CVD: Primary Care Intelligence Packs NHS Shropshire 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 Shropshire CCG are: NHS Northumberland CCG NHS Hambleton, Richmondshire and Whitby CCG NHS West Suffolk CCG NHS Herefordshire CCG NHS East Riding of Yorkshire CCG NHS South Norfolk CCG NHS North Derbyshire CCG NHS Ipswich and East Suffolk CCG NHS South Lincolnshire CCG NHS Stafford and Surrounds 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 West Suffolk CCG 17.5%

NHS South Lincolnshire CCG 17.5% • prevalence of 15.3% in NHS Shropshire CCG NHS Herefordshire CCG 17.1%

NHS Ipswich and East Suffolk CCG 16.8%

NHS South Norfolk CCG 16.4%

NHS North Derbyshire CCG 16.3%

NHS Northumberland CCG 16.2%

NHS Shropshire CCG 15.3% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS East Riding of Yorkshire CCG 15.2% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Stafford and Surrounds CCG 14.5% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS Hambleton, Richmondshire and Whitby CCG 14.0% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 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

SHROPSHIRE WALK IN HEALTH CENTRE Y02495 26.7% SEVERN FIELDS MEDICAL PRACTICE M82032 22.1% MOUNT PLEASANT MEDICAL PRACTICE M82050 22.0% RIVERSIDE MED.PRACTICE M82006 21.8% BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 21.6% HIGHLEY MEDICAL CENTRE M82031 21.1% • 39,603 people who are recorded as THE CAXTON SURGERY M82022 20.2% smokers in NHS Shropshire CCG MARYSVILLE MEDICAL PRACT M82040 18.9% CRAVEN ARMS SURGERY M82046 18.8% • GP practice range: 10.2% to 26.7% BROSELEY MEDICAL PRACTICE M82051 17.7% MARKET DRAYTON MEDICAL PRACTICE M82010 17.0% CAMBRIAN MEDICAL PRACTICE M82026 16.4% BELVIDERE MEDICAL PRACT. M82048 16.4% WEM AND PREES MEDICAL PRACTICE M82035 16.3% PLAS FFYNNON MEDICAL CTRE M82005 16.3% LUDLOW - PORTCULLIS M82043 15.9% SOUTH HERMITAGE SURGERY M82060 15.8% RICHMOND HOUSE SURGERY M82055 15.8% DODINGTON SURGERY M82044 15.6% BRIDGNORTH MEDICAL PRACTICE M82004 15.1% CLAREMONT BANK SURGERY M82034 14.6% MARDEN MEDICAL PRACTICE M82047 14.3% STATION DRIVE SURGERY M82014 14.1% SHAWBURY MEDICAL PRACTICE M82011 13.9% WORTHEN MEDICAL PRACTICE M82604 13.9% THE MEADOWS MEDICAL PRACTICE M82620 13.7% CLEOBURY MORTIMER SURGERY M82041 13.2% ELLESMERE MEDICAL PRACTICE M82025 13.2% HODNET MEDICAL PRACTICE M82058 13.1% BISHOPS CASTLE SURGERY M82033 13.1% PONTESBURY MEDICAL PRAC M82030 12.8% KNOCKIN MEDICAL CENTRE M82020 12.5% SHIFNAL MEDICAL PRACTICE M82038 12.4% WESTBURY MEDICAL CENTRE M82013 12.4% ALBRIGHTON MEDICAL PRACT M82021 12.1% BROWN CLEE MEDICAL CENTRE M82024 11.4% ALVELEY MEDICAL PRACTICE M82601 11.4% Note: This method is thought to be a reasonably BEECHES MEDICAL PRACTICE M82018 11.3% robust method in estimating smoking prevalence CLIVE MEDICAL PRACTICE M82017 11.3% RADBROOK GREEN SURGERY M82016 11.2% for the majority of GP practices. However, MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 10.8% caution is advised for extreme estimates of CHURCH STRETTON MEDICAL CENTRE M82008 10.5% MYTTON OAK MEDICAL PRACT. M82002 10.3% smoking prevalence and those with high PRESCOTT SURGERY M82023 10.2% numbers of smoking status not recorded and 0% 5% 10% 15% 20% 25% 30% 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 Shropshire CCG 0.60 • the ratio of those diagnosed with hypertension versus those expected to have hypertension is 0.6. This compares to 0.59 for England • this suggests that 60% of people with NHS Telford And Wrekin CCG 0.58 hypertension have been diagnosed

England 0.59 Note: this slide shows Hypertension prevalence 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 East Riding of Yorkshire CCG 0.62

NHS Northumberland CCG 0.61

NHS North Derbyshire CCG 0.61

NHS South Lincolnshire CCG 0.61

NHS Stafford and Surrounds CCG 0.60

NHS Hambleton, Richmondshire and Whitby CCG 0.60

NHS Shropshire CCG 0.60

NHS Herefordshire CCG 0.59

NHS South Norfolk CCG 0.59

NHS Ipswich and East Suffolk CCG 0.59

NHS West Suffolk CCG 0.59

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

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

GP practice CCG

CHURCH STRETTON MEDICAL CENTRE M82008 0.75 STATION DRIVE SURGERY M82014 0.69 ALVELEY MEDICAL PRACTICE M82601 0.69 RIVERSIDE MED.PRACTICE M82006 0.65 ALBRIGHTON MEDICAL PRACT M82021 0.65 CAMBRIAN MEDICAL PRACTICE M82026 0.63 • it is estimated that there are 32,844 HODNET MEDICAL PRACTICE M82058 0.63 WESTBURY MEDICAL CENTRE M82013 0.62 people with undiagnosed HIGHLEY MEDICAL CENTRE M82031 0.62 ELLESMERE MEDICAL PRACTICE M82025 0.61 hypertension in NHS Shropshire CCG PRESCOTT SURGERY M82023 0.60 DODINGTON SURGERY M82044 0.59 • GP practice range of observed to WORTHEN MEDICAL PRACTICE M82604 0.58 LUDLOW - PORTCULLIS M82043 0.58 expected hypertension prevalence CLIVE MEDICAL PRACTICE M82017 0.58 SHIFNAL MEDICAL PRACTICE M82038 0.58 0.46 to 0.75 BEECHES MEDICAL PRACTICE M82018 0.57 MOUNT PLEASANT MEDICAL PRACTICE M82050 0.57 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 0.56 SHAWBURY MEDICAL PRACTICE M82011 0.55 CRAVEN ARMS SURGERY M82046 0.55 BISHOPS CASTLE SURGERY M82033 0.55 MYTTON OAK MEDICAL PRACT. M82002 0.55 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 0.55 THE MEADOWS MEDICAL PRACTICE M82620 0.55 CLAREMONT BANK SURGERY M82034 0.54 BELVIDERE MEDICAL PRACT. M82048 0.54 RADBROOK GREEN SURGERY M82016 0.53 WEM AND PREES MEDICAL PRACTICE M82035 0.53 MARKET DRAYTON MEDICAL PRACTICE M82010 0.52 BROSELEY MEDICAL PRACTICE M82051 0.52 MARDEN MEDICAL PRACTICE M82047 0.52 THE CAXTON SURGERY M82022 0.51 MARYSVILLE MEDICAL PRACT M82040 0.51 PONTESBURY MEDICAL PRAC M82030 0.50 SEVERN FIELDS MEDICAL PRACTICE M82032 0.50 SOUTH HERMITAGE SURGERY M82060 0.50 RICHMOND HOUSE SURGERY M82055 0.49 PLAS FFYNNON MEDICAL CTRE M82005 0.48 CLEOBURY MORTIMER SURGERY M82041 0.48 KNOCKIN MEDICAL CENTRE M82020 0.48 BRIDGNORTH MEDICAL PRACTICE M82004 0.47 BROWN CLEE MEDICAL CENTRE M82024 0.46 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 Shropshire CCG 79.2% • 48,692 people with hypertension (diagnosed)* in NHS Shropshire CCG • 38,542 (79.2%) people whose blood pressure is <= 150/90 • 2,106 (4.3%) people who are NHS Telford And Wrekin CCG 78.8% excepted from optimal control • 8,044 (16.5%) additional people whose blood pressure is not <= 150/90

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 South Lincolnshire CCG 83.8%

