CVD: Primary Care Intelligence Packs NHS Central London (Westminster) 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 Central London (Westminster) CCG are: NHS Camden CCG NHS West London CCG NHS Brighton and Hove CCG NHS Portsmouth CCG NHS Islington CCG NHS Southampton CCG NHS Wandsworth CCG NHS Bristol CCG NHS Leeds West CCG NHS Hammersmith and Fulham 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 Brighton and Hove CCG 21.6%

NHS Portsmouth CCG 21.6% • prevalence of 15.9% in NHS Central London (Westminster) CCG NHS Southampton CCG 21.3%

NHS Bristol CCG 20.9%

NHS Islington CCG 20.6%

NHS Leeds West CCG 19.2%

NHS Hammersmith and Fulham CCG 19.0%

NHS West London CCG 18.7% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Camden CCG 17.8% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Wandsworth CCG 16.4% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS Central London (Westminster) CCG 15.9% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 5% 10% 15% 20% 25% recorded as current smokers) divided by GP practice’s estimated number of patients 15+

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

GP Practice CCG

THE DOCTOR HICKEY SURGERY E87740 71.7% CROMPTON MEDICAL CENTRE E87052 23.6% GROUND FLOOR LANARK MEDICAL CENTRE E87756 22.9% THE WESTBOURNE GREEN SURGERY Y00902 22.7% • 29,687 people who are recorded as COVENT GARDEN MEDICAL CENTRE E87045 21.3% SOHO CENTRE FOR HEALTH AND CARE E87069 21.0% smokers in NHS Central London LISSON GROVE HEALTH CENTRE E87011 20.7% (Westminster) CCG LITTLE VENICE MEDICAL CENTRE E87006 20.4% • GP practice range: 4.8% to 71.7% SOHO SQUARE GENERAL PRACTICE E87714 20.0% PADDINGTON GREEN HEALTH CENTRE E87008 19.9% WOODFIELD ROAD MEDICAL CENTRE E87741 19.3% PIMLICO HEALTH AT THE MARVEN SURGERY E87034 18.9% FITZROVIA MEDICAL CENTRE E87066 18.9% DR MAHER SHAKARCHI'S PRACTICE Y02260 17.9% NEWTON MEDICAL CENTRE E87681 17.5% MAIDA VALE MEDICAL CENTRE E87010 16.7% VICTORIA MEDICAL CENTRE E87002 16.5% MILLBANK MEDICAL CENTRE E87739 16.4% CONNAUGHT SQUARE PRACTICE E87037 16.1% MAYFAIR MEDICAL CENTRE E87648 15.9% NORTH WEST LONDON MEDICAL CENTRE E87017 15.8% THE RANDOLPH SURGERY E87046 15.1% CRAWFORD STREET SURGERY E87070 14.7% MARYLEBONE HEALTH CENTRE E87737 14.5% DR VICTORIA MUIR'S PRACTICE E87753 14.2% THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 13.8% CAVENDISH HEALTH CENTRE E87745 13.3% WELLINGTON HEALTH CENTRE E87754 12.5% KINGS COLLEGE HEALTH CENTRE E87768 12.0% Note: This method is thought to be a reasonably BELGRAVIA SURGERY E87005 11.0% robust method in estimating smoking prevalence THE ROYAL MEWS SURGERY E87694 9.5% for the majority of GP practices. However, ST JOHNS WOOD MEDICAL PRACTICE E87609 8.9% caution is advised for extreme estimates of WESTMINSTER SCHOOL E87691 6.6% smoking prevalence and those with high IMPERIAL COLLEGE HEALTH CENTRE E87677 4.8% numbers of smoking status not recorded and 0% 10% 20% 30% 40% 50% 60% 70% 80% exceptions.

14 CVD: Primary Care Intelligence Packs Hypertension

15 CVD: Primary Care Intelligence Packs Hypertension

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

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

NHS Harrow CCG 0.59

NHS Hillingdon CCG 0.58 • the ratio of those diagnosed with hypertension versus those expected NHS Brent CCG 0.58 to have hypertension is 0.48. This compares to 0.59 for England • this suggests that 48% of people with NHS Hounslow CCG 0.57 hypertension have been diagnosed

NHS Ealing CCG 0.57

NHS Hammersmith And Fulham CCG 0.51

NHS West London CCG 0.49

NHS Central London (Westminster) CCG 0.48

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

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

NHS Portsmouth CCG 0.56

NHS Leeds West CCG 0.55

NHS Camden CCG 0.54

NHS Bristol CCG 0.54

NHS Southampton CCG 0.53

NHS Brighton and Hove CCG 0.52

NHS Hammersmith and Fulham CCG 0.51

NHS Islington CCG 0.50

NHS West London CCG 0.49

NHS Wandsworth CCG 0.49

NHS Central London (Westminster) CCG 0.48

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

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

GP practice CCG

PIMLICO HEALTH AT THE MARVEN SURGERY E87034 0.56 SOHO SQUARE GENERAL PRACTICE E87714 0.51 BELGRAVIA SURGERY E87005 0.48 PADDINGTON GREEN HEALTH CENTRE E87008 0.48 • it is estimated that there are 18,205 CONNAUGHT SQUARE PRACTICE E87037 0.47 LITTLE VENICE MEDICAL CENTRE E87006 0.47 people with undiagnosed CROMPTON MEDICAL CENTRE E87052 0.47 hypertension in NHS Central London LISSON GROVE HEALTH CENTRE E87011 0.46 GROUND FLOOR LANARK MEDICAL CENTRE E87756 0.45 (Westminster) CCG THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 0.44 • GP practice range of observed to MARYLEBONE HEALTH CENTRE E87737 0.43 THE WESTBOURNE GREEN SURGERY Y00902 0.43 expected hypertension prevalence WOODFIELD ROAD MEDICAL CENTRE E87741 0.43 0.05 to 0.56 VICTORIA MEDICAL CENTRE E87002 0.42 DR VICTORIA MUIR'S PRACTICE E87753 0.42 ST JOHNS WOOD MEDICAL PRACTICE E87609 0.41 DR MAHER SHAKARCHI'S PRACTICE Y02260 0.41 MILLBANK MEDICAL CENTRE E87739 0.40 MAIDA VALE MEDICAL CENTRE E87010 0.38 NEWTON MEDICAL CENTRE E87681 0.37 NORTH WEST LONDON MEDICAL CENTRE E87017 0.37 MAYFAIR MEDICAL CENTRE E87648 0.36 FITZROVIA MEDICAL CENTRE E87066 0.36 COVENT GARDEN MEDICAL CENTRE E87045 0.33 WELLINGTON HEALTH CENTRE E87754 0.32 CAVENDISH HEALTH CENTRE E87745 0.32 THE RANDOLPH SURGERY E87046 0.32 CRAWFORD STREET SURGERY E87070 0.32 SOHO CENTRE FOR HEALTH AND CARE E87069 0.30 THE DOCTOR HICKEY SURGERY E87740 0.23 IMPERIAL COLLEGE HEALTH CENTRE E87677 0.14 KINGS COLLEGE HEALTH CENTRE E87768 0.05 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 Harrow CCG 80.3%

NHS Brent CCG 79.8% • 17,554 people with hypertension (diagnosed)* in NHS Central London NHS Hillingdon CCG 79.7% (Westminster) CCG • 13,210 (75.3%) people whose blood pressure is <= 150/90 NHS Hounslow CCG 78.8% • 737 (4.2%) people who are excepted from optimal control NHS Ealing CCG 78.7% • 3,607 (20.5%) additional people whose blood pressure is not <= 150/90 NHS West London CCG 77.6%

