CVD: Primary Care Intelligence Packs NHS Brighton and Hove 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 Brighton and Hove CCG are: NHS Newcastle Gateshead CCG NHS Greater Preston CCG NHS Portsmouth CCG NHS North Durham CCG NHS Bristol CCG NHS Southampton CCG NHS Lincolnshire West CCG NHS Sunderland CCG NHS Lancashire North CCG NHS Liverpool 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 Liverpool CCG 21.9%

NHS Brighton and Hove CCG 21.6% • prevalence of 21.6% in NHS Brighton and Hove CCG NHS Portsmouth CCG 21.6%

NHS Southampton CCG 21.3%

NHS Sunderland CCG 21.2%

NHS Bristol CCG 20.9%

NHS Newcastle Gateshead CCG 19.6%

NHS Greater Preston CCG 19.2% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Lincolnshire West CCG 18.2% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Lancashire North CCG 17.9% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS North Durham CCG 16.2% 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

BHH MORLEY STREET G81689 66.2% BROADWAY SURGERY G81669 35.3% THE PRACTICE WHITEHAWK ROAD G81676 31.5% THE AVENUE SURGERY G81075 31.0% ALBION STREET SURGERY G81090 30.8% NORTH LAINE MEDICAL CENTRE G81103 30.6% • 57,554 people who are recorded as SHIP STREET SURGERY G81694 30.4% smokers in NHS Brighton and Hove THE PRACTICE WILLOW HOUSE G81661 29.9% BRIGHTON STATION HEALTH CENTRE Y02676 29.6% CCG SEVEN DIALS MEDICAL CENTRE G81047 29.2% ST.PETER'S MEDICAL CENTRE G81011 27.4% • GP practice range: 10.7% to 66.2% REGENCY SURGERY G81656 27.1% LEWES ROAD SURGERY G81063 26.6% BRIGHTON HEALTH AND WELLBEING CENTRE G81638 26.3% THE PRACTICE NORTH STREET G81020 26.0% PAVILION SURGERY G81054 25.6% PARK CRESCENT HEALTH CENTRE G81028 25.5% SCHOOL HOUSE SURGERY G81613 25.0% BENFIELD VALLEY HEALTHCARE HUB G81680 22.3% ARDINGLY COURT SURGERY G81006 22.1% NEW LARCHWOOD SURGERY Y02404 21.4% PORTSLADE HEALTH CENTRE G81046 21.0% MILE OAK MEDICAL CENTRE G81073 20.9% CENTRAL HOVE SURGERY G81070 20.5% CHARTER MEDICAL CENTRE G81034 20.4% PRESTON PARK SURGERY G81018 20.3% SACKVILLE MEDICAL CENTRE G81009 20.1% LINKS ROAD SURGERY G81663 20.1% MONTPELIER SURGERY G81044 19.9% STANFORD MEDICAL CENTRE G81038 19.1% UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 18.7% CARDEN SURGERY G81014 18.7% THE PRACTICE HANGLETON MANOR Y00079 17.0% WOODINGDEAN MEDICAL CENTRE G81065 16.7% HOVE MEDICAL CENTRE G81001 16.7% THE HAVEN PRACTICE G81646 15.3% BEACONSFIELD MEDICAL PRACTICE G81042 15.2% Note: This method is thought to be a reasonably WISH PARK SURGERY G81083 15.1% robust method in estimating smoking prevalence RIDGEWAY SURGERY G81642 14.1% HOVE PARK VILLAS SURGERY G81094 13.7% for the majority of GP practices. However, ST LUKE'S SURGERY G81667 12.1% caution is advised for extreme estimates of WARMDENE SURGERY G81036 12.0% MATLOCK ROAD SURGERY G81684 11.8% smoking prevalence and those with high SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 10.7% numbers of smoking status not recorded and 0% 10% 20% 30% 40% 50% 60% 70% 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 Hastings And Rother CCG 0.64

NHS Eastbourne, Hailsham And Seaford CCG 0.61 • the ratio of those diagnosed with hypertension versus those expected NHS Coastal West Sussex CCG 0.60 to have hypertension is 0.52. This compares to 0.59 for England • this suggests that 52% of people with NHS Horsham And Mid Sussex CCG 0.59 hypertension have been diagnosed

NHS High Weald Lewes Havens CCG 0.59

NHS Crawley CCG 0.57

NHS East Surrey CCG 0.56

NHS Brighton And Hove CCG 0.52

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 Sunderland CCG 0.61

NHS North Durham CCG 0.60

NHS Newcastle Gateshead CCG 0.59

NHS Greater Preston CCG 0.59

NHS Lincolnshire West CCG 0.58

NHS Lancashire North CCG 0.58

NHS Liverpool CCG 0.58

NHS Portsmouth CCG 0.56

NHS Bristol CCG 0.54

NHS Southampton CCG 0.53

NHS Brighton and Hove CCG 0.52

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

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

GP practice CCG

BROADWAY SURGERY G81669 0.66 LEWES ROAD SURGERY G81063 0.63 RIDGEWAY SURGERY G81642 0.62 THE PRACTICE HANGLETON MANOR Y00079 0.58 THE PRACTICE WILLOW HOUSE G81661 0.58 BENFIELD VALLEY HEALTHCARE HUB G81680 0.56 • it is estimated that there are 27,751 MILE OAK MEDICAL CENTRE G81073 0.56 THE PRACTICE WHITEHAWK ROAD G81676 0.56 people with undiagnosed HOVE MEDICAL CENTRE G81001 0.54 REGENCY SURGERY G81656 0.53 hypertension in NHS Brighton and WOODINGDEAN MEDICAL CENTRE G81065 0.51 THE AVENUE SURGERY G81075 0.51 Hove CCG PORTSLADE HEALTH CENTRE G81046 0.51 • GP practice range of observed to SCHOOL HOUSE SURGERY G81613 0.51 WARMDENE SURGERY G81036 0.50 expected hypertension prevalence ST LUKE'S SURGERY G81667 0.49 CARDEN SURGERY G81014 0.47 0.1 to 0.66 ST.PETER'S MEDICAL CENTRE G81011 0.47 ALBION STREET SURGERY G81090 0.46 BEACONSFIELD MEDICAL PRACTICE G81042 0.46 LINKS ROAD SURGERY G81663 0.46 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 0.44 MATLOCK ROAD SURGERY G81684 0.44 WISH PARK SURGERY G81083 0.43 SHIP STREET SURGERY G81694 0.42 CHARTER MEDICAL CENTRE G81034 0.42 PRESTON PARK SURGERY G81018 0.41 SACKVILLE MEDICAL CENTRE G81009 0.40 PARK CRESCENT HEALTH CENTRE G81028 0.40 SEVEN DIALS MEDICAL CENTRE G81047 0.40 STANFORD MEDICAL CENTRE G81038 0.40 PAVILION SURGERY G81054 0.40 ARDINGLY COURT SURGERY G81006 0.39 THE HAVEN PRACTICE G81646 0.39 HOVE PARK VILLAS SURGERY G81094 0.39 CENTRAL HOVE SURGERY G81070 0.39 NORTH LAINE MEDICAL CENTRE G81103 0.37 THE PRACTICE NORTH STREET G81020 0.37 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 0.34 MONTPELIER SURGERY G81044 0.30 BRIGHTON STATION HEALTH CENTRE Y02676 0.21 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 0.10 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 Hastings And Rother CCG 80.4%

NHS Horsham And Mid Sussex CCG 80.3% • 30,304 people with hypertension (diagnosed)* in NHS Brighton and NHS Crawley CCG 79.6% Hove CCG • 22,217 (73.3%) people whose blood pressure is <= 150/90 NHS Eastbourne, Hailsham And Seaford CCG 77.3% • 1,569 (5.2%) people who are excepted from optimal control NHS East Surrey CCG 77.2% • 6,518 (21.5%) additional people whose blood pressure is not <= 150/90 NHS Coastal West Sussex CCG 76.1%

NHS High Weald Lewes Havens CCG 75.4%

NHS Brighton And Hove CCG 73.3%

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 Lincolnshire West CCG 82.3%

