CVD: Primary Care Intelligence Packs NHS Isle of Wight CCG

June 2017 Version 1 Contents

1. Introduction 3

2. CVD prevention • The narrative 11 • The data 13 3. Hypertension • The narrative 16 • The data 17 4. Stroke • The narrative 27 • The data 28 5. Diabetes • The narrative 42 • The data 43 6. Kidney • The narrative 53 • The data 54 7. Heart • The narrative 65 • The data 66 8. Outcomes 82

9. Appendix 88 This document is valid only when viewed via the internet. If it is printed into hard copy or saved to another location, you must first check that the version number on your copy matches that of the one online. Printed copies are uncontrolled copies.

2 CVD: Primary Care Intelligence Packs Introduction

3 CVD: Primary Care Intelligence Packs This intelligence pack has been compiled by GPs and nurses and pharmacists in the Primary Care CVD Leadership Forum in collaboration with the National Cardiovascular Intelligence Network

Matt Kearney Sarit Ghosh Kathryn Griffith George Kassianos Jo Whitmore Matthew Fay Chris Harris Jan Procter-King Yassir Javaid Ivan Benett Ruth Chambers Ahmet Fuat Mike Kirby Peter Green Kamlesh Khunti Helen Williams Quincy Chuhka Sheila McCorkindale Nigel Rowell Ali Morgan Stephen Kirk Sally Christie Clare Hawley Paul Wright Bruce Taylor Mike Knapton John Robson Richard Mendelsohn Chris Arden David Fitzmaurice

4 CVD: Primary Care Intelligence Packs Local intelligence as a tool for clinicians and commissioners to improve outcomes for our patients Why should we use this CVD Intelligence Pack The high risk conditions for cardiovascular disease (CVD) - such as hypertension, atrial fibrillation, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease - are the low hanging fruit for prevention in the NHS because in each case late diagnosis and suboptimal treatment is common and there is substantial variation. High quality primary care is central to improving outcomes in CVD because primary care is where much prevention and most diagnosis and treatment is delivered. This cardiovascular intelligence pack is a powerful resource for stimulating local conversations about quality improvement in primary care. Across a number of vascular conditions, looking at prevention, diagnosis, care and outcomes, the data allows comparison between clinical commissioning groups (CCGs) and between practices. This is not about performance management because we know that variation can have more than one interpretation. But patients have a right to expect that we will ask challenging questions about how the best practices are achieving the best, what average or below average performers could do differently, and how they could be supported to perform as well as the best.

How to use the CVD intelligence pack The intelligence pack has several sections – CVD prevention, hypertension, stroke and atrial fibrillation (AF), diabetes, kidney disease, heart disease and heart failure. Each section has one slide of narrative that makes the case and asks some questions. This is followed by data for a number of indicators, each with benchmarked comparison between CCGs and between practices. Use the pack to identify where there is variation that needs exploring and to start asking challenging questions about where and how quality could be improved. We suggest you then develop a local action plan for quality improvement – this might include establishing communities of practice to build clinical leadership, systematic local audit to get a better understanding of the gaps in care and outcomes, and developing new models of care that mobilise the wider primary care team to reduce burden on general practice.

5 CVD: Primary Care Intelligence Packs Data and methods

This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic transformation plan (STP) and England. Where a CCG is in more than one STP, it has been allocated to the STP with the greatest geographical or population coverage. The slide pack also compares the CCG to its 10 most similar CCGs in terms of demography, ethnicity and deprivation. For information on the methodology used to calculate the 10 most similar CCGs please go to: http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/

The 10 most similar CCGs to NHS Isle of Wight CCG are: NHS West Norfolk CCG NHS Lincolnshire East CCG NHS Hastings and Rother CCG NHS Great Yarmouth and Waveney CCG NHS Eastbourne, Hailsham and Seaford CCG NHS Hambleton, Richmondshire and Whitby CCG NHS Herefordshire CCG NHS South Kent Coast CCG NHS East Riding of Yorkshire CCG NHS Northumberland CCG

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

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

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

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

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

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

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

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

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

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

WELLINGTON ROAD SURGERY 7

EMERSONS GREEN MEDICAL CENTRE 9

LEAP VALLEY MEDICAL CENTRE 22

CHRISTCHURCH FAMILY MEDICAL CENTRE 21

CONISTON MEDICAL PRACTICE 17

FROME VALLEY MEDICAL CENTRE 31

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

THE WILLOW SURGERY 5

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

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

denominatorORCHARD MEDICAL plus CENTRE exceptions.

WEST WALK SURGERY

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

10 CVD: Primary Care Intelligence Packs CVD prevention

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

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

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

High systolic blood pressure

Dietary risks

High total cholesterol

High body-mass index

Tobacco smoke

High fasting plasma glucose

Low physical activity

Air pollution

Low glomerular filtration rate

Other environmental risks

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

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

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

NHS Hastings and Rother CCG 21.7%

NHS Great Yarmouth and Waveney CCG 21.1% • prevalence of 18.5% in NHS Isle of Wight CCG NHS South Kent Coast CCG 20.8%

NHS Lincolnshire East CCG 20.5%

NHS West Norfolk CCG 19.2%

NHS Isle of Wight CCG 18.5%

NHS Herefordshire CCG 17.1%

NHS Eastbourne, Hailsham and Seaford CCG 16.2% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Northumberland CCG 16.2% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS East Riding of Yorkshire CCG 15.2% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS Hambleton, Richmondshire and Whitby CCG 14.0% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 5% 10% 15% 20% 25% recorded as current smokers) divided by GP practice’s estimated number of patients 15+

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

GP Practice CCG

ESPLANADE SURGERY J84005 21.6%

GROVE HOUSE SURGERY J84018 21.3% • 22,653 people who are recorded as VENTNOR MEDICAL CENTRE J84003 20.6% smokers in NHS Isle of Wight CCG

TOWER HOUSE SURGERY J84012 20.3% • GP practice range: 10.8% to 21.6%

THE DOWER HOUSE J84014 20.0%

BEECH GROVE SURGERY J84020 19.9%

MEDINA HEALTHCARE J84017 19.6%

SHANKLIN MEDICAL CENTRE J84010 19.2%

SANDOWN HEALTH CENTRE J84013 19.0%

EAST COWES MEDICAL CENTRE J84004 18.0%

CARISBROOKE HEALTH CENTRE J84011 17.6%

COWES MEDICAL CENTRE J84015 17.0%

ARGYLL HOUSE J84008 16.8%

WEST WIGHT MEDICAL PRACTICE J84019 15.4% Note: This method is thought to be a reasonably ST.HELENS MEDICAL CENTRE J84007 12.3% robust method in estimating smoking prevalence for the majority of GP practices. However, SOUTH WIGHT MEDICAL PRACTICE J84016 10.8% caution is advised for extreme estimates of GARFIELD ROAD SURGERY J84602 smoking prevalence and those with high numbers of smoking status not recorded and 0% 5% 10% 15% 20% 25% exceptions.