NHS Central London (Westminster) CCG 75.3%

NHS Hammersmith And Fulham CCG 74.3%

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 Leeds West CCG 80.4%

NHS Portsmouth CCG 80.0%

NHS Wandsworth CCG 78.1%

NHS Bristol CCG 77.8%

NHS West London CCG 77.6%

NHS Camden CCG 76.9%

NHS Southampton CCG 76.8%

NHS Islington CCG 76.7%

NHS Central London (Westminster) CCG 75.3%

NHS Hammersmith and Fulham CCG 74.3%

NHS Brighton and Hove CCG 73.3%

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

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

No treatment Exceptions reported

THE DOCTOR HICKEY SURGERY E87740 49 CRAWFORD STREET SURGERY E87070 166 LITTLE VENICE MEDICAL CENTRE E87006 209 KINGS COLLEGE HEALTH CENTRE E87768 11 • in total, including exceptions, there MARYLEBONE HEALTH CENTRE E87737 265 FITZROVIA MEDICAL CENTRE E87066 189 are 4,344 people whose blood NORTH WEST LONDON MEDICAL CENTRE E87017 92 pressure is not <= 150/90 THE WESTBOURNE GREEN SURGERY Y00902 93 SOHO CENTRE FOR HEALTH AND CARE E87069 52 • GP practice range: 0.0% to 45.8% NEWTON MEDICAL CENTRE E87681 229 PADDINGTON GREEN HEALTH CENTRE E87008 263 SOHO SQUARE GENERAL PRACTICE E87714 101 MAYFAIR MEDICAL CENTRE E87648 59 WOODFIELD ROAD MEDICAL CENTRE E87741 85 COVENT GARDEN MEDICAL CENTRE E87045 71 MAIDA VALE MEDICAL CENTRE E87010 140 CONNAUGHT SQUARE PRACTICE E87037 186 THE RANDOLPH SURGERY E87046 116 WELLINGTON HEALTH CENTRE E87754 115 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 352 CAVENDISH HEALTH CENTRE E87745 100 MILLBANK MEDICAL CENTRE E87739 134 LISSON GROVE HEALTH CENTRE E87011 176 BELGRAVIA SURGERY E87005 202 VICTORIA MEDICAL CENTRE E87002 272 ST JOHNS WOOD MEDICAL PRACTICE E87609 261 GROUND FLOOR LANARK MEDICAL CENTRE E87756 58 DR MAHER SHAKARCHI'S PRACTICE Y02260 62 DR VICTORIA MUIR'S PRACTICE E87753 114 IMPERIAL COLLEGE HEALTH CENTRE E87677 32 CROMPTON MEDICAL CENTRE E87052 53 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 37 WESTMINSTER SCHOOL E87691 THE ROYAL MEWS SURGERY E87694 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 Hammersmith And Fulham CCG 84.4%

NHS Ealing CCG 83.4% • 64 people with a new diagnosis* of hypertension with a CVD risk of 20% NHS Hounslow CCG 78.4% or higher in NHS Central London (Westminster) CCG • 47 (73.4%) people who are currently NHS West London CCG 76.0% treated with statins • 16 (25%) people who are exempted NHS Central London (Westminster) CCG 73.4% from treatment with statins • 1 (1.6%) additional people who are not currently treated with statins NHS Hillingdon CCG 71.6%

NHS Brent CCG 70.1%

NHS Harrow CCG 65.4%

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 Hammersmith and Fulham CCG 84.4%

NHS Wandsworth CCG 76.5%

NHS West London CCG 76.0%

NHS Leeds West CCG 75.2%

NHS Islington CCG 74.5%

NHS Central London (Westminster) CCG 73.4%

NHS Southampton CCG 71.7%

NHS Portsmouth CCG 71.6%

NHS Bristol CCG 68.1%

NHS Camden CCG 62.5%

NHS Brighton and Hove CCG 60.5%

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

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

No treatment Exceptions reported

NORTH WEST LONDON MEDICAL CENTRE E87017 1 PADDINGTON GREEN HEALTH CENTRE E87008 4 MARYLEBONE HEALTH CENTRE E87737 2 VICTORIA MEDICAL CENTRE E87002 1 • in total, including exceptions, there CONNAUGHT SQUARE PRACTICE E87037 2 FITZROVIA MEDICAL CENTRE E87066 1 are 17 people who are not treated BELGRAVIA SURGERY E87005 1 with statins NEWTON MEDICAL CENTRE E87681 1 WOODFIELD ROAD MEDICAL CENTRE E87741 1 • GP practice range: 0.0% to 100.0% LISSON GROVE HEALTH CENTRE E87011 1 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 2 LITTLE VENICE MEDICAL CENTRE E87006 MAIDA VALE MEDICAL CENTRE E87010 COVENT GARDEN MEDICAL CENTRE E87045 CROMPTON MEDICAL CENTRE E87052 SOHO CENTRE FOR HEALTH AND CARE E87069 ST JOHNS WOOD MEDICAL PRACTICE E87609 MAYFAIR MEDICAL CENTRE E87648 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 IMPERIAL COLLEGE HEALTH CENTRE E87677 SOHO SQUARE GENERAL PRACTICE E87714 MILLBANK MEDICAL CENTRE E87739 THE DOCTOR HICKEY SURGERY E87740 CAVENDISH HEALTH CENTRE E87745 DR VICTORIA MUIR'S PRACTICE E87753 WELLINGTON HEALTH CENTRE E87754 DR MAHER SHAKARCHI'S PRACTICE Y02260 THE WESTBOURNE GREEN SURGERY Y00902 KINGS COLLEGE HEALTH CENTRE E87768 GROUND FLOOR LANARK MEDICAL CENTRE E87756 THE ROYAL MEWS SURGERY E87694 WESTMINSTER SCHOOL E87691 CRAWFORD STREET SURGERY E87070 THE RANDOLPH SURGERY E87046 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 Central London (Westminster) CCG 0.65

NHS Hammersmith And Fulham CCG 0.65 • the ratio of those diagnosed with atrial fibrillation versus those expected to NHS Hillingdon CCG 0.64 have atrial fibrillation is 0.65. This compares to 0.7 for England • this suggests that 65% of people with NHS Ealing CCG 0.61 atrial fibrillation have been diagnosed.

NHS Hounslow CCG 0.59

NHS Harrow CCG 0.58

NHS West London CCG 0.58

NHS Brent CCG 0.47 Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 2015/16 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence Network estimates produced in 2017. The estimates were developed by applying age-sex England 0.70 specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 NHS Digital. Estimates reported are adjusted for age and sex of the local population.

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

NHS Portsmouth CCG 0.74

NHS Bristol CCG 0.74

NHS Leeds West CCG 0.69

NHS Southampton CCG 0.68

NHS Brighton and Hove CCG 0.66

NHS Camden CCG 0.66

NHS Central London (Westminster) CCG 0.65

NHS Hammersmith and Fulham CCG 0.65

NHS Islington CCG 0.62

NHS West London CCG 0.58

NHS Wandsworth CCG 0.57

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

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

GP practice CCG

MILLBANK MEDICAL CENTRE E87739 0.9 VICTORIA MEDICAL CENTRE E87002 0.8 PADDINGTON GREEN HEALTH CENTRE E87008 0.8 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 0.8 • it is estimated that there are 3,401 DR VICTORIA MUIR'S PRACTICE E87753 0.8 BELGRAVIA SURGERY E87005 0.7 people with undiagnosed atrial LISSON GROVE HEALTH CENTRE E87011 0.7 fibrillation in NHS Central London ST JOHNS WOOD MEDICAL PRACTICE E87609 0.7 NEWTON MEDICAL CENTRE E87681 0.7 (Westminster) CCG MARYLEBONE HEALTH CENTRE E87737 0.7 • GP practice range of observed to CAVENDISH HEALTH CENTRE E87745 0.7 WELLINGTON HEALTH CENTRE E87754 0.7 expected atrial fibrillation prevalence LITTLE VENICE MEDICAL CENTRE E87006 0.6 0.3 to 0.9 CONNAUGHT SQUARE PRACTICE E87037 0.6 THE RANDOLPH SURGERY E87046 0.6 IMPERIAL COLLEGE HEALTH CENTRE E87677 0.6 NORTH WEST LONDON MEDICAL CENTRE E87017 0.5 COVENT GARDEN MEDICAL CENTRE E87045 0.5 CROMPTON MEDICAL CENTRE E87052 0.5 FITZROVIA MEDICAL CENTRE E87066 0.5 SOHO CENTRE FOR HEALTH AND CARE E87069 0.5 CRAWFORD STREET SURGERY E87070 0.5 MAYFAIR MEDICAL CENTRE E87648 0.5 THE DOCTOR HICKEY SURGERY E87740 0.5 WOODFIELD ROAD MEDICAL CENTRE E87741 0.5 GROUND FLOOR LANARK MEDICAL CENTRE E87756 0.5 MAIDA VALE MEDICAL CENTRE E87010 0.4 SOHO SQUARE GENERAL PRACTICE E87714 0.4 KINGS COLLEGE HEALTH CENTRE E87768 0.4 THE WESTBOURNE GREEN SURGERY Y00902 0.4 DR MAHER SHAKARCHI'S PRACTICE Y02260 0.4 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 0.3 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio

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

NHS Hounslow CCG 76.9% • 1,748 people with atrial fibrillation* NHS Hammersmith And Fulham CCG 76.4% with a CHA2DS2-VASc score >= 2 in NHS Central London (Westminster) NHS Central London (Westminster) CCG 76.1% CCG • 1,330 (76.1%) people treated with anti-coagulation therapy NHS Ealing CCG 75.9% • 106 (6.1%) people who are exceptions NHS West London CCG 75.9% • 312 (17.8%) additional people with a recorded CHA2DS2-VASc score >= 2 who are not treated NHS Hillingdon CCG 72.2%

