percent of total disability-adjusted life-years (DALYs) Estimated smoking prevalence (QOF) by CCG
Comparison with demographically similar CCGs
NHS North East Essex CCG 19.3%
NHS Kernow CCG 18.8% • Prevalence of 18.8% in NHS Kernow CCG NHS Somerset CCG 18.0%
NHS Cumbria CCG 17.7%
NHS Ipswich and East Suffolk CCG 17.3%
NHS Coastal West Sussex CCG 17.2%
NHS Dorset CCG 16.9%
NHS Northumberland CCG 16.7% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Gloucestershire CCG 16.4% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS East Riding of Yorkshire CCG 15.8% http://bmjopen.bmj.com/content/4/7/e005217.abs tract
NHS West Hampshire CCG 14.6% 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+
11 CVD: Primary Care Intelligence Packs Estimated smoking prevalence (QOF) by GP practice
GP Practice CCG
Cardrew Health Centre Y02596 26.8% Trevithick Surgery L82014 26.7% The Clays Practice L82051 25.8% Morrab Surgery Y01051 25.3% Newquay Health Centre Y02517 24.8% Pool Health Centre L82041 23.8% Stillmoor House Medical Practice L82010 23.8% The Alverton Practice L82021 23.2% The Park Medical Centre L82019 23.2% • 87,632 people who are recorded as Penalverne Surgery L82053 23.1% Manor Surgery L82042 22.1% Veor Surgery L82044 21.8% smokers in NHS Kernow CCG Rosmellyn Surgery Y01050 21.7% Middleway Surgery L82026 21.4% Phoenix Surgery L82617 21.4% • GP practice range: 10.2% to 26.8% Falmouth Health Centre L82049 21.2% Narrowcliff Surgery L82029 20.8% Clinton Road Surgery L82024 20.6% Polkyth Surgery Y04694 20.2% Rosedean House Surgery L82050 19.9% Harris Memorial & Lanner Surgeries L82620 19.9% Sunnyside Surgery L82070 19.9% Woodland Road Surgery L82040 19.8% Carnewater Practice L82009 19.7% Petroc Group Practice L82023 19.6% Churchfield Practice L82618 19.4% Neetside Surgery Y01127 19.3% Old Bridge Surgery L82022 19.2% Launceston Medical Centre L82030 19.1% Brannel Surgery L82011 19.1% Homecroft Surgery L82002 19.0% Millbrook Surgery L82621 18.8% Helston Medical Centre L82018 18.7% St Agnes & Mount Hawke Surgeries L82054 18.5% Fowey River Practice L82035 18.5% Isles Of Scilly Health Centre L82017 18.5% Bottreaux Surgery L82058 18.4% Westover Surgery L82622 18.3% Oak Tree Surgery L82016 18.3% Cape Cornwall Surgery L82038 18.3% The Rame Group Practice Y00969 18.2% Wheal Northey Surgery L82611 17.8% Trescobeas Surgery L82052 17.7% Bodriggy Health Centre L82036 17.7% The Stennack Surgery Y01922 17.6% Camelford Medical Centre L82007 17.5% Penryn Surgery L82006 17.4% Saltash Health Centre L82046 17.2% Praze Surgery L82068 17.0% Mevagissey Surgery L82025 16.9% St Keverne Health Centre L82057 16.9% Stratton Medical Centre L82008 16.5% Perranporth Surgery L82013 16.1% Chacewater And Devoran Surgeries L82015 15.9% Lander Medical Practice L82001 15.8% Tamar Valley Health L82012 15.5% Meneage Street Surgery L82059 15.4% Pensilva Health Centre L82037 15.3% Marazion Surgery L82047 15.2% Three Spires Medical Practice L82028 15.1% Note: This method is thought to be a reasonably Port Isaac Practice L82003 15.0% Mullion & Constantine Group Practice L82056 14.7% Wadebridge & Camel Estuary Practice L82004 14.2% robust method in estimating smoking prevalence Quay Lane Surgery L82043 14.0% Lostwithiel Medical Practice L82039 13.9% for the majority of GP practices. However, Port View Surgery L82066 13.7% Roseland Surgeries L82048 13.4% Probus & Grampound Surgeries L82045 12.4% caution is advised for extreme estimates of Carnon Downs Surgery L82061 10.2% smoking prevalence and those with high 0% 5% 10% 15% 20% 25% 30% numbers of smoking status not recorded and exceptions.
12 CVD: Primary Care Intelligence Packs Successful smoking quitters at 4 weeks, 2013/14
Comparison with CCGs in the SCN
NHS Swindon CCG 63.0%
NHS Gloucestershire CCG 61.4% • 59.7% successful smoking quitters at NHS Kernow CCG 59.7% 4 weeks in NHS Kernow CCG compared to 51.3% in England NHS Bath And North East Somerset CCG 57.9%
NHS South Devon And Torbay CCG 55.8%
NHS Wiltshire CCG 54.4%
NHS North Somerset CCG 52.0%
NHS Northern, Eastern And Western Devon CCG 48.8%
NHS South Gloucestershire CCG 45.7%
NHS Somerset CCG 43.7%
NHS Bristol CCG 42.9% Note: The local authority indicator, successful smoking quitters at 4 weeks from the Health and Social Care Information Centre, has been used as a basis for estimating CCG level smoking quitters. Where more than one local authority is England 51.3% contained within a CCG, the proportion of the local authority within the CCG has been 0% 10% 20% 30% 40% 50% 60% 70% allocated to the CCG and aggregated up to give CCG estimates.
13 CVD: Primary Care Intelligence Packs Excess weight (overweight or obese) in adults, 2012-2014
Comparison with CCGs in the SCN
NHS Swindon CCG 69.3%
NHS Kernow CCG 69.1% • 69.1% of adults with excess weight in NHS Somerset CCG 66.3% NHS Kernow CCG compared to 64.6% in England NHS South Devon And Torbay CCG 65.7%
NHS Gloucestershire CCG 65.3%
NHS Northern, Eastern And Western Devon CCG 64.1%
NHS Wiltshire CCG 63.6%
NHS South Gloucestershire CCG 63.2%
NHS North Somerset CCG 62.7%
NHS Bath And North East Somerset CCG 59.3%
NHS Bristol CCG 56.9% Note: Local authority prevalence estimates of excess weight from the Active People Survey, Sport England, have been used as a basis for estimating CCG level prevalence estimates of excess weight. Where more than one local England 64.6% authority is contained within a CCG, the proportion of the local authority within the CCG 0% 10% 20% 30% 40% 50% 60% 70% 80% has been allocated to the CCG and aggregated up to give CCG estimates.
14 CVD: Primary Care Intelligence Packs Percentage of inactive adults, 2014
Comparison with CCGs in the SCN
NHS Swindon CCG 30.7%
NHS South Devon And Torbay CCG 30.2% • 26.1% of adults who are inactive in NHS Somerset CCG 27.5% NHS Kernow CCG compared to 27.7% in England NHS South Gloucestershire CCG 27.5%
NHS Gloucestershire CCG 26.5%
NHS Kernow CCG 26.1%
NHS Northern, Eastern And Western Devon CCG 26.1%
NHS North Somerset CCG 24.6%
NHS Bristol CCG 22.8%
NHS Bath And North East Somerset CCG 22.4%
NHS Wiltshire CCG 21.4% Note: Local authority percentage estimates of inactive adults from the Active People Survey, Sport England, have been used as a basis for estimating CCG level percentage estimates of inactive adults. Where more than one local England 27.7% authority is contained within a CCG, the proportion of the local authority within the CCG 0% 5% 10% 15% 20% 25% 30% 35% has been allocated to the CCG and aggregated up to give CCG estimates.
15 CVD: Primary Care Intelligence Packs NHS Health Check offer and uptake, 2014/15
Comparison with CCGs in the SCN % of eligible people offered a NHS Health % of eligible people receiving a NHS check Health check • 100% of the eligible population should be invited NHS Bath And North East NHS Bath And North East 24.5% 12.2% Somerset CCG Somerset CCG for a Health Check over 5 years. NHS Gloucestershire CCG 24.4% NHS North Somerset CCG 9.8% • In 2014/15 10.5% of eligible people were offered a NHS NHS Wiltshire CCG 22.6% NHS Wiltshire CCG 9.6% Health Check in NHS NHS South Devon And Kernow CCG compared to NHS Swindon CCG 20.4% 9.1% Torbay CCG 19.7% in England NHS South Gloucestershire NHS North Somerset CCG 19.5% 9.1% CCG • 5.6% of eligible people NHS Northern, Eastern And NHS Bristol CCG 18.2% 9.1% received a NHS Health Western Devon CCG Check in NHS Kernow CCG NHS Northern, Eastern And 17.2% Western Devon CCG NHS Gloucestershire CCG 8.8% compared to 9.6% in England NHS South Devon And 16.8% Torbay CCG NHS Bristol CCG 7.9% NHS South Gloucestershire Note: Local authority indicators for 14.6% CCG NHS Somerset CCG 7.6% number of NHS Health Check offered and received have been used NHS Somerset CCG 13.2% NHS Swindon CCG 7.5% as a basis for estimating CCG level NHS Health Check offered and received. Where more than one NHS Kernow CCG 10.5% NHS Kernow CCG 5.6% local authority is contained within a CCG, the proportion of the local authority within the CCG has been allocated to the CCG and England 19.7% England 9.6% aggregated up to give CCG estimates. 0% 5% 10% 15% 20% 25% 30% 0% 2% 4% 6% 8% 10% 12% 14% 16 CVD: Primary Care Intelligence Packs Hypertension
17 CVD: Primary Care Intelligence Packs Hypertension
The Missing Millions The Global Burden of Disease On average each CCG in England has 25,000 residents with undiagnosed hypertension – these individuals are Study confirmed high blood unaware of their increased cardiovascular risk and are pressure as a leading cause of untreated. premature death and disability What questions should we ask in our CCG? 1. For each indicator how wide is the variation in High blood pressure is common and costly achievement and exception reporting? • It affects around a quarter of all adults 2. How many people would benefit if all practices • The NHS costs of hypertension are around £2bn performed as well as the best? • Social costs are probably considerably higher 3. How can we support practices who are average or below average to perform as well as the best in: • Detection of hypertension What do we know? • Management of hypertension • At least half of all heart attacks and strokes are caused by high blood pressure and it is a major risk factor for chronic kidney disease and cognitive What might help? decline • Support practices in systematic audit of detection and • Treatment is very effective at lowering blood management of hypertension. pressure and at improving outcomes • Work with practices and local authorities to maximise • Despite this 4 out of 10 adults with hypertension, uptake and follow up in the NHS Health Check around 5 million people in England, remain • Support access to self-test BP stations in waiting undiagnosed rooms and to ambulatory blood pressure monitoring. • And even when the condition is identified, treatment • Consider commissioning community pharmacists to is often suboptimal, with blood pressure poorly offer blood pressure checking and support for controlled in one in three individuals adherence to medication
18 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared to expected prevalence by CCG
Comparison with CCGs in the SCN
NHS Swindon CCG 0.60
NHS South Gloucestershire CCG 0.59
NHS North Somerset CCG 0.58 • 0.53 ratio of observed to expected hypertension prevalence in NHS NHS Somerset CCG 0.58 Kernow CCG compared to 0.56 in England. NHS Wiltshire CCG 0.58 • This suggests that 53% of people with hypertension have been diagnosed. NHS South Devon And Torbay CCG 0.56
NHS Northern, Eastern And Western Devon CCG 0.55
NHS Gloucestershire CCG 0.54
NHS Kernow CCG 0.53
NHS Bath And North East Somerset CCG 0.52
NHS Bristol CCG 0.49 Note: This slide compares the prevalence of hypertension recorded in QOF in 2014/15 to the expected prevalence of hypertension taken from England 0.56 the East of England Public Health Observatory modelled estimates produced in 2011. The 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 model was developed using data from the 2003- Ratio 2004 Health Surveys for England and takes into account age, sex, ethnicity, smoking status and deprivation.