14 CVD: Primary Care Intelligence Packs Hypertension

15 CVD: Primary Care Intelligence Packs Hypertension

The Missing Millions On average, each CCG in England has 26,000 residents with The Global Burden of Disease undiagnosed hypertension – these individuals are unaware of Study confirmed high blood pressure as their increased cardiovascular risk and are untreated. a leading cause of premature death and disability What questions should we ask in our CCG? 1. for each indicator how wide is the variation in achievement and exception reporting? 2. how many people would benefit if all practices performed High blood pressure is common and costly as well as the best? • it affects around a quarter of all adults 3. how can we support practices who are average or below • the NHS costs of hypertension are around £2bn average to perform as well as the best in: • social costs are probably considerably higher • detection of hypertension • management of hypertension What do we know? • at least half of all heart attacks and strokes are caused by high blood pressure and it is a major risk What might help? factor for chronic kidney disease and cognitive decline • support practices to share audit data and systematically • treatment is very effective – every 10mmHg reduction identify gaps and opportunities for improved detection and in systolic blood pressure lowers risk of heart attack management of hypertension and stroke by 20% • work with practices and local authorities to maximise • despite this 4 out of 10 adults with hypertension, over uptake and follow up in the NHS Health Check 5 and a half million people in England, remain • support access to self-test BP stations in waiting rooms undiagnosed and to ambulatory blood pressure monitoring. • and even when the condition is identified, treatment is • commission community pharmacists to offer blood often suboptimal, with blood pressure poorly pressure measurement, diagnosis and management controlled in about 1 out of 3 individuals support, including support for adherence to medication

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

NHS Isle Of Wight CCG 0.61

NHS Fareham And Gosport CCG 0.60 • the ratio of those diagnosed with hypertension versus those expected to have hypertension is 0.61. This NHS South Eastern Hampshire CCG 0.60 compares to 0.59 for England • this suggests that 61% of people with hypertension have been diagnosed NHS West Hampshire CCG 0.59

NHS North Hampshire CCG 0.57

NHS Portsmouth CCG 0.56

NHS Southampton CCG 0.53

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

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

NHS Hastings and Rother CCG 0.64

NHS East Riding of Yorkshire CCG 0.62

NHS West Norfolk CCG 0.62

NHS South Kent Coast CCG 0.61

NHS Northumberland CCG 0.61

NHS Eastbourne, Hailsham and Seaford CCG 0.61

NHS Lincolnshire East CCG 0.61

NHS Isle of Wight CCG 0.61

NHS Great Yarmouth and Waveney CCG 0.60

NHS Hambleton, Richmondshire and Whitby CCG 0.60

NHS Herefordshire CCG 0.59

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

18 CVD: Primary Care Intelligence Packs Hypertension observed prevalence compared with expected prevalence by GP practice

GP practice CCG

SANDOWN HEALTH CENTRE J84013 0.63

THE DOWER HOUSE J84014 0.62 • it is estimated that there are 15,971 SHANKLIN MEDICAL CENTRE J84010 0.61 people with undiagnosed ESPLANADE SURGERY J84005 0.59 hypertension in NHS Isle of Wight

SOUTH WIGHT MEDICAL PRACTICE J84016 0.59 CCG • GP practice range of observed to GROVE HOUSE SURGERY J84018 0.58 expected hypertension prevalence 0 EAST COWES MEDICAL CENTRE J84004 0.58 to 0.63 WEST WIGHT MEDICAL PRACTICE J84019 0.57

ST.HELENS MEDICAL CENTRE J84007 0.56

MEDINA HEALTHCARE J84017 0.53

CARISBROOKE HEALTH CENTRE J84011 0.52

COWES MEDICAL CENTRE J84015 0.51

VENTNOR MEDICAL CENTRE J84003 0.50

TOWER HOUSE SURGERY J84012 0.49

BEECH GROVE SURGERY J84020 0.49

ARGYLL HOUSE J84008 0.41

GARFIELD ROAD SURGERY J84602

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

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

NHS Isle Of Wight CCG 82.8%

NHS South Eastern Hampshire CCG 80.6% • 24,934 people with hypertension (diagnosed)* in NHS Isle of Wight CCG NHS Portsmouth CCG 80.0% • 20,653 (82.8%) people whose blood pressure is <= 150/90 • 1,138 (4.6%) people who are NHS North Hampshire CCG 78.6% excepted from optimal control • 3,143 (12.6%) additional people NHS West Hampshire CCG 78.3% whose blood pressure is not <= 150/90

NHS Southampton CCG 76.8%

NHS Fareham And Gosport CCG 75.7%

England 79.6%

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

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

NHS Isle of Wight CCG 82.8%

NHS Hambleton, Richmondshire and Whitby CCG 82.7%

NHS Northumberland CCG 81.8%

NHS Lincolnshire East CCG 81.3%

NHS West Norfolk CCG 81.1%

NHS Herefordshire CCG 80.7%

NHS Hastings and Rother CCG 80.4%

NHS South Kent Coast CCG 79.6%

NHS East Riding of Yorkshire CCG 79.4%

NHS Eastbourne, Hailsham and Seaford CCG 77.3%

NHS Great Yarmouth and Waveney CCG 76.9%

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

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

No treatment Exceptions reported

COWES MEDICAL CENTRE J84015 555

SOUTH WIGHT MEDICAL PRACTICE J84016 308 • in total, including exceptions, there MEDINA HEALTHCARE J84017 334 are 4,281 people whose blood

WEST WIGHT MEDICAL PRACTICE J84019 479 pressure is not <= 150/90 • GP practice range: 10.9% to 25.4% GROVE HOUSE SURGERY J84018 145

SHANKLIN MEDICAL CENTRE J84010 388

BEECH GROVE SURGERY J84020 120

CARISBROOKE HEALTH CENTRE J84011 229

GARFIELD ROAD SURGERY J84602 70

TOWER HOUSE SURGERY J84012 245

VENTNOR MEDICAL CENTRE J84003 131

ESPLANADE SURGERY J84005 256

SANDOWN HEALTH CENTRE J84013 348

ARGYLL HOUSE J84008 88

THE DOWER HOUSE J84014 282

ST.HELENS MEDICAL CENTRE J84007 145

EAST COWES MEDICAL CENTRE J84004 158

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

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

NHS South Eastern Hampshire CCG 77.7%

NHS Southampton CCG 71.7% • 84 people with a new diagnosis* of hypertension with a CVD risk of 20% or higher in NHS Isle of Wight CCG NHS Portsmouth CCG 71.6% • 46 (54.8%) people who are currently treated with statins • 34 (40.5%) people who are exempted NHS North Hampshire CCG 66.0% from treatment with statins • 4 (4.8%) additional people who are NHS Fareham And Gosport CCG 64.7% not currently treated with statins

NHS West Hampshire CCG 55.9%

NHS Isle Of Wight CCG 54.8%

England 66.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *Using the QOF clinical indicator CVD-PP001 denominator plus exceptions

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

NHS Hambleton, Richmondshire and Whitby CCG 71.6%

NHS South Kent Coast CCG 69.5%

NHS West Norfolk CCG 68.5%

NHS Hastings and Rother CCG 64.2%

NHS East Riding of Yorkshire CCG 64.0%

NHS Great Yarmouth and Waveney CCG 62.1%

NHS Northumberland CCG 61.9%

NHS Lincolnshire East CCG 60.2%

NHS Herefordshire CCG 57.6%

NHS Eastbourne, Hailsham and Seaford CCG 54.9%

NHS Isle of Wight CCG 54.8%

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

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

No treatment Exceptions reported

CARISBROOKE HEALTH CENTRE J84011 1

MEDINA HEALTHCARE J84017 2 • in total, including exceptions, there ARGYLL HOUSE J84008 3 are 38 people who are not treated

GROVE HOUSE SURGERY J84018 3 with statins • GP practice range: 20.0% to 100.0% WEST WIGHT MEDICAL PRACTICE J84019 3