NHS Harrow CCG 69.0%

NHS Brent CCG 68.3%

England 77.9%

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

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

NHS Bristol CCG 79.1%

NHS Southampton CCG 77.8%

NHS Hammersmith and Fulham CCG 76.4%

NHS Leeds West CCG 76.3%

NHS Central London (Westminster) CCG 76.1%

NHS West London CCG 75.9%

NHS Wandsworth CCG 75.1%

NHS Portsmouth CCG 74.2%

NHS Camden CCG 70.5%

NHS Brighton and Hove CCG 70.4%

NHS Islington CCG 66.4%

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

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

No treatment Exceptions reported

IMPERIAL COLLEGE HEALTH CENTRE E87677 9 MILLBANK MEDICAL CENTRE E87739 22 FITZROVIA MEDICAL CENTRE E87066 12 CAVENDISH HEALTH CENTRE E87745 19 • in total, including exceptions, there MARYLEBONE HEALTH CENTRE E87737 30 THE RANDOLPH SURGERY E87046 16 are 418 people with a recorded CRAWFORD STREET SURGERY E87070 12 CHA2DS2-VASc score >= 2 who are NORTH WEST LONDON MEDICAL CENTRE E87017 9 WELLINGTON HEALTH CENTRE E87754 17 not treated LITTLE VENICE MEDICAL CENTRE E87006 11 • GP practice range: 0.0% to 39.1% CROMPTON MEDICAL CENTRE E87052 6 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 43 SOHO SQUARE GENERAL PRACTICE E87714 4 MAIDA VALE MEDICAL CENTRE E87010 8 ST JOHNS WOOD MEDICAL PRACTICE E87609 39 COVENT GARDEN MEDICAL CENTRE E87045 6 DR VICTORIA MUIR'S PRACTICE E87753 15 PADDINGTON GREEN HEALTH CENTRE E87008 23 LISSON GROVE HEALTH CENTRE E87011 18 BELGRAVIA SURGERY E87005 21 VICTORIA MEDICAL CENTRE E87002 38 CONNAUGHT SQUARE PRACTICE E87037 13 WOODFIELD ROAD MEDICAL CENTRE E87741 3 MAYFAIR MEDICAL CENTRE E87648 5 THE WESTBOURNE GREEN SURGERY Y00902 2 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 1 SOHO CENTRE FOR HEALTH AND CARE E87069 3 NEWTON MEDICAL CENTRE E87681 13 THE DOCTOR HICKEY SURGERY E87740 GROUND FLOOR LANARK MEDICAL CENTRE E87756 DR MAHER SHAKARCHI'S PRACTICE Y02260 KINGS COLLEGE HEALTH CENTRE E87768 THE ROYAL MEWS SURGERY E87694 WESTMINSTER SCHOOL E87691 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

40% 20% 0% -20% -40% -60% -80% -100%

KINGS COLLEGE HEALTH CENTRE

IMPERIAL COLLEGE HEALTH CENTRE 5

MILLBANK MEDICAL CENTRE 12 • using the GP cluster method of FITZROVIA MEDICAL CENTRE 6 calculating potential gains, if each CAVENDISH HEALTH CENTRE 9 practice was to achieve as well as the MARYLEBONE HEALTH CENTRE 15 upper quartile of its national cluster, then an additional 143 people would NORTH WEST LONDON MEDICAL CENTRE 4 be treated CRAWFORD STREET SURGERY 6

WELLINGTON HEALTH CENTRE 8

LITTLE VENICE MEDICAL CENTRE 5

CONNAUGHT SQUARE PRACTICE 2

WOODFIELD ROAD MEDICAL CENTRE 0

THE WESTBOURNE GREEN SURGERY 0

MAYFAIR MEDICAL CENTRE 0

THIRD FLOOR LANARK ROAD MEDICAL CENTRE

NEWTON MEDICAL CENTRE

SOHO CENTRE FOR HEALTH AND CARE

GROUND FLOOR LANARK MEDICAL CENTRE

DR MAHER SHAKARCHI'S PRACTICE

THE DOCTOR HICKEY SURGERY Details of this methodology are available on slide 9. Click here to view them.

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

Below 150/90 Not below 150/90 Exceptions reported

NHS Harrow CCG 84.8% • 2,099 people with a history of stroke NHS Hounslow CCG 84.6% or TIA* in NHS Central London (Westminster) CCG NHS Brent CCG 84.2% • 1,741 (82.9%) people whose blood pressure is <= 150 / 90 • 78 (3.7%) people who are exceptions NHS Hillingdon CCG 83.3% • 280 (13.3%) additional people whose blood pressure is not <= 150 / 90 NHS Central London (Westminster) CCG 82.9%

NHS Ealing CCG 82.9%

NHS West London CCG 81.3%

NHS Hammersmith And Fulham CCG 80.3%

England 83.8%

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

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

NHS Camden CCG 85.6%

NHS Portsmouth CCG 84.4%

NHS Leeds West CCG 83.2%

NHS Central London (Westminster) CCG 82.9%

NHS Southampton CCG 82.9%

NHS Wandsworth CCG 82.5%

NHS Islington CCG 82.0%

NHS Bristol CCG 81.9%

NHS West London CCG 81.3%

NHS Hammersmith and Fulham CCG 80.3%

NHS Brighton and Hove CCG 78.6%

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

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

No treatment Exceptions reported

CRAWFORD STREET SURGERY E87070 17 COVENT GARDEN MEDICAL CENTRE E87045 10 LITTLE VENICE MEDICAL CENTRE E87006 18 WELLINGTON HEALTH CENTRE E87754 15 • in total, including exceptions, there MAYFAIR MEDICAL CENTRE E87648 5 PADDINGTON GREEN HEALTH CENTRE E87008 35 are 358 people whose blood pressure FITZROVIA MEDICAL CENTRE E87066 15 is not <= 150 / 90 MARYLEBONE HEALTH CENTRE E87737 23 SOHO CENTRE FOR HEALTH AND CARE E87069 3 • GP practice range: 0.0% to 47.2% THE RANDOLPH SURGERY E87046 13 NEWTON MEDICAL CENTRE E87681 20 CONNAUGHT SQUARE PRACTICE E87037 16 THE WESTBOURNE GREEN SURGERY Y00902 6 NORTH WEST LONDON MEDICAL CENTRE E87017 8 LISSON GROVE HEALTH CENTRE E87011 17 MILLBANK MEDICAL CENTRE E87739 8 MAIDA VALE MEDICAL CENTRE E87010 8 VICTORIA MEDICAL CENTRE E87002 29 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 23 IMPERIAL COLLEGE HEALTH CENTRE E87677 4 CROMPTON MEDICAL CENTRE E87052 6 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 3 CAVENDISH HEALTH CENTRE E87745 6 BELGRAVIA SURGERY E87005 14 DR MAHER SHAKARCHI'S PRACTICE Y02260 4 DR VICTORIA MUIR'S PRACTICE E87753 9 WOODFIELD ROAD MEDICAL CENTRE E87741 4 SOHO SQUARE GENERAL PRACTICE E87714 2 ST JOHNS WOOD MEDICAL PRACTICE E87609 16 GROUND FLOOR LANARK MEDICAL CENTRE E87756 1 WESTMINSTER SCHOOL E87691 THE ROYAL MEWS SURGERY E87694 THE DOCTOR HICKEY SURGERY E87740 KINGS COLLEGE HEALTH CENTRE E87768 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 Ealing CCG 93.0% • 1,241 people with a stroke shown to NHS Hounslow CCG 91.8% be non-haemorrhagic* in NHS Central London (Westminster) CCG NHS Central London (Westminster) CCG 90.8% • 1,127 (90.8%) people who are taking an anti-platetet agent or anti- coagulant NHS Hillingdon CCG 90.8% • 52 (4.2%) people who are exceptions • 62 (5%) additional people with no NHS Brent CCG 90.4% treatment