19 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared to expected prevalence by CCG
Comparison with demographically similar CCGs
NHS Northumberland CCG 0.61
NHS East Riding of Yorkshire CCG 0.60
NHS North East Essex CCG 0.59
NHS Somerset CCG 0.58
NHS Cumbria CCG 0.56
NHS West Hampshire CCG 0.56
NHS Ipswich and East Suffolk CCG 0.55
NHS Coastal West Sussex CCG 0.55
NHS Gloucestershire CCG 0.54
NHS Dorset CCG 0.54
NHS Kernow CCG 0.53
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Ratio
20 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared to expected prevalence by GP practice
GP practice CCG
The Alverton Practice L82021 0.71 Old Bridge Surgery L82022 0.65 Helston Medical Centre L82018 0.64 Pensilva Health Centre L82037 0.64 Cape Cornwall Surgery L82038 0.62 Penalverne Surgery L82053 0.61 Veor Surgery L82044 0.61 Marazion Surgery L82047 0.60 Praze Surgery L82068 0.59 • It is estimated that there are 75,673 Woodland Road Surgery L82040 0.59 Probus & Grampound Surgeries L82045 0.59 Tamar Valley Health L82012 0.58 people with undiagnosed Fowey River Practice L82035 0.58 Stratton Medical Centre L82008 0.58 Pool Health Centre L82041 0.58 Phoenix Surgery L82617 0.58 hypertension in NHS Kernow CCG Manor Surgery L82042 0.57 Oak Tree Surgery L82016 0.57 Roseland Surgeries L82048 0.57 • GP practice range of observed to Carnewater Practice L82009 0.57 Perranporth Surgery L82013 0.57 Rosedean House Surgery L82050 0.56 expected hypertension prevalence The Rame Group Practice Y00969 0.56 Carnon Downs Surgery L82061 0.56 Middleway Surgery L82026 0.56 0.37 to 0.71 Bodriggy Health Centre L82036 0.56 Homecroft Surgery L82002 0.55 Mullion & Constantine Group Practice L82056 0.55 The Park Medical Centre L82019 0.55 Meneage Street Surgery L82059 0.55 Trevithick Surgery L82014 0.54 Wadebridge & Camel Estuary Practice L82004 0.54 Clinton Road Surgery L82024 0.54 Launceston Medical Centre L82030 0.54 The Stennack Surgery Y01922 0.54 Stillmoor House Medical Practice L82010 0.53 Bottreaux Surgery L82058 0.53 Petroc Group Practice L82023 0.53 Chacewater And Devoran Surgeries L82015 0.53 Three Spires Medical Practice L82028 0.52 Port View Surgery L82066 0.52 Millbrook Surgery L82621 0.52 St Keverne Health Centre L82057 0.52 Trescobeas Surgery L82052 0.51 Newquay Health Centre Y02517 0.50 Rosmellyn Surgery Y01050 0.50 Falmouth Health Centre L82049 0.49 Sunnyside Surgery L82070 0.49 Brannel Surgery L82011 0.49 Penryn Surgery L82006 0.49 Camelford Medical Centre L82007 0.49 Westover Surgery L82622 0.48 Isles Of Scilly Health Centre L82017 0.48 Narrowcliff Surgery L82029 0.47 Neetside Surgery Y01127 0.47 Morrab Surgery Y01051 0.47 Lander Medical Practice L82001 0.47 Wheal Northey Surgery L82611 0.46 Saltash Health Centre L82046 0.45 Quay Lane Surgery L82043 0.44 St Agnes & Mount Hawke Surgeries L82054 0.44 Churchfield Practice L82618 0.44 Port Isaac Practice L82003 0.43 Harris Memorial & Lanner Surgeries L82620 0.42 The Clays Practice L82051 0.42 Mevagissey Surgery L82025 0.42 Lostwithiel Medical Practice L82039 0.37 Cardrew Health Centre Y02596 0.37 Polkyth Surgery Y04694 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Ratio
21 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 SCN Below 150/90 Not below 150/90 Exceptions reported
NHS Swindon CCG 81.9%
NHS Gloucestershire CCG 81.5% • 86,127 people with hypertension (diagnosed)* in NHS Kernow CCG NHS South Gloucestershire CCG 81.5% • 70,081 (81.4%) people whose blood pressure is <= 150/90 NHS Kernow CCG 81.4% • 3,837 (4.5%) people who are excepted from optimal control NHS Bath And North East Somerset CCG 81.1% • 12,209 (14.2%) additional people whose blood pressure is not <= NHS Wiltshire CCG 80.9% 150/90 NHS Northern, Eastern And Western Devon CCG 80.2%
NHS Bristol CCG 79.5%
NHS North Somerset CCG 78.9%
NHS South Devon And Torbay CCG 78.0%
NHS Somerset CCG 75.9%
England 80.4%
0% 20% 40% 60% 80% 100% *Using QOF clinical indicator HYP006 denominator plus exceptions
22 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 Below 150/90 Not below 150/90 Exceptions reported
NHS Northumberland CCG 83.1%
NHS Gloucestershire CCG 81.5%
NHS Kernow CCG 81.4%
NHS Cumbria CCG 81.1%
NHS North East Essex CCG 80.5%
NHS East Riding of Yorkshire CCG 80.3%
NHS Ipswich and East Suffolk CCG 80.2%
NHS Dorset CCG 80.1%
NHS West Hampshire CCG 79.1%
NHS Coastal West Sussex CCG 77.0%
NHS Somerset CCG 75.9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
23 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
Polkyth Surgery Y04694 398 Veor Surgery L82044 473 The Rame Group Practice Y00969 455 Cardrew Health Centre Y02596 42 St Agnes & Mount Hawke Surgeries L82054 266 Roseland Surgeries L82048 172 Clinton Road Surgery L82024 153 Petroc Group Practice L82023 540 Penryn Surgery L82006 500 • In total, including exceptions, there The Park Medical Centre L82019 268 Woodland Road Surgery L82040 309 Perranporth Surgery L82013 263 are 16,046 people whose blood Port View Surgery L82066 220 Trevithick Surgery L82014 152 pressure is not <= 150/90 Newquay Health Centre Y02517 418 Rosmellyn Surgery Y01050 189 Pensilva Health Centre L82037 200 • GP practice range: 8.9% to 40.9% Launceston Medical Centre L82030 570 Chacewater And Devoran Surgeries L82015 188 Morrab Surgery Y01051 177 • If all practices were to achieve as well Homecroft Surgery L82002 202 St Keverne Health Centre L82057 101 Quay Lane Surgery L82043 122 as the average of the best achieving Rosedean House Surgery L82050 282 Wheal Northey Surgery L82611 228 Praze Surgery L82068 184 practices, then an additional 2,859 Wadebridge & Camel Estuary Practice L82004 245 Lander Medical Practice L82001 364 Marazion Surgery L82047 267 people would have their hypertension Port Isaac Practice L82003 215 Brannel Surgery L82011 117 Narrowcliff Surgery L82029 299 controlled Carnon Downs Surgery L82061 191 Fowey River Practice L82035 229 The Alverton Practice L82021 247 Old Bridge Surgery L82022 393 Carnewater Practice L82009 312 Trescobeas Surgery L82052 243 Middleway Surgery L82026 183 Penalverne Surgery L82053 158 Manor Surgery L82042 324 Oak Tree Surgery L82016 312 The Stennack Surgery Y01922 356 Westover Surgery L82622 153 Sunnyside Surgery L82070 154 Lostwithiel Medical Practice L82039 93 Tamar Valley Health L82012 460 Bodriggy Health Centre L82036 271 Falmouth Health Centre L82049 196 The Clays Practice L82051 188 Harris Memorial & Lanner Surgeries L82620 102 Probus & Grampound Surgeries L82045 234 Mullion & Constantine Group Practice L82056 219 Stillmoor House Medical Practice L82010 232 Mevagissey Surgery L82025 111 Cape Cornwall Surgery L82038 145 Helston Medical Centre L82018 363 Meneage Street Surgery L82059 133 Neetside Surgery Y01127 88 Saltash Health Centre L82046 234 Isles Of Scilly Health Centre L82017 42 Three Spires Medical Practice L82028 297 Phoenix Surgery L82617 122 Bottreaux Surgery L82058 121 Camelford Medical Centre L82007 62 Millbrook Surgery L82621 49 Pool Health Centre L82041 217 Churchfield Practice L82618 52 Stratton Medical Centre L82008 181 0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
24 CVD: Primary Care Intelligence Packs The percentage of patients aged 79 or under with hypertension in whom the last recorded blood pressure reading (measured in the preceding 9 months) is 140/90 mmHg or less by GP practice
Treated No treatment Exceptions reported
Stratton Medical Centre L82008 83.4% Isles Of Scilly Health Centre L82017 76.8% Bodriggy Health Centre L82036 70.9% Pool Health Centre L82041 70.3% Meneage Street Surgery L82059 69.9% Neetside Surgery Y01127 68.1% Harris Memorial & Lanner Surgeries L82620 68.1% Carnewater Practice L82009 66.9% Sunnyside Surgery L82070 66.2% • All practices were invited to provide Three Spires Medical Practice L82028 65.8% Lostwithiel Medical Practice L82039 65.2% Churchfield Practice L82618 63.4% retired QOF data to the HSCIC Port Isaac Practice L82003 63.0% Middleway Surgery L82026 62.5% showing the number of patients with Mevagissey Surgery L82025 62.5% Phoenix Surgery L82617 62.3% Rosedean House Surgery L82050 62.2% hypertension achieving the NICE The Alverton Practice L82021 61.8% Falmouth Health Centre L82049 61.4% The Stennack Surgery Y01922 61.4% recommended treatment target of Manor Surgery L82042 61.1% Homecroft Surgery L82002 60.9% Penalverne Surgery L82053 60.0% 140/90 mmHg. Bottreaux Surgery L82058 60.0% Carnon Downs Surgery L82061 59.3% Stillmoor House Medical Practice L82010 58.8% Tamar Valley Health L82012 58.7% Probus & Grampound Surgeries L82045 58.4% • In NHS Kernow CCG, 59 out of 69 Oak Tree Surgery L82016 57.7% Marazion Surgery L82047 57.2% Trevithick Surgery L82014 57.0% (85.5%) practices agreed to provide Chacewater And Devoran Surgeries L82015 56.7% St Keverne Health Centre L82057 56.7% Rosmellyn Surgery Y01050 56.4% this data. Westover Surgery L82622 56.1% Lander Medical Practice L82001 56.1% Cape Cornwall Surgery L82038 56.1% Brannel Surgery L82011 55.5% Old Bridge Surgery L82022 55.4% • Across these 59 practices, there are Newquay Health Centre Y02517 54.4% Praze Surgery L82068 54.3% 21,405 people whose blood pressure Narrowcliff Surgery L82029 54.1% Clinton Road Surgery L82024 53.9% Pensilva Health Centre L82037 53.6% is not <= 140/90 Morrab Surgery Y01051 53.1% The Clays Practice L82051 53.0% St Agnes & Mount Hawke Surgeries L82054 52.1% Port View Surgery L82066 51.7% The Rame Group Practice Y00969 51.5% Quay Lane Surgery L82043 50.8% Wadebridge & Camel Estuary Practice L82004 50.5% Veor Surgery L82044 49.9% Petroc Group Practice L82023 49.8% Roseland Surgeries L82048 46.1% Cardrew Health Centre Y02596 46.0% Trescobeas Surgery L82052 45.8% Polkyth Surgery Y04694 Millbrook Surgery L82621 Wheal Northey Surgery L82611 Mullion & Constantine Group Practice L82056 Saltash Health Centre L82046 Woodland Road Surgery L82040 Fowey River Practice L82035 Launceston Medical Centre L82030 The Park Medical Centre L82019 Helston Medical Centre L82018 Perranporth Surgery L82013 Camelford Medical Centre L82007 Penryn Surgery L82006 0% 20% 40% 60% 80% 100%
25 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 SCN Treated No treatment Exceptions reported
NHS Swindon CCG 73.2%
NHS Bristol CCG 69.5% • 260 people with a new diagnosis* of hypertension with a CVD risk of 20% NHS Gloucestershire CCG 68.7% or higher in NHS Kernow CCG • 158 (60.8%) people who are currently NHS North Somerset CCG 68.1% treated with statins • 98 (37.7%) people who are exempted NHS South Gloucestershire CCG 68.0% from treatment with statins • 4 (1.5%) additional people who are NHS Northern, Eastern And Western Devon CCG 65.5% not currently treated with statins NHS Bath And North East Somerset CCG 64.8%
NHS South Devon And Torbay CCG 62.3%
NHS Wiltshire CCG 62.1%
NHS Kernow CCG 60.8%
NHS Somerset CCG 55.2%
England 67.7%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CVD-PP001 denominator plus exceptions
26 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 Treated No treatment Exceptions reported
NHS Gloucestershire CCG 68.7%
NHS Dorset CCG 66.0%
NHS East Riding of Yorkshire CCG 65.7%
NHS Northumberland CCG 63.8%
NHS Ipswich and East Suffolk CCG 61.7%
NHS Kernow CCG 60.8%
NHS Coastal West Sussex CCG 60.5%
NHS Cumbria CCG 60.4%
NHS North East Essex CCG 59.6%
NHS West Hampshire CCG 58.2%
NHS Somerset CCG 55.2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
27 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
Camelford Medical Centre L82007 1 Mevagissey Surgery L82025 1 Quay Lane Surgery L82043 1 Sunnyside Surgery L82070 4 Manor Surgery L82042 4 Carnon Downs Surgery L82061 4 Homecroft Surgery L82002 3 Pensilva Health Centre L82037 3 St Agnes & Mount Hawke Surgeries L82054 3 • In total, including exceptions, there Perranporth Surgery L82013 8 Westover Surgery L82622 5 Three Spires Medical Practice L82028 2 are 102 people who are not treated Probus & Grampound Surgeries L82045 2 Praze Surgery L82068 6 with statins The Stennack Surgery Y01922 2 Oak Tree Surgery L82016 5 Port View Surgery L82066 3 • GP practice range: 0.0% to 100.0% Wadebridge & Camel Estuary Practice L82004 2 Trevithick Surgery L82014 1 Old Bridge Surgery L82022 2 • If all practices were to achieve as well Middleway Surgery L82026 1 Lostwithiel Medical Practice L82039 1 Mullion & Constantine Group Practice L82056 2 as the average of the best achieving St Keverne Health Centre L82057 1 Lander Medical Practice L82001 7 Carnewater Practice L82009 6 practices, then an additional 90 The Park Medical Centre L82019 2 Petroc Group Practice L82023 2 Wheal Northey Surgery L82611 2 people would be treated Narrowcliff Surgery L82029 3 Stratton Medical Centre L82008 4 Penryn Surgery L82006 1 Meneage Street Surgery L82059 1 Newquay Health Centre Y02517 1 Clinton Road Surgery L82024 2 Bodriggy Health Centre L82036 1 Falmouth Health Centre L82049 1 Rosedean House Surgery L82050 1 Tamar Valley Health L82012 1 Port Isaac Practice L82003 Stillmoor House Medical Practice L82010 Brannel Surgery L82011 Chacewater And Devoran Surgeries L82015 Isles Of Scilly Health Centre L82017 Helston Medical Centre L82018 The Alverton Practice L82021 Launceston Medical Centre L82030 Fowey River Practice L82035 Pool Health Centre L82041 Veor Surgery L82044 Saltash Health Centre L82046 Marazion Surgery L82047 The Clays Practice L82051 Trescobeas Surgery L82052 Penalverne Surgery L82053 Bottreaux Surgery L82058 Phoenix Surgery L82617 Harris Memorial & Lanner Surgeries L82620 Millbrook Surgery L82621 The Rame Group Practice Y00969 Rosmellyn Surgery Y01050 Morrab Surgery Y01051 Neetside Surgery Y01127 Polkyth Surgery Y04694 Cardrew Health Centre Y02596 Churchfield Practice L82618 Roseland Surgeries L82048 Woodland Road Surgery L82040 Cape Cornwall Surgery L82038 0% 20% 40% 60% 80% 100% 120%
28 CVD: Primary Care Intelligence Packs Stroke
29 CVD: Primary Care Intelligence Packs Stroke Prevention
Less than half of people with known AF admitted with stroke are on What questions should we ask in our CCG? anticoagulant treatment at the time 1. For each indicator how wide is the variation in of their stroke. achievement and exception reporting? 2. How many people would benefit if all practices performed as well as the best? Stroke is one of the leading causes of 3. How can we support practices who are average premature death and disability. Stroke is and below average to perform as well as the devastating for individuals and families and best in: accounts for a substantial proportion of • Detection of atrial fibrillation health and social care expenditure. • Stroke prevention with anticoagulation
Atrial fibrillation increases the risk of stroke by a factor of 5, and strokes What might help? caused by AF are often more severe with • Increase opportunistic pulse checking especially in the over higher mortality and greater disability. 65s Anticoagulation substantially reduces the • Roll out GRASP-AF to identify people with AF who are risk of stroke in people with AF. undertreated • Promote use of CHADS-VASC and HASBLED Despite this, AF is underdiagnosed and under treated: up to a third of people with • Roll out of Warfarin Patient Safety Audit Tool to ensure AF are unaware they have the condition and optimal time in therapeutic range for people on warfarin even when diagnosed inadequate treatment • Disseminate latest evidence on risk-benefit balance for is common – large numbers do not receive anticoagulants including the newer treatments (NOACs) anticoagulants or have poor anticoagulant • Work with practices and local authorities to maximise uptake control. and follow up in the NHS Health Check
30 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG
Comparison with CCGs in the SCN
NHS South Devon And Torbay CCG 0.74
NHS North Somerset CCG 0.72
NHS Somerset CCG 0.71 • 0.66 ratio of observed to expected atrial fibrillation prevalence in NHS NHS Northern, Eastern And Western Devon CCG 0.69 Kernow CCG compared to 0.65 in England. NHS South Gloucestershire CCG 0.68 • This suggests that 66% of people with atrial fibrillation have been diagnosed. NHS Wiltshire CCG 0.68
NHS Bath And North East Somerset CCG 0.67
NHS Gloucestershire CCG 0.67
NHS Bristol CCG 0.66
NHS Kernow CCG 0.66 Note: This slide compares the prevalence of NHS Swindon CCG 0.65 atrial fibrillation recorded in QOF in 2013/14 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence Network estimates produced in 2015. The England 0.65 estimates were developed by applying age-sex specific prevalence rates as reported by Norberg 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 et al (2013) to GP population estimates from the Ratio Health and Social Care Information Centre. Estimates reported are adjusted for age and sex of the local population.