NHS Hambleton, Richmondshire and Whitby CCG 82.7%

NHS South Norfolk CCG 82.4%

NHS Northumberland CCG 81.8%

NHS West Suffolk CCG 81.2%

NHS North Derbyshire CCG 80.8%

NHS Herefordshire CCG 80.7%

NHS Ipswich and East Suffolk CCG 80.0%

NHS East Riding of Yorkshire CCG 79.4%

NHS Shropshire CCG 79.2%

NHS Stafford and Surrounds CCG 76.8%

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

SHIFNAL MEDICAL PRACTICE M82038 464 MARYSVILLE MEDICAL PRACT M82040 212 HIGHLEY MEDICAL CENTRE M82031 155 SEVERN FIELDS MEDICAL PRACTICE M82032 283 LUDLOW - PORTCULLIS M82043 392 HODNET MEDICAL PRACTICE M82058 180 • in total, including exceptions, there SOUTH HERMITAGE SURGERY M82060 270 MYTTON OAK MEDICAL PRACT. M82002 344 are 10,150 people whose blood WESTBURY MEDICAL CENTRE M82013 133 pressure is not <= 150/90 KNOCKIN MEDICAL CENTRE M82020 115 CHURCH STRETTON MEDICAL CENTRE M82008 449 • GP practice range: 9.6% to 32.5% RADBROOK GREEN SURGERY M82016 330 MOUNT PLEASANT MEDICAL PRACTICE M82050 242 WEM AND PREES MEDICAL PRACTICE M82035 366 MARDEN MEDICAL PRACTICE M82047 234 RIVERSIDE MED.PRACTICE M82006 427 PLAS FFYNNON MEDICAL CTRE M82005 270 PONTESBURY MEDICAL PRAC M82030 244 BRIDGNORTH MEDICAL PRACTICE M82004 515 BEECHES MEDICAL PRACTICE M82018 201 CLIVE MEDICAL PRACTICE M82017 155 BISHOPS CASTLE SURGERY M82033 188 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 149 THE CAXTON SURGERY M82022 358 STATION DRIVE SURGERY M82014 343 BROWN CLEE MEDICAL CENTRE M82024 94 PRESCOTT SURGERY M82023 184 ELLESMERE MEDICAL PRACTICE M82025 260 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 49 MARKET DRAYTON MEDICAL PRACTICE M82010 478 CLEOBURY MORTIMER SURGERY M82041 200 CAMBRIAN MEDICAL PRACTICE M82026 435 BELVIDERE MEDICAL PRACT. M82048 136 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 233 RICHMOND HOUSE SURGERY M82055 95 THE MEADOWS MEDICAL PRACTICE M82620 122 SHAWBURY MEDICAL PRACTICE M82011 105 CRAVEN ARMS SURGERY M82046 100 CLAREMONT BANK SURGERY M82034 165 BROSELEY MEDICAL PRACTICE M82051 98 WORTHEN MEDICAL PRACTICE M82604 44 ALBRIGHTON MEDICAL PRACT M82021 197 DODINGTON SURGERY M82044 88 ALVELEY MEDICAL PRACTICE M82601 48 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 Telford And Wrekin CCG 78.3% • 233 people with a new diagnosis* of hypertension with a CVD risk of 20% or higher in NHS Shropshire CCG • 134 (57.5%) people who are currently treated with statins NHS Shropshire CCG 57.5% • 94 (40.3%) people who are exempted from treatment with statins • 5 (2.1%) additional people who are not currently treated with statins

England 66.5%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 71.6%

NHS West Suffolk CCG 64.3%

NHS East Riding of Yorkshire CCG 64.0%

NHS Ipswich and East Suffolk CCG 62.1%

NHS Northumberland CCG 61.9%

NHS South Lincolnshire CCG 61.8%

NHS North Derbyshire CCG 58.8%

NHS Herefordshire CCG 57.6%

NHS Shropshire CCG 57.5%

NHS Stafford and Surrounds CCG 53.7%

NHS South Norfolk CCG 49.2%

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

BEECHES MEDICAL PRACTICE M82018 4 MARYSVILLE MEDICAL PRACT M82040 4 CLEOBURY MORTIMER SURGERY M82041 4 CRAVEN ARMS SURGERY M82046 2 SOUTH HERMITAGE SURGERY M82060 2 THE MEADOWS MEDICAL PRACTICE M82620 2 • in total, including exceptions, there STATION DRIVE SURGERY M82014 5 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 3 are 99 people who are not treated PLAS FFYNNON MEDICAL CTRE M82005 4 with statins SHIFNAL MEDICAL PRACTICE M82038 8 MARKET DRAYTON MEDICAL PRACTICE M82010 5 • GP practice range: 0.0% to 66.7% THE CAXTON SURGERY M82022 6 MYTTON OAK MEDICAL PRACT. M82002 5 RIVERSIDE MED.PRACTICE M82006 4 RADBROOK GREEN SURGERY M82016 2 KNOCKIN MEDICAL CENTRE M82020 1 BISHOPS CASTLE SURGERY M82033 1 WEM AND PREES MEDICAL PRACTICE M82035 5 MARDEN MEDICAL PRACTICE M82047 2 PRESCOTT SURGERY M82023 4 RICHMOND HOUSE SURGERY M82055 3 CHURCH STRETTON MEDICAL CENTRE M82008 2 LUDLOW - PORTCULLIS M82043 4 DODINGTON SURGERY M82044 2 BRIDGNORTH MEDICAL PRACTICE M82004 2 SHAWBURY MEDICAL PRACTICE M82011 1 CLIVE MEDICAL PRACTICE M82017 2 PONTESBURY MEDICAL PRAC M82030 1 ALVELEY MEDICAL PRACTICE M82601 1 WESTBURY MEDICAL CENTRE M82013 2 ALBRIGHTON MEDICAL PRACT M82021 2 MOUNT PLEASANT MEDICAL PRACTICE M82050 1 HODNET MEDICAL PRACTICE M82058 1 HIGHLEY MEDICAL CENTRE M82031 1 CAMBRIAN MEDICAL PRACTICE M82026 1 BROWN CLEE MEDICAL CENTRE M82024 ELLESMERE MEDICAL PRACTICE M82025 SEVERN FIELDS MEDICAL PRACTICE M82032 CLAREMONT BANK SURGERY M82034 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 BELVIDERE MEDICAL PRACT. M82048 BROSELEY MEDICAL PRACTICE M82051 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 WORTHEN MEDICAL PRACTICE M82604 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 Shropshire CCG 0.72 • the ratio of those diagnosed with atrial fibrillation versus those expected to have atrial fibrillation is 0.72. This compares to 0.7 for England • this suggests that 72% of people with NHS Telford And Wrekin CCG 0.69 atrial fibrillation have been diagnosed.

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 England 0.70 Network estimates produced in 2017. The estimates were developed by applying age-sex specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 NHS Digital. Estimates reported are adjusted for age and sex of the local population.

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

NHS North Derbyshire CCG 0.77

NHS Hambleton, Richmondshire and Whitby CCG 0.76

NHS South Lincolnshire CCG 0.73

NHS Northumberland CCG 0.73

NHS Stafford and Surrounds CCG 0.72

NHS Shropshire CCG 0.72

NHS Ipswich and East Suffolk CCG 0.72

NHS East Riding of Yorkshire CCG 0.71

NHS South Norfolk CCG 0.69

NHS Herefordshire CCG 0.69

NHS West Suffolk CCG 0.67

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

ALBRIGHTON MEDICAL PRACT M82021 0.9 MYTTON OAK MEDICAL PRACT. M82002 0.8 MARKET DRAYTON MEDICAL PRACTICE M82010 0.8 SHAWBURY MEDICAL PRACTICE M82011 0.8 STATION DRIVE SURGERY M82014 0.8 RADBROOK GREEN SURGERY M82016 0.8 • it is estimated that there are 10,014 CLIVE MEDICAL PRACTICE M82017 0.8 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 0.8 people with undiagnosed atrial THE CAXTON SURGERY M82022 0.8 PRESCOTT SURGERY M82023 0.8 fibrillation in NHS Shropshire CCG ELLESMERE MEDICAL PRACTICE M82025 0.8 LUDLOW - PORTCULLIS M82043 0.8 • GP practice range of observed to RICHMOND HOUSE SURGERY M82055 0.8 ALVELEY MEDICAL PRACTICE M82601 0.8 expected atrial fibrillation prevalence SHROPSHIRE WALK IN HEALTH CENTRE Y02495 0.8 BRIDGNORTH MEDICAL PRACTICE M82004 0.7 0.4 to 0.9 PLAS FFYNNON MEDICAL CTRE M82005 0.7 RIVERSIDE MED.PRACTICE M82006 0.7 CHURCH STRETTON MEDICAL CENTRE M82008 0.7 BEECHES MEDICAL PRACTICE M82018 0.7 KNOCKIN MEDICAL CENTRE M82020 0.7 BROWN CLEE MEDICAL CENTRE M82024 0.7 CAMBRIAN MEDICAL PRACTICE M82026 0.7 CLAREMONT BANK SURGERY M82034 0.7 WEM AND PREES MEDICAL PRACTICE M82035 0.7 SHIFNAL MEDICAL PRACTICE M82038 0.7 CLEOBURY MORTIMER SURGERY M82041 0.7 DODINGTON SURGERY M82044 0.7 CRAVEN ARMS SURGERY M82046 0.7 BELVIDERE MEDICAL PRACT. M82048 0.7 BROSELEY MEDICAL PRACTICE M82051 0.7 SOUTH HERMITAGE SURGERY M82060 0.7 WESTBURY MEDICAL CENTRE M82013 0.6 PONTESBURY MEDICAL PRAC M82030 0.6 HIGHLEY MEDICAL CENTRE M82031 0.6 BISHOPS CASTLE SURGERY M82033 0.6 MARYSVILLE MEDICAL PRACT M82040 0.6 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 0.6 MARDEN MEDICAL PRACTICE M82047 0.6 HODNET MEDICAL PRACTICE M82058 0.6 WORTHEN MEDICAL PRACTICE M82604 0.6 THE MEADOWS MEDICAL PRACTICE M82620 0.6 SEVERN FIELDS MEDICAL PRACTICE M82032 0.4 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 Telford And Wrekin CCG 78.9% • 6,014 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS Shropshire CCG • 4,571 (76%) people treated with anti- coagulation therapy • 725 (12.1%) people who are NHS Shropshire CCG 76.0% exceptions • 718 (11.9%) additional people with a recorded CHA2DS2-VASc score >= 2 who are not treated