NHS Harrow CCG 90.3%

NHS Hammersmith And Fulham CCG 90.2%

NHS West London CCG 87.3%

England 91.8%

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

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

NHS Southampton CCG 92.3%

NHS Leeds West CCG 92.2%

NHS Camden CCG 92.1%

NHS Central London (Westminster) CCG 90.8%

NHS Bristol CCG 90.8%

NHS Portsmouth CCG 90.6%

NHS Wandsworth CCG 90.3%

NHS Brighton and Hove CCG 90.2%

NHS Hammersmith and Fulham CCG 90.2%

NHS Islington CCG 89.1%

NHS West London CCG 87.3%

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

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

No treatment Exceptions reported

WESTMINSTER SCHOOL E87691 1 THE ROYAL MEWS SURGERY E87694 1 IMPERIAL COLLEGE HEALTH CENTRE E87677 5 THE RANDOLPH SURGERY E87046 13 • in total, including exceptions, there SOHO CENTRE FOR HEALTH AND CARE E87069 1 CROMPTON MEDICAL CENTRE E87052 6 are 114 people who are not taking an CAVENDISH HEALTH CENTRE E87745 5 anti-platelet agent or anti-coagulant NORTH WEST LONDON MEDICAL CENTRE E87017 6 FITZROVIA MEDICAL CENTRE E87066 5 • GP practice range: 0.0% to 100.0% THE DOCTOR HICKEY SURGERY E87740 1 COVENT GARDEN MEDICAL CENTRE E87045 2 CRAWFORD STREET SURGERY E87070 3 MARYLEBONE HEALTH CENTRE E87737 9 PADDINGTON GREEN HEALTH CENTRE E87008 8 NEWTON MEDICAL CENTRE E87681 6 WOODFIELD ROAD MEDICAL CENTRE E87741 3 LITTLE VENICE MEDICAL CENTRE E87006 4 THE WESTBOURNE GREEN SURGERY Y00902 1 MAYFAIR MEDICAL CENTRE E87648 1 MILLBANK MEDICAL CENTRE E87739 2 ST JOHNS WOOD MEDICAL PRACTICE E87609 9 LISSON GROVE HEALTH CENTRE E87011 3 BELGRAVIA SURGERY E87005 5 DR VICTORIA MUIR'S PRACTICE E87753 3 CONNAUGHT SQUARE PRACTICE E87037 3 MAIDA VALE MEDICAL CENTRE E87010 1 WELLINGTON HEALTH CENTRE E87754 1 VICTORIA MEDICAL CENTRE E87002 4 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 2 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 SOHO SQUARE GENERAL PRACTICE E87714 GROUND FLOOR LANARK MEDICAL CENTRE E87756 DR MAHER SHAKARCHI'S PRACTICE Y02260 KINGS COLLEGE HEALTH CENTRE E87768 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 Harrow CCG 0.87

• 0.57 ratio of observed to expected NHS Hillingdon CCG 0.81 diabetes prevalence in NHS Central London (Westminster) CCG, NHS Hounslow CCG 0.79 compared to 0.77 in England • this suggests 57% of people have NHS Brent CCG 0.78 been diagnosed

NHS Ealing CCG 0.76

NHS Hammersmith And Fulham CCG 0.60

NHS Central London (Westminster) CCG 0.57

NHS West London CCG 0.56

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 1.0

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

NHS Portsmouth CCG 0.78

NHS Southampton CCG 0.76

NHS Leeds West CCG 0.74

NHS Bristol CCG 0.71

NHS Islington CCG 0.66

NHS Wandsworth CCG 0.62

NHS Camden CCG 0.60

NHS Hammersmith and Fulham CCG 0.60

NHS Brighton and Hove CCG 0.60

NHS Central London (Westminster) CCG 0.57

NHS West London CCG 0.56

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

GP practice CCG

THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 9.1% GROUND FLOOR LANARK MEDICAL CENTRE E87756 8.6% CROMPTON MEDICAL CENTRE E87052 8.3% LISSON GROVE HEALTH CENTRE E87011 8.1% • GP practice range of observed PADDINGTON GREEN HEALTH CENTRE E87008 6.9% THE WESTBOURNE GREEN SURGERY Y00902 6.7% diabetes 0.4% to 9.1% NORTH WEST LONDON MEDICAL CENTRE E87017 5.7% • there are an estimated 5,635 people MAYFAIR MEDICAL CENTRE E87648 5.5% CONNAUGHT SQUARE PRACTICE E87037 5.4% with undiagnosed diabetes in NHS LITTLE VENICE MEDICAL CENTRE E87006 5.1% Central London (Westminster) CCG MILLBANK MEDICAL CENTRE E87739 5.0% VICTORIA MEDICAL CENTRE E87002 4.9% SOHO SQUARE GENERAL PRACTICE E87714 4.6% PIMLICO HEALTH AT THE MARVEN SURGERY E87034 4.5% FITZROVIA MEDICAL CENTRE E87066 4.3% COVENT GARDEN MEDICAL CENTRE E87045 4.1% WOODFIELD ROAD MEDICAL CENTRE E87741 4.0% DR MAHER SHAKARCHI'S PRACTICE Y02260 4.0% NEWTON MEDICAL CENTRE E87681 4.0% ST JOHNS WOOD MEDICAL PRACTICE E87609 3.9% CRAWFORD STREET SURGERY E87070 3.7% WELLINGTON HEALTH CENTRE E87754 3.4% BELGRAVIA SURGERY E87005 3.1% MAIDA VALE MEDICAL CENTRE E87010 3.1% DR VICTORIA MUIR'S PRACTICE E87753 3.0% MARYLEBONE HEALTH CENTRE E87737 2.9% SOHO CENTRE FOR HEALTH AND CARE E87069 2.9% THE RANDOLPH SURGERY E87046 2.8% CAVENDISH HEALTH CENTRE E87745 2.8% THE DOCTOR HICKEY SURGERY E87740 2.6% THE ROYAL MEWS SURGERY E87694 1.8% WESTMINSTER SCHOOL E87691 0.9% Note: The estimated number of undiagnosed IMPERIAL COLLEGE HEALTH CENTRE E87677 0.6% people with diabetes has been calculated by KINGS COLLEGE HEALTH CENTRE E87768 0.4% multiplying the estimated prevalence rate to the 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 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 Harrow CCG 9.1% 1.3% 13.6% • the estimated total prevalence of diabetes in NHS Central London (Westminster) CCG is 7.0% NHS Brent CCG 8.6% 2.5% 12.4% (diagnosed and undiagnosed) • in addition, there are an estimated NHS Ealing CCG 7.8% 2.5% 11.9% 8.8% of people in NHS Central London (Westminster) CCG who are NHS Hounslow CCG 7.3% 1.9% 11.2% at increased risk of developing diabetes (i.e. with non-diabetic NHS Hillingdon CCG 7.0% 1.6% 11.6% hyperglycaemia) • this means that 15.9% of the NHS West London CCG 4.6% 3.7% 9.4% population in NHS Central London (Westminster) CCG are estimated to NHS Hammersmith And Fulham CCG 4.5% 2.9% 8.7% have diabetes, or at high risk of developing of diabetes

NHS Central London (Westminster) CCG 4.0% 3.1% 8.8%

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% 30% 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 Ealing CCG 62.1%

NHS Hounslow CCG 59.5% • data on care processes and treatment targets are taken from the National Diabetes Audit (NDA) NHS West London CCG 50.5% • overall practice participation in the 2015/16 audit was 81.4% in England NHS Central London (Westminster) CCG 49.5% • in NHS Central London (Westminster) NHS Hammersmith And Fulham CCG 47.1% CCG, 29 out of 35 practices (82.9%) participated in the NDA. Data is not available for the remaining practices NHS Hillingdon CCG 39.6%

NHS Brent CCG 36.8% • 49.5% of people with diabetes (of practices who participated in the audit) had the eight recommended NHS Harrow CCG 31.9% care processes in NHS Central London (Westminster) CCG, compared to 52.6% in England

England 52.6%

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

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

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

DR VICTORIA MUIR'S PRACTICE E87753 72.8% MAYFAIR MEDICAL CENTRE E87648 68.7% VICTORIA MEDICAL CENTRE E87002 67.2% • achievement - 8 care processes: in ST JOHNS WOOD MEDICAL PRACTICE E87609 67.0% SOHO SQUARE GENERAL PRACTICE E87714 65.3% practices who provided data via the NEWTON MEDICAL CENTRE E87681 62.0% NDA, between 20.2% and 72.8% of DR MAHER SHAKARCHI'S PRACTICE Y02260 61.8% LISSON GROVE HEALTH CENTRE E87011 59.7% patients received all 8 care processes KINGS COLLEGE HEALTH CENTRE E87768 58.3% CAVENDISH HEALTH CENTRE E87745 55.5% COVENT GARDEN MEDICAL CENTRE E87045 55.1% • at least 3,258 people did not receive MILLBANK MEDICAL CENTRE E87739 54.4% THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 53.6% the eight care processes FITZROVIA MEDICAL CENTRE E87066 52.4% PADDINGTON GREEN HEALTH CENTRE E87008 49.0% MARYLEBONE HEALTH CENTRE E87737 47.3% BELGRAVIA SURGERY E87005 46.6% SOHO CENTRE FOR HEALTH AND CARE E87069 46.2% IMPERIAL COLLEGE HEALTH CENTRE E87677 45.6% WELLINGTON HEALTH CENTRE E87754 38.8% PIMLICO HEALTH AT THE MARVEN SURGERY E87034 32.4% CONNAUGHT SQUARE PRACTICE E87037 31.5% THE RANDOLPH SURGERY E87046 30.2% MAIDA VALE MEDICAL CENTRE E87010 25.1% CRAWFORD STREET SURGERY E87070 22.3% GROUND FLOOR LANARK MEDICAL CENTRE E87756 20.9% THE WESTBOURNE GREEN SURGERY Y00902 20.2% WOODFIELD ROAD MEDICAL CENTRE E87741 THE DOCTOR HICKEY SURGERY E87740 THE ROYAL MEWS SURGERY E87694 WESTMINSTER SCHOOL E87691 CROMPTON MEDICAL CENTRE E87052 NORTH WEST LONDON MEDICAL CENTRE E87017 LITTLE VENICE MEDICAL CENTRE E87006 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 Hillingdon CCG 42.8%