ESPLANADE SURGERY J84005 2

EAST COWES MEDICAL CENTRE J84004 3

BEECH GROVE SURGERY J84020 1

THE DOWER HOUSE J84014 3

SHANKLIN MEDICAL CENTRE J84010 5

SANDOWN HEALTH CENTRE J84013 5

VENTNOR MEDICAL CENTRE J84003 1

ST.HELENS MEDICAL CENTRE J84007 1

COWES MEDICAL CENTRE J84015 1

SOUTH WIGHT MEDICAL PRACTICE J84016 2

TOWER HOUSE SURGERY J84012 2

GARFIELD ROAD SURGERY J84602

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

25 CVD: Primary Care Intelligence Packs Stroke

26 CVD: Primary Care Intelligence Packs Stroke prevention

What questions should we ask in our CCG? Only a half of people with known 1. for each indicator how wide is the variation in detection, treatment and exception reporting? AF who then suffer a stroke have been 2. how many people would benefit if all practices anticoagulated before their stroke. performed as well as the best? 3. how can we support practices who are average and below average to perform as well as the best in detection of atrial fibrillation and stroke prevention with anticoagulation. Stroke is one of the leading causes of premature death and disability. Stroke is What might help? devastating for individuals and families, and • increase opportunistic pulse checking especially in over 65s accounts for a substantial proportion of health • support practices to share audit data and systematically and social care expenditure. identify gaps and opportunities for improved detection and management of AF - eg GRASP-AF Atrial fibrillation increases the risk of stroke • promote systematic use of CHADS-VASC and HASBLED to by a factor of 5, and strokes caused by AF are ensure those at high risk are offered stroke prevention often more severe, with higher mortality and • promote systematic use of Warfarin Patient Safety Audit Tool greater disability. to ensure optimal time in therapeutic range for people on Anticoagulation reduces the risk of stroke in warfarin people with AF by two thirds. • develop local consensus statement on risk-benefit balance for Despite this, AF is underdiagnosed and under anticoagulants, including the newer treatments (NOACs) treated: up to a third of people with AF are • work with practices and local authorities to maximise uptake unaware they have the condition and even when and clinical follow up in the NHS Health Check diagnosed inadequate treatment is common – • commission community pharmacists to offer pulse checks, large numbers do not receive anticoagulants or anticoagulant monitoring, and support for adherence to have poor anticoagulant control. medication

27 CVD: Primary Care Intelligence Packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with CCGs in the STP

NHS Portsmouth CCG 0.74

NHS South Eastern Hampshire CCG 0.74 • the ratio of those diagnosed with atrial fibrillation versus those expected to have atrial fibrillation is 0.63. This NHS Fareham And Gosport CCG 0.71 compares to 0.7 for England • this suggests that 63% of people with atrial fibrillation have been diagnosed. NHS West Hampshire CCG 0.70

NHS Southampton CCG 0.68

NHS North Hampshire CCG 0.66

NHS Isle Of Wight CCG 0.63 Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 2015/16 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence Network estimates produced in 2017. The estimates were developed by applying age-sex England 0.70 specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 NHS Digital. Estimates reported are adjusted for age and sex of the local population.

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

NHS Eastbourne, Hailsham and Seaford CCG 0.84

NHS West Norfolk CCG 0.79

NHS South Kent Coast CCG 0.78

NHS Hastings and Rother CCG 0.78

NHS Hambleton, Richmondshire and Whitby CCG 0.76

NHS Northumberland CCG 0.73

NHS Lincolnshire East CCG 0.72

NHS East Riding of Yorkshire CCG 0.71

NHS Herefordshire CCG 0.69

NHS Great Yarmouth and Waveney CCG 0.66

NHS Isle of Wight CCG 0.63

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

GP practice CCG

SANDOWN HEALTH CENTRE J84013 0.8

ST.HELENS MEDICAL CENTRE J84007 0.7 • it is estimated that there are 5,098 SHANKLIN MEDICAL CENTRE J84010 0.7 people with undiagnosed atrial

THE DOWER HOUSE J84014 0.7 fibrillation in NHS Isle of Wight CCG • GP practice range of observed to COWES MEDICAL CENTRE J84015 0.7 expected atrial fibrillation prevalence SOUTH WIGHT MEDICAL PRACTICE J84016 0.7 0.5 to 0.8

EAST COWES MEDICAL CENTRE J84004 0.6

ESPLANADE SURGERY J84005 0.6

GROVE HOUSE SURGERY J84018 0.6

WEST WIGHT MEDICAL PRACTICE J84019 0.6

BEECH GROVE SURGERY J84020 0.6

VENTNOR MEDICAL CENTRE J84003 0.5

ARGYLL HOUSE J84008 0.5

CARISBROOKE HEALTH CENTRE J84011 0.5

TOWER HOUSE SURGERY J84012 0.5

MEDINA HEALTHCARE J84017 0.5

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

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

NHS West Hampshire CCG 81.0% • 2,629 people with atrial fibrillation* NHS North Hampshire CCG 79.9% with a CHA2DS2-VASc score >= 2 in NHS Isle of Wight CCG • 1,933 (73.5%) people treated with NHS Southampton CCG 77.8% anti-coagulation therapy • 350 (13.3%) people who are exceptions NHS South Eastern Hampshire CCG 76.2% • 346 (13.2%) additional people with a recorded CHA2DS2-VASc score >= 2 NHS Fareham And Gosport CCG 75.2% who are not treated

NHS Portsmouth CCG 74.2%

NHS Isle Of Wight CCG 73.5%

England 77.9%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 83.7%

NHS Lincolnshire East CCG 81.1%

NHS Herefordshire CCG 80.8%

NHS South Kent Coast CCG 78.6%

NHS Eastbourne, Hailsham and Seaford CCG 78.1%

NHS Hastings and Rother CCG 77.6%

NHS East Riding of Yorkshire CCG 76.6%

NHS West Norfolk CCG 74.8%

NHS Isle of Wight CCG 73.5%

NHS Northumberland CCG 72.3%

NHS Great Yarmouth and Waveney CCG 71.3%

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

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

No treatment Exceptions reported

ARGYLL HOUSE J84008 31

GROVE HOUSE SURGERY J84018 28 • in total, including exceptions, there TOWER HOUSE SURGERY J84012 58 are 696 people with a recorded

BEECH GROVE SURGERY J84020 30 CHA2DS2-VASc score >= 2 who are not treated MEDINA HEALTHCARE J84017 42 • GP practice range: 16.5% to 43.7% GARFIELD ROAD SURGERY J84602 6

WEST WIGHT MEDICAL PRACTICE J84019 82

EAST COWES MEDICAL CENTRE J84004 41

SHANKLIN MEDICAL CENTRE J84010 70

SOUTH WIGHT MEDICAL PRACTICE J84016 27

THE DOWER HOUSE J84014 55

COWES MEDICAL CENTRE J84015 61

SANDOWN HEALTH CENTRE J84013 62

ESPLANADE SURGERY J84005 37

CARISBROOKE HEALTH CENTRE J84011 23

ST.HELENS MEDICAL CENTRE J84007 30

VENTNOR MEDICAL CENTRE J84003 13

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

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

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

ARGYLL HOUSE 20

GROVE HOUSE SURGERY 17

TOWER HOUSE SURGERY 31 • using the GP cluster method of calculating potential gains, if each BEECH GROVE SURGERY 17 practice was to achieve as well as the

MEDINA HEALTHCARE 20 upper quartile of its national cluster, then an additional 246 people would EAST COWES MEDICAL CENTRE 19 be treated WEST WIGHT MEDICAL PRACTICE 33

SHANKLIN MEDICAL CENTRE 27

SOUTH WIGHT MEDICAL PRACTICE 9

THE DOWER HOUSE 15

COWES MEDICAL CENTRE 14

SANDOWN HEALTH CENTRE 14

ESPLANADE SURGERY 7

CARISBROOKE HEALTH CENTRE 3

VENTNOR MEDICAL CENTRE 1

ST.HELENS MEDICAL CENTRE Details of this methodology are available on slide 9. Click here to view them.