England 77.9%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 83.7%

NHS South Lincolnshire CCG 83.4%

NHS North Derbyshire CCG 82.0%

NHS Herefordshire CCG 80.8%

NHS Ipswich and East Suffolk CCG 79.8%

NHS Stafford and Surrounds CCG 78.2%

NHS South Norfolk CCG 77.4%

NHS East Riding of Yorkshire CCG 76.6%

NHS Shropshire CCG 76.0%

NHS West Suffolk CCG 75.7%

NHS Northumberland CCG 72.3%

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

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

No treatment Exceptions reported

RICHMOND HOUSE SURGERY M82055 30 SOUTH HERMITAGE SURGERY M82060 48 CLEOBURY MORTIMER SURGERY M82041 40 MARDEN MEDICAL PRACTICE M82047 29 MOUNT PLEASANT MEDICAL PRACTICE M82050 31 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 51 • in total, including exceptions, there ALBRIGHTON MEDICAL PRACT M82021 82 RADBROOK GREEN SURGERY M82016 66 are 1,443 people with a recorded HIGHLEY MEDICAL CENTRE M82031 17 CHA2DS2-VASc score >= 2 who are BRIDGNORTH MEDICAL PRACTICE M82004 91 ELLESMERE MEDICAL PRACTICE M82025 47 not treated CLAREMONT BANK SURGERY M82034 32 MARYSVILLE MEDICAL PRACT M82040 15 • GP practice range: 12.7% to 38.0% BROWN CLEE MEDICAL CENTRE M82024 17 WEM AND PREES MEDICAL PRACTICE M82035 47 BEECHES MEDICAL PRACTICE M82018 32 PONTESBURY MEDICAL PRAC M82030 31 LUDLOW - PORTCULLIS M82043 50 SHAWBURY MEDICAL PRACTICE M82011 23 MARKET DRAYTON MEDICAL PRACTICE M82010 84 ALVELEY MEDICAL PRACTICE M82601 15 CHURCH STRETTON MEDICAL CENTRE M82008 50 MYTTON OAK MEDICAL PRACT. M82002 40 CLIVE MEDICAL PRACTICE M82017 25 HODNET MEDICAL PRACTICE M82058 17 BISHOPS CASTLE SURGERY M82033 25 SHIFNAL MEDICAL PRACTICE M82038 34 THE CAXTON SURGERY M82022 54 PLAS FFYNNON MEDICAL CTRE M82005 35 CRAVEN ARMS SURGERY M82046 18 BELVIDERE MEDICAL PRACT. M82048 21 BROSELEY MEDICAL PRACTICE M82051 18 WESTBURY MEDICAL CENTRE M82013 10 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 16 RIVERSIDE MED.PRACTICE M82006 41 KNOCKIN MEDICAL CENTRE M82020 13 THE MEADOWS MEDICAL PRACTICE M82620 15 CAMBRIAN MEDICAL PRACTICE M82026 40 PRESCOTT SURGERY M82023 21 DODINGTON SURGERY M82044 17 WORTHEN MEDICAL PRACTICE M82604 5 STATION DRIVE SURGERY M82014 31 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 3 SEVERN FIELDS MEDICAL PRACTICE M82032 16 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

RICHMOND HOUSE SURGERY 18

SOUTH HERMITAGE SURGERY 24

CLEOBURY MORTIMER SURGERY 21 • using the GP cluster method of MARDEN MEDICAL PRACTICE 15 calculating potential gains, if each MOUNT PLEASANT MEDICAL PRACTICE 16 practice was to achieve as well as the MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE 26 upper quartile of its national cluster, then an additional 464 people would HIGHLEY MEDICAL CENTRE 8 be treated ELLESMERE MEDICAL PRACTICE 20

CLAREMONT BANK SURGERY 14

MARYSVILLE MEDICAL PRACT 6

CHURCH STRETTON MEDICAL CENTRE 9

THE MEADOWS MEDICAL PRACTICE 3

RIVERSIDE MED.PRACTICE 6

PRESCOTT SURGERY 2

DODINGTON SURGERY 2

WORTHEN MEDICAL PRACTICE 0

CAMBRIAN MEDICAL PRACTICE 1

STATION DRIVE SURGERY

SHROPSHIRE WALK IN HEALTH CENTRE

SEVERN FIELDS MEDICAL PRACTICE 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 Shropshire CCG 84.7% • 7,447 people with a history of stroke or TIA* in NHS Shropshire CCG • 6,308 (84.7%) people whose blood pressure is <= 150 / 90 • 287 (3.9%) people who are exceptions NHS Telford And Wrekin CCG 82.7% • 852 (11.4%) additional people whose blood pressure is not <= 150 / 90

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 South Lincolnshire CCG 86.5%

NHS West Suffolk CCG 85.5%

NHS Hambleton, Richmondshire and Whitby CCG 85.4%

NHS South Norfolk CCG 84.8%

NHS Shropshire CCG 84.7%

NHS Northumberland CCG 84.7%

NHS North Derbyshire CCG 84.1%

NHS Herefordshire CCG 84.1%

NHS Ipswich and East Suffolk CCG 84.0%

NHS East Riding of Yorkshire CCG 82.9%

NHS Stafford and Surrounds CCG 80.4%

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

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

No treatment Exceptions reported

HODNET MEDICAL PRACTICE M82058 24 MARYSVILLE MEDICAL PRACT M82040 21 LUDLOW - PORTCULLIS M82043 63 SHIFNAL MEDICAL PRACTICE M82038 45 THE MEADOWS MEDICAL PRACTICE M82620 20 MARDEN MEDICAL PRACTICE M82047 36 • in total, including exceptions, there RADBROOK GREEN SURGERY M82016 57 RIVERSIDE MED.PRACTICE M82006 50 are 1,139 people whose blood HIGHLEY MEDICAL CENTRE M82031 15 pressure is not <= 150 / 90 SEVERN FIELDS MEDICAL PRACTICE M82032 31 MOUNT PLEASANT MEDICAL PRACTICE M82050 27 • GP practice range: 0.0% to 27.0% CHURCH STRETTON MEDICAL CENTRE M82008 43 RICHMOND HOUSE SURGERY M82055 17 BRIDGNORTH MEDICAL PRACTICE M82004 66 SOUTH HERMITAGE SURGERY M82060 28 MARKET DRAYTON MEDICAL PRACTICE M82010 63 PONTESBURY MEDICAL PRAC M82030 30 BEECHES MEDICAL PRACTICE M82018 28 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 19 KNOCKIN MEDICAL CENTRE M82020 11 CLIVE MEDICAL PRACTICE M82017 20 WEM AND PREES MEDICAL PRACTICE M82035 37 CLEOBURY MORTIMER SURGERY M82041 27 BELVIDERE MEDICAL PRACT. M82048 18 PRESCOTT SURGERY M82023 20 CRAVEN ARMS SURGERY M82046 16 CAMBRIAN MEDICAL PRACTICE M82026 39 MYTTON OAK MEDICAL PRACT. M82002 26 PLAS FFYNNON MEDICAL CTRE M82005 27 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 24 BROSELEY MEDICAL PRACTICE M82051 15 STATION DRIVE SURGERY M82014 29 THE CAXTON SURGERY M82022 38 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 3 SHAWBURY MEDICAL PRACTICE M82011 14 ELLESMERE MEDICAL PRACTICE M82025 22 CLAREMONT BANK SURGERY M82034 18 WESTBURY MEDICAL CENTRE M82013 6 WORTHEN MEDICAL PRACTICE M82604 4 ALBRIGHTON MEDICAL PRACT M82021 20 DODINGTON SURGERY M82044 10 BISHOPS CASTLE SURGERY M82033 9 BROWN CLEE MEDICAL CENTRE M82024 3 ALVELEY MEDICAL PRACTICE M82601 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 Telford And Wrekin CCG 92.0% • 4,706 people with a stroke shown to be non-haemorrhagic* in NHS Shropshire CCG • 4,247 (90.2%) people who are taking an anti-platetet agent or anti- coagulant NHS Shropshire CCG 90.2% • 317 (6.7%) people who are exceptions • 142 (3%) additional people with no treatment

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 South Lincolnshire CCG 94.0%