NHS Central London (Westminster) CCG 42.2% • 42.2% of people with diabetes (of practices who participated in the audit) met the three treatment targets NHS Harrow CCG 40.4% in NHS Central London (Westminster) CCG, compared to 39.0% in England

NHS Brent CCG 39.1%

NHS West London CCG 39.1%

NHS Hounslow CCG 38.6%

NHS Ealing CCG 37.2%

NHS Hammersmith And Fulham CCG 37.0%

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

THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 57.7% VICTORIA MEDICAL CENTRE E87002 53.9% DR VICTORIA MUIR'S PRACTICE E87753 53.0% • achievement - 3 treatment targets: in ST JOHNS WOOD MEDICAL PRACTICE E87609 47.6% MILLBANK MEDICAL CENTRE E87739 47.1% practices who provided data via the GROUND FLOOR LANARK MEDICAL CENTRE E87756 46.1% NDA, between 23.3% and 57.7% of DR MAHER SHAKARCHI'S PRACTICE Y02260 46.0% SOHO SQUARE GENERAL PRACTICE E87714 45.5% patients achieved all 3 treatment BELGRAVIA SURGERY E87005 45.3% targets MAYFAIR MEDICAL CENTRE E87648 43.7% NEWTON MEDICAL CENTRE E87681 43.6% • at least 3,193 people did not meet the PIMLICO HEALTH AT THE MARVEN SURGERY E87034 42.8% MAIDA VALE MEDICAL CENTRE E87010 41.7% three treatment targets IMPERIAL COLLEGE HEALTH CENTRE E87677 40.9% FITZROVIA MEDICAL CENTRE E87066 40.8% MARYLEBONE HEALTH CENTRE E87737 39.3% SOHO CENTRE FOR HEALTH AND CARE E87069 38.1% CAVENDISH HEALTH CENTRE E87745 37.5% LISSON GROVE HEALTH CENTRE E87011 37.0% COVENT GARDEN MEDICAL CENTRE E87045 37.0% CONNAUGHT SQUARE PRACTICE E87037 35.5% CRAWFORD STREET SURGERY E87070 33.3% THE RANDOLPH SURGERY E87046 32.9% THE WESTBOURNE GREEN SURGERY Y00902 32.3% PADDINGTON GREEN HEALTH CENTRE E87008 31.8% WELLINGTON HEALTH CENTRE E87754 30.1% KINGS COLLEGE HEALTH CENTRE E87768 23.3% WOODFIELD ROAD MEDICAL CENTRE E87741 THE DOCTOR HICKEY SURGERY E87740 THE ROYAL MEWS SURGERY E87694 WESTMINSTER SCHOOL E87691 CROMPTON MEDICAL CENTRE E87052 NORTH WEST LONDON MEDICAL CENTRE E87017 LITTLE VENICE MEDICAL CENTRE E87006 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

KINGS COLLEGE HEALTH CENTRE 6

WELLINGTON HEALTH CENTRE 22

PADDINGTON GREEN HEALTH CENTRE 57 • using the GP cluster method of CRAWFORD STREET SURGERY 10 calculating potential gains, if each THE WESTBOURNE GREEN SURGERY 16 practice was to achieve as well as the CONNAUGHT SQUARE PRACTICE 28 upper quartile of its national cluster, then an additional 243 people would THE RANDOLPH SURGERY 14 be treated CAVENDISH HEALTH CENTRE 10

LISSON GROVE HEALTH CENTRE 31

COVENT GARDEN MEDICAL CENTRE 6

NEWTON MEDICAL CENTRE 5

MAYFAIR MEDICAL CENTRE

DR MAHER SHAKARCHI'S PRACTICE

MILLBANK MEDICAL CENTRE

GROUND FLOOR LANARK MEDICAL CENTRE

SOHO SQUARE GENERAL PRACTICE

ST JOHNS WOOD MEDICAL PRACTICE

DR VICTORIA MUIR'S PRACTICE

VICTORIA MEDICAL CENTRE

THIRD FLOOR LANARK ROAD MEDICAL CENTRE Details of this methodology are available on slide 9. Click here to view them.

51 CVD: Primary Care Intelligence Packs Kidney

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

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

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

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

NHS Hounslow CCG 0.56

NHS Hammersmith And Fulham CCG 0.55 • the ratio of those diagnosed with chronic kidney disease versus those NHS Hillingdon CCG 0.50 expected to have chronic kidney disease is 0.33. This compares to NHS Brent CCG 0.49 0.68 for England • this suggests that 33% of people with chronic kidney disease have been NHS Ealing CCG 0.43 diagnosed

NHS Harrow CCG 0.41

NHS West London CCG 0.40

NHS Central London (Westminster) CCG 0.33 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 Bristol CCG 0.87

NHS Brighton and Hove CCG 0.66

NHS Southampton CCG 0.62

NHS Camden CCG 0.61

NHS Portsmouth CCG 0.60

NHS Leeds West CCG 0.55

NHS Hammersmith and Fulham CCG 0.55

NHS Islington CCG 0.51

NHS Wandsworth CCG 0.42

NHS West London CCG 0.40

NHS Central London (Westminster) CCG 0.33

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

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

GP practice CCG

ST JOHNS WOOD MEDICAL PRACTICE E87609 4.1% MAIDA VALE MEDICAL CENTRE E87010 2.6% PIMLICO HEALTH AT THE MARVEN SURGERY E87034 2.6% DR VICTORIA MUIR'S PRACTICE E87753 2.5% • it is estimated that there are 5,548 PADDINGTON GREEN HEALTH CENTRE E87008 2.3% LISSON GROVE HEALTH CENTRE E87011 2.2% people with undiagnosed chronic BELGRAVIA SURGERY E87005 2.1% kidney disease in NHS Central MAYFAIR MEDICAL CENTRE E87648 2.0% MARYLEBONE HEALTH CENTRE E87737 1.9% London (Westminster) CCG NORTH WEST LONDON MEDICAL CENTRE E87017 1.9% • GP practice range of observed CKD: THE RANDOLPH SURGERY E87046 1.6% CRAWFORD STREET SURGERY E87070 1.5% 0.0% to 4.1% VICTORIA MEDICAL CENTRE E87002 1.4% CONNAUGHT SQUARE PRACTICE E87037 1.4% LITTLE VENICE MEDICAL CENTRE E87006 1.4% CAVENDISH HEALTH CENTRE E87745 1.3% WELLINGTON HEALTH CENTRE E87754 1.3% FITZROVIA MEDICAL CENTRE E87066 1.2% THE WESTBOURNE GREEN SURGERY Y00902 1.1% NEWTON MEDICAL CENTRE E87681 1.0% DR MAHER SHAKARCHI'S PRACTICE Y02260 1.0% THE ROYAL MEWS SURGERY E87694 0.9% MILLBANK MEDICAL CENTRE E87739 0.9% WOODFIELD ROAD MEDICAL CENTRE E87741 0.8% THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 0.8% CROMPTON MEDICAL CENTRE E87052 0.5% COVENT GARDEN MEDICAL CENTRE E87045 0.4% SOHO CENTRE FOR HEALTH AND CARE E87069 0.4% SOHO SQUARE GENERAL PRACTICE E87714 0.4% GROUND FLOOR LANARK MEDICAL CENTRE E87756 0.2% Note: CCG estimates for the estimated THE DOCTOR HICKEY SURGERY E87740 0.1% number of people with CKD are based on IMPERIAL COLLEGE HEALTH CENTRE E87677 0.1% applying a proportion from a resident based KINGS COLLEGE HEALTH CENTRE E87768 WESTMINSTER SCHOOL E87691 population estimate to a GP registered population. The characteristics of registered 0% 1% 1% 2% 2% 3% 3% 4% 4% 5% and resident populations may vary in some CCGs, and local interpretation is required.