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

Below 150/90 Not below 150/90 Exceptions reported

NHS South Eastern Hampshire CCG 84.7% • 3,243 people with a history of stroke NHS Portsmouth CCG 84.4% or TIA* in NHS Isle of Wight CCG • 2,734 (84.3%) people whose blood pressure is <= 150 / 90 NHS Isle Of Wight CCG 84.3% • 171 (5.3%) people who are exceptions • 338 (10.4%) additional people whose NHS North Hampshire CCG 83.3% blood pressure is not <= 150 / 90

NHS Southampton CCG 82.9%

NHS West Hampshire CCG 82.3%

NHS Fareham And Gosport CCG 82.2%

England 83.8%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 85.4%

NHS West Norfolk CCG 84.8%

NHS Northumberland CCG 84.7%

NHS Hastings and Rother CCG 84.6%

NHS Lincolnshire East CCG 84.4%

NHS Isle of Wight CCG 84.3%

NHS Herefordshire CCG 84.1%

NHS South Kent Coast CCG 83.8%

NHS East Riding of Yorkshire CCG 82.9%

NHS Eastbourne, Hailsham and Seaford CCG 82.6%

NHS Great Yarmouth and Waveney CCG 81.4%

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

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

No treatment Exceptions reported

CARISBROOKE HEALTH CENTRE J84011 42

WEST WIGHT MEDICAL PRACTICE J84019 72 • in total, including exceptions, there GROVE HOUSE SURGERY J84018 25 are 509 people whose blood pressure

COWES MEDICAL CENTRE J84015 65 is not <= 150 / 90 • GP practice range: 4.6% to 22.6% SHANKLIN MEDICAL CENTRE J84010 59

MEDINA HEALTHCARE J84017 42

GARFIELD ROAD SURGERY J84602 6

SOUTH WIGHT MEDICAL PRACTICE J84016 14

ST.HELENS MEDICAL CENTRE J84007 35

VENTNOR MEDICAL CENTRE J84003 19

TOWER HOUSE SURGERY J84012 16

THE DOWER HOUSE J84014 41

SANDOWN HEALTH CENTRE J84013 41

EAST COWES MEDICAL CENTRE J84004 8

ARGYLL HOUSE J84008 6

ESPLANADE SURGERY J84005 13

BEECH GROVE SURGERY J84020 5

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

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

NHS Southampton CCG 92.3% • 2,264 people with a stroke shown to NHS West Hampshire CCG 91.9% be non-haemorrhagic* in NHS Isle of Wight CCG • 2,077 (91.7%) people who are taking NHS Isle Of Wight CCG 91.7% an anti-platetet agent or anti- coagulant • 138 (6.1%) people who are NHS Fareham And Gosport CCG 91.6% exceptions • 49 (2.2%) additional people with no NHS South Eastern Hampshire CCG 91.5% treatment

NHS North Hampshire CCG 91.2%

NHS Portsmouth CCG 90.6%

England 91.8%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 93.9%

NHS South Kent Coast CCG 93.0%

NHS West Norfolk CCG 92.3%

NHS Northumberland CCG 92.3%

NHS Eastbourne, Hailsham and Seaford CCG 92.1%

NHS Isle of Wight CCG 91.7%

NHS East Riding of Yorkshire CCG 91.7%

NHS Lincolnshire East CCG 91.6%

NHS Hastings and Rother CCG 91.6%

NHS Herefordshire CCG 91.3%

NHS Great Yarmouth and Waveney CCG 90.6%

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

39 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who do not have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by GP practice

No treatment Exceptions reported

SOUTH WIGHT MEDICAL PRACTICE J84016 14

WEST WIGHT MEDICAL PRACTICE J84019 34 • in total, including exceptions, there GROVE HOUSE SURGERY J84018 12 are 187 people who are not taking an

TOWER HOUSE SURGERY J84012 14 anti-platelet agent or anti-coagulant • GP practice range: 1.4% to 15.7% THE DOWER HOUSE J84014 21

MEDINA HEALTHCARE J84017 18

ST.HELENS MEDICAL CENTRE J84007 13

SHANKLIN MEDICAL CENTRE J84010 15

CARISBROOKE HEALTH CENTRE J84011 9

VENTNOR MEDICAL CENTRE J84003 6

ARGYLL HOUSE J84008 3

BEECH GROVE SURGERY J84020 4

COWES MEDICAL CENTRE J84015 13

GARFIELD ROAD SURGERY J84602 1

ESPLANADE SURGERY J84005 5

SANDOWN HEALTH CENTRE J84013 4

EAST COWES MEDICAL CENTRE J84004 1

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

40 CVD: Primary Care Intelligence Packs Diabetes

41 CVD: Primary Care Intelligence Packs Diabetes prevention and management

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

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

NHS Fareham And Gosport CCG 0.81

• 0.67 ratio of observed to expected NHS South Eastern Hampshire CCG 0.80 diabetes prevalence in NHS Isle of Wight CCG, compared to 0.77 in England NHS North Hampshire CCG 0.78 • this suggests 67% of people have been diagnosed NHS Portsmouth CCG 0.78

NHS Southampton CCG 0.76

NHS Isle Of Wight CCG 0.67

NHS West Hampshire CCG 0.66

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

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

NHS Lincolnshire East CCG 0.87

NHS Northumberland CCG 0.83

NHS East Riding of Yorkshire CCG 0.82

NHS West Norfolk CCG 0.82

NHS Great Yarmouth and Waveney CCG 0.79

NHS South Kent Coast CCG 0.77

NHS Hastings and Rother CCG 0.73

NHS Herefordshire CCG 0.69

NHS Eastbourne, Hailsham and Seaford CCG 0.67

NHS Isle of Wight CCG 0.67

NHS Hambleton, Richmondshire and Whitby CCG 0.66

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0

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

GP practice CCG

SANDOWN HEALTH CENTRE J84013 7.7%

SHANKLIN MEDICAL CENTRE J84010 7.6% • GP practice range of observed WEST WIGHT MEDICAL PRACTICE J84019 7.5% diabetes 0.0% to 7.7%

SOUTH WIGHT MEDICAL PRACTICE J84016 7.3% • there are an estimated 4,061 people with undiagnosed diabetes in NHS ST.HELENS MEDICAL CENTRE J84007 7.3% Isle of Wight CCG EAST COWES MEDICAL CENTRE J84004 7.3%

MEDINA HEALTHCARE J84017 6.9%

BEECH GROVE SURGERY J84020 6.5%

GROVE HOUSE SURGERY J84018 6.4%

ESPLANADE SURGERY J84005 6.4%

THE DOWER HOUSE J84014 6.3%

VENTNOR MEDICAL CENTRE J84003 6.3%

ARGYLL HOUSE J84008 6.1%

CARISBROOKE HEALTH CENTRE J84011 6.0%

COWES MEDICAL CENTRE J84015 5.8%

TOWER HOUSE SURGERY J84012 4.9% Note: The estimated number of undiagnosed GARFIELD ROAD SURGERY J84602 people with diabetes has been calculated by multiplying the estimated prevalence rate to the 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 2015/16 QOF list size and subtracting the number of people on the diabetes register.

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

Diabetes prevalence Undiagnosed diabetes prevalence Expected non-diabetic hyperglycaemia prevalence

NHS Isle Of Wight CCG 6.8% 3.4% 12.7% • the estimated total prevalence of diabetes in NHS Isle of Wight CCG is 10.2% (diagnosed and undiagnosed) NHS South Eastern Hampshire CCG 6.9% 1.7% 12.0% • in addition, there are an estimated NHS West Hampshire CCG 5.5% 2.8% 12.0% 12.7% of people in NHS Isle of Wight CCG who are at increased risk of developing diabetes (i.e. with non- NHS Fareham And Gosport CCG 6.7% 1.6% 11.7% diabetic hyperglycaemia)

NHS North Hampshire CCG 5.7% 1.6% 10.7% • this means that 22.9% of the population in NHS Isle of Wight CCG NHS Portsmouth CCG 5.8% 1.6% 9.6% are estimated to have diabetes, or at high risk of developing of diabetes

NHS Southampton CCG 5.5% 1.8% 9.7%

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 6.5% 1.9% 11.2% estimates take into account the age, ethnic group and estimated body mass index of the population. 0% 5% 10% 15% 20% 25% These estimates were produced using the GP registered population.