NHS Hambleton, Richmondshire and Whitby CCG 93.9%

NHS West Suffolk CCG 92.9%

NHS North Derbyshire CCG 92.8%

NHS Northumberland CCG 92.3%

NHS Ipswich and East Suffolk CCG 91.8%

NHS East Riding of Yorkshire CCG 91.7%

NHS South Norfolk CCG 91.5%

NHS Herefordshire CCG 91.3%

NHS Stafford and Surrounds CCG 90.6%

NHS Shropshire CCG 90.2%

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

LUDLOW - PORTCULLIS M82043 26 CAMBRIAN MEDICAL PRACTICE M82026 28 RADBROOK GREEN SURGERY M82016 27 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 2 WORTHEN MEDICAL PRACTICE M82604 4 SHAWBURY MEDICAL PRACTICE M82011 7 • in total, including exceptions, there PRESCOTT SURGERY M82023 12 MARYSVILLE MEDICAL PRACT M82040 5 are 459 people who are not taking an BEECHES MEDICAL PRACTICE M82018 12 anti-platelet agent or anti-coagulant RICHMOND HOUSE SURGERY M82055 7 PLAS FFYNNON MEDICAL CTRE M82005 15 • GP practice range: 3.3% to 19.7% SOUTH HERMITAGE SURGERY M82060 11 CLAREMONT BANK SURGERY M82034 10 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 13 BRIDGNORTH MEDICAL PRACTICE M82004 25 CHURCH STRETTON MEDICAL CENTRE M82008 17 WESTBURY MEDICAL CENTRE M82013 4 CRAVEN ARMS SURGERY M82046 11 SEVERN FIELDS MEDICAL PRACTICE M82032 9 RIVERSIDE MED.PRACTICE M82006 21 MYTTON OAK MEDICAL PRACT. M82002 11 PONTESBURY MEDICAL PRAC M82030 11 STATION DRIVE SURGERY M82014 14 KNOCKIN MEDICAL CENTRE M82020 6 MARKET DRAYTON MEDICAL PRACTICE M82010 18 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 7 ELLESMERE MEDICAL PRACTICE M82025 10 MARDEN MEDICAL PRACTICE M82047 9 SHIFNAL MEDICAL PRACTICE M82038 14 BROWN CLEE MEDICAL CENTRE M82024 3 ALBRIGHTON MEDICAL PRACT M82021 10 BELVIDERE MEDICAL PRACT. M82048 9 THE CAXTON SURGERY M82022 20 HODNET MEDICAL PRACTICE M82058 5 THE MEADOWS MEDICAL PRACTICE M82620 4 CLIVE MEDICAL PRACTICE M82017 6 HIGHLEY MEDICAL CENTRE M82031 4 DODINGTON SURGERY M82044 5 MOUNT PLEASANT MEDICAL PRACTICE M82050 4 CLEOBURY MORTIMER SURGERY M82041 8 WEM AND PREES MEDICAL PRACTICE M82035 7 BROSELEY MEDICAL PRACTICE M82051 3 BISHOPS CASTLE SURGERY M82033 3 ALVELEY MEDICAL PRACTICE M82601 2 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 Telford And Wrekin CCG 0.84 • 0.70 ratio of observed to expected diabetes prevalence in NHS Shropshire CCG, compared to 0.77 in England

• this suggests 70% of people have been diagnosed NHS Shropshire CCG 0.70

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

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

NHS South Lincolnshire CCG 0.84

NHS Northumberland CCG 0.83

NHS East Riding of Yorkshire CCG 0.82

NHS North Derbyshire CCG 0.78

NHS Stafford and Surrounds CCG 0.77

NHS West Suffolk CCG 0.73

NHS South Norfolk CCG 0.71

NHS Shropshire CCG 0.70

NHS Herefordshire CCG 0.69

NHS Ipswich and East Suffolk CCG 0.68

NHS Hambleton, Richmondshire and Whitby CCG 0.66

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

GP practice CCG

ALVELEY MEDICAL PRACTICE M82601 9.0% SHAWBURY MEDICAL PRACTICE M82011 8.1% ALBRIGHTON MEDICAL PRACT M82021 7.9% HIGHLEY MEDICAL CENTRE M82031 7.9% WESTBURY MEDICAL CENTRE M82013 7.6% CLIVE MEDICAL PRACTICE M82017 7.5% • GP practice range of observed WORTHEN MEDICAL PRACTICE M82604 7.3% THE CAXTON SURGERY M82022 7.3% diabetes 4.2% to 9.0% CLEOBURY MORTIMER SURGERY M82041 7.2% • there are an estimated 6,999 people HODNET MEDICAL PRACTICE M82058 7.2% RICHMOND HOUSE SURGERY M82055 7.2% with undiagnosed diabetes in NHS RIVERSIDE MED.PRACTICE M82006 7.1% DODINGTON SURGERY M82044 7.1% Shropshire CCG ELLESMERE MEDICAL PRACTICE M82025 7.0% MOUNT PLEASANT MEDICAL PRACTICE M82050 7.0% CRAVEN ARMS SURGERY M82046 6.9% WEM AND PREES MEDICAL PRACTICE M82035 6.7% STATION DRIVE SURGERY M82014 6.7% PONTESBURY MEDICAL PRAC M82030 6.6% CHURCH STRETTON MEDICAL CENTRE M82008 6.6% MARKET DRAYTON MEDICAL PRACTICE M82010 6.6% RADBROOK GREEN SURGERY M82016 6.6% BRIDGNORTH MEDICAL PRACTICE M82004 6.5% CAMBRIAN MEDICAL PRACTICE M82026 6.5% MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 6.4% BISHOPS CASTLE SURGERY M82033 6.4% BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 6.3% BROSELEY MEDICAL PRACTICE M82051 6.3% LUDLOW - PORTCULLIS M82043 6.3% BELVIDERE MEDICAL PRACT. M82048 6.3% CLAREMONT BANK SURGERY M82034 6.2% SHIFNAL MEDICAL PRACTICE M82038 6.1% MARDEN MEDICAL PRACTICE M82047 6.1% PLAS FFYNNON MEDICAL CTRE M82005 6.0% BEECHES MEDICAL PRACTICE M82018 5.8% SEVERN FIELDS MEDICAL PRACTICE M82032 5.8% THE MEADOWS MEDICAL PRACTICE M82620 5.7% PRESCOTT SURGERY M82023 5.6% MARYSVILLE MEDICAL PRACT M82040 5.4% SOUTH HERMITAGE SURGERY M82060 5.1% KNOCKIN MEDICAL CENTRE M82020 5.1% MYTTON OAK MEDICAL PRACT. M82002 4.9% Note: The estimated number of undiagnosed BROWN CLEE MEDICAL CENTRE M82024 4.6% people with diabetes has been calculated by SHROPSHIRE WALK IN HEALTH CENTRE Y02495 4.2% multiplying the estimated prevalence rate to the 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 2015/16 QOF list size and subtracting the number of people on the diabetes register.

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

Diabetes prevalence Undiagnosed diabetes prevalence Expected non-diabetic hyperglycaemia prevalence

• the estimated total prevalence of diabetes in NHS Shropshire CCG is NHS Shropshire CCG 6.5% 2.8% 12.3% 9.3% (diagnosed and undiagnosed)

• in addition, there are an estimated 12.3% of people in NHS Shropshire CCG who are at increased risk of NHS Telford And Wrekin CCG 6.9% 1.4% 11.2% developing diabetes (i.e. with non- diabetic hyperglycaemia)

• this means that 21.5% of the population in NHS Shropshire CCG are estimated to have diabetes, or at high risk of developing of diabetes

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

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

NHS Telford And Wrekin CCG 45.0% • data on care processes and treatment targets are taken from the National Diabetes Audit (NDA) • overall practice participation in the 2015/16 audit was 81.4% in England

NHS Shropshire CCG 44.1% • in NHS Shropshire CCG, 43 out of 43 practices (100.0%) participated in the NDA

• 44.1% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS Shropshire CCG, compared to 52.6% in England

England 52.6%

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

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

PLAS FFYNNON MEDICAL CTRE M82005 72.7% CRAVEN ARMS SURGERY M82046 71.4% DODINGTON SURGERY M82044 70.4% SHIFNAL MEDICAL PRACTICE M82038 68.9% • achievement - 8 care processes: in RIVERSIDE MED.PRACTICE M82006 68.7% MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 64.1% practices who provided data via the MARYSVILLE MEDICAL PRACT M82040 63.7% KNOCKIN MEDICAL CENTRE M82020 60.5% NDA, between 15.2% and 72.7% of CLIVE MEDICAL PRACTICE M82017 60.0% THE MEADOWS MEDICAL PRACTICE M82620 58.2% patients received all 8 care processes RICHMOND HOUSE SURGERY M82055 57.2% BRIDGNORTH MEDICAL PRACTICE M82004 57.0% RADBROOK GREEN SURGERY M82016 55.0% CLAREMONT BANK SURGERY M82034 52.7% PONTESBURY MEDICAL PRAC M82030 51.7% • at least 8,894 people did not receive MARDEN MEDICAL PRACTICE M82047 51.1% the eight care processes CHURCH STRETTON MEDICAL CENTRE M82008 50.7% SEVERN FIELDS MEDICAL PRACTICE M82032 48.9% SOUTH HERMITAGE SURGERY M82060 46.1% BROSELEY MEDICAL PRACTICE M82051 45.6% LUDLOW - PORTCULLIS M82043 44.0% HIGHLEY MEDICAL CENTRE M82031 42.3% CLEOBURY MORTIMER SURGERY M82041 39.9% BELVIDERE MEDICAL PRACT. M82048 39.7% CAMBRIAN MEDICAL PRACTICE M82026 38.5% BISHOPS CASTLE SURGERY M82033 36.1% HODNET MEDICAL PRACTICE M82058 35.7% ELLESMERE MEDICAL PRACTICE M82025 35.6% SHROPSHIRE WALK IN HEALTH CENTRE Y02495 33.0% BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 32.0% PRESCOTT SURGERY M82023 30.9% BEECHES MEDICAL PRACTICE M82018 29.9% ALBRIGHTON MEDICAL PRACT M82021 28.2% MYTTON OAK MEDICAL PRACT. M82002 27.8% WEM AND PREES MEDICAL PRACTICE M82035 27.7% THE CAXTON SURGERY M82022 26.6% SHAWBURY MEDICAL PRACTICE M82011 26.4% MARKET DRAYTON MEDICAL PRACTICE M82010 25.1% ALVELEY MEDICAL PRACTICE M82601 25.0% WORTHEN MEDICAL PRACTICE M82604 22.9% WESTBURY MEDICAL CENTRE M82013 20.0% BROWN CLEE MEDICAL CENTRE M82024 19.4% STATION DRIVE SURGERY M82014 15.2% MOUNT PLEASANT MEDICAL PRACTICE M82050 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 Shropshire CCG 36.3% • 36.3% of people with diabetes (of practices who participated in the audit) met the three treatment targets in NHS Shropshire CCG, compared to 39.0% in England