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

NHS Hillingdon CCG 77.1% • 2,766 people with CKD (diagnosed*) NHS Ealing CCG 75.7% in NHS Central London (Westminster) CCG NHS Brent CCG 75.3% • 2,027 (73.3%) people whose blood pressure is <= 140 /85 • 219 (7.9%) people who are NHS Harrow CCG 75.1% exceptions • 520 (18.8%) additional people whose NHS Hounslow CCG 74.9% blood pressure is not <= 140 / 85

NHS West London CCG 73.3%

NHS Central London (Westminster) CCG 73.3%

NHS Hammersmith And Fulham CCG 70.3%

*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 Portsmouth CCG 78.8%

NHS Islington CCG 76.0%

NHS Wandsworth CCG 75.4%

NHS Camden CCG 74.9%

NHS Bristol CCG 74.4%

NHS Southampton CCG 74.0%

NHS Leeds West CCG 73.6%

NHS West London CCG 73.3%

NHS Central London (Westminster) CCG 73.3%

NHS Brighton and Hove CCG 72.3%

NHS Hammersmith and Fulham CCG 70.3%

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

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

Not below 140/85 Exceptions reported

NORTH WEST LONDON MEDICAL CENTRE E87017 19 FITZROVIA MEDICAL CENTRE E87066 27 THE CONNAUGHT SQUARE PRACTICE E87037 33 PADDINGTON GREEN HEALTH CENTRE E87008 65 • in total, including exceptions, there CAVENDISH HEALTH CENTRE E87745 25 are 739 people whose blood pressure THE MAYFAIR MEDICAL CENTRE E87648 12 MARYLEBONE HEALTH CENTRE E87737 55 is not <= 140 / 85 BELGRAVIA SURGERY E87005 45 • GP practice range: 0.0% to 41.3% MILLBANK MEDICAL CENTRE E87739 15 DR AMAKYE & MR V PATEL E87070 20 THE WELLINGTON HEALTH CENTRE E87754 25 THE WESTBOURNE GREEN SURGERY Y00902 11 LISSON GROVE HEALTH CENTRE E87011 41 LITTLE VENICE MEDICAL CENTRE E87006 18 MARVEN MEDICAL PRACTICE E87034 83 THE NEWTON MEDICAL CENTRE E87681 22 ST JOHNS WOOD MEDICAL PRACTICE E87609 106 SOHO SQUARE GENERAL PRACTICE E87714 4 THE RANDOLPH SURGERY E87046 23 COVENT GARDEN MEDICAL CENTRE E87045 2 MAIDA VALE MEDICAL CENTRE E87010 37 DR MAHER SHAKARCHI'S PRACTICE Y02260 6 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 3 VICTORIA MEDICAL CENTRE E87002 20 IMPERIAL COLLEGE HEALTH CENTRE E87677 2 DR VICTORIA MUIR'S PRACTICE E87753 16 WOODFIELD ROAD MEDICAL CENTRE E87741 3 SOHO CENTRE FOR HEALTH AND CARE E87069 1 CROMPTON MEDICAL CENTRE E87052 DR EVANS(TIMOTHY) E87694 THE DOCTOR HICKEY SURGERY E87740 LANARK MEDICAL CENTRE E87756 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

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

KINGS COLLEGE HEALTH CENTRE

NORTH WEST LONDON MEDICAL CENTRE 11

FITZROVIA MEDICAL CENTRE 16 • using the GP cluster method of THE CONNAUGHT SQUARE PRACTICE 19 calculating potential gains, if each PADDINGTON GREEN HEALTH CENTRE 37 practice was to achieve as well as the CAVENDISH HEALTH CENTRE 14 upper quartile of its national cluster, then an additional 292 people would MARYLEBONE HEALTH CENTRE 30 be treated THE MAYFAIR MEDICAL CENTRE 6

MILLBANK MEDICAL CENTRE 8

BELGRAVIA SURGERY 23

THE RANDOLPH SURGERY 3

THIRD FLOOR LANARK ROAD MEDICAL CENTRE 0

VICTORIA MEDICAL CENTRE

IMPERIAL COLLEGE HEALTH CENTRE

DR VICTORIA MUIR'S PRACTICE

WOODFIELD ROAD MEDICAL CENTRE

SOHO CENTRE FOR HEALTH AND CARE

LANARK MEDICAL CENTRE

CROMPTON MEDICAL CENTRE

THE DOCTOR HICKEY 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 Hillingdon CCG 78.6% • 2,766 people with CKD (diagnosed*) NHS Harrow CCG 76.0% in NHS Central London (Westminster) CCG NHS Ealing CCG 75.5% • 2,033 (73.5%) people who have a record of urine albumin:creatinine ratio test NHS Brent CCG 74.4% • 161 (5.8%) people who are exceptions NHS Hounslow CCG 74.1% • 572 (20.7%) additional people who have no record of urine albumin:creatinine ratio test NHS Central London (Westminster) CCG 73.5%

NHS West London CCG 73.5%

NHS Hammersmith And Fulham CCG 69.6%

*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 Camden CCG 78.9%

NHS Islington CCG 77.2%

NHS Southampton CCG 77.1%

NHS Bristol CCG 76.8%

NHS Wandsworth CCG 76.7%

NHS Leeds West CCG 76.2%

NHS Portsmouth CCG 75.3%

NHS Brighton and Hove CCG 73.8%

NHS Central London (Westminster) CCG 73.5%

NHS West London CCG 73.5%

NHS Hammersmith and Fulham CCG 69.6%

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

CROMPTON MEDICAL CENTRE E87052 6 COVENT GARDEN MEDICAL CENTRE E87045 6 NORTH WEST LONDON MEDICAL CENTRE E87017 30 FITZROVIA MEDICAL CENTRE E87066 33 • in total, including exceptions, there THE CONNAUGHT SQUARE PRACTICE E87037 36 are 733 people who have no record of THE MAYFAIR MEDICAL CENTRE E87648 14 THE NEWTON MEDICAL CENTRE E87681 34 urine albumin:creatinine ratio test MARYLEBONE HEALTH CENTRE E87737 59 • GP practice range: 0.0% to 75.0% THE WESTBOURNE GREEN SURGERY Y00902 13 THE WELLINGTON HEALTH CENTRE E87754 29 MARVEN MEDICAL PRACTICE E87034 109 PADDINGTON GREEN HEALTH CENTRE E87008 57 MILLBANK MEDICAL CENTRE E87739 14 SOHO CENTRE FOR HEALTH AND CARE E87069 3 MAIDA VALE MEDICAL CENTRE E87010 48 DR AMAKYE & MR V PATEL E87070 18 LISSON GROVE HEALTH CENTRE E87011 38 LITTLE VENICE MEDICAL CENTRE E87006 17 DR MAHER SHAKARCHI'S PRACTICE Y02260 6 CAVENDISH HEALTH CENTRE E87745 14 LANARK MEDICAL CENTRE E87756 1 SOHO SQUARE GENERAL PRACTICE E87714 3 DR VICTORIA MUIR'S PRACTICE E87753 26 BELGRAVIA SURGERY E87005 21 THE RANDOLPH SURGERY E87046 15 ST JOHNS WOOD MEDICAL PRACTICE E87609 63 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 2 WOODFIELD ROAD MEDICAL CENTRE E87741 3 VICTORIA MEDICAL CENTRE E87002 14 IMPERIAL COLLEGE HEALTH CENTRE E87677 1 DR EVANS(TIMOTHY) E87694 THE DOCTOR HICKEY SURGERY E87740 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 Harrow CCG 0.57%

NHS Brent CCG 0.54% • prevalence of 0.44% in NHS Central London (Westminster) CCG NHS Hounslow CCG 0.51% compared to 0.76% in England