NHS North Durham CCG 82.1%

NHS Newcastle Gateshead CCG 81.3%

NHS Greater Preston CCG 80.5%

NHS Liverpool CCG 80.3%

NHS Portsmouth CCG 80.0%

NHS Sunderland CCG 79.5%

NHS Bristol CCG 77.8%

NHS Lancashire North CCG 76.8%

NHS Southampton CCG 76.8%

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

UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 52 WISH PARK SURGERY G81083 329 LEWES ROAD SURGERY G81063 138 CHARTER MEDICAL CENTRE G81034 853 BHH MORLEY STREET G81689 21 SEVEN DIALS MEDICAL CENTRE G81047 258 • in total, including exceptions, there BENFIELD VALLEY HEALTHCARE HUB G81680 257 HOVE PARK VILLAS SURGERY G81094 157 are 8,087 people whose blood BRIGHTON HEALTH AND WELLBEING CENTRE G81638 234 pressure is not <= 150/90 NORTH LAINE MEDICAL CENTRE G81103 111 ST.PETER'S MEDICAL CENTRE G81011 404 • GP practice range: 10.8% to 43.0% THE PRACTICE WHITEHAWK ROAD G81676 139 ST LUKE'S SURGERY G81667 103 PAVILION SURGERY G81054 295 BRIGHTON STATION HEALTH CENTRE Y02676 43 THE PRACTICE HANGLETON MANOR Y00079 81 RIDGEWAY SURGERY G81642 102 THE PRACTICE NORTH STREET G81020 40 HOVE MEDICAL CENTRE G81001 369 WARMDENE SURGERY G81036 350 BROADWAY SURGERY G81669 91 ARDINGLY COURT SURGERY G81006 234 SACKVILLE MEDICAL CENTRE G81009 276 CENTRAL HOVE SURGERY G81070 154 REGENCY SURGERY G81656 134 CARDEN SURGERY G81014 173 PORTSLADE HEALTH CENTRE G81046 366 LINKS ROAD SURGERY G81663 166 PRESTON PARK SURGERY G81018 228 THE PRACTICE WILLOW HOUSE G81661 58 BEACONSFIELD MEDICAL PRACTICE G81042 271 THE HAVEN PRACTICE G81646 51 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 276 ALBION STREET SURGERY G81090 116 NEW LARCHWOOD SURGERY Y02404 25 WOODINGDEAN MEDICAL CENTRE G81065 182 THE AVENUE SURGERY G81075 133 MILE OAK MEDICAL CENTRE G81073 189 PARK CRESCENT HEALTH CENTRE G81028 190 STANFORD MEDICAL CENTRE G81038 241 SCHOOL HOUSE SURGERY G81613 78 SHIP STREET SURGERY G81694 26 MONTPELIER SURGERY G81044 58 MATLOCK ROAD SURGERY G81684 35 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 Crawley CCG 75.0%

NHS Hastings And Rother CCG 64.2% • 114 people with a new diagnosis* of hypertension with a CVD risk of 20% NHS High Weald Lewes Havens CCG 61.9% or higher in NHS Brighton and Hove CCG • 69 (60.5%) people who are currently NHS Horsham And Mid Sussex CCG 61.6% treated with statins • 39 (34.2%) people who are exempted NHS Brighton And Hove CCG 60.5% from treatment with statins • 6 (5.3%) additional people who are not currently treated with statins NHS East Surrey CCG 59.7%

NHS Coastal West Sussex CCG 59.6%

NHS Eastbourne, Hailsham And Seaford CCG 54.9%

England 66.5%

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

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

NHS Newcastle Gateshead CCG 73.6%

NHS Southampton CCG 71.7%

NHS Portsmouth CCG 71.6%

NHS North Durham CCG 71.2%

NHS Liverpool CCG 70.9%

NHS Lincolnshire West CCG 68.4%

NHS Bristol CCG 68.1%

NHS Sunderland CCG 61.8%

NHS Brighton and Hove CCG 60.5%

NHS Greater Preston CCG 59.7%

NHS Lancashire North CCG 55.6%

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

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

No treatment Exceptions reported

CHARTER MEDICAL CENTRE G81034 3 NORTH LAINE MEDICAL CENTRE G81103 1 THE HAVEN PRACTICE G81646 1 PAVILION SURGERY G81054 7 PARK CRESCENT HEALTH CENTRE G81028 3 THE PRACTICE HANGLETON MANOR Y00079 3 • in total, including exceptions, there BRIGHTON HEALTH AND WELLBEING CENTRE G81638 2 PRESTON PARK SURGERY G81018 4 are 45 people who are not treated ARDINGLY COURT SURGERY G81006 4 with statins STANFORD MEDICAL CENTRE G81038 3 MILE OAK MEDICAL CENTRE G81073 2 • GP practice range: 0.0% to 100.0% THE AVENUE SURGERY G81075 1 LINKS ROAD SURGERY G81663 1 BENFIELD VALLEY HEALTHCARE HUB G81680 1 SACKVILLE MEDICAL CENTRE G81009 1 CARDEN SURGERY G81014 1 BEACONSFIELD MEDICAL PRACTICE G81042 2 MONTPELIER SURGERY G81044 1 PORTSLADE HEALTH CENTRE G81046 2 ALBION STREET SURGERY G81090 1 CENTRAL HOVE SURGERY G81070 1 HOVE MEDICAL CENTRE G81001 ST.PETER'S MEDICAL CENTRE G81011 THE PRACTICE NORTH STREET G81020 WARMDENE SURGERY G81036 SEVEN DIALS MEDICAL CENTRE G81047 LEWES ROAD SURGERY G81063 WOODINGDEAN MEDICAL CENTRE G81065 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 WISH PARK SURGERY G81083 HOVE PARK VILLAS SURGERY G81094 SCHOOL HOUSE SURGERY G81613 RIDGEWAY SURGERY G81642 REGENCY SURGERY G81656 BROADWAY SURGERY G81669 THE PRACTICE WHITEHAWK ROAD G81676 MATLOCK ROAD SURGERY G81684 BHH MORLEY STREET G81689 NEW LARCHWOOD SURGERY Y02404 BRIGHTON STATION HEALTH CENTRE Y02676 SHIP STREET SURGERY G81694 ST LUKE'S SURGERY G81667 THE PRACTICE WILLOW HOUSE G81661 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 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 Eastbourne, Hailsham And Seaford CCG 0.84

NHS Hastings And Rother CCG 0.78 • the ratio of those diagnosed with atrial fibrillation versus those expected to NHS East Surrey CCG 0.78 have atrial fibrillation is 0.66. This compares to 0.7 for England • this suggests that 66% of people with NHS High Weald Lewes Havens CCG 0.74 atrial fibrillation have been diagnosed.

NHS Coastal West Sussex CCG 0.72

NHS Horsham And Mid Sussex CCG 0.70

NHS Crawley CCG 0.67

NHS Brighton And Hove CCG 0.66 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 0.9 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 Liverpool CCG 0.79

NHS Lancashire North CCG 0.75

NHS Portsmouth CCG 0.74

NHS Bristol CCG 0.74

NHS Sunderland CCG 0.74

NHS Greater Preston CCG 0.70

NHS Newcastle Gateshead CCG 0.70

NHS Lincolnshire West CCG 0.70

NHS North Durham CCG 0.69

NHS Southampton CCG 0.68

NHS Brighton and Hove CCG 0.66

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

GP practice CCG

THE PRACTICE NORTH STREET G81020 1.3 REGENCY SURGERY G81656 0.9 THE PRACTICE HANGLETON MANOR Y00079 0.9 WARMDENE SURGERY G81036 0.8 MONTPELIER SURGERY G81044 0.8 WOODINGDEAN MEDICAL CENTRE G81065 0.8 • it is estimated that there are 6,128 RIDGEWAY SURGERY G81642 0.8 BROADWAY SURGERY G81669 0.8 people with undiagnosed atrial HOVE MEDICAL CENTRE G81001 0.7 ARDINGLY COURT SURGERY G81006 0.7 fibrillation in NHS Brighton and Hove ST.PETER'S MEDICAL CENTRE G81011 0.7 PRESTON PARK SURGERY G81018 0.7 CCG PARK CRESCENT HEALTH CENTRE G81028 0.7 CHARTER MEDICAL CENTRE G81034 0.7 • GP practice range of observed to STANFORD MEDICAL CENTRE G81038 0.7 PORTSLADE HEALTH CENTRE G81046 0.7 expected atrial fibrillation prevalence CENTRAL HOVE SURGERY G81070 0.7 MILE OAK MEDICAL CENTRE G81073 0.7 0.3 to 1.3 ALBION STREET SURGERY G81090 0.7 NORTH LAINE MEDICAL CENTRE G81103 0.7 THE PRACTICE WHITEHAWK ROAD G81676 0.7 BENFIELD VALLEY HEALTHCARE HUB G81680 0.7 SHIP STREET SURGERY G81694 0.7 NEW LARCHWOOD SURGERY Y02404 0.7 SACKVILLE MEDICAL CENTRE G81009 0.6 CARDEN SURGERY G81014 0.6 BEACONSFIELD MEDICAL PRACTICE G81042 0.6 PAVILION SURGERY G81054 0.6 LEWES ROAD SURGERY G81063 0.6 THE AVENUE SURGERY G81075 0.6 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 0.6 WISH PARK SURGERY G81083 0.6 SCHOOL HOUSE SURGERY G81613 0.6 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 0.6 THE HAVEN PRACTICE G81646 0.6 THE PRACTICE WILLOW HOUSE G81661 0.6 LINKS ROAD SURGERY G81663 0.6 SEVEN DIALS MEDICAL CENTRE G81047 0.5 HOVE PARK VILLAS SURGERY G81094 0.5 MATLOCK ROAD SURGERY G81684 0.5 BRIGHTON STATION HEALTH CENTRE Y02676 0.5 ST LUKE'S SURGERY G81667 0.4 BHH MORLEY STREET G81689 0.4 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 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 Eastbourne, Hailsham And Seaford CCG 78.1% • 3,190 people with atrial fibrillation* NHS High Weald Lewes Havens CCG 77.8% with a CHA2DS2-VASc score >= 2 in NHS Brighton and Hove CCG NHS Hastings And Rother CCG 77.6% • 2,245 (70.4%) people treated with anti-coagulation therapy • 564 (17.7%) people who are NHS Crawley CCG 77.1% exceptions • 381 (11.9%) additional people with a NHS East Surrey CCG 76.5% recorded CHA2DS2-VASc score >= 2 who are not treated