31 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG
Comparison with demographically similar CCGs
NHS Somerset CCG 0.71
NHS Dorset CCG 0.70
NHS Coastal West Sussex CCG 0.67
NHS East Riding of Yorkshire CCG 0.67
NHS Gloucestershire CCG 0.67
NHS Ipswich and East Suffolk CCG 0.67
NHS Northumberland CCG 0.67
NHS North East Essex CCG 0.67
NHS Cumbria CCG 0.66
NHS Kernow CCG 0.66
NHS West Hampshire CCG 0.63
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Ratio
32 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by GP practice
GP practice CCG
Falmouth Health Centre L82049 0.83 Roseland Surgeries L82048 0.81 Praze Surgery L82068 0.79 Carnon Downs Surgery L82061 0.77 The Stennack Surgery Y01922 0.76 Neetside Surgery Y01127 0.76 Saltash Health Centre L82046 0.76 Rosedean House Surgery L82050 0.75 Meneage Street Surgery L82059 0.73 • It is estimated that there are 5,864 Old Bridge Surgery L82022 0.73 Petroc Group Practice L82023 0.72 Stratton Medical Centre L82008 0.72 people with undiagnosed atrial Penryn Surgery L82006 0.71 Veor Surgery L82044 0.71 Launceston Medical Centre L82030 0.70 Quay Lane Surgery L82043 0.70 fibrillation in NHS Kernow CCG Penalverne Surgery L82053 0.70 Carnewater Practice L82009 0.69 The Alverton Practice L82021 0.69 • GP practice range of observed to Tamar Valley Health L82012 0.69 Homecroft Surgery L82002 0.69 Pensilva Health Centre L82037 0.69 expected atrial fibrillation prevalence Woodland Road Surgery L82040 0.69 Sunnyside Surgery L82070 0.69 Mullion & Constantine Group Practice L82056 0.68 0 to 0.83 Cape Cornwall Surgery L82038 0.68 Three Spires Medical Practice L82028 0.68 Trescobeas Surgery L82052 0.68 Oak Tree Surgery L82016 0.66 Narrowcliff Surgery L82029 0.66 Marazion Surgery L82047 0.66 Westover Surgery L82622 0.65 The Rame Group Practice Y00969 0.65 Probus & Grampound Surgeries L82045 0.65 The Park Medical Centre L82019 0.65 Chacewater And Devoran Surgeries L82015 0.65 Bodriggy Health Centre L82036 0.65 The Clays Practice L82051 0.64 Wadebridge & Camel Estuary Practice L82004 0.64 Helston Medical Centre L82018 0.63 St Agnes & Mount Hawke Surgeries L82054 0.63 Phoenix Surgery L82617 0.62 Churchfield Practice L82618 0.62 Perranporth Surgery L82013 0.62 Newquay Health Centre Y02517 0.62 Lander Medical Practice L82001 0.62 St Keverne Health Centre L82057 0.61 Port Isaac Practice L82003 0.60 Harris Memorial & Lanner Surgeries L82620 0.60 Fowey River Practice L82035 0.59 Mevagissey Surgery L82025 0.59 Trevithick Surgery L82014 0.59 Camelford Medical Centre L82007 0.58 Pool Health Centre L82041 0.57 Port View Surgery L82066 0.57 Isles Of Scilly Health Centre L82017 0.56 Manor Surgery L82042 0.56 Rosmellyn Surgery Y01050 0.55 Millbrook Surgery L82621 0.54 Bottreaux Surgery L82058 0.54 Morrab Surgery Y01051 0.53 Middleway Surgery L82026 0.52 Stillmoor House Medical Practice L82010 0.52 Clinton Road Surgery L82024 0.51 Lostwithiel Medical Practice L82039 0.50 Wheal Northey Surgery L82611 0.49 Brannel Surgery L82011 0.49 Cardrew Health Centre Y02596 Polkyth Surgery Y04694 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Ratio
33 CVD: Primary Care Intelligence Packs In patients with AF with a CHADS2 > 1, the percentage treated with anti-coagulation therapy by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported
NHS Somerset CCG 79.2%
NHS South Devon And Torbay CCG 78.0% • 6,108 people with atrial fibrillation* with a CHADS2 score > 1 in NHS NHS South Gloucestershire CCG 77.5% Kernow CCG • 4,695 (76.9%) people treated with NHS Bristol CCG 77.4% anti-coagulation therapy • 718 (11.8%) people who are NHS Northern, Eastern And Western Devon CCG 77.0% exceptions • 695 (11.4%) additional people with a NHS Bath And North East Somerset CCG 76.9% recorded CHADS2 score > 1 who are NHS Swindon CCG 76.9% not treated
NHS Kernow CCG 76.9%
NHS Gloucestershire CCG 76.8%
NHS Wiltshire CCG 76.0%
NHS North Somerset CCG 74.8%
England 74.3%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator AF004 denominator plus exceptions
34 CVD: Primary Care Intelligence Packs In patients with AF with a CHADS2 > 1, the percentage treated with anti-coagulation therapy by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported
NHS Somerset CCG 79.2%
NHS West Hampshire CCG 77.8%
NHS Kernow CCG 76.9%
NHS Gloucestershire CCG 76.8%
NHS Ipswich and East Suffolk CCG 76.8%
NHS East Riding of Yorkshire CCG 74.2%
NHS Dorset CCG 73.0%
NHS Coastal West Sussex CCG 72.4%
NHS North East Essex CCG 72.0%
NHS Cumbria CCG 70.7%
NHS Northumberland CCG 69.8%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
35 CVD: Primary Care Intelligence Packs In patients with AF with a CHADS2 > 1, the percentage not treated with anti- coagulation therapy by GP practice
No treatment Exceptions reported
St Agnes & Mount Hawke Surgeries L82054 54 The Rame Group Practice Y00969 38 Trevithick Surgery L82014 14 Petroc Group Practice L82023 33 Brannel Surgery L82011 10 Phoenix Surgery L82617 18 Lostwithiel Medical Practice L82039 17 Marazion Surgery L82047 25 Isles Of Scilly Health Centre L82017 6 • In total, including exceptions, there Pool Health Centre L82041 28 Port Isaac Practice L82003 24 Rosmellyn Surgery Y01050 22 are 1,413 people with a recorded Praze Surgery L82068 23 Polkyth Surgery Y04694 21 CHADS2 score > 1 who are not Stratton Medical Centre L82008 50 Quay Lane Surgery L82043 15 Launceston Medical Centre L82030 49 treated Woodland Road Surgery L82040 33 Chacewater And Devoran Surgeries L82015 25 Wheal Northey Surgery L82611 21 • GP practice range: 0.0% to 41.9% The Stennack Surgery Y01922 28 Carnewater Practice L82009 34 Trescobeas Surgery L82052 39 • If all practices were to achieve as well Helston Medical Centre L82018 21 Sunnyside Surgery L82070 18 Neetside Surgery Y01127 11 as the average of the best achieving Saltash Health Centre L82046 30 Port View Surgery L82066 15 Pensilva Health Centre L82037 13 practices, then an additional 460 The Park Medical Centre L82019 20 Oak Tree Surgery L82016 30 Bodriggy Health Centre L82036 27 people would be treated Falmouth Health Centre L82049 32 The Alverton Practice L82021 19 Probus & Grampound Surgeries L82045 21 Westover Surgery L82622 20 Perranporth Surgery L82013 21 Clinton Road Surgery L82024 2 Penalverne Surgery L82053 14 Newquay Health Centre Y02517 36 Tamar Valley Health L82012 55 Three Spires Medical Practice L82028 42 Roseland Surgeries L82048 12 Stillmoor House Medical Practice L82010 17 Middleway Surgery L82026 13 Old Bridge Surgery L82022 31 Rosedean House Surgery L82050 20 Camelford Medical Centre L82007 5 Narrowcliff Surgery L82029 29 Penryn Surgery L82006 31 St Keverne Health Centre L82057 6 Veor Surgery L82044 23 Lander Medical Practice L82001 26 Carnon Downs Surgery L82061 18 Churchfield Practice L82618 5 Manor Surgery L82042 20 The Clays Practice L82051 13 Fowey River Practice L82035 16 Meneage Street Surgery L82059 11 Homecroft Surgery L82002 7 Wadebridge & Camel Estuary Practice L82004 12 Morrab Surgery Y01051 6 Mullion & Constantine Group Practice L82056 13 Cape Cornwall Surgery L82038 1 Millbrook Surgery L82621 1 Bottreaux Surgery L82058 3 Mevagissey Surgery L82025 Harris Memorial & Lanner Surgeries L82620 Cardrew Health Centre Y02596 0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
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 150/90 mmHg or less by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported
NHS South Gloucestershire CCG 86.2%
NHS Swindon CCG 85.6% • 13,901 people with a history of stroke or TIA* in NHS Kernow CCG NHS Wiltshire CCG 84.9% • 11,621 (83.6%) people whose blood pressure is <= 150 / 90 NHS Gloucestershire CCG 84.5% • 655 (4.7%) people who are exceptions NHS Bristol CCG 83.9% • 1,625 (11.7%) additional people whose blood pressure is not <= 150 / NHS North Somerset CCG 83.8% 90 NHS Kernow CCG 83.6%
NHS Northern, Eastern And Western Devon CCG 83.6%
NHS Bath And North East Somerset CCG 83.1%
NHS South Devon And Torbay CCG 82.2%
NHS Somerset CCG 79.3%
England 84.3%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA003 denominator plus exceptions
37 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 Northumberland CCG 86.2%
NHS Ipswich and East Suffolk CCG 84.7%
NHS Gloucestershire CCG 84.5%
NHS North East Essex CCG 84.4%
NHS Cumbria CCG 84.0%
NHS Kernow CCG 83.6%
NHS Dorset CCG 83.1%
NHS East Riding of Yorkshire CCG 83.0%
NHS West Hampshire CCG 82.5%
NHS Coastal West Sussex CCG 81.1%
NHS Somerset CCG 79.3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
38 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
Cardrew Health Centre Y02596 7 Polkyth Surgery Y04694 54 Woodland Road Surgery L82040 52 Veor Surgery L82044 76 Penryn Surgery L82006 97 The Rame Group Practice Y00969 63 Morrab Surgery Y01051 39 Rosmellyn Surgery Y01050 43 Perranporth Surgery L82013 40 • In total, including exceptions, there St Agnes & Mount Hawke Surgeries L82054 40 Saltash Health Centre L82046 48 Mevagissey Surgery L82025 38 are 2,280 people whose blood Trevithick Surgery L82014 22 Port View Surgery L82066 30 pressure is not <= 150 / 90 Launceston Medical Centre L82030 65 Petroc Group Practice L82023 72 Harris Memorial & Lanner Surgeries L82620 24 • GP practice range: 9.6% to 36.8% Brannel Surgery L82011 16 Roseland Surgeries L82048 22 Churchfield Practice L82618 15 • If all practices were to achieve as well Three Spires Medical Practice L82028 61 Oak Tree Surgery L82016 47 Isles Of Scilly Health Centre L82017 8 as the average of the best achieving The Park Medical Centre L82019 33 Port Isaac Practice L82003 38 Trescobeas Surgery L82052 41 practices, then an additional 502 Bodriggy Health Centre L82036 47 Clinton Road Surgery L82024 14 Narrowcliff Surgery L82029 51 people would have their blood Quay Lane Surgery L82043 11 Millbrook Surgery L82621 5 Wadebridge & Camel Estuary Practice L82004 37 pressure controlled Stillmoor House Medical Practice L82010 40 Penalverne Surgery L82053 21 The Clays Practice L82051 31 Wheal Northey Surgery L82611 27 Sunnyside Surgery L82070 25 Newquay Health Centre Y02517 44 Old Bridge Surgery L82022 43 Homecroft Surgery L82002 28 The Stennack Surgery Y01922 61 Praze Surgery L82068 15 Lostwithiel Medical Practice L82039 20 Rosedean House Surgery L82050 29 Stratton Medical Centre L82008 48 Tamar Valley Health L82012 55 Manor Surgery L82042 44 Chacewater And Devoran Surgeries L82015 25 Westover Surgery L82622 26 Bottreaux Surgery L82058 18 Carnewater Practice L82009 33 Probus & Grampound Surgeries L82045 21 Pool Health Centre L82041 33 Carnon Downs Surgery L82061 25 Mullion & Constantine Group Practice L82056 38 Middleway Surgery L82026 20 Camelford Medical Centre L82007 7 Fowey River Practice L82035 28 Helston Medical Centre L82018 42 Cape Cornwall Surgery L82038 14 Neetside Surgery Y01127 12 Lander Medical Practice L82001 31 Phoenix Surgery L82617 20 Meneage Street Surgery L82059 17 Marazion Surgery L82047 23 Falmouth Health Centre L82049 24 St Keverne Health Centre L82057 8 Pensilva Health Centre L82037 12 The Alverton Practice L82021 16 0% 5% 10% 15% 20% 25% 30% 35% 40%