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

NHS Southampton CCG 65.5%

• data on care processes and treatment NHS North Hampshire CCG 59.2% targets are taken from the National Diabetes Audit (NDA)

NHS Isle Of Wight CCG 55.3% • overall practice participation in the 2015/16 audit was 81.4% in England

NHS West Hampshire CCG 54.6% • in NHS Isle of Wight CCG, 15 out of 16 practices (93.8%) participated in the NDA. Data is not available for the NHS South Eastern Hampshire CCG 45.4% remaining practices

NHS Portsmouth CCG 43.6% • 55.3% of people with diabetes (of practices who participated in the NHS Fareham And Gosport CCG 40.8% audit) had the eight recommended care processes in NHS Isle of Wight CCG, compared to 52.6% in England

England 52.6%

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

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

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

VENTNOR MEDICAL CENTRE J84003 73.1%

ARGYLL HOUSE J84008 71.1% • achievement - 8 care processes: in practices who provided data via the SANDOWN HEALTH CENTRE J84013 71.0% NDA, between 37.8% and 73.1% of THE DOWER HOUSE J84014 64.1% patients received all 8 care processes

ST.HELENS MEDICAL CENTRE J84007 63.9%

TOWER HOUSE SURGERY J84012 57.5% • at least 3,437 people did not receive the eight care processes SOUTH WIGHT MEDICAL PRACTICE J84016 56.8%

EAST COWES MEDICAL CENTRE J84004 52.9%

MEDINA HEALTHCARE J84017 52.4%

ESPLANADE SURGERY J84005 51.8%

WEST WIGHT MEDICAL PRACTICE J84019 50.1%

CARISBROOKE HEALTH CENTRE J84011 49.5%

COWES MEDICAL CENTRE J84015 47.9%

GROVE HOUSE SURGERY J84018 41.6%

SHANKLIN MEDICAL CENTRE J84010 37.8%

GARFIELD ROAD SURGERY J84602

BEECH GROVE SURGERY J84020

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

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

NHS South Eastern Hampshire CCG 37.9%

• 37.6% of people with diabetes (of NHS Southampton CCG 37.8% practices who participated in the audit) met the three treatment targets in NHS Isle of Wight CCG, compared NHS Portsmouth CCG 37.7% to 39.0% in England

NHS Isle Of Wight CCG 37.6%

NHS Fareham And Gosport CCG 36.4%

NHS West Hampshire CCG 36.1%

NHS North Hampshire CCG 35.4%

England 39.0%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

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

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

SANDOWN HEALTH CENTRE J84013 43.4%

TOWER HOUSE SURGERY J84012 41.5% • achievement - 3 treatment targets: in practices who provided data via the ST.HELENS MEDICAL CENTRE J84007 41.0% NDA, between 27.0% and 43.4% of ARGYLL HOUSE J84008 40.1% patients achieved all 3 treatment

CARISBROOKE HEALTH CENTRE J84011 39.7% targets

EAST COWES MEDICAL CENTRE J84004 39.6% • at least 4,158 people did not meet the three treatment targets COWES MEDICAL CENTRE J84015 39.0%

THE DOWER HOUSE J84014 38.7%

SHANKLIN MEDICAL CENTRE J84010 38.0%

VENTNOR MEDICAL CENTRE J84003 33.9%

SOUTH WIGHT MEDICAL PRACTICE J84016 33.9%

WEST WIGHT MEDICAL PRACTICE J84019 33.3%

MEDINA HEALTHCARE J84017 33.0%

ESPLANADE SURGERY J84005 31.4%

GROVE HOUSE SURGERY J84018 27.0%

GARFIELD ROAD SURGERY J84602

BEECH GROVE SURGERY J84020

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

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

0% -2% -4% -6% -8% -10% -12% -14% -16% -18% -20%

GROVE HOUSE SURGERY 32

ESPLANADE SURGERY 59 • using the GP cluster method of VENTNOR MEDICAL CENTRE 27 calculating potential gains, if each MEDINA HEALTHCARE 51 practice was to achieve as well as the upper quartile of its national cluster, WEST WIGHT MEDICAL PRACTICE 61 then an additional 469 people would SOUTH WIGHT MEDICAL PRACTICE 33 be treated

ARGYLL HOUSE 22

SHANKLIN MEDICAL CENTRE 41

EAST COWES MEDICAL CENTRE 27

THE DOWER HOUSE 33

COWES MEDICAL CENTRE 31

CARISBROOKE HEALTH CENTRE 22

ST.HELENS MEDICAL CENTRE 10

TOWER HOUSE SURGERY 13

SANDOWN HEALTH CENTRE 6 Details of this methodology are available on slide 9. Click here to view them.

51 CVD: Primary Care Intelligence Packs Kidney

52 CVD: Primary Care Intelligence Packs Management of chronic kidney disease

Chronic Kidney Disease can progress to kidney failure and it Late diagnosis of CKD is common. substantially increases the risk Around a third of people with CKD are undiagnosed. More of heart attack and stroke. opportunistic testing and improved uptake of the NHS Health Check will increase detection rates.

Chronic Kidney Disease (CKD) is common. What questions should we ask in our CCG? It is one of the commonest co-morbidities and affects a third 1. for each indicator how wide is the variation in of people over 75. In 2010 it was estimated to cost the NHS achievement and exception reporting? around £1.5bn. Average length of stay in hospital tends to 2. how many people would benefit if all practices be longer and outcomes are considerably worse: performed as well as the best? approximately 7,000 excess strokes and 12,000 excess 3. how can we support practices who are average and heart attacks occur each year in people with CKD below average to perform as well as the best in: compared to those without. • detection of CKD Individuals with CKD are also at much higher risk of • more systematic delivery of evidence based care developing acute kidney injury when they have an intercurrent illness such as pneumonia What might help • Support practices to share audit data and systematically Evidence based guidance from NICE highlights CVD identify gaps and opportunities for improved detection risk reduction, good blood pressure control and and management of CKD. management of proteinuria as essential steps to reduce the • Promote uptake of and follow up from the NHS Health risk of cardiovascular events and progression to kidney Check to aid detection and management of CKD failure. Despite this there is often significant variation • Offer local training and education in the detection and between practices in achievement and exception reporting. management of CKD

53 CVD: Primary Care Intelligence Packs Chronic kidney disease (CKD) observed prevalence (2015/16) compared with expected prevalence (2011) by CCG Comparison with CCGs in the STP

NHS South Eastern Hampshire CCG 0.64

NHS Southampton CCG 0.62 • the ratio of those diagnosed with chronic kidney disease versus those

NHS Portsmouth CCG 0.60 expected to have chronic kidney disease is 0.53. This compares to 0.68 for England NHS Fareham And Gosport CCG 0.57 • this suggests that 53% of people with chronic kidney disease have been diagnosed NHS North Hampshire CCG 0.56

NHS Isle Of Wight CCG 0.53

NHS West Hampshire CCG 0.50

Note: This slide compares the prevalence of CKD recorded in QOF in 2015/16 to the expected prevalence of CKD produced by the University of Southampton in 2011. A small number of CCGs 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 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.