NHS Horsham And Mid Sussex CCG 75.3%

NHS Coastal West Sussex CCG 74.7%

NHS Brighton And Hove CCG 70.4%

England 77.9%

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

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

NHS Lincolnshire West CCG 84.5%

NHS North Durham CCG 83.5%

NHS Sunderland CCG 80.0%

NHS Bristol CCG 79.1%

NHS Liverpool CCG 79.0%

NHS Newcastle Gateshead CCG 78.4%

NHS Southampton CCG 77.8%

NHS Portsmouth CCG 74.2%

NHS Greater Preston CCG 74.1%

NHS Lancashire North CCG 73.4%

NHS Brighton and Hove CCG 70.4%

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

BHH MORLEY STREET G81689 1 THE PRACTICE NORTH STREET G81020 3 NEW LARCHWOOD SURGERY Y02404 9 SCHOOL HOUSE SURGERY G81613 26 SEVEN DIALS MEDICAL CENTRE G81047 18 SHIP STREET SURGERY G81694 10 • in total, including exceptions, there THE PRACTICE WILLOW HOUSE G81661 6 WISH PARK SURGERY G81083 31 are 945 people with a recorded THE HAVEN PRACTICE G81646 7 CHA2DS2-VASc score >= 2 who are SACKVILLE MEDICAL CENTRE G81009 60 ARDINGLY COURT SURGERY G81006 47 not treated BRIGHTON HEALTH AND WELLBEING CENTRE G81638 15 CARDEN SURGERY G81014 33 • GP practice range: 3.4% to 100.0% ST.PETER'S MEDICAL CENTRE G81011 35 PRESTON PARK SURGERY G81018 36 BRIGHTON STATION HEALTH CENTRE Y02676 2 LEWES ROAD SURGERY G81063 8 THE PRACTICE HANGLETON MANOR Y00079 8 WOODINGDEAN MEDICAL CENTRE G81065 45 NORTH LAINE MEDICAL CENTRE G81103 7 MATLOCK ROAD SURGERY G81684 5 MILE OAK MEDICAL CENTRE G81073 32 LINKS ROAD SURGERY G81663 16 CENTRAL HOVE SURGERY G81070 24 ALBION STREET SURGERY G81090 17 PAVILION SURGERY G81054 29 PARK CRESCENT HEALTH CENTRE G81028 28 PORTSLADE HEALTH CENTRE G81046 51 HOVE MEDICAL CENTRE G81001 44 BEACONSFIELD MEDICAL PRACTICE G81042 32 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 52 REGENCY SURGERY G81656 13 STANFORD MEDICAL CENTRE G81038 39 CHARTER MEDICAL CENTRE G81034 57 BENFIELD VALLEY HEALTHCARE HUB G81680 18 WARMDENE SURGERY G81036 46 HOVE PARK VILLAS SURGERY G81094 9 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 1 THE PRACTICE WHITEHAWK ROAD G81676 5 THE AVENUE SURGERY G81075 8 ST LUKE'S SURGERY G81667 3 MONTPELIER SURGERY G81044 5 RIDGEWAY SURGERY G81642 3 BROADWAY SURGERY G81669 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

BHH MORLEY STREET 1

THE PRACTICE NORTH STREET 2

NEW LARCHWOOD SURGERY 7 • using the GP cluster method of SCHOOL HOUSE SURGERY 19 calculating potential gains, if each SEVEN DIALS MEDICAL CENTRE 12 practice was to achieve as well as the THE PRACTICE WILLOW HOUSE 4 upper quartile of its national cluster, then an additional 431 people would SHIP STREET SURGERY 6 be treated WISH PARK SURGERY 20

THE HAVEN PRACTICE 4

ARDINGLY COURT SURGERY 29

SALTDEAN AND ROTTINGDEAN MED PRACTICE 15

WARMDENE SURGERY 14

CHARTER MEDICAL CENTRE 17

THE PRACTICE WHITEHAWK ROAD 1

UNIVERSITY OF SUSSEX HEALTH CENTRE 0

ST LUKE'S SURGERY

THE AVENUE SURGERY

MONTPELIER SURGERY

RIDGEWAY SURGERY

BROADWAY 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 Hastings And Rother CCG 84.6% • 3,913 people with a history of stroke NHS Horsham And Mid Sussex CCG 84.2% or TIA* in NHS Brighton and Hove CCG NHS Crawley CCG 84.1% • 3,075 (78.6%) people whose blood pressure is <= 150 / 90 • 219 (5.6%) people who are NHS East Surrey CCG 82.8% exceptions • 619 (15.8%) additional people whose NHS Eastbourne, Hailsham And Seaford CCG 82.6% blood pressure is not <= 150 / 90

NHS High Weald Lewes Havens CCG 82.1%

NHS Coastal West Sussex CCG 79.7%

NHS Brighton And Hove CCG 78.6%

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 Lincolnshire West CCG 86.1%

NHS North Durham CCG 85.7%

NHS Newcastle Gateshead CCG 85.7%

NHS Greater Preston CCG 85.4%

NHS Liverpool CCG 84.9%

NHS Portsmouth CCG 84.4%

NHS Sunderland CCG 83.0%

NHS Southampton CCG 82.9%

NHS Bristol CCG 81.9%

NHS Lancashire North CCG 81.0%

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

LEWES ROAD SURGERY G81063 13 BHH MORLEY STREET G81689 4 SEVEN DIALS MEDICAL CENTRE G81047 38 WISH PARK SURGERY G81083 39 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 1 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 21 • in total, including exceptions, there CHARTER MEDICAL CENTRE G81034 86 HOVE MEDICAL CENTRE G81001 49 are 838 people whose blood pressure HOVE PARK VILLAS SURGERY G81094 15 is not <= 150 / 90 THE PRACTICE HANGLETON MANOR Y00079 6 BENFIELD VALLEY HEALTHCARE HUB G81680 22 • GP practice range: 3.8% to 48.1% RIDGEWAY SURGERY G81642 15 ST LUKE'S SURGERY G81667 13 NORTH LAINE MEDICAL CENTRE G81103 10 LINKS ROAD SURGERY G81663 19 SACKVILLE MEDICAL CENTRE G81009 39 BROADWAY SURGERY G81669 7 CENTRAL HOVE SURGERY G81070 21 ARDINGLY COURT SURGERY G81006 33 NEW LARCHWOOD SURGERY Y02404 5 PAVILION SURGERY G81054 25 THE AVENUE SURGERY G81075 20 PRESTON PARK SURGERY G81018 29 BEACONSFIELD MEDICAL PRACTICE G81042 26 CARDEN SURGERY G81014 19 WARMDENE SURGERY G81036 35 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 44 THE HAVEN PRACTICE G81646 7 SCHOOL HOUSE SURGERY G81613 10 ST.PETER'S MEDICAL CENTRE G81011 28 THE PRACTICE NORTH STREET G81020 1 REGENCY SURGERY G81656 10 PORTSLADE HEALTH CENTRE G81046 30 THE PRACTICE WHITEHAWK ROAD G81676 10 PARK CRESCENT HEALTH CENTRE G81028 18 THE PRACTICE WILLOW HOUSE G81661 4 WOODINGDEAN MEDICAL CENTRE G81065 19 MATLOCK ROAD SURGERY G81684 5 MILE OAK MEDICAL CENTRE G81073 13 ALBION STREET SURGERY G81090 7 MONTPELIER SURGERY G81044 5 STANFORD MEDICAL CENTRE G81038 15 BRIGHTON STATION HEALTH CENTRE Y02676 1 SHIP STREET SURGERY G81694 1 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 Crawley CCG 92.8% • 2,602 people with a stroke shown to NHS High Weald Lewes Havens CCG 92.2% be non-haemorrhagic* in NHS Brighton and Hove CCG NHS Eastbourne, Hailsham And Seaford CCG 92.1% • 2,348 (90.2%) people who are taking an anti-platetet agent or anti- coagulant NHS Hastings And Rother CCG 91.6% • 138 (5.3%) people who are exceptions NHS Horsham And Mid Sussex CCG 91.4% • 116 (4.5%) additional people with no treatment