39 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 SCN Below 150/90 Not below 150/90 Exceptions reported
NHS Northern, Eastern And Western Devon CCG 92.9%
NHS Kernow CCG 92.7% • 10,102 people with a stroke shown to be non-haemorrhagic* in NHS NHS Gloucestershire CCG 92.4% Kernow CCG • 9,363 (92.7%) people who are taking NHS South Devon And Torbay CCG 92.3% an anti-platetet agent or anti- coagulant NHS North Somerset CCG 92.1% • 495 (4.9%) people who are exceptions NHS Bath And North East Somerset CCG 91.9% • 244 (2.4%) additional people with no NHS South Gloucestershire CCG 91.9% treatment
NHS Swindon CCG 91.6%
NHS Bristol CCG 91.6%
NHS Wiltshire CCG 91.2%
NHS Somerset CCG 89.2%
England 91.7%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA007 denominator plus exceptions
40 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 Kernow CCG 92.7%
NHS Gloucestershire CCG 92.4%
NHS Northumberland CCG 92.3%
NHS Dorset CCG 92.1%
NHS West Hampshire CCG 91.7%
NHS East Riding of Yorkshire CCG 91.7%
NHS Ipswich and East Suffolk CCG 91.4%
NHS Cumbria CCG 90.9%
NHS North East Essex CCG 90.4%
NHS Coastal West Sussex CCG 90.1%
NHS Somerset CCG 89.2%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
41 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
Cardrew Health Centre Y02596 3 Mevagissey Surgery L82025 24 Rosmellyn Surgery Y01050 18 Saltash Health Centre L82046 14 The Rame Group Practice Y00969 22 Port Isaac Practice L82003 23 Woodland Road Surgery L82040 15 Veor Surgery L82044 18 Oak Tree Surgery L82016 19 • In total, including exceptions, there Polkyth Surgery Y04694 13 Stratton Medical Centre L82008 19 Middleway Surgery L82026 14 are 739 people who are not taking an Westover Surgery L82622 11 Lostwithiel Medical Practice L82039 9 anti-platelet agent or anti-coagulant Perranporth Surgery L82013 12 Harris Memorial & Lanner Surgeries L82620 8 Cape Cornwall Surgery L82038 8 • GP practice range: 1.4% to 25.0% Manor Surgery L82042 22 Bodriggy Health Centre L82036 16 Wadebridge & Camel Estuary Practice L82004 15 • If all practices were to achieve as well Penryn Surgery L82006 27 Stillmoor House Medical Practice L82010 13 Praze Surgery L82068 6 as the average of the best achieving Petroc Group Practice L82023 25 Tamar Valley Health L82012 23 Probus & Grampound Surgeries L82045 10 practices, then an additional 277 Isles Of Scilly Health Centre L82017 3 Fowey River Practice L82035 13 Old Bridge Surgery L82022 18 people would be taking an anti- Mullion & Constantine Group Practice L82056 16 Falmouth Health Centre L82049 12 Helston Medical Centre L82018 20 platelet agent or anti-coagulant Neetside Surgery Y01127 7 Morrab Surgery Y01051 8 Port View Surgery L82066 7 Carnewater Practice L82009 10 Marazion Surgery L82047 11 Three Spires Medical Practice L82028 15 The Stennack Surgery Y01922 23 Homecroft Surgery L82002 11 Rosedean House Surgery L82050 10 Launceston Medical Centre L82030 16 Quay Lane Surgery L82043 3 Wheal Northey Surgery L82611 6 Sunnyside Surgery L82070 9 The Park Medical Centre L82019 8 The Clays Practice L82051 7 St Agnes & Mount Hawke Surgeries L82054 8 Clinton Road Surgery L82024 3 Pensilva Health Centre L82037 5 Newquay Health Centre Y02517 9 Chacewater And Devoran Surgeries L82015 7 Trescobeas Surgery L82052 7 Penalverne Surgery L82053 6 Phoenix Surgery L82617 6 Narrowcliff Surgery L82029 8 Lander Medical Practice L82001 7 Bottreaux Surgery L82058 3 Meneage Street Surgery L82059 4 Pool Health Centre L82041 6 Roseland Surgeries L82048 3 Carnon Downs Surgery L82061 6 Millbrook Surgery L82621 1 The Alverton Practice L82021 4 St Keverne Health Centre L82057 2 Camelford Medical Centre L82007 1 Brannel Surgery L82011 1 Trevithick Surgery L82014 1 Churchfield Practice L82618 1 0% 5% 10% 15% 20% 25% 30%
42 CVD: Primary Care Intelligence Packs Diabetes
43 CVD: Primary Care Intelligence Packs Diabetes Prevention and Management
Type 2 Diabetes in numbers • Diagnosed prevalence – 2.9 million Diabetes is estimated to cost • Non-diabetic hyperglycaemia (high risk) – 5 million the NHS £5.6 billion per year. It • Data from the Health Survey for England suggests a further is also often preventable. 2.4% of adults have undiagnosed diabetes and that approximately 30% of all diabetes is undiagnosed
What questions should we ask in our CCG? Type 2 diabetes is often preventable 1. For each indicator how wide is the variation in achievement and People at high risk of developing type 2 exception reporting? diabetes can be identified through the NHS 2. How many people would benefit if all practices performed as well Health Check and the disease could be as the best? prevented in 30-60% through appropriate 3. How can we support practices who are average and below behaviour change support. average to perform as well as the best in: • Detection of diabetes Complications of diabetes are preventable • Delivery of the 8 care processes Diabetes is a major cause of premature death • Identification and management of Non-diabetic hyperglycaemia and disability and greatly increases the risk of heart disease and stroke, kidney failure, What might help amputations and blindness. 80% of NHS • Promote participation by all practices in the National Diabetes spending on diabetes goes on managing these Audit (NDA) complications, most of which could be prevented. • Benchmark practice level data from the NDA – and support practices to explore variation There are 8 essential care processes, in addition to retinal screening, that together • Increase support for patient education and shared substantially reduce complication rates. management Despite this, around a third of people with • Maximise uptake of the NHS Health Check to aid detection of diabetes do not receive all 8 care processes, diabetes and Non Diabetic Hyperglycaemia and there is widespread variation between • Maximise uptake of the NHS Diabetes Prevention Programme CCGs and practices in levels of achievement. Diabetes observed prevalence by CCG
Comparison with CCGs in the SCN
NHS Swindon CCG 6.8%
NHS South Devon And Torbay CCG 6.6% • 6.2% observed diabetes prevalence in NHS Kernow CCG, compared to NHS Northern, Eastern And Western Devon CCG 6.5% 6.4% in England.
NHS Somerset CCG 6.5%
NHS Kernow CCG 6.2%
NHS Gloucestershire CCG 6.1%
NHS North Somerset CCG 5.8%
NHS Wiltshire CCG 5.8%
NHS South Gloucestershire CCG 5.5%
NHS Bristol CCG 5.0%
NHS Bath And North East Somerset CCG 4.6%
England 6.4%
0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%
45 CVD: Primary Care Intelligence Packs Diabetes observed prevalence by CCG
Comparison with demographically similar CCGs
NHS Northumberland CCG 7.3%
NHS Cumbria CCG 7.1%
NHS East Riding of Yorkshire CCG 7.0%
NHS Coastal West Sussex CCG 6.7%
NHS North East Essex CCG 6.7%
NHS Somerset CCG 6.5%
NHS Kernow CCG 6.2%
NHS Gloucestershire CCG 6.1%
NHS Dorset CCG 6.0%
NHS Ipswich and East Suffolk CCG 5.8%
NHS West Hampshire CCG 5.4%
0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%
46 CVD: Primary Care Intelligence Packs Diabetes prevalence by GP practice
GP practice CCG
Stratton Medical Centre L82008 8.7% Churchfield Practice L82618 8.5% Trevithick Surgery L82014 8.4% Veor Surgery L82044 8.1% Cape Cornwall Surgery L82038 8.1% Harris Memorial & Lanner Surgeries L82620 8.0% Middleway Surgery L82026 7.9% The Clays Practice L82051 7.7% Camelford Medical Centre L82007 7.5% • GP practice range of observed Oak Tree Surgery L82016 7.2% Pensilva Health Centre L82037 7.2% Old Bridge Surgery L82022 7.1% diabetes 3.9% to 8.7% Brannel Surgery L82011 7.0% Stillmoor House Medical Practice L82010 7.0% Pool Health Centre L82041 7.0% Woodland Road Surgery L82040 6.9% Clinton Road Surgery L82024 6.9% Penalverne Surgery L82053 6.9% Meneage Street Surgery L82059 6.8% Mevagissey Surgery L82025 6.7% Fowey River Practice L82035 6.7% Manor Surgery L82042 6.6% Homecroft Surgery L82002 6.6% The Park Medical Centre L82019 6.6% The Rame Group Practice Y00969 6.6% Port View Surgery L82066 6.6% Phoenix Surgery L82617 6.6% The Alverton Practice L82021 6.5% Mullion & Constantine Group Practice L82056 6.5% Wadebridge & Camel Estuary Practice L82004 6.5% Praze Surgery L82068 6.5% Bodriggy Health Centre L82036 6.5% Tamar Valley Health L82012 6.5% Petroc Group Practice L82023 6.4% Helston Medical Centre L82018 6.4% Marazion Surgery L82047 6.3% Sunnyside Surgery L82070 6.3% St Keverne Health Centre L82057 6.2% Launceston Medical Centre L82030 6.2% Bottreaux Surgery L82058 6.2% Perranporth Surgery L82013 6.1% Probus & Grampound Surgeries L82045 6.1% Polkyth Surgery Y04694 6.1% Rosedean House Surgery L82050 6.1% Roseland Surgeries L82048 6.0% Carnon Downs Surgery L82061 5.9% Carnewater Practice L82009 5.9% Wheal Northey Surgery L82611 5.8% Chacewater And Devoran Surgeries L82015 5.8% The Stennack Surgery Y01922 5.8% St Agnes & Mount Hawke Surgeries L82054 5.6% Quay Lane Surgery L82043 5.6% Rosmellyn Surgery Y01050 5.5% Lander Medical Practice L82001 5.5% Millbrook Surgery L82621 5.5% Port Isaac Practice L82003 5.4% Saltash Health Centre L82046 5.4% Lostwithiel Medical Practice L82039 5.4% Trescobeas Surgery L82052 5.4% Narrowcliff Surgery L82029 5.3% Falmouth Health Centre L82049 5.3% Three Spires Medical Practice L82028 5.2% Newquay Health Centre Y02517 5.2% Neetside Surgery Y01127 4.9% Morrab Surgery Y01051 4.8% Penryn Surgery L82006 4.5% Isles Of Scilly Health Centre L82017 4.2% Westover Surgery L82622 4.0% Cardrew Health Centre Y02596 3.9% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%
47 CVD: Primary Care Intelligence Packs Prevalence estimates of non-diabetic hyperglycaemia
NHS South Devon And Torbay CCG 12.7%
NHS Kernow CCG 12.5% • Non-diabetic hyperglycaemia, also NHS Somerset CCG 12.2% known as pre-diabetes or impaired glucose regulation, refers to raised NHS North Somerset CCG 12.0% blood glucose levels, but not in the diabetic range. People with non- NHS Northern, Eastern And Western Devon CCG 11.7% diabetic hyperglycaemia are at increased risk of developing Type 2 NHS Wiltshire CCG 11.6% diabetes.