NHS Hillingdon CCG 0.49%

NHS Ealing CCG 0.46%

NHS Central London (Westminster) CCG 0.44%

NHS Hammersmith And Fulham CCG 0.41%

NHS West London CCG 0.40%

England 0.76%

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

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

NHS Camden CCG 0.64%

NHS Bristol CCG 0.64%

NHS Portsmouth CCG 0.64%

NHS Leeds West CCG 0.61%

NHS Southampton CCG 0.59%

NHS Brighton and Hove CCG 0.53%

NHS Islington CCG 0.49%

NHS Central London (Westminster) CCG 0.44%

NHS Hammersmith and Fulham CCG 0.41%

NHS West London CCG 0.40%

NHS Wandsworth CCG 0.32%

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

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

GP practice CCG

DR VICTORIA MUIR'S PRACTICE E87753 1.1% BELGRAVIA SURGERY E87005 0.9% CROMPTON MEDICAL CENTRE E87052 0.9% VICTORIA MEDICAL CENTRE E87002 0.8% • 937 people with diagnosed heart NORTH WEST LONDON MEDICAL CENTRE E87017 0.8% PIMLICO HEALTH AT THE MARVEN SURGERY E87034 0.7% failure in NHS Central London LISSON GROVE HEALTH CENTRE E87011 0.6% (Westminster) CCG DR MAHER SHAKARCHI'S PRACTICE Y02260 0.6% MILLBANK MEDICAL CENTRE E87739 0.5% • GP practice range: 0.0% to 1.1% PADDINGTON GREEN HEALTH CENTRE E87008 0.5% GROUND FLOOR LANARK MEDICAL CENTRE E87756 0.5% ST JOHNS WOOD MEDICAL PRACTICE E87609 0.4% CONNAUGHT SQUARE PRACTICE E87037 0.4% WELLINGTON HEALTH CENTRE E87754 0.4% NEWTON MEDICAL CENTRE E87681 0.4% FITZROVIA MEDICAL CENTRE E87066 0.4% THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 0.4% LITTLE VENICE MEDICAL CENTRE E87006 0.4% CAVENDISH HEALTH CENTRE E87745 0.4% COVENT GARDEN MEDICAL CENTRE E87045 0.3% MAYFAIR MEDICAL CENTRE E87648 0.3% MAIDA VALE MEDICAL CENTRE E87010 0.3% MARYLEBONE HEALTH CENTRE E87737 0.3% CRAWFORD STREET SURGERY E87070 0.3% THE DOCTOR HICKEY SURGERY E87740 0.3% WOODFIELD ROAD MEDICAL CENTRE E87741 0.3% SOHO SQUARE GENERAL PRACTICE E87714 0.2% SOHO CENTRE FOR HEALTH AND CARE E87069 0.2% THE RANDOLPH SURGERY E87046 0.2% THE WESTBOURNE GREEN SURGERY Y00902 0.2% IMPERIAL COLLEGE HEALTH CENTRE E87677 0.1% WESTMINSTER SCHOOL E87691 THE ROYAL MEWS SURGERY E87694 KINGS COLLEGE HEALTH CENTRE E87768 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%

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 Hounslow CCG 91.5% • 214 people with heart failure* with NHS Ealing CCG 91.5% LVSD in NHS Central London (Westminster) CCG NHS Brent CCG 88.4% • 184 (86%) people treated with ACE-I or ARB • 30 (14%) people who are exceptions NHS Hillingdon CCG 87.6% • 0 (0%) additional people who are not treated with ACE-I or ARB NHS Central London (Westminster) CCG 86.0%

NHS Harrow CCG 86.0%

NHS Hammersmith And Fulham CCG 84.8%

NHS West London CCG 82.7%

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 Portsmouth CCG 86.6%

NHS Wandsworth CCG 86.3%

NHS Central London (Westminster) CCG 86.0%

NHS Hammersmith and Fulham CCG 84.8%

NHS Bristol CCG 83.6%

NHS Camden CCG 83.6%

NHS Southampton CCG 83.0%

NHS West London CCG 82.7%

NHS Leeds West CCG 82.3%

NHS Islington CCG 81.7%

NHS Brighton and Hove CCG 81.3%

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

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

No treatment Exceptions reported

ST JOHNS WOOD MEDICAL PRACTICE E87609 3 LISSON GROVE HEALTH CENTRE E87011 2 SOHO CENTRE FOR HEALTH AND CARE E87069 1 THE WESTBOURNE GREEN SURGERY Y00902 1 • in total, including exceptions, there WOODFIELD ROAD MEDICAL CENTRE E87741 1 WELLINGTON HEALTH CENTRE E87754 2 are 30 people who are not treated PIMLICO HEALTH AT THE MARVEN SURGERY E87034 4 with ACE-I or ARB THE RANDOLPH SURGERY E87046 1 NEWTON MEDICAL CENTRE E87681 4 • GP practice range: 0.0% to 37.5% BELGRAVIA SURGERY E87005 7 FITZROVIA MEDICAL CENTRE E87066 1 VICTORIA MEDICAL CENTRE E87002 1 DR VICTORIA MUIR'S PRACTICE E87753 2 LITTLE VENICE MEDICAL CENTRE E87006 PADDINGTON GREEN HEALTH CENTRE E87008 MAIDA VALE MEDICAL CENTRE E87010 NORTH WEST LONDON MEDICAL CENTRE E87017 CONNAUGHT SQUARE PRACTICE E87037 COVENT GARDEN MEDICAL CENTRE E87045 CROMPTON MEDICAL CENTRE E87052 CRAWFORD STREET SURGERY E87070 MAYFAIR MEDICAL CENTRE E87648 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 IMPERIAL COLLEGE HEALTH CENTRE E87677 SOHO SQUARE GENERAL PRACTICE E87714 MARYLEBONE HEALTH CENTRE E87737 MILLBANK MEDICAL CENTRE E87739 THE DOCTOR HICKEY SURGERY E87740 CAVENDISH HEALTH CENTRE E87745 GROUND FLOOR LANARK MEDICAL CENTRE E87756 DR MAHER SHAKARCHI'S PRACTICE Y02260 KINGS COLLEGE HEALTH CENTRE E87768 THE ROYAL MEWS SURGERY E87694 WESTMINSTER SCHOOL E87691 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 Ealing CCG 83.6% • 184 people with heart failure* with NHS Hounslow CCG 82.8% LVSD treated with ACE-I/ARB in NHS Central London (Westminster) CCG NHS Brent CCG 82.5% • 132 (71.7%) people treated with ACE- I/ARB and BB • 36 (19.6%) people who are NHS Harrow CCG 77.4% exceptions • 16 (8.7%) additional people who are NHS Hammersmith And Fulham CCG 74.0% not treated with ACE-I/ARB and BB

NHS West London CCG 73.4%

NHS Hillingdon CCG 72.6%

NHS Central London (Westminster) CCG 71.7%

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 Portsmouth CCG 85.5%

NHS Islington CCG 82.9%

NHS Leeds West CCG 82.8%

NHS Wandsworth CCG 82.2%

NHS Bristol CCG 81.2%

NHS Southampton CCG 78.6%

NHS Camden CCG 77.2%

NHS Brighton and Hove CCG 75.6%

NHS Hammersmith and Fulham CCG 74.0%

NHS West London CCG 73.4%

NHS Central London (Westminster) CCG 71.7%

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

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

No treatment Exceptions reported

COVENT GARDEN MEDICAL CENTRE E87045 1 IMPERIAL COLLEGE HEALTH CENTRE E87677 2 DR MAHER SHAKARCHI'S PRACTICE Y02260 2 ST JOHNS WOOD MEDICAL PRACTICE E87609 3 • in total, including exceptions, there LITTLE VENICE MEDICAL CENTRE E87006 1 LISSON GROVE HEALTH CENTRE E87011 2 are 52 people who are not treated SOHO CENTRE FOR HEALTH AND CARE E87069 1 with ACE-I or ARB MAYFAIR MEDICAL CENTRE E87648 1 THE WESTBOURNE GREEN SURGERY Y00902 1 • GP practice range: 0.0% to 100.0% DR VICTORIA MUIR'S PRACTICE E87753 9 MARYLEBONE HEALTH CENTRE E87737 4 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 6 PADDINGTON GREEN HEALTH CENTRE E87008 1 WOODFIELD ROAD MEDICAL CENTRE E87741 1 VICTORIA MEDICAL CENTRE E87002 2 MAIDA VALE MEDICAL CENTRE E87010 1 THE RANDOLPH SURGERY E87046 1 BELGRAVIA SURGERY E87005 8 MILLBANK MEDICAL CENTRE E87739 2 FITZROVIA MEDICAL CENTRE E87066 1 WELLINGTON HEALTH CENTRE E87754 1 NEWTON MEDICAL CENTRE E87681 1 NORTH WEST LONDON MEDICAL CENTRE E87017 CONNAUGHT SQUARE PRACTICE E87037 CROMPTON MEDICAL CENTRE E87052 CRAWFORD STREET SURGERY E87070 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 SOHO SQUARE GENERAL PRACTICE E87714 THE DOCTOR HICKEY SURGERY E87740 CAVENDISH HEALTH CENTRE E87745 GROUND FLOOR LANARK MEDICAL CENTRE E87756 KINGS COLLEGE HEALTH CENTRE E87768 THE ROYAL MEWS SURGERY E87694 WESTMINSTER SCHOOL E87691 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 Brent CCG 89.8% • 3,734 people with coronary heart NHS Harrow CCG 89.5% disease* in NHS Central London (Westminster) CCG NHS Hillingdon CCG 89.1% • 3,221 (86.3%) people whose blood pressure <= 150 / 90 • 145 (3.9%) people who are NHS Ealing CCG 88.0% exceptions • 368 (9.9%) additional people whose NHS Hounslow CCG 87.9% blood pressure is not <= 150 / 90