NHS Telford And Wrekin CCG 34.8%

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

ALVELEY MEDICAL PRACTICE M82601 63.1% WORTHEN MEDICAL PRACTICE M82604 50.9% ELLESMERE MEDICAL PRACTICE M82025 47.7% DODINGTON SURGERY M82044 46.4% • achievement - 3 treatment targets: in STATION DRIVE SURGERY M82014 45.6% BELVIDERE MEDICAL PRACT. M82048 44.5% practices who provided data via the CLEOBURY MORTIMER SURGERY M82041 44.2% RICHMOND HOUSE SURGERY M82055 44.0% NDA, between 24.3% and 63.1% of RIVERSIDE MED.PRACTICE M82006 43.7% CLAREMONT BANK SURGERY M82034 43.0% patients achieved all 3 treatment BRIDGNORTH MEDICAL PRACTICE M82004 40.6% LUDLOW - PORTCULLIS M82043 40.1% targets ALBRIGHTON MEDICAL PRACT M82021 39.9% MARYSVILLE MEDICAL PRACT M82040 39.6% BROSELEY MEDICAL PRACTICE M82051 39.3% • at least 9,139 people did not meet the HIGHLEY MEDICAL CENTRE M82031 39.2% three treatment targets THE CAXTON SURGERY M82022 38.5% CHURCH STRETTON MEDICAL CENTRE M82008 37.5% BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 37.5% HODNET MEDICAL PRACTICE M82058 36.4% CAMBRIAN MEDICAL PRACTICE M82026 36.3% BEECHES MEDICAL PRACTICE M82018 35.3% SHROPSHIRE WALK IN HEALTH CENTRE Y02495 35.1% CRAVEN ARMS SURGERY M82046 34.6% BROWN CLEE MEDICAL CENTRE M82024 34.5% RADBROOK GREEN SURGERY M82016 34.2% MARDEN MEDICAL PRACTICE M82047 34.0% MYTTON OAK MEDICAL PRACT. M82002 33.7% MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 33.3% SHAWBURY MEDICAL PRACTICE M82011 33.0% WESTBURY MEDICAL CENTRE M82013 32.9% KNOCKIN MEDICAL CENTRE M82020 32.2% SOUTH HERMITAGE SURGERY M82060 31.3% PLAS FFYNNON MEDICAL CTRE M82005 30.9% MARKET DRAYTON MEDICAL PRACTICE M82010 30.8% PRESCOTT SURGERY M82023 29.9% THE MEADOWS MEDICAL PRACTICE M82620 29.3% SEVERN FIELDS MEDICAL PRACTICE M82032 28.6% BISHOPS CASTLE SURGERY M82033 28.4% PONTESBURY MEDICAL PRAC M82030 28.0% CLIVE MEDICAL PRACTICE M82017 27.0% SHIFNAL MEDICAL PRACTICE M82038 26.3% WEM AND PREES MEDICAL PRACTICE M82035 24.3% MOUNT PLEASANT MEDICAL PRACTICE M82050 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

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

WEM AND PREES MEDICAL PRACTICE 104

SHIFNAL MEDICAL PRACTICE 83

CLIVE MEDICAL PRACTICE 48 • using the GP cluster method of PONTESBURY MEDICAL PRAC 65 calculating potential gains, if each SEVERN FIELDS MEDICAL PRACTICE 118 practice was to achieve as well as the BISHOPS CASTLE SURGERY 45 upper quartile of its national cluster, then an additional 1,273 people would THE MEADOWS MEDICAL PRACTICE 28 be treated PRESCOTT SURGERY 40

PLAS FFYNNON MEDICAL CTRE 54

KNOCKIN MEDICAL CENTRE 15

CLAREMONT BANK SURGERY 8

RICHMOND HOUSE SURGERY 3

CLEOBURY MORTIMER SURGERY 5

BELVIDERE MEDICAL PRACT. 2

RIVERSIDE MED.PRACTICE 3

STATION DRIVE SURGERY

DODINGTON SURGERY

ELLESMERE MEDICAL PRACTICE

WORTHEN MEDICAL PRACTICE

ALVELEY MEDICAL PRACTICE 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 Shropshire CCG 0.80 • the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney disease is 0.8. This compares to 0.68 for England NHS Telford And Wrekin CCG 0.79 • this suggests that 80% of people with chronic kidney disease have been diagnosed

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 England 0.68 Southampton in 2011. A small number of CCGs have a ratio greater than 1. It is unlikely that all people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 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 South Lincolnshire CCG 0.93

NHS Northumberland CCG 0.85

NHS North Derbyshire CCG 0.84

NHS Shropshire CCG 0.80

NHS Ipswich and East Suffolk CCG 0.78

NHS East Riding of Yorkshire CCG 0.71

NHS Herefordshire CCG 0.66

NHS South Norfolk CCG 0.65

NHS Hambleton, Richmondshire and Whitby CCG 0.57

NHS Stafford and Surrounds CCG 0.52

NHS West Suffolk CCG 0.52

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

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

GP practice CCG

CHURCH STRETTON MEDICAL CENTRE M82008 9.0% STATION DRIVE SURGERY M82014 8.5% HODNET MEDICAL PRACTICE M82058 8.2% RIVERSIDE MED.PRACTICE M82006 8.0% SHAWBURY MEDICAL PRACTICE M82011 7.9% LUDLOW - PORTCULLIS M82043 7.9% • it is estimated that there are 3,602 BEECHES MEDICAL PRACTICE M82018 7.7% ALVELEY MEDICAL PRACTICE M82601 7.5% people with undiagnosed chronic MYTTON OAK MEDICAL PRACT. M82002 7.2% kidney disease in NHS Shropshire BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 7.2% HIGHLEY MEDICAL CENTRE M82031 7.1% CCG CRAVEN ARMS SURGERY M82046 7.0% BISHOPS CASTLE SURGERY M82033 6.9% • GP practice range of observed CKD: ELLESMERE MEDICAL PRACTICE M82025 6.9% MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 6.8% 1.3% to 9.0% ALBRIGHTON MEDICAL PRACT M82021 6.8% DODINGTON SURGERY M82044 6.3% THE MEADOWS MEDICAL PRACTICE M82620 6.2% BELVIDERE MEDICAL PRACT. M82048 6.1% MOUNT PLEASANT MEDICAL PRACTICE M82050 6.0% PONTESBURY MEDICAL PRAC M82030 5.8% CAMBRIAN MEDICAL PRACTICE M82026 5.7% WORTHEN MEDICAL PRACTICE M82604 5.7% BROSELEY MEDICAL PRACTICE M82051 5.5% CLEOBURY MORTIMER SURGERY M82041 5.5% SOUTH HERMITAGE SURGERY M82060 5.4% BRIDGNORTH MEDICAL PRACTICE M82004 5.3% MARYSVILLE MEDICAL PRACT M82040 5.3% SHIFNAL MEDICAL PRACTICE M82038 5.1% RICHMOND HOUSE SURGERY M82055 4.9% MARKET DRAYTON MEDICAL PRACTICE M82010 4.9% SEVERN FIELDS MEDICAL PRACTICE M82032 4.7% PRESCOTT SURGERY M82023 4.6% MARDEN MEDICAL PRACTICE M82047 4.5% RADBROOK GREEN SURGERY M82016 4.5% CLIVE MEDICAL PRACTICE M82017 4.4% BROWN CLEE MEDICAL CENTRE M82024 4.3% CLAREMONT BANK SURGERY M82034 4.2% THE CAXTON SURGERY M82022 4.0% Note: CCG estimates for the estimated KNOCKIN MEDICAL CENTRE M82020 4.0% number of people with CKD are based on WESTBURY MEDICAL CENTRE M82013 3.9% WEM AND PREES MEDICAL PRACTICE M82035 3.8% applying a proportion from a resident based PLAS FFYNNON MEDICAL CTRE M82005 3.1% SHROPSHIRE WALK IN HEALTH CENTRE Y02495 1.3% population estimate to a GP registered population. The characteristics of registered 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% and resident populations may vary in some CCGs, and local interpretation is required.