NHS Gloucestershire CCG 11.5% • The estimated prevalence of non- diabetic hyperglycaemia in NHS NHS South Gloucestershire CCG 10.7% Kernow CCG is 12.5%, compared to 11.2% in England. NHS Swindon CCG 10.5%
NHS Bath And North East Somerset CCG 10.3%
NHS Bristol CCG 9.5% Note: Prevalence estimates of non-diabetic hyperglycaemia were developed using Health Survey for England (HSE) data. Five years of HSE data were combined, 2009- 2013. The England 11.2% estimates take into account the age, ethnic group and estimated body mass index of the population. 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% These estimates were produced using the GP registered population.
48 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by GP practice, 2014/15
GP practice Average of practices in the CCG who participated in the audit
Stillmoor House Medical Practice L82010 81.0% Chacewater And Devoran Surgeries L82015 78.6% Meneage Street Surgery L82059 77.3% Quay Lane Surgery L82043 75.8% Tamar Valley Health L82012 73.9% Port Isaac Practice L82003 72.9% • Data on care processes and Helston Medical Centre L82018 72.5% Praze Surgery L82068 71.2% St Agnes & Mount Hawke Surgeries L82054 70.1% treatment targets are taken from the The Stennack Surgery Y01922 69.8% Port View Surgery L82066 69.6% Probus & Grampound Surgeries L82045 69.3% National Diabetes Audit (NDA). Harris Memorial & Lanner Surgeries L82620 68.7% Neetside Surgery Y01127 68.5% Newquay Health Centre Y02517 68.5% Overall practice participation in the Cape Cornwall Surgery L82038 67.9% Marazion Surgery L82047 67.7% Lostwithiel Medical Practice L82039 66.7% 2014/15 audit was 54.9% in England. Lander Medical Practice L82001 66.6% Rosedean House Surgery L82050 66.5% Oak Tree Surgery L82016 65.7% Within CCGs participation varied Launceston Medical Centre L82030 64.3% Perranporth Surgery L82013 62.7% Brannel Surgery L82011 62.3% between 0% to 100%. Three Spires Medical Practice L82028 61.0% Carnewater Practice L82009 60.2% The Clays Practice L82051 59.7% Sunnyside Surgery L82070 59.7% Penryn Surgery L82006 58.7% • In NHS Kernow CCG, 45 out of 64 Saltash Health Centre L82046 58.6% St Keverne Health Centre L82057 58.5% Wadebridge & Camel Estuary Practice L82004 58.3% practices (70.3%) participated in the Middleway Surgery L82026 58.1% Manor Surgery L82042 54.1% Old Bridge Surgery L82022 53.4% NDA. Data is not available for the Petroc Group Practice L82023 50.2% Homecroft Surgery L82002 48.2% Clinton Road Surgery L82024 47.2% remaining practices. Rosmellyn Surgery Y01050 43.4% Pool Health Centre L82041 41.6% Veor Surgery L82044 41.1% Narrowcliff Surgery L82029 39.0% The Rame Group Practice Y00969 32.2% • Achievement - 8 care processes: in Roseland Surgeries L82048 29.8% Camelford Medical Centre L82007 17.0% Polkyth Surgery Y04694 practices who provided data via the Cardrew Health Centre Y02596 Morrab Surgery Y01051 Westover Surgery L82622 NDA, between 17.0% and 81.0% of Millbrook Surgery L82621 Churchfield Practice L82618 Phoenix Surgery L82617 patients received all 8 care Wheal Northey Surgery L82611 Carnon Downs Surgery L82061 Bottreaux Surgery L82058 processes. Mullion & Constantine Group Practice L82056 Penalverne Surgery L82053 Trescobeas Surgery L82052 Falmouth Health Centre L82049 Woodland Road Surgery L82040 Pensilva Health Centre L82037 Bodriggy Health Centre L82036 Fowey River Practice L82035 Mevagissey Surgery L82025 The Alverton Practice L82021 The Park Medical Centre L82019 Isles Of Scilly Health Centre L82017 Trevithick Surgery L82014 Stratton Medical Centre L82008 0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
49 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2014/15
GP practice Average of practices in the CCG who participated in the audit
Homecroft Surgery L82002 100.0% Marazion Surgery L82047 100.0% Neetside Surgery Y01127 100.0% Roseland Surgeries L82048 62.5% Cape Cornwall Surgery L82038 47.8% Middleway Surgery L82026 42.9% • Data on care processes and Wadebridge & Camel Estuary Practice L82004 40.3% Quay Lane Surgery L82043 40.0% St Keverne Health Centre L82057 40.0% treatment targets are taken from the Camelford Medical Centre L82007 37.7% Tamar Valley Health L82012 37.2% Sunnyside Surgery L82070 36.9% National Diabetes Audit (NDA). Pool Health Centre L82041 36.9% Launceston Medical Centre L82030 36.5% Lostwithiel Medical Practice L82039 35.8% Overall practice participation in the Lander Medical Practice L82001 35.5% The Stennack Surgery Y01922 35.4% Helston Medical Centre L82018 35.3% 2014/15 audit was 54.9% in England. Harris Memorial & Lanner Surgeries L82620 33.8% Manor Surgery L82042 33.6% Clinton Road Surgery L82024 33.1% Within CCGs participation varied Carnewater Practice L82009 32.9% Penryn Surgery L82006 32.9% Newquay Health Centre Y02517 32.9% between 0% to 100%. Three Spires Medical Practice L82028 32.7% Narrowcliff Surgery L82029 32.7% Perranporth Surgery L82013 32.6% Meneage Street Surgery L82059 31.3% Saltash Health Centre L82046 31.3% • In NHS Kernow CCG, 45 out of 64 Veor Surgery L82044 31.0% Port View Surgery L82066 30.1% Port Isaac Practice L82003 29.2% practices (70.3%) participated in the St Agnes & Mount Hawke Surgeries L82054 28.6% Rosmellyn Surgery Y01050 28.2% Petroc Group Practice L82023 27.5% NDA. Data is not available for the Probus & Grampound Surgeries L82045 27.2% Brannel Surgery L82011 27.1% Stillmoor House Medical Practice L82010 25.0% remaining practices. Old Bridge Surgery L82022 22.2% Oak Tree Surgery L82016 Rosedean House Surgery L82050 Praze Surgery L82068 The Rame Group Practice Y00969 • Achievement - 3 treatment targets: in Polkyth Surgery Y04694 Cardrew Health Centre Y02596 Morrab Surgery Y01051 practices who provided data via the Westover Surgery L82622 Millbrook Surgery L82621 Churchfield Practice L82618 NDA, between 0.0% and 100.0% of Phoenix Surgery L82617 Wheal Northey Surgery L82611 Carnon Downs Surgery L82061 patients achieved all 3 treatment Bottreaux Surgery L82058 Mullion & Constantine Group Practice L82056 Penalverne Surgery L82053 targets. Trescobeas Surgery L82052 The Clays Practice L82051 Falmouth Health Centre L82049 Woodland Road Surgery L82040 Pensilva Health Centre L82037 Bodriggy Health Centre L82036 Fowey River Practice L82035 Mevagissey Surgery L82025 The Alverton Practice L82021 The Park Medical Centre L82019 Isles Of Scilly Health Centre L82017 Chacewater And Devoran Surgeries L82015 Trevithick Surgery L82014 Stratton Medical Centre L82008 0% 20% 40% 60% 80% 100% 120%
50 CVD: Primary Care Intelligence Packs Kidney
51 CVD: Primary Care Intelligence Packs Management of Chronic Kidney Disease
Chronic Kidney Disease can Late diagnosis of CKD is common. progress to kidney failure and it Around a third of people with CKD are undiagnosed. More opportunistic testing substantially increases the risk of and improved uptake of the NHS Health heart attack and stroke. 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 1. For each indicator how wide is the variation in achievement and affects a third of people over 75. In 2010 it was exception reporting? estimated to cost the NHS around £1.5bn. 2. How many people would benefit if all practices performed as well Average length of stay in hospital tends to be as the best? longer and outcomes are considerably worse: 3. How can we support practices who are average and below approximately 7,000 excess strokes and 12,000 average to perform as well as the best in: excess heart attacks occur each year in people • Detection of CKD with CKD compared to those without. • More systematic delivery of evidence based care Individuals with CKD are also at much higher risk of developing acute kidney injury when they have an intercurrent illness such as pneumonia. What might help • Promote participation by all practices in the National Evidence based guidance from NICE CKD Audit identifies CVD risk reduction, good blood • Obtain and benchmark practice level data from the pressure control and management of National CKD Audit proteinuria as essential steps to reduce the risk • Promote uptake of and follow up from the NHS of cardiovascular events and progression to Health Check to aid detection and management of kidney failure. Despite this there is often CKD significant variation between practices in • Local training and education in the detection and achievement and exception reporting. management of CKD Chronic kidney disease (CKD) observed prevalence (2014/15) compared to expected prevalence (2011) by CCG Comparison with CCGs in the SCN
NHS Gloucestershire CCG 0.96
NHS Bristol CCG 0.87
NHS South Gloucestershire CCG 0.85 • 0.74 ratio of observed to expected CKD prevalence in NHS Kernow NHS Kernow CCG 0.74 CCG compared to 0.68 in England. • This suggests that 74% of people with NHS North Somerset CCG 0.71 chronic kidney disease have been diagnosed. NHS Northern, Eastern And Western Devon CCG 0.69
NHS Somerset CCG 0.66
NHS South Devon And Torbay CCG 0.64
NHS Wiltshire CCG 0.58
NHS Bath And North East Somerset CCG 0.52 Note: This slide compares the prevalence of CKD NHS Swindon CCG 0.49 recorded in QOF in 2014/15 to the expected prevalence of CKD produced by the University of Southampton in 2011. A small number of CCGs have a ratio greater than 1. It is unlikely that all England 0.68 people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that 0.0 0.2 0.4 0.6 0.8 1.0 1.2 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.
53 CVD: Primary Care Intelligence Packs Chronic kidney disease (CKD) observed prevalence (2014/15) compared to expected prevalence (2011) by CCG Comparison with demographically similar CCGs
NHS Gloucestershire CCG 0.96
NHS Northumberland CCG 0.87
NHS Ipswich and East Suffolk CCG 0.76
NHS Kernow CCG 0.74
NHS Dorset CCG 0.72
NHS East Riding of Yorkshire CCG 0.71
NHS North East Essex CCG 0.70
NHS Cumbria CCG 0.69
NHS Somerset CCG 0.66
NHS Coastal West Sussex CCG 0.60
NHS West Hampshire CCG 0.52
0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio
54 CVD: Primary Care Intelligence Packs CKD prevalence by GP practice, 2014/15
GP practice CCG
Carnon Downs Surgery L82061 9.4% Bottreaux Surgery L82058 9.2% Chacewater And Devoran Surgeries L82015 9.1% Port Isaac Practice L82003 8.9% Veor Surgery L82044 7.9% Cape Cornwall Surgery L82038 7.9% Middleway Surgery L82026 7.7% Probus & Grampound Surgeries L82045 7.6% Meneage Street Surgery L82059 7.6% • It is estimated that there are 8,671 Neetside Surgery Y01127 7.6% Stratton Medical Centre L82008 7.5% Homecroft Surgery L82002 7.4% people with undiagnosed chronic Trevithick Surgery L82014 7.3% Woodland Road Surgery L82040 7.3% The Park Medical Centre L82019 7.2% kidney disease in NHS Kernow CCG Stillmoor House Medical Practice L82010 7.1% Fowey River Practice L82035 7.0% • GP practice range of observed CKD: Camelford Medical Centre L82007 6.6% The Stennack Surgery Y01922 6.5% Phoenix Surgery L82617 6.5% 1.2% to 9.4% Wheal Northey Surgery L82611 6.5% Narrowcliff Surgery L82029 6.5% Trescobeas Surgery L82052 6.4% Manor Surgery L82042 6.1% Three Spires Medical Practice L82028 6.1% Quay Lane Surgery L82043 6.0% St Keverne Health Centre L82057 6.0% Falmouth Health Centre L82049 5.8% Sunnyside Surgery L82070 5.8% Brannel Surgery L82011 5.8% The Alverton Practice L82021 5.7% Mevagissey Surgery L82025 5.7% Old Bridge Surgery L82022 5.6% Churchfield Practice L82618 5.5% Lander Medical Practice L82001 5.5% Clinton Road Surgery L82024 5.4% Petroc Group Practice L82023 5.4% Marazion Surgery L82047 5.3% Bodriggy Health Centre L82036 5.3% Helston Medical Centre L82018 5.2% Penryn Surgery L82006 5.1% Penalverne Surgery L82053 4.9% Pool Health Centre L82041 4.9% Port View Surgery L82066 4.9% Mullion & Constantine Group Practice L82056 4.9% Tamar Valley Health L82012 4.8% Carnewater Practice L82009 4.8% Wadebridge & Camel Estuary Practice L82004 4.7% Praze Surgery L82068 4.3% Rosmellyn Surgery Y01050 4.3% Pensilva Health Centre L82037 4.3% Newquay Health Centre Y02517 4.2% Westover Surgery L82622 4.2% Launceston Medical Centre L82030 4.1% Polkyth Surgery Y04694 4.1% Isles Of Scilly Health Centre L82017 3.9% Rosedean House Surgery L82050 3.8% Perranporth Surgery L82013 3.7% Harris Memorial & Lanner Surgeries L82620 3.7% Morrab Surgery Y01051 3.6% The Rame Group Practice Y00969 3.5% Note: CCG estimates for the estimated The Clays Practice L82051 3.2% Lostwithiel Medical Practice L82039 3.1% number of people with CKD are based on Millbrook Surgery L82621 3.0% Oak Tree Surgery L82016 2.9% Saltash Health Centre L82046 2.8% applying a proportion from a resident based St Agnes & Mount Hawke Surgeries L82054 2.7% Roseland Surgeries L82048 2.5% population estimate to a GP registered Cardrew Health Centre Y02596 1.2% population. The characteristics of registered 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% and resident populations may vary in some CCGs, and local interpretation is required.