NHS West London CCG 86.5%

NHS Central London (Westminster) CCG 86.3%

NHS Hammersmith And Fulham CCG 83.9%

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 Wandsworth CCG 89.0%

NHS Leeds West CCG 88.7%

NHS Portsmouth CCG 88.5%

NHS Southampton CCG 88.5%

NHS Camden CCG 88.5%

NHS Islington CCG 87.2%

NHS Bristol CCG 86.9%

NHS West London CCG 86.5%

NHS Central London (Westminster) CCG 86.3%

NHS Hammersmith and Fulham CCG 83.9%

NHS Brighton and Hove CCG 83.0%

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

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

Not below 150/90 Exceptions reported

FITZROVIA MEDICAL CENTRE E87066 32 LITTLE VENICE MEDICAL CENTRE E87006 30 CRAWFORD STREET SURGERY E87070 23 THE DOCTOR HICKEY SURGERY E87740 6 • in total, including exceptions, there THE ROYAL MEWS SURGERY E87694 1 MAYFAIR MEDICAL CENTRE E87648 16 are 513 people whose blood pressure NORTH WEST LONDON MEDICAL CENTRE E87017 17 is not <= 150 / 90 COVENT GARDEN MEDICAL CENTRE E87045 10 PADDINGTON GREEN HEALTH CENTRE E87008 43 • GP practice range: 0.0% to 33.3% THE WESTBOURNE GREEN SURGERY Y00902 8 SOHO CENTRE FOR HEALTH AND CARE E87069 7 MILLBANK MEDICAL CENTRE E87739 23 THE RANDOLPH SURGERY E87046 16 CONNAUGHT SQUARE PRACTICE E87037 29 WELLINGTON HEALTH CENTRE E87754 15 SOHO SQUARE GENERAL PRACTICE E87714 5 IMPERIAL COLLEGE HEALTH CENTRE E87677 6 CROMPTON MEDICAL CENTRE E87052 14 NEWTON MEDICAL CENTRE E87681 19 WOODFIELD ROAD MEDICAL CENTRE E87741 6 MAIDA VALE MEDICAL CENTRE E87010 11 MARYLEBONE HEALTH CENTRE E87737 15 GROUND FLOOR LANARK MEDICAL CENTRE E87756 14 ST JOHNS WOOD MEDICAL PRACTICE E87609 33 DR VICTORIA MUIR'S PRACTICE E87753 11 CAVENDISH HEALTH CENTRE E87745 9 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 26 BELGRAVIA SURGERY E87005 17 LISSON GROVE HEALTH CENTRE E87011 17 VICTORIA MEDICAL CENTRE E87002 26 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 6 DR MAHER SHAKARCHI'S PRACTICE Y02260 2 KINGS COLLEGE HEALTH CENTRE E87768 WESTMINSTER SCHOOL E87691 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

FITZROVIA MEDICAL CENTRE 26

LITTLE VENICE MEDICAL CENTRE 24

THE DOCTOR HICKEY SURGERY 5 • using the GP cluster method of CRAWFORD STREET SURGERY 18 calculating potential gains, if each MAYFAIR MEDICAL CENTRE 12 practice was to achieve as well as the NORTH WEST LONDON MEDICAL CENTRE 12 upper quartile of its national cluster, then an additional 275 people would COVENT GARDEN MEDICAL CENTRE 7 be treated PADDINGTON GREEN HEALTH CENTRE 30

THE WESTBOURNE GREEN SURGERY 5

SOHO CENTRE FOR HEALTH AND CARE 5

DR VICTORIA MUIR'S PRACTICE 4

CAVENDISH HEALTH CENTRE 3

PIMLICO HEALTH AT THE MARVEN SURGERY 9

BELGRAVIA SURGERY 4

LISSON GROVE HEALTH CENTRE 4

ST JOHNS WOOD MEDICAL PRACTICE 6

VICTORIA MEDICAL CENTRE 6

THIRD FLOOR LANARK ROAD MEDICAL CENTRE

DR MAHER SHAKARCHI'S PRACTICE

KINGS COLLEGE HEALTH CENTRE 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 Hillingdon CCG 93.5% • 3,734 people with coronary heart NHS Brent CCG 93.3% disease* in NHS Central London (Westminster) CCG NHS Ealing CCG 92.8% • 3,328 (89.1%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant NHS Harrow CCG 92.4% • 152 (4.1%) people who are exceptions NHS Hounslow CCG 91.8% • 254 (6.8%) additional people who are not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant NHS Central London (Westminster) CCG 89.1%

NHS West London CCG 88.4%

NHS Hammersmith And Fulham CCG 87.9%

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 Wandsworth CCG 93.0%

NHS Camden CCG 92.6%

NHS Southampton CCG 92.6%

NHS Leeds West CCG 92.1%

NHS Islington CCG 92.0%

NHS Bristol CCG 91.8%

NHS Portsmouth CCG 89.5%

NHS Brighton and Hove CCG 89.4%

NHS Central London (Westminster) CCG 89.1%

NHS West London CCG 88.4%

NHS Hammersmith and Fulham CCG 87.9%

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

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

No treatment Exceptions reported

KINGS COLLEGE HEALTH CENTRE E87768 2 GROUND FLOOR LANARK MEDICAL CENTRE E87756 45 NORTH WEST LONDON MEDICAL CENTRE E87017 23 THE DOCTOR HICKEY SURGERY E87740 6 • in total, including exceptions, there SOHO CENTRE FOR HEALTH AND CARE E87069 11 THE ROYAL MEWS SURGERY E87694 1 are 406 people are not taking aspirin, FITZROVIA MEDICAL CENTRE E87066 22 an alternative anti-platelet therapy, or COVENT GARDEN MEDICAL CENTRE E87045 9 CRAWFORD STREET SURGERY E87070 14 an anti-coagulant LITTLE VENICE MEDICAL CENTRE E87006 15 • GP practice range: 1.8% to 100.0% THE RANDOLPH SURGERY E87046 14 IMPERIAL COLLEGE HEALTH CENTRE E87677 6 MILLBANK MEDICAL CENTRE E87739 18 CROMPTON MEDICAL CENTRE E87052 14 MAYFAIR MEDICAL CENTRE E87648 9 WOODFIELD ROAD MEDICAL CENTRE E87741 6 DR VICTORIA MUIR'S PRACTICE E87753 14 MARYLEBONE HEALTH CENTRE E87737 17 WELLINGTON HEALTH CENTRE E87754 11 PADDINGTON GREEN HEALTH CENTRE E87008 22 CAVENDISH HEALTH CENTRE E87745 9 THE WESTBOURNE GREEN SURGERY Y00902 4 SOHO SQUARE GENERAL PRACTICE E87714 3 NEWTON MEDICAL CENTRE E87681 12 ST JOHNS WOOD MEDICAL PRACTICE E87609 25 CONNAUGHT SQUARE PRACTICE E87037 14 PIMLICO HEALTH AT THE MARVEN SURGERY E87034 21 DR MAHER SHAKARCHI'S PRACTICE Y02260 4 MAIDA VALE MEDICAL CENTRE E87010 5 BELGRAVIA SURGERY E87005 9 LISSON GROVE HEALTH CENTRE E87011 8 VICTORIA MEDICAL CENTRE E87002 11 THIRD FLOOR LANARK ROAD MEDICAL CENTRE E87663 2 WESTMINSTER SCHOOL E87691 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 Central London (Westminster) CCG England 800

700 • in NHS Central London (Westminster) CCG, the hospital admission rate for coronary heart disease in 2015/16 600 was 442.4 (537) 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 Central London (Westminster) CCG England 300

• in NHS Central London (Westminster) 250 CCG, the hospital admission rate for stroke in 2015/16 was 185.3 (220) compared to 172.8 for England

200

150

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

50

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

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

NHS Central London (Westminster) CCG England

173.5% Angina 136.8% • The risk of a stroke was 102.7% higher and the risk of a heart attack 178.6% was 178.6% higher compared to Heart Attack 108.6% people without diabetes. The risk of a major amputation was 712.1% higher. 191.4% Heart failure 150.0%

102.7% Stroke 81.3%

712.1% Major amputation 445.8%

1109.2% Minor amputation 753.5%

320.8% RRT 293.0%

0% 200% 400% 600% 800% 1000% 1200% Note: This slide uses data from the National Diabetes Audit (NDA)

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

NHS Central London (Westminster) CCG England 90

80 • in NHS Central London (Westminster) CCG, the early mortality rate for 70 coronary heart disease in 2013-15 was 29.5, compared to 40.6 for England 60

50

40

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

10

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

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

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

NHS Central London (Westminster) CCG England 30

• in NHS Central London (Westminster) 25 CCG, the early mortality rate for stroke in 2013-15 was 16, compared to 13.6 for England

20

15

10 Age Age standardised (per rate 100,000)

5

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

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

87 CVD: Primary Care Intelligence Packs Appendix Data sources

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

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

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

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

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

• NHS Stop smoking services Copyright © 2014, NHS Digital

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

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

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

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

88 CVD: Primary Care Intelligence Packs About Public Health England

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Published June 2017 Gateway number 2017095

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