NHS East Surrey CCG 90.7%

NHS Brighton And Hove CCG 90.2%

NHS Coastal West Sussex CCG 90.2%

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 Greater Preston CCG 93.5%

NHS Liverpool CCG 93.4%

NHS Newcastle Gateshead CCG 93.4%

NHS Sunderland CCG 93.2%

NHS North Durham CCG 92.5%

NHS Southampton CCG 92.3%

NHS Bristol CCG 90.8%

NHS Lincolnshire West CCG 90.6%

NHS Portsmouth CCG 90.6%

NHS Brighton and Hove CCG 90.2%

NHS Lancashire North CCG 90.1%

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

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

No treatment Exceptions reported

BHH MORLEY STREET G81689 3 RIDGEWAY SURGERY G81642 8 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 8 SEVEN DIALS MEDICAL CENTRE G81047 9 THE HAVEN PRACTICE G81646 3 PRESTON PARK SURGERY G81018 14 • in total, including exceptions, there THE PRACTICE WILLOW HOUSE G81661 3 SHIP STREET SURGERY G81694 2 are 254 people who are not taking an THE AVENUE SURGERY G81075 9 anti-platelet agent or anti-coagulant SACKVILLE MEDICAL CENTRE G81009 15 PAVILION SURGERY G81054 7 • GP practice range: 0.0% to 75.0% HOVE MEDICAL CENTRE G81001 12 ST.PETER'S MEDICAL CENTRE G81011 17 LINKS ROAD SURGERY G81663 5 WISH PARK SURGERY G81083 8 THE PRACTICE HANGLETON MANOR Y00079 2 WOODINGDEAN MEDICAL CENTRE G81065 12 MATLOCK ROAD SURGERY G81684 3 STANFORD MEDICAL CENTRE G81038 15 WARMDENE SURGERY G81036 10 CHARTER MEDICAL CENTRE G81034 19 ARDINGLY COURT SURGERY G81006 9 NORTH LAINE MEDICAL CENTRE G81103 3 BEACONSFIELD MEDICAL PRACTICE G81042 8 CENTRAL HOVE SURGERY G81070 4 ALBION STREET SURGERY G81090 4 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 13 THE PRACTICE WHITEHAWK ROAD G81676 3 HOVE PARK VILLAS SURGERY G81094 2 SCHOOL HOUSE SURGERY G81613 2 LEWES ROAD SURGERY G81063 1 MILE OAK MEDICAL CENTRE G81073 4 BROADWAY SURGERY G81669 1 BENFIELD VALLEY HEALTHCARE HUB G81680 3 CARDEN SURGERY G81014 3 PORTSLADE HEALTH CENTRE G81046 4 PARK CRESCENT HEALTH CENTRE G81028 3 REGENCY SURGERY G81656 1 ST LUKE'S SURGERY G81667 1 MONTPELIER SURGERY G81044 1 THE PRACTICE NORTH STREET G81020 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 NEW LARCHWOOD SURGERY Y02404 BRIGHTON STATION HEALTH CENTRE Y02676 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 Crawley CCG 0.84

• 0.60 ratio of observed to expected NHS Coastal West Sussex CCG 0.76 diabetes prevalence in NHS Brighton and Hove CCG, compared to 0.77 in NHS Hastings And Rother CCG 0.73 England • this suggests 60% of people have NHS East Surrey CCG 0.70 been diagnosed

NHS Horsham And Mid Sussex CCG 0.69

NHS Eastbourne, Hailsham And Seaford CCG 0.67

NHS High Weald Lewes Havens CCG 0.64

NHS Brighton And Hove CCG 0.60

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

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

NHS North Durham CCG 0.86

NHS Lancashire North CCG 0.85

NHS Lincolnshire West CCG 0.82

NHS Newcastle Gateshead CCG 0.81

NHS Sunderland CCG 0.78

NHS Portsmouth CCG 0.78

NHS Greater Preston CCG 0.77

NHS Liverpool CCG 0.76

NHS Southampton CCG 0.76

NHS Bristol CCG 0.71

NHS Brighton and Hove CCG 0.60

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

LEWES ROAD SURGERY G81063 7.6% BROADWAY SURGERY G81669 7.2% THE PRACTICE HANGLETON MANOR Y00079 6.8% THE AVENUE SURGERY G81075 6.7% BENFIELD VALLEY HEALTHCARE HUB G81680 6.5% PORTSLADE HEALTH CENTRE G81046 6.4% • GP practice range of observed HOVE MEDICAL CENTRE G81001 6.3% RIDGEWAY SURGERY G81642 6.2% diabetes 0.4% to 7.6% MILE OAK MEDICAL CENTRE G81073 6.1% • there are an estimated 7,203 people ST LUKE'S SURGERY G81667 6.1% THE PRACTICE WHITEHAWK ROAD G81676 6.1% with undiagnosed diabetes in NHS SCHOOL HOUSE SURGERY G81613 6.0% THE PRACTICE WILLOW HOUSE G81661 5.8% Brighton and Hove CCG WOODINGDEAN MEDICAL CENTRE G81065 5.7% SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 5.6% ARDINGLY COURT SURGERY G81006 5.2% ST.PETER'S MEDICAL CENTRE G81011 5.1% LINKS ROAD SURGERY G81663 4.9% WARMDENE SURGERY G81036 4.8% CARDEN SURGERY G81014 4.7% PAVILION SURGERY G81054 4.6% WISH PARK SURGERY G81083 4.6% MATLOCK ROAD SURGERY G81684 4.5% NORTH LAINE MEDICAL CENTRE G81103 4.4% BEACONSFIELD MEDICAL PRACTICE G81042 4.2% SACKVILLE MEDICAL CENTRE G81009 4.2% REGENCY SURGERY G81656 4.2% ALBION STREET SURGERY G81090 4.1% SHIP STREET SURGERY G81694 3.9% CHARTER MEDICAL CENTRE G81034 3.8% NEW LARCHWOOD SURGERY Y02404 3.6% CENTRAL HOVE SURGERY G81070 3.5% STANFORD MEDICAL CENTRE G81038 3.4% PARK CRESCENT HEALTH CENTRE G81028 3.3% SEVEN DIALS MEDICAL CENTRE G81047 3.2% HOVE PARK VILLAS SURGERY G81094 3.2% PRESTON PARK SURGERY G81018 3.2% THE HAVEN PRACTICE G81646 2.6% BRIGHTON HEALTH AND WELLBEING CENTRE G81638 2.4% BHH MORLEY STREET G81689 2.3% THE PRACTICE NORTH STREET G81020 2.2% MONTPELIER SURGERY G81044 2.2% Note: The estimated number of undiagnosed BRIGHTON STATION HEALTH CENTRE Y02676 1.0% people with diabetes has been calculated by UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 0.4% multiplying the estimated prevalence rate to the 0% 1% 2% 3% 4% 5% 6% 7% 8% 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 Hastings And Rother CCG 7.2% 2.7% 12.6% • the estimated total prevalence of diabetes in NHS Brighton and Hove CCG is 6.9% (diagnosed and NHS Eastbourne, Hailsham And Seaford CCG 6.4% 3.1% 12.9% undiagnosed) • in addition, there are an estimated NHS Coastal West Sussex CCG 7.0% 2.2% 12.5% 8.4% of people in NHS Brighton and Hove CCG who are at increased risk NHS High Weald Lewes Havens CCG 5.5% 3.0% 12.1% of developing diabetes (i.e. with non- diabetic hyperglycaemia) NHS Horsham And Mid Sussex CCG 5.3% 2.3% 11.4% • this means that 15.3% of the NHS East Surrey CCG 5.3% 2.3% 10.9% population in NHS Brighton and Hove CCG are estimated to have diabetes, NHS Crawley CCG 6.6% 1.2% 10.4% or at high risk of developing of diabetes

NHS Brighton And Hove CCG 4.1% 2.8% 8.4%

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

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

NHS Coastal West Sussex CCG 63.3%

NHS Hastings And Rother CCG 59.4% • data on care processes and treatment targets are taken from the National Diabetes Audit (NDA) NHS Eastbourne, Hailsham And Seaford CCG 57.9% • overall practice participation in the 2015/16 audit was 81.4% in England NHS Crawley CCG 57.7% • in NHS Brighton and Hove CCG, 44 NHS Horsham And Mid Sussex CCG 55.4% out of 44 practices (100.0%) participated in the NDA

NHS High Weald Lewes Havens CCG 52.0%

NHS Brighton And Hove CCG 51.8% • 51.8% of people with diabetes (of practices who participated in the audit) had the eight recommended NHS East Surrey CCG 50.4% care processes in NHS Brighton and Hove 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

ST LUKE'S SURGERY G81667 77.5% ST.PETER'S MEDICAL CENTRE G81011 75.6% WARMDENE SURGERY G81036 75.1% STANFORD MEDICAL CENTRE G81038 72.9% • achievement - 8 care processes: in ALBION STREET SURGERY G81090 70.3% HOVE MEDICAL CENTRE G81001 70.2% practices who provided data via the PORTSLADE HEALTH CENTRE G81046 66.8% CHARTER MEDICAL CENTRE G81034 64.1% NDA, between 5.6% and 77.5% of ARDINGLY COURT SURGERY G81006 63.5% BROADWAY SURGERY G81669 63.3% patients received all 8 care processes MILE OAK MEDICAL CENTRE G81073 62.0% SHIP STREET SURGERY G81694 61.2% LINKS ROAD SURGERY G81663 60.6% BEACONSFIELD MEDICAL PRACTICE G81042 59.8% REGENCY SURGERY G81656 58.8% • at least 5,050 people did not receive THE AVENUE SURGERY G81075 57.0% the eight care processes CENTRAL HOVE SURGERY G81070 56.7% THE PRACTICE WILLOW HOUSE G81661 56.4% SEVEN DIALS MEDICAL CENTRE G81047 54.7% BENFIELD VALLEY HEALTHCARE HUB G81680 54.6% CARDEN SURGERY G81014 53.9% BRIGHTON STATION HEALTH CENTRE Y02676 52.3% THE PRACTICE HANGLETON MANOR Y00079 52.1% BRIGHTON HEALTH AND WELLBEING CENTRE G81638 46.8% RIDGEWAY SURGERY G81642 42.9% SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 40.1% NORTH LAINE MEDICAL CENTRE G81103 39.2% SACKVILLE MEDICAL CENTRE G81009 39.1% WISH PARK SURGERY G81083 35.3% PRESTON PARK SURGERY G81018 32.5% MONTPELIER SURGERY G81044 31.1% BHH MORLEY STREET G81689 31.0% PARK CRESCENT HEALTH CENTRE G81028 30.5% NEW LARCHWOOD SURGERY Y02404 28.2% PAVILION SURGERY G81054 27.3% SCHOOL HOUSE SURGERY G81613 24.4% WOODINGDEAN MEDICAL CENTRE G81065 24.2% UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 21.9% THE HAVEN PRACTICE G81646 21.7% THE PRACTICE NORTH STREET G81020 21.4% MATLOCK ROAD SURGERY G81684 18.6% LEWES ROAD SURGERY G81063 18.2% THE PRACTICE WHITEHAWK ROAD G81676 14.8% HOVE PARK VILLAS SURGERY G81094 5.6% 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 Hastings And Rother CCG 42.4%