55 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 SCN Below 140/85 Not below 140/85 Exceptions reported
NHS South Gloucestershire CCG 76.6%
NHS Swindon CCG 76.3% • 24,446 people with CKD (diagnosed*) in NHS Kernow CCG NHS North Somerset CCG 75.5% • 17,721 (72.5%) people whose blood pressure is <= 140 /85 NHS Gloucestershire CCG 74.4% • 2,617 (10.7%) people who are exceptions NHS Bristol CCG 74.4% • 4,108 (16.8%) additional people whose blood pressure is not <= 140 / NHS Wiltshire CCG 73.3% 85 NHS Bath And North East Somerset CCG 73.1%
NHS Kernow CCG 72.5%
NHS Northern, Eastern And Western Devon CCG 71.1%
NHS South Devon And Torbay CCG 69.3%
NHS Somerset CCG 67.3%
England 74.4%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CKD002 denominator plus exceptions
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 demographically similar CCGs Below 140/85 Not below 140/85 Exceptions reported
NHS Northumberland CCG 76.5%
NHS Cumbria CCG 74.4%
NHS Gloucestershire CCG 74.4%
NHS North East Essex CCG 74.1%
NHS Dorset CCG 72.9%
NHS East Riding of Yorkshire CCG 72.7%
NHS Kernow CCG 72.5%
NHS Ipswich and East Suffolk CCG 72.0%
NHS West Hampshire CCG 69.6%
NHS Coastal West Sussex CCG 68.6%
NHS Somerset CCG 67.3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
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 not 140/85 mmHg or less by GP practice, 2014/15
Not below 140/85 Exceptions reported
Polkyth Surgery Y04694 109 Quay Lane Surgery L82043 99 Veor Surgery L82044 204 Cardrew Health Centre Y02596 10 Wheal Northey Surgery L82611 178 Carnon Downs Surgery L82061 161 Petroc Group Practice L82023 252 Newquay Health Centre Y02517 191 Pensilva Health Centre L82037 58 • In total, including exceptions, there Rosmellyn Surgery Y01050 80 Chacewater And Devoran Surgeries L82015 142 Port View Surgery L82066 89 are 6,725 people whose blood The Clays Practice L82051 88 Perranporth Surgery L82013 68 pressure is not <= 140 / 85 Middleway Surgery L82026 126 Penalverne Surgery L82053 66 Trevithick Surgery L82014 83 • GP practice range: 16.1% to 47.0% Trescobeas Surgery L82052 157 Rosedean House Surgery L82050 84 Woodland Road Surgery L82040 141 • If all practices were to achieve as well Churchfield Practice L82618 43 Wadebridge & Camel Estuary Practice L82004 91 Penryn Surgery L82006 245 as the average of the best achieving Millbrook Surgery L82621 19 The Rame Group Practice Y00969 80 Port Isaac Practice L82003 183 practices, then an additional 1,229 Morrab Surgery Y01051 55 Meneage Street Surgery L82059 102 Narrowcliff Surgery L82029 186 people would have their blood Mevagissey Surgery L82025 68 Oak Tree Surgery L82016 72 Brannel Surgery L82011 62 pressure controlled St Agnes & Mount Hawke Surgeries L82054 49 Probus & Grampound Surgeries L82045 152 Westover Surgery L82622 78 Clinton Road Surgery L82024 50 Saltash Health Centre L82046 77 Sunnyside Surgery L82070 76 Harris Memorial & Lanner Surgeries L82620 41 The Park Medical Centre L82019 113 Praze Surgery L82068 50 Roseland Surgeries L82048 19 Bodriggy Health Centre L82036 108 Launceston Medical Centre L82030 140 Lander Medical Practice L82001 167 Tamar Valley Health L82012 151 Homecroft Surgery L82002 89 Camelford Medical Centre L82007 39 Helston Medical Centre L82018 126 Old Bridge Surgery L82022 101 Neetside Surgery Y01127 56 Carnewater Practice L82009 94 Falmouth Health Centre L82049 89 Stillmoor House Medical Practice L82010 127 Fowey River Practice L82035 86 Mullion & Constantine Group Practice L82056 68 Marazion Surgery L82047 65 Lostwithiel Medical Practice L82039 26 The Stennack Surgery Y01922 141 Isles Of Scilly Health Centre L82017 15 Manor Surgery L82042 114 Three Spires Medical Practice L82028 143 Bottreaux Surgery L82058 78 Cape Cornwall Surgery L82038 61 Stratton Medical Centre L82008 132 Pool Health Centre L82041 87 St Keverne Health Centre L82057 26 The Alverton Practice L82021 51 Phoenix Surgery L82617 48 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
58 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 SCN Recorded Not recorded Exceptions reported
NHS South Gloucestershire CCG 80.2%
NHS Bath And North East Somerset CCG 79.1% • 24,461 people with CKD (diagnosed*) in NHS Kernow CCG NHS Kernow CCG 77.0% • 18,836 (77%) people who have a record of urine albumin:creatinine NHS Bristol CCG 76.8% ratio test • 1,636 (6.7%) people who are NHS Northern, Eastern And Western Devon CCG 75.8% exceptions • 3,989 (16.3%) additional people who NHS Swindon CCG 75.3% have no record of urine NHS North Somerset CCG 74.8% albumin:creatinine ratio test
NHS Gloucestershire CCG 74.1%
NHS Wiltshire CCG 73.9%
NHS South Devon And Torbay CCG 68.1%
NHS Somerset CCG 61.5%
England 75.4%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CKD004 denominator plus exceptions
59 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 Northumberland CCG 78.9%
NHS Kernow CCG 77.0%
NHS Cumbria CCG 76.9%
NHS East Riding of Yorkshire CCG 74.7%
NHS Gloucestershire CCG 74.1%
NHS North East Essex CCG 73.8%
NHS Dorset CCG 73.1%
NHS Ipswich and East Suffolk CCG 71.5%
NHS West Hampshire CCG 71.2%
NHS Coastal West Sussex CCG 67.4%
NHS Somerset CCG 61.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
60 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
Pensilva Health Centre L82037 85 The Rame Group Practice Y00969 107 Bodriggy Health Centre L82036 165 Trevithick Surgery L82014 95 Phoenix Surgery L82617 105 Penryn Surgery L82006 272 Carnewater Practice L82009 145 Lander Medical Practice L82001 229 Cardrew Health Centre Y02596 8 • In total, including exceptions, there Mevagissey Surgery L82025 75 Veor Surgery L82044 158 Port Isaac Practice L82003 184 are 5,625 people who have no record Probus & Grampound Surgeries L82045 154 Woodland Road Surgery L82040 122 of urine albumin:creatinine ratio test Wheal Northey Surgery L82611 122 Lostwithiel Medical Practice L82039 33 Polkyth Surgery Y04694 66 • GP practice range: 10.6% to 51.2% Roseland Surgeries L82048 20 Newquay Health Centre Y02517 140 Middleway Surgery L82026 101 • If all practices were to achieve as well Praze Surgery L82068 50 The Stennack Surgery Y01922 170 Camelford Medical Centre L82007 39 as the average of the best achieving Three Spires Medical Practice L82028 166 Petroc Group Practice L82023 159 Narrowcliff Surgery L82029 149 practices, then an additional 1,532 Oak Tree Surgery L82016 56 Quay Lane Surgery L82043 47 Wadebridge & Camel Estuary Practice L82004 61 people would have their urine Stratton Medical Centre L82008 140 Sunnyside Surgery L82070 59 Manor Surgery L82042 115 albumin/creatine ratio recorded The Park Medical Centre L82019 89 Falmouth Health Centre L82049 82 Launceston Medical Centre L82030 115 Chacewater And Devoran Surgeries L82015 83 Rosedean House Surgery L82050 53 Trescobeas Surgery L82052 97 The Alverton Practice L82021 56 Pool Health Centre L82041 87 Port View Surgery L82066 50 Mullion & Constantine Group Practice L82056 60 Homecroft Surgery L82002 69 Meneage Street Surgery L82059 64 Churchfield Practice L82618 25 Clinton Road Surgery L82024 33 Perranporth Surgery L82013 38 Penalverne Surgery L82053 37 Old Bridge Surgery L82022 80 Neetside Surgery Y01127 44 Carnon Downs Surgery L82061 73 Bottreaux Surgery L82058 67 Morrab Surgery Y01051 32 Cape Cornwall Surgery L82038 53 Helston Medical Centre L82018 88 Rosmellyn Surgery Y01050 38 Tamar Valley Health L82012 102 St Keverne Health Centre L82057 23 Harris Memorial & Lanner Surgeries L82620 25 Stillmoor House Medical Practice L82010 92 Westover Surgery L82622 43 St Agnes & Mount Hawke Surgeries L82054 26 The Clays Practice L82051 38 Saltash Health Centre L82046 38 Millbrook Surgery L82621 8 Fowey River Practice L82035 51 Isles Of Scilly Health Centre L82017 9 Marazion Surgery L82047 37 Brannel Surgery L82011 23 0% 10% 20% 30% 40% 50% 60%
61 CVD: Primary Care Intelligence Packs Heart
62 CVD: Primary Care Intelligence Packs Management of Heart Disease
Premature death and disability in What questions should we ask in our CCG? people with CHD can be reduced 1. For each indicator how wide is the variation in achievement and exception reporting? significantly by systematic evidence 2. How many people would benefit if all based management in primary care practices 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: Coronary Heart Disease is one of the principal causes of • More systematic delivery of evidence premature death and disability. The key elements of based care for people with CHD management for an individual who already has had a heart attack • Improved detection and management or angina are symptom control and secondary prevention of of heart failure further cardiovascular events and premature mortality. There is robust evidence to support the use of anti-platelet treatment, statins, beta-blockers and angiotensin converting enzyme What might help inhibitors or angiotensin receptor blockers. There is also robust 1. Roll out of GRASP-Heart Failure audit tool evidence to support good control of blood pressure. Each of these that identifies people with heart failure who interventions is incentivised in QOF but variation in achievement are undiagnosed or under treated and exception reporting at practice level shows that there is often 2. Education for health professionals to considerable potential for improving management and outcomes. promote evidence based management of CHD and high quality measurement of Heart failure is a common and an important complication of blood pressure coronary heart disease and other conditions. Again there is good 3. Education and training to support delivery evidence that appropriate treatment including up-titration of ace of behaviour change interventions for CVD inhibitors and beta blockers in heart failure due to LVSD can risk reduction in primary care significantly improve symptom control and quality of life, and 4. Ensure access to rapid access diagnostic improve outcomes for patients. Despite this, around a quarter of clinics and specialist support for people with heart failure are undetected and untreated. And management of angina and heart failure amongst those who are diagnosed, there is significant variation in 5. Ensure access to cardiac rehab for the quality of care. individuals with CHD and heart failure Heart failure prevalence by CCG
Comparison with CCGs in the SCN
NHS Kernow CCG 0.98%
NHS Somerset CCG 0.85% • Prevalence of 0.98% in NHS Kernow NHS Northern, Eastern And Western Devon CCG 0.84% CCG compared to 0.72% in England
NHS North Somerset CCG 0.84%
NHS Bath And North East Somerset CCG 0.79%
NHS South Devon And Torbay CCG 0.78%
NHS Wiltshire CCG 0.78%
NHS Gloucestershire CCG 0.73%
NHS South Gloucestershire CCG 0.65%
NHS Bristol CCG 0.60%
NHS Swindon CCG 0.56%
England 0.72%
0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%
64 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG
Comparison with demographically similar CCGs
NHS Cumbria CCG 1.09%
NHS Northumberland CCG 0.99%
NHS Kernow CCG 0.98%
NHS North East Essex CCG 0.91%
NHS Dorset CCG 0.87%
NHS East Riding of Yorkshire CCG 0.87%
NHS Coastal West Sussex CCG 0.85%
NHS Somerset CCG 0.85%
NHS Ipswich and East Suffolk CCG 0.84%
NHS Gloucestershire CCG 0.73%
NHS West Hampshire CCG 0.71%
0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%
65 CVD: Primary Care Intelligence Packs Heart failure prevalence by GP practice
GP practice CCG