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

NHS Lincolnshire East CCG 1.05

NHS Northumberland CCG 0.85

NHS South Kent Coast CCG 0.78

NHS Eastbourne, Hailsham and Seaford CCG 0.75

NHS Great Yarmouth and Waveney CCG 0.71

NHS East Riding of Yorkshire CCG 0.71

NHS West Norfolk CCG 0.66

NHS Herefordshire CCG 0.66

NHS Hambleton, Richmondshire and Whitby CCG 0.57

NHS Hastings and Rother CCG 0.56

NHS Isle of Wight CCG 0.53

0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio

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

GP practice CCG

SANDOWN HEALTH CENTRE J84013 6.5%

SHANKLIN MEDICAL CENTRE J84010 6.3% • it is estimated that there are 4,416 SOUTH WIGHT MEDICAL PRACTICE J84016 5.5% people with undiagnosed chronic

VENTNOR MEDICAL CENTRE J84003 5.1% kidney disease in NHS Isle of Wight CCG GROVE HOUSE SURGERY J84018 4.9% • GP practice range of observed CKD: THE DOWER HOUSE J84014 4.8% 0.0% to 6.5%

ST.HELENS MEDICAL CENTRE J84007 4.7%

MEDINA HEALTHCARE J84017 4.1%

COWES MEDICAL CENTRE J84015 4.1%

TOWER HOUSE SURGERY J84012 3.9%

WEST WIGHT MEDICAL PRACTICE J84019 3.6%

ESPLANADE SURGERY J84005 3.2%

BEECH GROVE SURGERY J84020 2.9%

EAST COWES MEDICAL CENTRE J84004 2.8%

CARISBROOKE HEALTH CENTRE J84011 1.8% Note: CCG estimates for the estimated ARGYLL HOUSE J84008 1.6% number of people with CKD are based on applying a proportion from a resident based GARFIELD ROAD SURGERY J84602 population estimate to a GP registered population. The characteristics of registered 0% 1% 2% 3% 4% 5% 6% 7% and resident populations may vary in some CCGs, and local interpretation is required.

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

NHS Portsmouth CCG 78.8% • 5,076 people with CKD (diagnosed*) NHS Isle Of Wight CCG 76.0% in NHS Isle of Wight CCG • 3,860 (76%) people whose blood pressure is <= 140 /85 NHS South Eastern Hampshire CCG 75.2% • 421 (8.3%) people who are exceptions • 795 (15.7%) additional people whose NHS Fareham And Gosport CCG 74.6% blood pressure is not <= 140 / 85

NHS Southampton CCG 74.0%

NHS North Hampshire CCG 71.2%

NHS West Hampshire CCG 69.6%

*Using the QOF clinical indicator CKD002 England 74.4% denominator plus exceptions. Note: as the CKD002 indicator was removed from 0% 20% 40% 60% 80% 100% the QOF in 15/16 this is historic data taken from the 2014/15 QOF.

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

NHS Hastings and Rother CCG 77.9%

NHS Northumberland CCG 76.5%

NHS Isle of Wight CCG 76.0%

NHS Hambleton, Richmondshire and Whitby CCG 75.2%

NHS Lincolnshire East CCG 75.2%

NHS Eastbourne, Hailsham and Seaford CCG 74.7%

NHS South Kent Coast CCG 73.7%

NHS East Riding of Yorkshire CCG 72.7%

NHS West Norfolk CCG 72.5%

NHS Herefordshire CCG 72.5%

NHS Great Yarmouth and Waveney CCG 71.8%

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

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

Not below 140/85 Exceptions reported

SOUTH WIGHT MEDICAL PRACTICE J84016 119

BROOKSIDE HEALTH CENTRE J84019 131 • in total, including exceptions, there THE ESPLANADE SURGERY J84005 83 are 1,216 people whose blood

MEDINA HEALTHCARE J84017 105 pressure is not <= 140 / 85 • GP practice range: 10.3% to 39.7% COWES HEALTH CENTRE J84015 105

GROVE HOUSE SURGERY J84018 39

SHANKLIN MEDICAL CENTRE J84010 144

TOWER HOUSE SURGERY J84012 81

ARGYLL HOUSE J84008 12

CARISBROOKE HEALTH CENTRE J84011 31

GARFIELD ROAD SURGERY J84602 21

THE DOWER HOUSE J84014 95

SANDOWN HEALTH CENTRE J84013 122

VENTNOR MEDICAL CENTRE J84003 41

ST HELENS MEDICAL CENTRE J84007 48

EAST COWES MEDICAL CENTRE J84004 24

BEECH GROVE SURGERY J84020 15

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

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

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

SOUTH WIGHT MEDICAL PRACTICE 56

BROOKSIDE HEALTH CENTRE 59

THE ESPLANADE SURGERY 25 • using the GP cluster method of calculating potential gains, if each MEDINA HEALTHCARE 28 practice was to achieve as well as the COWES HEALTH CENTRE 26 upper quartile of its national cluster, then an additional 223 people would GROVE HOUSE SURGERY 9 be treated ARGYLL HOUSE 2

TOWER HOUSE SURGERY 9

SHANKLIN MEDICAL CENTRE 8

VENTNOR MEDICAL CENTRE 1

CARISBROOKE HEALTH CENTRE

THE DOWER HOUSE

SANDOWN HEALTH CENTRE

ST HELENS MEDICAL CENTRE

EAST COWES MEDICAL CENTRE

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

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

NHS North Hampshire CCG 77.2% • 5,076 people with CKD (diagnosed*) NHS Southampton CCG 77.1% in NHS Isle of Wight CCG • 3,801 (74.9%) people who have a record of urine albumin:creatinine NHS Fareham And Gosport CCG 76.6% ratio test • 362 (7.1%) people who are exceptions NHS Portsmouth CCG 75.3% • 913 (18%) additional people who have no record of urine NHS Isle Of Wight CCG 74.9% albumin:creatinine ratio test

NHS West Hampshire CCG 71.2%

NHS South Eastern Hampshire CCG 70.8%

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

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

NHS Hastings and Rother CCG 80.3%

NHS Herefordshire CCG 79.2%

NHS Northumberland CCG 78.9%

NHS Hambleton, Richmondshire and Whitby CCG 78.3%

NHS West Norfolk CCG 77.7%

NHS South Kent Coast CCG 76.1%

NHS Great Yarmouth and Waveney CCG 75.9%

NHS Isle of Wight CCG 74.9%

NHS Eastbourne, Hailsham and Seaford CCG 74.9%

NHS East Riding of Yorkshire CCG 74.7%

NHS Lincolnshire East CCG 73.3%

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

62 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes do not have a record of a urine albumin: creatinine ratio test in the preceding 12 months by GP practice, 2014/15

Not recorded Exceptions reported

MEDINA HEALTHCARE J84017 148

BROOKSIDE HEALTH CENTRE J84019 135 • in total, including exceptions, there CARISBROOKE HEALTH CENTRE J84011 56 are 1,275 people who have no record

GROVE HOUSE SURGERY J84018 54 of urine albumin:creatinine ratio test • GP practice range: 6.8% to 41.5% SANDOWN HEALTH CENTRE J84013 197