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 Telford And Wrekin CCG 74.5% • 14,329 people with CKD (diagnosed*) in NHS Shropshire CCG • 10,305 (71.9%) people whose blood pressure is <= 140 /85 • 1,389 (9.7%) people who are exceptions NHS Shropshire CCG 71.9% • 2,635 (18.4%) additional people whose blood pressure is not <= 140 / 85

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

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

NHS South Lincolnshire CCG 77.4%

NHS Northumberland CCG 76.5%

NHS Hambleton, Richmondshire and Whitby CCG 75.2%

NHS West Suffolk CCG 74.8%

NHS South Norfolk CCG 73.7%

NHS North Derbyshire CCG 72.9%

NHS East Riding of Yorkshire CCG 72.7%

NHS Herefordshire CCG 72.5%

NHS Ipswich and East Suffolk CCG 72.0%

NHS Shropshire CCG 71.9%

NHS Stafford and Surrounds CCG 71.6%

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

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

Not below 140/85 Exceptions reported

SOUTH HERMITAGE SURGERY M82060 129 PLAS FFYNNON MEDICAL CTRE M82005 92 MOUNT PLEASANT MEDICAL CENTRE M82050 141 LUDLOW - PORTCULLIS M82043 216 MYTTON OAK MEDICAL PRACT. M82002 227 HAUGHMOND VIEW MEDICAL PRACTICE M82032 119 • in total, including exceptions, there BISHOPS CASTLE SURGERY M82033 85 MARYSVILLE MEDICAL PRACT M82040 80 are 4,024 people whose blood SHIFNAL MEDICAL PRACTICE M82038 155 pressure is not <= 140 / 85 PONTESBURY MEDICAL PRAC M82030 111 THE MEADOWS MEDICAL PRACTICE M82620 73 • GP practice range: 11.5% to 41.6% CHURCH STRETTON MEDICAL PRACTICE M82008 190 WEM & PREES MEDICAL PRACTICE M82035 112 BROSELEY MEDICAL PRACTICE M82051 68 RADBROOK GREEN SURGERY M82016 107 MUCH WENLOCK PRACTICE M82019 113 CRAVEN ARMS SURGERY M82046 66 CLEOBURY MORTIMER MEDICAL CENTRE M82041 52 RIVERSIDE MED.PRACTICE M82006 197 MARKET DRAYTON MEDICAL PRACTICE M82010 195 CLIVE MEDICAL PRACTICE M82017 47 WESTBURY MEDICAL CENTRE M82013 26 KNOCKIN MEDICAL CENTRE M82020 31 BEECHES MEDICAL PRACTICE M82018 101 PRESCOTT SURGERY M82023 59 MARDEN MEDICAL PRACTICE M82047 70 THE CAXTON SURGERY M82022 99 BRIDGNORTH MEDICAL PRACTICE M82004 183 STATION DRIVE SURGERY M82014 121 BELVIDERE MEDICAL PRACT. M82048 63 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 8 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 66 HODNET MEDICAL PRACTICE M82058 60 ELLESMERE MEDICAL PRACTICE M82025 90 CLAREMONT BANK SURGERY M82034 61 RICHMOND HOUSE SURGERY M82055 37 WILLOW STREET MEDICAL CTR M82026 132 SHAWBURY MEDICAL PRACTICE M82011 48 BROWN CLEE MEDICAL PRACTICE M82024 25 HIGHLEY MEDICAL CENTRE M82031 31 ALVELEY MEDICAL PRACTICE M82601 21 DODINGTON SURGERY M82044 35 ALBRIGHTON MEDICAL PRACT M82021 71 WORTHEN MEDICAL PRACTICE M82604 11 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

MOUNT PLEASANT MEDICAL CENTRE 80

HAUGHMOND VIEW MEDICAL PRACTICE 66

SOUTH HERMITAGE SURGERY 62 • using the GP cluster method of BISHOPS CASTLE SURGERY 44 calculating potential gains, if each MYTTON OAK MEDICAL PRACT. 115 practice was to achieve as well as the MARYSVILLE MEDICAL PRACT 40 upper quartile of its national cluster, then an additional 1,299 people would SHIFNAL MEDICAL PRACTICE 78 be treated LUDLOW - PORTCULLIS 98

PLAS FFYNNON MEDICAL CTRE 41

PONTESBURY MEDICAL PRAC 53

RICHMOND HOUSE SURGERY 6

BRIDGNORTH MEDICAL PRACTICE 21

SHAWBURY MEDICAL PRACTICE 4

BROWN CLEE MEDICAL PRACTICE 2

WILLOW STREET MEDICAL CTR 0

HIGHLEY MEDICAL CENTRE

ALVELEY MEDICAL PRACTICE

DODINGTON SURGERY

ALBRIGHTON MEDICAL PRACT

WORTHEN MEDICAL PRACTICE 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 Telford And Wrekin CCG 80.6% • 14,329 people with CKD (diagnosed*) in NHS Shropshire CCG • 10,837 (75.6%) people who have a record of urine albumin:creatinine ratio test • 672 (4.7%) people who are NHS Shropshire CCG 75.6% exceptions • 2,820 (19.7%) additional people who have no record of urine albumin:creatinine ratio test

England 75.4% *Using the QOF clinical indicator CKD004 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 Herefordshire CCG 79.2%

NHS Northumberland CCG 78.9%

NHS Hambleton, Richmondshire and Whitby CCG 78.3%

NHS South Lincolnshire CCG 77.9%

NHS North Derbyshire CCG 77.8%

NHS South Norfolk CCG 77.4%

NHS Shropshire CCG 75.6%

NHS East Riding of Yorkshire CCG 74.7%

NHS Stafford and Surrounds CCG 72.9%

NHS Ipswich and East Suffolk CCG 71.5%

NHS West Suffolk CCG 70.7%

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

HODNET MEDICAL PRACTICE M82058 155 HAUGHMOND VIEW MEDICAL PRACTICE M82032 122 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 103 MYTTON OAK MEDICAL PRACT. M82002 218 BEECHES MEDICAL PRACTICE M82018 141 PRESCOTT SURGERY M82023 83 • in total, including exceptions, there CLEOBURY MORTIMER MEDICAL CENTRE M82041 64 RADBROOK GREEN SURGERY M82016 123 are 3,492 people who have no record MARKET DRAYTON MEDICAL PRACTICE M82010 237 of urine albumin:creatinine ratio test LUDLOW - PORTCULLIS M82043 181 THE CAXTON SURGERY M82022 120 • GP practice range: 8.3% to 58.5% MOUNT PLEASANT MEDICAL CENTRE M82050 108 MUCH WENLOCK PRACTICE M82019 108 SHIFNAL MEDICAL PRACTICE M82038 104 WEM & PREES MEDICAL PRACTICE M82035 86 CRAVEN ARMS SURGERY M82046 56 BROWN CLEE MEDICAL PRACTICE M82024 31 MARDEN MEDICAL PRACTICE M82047 67 WILLOW STREET MEDICAL CTR M82026 146 WESTBURY MEDICAL CENTRE M82013 23 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 8 BRIDGNORTH MEDICAL PRACTICE M82004 154 BROSELEY MEDICAL PRACTICE M82051 44 PONTESBURY MEDICAL PRAC M82030 64 BISHOPS CASTLE SURGERY M82033 45 SOUTH HERMITAGE SURGERY M82060 61 CLAREMONT BANK SURGERY M82034 53 MARYSVILLE MEDICAL PRACT M82040 41 DODINGTON SURGERY M82044 45 STATION DRIVE SURGERY M82014 93 ELLESMERE MEDICAL PRACTICE M82025 74 THE MEADOWS MEDICAL PRACTICE M82620 38 RIVERSIDE MED.PRACTICE M82006 120 PLAS FFYNNON MEDICAL CTRE M82005 38 ALBRIGHTON MEDICAL PRACT M82021 78 HIGHLEY MEDICAL CENTRE M82031 27 CLIVE MEDICAL PRACTICE M82017 25 BELVIDERE MEDICAL PRACT. M82048 37 ALVELEY MEDICAL PRACTICE M82601 20 RICHMOND HOUSE SURGERY M82055 23 SHAWBURY MEDICAL PRACTICE M82011 31 KNOCKIN MEDICAL CENTRE M82020 15 CHURCH STRETTON MEDICAL PRACTICE M82008 74 WORTHEN MEDICAL PRACTICE M82604 8 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 Shropshire CCG 0.84% • prevalence of 0.84% in NHS Shropshire CCG compared to 0.76% in England