Meneage Street Surgery L82059 4.0% Roseland Surgeries L82048 1.7% Marazion Surgery L82047 1.6% Bodriggy Health Centre L82036 1.5% Veor Surgery L82044 1.5% Woodland Road Surgery L82040 1.5% The Alverton Practice L82021 1.4% Homecroft Surgery L82002 1.4% St Keverne Health Centre L82057 1.4% • 5,412 people with diagnosed heart Manor Surgery L82042 1.3% Penalverne Surgery L82053 1.2% Chacewater And Devoran Surgeries L82015 1.2% failure in NHS Kernow CCG Old Bridge Surgery L82022 1.2% Phoenix Surgery L82617 1.2% • GP practice range: 0.3% to 4.0% The Park Medical Centre L82019 1.1% Praze Surgery L82068 1.1% Fowey River Practice L82035 1.1% Carnon Downs Surgery L82061 1.1% Cape Cornwall Surgery L82038 1.1% Mevagissey Surgery L82025 1.1% Middleway Surgery L82026 1.1% Clinton Road Surgery L82024 1.1% Tamar Valley Health L82012 1.1% Sunnyside Surgery L82070 1.1% Bottreaux Surgery L82058 1.0% Trescobeas Surgery L82052 1.0% Pensilva Health Centre L82037 1.0% Falmouth Health Centre L82049 1.0% Westover Surgery L82622 1.0% Narrowcliff Surgery L82029 1.0% Mullion & Constantine Group Practice L82056 1.0% Carnewater Practice L82009 0.9% Stratton Medical Centre L82008 0.9% Harris Memorial & Lanner Surgeries L82620 0.9% Brannel Surgery L82011 0.9% Probus & Grampound Surgeries L82045 0.9% Polkyth Surgery Y04694 0.9% Penryn Surgery L82006 0.9% Trevithick Surgery L82014 0.9% St Agnes & Mount Hawke Surgeries L82054 0.9% Three Spires Medical Practice L82028 0.9% Lander Medical Practice L82001 0.9% Petroc Group Practice L82023 0.9% Helston Medical Centre L82018 0.9% Stillmoor House Medical Practice L82010 0.8% Perranporth Surgery L82013 0.8% The Stennack Surgery Y01922 0.8% Oak Tree Surgery L82016 0.8% Wadebridge & Camel Estuary Practice L82004 0.8% Neetside Surgery Y01127 0.8% The Rame Group Practice Y00969 0.8% Rosedean House Surgery L82050 0.8% Wheal Northey Surgery L82611 0.8% The Clays Practice L82051 0.8% Isles Of Scilly Health Centre L82017 0.8% Churchfield Practice L82618 0.8% Saltash Health Centre L82046 0.7% Rosmellyn Surgery Y01050 0.7% Launceston Medical Centre L82030 0.7% Quay Lane Surgery L82043 0.7% Morrab Surgery Y01051 0.7% Newquay Health Centre Y02517 0.7% Port View Surgery L82066 0.7% Pool Health Centre L82041 0.6% Millbrook Surgery L82621 0.6% Camelford Medical Centre L82007 0.5% Lostwithiel Medical Practice L82039 0.5% Port Isaac Practice L82003 0.5% Cardrew Health Centre Y02596 0.3% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5%
66 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 SCN Treatment No treatment Exceptions reported
NHS Swindon CCG 87.6%
NHS Gloucestershire CCG 87.3% • 2,320 people with heart failure* with LVSD in NHS Kernow CCG NHS North Somerset CCG 85.9% • 1,919 (82.7%) people treated with ACE-I or ARB NHS Wiltshire CCG 85.9% • 385 (16.6%) people who are exceptions NHS South Gloucestershire CCG 85.4% • 16 (0.7%) additional people who are not treated with ACE-I or ARB NHS Bristol CCG 85.4%
NHS Bath And North East Somerset CCG 84.9%
NHS Somerset CCG 83.2%
NHS Northern, Eastern And Western Devon CCG 83.1%
NHS Kernow CCG 82.7%
NHS South Devon And Torbay CCG 81.4%
England 86.0%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF003 denominator plus exceptions
67 CVD: Primary Care Intelligence Packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported
NHS East Riding of Yorkshire CCG 87.6%
NHS Gloucestershire CCG 87.3%
NHS Cumbria CCG 86.9%
NHS West Hampshire CCG 86.6%
NHS North East Essex CCG 84.6%
NHS Northumberland CCG 83.3%
NHS Somerset CCG 83.2%
NHS Kernow CCG 82.7%
NHS Dorset CCG 82.7%
NHS Ipswich and East Suffolk CCG 82.4%
NHS Coastal West Sussex CCG 79.6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
68 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
Cardrew Health Centre Y02596 1 The Rame Group Practice Y00969 3 Rosedean House Surgery L82050 3 Phoenix Surgery L82617 9 Sunnyside Surgery L82070 15 Clinton Road Surgery L82024 6 Perranporth Surgery L82013 5 Probus & Grampound Surgeries L82045 8 Port View Surgery L82066 2 • In total, including exceptions, there Brannel Surgery L82011 5 Trevithick Surgery L82014 3 Quay Lane Surgery L82043 1 are 401 people who are not treated The Stennack Surgery Y01922 16 Veor Surgery L82044 14 with ACE-I or ARB Falmouth Health Centre L82049 10 St Keverne Health Centre L82057 5 Bodriggy Health Centre L82036 19 • GP practice range: 0.0% to 50.0% Cape Cornwall Surgery L82038 6 Roseland Surgeries L82048 3 Meneage Street Surgery L82059 23 • If all practices were to achieve as well Pensilva Health Centre L82037 4 Helston Medical Centre L82018 5 Old Bridge Surgery L82022 4 as the average of the best achieving Millbrook Surgery L82621 1 Manor Surgery L82042 18 Pool Health Centre L82041 6 practices, then an additional 165 Neetside Surgery Y01127 6 Port Isaac Practice L82003 4 Fowey River Practice L82035 6 people would be treated St Agnes & Mount Hawke Surgeries L82054 5 Harris Memorial & Lanner Surgeries L82620 5 Carnewater Practice L82009 6 Penalverne Surgery L82053 8 Homecroft Surgery L82002 14 The Clays Practice L82051 7 Narrowcliff Surgery L82029 16 Carnon Downs Surgery L82061 5 Stratton Medical Centre L82008 3 Wheal Northey Surgery L82611 5 Isles Of Scilly Health Centre L82017 2 Westover Surgery L82622 6 Middleway Surgery L82026 6 Rosmellyn Surgery Y01050 3 Lander Medical Practice L82001 11 Launceston Medical Centre L82030 1 Trescobeas Surgery L82052 6 Penryn Surgery L82006 17 Woodland Road Surgery L82040 8 Tamar Valley Health L82012 9 The Park Medical Centre L82019 5 Petroc Group Practice L82023 6 Mevagissey Surgery L82025 4 Three Spires Medical Practice L82028 6 Morrab Surgery Y01051 3 Marazion Surgery L82047 5 Chacewater And Devoran Surgeries L82015 6 Mullion & Constantine Group Practice L82056 2 Praze Surgery L82068 2 Oak Tree Surgery L82016 1 Newquay Health Centre Y02517 3 The Alverton Practice L82021 2 Wadebridge & Camel Estuary Practice L82004 1 Polkyth Surgery Y04694 1 Camelford Medical Centre L82007 Stillmoor House Medical Practice L82010 Lostwithiel Medical Practice L82039 Saltash Health Centre L82046 Bottreaux Surgery L82058 Churchfield Practice L82618 0% 10% 20% 30% 40% 50% 60%
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 and BB by CCG Comparison with CCGs in the SCN Treatment No treatment Exceptions reported
NHS South Gloucestershire CCG 81.9%
NHS Bristol CCG 79.3% • 1,906 people with heart failure* with LVSD treated with ACE-I/ARB in NHS NHS North Somerset CCG 77.4% Kernow CCG • 1,321 (69.3%) people treated with NHS Gloucestershire CCG 75.2% ACE-I/ARB and BB • 437 (22.9%) people who are NHS Somerset CCG 73.5% exceptions • 148 (7.8%) additional people who are NHS Swindon CCG 71.3% not treated with ACE-I/ARB and BB NHS Wiltshire CCG 70.8%
NHS Northern, Eastern And Western Devon CCG 70.3%
NHS Kernow CCG 69.3%
NHS Bath And North East Somerset CCG 66.6%
NHS South Devon And Torbay CCG 60.2%
England 76.3%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF004 denominator plus exceptions
70 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 East Riding of Yorkshire CCG 80.7%
NHS Northumberland CCG 78.7%
NHS Cumbria CCG 76.5%
NHS North East Essex CCG 75.4%
NHS Gloucestershire CCG 75.2%
NHS West Hampshire CCG 75.1%
NHS Ipswich and East Suffolk CCG 75.1%
NHS Dorset CCG 73.5%
NHS Somerset CCG 73.5%
NHS Coastal West Sussex CCG 72.9%
NHS Kernow CCG 69.3%
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 not treated with ACE-I / ARB and BB by GP practice
No treatment Exceptions reported
Old Bridge Surgery L82022 9 Homecroft Surgery L82002 35 Camelford Medical Centre L82007 1 Clinton Road Surgery L82024 6 Bottreaux Surgery L82058 1 The Rame Group Practice Y00969 2 Carnon Downs Surgery L82061 12 Neetside Surgery Y01127 12 Trevithick Surgery L82014 4 • In total, including exceptions, there Mullion & Constantine Group Practice L82056 7 St Keverne Health Centre L82057 7 Cape Cornwall Surgery L82038 9 are 585 people who are not treated Brannel Surgery L82011 6 Pensilva Health Centre L82037 6 with ACE-I or ARB Narrowcliff Surgery L82029 31 Middleway Surgery L82026 13 Penryn Surgery L82006 38 • GP practice range: 0.0% to 56.3% Bodriggy Health Centre L82036 25 Wadebridge & Camel Estuary Practice L82004 9 Mevagissey Surgery L82025 10 • If all practices were to achieve as well Penalverne Surgery L82053 13 Quay Lane Surgery L82043 1 Rosedean House Surgery L82050 2 as the average of the best achieving Wheal Northey Surgery L82611 9 Churchfield Practice L82618 1 The Stennack Surgery Y01922 16 practices, then an additional 208 Meneage Street Surgery L82059 27 Westover Surgery L82622 10 Petroc Group Practice L82023 13 people would be treated Pool Health Centre L82041 8 Newquay Health Centre Y02517 10 Stillmoor House Medical Practice L82010 3 Helston Medical Centre L82018 6 Probus & Grampound Surgeries L82045 6 Fowey River Practice L82035 8 Chacewater And Devoran Surgeries L82015 15 The Clays Practice L82051 10 Phoenix Surgery L82617 5 Veor Surgery L82044 13 Woodland Road Surgery L82040 14 Isles Of Scilly Health Centre L82017 3 Roseland Surgeries L82048 3 Falmouth Health Centre L82049 9 Marazion Surgery L82047 11 Lander Medical Practice L82001 17 The Alverton Practice L82021 6 Harris Memorial & Lanner Surgeries L82620 6 Stratton Medical Centre L82008 4 Carnewater Practice L82009 7 Tamar Valley Health L82012 15 Three Spires Medical Practice L82028 10 The Park Medical Centre L82019 8 Praze Surgery L82068 4 Port Isaac Practice L82003 4 St Agnes & Mount Hawke Surgeries L82054 5 Trescobeas Surgery L82052 8 Morrab Surgery Y01051 5 Port View Surgery L82066 1 Rosmellyn Surgery Y01050 3 Perranporth Surgery L82013 2 Manor Surgery L82042 12 Polkyth Surgery Y04694 4 Sunnyside Surgery L82070 4 Oak Tree Surgery L82016 1 Launceston Medical Centre L82030 Lostwithiel Medical Practice L82039 Saltash Health Centre L82046 Millbrook Surgery L82621 Cardrew Health Centre Y02596 0% 10% 20% 30% 40% 50% 60%
72 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 SCN Below 150/90 Not below 150/90 Exceptions reported
NHS South Gloucestershire CCG 89.9%
NHS Swindon CCG 89.4% • 22,671 people with coronary heart disease* in NHS Kernow CCG NHS Gloucestershire CCG 89.3% • 20,196 (89.1%) people whose blood pressure <= 150 / 90 NHS Kernow CCG 89.1% • 938 (4.1%) people who are exceptions NHS North Somerset CCG 88.8% • 1,537 (6.8%) additional people whose blood pressure is not <= 150 / 90 NHS Bath And North East Somerset CCG 88.7%
NHS Wiltshire CCG 88.1%
NHS Bristol CCG 87.7%
NHS Northern, Eastern And Western Devon CCG 87.3%
NHS South Devon And Torbay CCG 85.3%
NHS Somerset CCG 82.9%
England 88.4%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD002 denominator plus exceptions
73 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 Northumberland CCG 89.5%
NHS Gloucestershire CCG 89.3%
NHS Kernow CCG 89.1%
NHS Cumbria CCG 88.9%
NHS North East Essex CCG 88.1%
NHS Ipswich and East Suffolk CCG 87.8%
NHS Dorset CCG 87.5%
NHS West Hampshire CCG 87.4%
NHS East Riding of Yorkshire CCG 87.3%
NHS Coastal West Sussex CCG 85.2%
NHS Somerset CCG 82.9%
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 not 150/90 mmHg or less by GP practice
Not below 150/90 Exceptions reported
Polkyth Surgery Y04694 93 Veor Surgery L82044 124 Cardrew Health Centre Y02596 7 Penryn Surgery L82006 96 Carnon Downs Surgery L82061 48 The Rame Group Practice Y00969 60 Camelford Medical Centre L82007 19 Woodland Road Surgery L82040 66 Rosmellyn Surgery Y01050 36 • In total, including exceptions, there Pensilva Health Centre L82037 31 The Park Medical Centre L82019 47 Trevithick Surgery L82014 29 are 2,475 people whose blood Brannel Surgery L82011 21 Port Isaac Practice L82003 41 pressure is not <= 150 / 90 Clinton Road Surgery L82024 29 Roseland Surgeries L82048 29 Wheal Northey Surgery L82611 43 • GP practice range: 3.1% to 32.2% St Agnes & Mount Hawke Surgeries L82054 39 Rosedean House Surgery L82050 41 Middleway Surgery L82026 31 • If all practices were to achieve as well Praze Surgery L82068 27 Port View Surgery L82066 34 Fowey River Practice L82035 42 as the average of the best achieving Perranporth Surgery L82013 34 Wadebridge & Camel Estuary Practice L82004 41 Bodriggy Health Centre L82036 52 practices, then an additional 700 Saltash Health Centre L82046 49 Old Bridge Surgery L82022 56 Homecroft Surgery L82002 33 people would be treated Morrab Surgery Y01051 25 Isles Of Scilly Health Centre L82017 9 Trescobeas Surgery L82052 40 Harris Memorial & Lanner Surgeries L82620 27 Oak Tree Surgery L82016 51 Newquay Health Centre Y02517 54 Lostwithiel Medical Practice L82039 15 Petroc Group Practice L82023 66 Narrowcliff Surgery L82029 45 Quay Lane Surgery L82043 17 Carnewater Practice L82009 43 Chacewater And Devoran Surgeries L82015 25 Probus & Grampound Surgeries L82045 34 Manor Surgery L82042 61 Launceston Medical Centre L82030 56 Mevagissey Surgery L82025 22 Meneage Street Surgery L82059 20 Helston Medical Centre L82018 53 The Stennack Surgery Y01922 50 The Clays Practice L82051 33 Marazion Surgery L82047 34 Bottreaux Surgery L82058 18 Tamar Valley Health L82012 57 Sunnyside Surgery L82070 21 Westover Surgery L82622 21 Churchfield Practice L82618 11 Mullion & Constantine Group Practice L82056 32 Lander Medical Practice L82001 38 St Keverne Health Centre L82057 10 Stratton Medical Centre L82008 34 Neetside Surgery Y01127 11 Falmouth Health Centre L82049 20 Penalverne Surgery L82053 16 Pool Health Centre L82041 22 Three Spires Medical Practice L82028 29 Cape Cornwall Surgery L82038 12 Millbrook Surgery L82621 4 Stillmoor House Medical Practice L82010 19 Phoenix Surgery L82617 10 The Alverton Practice L82021 12 0% 5% 10% 15% 20% 25% 30% 35%