THE ESPLANADE SURGERY J84005 77

COWES HEALTH CENTRE J84015 105

THE DOWER HOUSE J84014 128

SOUTH WIGHT MEDICAL PRACTICE J84016 75

TOWER HOUSE SURGERY J84012 69

BEECH GROVE SURGERY J84020 24

VENTNOR MEDICAL CENTRE J84003 35

EAST COWES MEDICAL CENTRE J84004 30

SHANKLIN MEDICAL CENTRE J84010 94

ST HELENS MEDICAL CENTRE J84007 33

GARFIELD ROAD SURGERY J84602 11

ARGYLL HOUSE J84008 4

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

63 CVD: Primary Care Intelligence Packs Heart

64 CVD: Primary Care Intelligence Packs Management of Heart Disease

Premature death and disability in people with What questions should we ask in our CCG? CHD can be reduced significantly by systematic 1. for each indicator how wide is the variation in evidence based management in primary care achievement and exception reporting? 2. how many people would benefit if all practices performed as well as the best? 3. how can we support practices who are Coronary Heart Disease is one of the principal causes of average and below average to perform as premature death and disability. The key elements of management for well as the best in: an individual who has already had a heart attack or angina are • more systematic delivery of evidence symptom control and secondary prevention of further cardiovascular based care for people with CHD events and premature mortality. There is robust evidence to support the • improved detection and management use of anti-platelet treatment, statins, beta-blockers and angiotensin of heart failure converting enzyme inhibitors or angiotensin receptor blockers. There is also robust evidence to support good control of blood pressure. Each of these interventions is incentivised in QOF but variation in achievement What might help and exception reporting at practice level shows that there is often 1. roll out of GRASP-Heart Failure audit tool considerable potential for improving management and outcomes. that identifies people with heart failure who are undiagnosed or under treated 2. education for health professionals to Heart failure is a common and an important complication of promote evidence based management of coronary heart disease and other conditions. Appropriate treatment CHD and high quality measurement of including up-titration of ace inhibitors and beta blockers in heart failure blood pressure due to LVSD can significantly improve symptom control and quality of 3. ensure access to rapid access diagnostic life, and improve outcomes for patients. Despite this, around a quarter clinics and specialist support for of people with heart failure are undetected and untreated. And amongst management of angina and heart failure those who are diagnosed, there is significant variation in the quality of 4. ensure access to cardiac rehab for care. individuals with CHD and heart failure

65 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with CCGs in the STP

NHS Isle Of Wight CCG 0.98%

NHS South Eastern Hampshire CCG 0.83% • prevalence of 0.98% in NHS Isle of Wight CCG compared to 0.76% in England NHS Fareham And Gosport CCG 0.80%

NHS West Hampshire CCG 0.78%

NHS Portsmouth CCG 0.64%

NHS Southampton CCG 0.59%

NHS North Hampshire CCG 0.46%

England 0.76%

0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%

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

NHS Eastbourne, Hailsham and Seaford CCG 1.13%

NHS Lincolnshire East CCG 1.08%

NHS Northumberland CCG 1.07%

NHS Hastings and Rother CCG 1.05%

NHS Herefordshire CCG 1.01%

NHS Isle of Wight CCG 0.98%

NHS Hambleton, Richmondshire and Whitby CCG 0.95%

NHS West Norfolk CCG 0.93%

NHS Great Yarmouth and Waveney CCG 0.91%

NHS East Riding of Yorkshire CCG 0.88%

NHS South Kent Coast CCG 0.70%

0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%

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

GP practice CCG

SANDOWN HEALTH CENTRE J84013 1.7%

SHANKLIN MEDICAL CENTRE J84010 1.5% • 1,396 people with diagnosed heart GROVE HOUSE SURGERY J84018 1.4% failure in NHS Isle of Wight CCG

ST.HELENS MEDICAL CENTRE J84007 1.3% • GP practice range: 0.4% to 1.7%

WEST WIGHT MEDICAL PRACTICE J84019 1.1%

THE DOWER HOUSE J84014 1.1%

ESPLANADE SURGERY J84005 0.9%

COWES MEDICAL CENTRE J84015 0.9%

MEDINA HEALTHCARE J84017 0.9%

SOUTH WIGHT MEDICAL PRACTICE J84016 0.8%

VENTNOR MEDICAL CENTRE J84003 0.8%

BEECH GROVE SURGERY J84020 0.7%

EAST COWES MEDICAL CENTRE J84004 0.7%

TOWER HOUSE SURGERY J84012 0.6%

CARISBROOKE HEALTH CENTRE J84011 0.5%

ARGYLL HOUSE J84008 0.4%

GARFIELD ROAD SURGERY J84602

0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8%

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

NHS Isle Of Wight CCG 87.9% • 430 people with heart failure* with NHS South Eastern Hampshire CCG 86.8% LVSD in NHS Isle of Wight CCG • 378 (87.9%) people treated with ACE- I or ARB NHS Portsmouth CCG 86.6% • 52 (12.1%) people who are exceptions • 0 (0%) additional people who are not NHS North Hampshire CCG 85.3% treated with ACE-I or ARB

NHS Fareham And Gosport CCG 84.8%

NHS West Hampshire CCG 84.0%

NHS Southampton CCG 83.0%

England 84.7%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 89.3%

NHS Isle of Wight CCG 87.9%

NHS South Kent Coast CCG 87.4%

NHS East Riding of Yorkshire CCG 87.0%

NHS Lincolnshire East CCG 86.1%

NHS Great Yarmouth and Waveney CCG 85.6%

NHS Northumberland CCG 85.1%

NHS Hastings and Rother CCG 84.2%

NHS Eastbourne, Hailsham and Seaford CCG 83.4%

NHS West Norfolk CCG 81.9%

NHS Herefordshire CCG 81.1%

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

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

No treatment Exceptions reported

SOUTH WIGHT MEDICAL PRACTICE J84016 4

BEECH GROVE SURGERY J84020 2 • in total, including exceptions, there GARFIELD ROAD SURGERY J84602 1 are 52 people who are not treated

GROVE HOUSE SURGERY J84018 5 with ACE-I or ARB • GP practice range: 0.0% to 57.1% ESPLANADE SURGERY J84005 3

ARGYLL HOUSE J84008 1

THE DOWER HOUSE J84014 14

TOWER HOUSE SURGERY J84012 3

SHANKLIN MEDICAL CENTRE J84010 6

COWES MEDICAL CENTRE J84015 6

MEDINA HEALTHCARE J84017 2

EAST COWES MEDICAL CENTRE J84004 1

SANDOWN HEALTH CENTRE J84013 4

VENTNOR MEDICAL CENTRE J84003

ST.HELENS MEDICAL CENTRE J84007

CARISBROOKE HEALTH CENTRE J84011

WEST WIGHT MEDICAL PRACTICE J84019

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

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

NHS Portsmouth CCG 85.5% • 378 people with heart failure* with NHS South Eastern Hampshire CCG 82.0% LVSD treated with ACE-I/ARB in NHS Isle of Wight CCG • 262 (69.3%) people treated with ACE- NHS Fareham And Gosport CCG 81.2% I/ARB and BB • 85 (22.5%) people who are exceptions NHS Southampton CCG 78.6% • 31 (8.2%) additional people who are not treated with ACE-I/ARB and BB NHS West Hampshire CCG 77.4%

NHS North Hampshire CCG 74.2%

NHS Isle Of Wight CCG 69.3%

England 77.7%

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

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

NHS East Riding of Yorkshire CCG 82.2%

NHS Hambleton, Richmondshire and Whitby CCG 81.3%

NHS Hastings and Rother CCG 79.5%

NHS Northumberland CCG 78.8%

NHS South Kent Coast CCG 77.0%

NHS Lincolnshire East CCG 76.7%

NHS Eastbourne, Hailsham and Seaford CCG 74.9%

NHS Great Yarmouth and Waveney CCG 74.1%

NHS West Norfolk CCG 73.3%

NHS Isle of Wight CCG 69.3%

NHS Herefordshire CCG 69.3%

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

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

No treatment Exceptions reported

ARGYLL HOUSE J84008 2

ST.HELENS MEDICAL CENTRE J84007 7 • in total, including exceptions, there GROVE HOUSE SURGERY J84018 7 are 116 people who are not treated

SHANKLIN MEDICAL CENTRE J84010 15 with ACE-I or ARB • GP practice range: 0.0% to 66.7% MEDINA HEALTHCARE J84017 8