NHS Eastbourne, Hailsham And Seaford CCG 41.0% • 38.4% of people with diabetes (of practices who participated in the audit) met the three treatment targets NHS Horsham And Mid Sussex CCG 39.9% in NHS Brighton and Hove CCG, compared to 39.0% in England

NHS Brighton And Hove CCG 38.4%

NHS High Weald Lewes Havens CCG 37.9%

NHS Coastal West Sussex CCG 37.2%

NHS East Surrey CCG 35.4%

NHS Crawley CCG 33.8%

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

THE PRACTICE NORTH STREET G81020 54.5% MATLOCK ROAD SURGERY G81684 54.4% REGENCY SURGERY G81656 53.7% SHIP STREET SURGERY G81694 52.8% • achievement - 3 treatment targets: in SCHOOL HOUSE SURGERY G81613 48.7% PRESTON PARK SURGERY G81018 47.2% practices who provided data via the MONTPELIER SURGERY G81044 46.5% SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 46.1% NDA, between 21.6% and 54.5% of STANFORD MEDICAL CENTRE G81038 45.9% ARDINGLY COURT SURGERY G81006 44.9% patients achieved all 3 treatment WARMDENE SURGERY G81036 43.9% BROADWAY SURGERY G81669 42.5% targets MILE OAK MEDICAL CENTRE G81073 42.4% RIDGEWAY SURGERY G81642 42.0% ST.PETER'S MEDICAL CENTRE G81011 41.5% • at least 5,490 people did not meet the THE PRACTICE WILLOW HOUSE G81661 40.7% three treatment targets NEW LARCHWOOD SURGERY Y02404 40.5% CARDEN SURGERY G81014 39.8% BEACONSFIELD MEDICAL PRACTICE G81042 39.7% PARK CRESCENT HEALTH CENTRE G81028 39.3% THE AVENUE SURGERY G81075 39.0% SEVEN DIALS MEDICAL CENTRE G81047 38.1% SACKVILLE MEDICAL CENTRE G81009 37.7% HOVE PARK VILLAS SURGERY G81094 37.5% THE HAVEN PRACTICE G81646 37.0% CENTRAL HOVE SURGERY G81070 36.9% BENFIELD VALLEY HEALTHCARE HUB G81680 36.9% WOODINGDEAN MEDICAL CENTRE G81065 36.2% LINKS ROAD SURGERY G81663 34.6% HOVE MEDICAL CENTRE G81001 34.6% WISH PARK SURGERY G81083 33.9% LEWES ROAD SURGERY G81063 32.8% CHARTER MEDICAL CENTRE G81034 30.9% PORTSLADE HEALTH CENTRE G81046 30.8% ST LUKE'S SURGERY G81667 30.5% PAVILION SURGERY G81054 30.1% NORTH LAINE MEDICAL CENTRE G81103 29.9% BRIGHTON HEALTH AND WELLBEING CENTRE G81638 29.3% ALBION STREET SURGERY G81090 29.2% THE PRACTICE HANGLETON MANOR Y00079 28.8% UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 28.2% THE PRACTICE WHITEHAWK ROAD G81676 27.9% BHH MORLEY STREET G81689 27.3% BRIGHTON STATION HEALTH CENTRE Y02676 21.6% 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%

BRIGHTON STATION HEALTH CENTRE 11

THE PRACTICE HANGLETON MANOR 11

ALBION STREET SURGERY 31 • using the GP cluster method of BHH MORLEY STREET 3 calculating potential gains, if each NORTH LAINE MEDICAL CENTRE 20 practice was to achieve as well as the THE PRACTICE WHITEHAWK ROAD 23 upper quartile of its national cluster, then an additional 631 people would ST LUKE'S SURGERY 14 be treated UNIVERSITY OF SUSSEX HEALTH CENTRE 6

LEWES ROAD SURGERY 17

BRIGHTON HEALTH AND WELLBEING CENTRE 23

WARMDENE SURGERY 1

MONTPELIER SURGERY

SCHOOL HOUSE SURGERY

STANFORD MEDICAL CENTRE

PRESTON PARK SURGERY

SALTDEAN AND ROTTINGDEAN MED PRACTICE

MATLOCK ROAD SURGERY

SHIP STREET SURGERY

REGENCY SURGERY

THE PRACTICE NORTH STREET 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 Crawley CCG 0.86

NHS Eastbourne, Hailsham And Seaford CCG 0.75 • the ratio of those diagnosed with chronic kidney disease versus those NHS East Surrey CCG 0.66 expected to have chronic kidney disease is 0.66. This compares to NHS Brighton And Hove CCG 0.66 0.68 for England • this suggests that 66% of people with chronic kidney disease have been NHS Horsham And Mid Sussex CCG 0.65 diagnosed

NHS High Weald Lewes Havens CCG 0.62

NHS Coastal West Sussex CCG 0.58

NHS Hastings And Rother CCG 0.56 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 0.9 1.0 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 Liverpool CCG 1.05

NHS Lincolnshire West CCG 1.00

NHS Newcastle Gateshead CCG 0.89

NHS Bristol CCG 0.87

NHS Greater Preston CCG 0.84

NHS Lancashire North CCG 0.79

NHS North Durham CCG 0.71

NHS Sunderland CCG 0.68

NHS Brighton and Hove CCG 0.66

NHS Southampton CCG 0.62

NHS Portsmouth CCG 0.60

0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio

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

GP practice CCG

WOODINGDEAN MEDICAL CENTRE G81065 8.2% HOVE MEDICAL CENTRE G81001 6.1% SCHOOL HOUSE SURGERY G81613 5.9% MILE OAK MEDICAL CENTRE G81073 5.5% WARMDENE SURGERY G81036 5.3% RIDGEWAY SURGERY G81642 5.1% • it is estimated that there are 4,288 THE PRACTICE WILLOW HOUSE G81661 4.8% ST.PETER'S MEDICAL CENTRE G81011 4.7% people with undiagnosed chronic BENFIELD VALLEY HEALTHCARE HUB G81680 4.7% kidney disease in NHS Brighton and THE PRACTICE HANGLETON MANOR Y00079 4.6% BEACONSFIELD MEDICAL PRACTICE G81042 4.2% Hove CCG PRESTON PARK SURGERY G81018 4.2% ARDINGLY COURT SURGERY G81006 4.1% • GP practice range of observed CKD: THE PRACTICE WHITEHAWK ROAD G81676 4.1% SHIP STREET SURGERY G81694 4.1% 0.1% to 8.2% LINKS ROAD SURGERY G81663 3.9% REGENCY SURGERY G81656 3.7% NEW LARCHWOOD SURGERY Y02404 3.7% STANFORD MEDICAL CENTRE G81038 3.6% SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 3.4% WISH PARK SURGERY G81083 3.4% CHARTER MEDICAL CENTRE G81034 3.4% PARK CRESCENT HEALTH CENTRE G81028 3.3% BROADWAY SURGERY G81669 3.2% ALBION STREET SURGERY G81090 3.0% PORTSLADE HEALTH CENTRE G81046 3.0% THE AVENUE SURGERY G81075 3.0% MATLOCK ROAD SURGERY G81684 2.9% CENTRAL HOVE SURGERY G81070 2.9% SACKVILLE MEDICAL CENTRE G81009 2.8% HOVE PARK VILLAS SURGERY G81094 2.7% THE HAVEN PRACTICE G81646 2.7% PAVILION SURGERY G81054 2.6% CARDEN SURGERY G81014 2.4% SEVEN DIALS MEDICAL CENTRE G81047 2.2% MONTPELIER SURGERY G81044 2.0% ST LUKE'S SURGERY G81667 1.8% BRIGHTON HEALTH AND WELLBEING CENTRE G81638 1.6% NORTH LAINE MEDICAL CENTRE G81103 1.4% Note: CCG estimates for the estimated LEWES ROAD SURGERY G81063 1.0% number of people with CKD are based on THE PRACTICE NORTH STREET G81020 0.8% BRIGHTON STATION HEALTH CENTRE Y02676 0.4% applying a proportion from a resident based BHH MORLEY STREET G81689 0.1% UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 0.1% population estimate to a GP registered population. The characteristics of registered 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 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 Hastings And Rother CCG 77.9% • 8,771 people with CKD (diagnosed*) NHS Eastbourne, Hailsham And Seaford CCG 74.7% in NHS Brighton and Hove CCG • 6,341 (72.3%) people whose blood NHS East Surrey CCG 73.9% pressure is <= 140 /85 • 833 (9.5%) people who are exceptions NHS Crawley CCG 73.5% • 1,597 (18.2%) additional people whose blood pressure is not <= 140 / NHS Brighton And Hove CCG 72.3% 85