75 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 SCN Optimal management No treatment Exceptions reported
NHS Bath And North East Somerset CCG 93.2%
NHS South Gloucestershire CCG 92.9% • 22,673 people with coronary heart disease* in NHS Kernow CCG NHS Kernow CCG 92.9% • 21,053 (92.9%) people who are taking aspirin, an alternative anti- NHS North Somerset CCG 92.6% platelet therapy, or an anti-coagulant • 935 (4.1%) people who are NHS Northern, Eastern And Western Devon CCG 92.0% exceptions • 685 (3%) additional people who are NHS Bristol CCG 91.9% not taking aspirin, an alternative anti- NHS Gloucestershire CCG 91.7% platelet therapy, or an anti-coagulant
NHS Swindon CCG 91.5%
NHS Wiltshire CCG 91.1%
NHS Somerset CCG 89.8%
NHS South Devon And Torbay CCG 88.9%
England 91.7%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD005 denominator plus exceptions
76 CVD: Primary Care Intelligence Packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported
NHS Kernow CCG 92.9%
NHS West Hampshire CCG 92.6%
NHS Northumberland CCG 91.8%
NHS Dorset CCG 91.7%
NHS Gloucestershire CCG 91.7%
NHS Cumbria CCG 91.6%
NHS East Riding of Yorkshire CCG 90.8%
NHS North East Essex CCG 90.6%
NHS Ipswich and East Suffolk CCG 90.4%
NHS Coastal West Sussex CCG 89.9%
NHS Somerset CCG 89.8%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
77 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
Lostwithiel Medical Practice L82039 21 Polkyth Surgery Y04694 41 Woodland Road Surgery L82040 56 Penryn Surgery L82006 72 Helston Medical Centre L82018 74 The Rame Group Practice Y00969 42 Isles Of Scilly Health Centre L82017 9 Praze Surgery L82068 24 Launceston Medical Centre L82030 62 • In total, including exceptions, there Mevagissey Surgery L82025 24 Rosmellyn Surgery Y01050 23 Oak Tree Surgery L82016 46 are 1,620 people are not taking Quay Lane Surgery L82043 16 Bodriggy Health Centre L82036 39 aspirin, an alternative anti-platelet Port Isaac Practice L82003 26 Veor Surgery L82044 40 Homecroft Surgery L82002 24 therapy, or an anti-coagulant Trevithick Surgery L82014 16 Rosedean House Surgery L82050 26 The Park Medical Centre L82019 25 • GP practice range: 2.9% to 14.3% St Agnes & Mount Hawke Surgeries L82054 23 Churchfield Practice L82618 11 Pensilva Health Centre L82037 15 • If all practices were to achieve as well Probus & Grampound Surgeries L82045 25 Wadebridge & Camel Estuary Practice L82004 25 Stratton Medical Centre L82008 34 as the average of the best achieving Perranporth Surgery L82013 20 The Alverton Practice L82021 26 Saltash Health Centre L82046 29 practices, then an additional 462 Westover Surgery L82622 18 Manor Surgery L82042 42 Cardrew Health Centre Y02596 2 people would be treated Clinton Road Surgery L82024 14 Penalverne Surgery L82053 17 Harris Memorial & Lanner Surgeries L82620 16 Mullion & Constantine Group Practice L82056 27 Petroc Group Practice L82023 41 The Stennack Surgery Y01922 35 Camelford Medical Centre L82007 7 Wheal Northey Surgery L82611 20 Port View Surgery L82066 17 Roseland Surgeries L82048 13 Old Bridge Surgery L82022 29 Carnon Downs Surgery L82061 16 Bottreaux Surgery L82058 13 Trescobeas Surgery L82052 21 Fowey River Practice L82035 20 Sunnyside Surgery L82070 15 Tamar Valley Health L82012 39 Millbrook Surgery L82621 4 Newquay Health Centre Y02517 27 Chacewater And Devoran Surgeries L82015 13 Pool Health Centre L82041 19 Cape Cornwall Surgery L82038 11 Narrowcliff Surgery L82029 22 Carnewater Practice L82009 21 Middleway Surgery L82026 12 Three Spires Medical Practice L82028 25 Meneage Street Surgery L82059 10 Falmouth Health Centre L82049 15 Marazion Surgery L82047 17 Stillmoor House Medical Practice L82010 18 Phoenix Surgery L82617 10 Lander Medical Practice L82001 22 St Keverne Health Centre L82057 6 Morrab Surgery Y01051 9 The Clays Practice L82051 13 Brannel Surgery L82011 5 Neetside Surgery Y01127 5 0% 2% 4% 6% 8% 10% 12% 14% 16%
78 CVD: Primary Care Intelligence Packs The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported
NHS Bath And North East Somerset CCG 70.6%
NHS South Gloucestershire CCG 70.0% • 3,088 people with a history of myocardial infarction* in NHS Kernow NHS Somerset CCG 69.5% CCG • 1,915 (62%) people who are taking NHS Bristol CCG 68.8% an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta- NHS Gloucestershire CCG 68.2% blocker and statin <= 150 / 90 • 1,083 (35.1%) people who are NHS Wiltshire CCG 67.6% exceptions NHS Swindon CCG 66.4% • 90 (2.9%) additional people who are not taking an ACE-I / ARB, aspirin or NHS Northern, Eastern And Western Devon CCG 64.0% an alternative anti-platelet therapy, beta-blocker and statin NHS North Somerset CCG 62.5%
NHS Kernow CCG 62.0%
NHS South Devon And Torbay CCG 57.8%
England 69.1%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD006 denominator plus exceptions
79 CVD: Primary Care Intelligence Packs The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported
NHS North East Essex CCG 73.3%
NHS Northumberland CCG 71.2%
NHS East Riding of Yorkshire CCG 69.7%
NHS Somerset CCG 69.5%
NHS Gloucestershire CCG 68.2%
NHS Ipswich and East Suffolk CCG 66.1%
NHS Cumbria CCG 66.0%
NHS West Hampshire CCG 65.1%
NHS Kernow CCG 62.0%
NHS Dorset CCG 61.6%
NHS Coastal West Sussex CCG 56.7%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
80 CVD: Primary Care Intelligence Packs The percentage of patients with a history of MI not currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by GP practice
No treatment Exceptions reported
St Keverne Health Centre L82057 15 Port Isaac Practice L82003 21 Veor Surgery L82044 27 Carnon Downs Surgery L82061 22 St Agnes & Mount Hawke Surgeries L82054 26 Stratton Medical Centre L82008 34 Manor Surgery L82042 42 Clinton Road Surgery L82024 58 Middleway Surgery L82026 18 • In total, including exceptions, there Morrab Surgery Y01051 47 Petroc Group Practice L82023 66 Mevagissey Surgery L82025 23 are 1,173 people who are not taking Rosedean House Surgery L82050 17 Polkyth Surgery Y04694 16 an ACE-I / ARB, aspirin or an Lander Medical Practice L82001 25 Rosmellyn Surgery Y01050 17 Pensilva Health Centre L82037 13 alternative anti-platelet therapy, beta- Bottreaux Surgery L82058 13 Homecroft Surgery L82002 18 Saltash Health Centre L82046 18 blocker and statin Sunnyside Surgery L82070 14 Probus & Grampound Surgeries L82045 19 The Stennack Surgery Y01922 34 • GP practice range: 12.0% to 60.0% Wadebridge & Camel Estuary Practice L82004 18 Quay Lane Surgery L82043 9 Port View Surgery L82066 15 • If all practices were to achieve as well The Rame Group Practice Y00969 19 Roseland Surgeries L82048 12 Meneage Street Surgery L82059 8 as the average of the best achieving Woodland Road Surgery L82040 30 Carnewater Practice L82009 17 Perranporth Surgery L82013 5 practices, then an additional 325 Bodriggy Health Centre L82036 20 Narrowcliff Surgery L82029 18 Wheal Northey Surgery L82611 3 people would be treated Mullion & Constantine Group Practice L82056 10 Oak Tree Surgery L82016 26 Westover Surgery L82622 13 Pool Health Centre L82041 18 Fowey River Practice L82035 17 Harris Memorial & Lanner Surgeries L82620 18 Helston Medical Centre L82018 35 The Park Medical Centre L82019 17 Three Spires Medical Practice L82028 4 Neetside Surgery Y01127 9 Old Bridge Surgery L82022 20 Falmouth Health Centre L82049 17 Phoenix Surgery L82617 9 The Clays Practice L82051 17 Lostwithiel Medical Practice L82039 7 Launceston Medical Centre L82030 18 Stillmoor House Medical Practice L82010 20 Trevithick Surgery L82014 6 Tamar Valley Health L82012 19 Penalverne Surgery L82053 7 Newquay Health Centre Y02517 16 Camelford Medical Centre L82007 2 Chacewater And Devoran Surgeries L82015 9 Cape Cornwall Surgery L82038 6 Cardrew Health Centre Y02596 1 Isles Of Scilly Health Centre L82017 3 Praze Surgery L82068 8 Marazion Surgery L82047 9 Millbrook Surgery L82621 3 Trescobeas Surgery L82052 12 Churchfield Practice L82618 3 Penryn Surgery L82006 8 The Alverton Practice L82021 6 Brannel Surgery L82011 3 0% 10% 20% 30% 40% 50% 60% 70%
81 CVD: Primary Care Intelligence Packs Some data on outcomes for people with cardiovascular disease
82 CVD: Primary Care Intelligence Packs Hospital admissions for myocardial infarction for all ages 2002/03 – 2014/15
NHS Kernow CCG England 900
800 • In NHS Kernow CCG, the hospital admission rate for myocardial 700 infarction in 2014/15 was 593.7 (3,732) compared to 539.7 for England 600
500
400
300 Age Age standardised (per rate 100,000) 200
100
0 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Source: Hospital Episode Statistics (HES), 2002/03 - 2014/15, Copyright © 2016, Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved
83 CVD: Primary Care Intelligence Packs Hospital admissions for stroke for all ages 2002/03 – 2014/15
NHS Kernow CCG England 300
• In NHS Kernow CCG, the hospital 250 admission rate for stroke in 2014/15 was 224.3 (1,431) compared to 171.9 for England
200
150
100 Age standardised standardised Age (per rate 100,000)
50
0 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Source: Hospital Episode Statistics (HES), 2002/03 - 2014/15, Copyright © 2016, Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved
84 CVD: Primary Care Intelligence Packs Additional risk of complications for people with diabetes, three year follow up, 2012/13
NHS Kernow CCG England
115.0% Angina 136.8% • The risk of a stroke was 73.5% higher and the risk of a heart attack was 105.2% 105.2% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 353.1% higher. 123.8% Heart failure 150.0%
73.5% Stroke 81.3%
353.1% Major amputation 445.8%
571.9% Minor amputation 753.5%
196.1% RRT 293.0%
0.0% 100.0% 200.0% 300.0% 400.0% 500.0% 600.0% 700.0% 800.0% Note: This slide uses data from the National Diabetes Audit (NDA)
85 CVD: Primary Care Intelligence Packs Deaths from myocardial infarction, under 75s
NHS Kernow CCG England 90
80 • In NHS Kernow CCG, the early mortality rate for myocardial infarction 70 in 2012-14 was 36.4, compared to 41.5 for England
60
50
40
30 Age Age standardised rate(per 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
Source: Office for National Statistics (ONS) mortality data 2002 - 2014
86 CVD: Primary Care Intelligence Packs Deaths from stroke, under 75s
NHS Kernow CCG England 30
• In NHS Kernow CCG, the early 25 mortality rate for stroke in 2012-14 was 13.6, compared to 13.8 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
Source: Office for National Statistics (ONS) mortality data 2002 - 2014
87 CVD: Primary Care Intelligence Packs Appendix
Data sources
• Quality and Outcomes Framework (QOF), 2014/15, Copyright © 2016, re-used with the permission of the Health and Social Care Information Centre. All rights reserved
• Active people survey, Sport England, 2012, and 2012-2014
• East of England Public Health Observatory modelled estimates 2011
• CKD Prevalence model, G.Aitken, University of Southampton
• NHS Stop smoking services Copyright © 2014, Health and Social Care Information Centre
• NHS Health checks, 2014/15
• 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, 2012/13 and 2013/14, Copyright © 2016, re-used with the permission of the Health and Social Care Information Centre. All rights reserved
• Hospital Episode Statistics (HES), 2002/03 - 2014/15, Copyright © 2016, Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved
• Office for National Statistics (ONS) mortality data 2002 – 2014, Copyright © 2016, 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. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health.
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Published March 2016
89 CVD: Primary Care Intelligence Packs