THE DOWER HOUSE J84014 22

SOUTH WIGHT MEDICAL PRACTICE J84016 1

TOWER HOUSE SURGERY J84012 4

SANDOWN HEALTH CENTRE J84013 29

COWES MEDICAL CENTRE J84015 12

WEST WIGHT MEDICAL PRACTICE J84019 3

ESPLANADE SURGERY J84005 2

EAST COWES MEDICAL CENTRE J84004 4

VENTNOR MEDICAL CENTRE J84003

CARISBROOKE HEALTH CENTRE J84011

BEECH GROVE SURGERY J84020

GARFIELD ROAD SURGERY J84602

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

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

NHS South Eastern Hampshire CCG 89.5% • 5,663 people with coronary heart NHS Portsmouth CCG 88.5% disease* in NHS Isle of Wight CCG • 4,961 (87.6%) people whose blood pressure <= 150 / 90 NHS Southampton CCG 88.5% • 320 (5.7%) people who are exceptions • 382 (6.7%) additional people whose NHS North Hampshire CCG 88.0% blood pressure is not <= 150 / 90

NHS Isle Of Wight CCG 87.6%

NHS West Hampshire CCG 86.8%

NHS Fareham And Gosport CCG 86.6%

England 88.2%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 91.0%

NHS Hastings and Rother CCG 89.8%

NHS Herefordshire CCG 89.4%

NHS West Norfolk CCG 89.3%

NHS Northumberland CCG 88.8%

NHS South Kent Coast CCG 88.6%

NHS Isle of Wight CCG 87.6%

NHS Lincolnshire East CCG 87.4%

NHS East Riding of Yorkshire CCG 87.0%

NHS Eastbourne, Hailsham and Seaford CCG 86.5%

NHS Great Yarmouth and Waveney CCG 84.5%

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

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

Not below 150/90 Exceptions reported

SOUTH WIGHT MEDICAL PRACTICE J84016 65

MEDINA HEALTHCARE J84017 67 • in total, including exceptions, there WEST WIGHT MEDICAL PRACTICE J84019 92 are 702 people whose blood pressure

COWES MEDICAL CENTRE J84015 73 is not <= 150 / 90 • GP practice range: 5.9% to 21.7% SANDOWN HEALTH CENTRE J84013 74

VENTNOR MEDICAL CENTRE J84003 24

GROVE HOUSE SURGERY J84018 22

ESPLANADE SURGERY J84005 41

TOWER HOUSE SURGERY J84012 37

ST.HELENS MEDICAL CENTRE J84007 32

SHANKLIN MEDICAL CENTRE J84010 52

GARFIELD ROAD SURGERY J84602 7

CARISBROOKE HEALTH CENTRE J84011 29

THE DOWER HOUSE J84014 46

EAST COWES MEDICAL CENTRE J84004 21

ARGYLL HOUSE J84008 9

BEECH GROVE SURGERY J84020 11

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

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

2% 0% -2% -4% -6% -8% -10% -12% -14% -16%

SOUTH WIGHT MEDICAL PRACTICE 40

MEDINA HEALTHCARE 39

WEST WIGHT MEDICAL PRACTICE 47 • using the GP cluster method of calculating potential gains, if each COWES MEDICAL CENTRE 34 practice was to achieve as well as the

SANDOWN HEALTH CENTRE 27 upper quartile of its national cluster, then an additional 242 people would VENTNOR MEDICAL CENTRE 10 be treated GROVE HOUSE SURGERY 9

ESPLANADE SURGERY 10

TOWER HOUSE SURGERY 8

ST.HELENS MEDICAL CENTRE 5

SHANKLIN MEDICAL CENTRE 6

CARISBROOKE HEALTH CENTRE 2

THE DOWER HOUSE 3

EAST COWES MEDICAL CENTRE 0

ARGYLL HOUSE

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

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

NHS Southampton CCG 92.6% • 5,663 people with coronary heart NHS West Hampshire CCG 92.6% disease* in NHS Isle of Wight CCG • 5,187 (91.6%) people who are taking aspirin, an alternative anti-platelet NHS Fareham And Gosport CCG 92.2% therapy, or an anti-coagulant • 292 (5.2%) people who are exceptions NHS North Hampshire CCG 92.1% • 184 (3.2%) additional people who are not taking aspirin, an alternative anti- NHS Isle Of Wight CCG 91.6% platelet therapy, or an anti-coagulant

NHS South Eastern Hampshire CCG 91.5%

NHS Portsmouth CCG 89.5%

England 91.8%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 94.1%

NHS Hastings and Rother CCG 92.9%

NHS Eastbourne, Hailsham and Seaford CCG 92.4%

NHS Northumberland CCG 92.2%

NHS South Kent Coast CCG 92.1%

NHS Isle of Wight CCG 91.6%

NHS Herefordshire CCG 91.4%

NHS West Norfolk CCG 91.1%

NHS East Riding of Yorkshire CCG 90.6%

NHS Lincolnshire East CCG 90.6%

NHS Great Yarmouth and Waveney CCG 90.0%

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

80 CVD: Primary Care Intelligence Packs Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice

No treatment Exceptions reported

WEST WIGHT MEDICAL PRACTICE J84019 84

GARFIELD ROAD SURGERY J84602 11 • in total, including exceptions, there TOWER HOUSE SURGERY J84012 48 are 476 people are not taking aspirin,

SOUTH WIGHT MEDICAL PRACTICE J84016 32 an alternative anti-platelet therapy, or an anti-coagulant GROVE HOUSE SURGERY J84018 20 • GP practice range: 4.2% to 15.6% ST.HELENS MEDICAL CENTRE J84007 34

MEDINA HEALTHCARE J84017 32

ESPLANADE SURGERY J84005 28

COWES MEDICAL CENTRE J84015 33

THE DOWER HOUSE J84014 34

CARISBROOKE HEALTH CENTRE J84011 21

VENTNOR MEDICAL CENTRE J84003 12

SHANKLIN MEDICAL CENTRE J84010 32

ARGYLL HOUSE J84008 8

BEECH GROVE SURGERY J84020 10

EAST COWES MEDICAL CENTRE J84004 14

SANDOWN HEALTH CENTRE J84013 23

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

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

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

NHS Isle of Wight CCG England 800

700 • in NHS Isle of Wight CCG, the hospital admission rate for coronary heart disease in 2015/16 was 403.3 600 (695) compared to 527.9 for England

500

400

300

Age Age standardised (per rate 100,000) 200

100

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

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

NHS Isle of Wight CCG England 250

• in NHS Isle of Wight CCG, the hospital admission rate for stroke in 200 2015/16 was 137.3 (242) compared to 172.8 for England

150

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

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

NHS Isle of Wight CCG England

94.3% Angina 136.8% • The risk of a stroke was 84.2% higher and the risk of a heart attack was 88.2% 88.2% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 894.9% higher. 116.7% Heart failure 150.0%

84.2% Stroke 81.3%

894.9% Major amputation 445.8%

616.6% Minor amputation 753.5%

194.8% RRT 293.0%

0% 100% 200% 300% 400% 500% 600% 700% 800% 900% 1000% Note: This slide uses data from the National Diabetes Audit (NDA)

85 CVD: Primary Care Intelligence Packs Deaths from coronary heart disease, under 75s

NHS Isle of Wight CCG England 90

80 • in NHS Isle of Wight CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 35.8, compared to 40.6 for England

30 Age Age standardised (per rate 1000,000) 20

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

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

86 CVD: Primary Care Intelligence Packs Deaths from stroke, under 75s

NHS Isle of Wight CCG England 30

• in NHS Isle of Wight CCG, the early 25 mortality rate for stroke in 2013-15 was 9.5, compared to 13.6 for England

10 Age Age standardised (per rate 100,000)

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

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

87 CVD: Primary Care Intelligence Packs Appendix Data sources

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

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

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

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

• 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.

88 CVD: Primary Care Intelligence Packs About Public Health England

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Published June 2017 Gateway number 2017095