NHS Horsham And Mid Sussex CCG 72.2%

NHS High Weald Lewes Havens CCG 71.5%

NHS Coastal West Sussex CCG 68.6%

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

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

NHS Portsmouth CCG 78.8%

NHS Liverpool CCG 77.7%

NHS Greater Preston CCG 76.8%

NHS North Durham CCG 76.2%

NHS Lincolnshire West CCG 76.0%

NHS Newcastle Gateshead CCG 74.9%

NHS Sunderland CCG 74.6%

NHS Lancashire North CCG 74.4%

NHS Bristol CCG 74.4%

NHS Southampton CCG 74.0%

NHS Brighton and Hove CCG 72.3%

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

ST LUKE'S SURGERY G81667 21 BHH MORLEY STREET G81689 2 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 61 SEVEN DIALS MEDICAL CENTRE G81047 66 DR SHARP AND PARTNER G81103 20 THE PRACTICE WILLOW HOUSE G81661 27 • in total, including exceptions, there ALBION STREET SURGERY G81090 67 DR CONDON & PARTNERS G81034 189 are 2,430 people whose blood PAVILION SURGERY G81054 84 BENFIELD VALLEY HEALTHCARE HUB G81680 77 pressure is not <= 140 / 85 WISH PARK SURGERY G81083 65 • GP practice range: 11.1% to 51.2% HOVE MEDICAL CENTRE G81001 155 THE PRACTICE HANGLETON MANOR Y00079 26 GOODWOOD COURT MEDICAL CENTRE G81687 64 DR NALLETAMBY & PARTNERS G81011 156 THE PRACTICE NORTH STREET G81020 9 PRESTON PARK SURGERY G81018 122 CENTRAL HOVE SURGERY G81070 47 WARMDENE SURGERY G81036 116 RIDGEWAY SURGERY G81642 25 DR BIRD & PARTNERS G81042 106 PORTSLADE HEALTH CENTRE G81046 88 HOVE PARK VILLAS SURGERY G81094 23 LINKS ROAD SURGERY G81663 51 SACKVILLE ROAD SURGERY G81009 62 ARDINGLY COURT SURGERY G81006 65 THE AVENUE SURGERY G81075 41 LEWES ROAD SURGERY G81063 5 NEW LARCHWOOD SURGERY Y02404 10 WOODINGDEAN MEDICAL CENTRE G81065 96 MONTPELIER SURGERY G81044 29 PARK CRESCENT HEALTH CENTRE G81028 80 DR GRAHAM & PARTNERS G81038 113 THE HAVEN PRACTICE G81646 13 REGENCY SURGERY G81656 26 BROADWAY SURGERY G81669 11 THE PRACTICE WHITEHAWK ROAD G81676 20 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 51 DR BARNARD & PARTNERS G81073 60 CARDEN SURGERY G81014 16 SCHOOL HOUSE SURGERY G81613 39 DR CHANG & PARTNER G81684 13 BRIGHTON STATION HEALTH CENTRE Y02676 3 SHIP STREET SURGERY G81694 9 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

BHH MORLEY STREET 1

ST LUKE'S SURGERY 14

BRIGHTON HEALTH AND WELLBEING CENTRE 39 • using the GP cluster method of SEVEN DIALS MEDICAL CENTRE 39 calculating potential gains, if each DR SHARP AND PARTNER 12 practice was to achieve as well as the THE PRACTICE WILLOW HOUSE 15 upper quartile of its national cluster, then an additional 798 people would ALBION STREET SURGERY 38 be treated PAVILION SURGERY 46

BENFIELD VALLEY HEALTHCARE HUB 42

THE PRACTICE HANGLETON MANOR 14

PARK CRESCENT HEALTH CENTRE 3

DR BARNARD & PARTNERS 3

SCHOOL HOUSE SURGERY 1

DR GRAHAM & PARTNERS 1

CARDEN SURGERY

DR CHANG & PARTNER

SALTDEAN AND ROTTINGDEAN MED PRACTICE

BRIGHTON STATION HEALTH CENTRE

SHIP STREET SURGERY

UNIVERSITY OF SUSSEX HEALTH CENTRE 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 Hastings And Rother CCG 80.3% • 8,771 people with CKD (diagnosed*) NHS Crawley CCG 76.1% in NHS Brighton and Hove CCG • 6,477 (73.8%) people who have a NHS Eastbourne, Hailsham And Seaford CCG 74.9% record of urine albumin:creatinine ratio test • 632 (7.2%) people who are NHS Brighton And Hove CCG 73.8% exceptions • 1,662 (18.9%) additional people who NHS East Surrey CCG 73.2% have no record of urine albumin:creatinine ratio test

NHS High Weald Lewes Havens CCG 73.0%

NHS Horsham And Mid Sussex CCG 71.4%

NHS Coastal West Sussex CCG 67.4%

*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 Liverpool CCG 81.2%

NHS North Durham CCG 80.1%

NHS Lincolnshire West CCG 78.3%

NHS Southampton CCG 77.1%

NHS Bristol CCG 76.8%

NHS Newcastle Gateshead CCG 76.1%

NHS Greater Preston CCG 75.7%

NHS Portsmouth CCG 75.3%

NHS Sunderland CCG 74.7%

NHS Lancashire North CCG 74.1%

NHS Brighton and Hove CCG 73.8%

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

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

Not recorded Exceptions reported

HOVE PARK VILLAS SURGERY G81094 58 THE PRACTICE NORTH STREET G81020 15 WISH PARK SURGERY G81083 97 SEVEN DIALS MEDICAL CENTRE G81047 76 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 4 MONTPELIER SURGERY G81044 59 • in total, including exceptions, there CENTRAL HOVE SURGERY G81070 68 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 52 are 2,294 people who have no record DR CONDON & PARTNERS G81034 199 SACKVILLE ROAD SURGERY G81009 90 of urine albumin:creatinine ratio test THE PRACTICE HANGLETON MANOR Y00079 24 • GP practice range: 2.3% to 64.4% RIDGEWAY SURGERY G81642 27 REGENCY SURGERY G81656 40 PRESTON PARK SURGERY G81018 117 ST LUKE'S SURGERY G81667 12 HOVE MEDICAL CENTRE G81001 129 DR NALLETAMBY & PARTNERS G81011 133 DR BIRD & PARTNERS G81042 101 THE PRACTICE WILLOW HOUSE G81661 19 PORTSLADE HEALTH CENTRE G81046 84 CARDEN SURGERY G81014 24 BHH MORLEY STREET G81689 1 ARDINGLY COURT SURGERY G81006 66 WARMDENE SURGERY G81036 95 LEWES ROAD SURGERY G81063 5 ALBION STREET SURGERY G81090 42 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 64 THE AVENUE SURGERY G81075 38 GOODWOOD COURT MEDICAL CENTRE G81687 42 SCHOOL HOUSE SURGERY G81613 47 LINKS ROAD SURGERY G81663 42 BENFIELD VALLEY HEALTHCARE HUB G81680 44 PAVILION SURGERY G81054 46 DR GRAHAM & PARTNERS G81038 110 THE HAVEN PRACTICE G81646 11 DR BARNARD & PARTNERS G81073 52 THE PRACTICE WHITEHAWK ROAD G81676 16 PARK CRESCENT HEALTH CENTRE G81028 56 SHIP STREET SURGERY G81694 11 DR SHARP AND PARTNER G81103 7 WOODINGDEAN MEDICAL CENTRE G81065 55 BROADWAY SURGERY G81669 6 DR CHANG & PARTNER G81684 7 BRIGHTON STATION HEALTH CENTRE Y02676 2 NEW LARCHWOOD SURGERY Y02404 1 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 Eastbourne, Hailsham And Seaford CCG 1.13%

NHS Hastings And Rother CCG 1.05% • prevalence of 0.53% in NHS Brighton and Hove CCG compared to 0.76% in NHS Coastal West Sussex CCG 0.88% England