NHS Telford And Wrekin CCG 0.75%

England 0.76%

0.0% 0.1% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9%

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

NHS North Derbyshire CCG 1.11%

NHS Northumberland CCG 1.07%

NHS Herefordshire CCG 1.01%

NHS South Lincolnshire CCG 1.01%

NHS Hambleton, Richmondshire and Whitby CCG 0.95%

NHS East Riding of Yorkshire CCG 0.88%

NHS Ipswich and East Suffolk CCG 0.87%

NHS Shropshire CCG 0.84%

NHS West Suffolk CCG 0.83%

NHS South Norfolk CCG 0.82%

NHS Stafford and Surrounds CCG 0.77%

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

ALBRIGHTON MEDICAL PRACT M82021 1.7% ALVELEY MEDICAL PRACTICE M82601 1.6% BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 1.5% STATION DRIVE SURGERY M82014 1.4% ELLESMERE MEDICAL PRACTICE M82025 1.2% BRIDGNORTH MEDICAL PRACTICE M82004 1.2% • 2,554 people with diagnosed heart SHAWBURY MEDICAL PRACTICE M82011 1.1% CRAVEN ARMS SURGERY M82046 1.1% failure in NHS Shropshire CCG THE CAXTON SURGERY M82022 1.1% • GP practice range: 0.2% to 1.7% CLEOBURY MORTIMER SURGERY M82041 1.1% MARKET DRAYTON MEDICAL PRACTICE M82010 1.0% BROSELEY MEDICAL PRACTICE M82051 0.9% WESTBURY MEDICAL CENTRE M82013 0.9% HIGHLEY MEDICAL CENTRE M82031 0.9% SHIFNAL MEDICAL PRACTICE M82038 0.9% LUDLOW - PORTCULLIS M82043 0.9% SOUTH HERMITAGE SURGERY M82060 0.8% CAMBRIAN MEDICAL PRACTICE M82026 0.8% CHURCH STRETTON MEDICAL CENTRE M82008 0.8% DODINGTON SURGERY M82044 0.8% BEECHES MEDICAL PRACTICE M82018 0.8% THE MEADOWS MEDICAL PRACTICE M82620 0.8% MARDEN MEDICAL PRACTICE M82047 0.8% RADBROOK GREEN SURGERY M82016 0.8% RIVERSIDE MED.PRACTICE M82006 0.7% BROWN CLEE MEDICAL CENTRE M82024 0.7% RICHMOND HOUSE SURGERY M82055 0.7% MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 0.7% BELVIDERE MEDICAL PRACT. M82048 0.7% PLAS FFYNNON MEDICAL CTRE M82005 0.6% BISHOPS CASTLE SURGERY M82033 0.6% PONTESBURY MEDICAL PRAC M82030 0.6% KNOCKIN MEDICAL CENTRE M82020 0.6% SEVERN FIELDS MEDICAL PRACTICE M82032 0.6% MYTTON OAK MEDICAL PRACT. M82002 0.6% WEM AND PREES MEDICAL PRACTICE M82035 0.6% CLAREMONT BANK SURGERY M82034 0.5% WORTHEN MEDICAL PRACTICE M82604 0.5% CLIVE MEDICAL PRACTICE M82017 0.5% HODNET MEDICAL PRACTICE M82058 0.5% PRESCOTT SURGERY M82023 0.4% MARYSVILLE MEDICAL PRACT M82040 0.3% MOUNT PLEASANT MEDICAL PRACTICE M82050 0.3% SHROPSHIRE WALK IN HEALTH CENTRE Y02495 0.2% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 1.8%

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

NHS Telford And Wrekin CCG 85.6% • 1,061 people with heart failure* with LVSD in NHS Shropshire CCG • 884 (83.3%) people treated with ACE- I or ARB • 177 (16.7%) people who are exceptions NHS Shropshire CCG 83.3% • 0 (0%) additional people who are not treated with ACE-I or ARB

England 84.7%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 89.3%

NHS East Riding of Yorkshire CCG 87.0%

NHS South Norfolk CCG 85.9%

NHS Northumberland CCG 85.1%

NHS Stafford and Surrounds CCG 84.3%

NHS Shropshire CCG 83.3%

NHS North Derbyshire CCG 82.3%

NHS Ipswich and East Suffolk CCG 81.9%

NHS Herefordshire CCG 81.1%

NHS South Lincolnshire CCG 79.9%

NHS West Suffolk CCG 79.7%

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

WESTBURY MEDICAL CENTRE M82013 1 HODNET MEDICAL PRACTICE M82058 4 BELVIDERE MEDICAL PRACT. M82048 7 CAMBRIAN MEDICAL PRACTICE M82026 3 LUDLOW - PORTCULLIS M82043 5 MYTTON OAK MEDICAL PRACT. M82002 4 • in total, including exceptions, there MARDEN MEDICAL PRACTICE M82047 8 STATION DRIVE SURGERY M82014 8 are 177 people who are not treated PONTESBURY MEDICAL PRAC M82030 4 with ACE-I or ARB BISHOPS CASTLE SURGERY M82033 4 RADBROOK GREEN SURGERY M82016 6 • GP practice range: 0.0% to 50.0% ELLESMERE MEDICAL PRACTICE M82025 13 SHAWBURY MEDICAL PRACTICE M82011 2 CLEOBURY MORTIMER SURGERY M82041 12 PLAS FFYNNON MEDICAL CTRE M82005 6 BRIDGNORTH MEDICAL PRACTICE M82004 24 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 4 RICHMOND HOUSE SURGERY M82055 2 SEVERN FIELDS MEDICAL PRACTICE M82032 4 ALVELEY MEDICAL PRACTICE M82601 4 ALBRIGHTON MEDICAL PRACT M82021 8 CLIVE MEDICAL PRACTICE M82017 1 BEECHES MEDICAL PRACTICE M82018 2 DODINGTON SURGERY M82044 2 WORTHEN MEDICAL PRACTICE M82604 1 SOUTH HERMITAGE SURGERY M82060 5 MARKET DRAYTON MEDICAL PRACTICE M82010 11 SHIFNAL MEDICAL PRACTICE M82038 3 CRAVEN ARMS SURGERY M82046 3 THE CAXTON SURGERY M82022 6 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 3 THE MEADOWS MEDICAL PRACTICE M82620 1 CHURCH STRETTON MEDICAL CENTRE M82008 1 RIVERSIDE MED.PRACTICE M82006 2 CLAREMONT BANK SURGERY M82034 1 MOUNT PLEASANT MEDICAL PRACTICE M82050 1 BROSELEY MEDICAL PRACTICE M82051 1 KNOCKIN MEDICAL CENTRE M82020 PRESCOTT SURGERY M82023 BROWN CLEE MEDICAL CENTRE M82024 HIGHLEY MEDICAL CENTRE M82031 WEM AND PREES MEDICAL PRACTICE M82035 MARYSVILLE MEDICAL PRACT M82040 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 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 Shropshire CCG 74.0% • 884 people with heart failure* with LVSD treated with ACE-I/ARB in NHS Shropshire CCG • 654 (74%) people treated with ACE- I/ARB and BB • 151 (17.1%) people who are NHS Telford And Wrekin CCG 73.6% exceptions • 79 (8.9%) additional people who are not treated with ACE-I/ARB and BB

England 77.7%

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

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

NHS East Riding of Yorkshire CCG 82.2%

NHS Hambleton, Richmondshire and Whitby CCG 81.3%

NHS Northumberland CCG 78.8%

NHS West Suffolk CCG 78.7%

NHS Stafford and Surrounds CCG 77.7%

NHS Ipswich and East Suffolk CCG 77.4%

NHS North Derbyshire CCG 76.9%

NHS Shropshire CCG 74.0%

NHS South Lincolnshire CCG 72.4%

NHS Herefordshire CCG 69.3%

NHS South Norfolk CCG 68.8%

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

HODNET MEDICAL PRACTICE M82058 3 CAMBRIAN MEDICAL PRACTICE M82026 3 LUDLOW - PORTCULLIS M82043 6 MOUNT PLEASANT MEDICAL PRACTICE M82050 8 ELLESMERE MEDICAL PRACTICE M82025 20 CHURCH STRETTON MEDICAL CENTRE M82008 5 • in total, including exceptions, there PONTESBURY MEDICAL PRAC M82030 4 BROSELEY MEDICAL PRACTICE M82051 12 are 230 people who are not treated ALVELEY MEDICAL PRACTICE M82601 7 with ACE-I or ARB CLEOBURY MORTIMER SURGERY M82041 15 CLIVE MEDICAL PRACTICE M82017 2 • GP practice range: 0.0% to 75.0% MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 6 WORTHEN MEDICAL PRACTICE M82604 2 HIGHLEY MEDICAL CENTRE M82031 4 SEVERN FIELDS MEDICAL PRACTICE M82032 6 SHAWBURY MEDICAL PRACTICE M82011 2 WEM AND PREES MEDICAL PRACTICE M82035 3 SOUTH HERMITAGE SURGERY M82060 9 BRIDGNORTH MEDICAL PRACTICE M82004 27 PLAS FFYNNON MEDICAL CTRE M82005 6 STATION DRIVE SURGERY M82014 5 RADBROOK GREEN SURGERY M82016 5 KNOCKIN MEDICAL CENTRE M82020 1 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 7 ALBRIGHTON MEDICAL PRACT M82021 10 MYTTON OAK MEDICAL PRACT. M82002 2 SHIFNAL MEDICAL PRACTICE M82038 5 CRAVEN ARMS SURGERY M82046 5 THE MEADOWS MEDICAL PRACTICE M82620 2 THE CAXTON SURGERY M82022 11 MARKET DRAYTON MEDICAL PRACTICE M82010 13 MARDEN MEDICAL PRACTICE M82047 3 BISHOPS CASTLE SURGERY M82033 2 MARYSVILLE MEDICAL PRACT M82040 1 RIVERSIDE MED.PRACTICE M82006 4 RICHMOND HOUSE SURGERY M82055 1 BELVIDERE MEDICAL PRACT. M82048 1 BEECHES MEDICAL PRACTICE M82018 1 DODINGTON SURGERY M82044 1 WESTBURY MEDICAL CENTRE M82013 PRESCOTT SURGERY M82023 BROWN CLEE MEDICAL CENTRE M82024 CLAREMONT BANK SURGERY M82034 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 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 Shropshire CCG 88.5% • 11,421 people with coronary heart disease* in NHS Shropshire CCG • 10,108 (88.5%) people whose blood pressure <= 150 / 90 • 460 (4%) people who are exceptions • 853 (7.5%) additional people whose NHS Telford And Wrekin CCG 87.8% blood pressure is not <= 150 / 90