NHS High Weald Lewes Havens CCG 0.73%

NHS Horsham And Mid Sussex CCG 0.72%

NHS East Surrey CCG 0.61%

NHS Crawley CCG 0.58%

NHS Brighton And Hove CCG 0.53%

England 0.76%

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

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

NHS Sunderland CCG 1.01%

NHS Greater Preston CCG 0.92%

NHS North Durham CCG 0.89%

NHS Liverpool CCG 0.84%

NHS Newcastle Gateshead CCG 0.82%

NHS Lancashire North CCG 0.80%

NHS Lincolnshire West CCG 0.78%

NHS Bristol CCG 0.64%

NHS Portsmouth CCG 0.64%

NHS Southampton CCG 0.59%

NHS Brighton and Hove CCG 0.53%

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

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

GP practice CCG

RIDGEWAY SURGERY G81642 1.8% WOODINGDEAN MEDICAL CENTRE G81065 1.1% ARDINGLY COURT SURGERY G81006 1.1% LEWES ROAD SURGERY G81063 0.9% ST LUKE'S SURGERY G81667 0.8% BENFIELD VALLEY HEALTHCARE HUB G81680 0.8% • 1,636 people with diagnosed heart CARDEN SURGERY G81014 0.8% MATLOCK ROAD SURGERY G81684 0.8% failure in NHS Brighton and Hove WISH PARK SURGERY G81083 0.8% CCG PORTSLADE HEALTH CENTRE G81046 0.7% SACKVILLE MEDICAL CENTRE G81009 0.7% • GP practice range: 0.0% to 1.8% MILE OAK MEDICAL CENTRE G81073 0.7% WARMDENE SURGERY G81036 0.7% HOVE MEDICAL CENTRE G81001 0.6% SHIP STREET SURGERY G81694 0.6% PAVILION SURGERY G81054 0.6% THE AVENUE SURGERY G81075 0.6% BEACONSFIELD MEDICAL PRACTICE G81042 0.5% REGENCY SURGERY G81656 0.5% PRESTON PARK SURGERY G81018 0.5% ALBION STREET SURGERY G81090 0.5% THE PRACTICE WILLOW HOUSE G81661 0.5% CHARTER MEDICAL CENTRE G81034 0.5% ST.PETER'S MEDICAL CENTRE G81011 0.5% SCHOOL HOUSE SURGERY G81613 0.5% BROADWAY SURGERY G81669 0.5% SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 0.5% THE PRACTICE WHITEHAWK ROAD G81676 0.5% THE PRACTICE HANGLETON MANOR Y00079 0.4% NEW LARCHWOOD SURGERY Y02404 0.4% PARK CRESCENT HEALTH CENTRE G81028 0.4% CENTRAL HOVE SURGERY G81070 0.4% LINKS ROAD SURGERY G81663 0.4% STANFORD MEDICAL CENTRE G81038 0.4% BHH MORLEY STREET G81689 0.4% SEVEN DIALS MEDICAL CENTRE G81047 0.4% THE HAVEN PRACTICE G81646 0.4% NORTH LAINE MEDICAL CENTRE G81103 0.3% BRIGHTON HEALTH AND WELLBEING CENTRE G81638 0.3% MONTPELIER SURGERY G81044 0.3% HOVE PARK VILLAS SURGERY G81094 0.3% THE PRACTICE NORTH STREET G81020 0.2% BRIGHTON STATION HEALTH CENTRE Y02676 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8% 2.0%

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

NHS Crawley CCG 89.7% • 327 people with heart failure* with NHS Hastings And Rother CCG 84.2% LVSD in NHS Brighton and Hove CCG NHS Eastbourne, Hailsham And Seaford CCG 83.4% • 266 (81.3%) people treated with ACE- I or ARB • 53 (16.2%) people who are NHS High Weald Lewes Havens CCG 82.7% exceptions • 8 (2.4%) additional people who are NHS Horsham And Mid Sussex CCG 82.6% not treated with ACE-I or ARB

NHS East Surrey CCG 81.5%

NHS Brighton And Hove CCG 81.3%

NHS Coastal West Sussex CCG 79.4%

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 North Durham CCG 88.9%

NHS Lancashire North CCG 87.6%

NHS Newcastle Gateshead CCG 87.0%

NHS Portsmouth CCG 86.6%

NHS Sunderland CCG 86.4%

NHS Greater Preston CCG 86.2%

NHS Bristol CCG 83.6%

NHS Southampton CCG 83.0%

NHS Lincolnshire West CCG 83.0%

NHS Brighton and Hove CCG 81.3%

NHS Liverpool CCG 81.2%

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

LEWES ROAD SURGERY G81063 2 BENFIELD VALLEY HEALTHCARE HUB G81680 2 MONTPELIER SURGERY G81044 4 ST LUKE'S SURGERY G81667 2 MATLOCK ROAD SURGERY G81684 1 THE PRACTICE HANGLETON MANOR Y00079 1 • in total, including exceptions, there ALBION STREET SURGERY G81090 3 HOVE PARK VILLAS SURGERY G81094 2 are 61 people who are not treated WOODINGDEAN MEDICAL CENTRE G81065 3 with ACE-I or ARB ST.PETER'S MEDICAL CENTRE G81011 4 WISH PARK SURGERY G81083 1 • GP practice range: 0.0% to 66.7% NORTH LAINE MEDICAL CENTRE G81103 1 SCHOOL HOUSE SURGERY G81613 2 RIDGEWAY SURGERY G81642 1 STANFORD MEDICAL CENTRE G81038 5 CHARTER MEDICAL CENTRE G81034 6 MILE OAK MEDICAL CENTRE G81073 3 THE AVENUE SURGERY G81075 2 WARMDENE SURGERY G81036 3 ARDINGLY COURT SURGERY G81006 3 BEACONSFIELD MEDICAL PRACTICE G81042 2 CARDEN SURGERY G81014 1 PARK CRESCENT HEALTH CENTRE G81028 1 HOVE MEDICAL CENTRE G81001 2 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 1 THE HAVEN PRACTICE G81646 1 PORTSLADE HEALTH CENTRE G81046 1 SACKVILLE MEDICAL CENTRE G81009 1 PRESTON PARK SURGERY G81018 THE PRACTICE NORTH STREET G81020 SEVEN DIALS MEDICAL CENTRE G81047 PAVILION SURGERY G81054 CENTRAL HOVE SURGERY G81070 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 REGENCY SURGERY G81656 THE PRACTICE WILLOW HOUSE G81661 LINKS ROAD SURGERY G81663 BROADWAY SURGERY G81669 THE PRACTICE WHITEHAWK ROAD G81676 BHH MORLEY STREET G81689 SHIP STREET SURGERY G81694 NEW LARCHWOOD SURGERY Y02404 BRIGHTON STATION HEALTH CENTRE Y02676 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 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 Hastings And Rother CCG 79.5% • 266 people with heart failure* with NHS Crawley CCG 78.6% LVSD treated with ACE-I/ARB in NHS Brighton and Hove CCG NHS East Surrey CCG 77.8% • 201 (75.6%) people treated with ACE- I/ARB and BB • 45 (16.9%) people who are NHS Horsham And Mid Sussex CCG 76.9% exceptions • 20 (7.5%) additional people who are NHS Brighton And Hove CCG 75.6% not treated with ACE-I/ARB and BB

NHS Eastbourne, Hailsham And Seaford CCG 74.9%

NHS Coastal West Sussex CCG 73.8%

NHS High Weald Lewes Havens CCG 72.9%

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 Greater Preston CCG 84.6%

NHS Lancashire North CCG 82.1%

NHS Bristol CCG 81.2%

NHS Liverpool CCG 80.5%

NHS Sunderland CCG 79.8%

NHS Newcastle Gateshead CCG 78.7%

NHS Southampton CCG 78.6%

NHS North Durham CCG 76.2%

NHS Brighton and Hove CCG 75.6%

NHS Lincolnshire West CCG 75.0%

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

LEWES ROAD SURGERY G81063 1 WISH PARK SURGERY G81083 1 ALBION STREET SURGERY G81090 2 SHIP STREET SURGERY G81694 1 WARMDENE SURGERY G81036 7 THE HAVEN PRACTICE G81646 4 • in total, including exceptions, there MILE OAK MEDICAL CENTRE G81073 3 SACKVILLE MEDICAL CENTRE G81009 5 are 65 people who are not treated PRESTON PARK SURGERY G81018 4 with ACE-I or ARB PORTSLADE HEALTH CENTRE G81046 4 PAVILION SURGERY G81054 5 • GP practice range: 0.0% to 100.0% CENTRAL HOVE SURGERY G81070 1 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 2 HOVE PARK VILLAS SURGERY G81094 1 BROADWAY SURGERY G81669 1 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 3 CARDEN SURGERY G81014 2 THE AVENUE SURGERY G81075 2 CHARTER MEDICAL CENTRE G81034 4 MONTPELIER SURGERY G81044 1 SCHOOL HOUSE SURGERY G81613 1 ARDINGLY COURT SURGERY G81006 4 WOODINGDEAN MEDICAL CENTRE G81065 1 STANFORD MEDICAL CENTRE G81038 2 ST.PETER'S MEDICAL CENTRE G81011 1 BEACONSFIELD MEDICAL PRACTICE G81042 1 HOVE MEDICAL CENTRE G81001 1 THE PRACTICE NORTH STREET G81020 PARK CRESCENT HEALTH CENTRE G81028 SEVEN DIALS MEDICAL CENTRE G81047 NORTH LAINE MEDICAL CENTRE G81103 RIDGEWAY SURGERY G81642 REGENCY SURGERY G81656 THE PRACTICE WILLOW HOUSE G81661 LINKS ROAD SURGERY G81663 ST LUKE'S SURGERY G81667 THE PRACTICE WHITEHAWK ROAD G81676 BENFIELD VALLEY HEALTHCARE HUB G81680 MATLOCK ROAD SURGERY G81684 BHH MORLEY STREET G81689 THE PRACTICE HANGLETON MANOR Y00079 NEW LARCHWOOD SURGERY Y02404 BRIGHTON STATION HEALTH CENTRE Y02676 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 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 Hastings And Rother CCG 89.8% • 6,805 people with coronary heart NHS Horsham And Mid Sussex CCG 89.3% disease* in NHS Brighton and Hove CCG NHS Crawley CCG 87.6% • 5,645 (83%) people whose blood pressure <= 150 / 90 • 388 (5.7%) people who are NHS East Surrey CCG 86.6% exceptions • 772 (11.3%) additional people whose NHS Eastbourne, Hailsham And Seaford CCG 86.5% blood pressure is not <= 150 / 90

NHS High Weald Lewes Havens CCG 86.0%

NHS Coastal West Sussex CCG 84.3%

NHS Brighton And Hove CCG 83.0%

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 North Durham CCG 89.4%

NHS Lincolnshire West CCG 89.4%

NHS Newcastle Gateshead CCG 89.2%

NHS Liverpool CCG 88.9%

NHS Greater Preston CCG 88.8%

NHS Portsmouth CCG 88.5%

NHS Southampton CCG 88.5%

NHS Sunderland CCG 88.2%

NHS Bristol CCG 86.9%

NHS Lancashire North CCG 85.4%

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

BHH MORLEY STREET G81689 9 BRIGHTON HEALTH AND WELLBEING CENTRE G81638 43 THE PRACTICE NORTH STREET G81020 7 SEVEN DIALS MEDICAL CENTRE G81047 53 ST LUKE'S SURGERY G81667 23 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 3 • in total, including exceptions, there HOVE PARK VILLAS SURGERY G81094 23 LEWES ROAD SURGERY G81063 25 are 1,160 people whose blood WISH PARK SURGERY G81083 45 pressure is not <= 150 / 90 BEACONSFIELD MEDICAL PRACTICE G81042 59 BENFIELD VALLEY HEALTHCARE HUB G81680 40 • GP practice range: 4.2% to 42.9% CHARTER MEDICAL CENTRE G81034 100 RIDGEWAY SURGERY G81642 15 BROADWAY SURGERY G81669 16 HOVE MEDICAL CENTRE G81001 62 LINKS ROAD SURGERY G81663 31 THE HAVEN PRACTICE G81646 12 PAVILION SURGERY G81054 42 CENTRAL HOVE SURGERY G81070 25 WARMDENE SURGERY G81036 42 NEW LARCHWOOD SURGERY Y02404 4 THE AVENUE SURGERY G81075 32 THE PRACTICE WHITEHAWK ROAD G81676 14 PRESTON PARK SURGERY G81018 34 SCHOOL HOUSE SURGERY G81613 17 ST.PETER'S MEDICAL CENTRE G81011 43 ARDINGLY COURT SURGERY G81006 36 BRIGHTON STATION HEALTH CENTRE Y02676 4 ALBION STREET SURGERY G81090 20 SACKVILLE MEDICAL CENTRE G81009 37 PORTSLADE HEALTH CENTRE G81046 51 CARDEN SURGERY G81014 26 THE PRACTICE WILLOW HOUSE G81661 7 STANFORD MEDICAL CENTRE G81038 37 NORTH LAINE MEDICAL CENTRE G81103 10 THE PRACTICE HANGLETON MANOR Y00079 5 MILE OAK MEDICAL CENTRE G81073 23 PARK CRESCENT HEALTH CENTRE G81028 22 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 29 WOODINGDEAN MEDICAL CENTRE G81065 17 REGENCY SURGERY G81656 6 MONTPELIER SURGERY G81044 6 SHIP STREET SURGERY G81694 2 MATLOCK ROAD SURGERY G81684 3 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

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

BHH MORLEY STREET 8

BRIGHTON HEALTH AND WELLBEING CENTRE 36

THE PRACTICE NORTH STREET 6 • using the GP cluster method of SEVEN DIALS MEDICAL CENTRE 44 calculating potential gains, if each ST LUKE'S SURGERY 18 practice was to achieve as well as the UNIVERSITY OF SUSSEX HEALTH CENTRE 2 upper quartile of its national cluster, then an additional 659 people would HOVE PARK VILLAS SURGERY 17 be treated LEWES ROAD SURGERY 18

WISH PARK SURGERY 33

BENFIELD VALLEY HEALTHCARE HUB 28

STANFORD MEDICAL CENTRE 12

THE PRACTICE HANGLETON MANOR 2

MILE OAK MEDICAL CENTRE 8

PARK CRESCENT HEALTH CENTRE 3

REGENCY SURGERY 1

SALTDEAN AND ROTTINGDEAN MED PRACTICE 3

MONTPELIER SURGERY 0

WOODINGDEAN MEDICAL CENTRE

SHIP STREET SURGERY

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

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

NHS Hastings And Rother CCG 92.9% • 6,805 people with coronary heart NHS Eastbourne, Hailsham And Seaford CCG 92.4% disease* in NHS Brighton and Hove CCG NHS Horsham And Mid Sussex CCG 91.7% • 6,086 (89.4%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant NHS Crawley CCG 91.6% • 294 (4.3%) people who are exceptions NHS High Weald Lewes Havens CCG 91.4% • 425 (6.2%) additional people who are not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant NHS East Surrey CCG 91.1%

NHS Coastal West Sussex CCG 89.8%

NHS Brighton And Hove CCG 89.4%

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 Newcastle Gateshead CCG 93.7%

NHS Sunderland CCG 93.6%

NHS Liverpool CCG 93.2%

NHS Greater Preston CCG 93.1%

NHS North Durham CCG 92.9%

NHS Southampton CCG 92.6%

NHS Bristol CCG 91.8%

NHS Lincolnshire West CCG 91.1%

NHS Lancashire North CCG 90.7%

NHS Portsmouth CCG 89.5%

NHS Brighton and Hove CCG 89.4%

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

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

No treatment Exceptions reported

HOVE PARK VILLAS SURGERY G81094 23 THE PRACTICE NORTH STREET G81020 5 BRIGHTON STATION HEALTH CENTRE Y02676 7 SEVEN DIALS MEDICAL CENTRE G81047 36 THE HAVEN PRACTICE G81646 13 ST LUKE'S SURGERY G81667 13 • in total, including exceptions, there THE PRACTICE HANGLETON MANOR Y00079 9 BHH MORLEY STREET G81689 4 are 719 people are not taking aspirin, BRIGHTON HEALTH AND WELLBEING CENTRE G81638 19 an alternative anti-platelet therapy, or BEACONSFIELD MEDICAL PRACTICE G81042 40 PRESTON PARK SURGERY G81018 30 an anti-coagulant WISH PARK SURGERY G81083 25 BROADWAY SURGERY G81669 11 • GP practice range: 2.6% to 26.7% HOVE MEDICAL CENTRE G81001 42 SALTDEAN AND ROTTINGDEAN MED PRACTICE G81076 41 BENFIELD VALLEY HEALTHCARE HUB G81680 23 SCHOOL HOUSE SURGERY G81613 13 CHARTER MEDICAL CENTRE G81034 56 THE AVENUE SURGERY G81075 22 LEWES ROAD SURGERY G81063 11 THE PRACTICE WHITEHAWK ROAD G81676 9 UNIVERSITY OF SUSSEX HEALTH CENTRE G81071 1 THE PRACTICE WILLOW HOUSE G81661 5 STANFORD MEDICAL CENTRE G81038 27 LINKS ROAD SURGERY G81663 14 PARK CRESCENT HEALTH CENTRE G81028 20 NORTH LAINE MEDICAL CENTRE G81103 8 PORTSLADE HEALTH CENTRE G81046 32 ARDINGLY COURT SURGERY G81006 17 WOODINGDEAN MEDICAL CENTRE G81065 18 PAVILION SURGERY G81054 16 ST.PETER'S MEDICAL CENTRE G81011 19 RIDGEWAY SURGERY G81642 5 MATLOCK ROAD SURGERY G81684 5 MILE OAK MEDICAL CENTRE G81073 15 CENTRAL HOVE SURGERY G81070 9 SACKVILLE MEDICAL CENTRE G81009 16 ALBION STREET SURGERY G81090 8 REGENCY SURGERY G81656 5 CARDEN SURGERY G81014 10 WARMDENE SURGERY G81036 11 NEW LARCHWOOD SURGERY Y02404 1 MONTPELIER SURGERY G81044 4 SHIP STREET SURGERY G81694 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

NHS Brighton and Hove CCG England 800

700 • in NHS Brighton and Hove CCG, the hospital admission rate for coronary heart disease in 2015/16 was 535 600 (1,107) 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 Brighton and Hove CCG England 250

• in NHS Brighton and Hove CCG, the hospital admission rate for stroke in 200 2015/16 was 161.8 (340) compared to 172.8 for England

150

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

50

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

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

NHS Brighton and Hove CCG England

137.9% Angina 136.8% • The risk of a stroke was 98.2% higher and the risk of a heart attack was 91.0% 91% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 483.7% higher. 150.8% Heart failure 150.0%

98.2% Stroke 81.3%

483.7% Major amputation 445.8%

757.0% Minor amputation 753.5%

318.1% RRT 293.0%

0% 100% 200% 300% 400% 500% 600% 700% 800% 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 Brighton and Hove CCG England 90

80 • in NHS Brighton and Hove CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 31.6, 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 Brighton and Hove CCG England 30

• in NHS Brighton and Hove CCG, the 25 early mortality rate for stroke in 2013- 15 was 13.5, 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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