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 South Lincolnshire CCG 91.0%

NHS Hambleton, Richmondshire and Whitby CCG 91.0%

NHS Herefordshire CCG 89.4%

NHS North Derbyshire CCG 88.9%

NHS Northumberland CCG 88.8%

NHS South Norfolk CCG 88.6%

NHS Shropshire CCG 88.5%

NHS West Suffolk CCG 88.5%

NHS Ipswich and East Suffolk CCG 87.7%

NHS East Riding of Yorkshire CCG 87.0%

NHS Stafford and Surrounds CCG 83.8%

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

HIGHLEY MEDICAL CENTRE M82031 25 LUDLOW - PORTCULLIS M82043 73 SHIFNAL MEDICAL PRACTICE M82038 69 MARYSVILLE MEDICAL PRACT M82040 25 MYTTON OAK MEDICAL PRACT. M82002 54 SOUTH HERMITAGE SURGERY M82060 45 • in total, including exceptions, there CHURCH STRETTON MEDICAL CENTRE M82008 61 THE MEADOWS MEDICAL PRACTICE M82620 26 are 1,313 people whose blood SEVERN FIELDS MEDICAL PRACTICE M82032 40 pressure is not <= 150 / 90 WEM AND PREES MEDICAL PRACTICE M82035 58 RIVERSIDE MED.PRACTICE M82006 59 • GP practice range: 0.0% to 23.8% HODNET MEDICAL PRACTICE M82058 17 CLIVE MEDICAL PRACTICE M82017 25 RADBROOK GREEN SURGERY M82016 54 BISHOPS CASTLE SURGERY M82033 26 MOUNT PLEASANT MEDICAL PRACTICE M82050 28 MARDEN MEDICAL PRACTICE M82047 33 MARKET DRAYTON MEDICAL PRACTICE M82010 68 CLEOBURY MORTIMER SURGERY M82041 32 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 5 SHAWBURY MEDICAL PRACTICE M82011 20 BEECHES MEDICAL PRACTICE M82018 24 ELLESMERE MEDICAL PRACTICE M82025 35 BROSELEY MEDICAL PRACTICE M82051 18 THE CAXTON SURGERY M82022 38 PRESCOTT SURGERY M82023 17 RICHMOND HOUSE SURGERY M82055 14 PONTESBURY MEDICAL PRAC M82030 26 WESTBURY MEDICAL CENTRE M82013 8 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 27 BRIDGNORTH MEDICAL PRACTICE M82004 55 BELVIDERE MEDICAL PRACT. M82048 17 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 15 CAMBRIAN MEDICAL PRACTICE M82026 38 KNOCKIN MEDICAL CENTRE M82020 7 STATION DRIVE SURGERY M82014 26 PLAS FFYNNON MEDICAL CTRE M82005 25 CLAREMONT BANK SURGERY M82034 18 CRAVEN ARMS SURGERY M82046 12 DODINGTON SURGERY M82044 11 ALBRIGHTON MEDICAL PRACT M82021 28 BROWN CLEE MEDICAL CENTRE M82024 7 ALVELEY MEDICAL PRACTICE M82601 4 WORTHEN MEDICAL PRACTICE M82604 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

HIGHLEY MEDICAL CENTRE 18

LUDLOW - PORTCULLIS 43

SHIFNAL MEDICAL PRACTICE 43 • using the GP cluster method of MARYSVILLE MEDICAL PRACT 15 calculating potential gains, if each MYTTON OAK MEDICAL PRACT. 33 practice was to achieve as well as the SEVERN FIELDS MEDICAL PRACTICE 24 upper quartile of its national cluster, then an additional 465 people would THE MEADOWS MEDICAL PRACTICE 15 be treated SOUTH HERMITAGE SURGERY 22

CHURCH STRETTON MEDICAL CENTRE 31

HODNET MEDICAL PRACTICE 9

CLAREMONT BANK SURGERY

BRIDGNORTH MEDICAL PRACTICE

CRAVEN ARMS SURGERY

CAMBRIAN MEDICAL PRACTICE

DODINGTON SURGERY

BROWN CLEE MEDICAL CENTRE

PLAS FFYNNON MEDICAL CTRE

ALBRIGHTON MEDICAL PRACT

ALVELEY MEDICAL PRACTICE

WORTHEN MEDICAL PRACTICE Details of this methodology are available on slide 9. Click here to view them.

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

NHS Telford And Wrekin CCG 93.1% • 11,421 people with coronary heart disease* in NHS Shropshire CCG • 10,347 (90.6%) people who are taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant • 678 (5.9%) people who are NHS Shropshire CCG 90.6% exceptions • 396 (3.5%) additional people who are not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant

England 91.8%

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

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

NHS Hambleton, Richmondshire and Whitby CCG 94.1%

NHS West Suffolk CCG 93.0%

NHS South Lincolnshire CCG 92.6%

NHS Stafford and Surrounds CCG 92.3%

NHS Northumberland CCG 92.2%

NHS North Derbyshire CCG 92.1%

NHS South Norfolk CCG 91.7%

NHS Herefordshire CCG 91.4%

NHS East Riding of Yorkshire CCG 90.6%

NHS Shropshire CCG 90.6%

NHS Ipswich and East Suffolk CCG 90.5%

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

LUDLOW - PORTCULLIS M82043 72 WESTBURY MEDICAL CENTRE M82013 17 STATION DRIVE SURGERY M82014 58 MARDEN MEDICAL PRACTICE M82047 43 RADBROOK GREEN SURGERY M82016 55 BROWN CLEE MEDICAL CENTRE M82024 15 • in total, including exceptions, there MARYSVILLE MEDICAL PRACT M82040 16 ELLESMERE MEDICAL PRACTICE M82025 38 are 1,074 people are not taking WORTHEN MEDICAL PRACTICE M82604 8 aspirin, an alternative anti-platelet CHURCH STRETTON MEDICAL CENTRE M82008 40 CLAREMONT BANK SURGERY M82034 27 therapy, or an anti-coagulant WEM AND PREES MEDICAL PRACTICE M82035 40 RIVERSIDE MED.PRACTICE M82006 41 • GP practice range: 3.4% to 20.1% BISHOPS CASTLE SURGERY M82033 20 CRAVEN ARMS SURGERY M82046 18 CAMBRIAN MEDICAL PRACTICE M82026 46 SHAWBURY MEDICAL PRACTICE M82011 17 RICHMOND HOUSE SURGERY M82055 15 PLAS FFYNNON MEDICAL CTRE M82005 33 ALVELEY MEDICAL PRACTICE M82601 11 SHROPSHIRE WALK IN HEALTH CENTRE Y02495 4 MUCH WENLOCK & CRESSAGE MEDICAL PRACTICE M82019 30 SOUTH HERMITAGE SURGERY M82060 24 BRIDGEWATER FAMILY MEDICAL PRACTICE M82045 16 HIGHLEY MEDICAL CENTRE M82031 9 THE CAXTON SURGERY M82022 34 MARKET DRAYTON MEDICAL PRACTICE M82010 48 HODNET MEDICAL PRACTICE M82058 10 BRIDGNORTH MEDICAL PRACTICE M82004 55 DODINGTON SURGERY M82044 14 PONTESBURY MEDICAL PRAC M82030 23 CLIVE MEDICAL PRACTICE M82017 14 MYTTON OAK MEDICAL PRACT. M82002 21 MOUNT PLEASANT MEDICAL PRACTICE M82050 15 THE MEADOWS MEDICAL PRACTICE M82620 11 CLEOBURY MORTIMER SURGERY M82041 18 BEECHES MEDICAL PRACTICE M82018 14 BROSELEY MEDICAL PRACTICE M82051 11 PRESCOTT SURGERY M82023 12 SHIFNAL MEDICAL PRACTICE M82038 20 SEVERN FIELDS MEDICAL PRACTICE M82032 12 ALBRIGHTON MEDICAL PRACT M82021 18 BELVIDERE MEDICAL PRACT. M82048 8 KNOCKIN MEDICAL CENTRE M82020 3 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 Shropshire CCG England 800

700 • in NHS Shropshire CCG, the hospital admission rate for coronary heart disease in 2015/16 was 475.9 (1,706) 600 compared to 527.9 for England

500

400

300

Age Age standardised (per rate 100,000) 200

100

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

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

NHS Shropshire CCG England 250

• in NHS Shropshire CCG, the hospital admission rate for stroke in 2015/16 200 was 159.8 (571) 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 Shropshire CCG England

110.4% Angina 136.8% • The risk of a stroke was 67.7% higher and the risk of a heart attack was 91.4% 91.4% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 143.5% higher. 143.3% Heart failure 150.0%

67.7% Stroke 81.3%

143.5% Major amputation 445.8%

550.8% Minor amputation 753.5%

188.4% 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 Shropshire CCG England 90

80 • in NHS Shropshire CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 36.5, compared to 40.6 for England

60

50

40

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

10

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

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

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

NHS Shropshire CCG England 30

• in NHS Shropshire CCG, the early 25 mortality rate for stroke in 2013-15 was 12, 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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