CVD: Primary Care Intelligence Packs NHS South West Lincolnshire 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 South West Lincolnshire CCG are: NHS High Weald Lewes Havens CCG NHS South Norfolk CCG NHS South Lincolnshire CCG NHS West Suffolk CCG NHS Hambleton, Richmondshire and Whitby CCG NHS Newark & Sherwood CCG NHS East Staffordshire CCG NHS South Worcestershire CCG NHS Rushcliffe CCG NHS South Cheshire 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 16.7% in NHS South West Lincolnshire CCG NHS East Staffordshire CCG 17.5%
NHS Newark & Sherwood CCG 17.4%
NHS South Cheshire CCG 16.9%
NHS South Worcestershire CCG 16.7%
NHS South West Lincolnshire CCG 16.7%
NHS South Norfolk CCG 16.4% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS High Weald Lewes Havens CCG 15.1% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Hambleton, Richmondshire and Whitby CCG 14.0% http://bmjopen.bmj.com/content/4/7/e005217.abs tract
NHS Rushcliffe CCG 11.6% 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
SWINGBRIDGE SURGERY C83008 26.7%
THE HARROWBY LANE SURGERY C83080 21.5% • 18,433 people who are recorded as ST. JOHNS MEDICAL CENTRE C83048 21.5% smokers in NHS South West ST. PETERS HILL SURGERY C83040 19.7% Lincolnshire CCG
COLSTERWORTH SURGERY C83053 17.9% • GP practice range: 8.4% to 26.7%
SLEAFORD MEDICAL GROUP C83023 17.6%
VINE STREET SURGERY C83075 16.4%
BILLINGHAY MEDICAL PRACTICE C83030 16.3%
WOOLSTHORPE SURGERY C83628 16.2%
THE GLENSIDE COUNTRY PRACTICE C83024 15.4%
RUSKINGTON SURGERY C83013 15.3%
THE NEW SPRINGWELLS PRACTICE Y01652 14.7%
MILLVIEW MEDICAL CENTRE C83011 14.5%
MARKET CROSS SURGERY C83649 12.5%
THE STACKYARD SURGERY C83653 12.4%
ANCASTER SURGERY C83020 11.0% Note: This method is thought to be a reasonably
THE WELBY PRACTICE C82076 10.9% robust method in estimating smoking prevalence for the majority of GP practices. However, BELVOIR VALE SURGERY C82123 9.8% caution is advised for extreme estimates of
LONG BENNINGTON SURGERY C83067 8.4% smoking prevalence and those with high 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 South West Lincolnshire CCG 0.62
• the ratio of those diagnosed with hypertension versus those expected NHS Lincolnshire East CCG 0.61 to have hypertension is 0.62. This compares to 0.59 for England • this suggests that 62% of people with hypertension have been diagnosed NHS South Lincolnshire CCG 0.61
NHS Lincolnshire West CCG 0.58
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 South West Lincolnshire CCG 0.62
NHS South Cheshire CCG 0.61
NHS South Lincolnshire CCG 0.61
NHS South Worcestershire CCG 0.60
NHS Newark & Sherwood CCG 0.60
NHS Hambleton, Richmondshire and Whitby CCG 0.60
NHS Rushcliffe CCG 0.59
NHS South Norfolk CCG 0.59
NHS High Weald Lewes Havens CCG 0.59
NHS West Suffolk CCG 0.59
NHS East Staffordshire CCG 0.57
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
WOOLSTHORPE SURGERY C83628 0.85
ANCASTER SURGERY C83020 0.76
RUSKINGTON SURGERY C83013 0.74 • it is estimated that there are 13,694 people with undiagnosed THE GLENSIDE COUNTRY PRACTICE C83024 0.72 hypertension in NHS South West MILLVIEW MEDICAL CENTRE C83011 0.70 Lincolnshire CCG ST. PETERS HILL SURGERY C83040 0.67 • GP practice range of observed to THE WELBY PRACTICE C82076 0.66 expected hypertension prevalence BELVOIR VALE SURGERY C82123 0.64 0.48 to 0.85
SLEAFORD MEDICAL GROUP C83023 0.63
LONG BENNINGTON SURGERY C83067 0.62
SWINGBRIDGE SURGERY C83008 0.62
VINE STREET SURGERY C83075 0.61
THE NEW SPRINGWELLS PRACTICE Y01652 0.60
THE HARROWBY LANE SURGERY C83080 0.59
THE STACKYARD SURGERY C83653 0.58
MARKET CROSS SURGERY C83649 0.55
BILLINGHAY MEDICAL PRACTICE C83030 0.54
COLSTERWORTH SURGERY C83053 0.49
ST. JOHNS MEDICAL CENTRE C83048 0.48
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 South Lincolnshire CCG 83.8%
• 22,457 people with hypertension (diagnosed)* in NHS South West NHS Lincolnshire West CCG 82.3% Lincolnshire CCG • 18,255 (81.3%) people whose blood pressure is <= 150/90 • 703 (3.1%) people who are excepted NHS Lincolnshire East CCG 81.3% from optimal control • 3,499 (15.6%) additional people whose blood pressure is not <= 150/90
NHS South West Lincolnshire CCG 81.3%
England 79.6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *Using QOF clinical indicator HYP006 denominator plus exceptions
20 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs
NHS South Worcestershire CCG 85.2%
NHS South Lincolnshire CCG 83.8%
NHS Rushcliffe CCG 83.1%
NHS Hambleton, Richmondshire and Whitby CCG 82.7%
NHS South Norfolk CCG 82.4%
NHS South West Lincolnshire CCG 81.3%
NHS West Suffolk CCG 81.2%
NHS East Staffordshire CCG 80.4%
NHS South Cheshire CCG 80.3%
NHS Newark & Sherwood CCG 80.2%
NHS High Weald Lewes Havens CCG 75.4%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
21 CVD: Primary Care Intelligence Packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice
No treatment Exceptions reported
THE WELBY PRACTICE C82076 271
COLSTERWORTH SURGERY C83053 93 • in total, including exceptions, there WOOLSTHORPE SURGERY C83628 82 are 4,202 people whose blood THE HARROWBY LANE SURGERY C83080 175 pressure is not <= 150/90 ANCASTER SURGERY C83020 445 • GP practice range: 12.0% to 31.6%
SWINGBRIDGE SURGERY C83008 191
ST. JOHNS MEDICAL CENTRE C83048 383
THE GLENSIDE COUNTRY PRACTICE C83024 144
THE STACKYARD SURGERY C83653 46
LONG BENNINGTON SURGERY C83067 200
ST. PETERS HILL SURGERY C83040 553
MILLVIEW MEDICAL CENTRE C83011 291
SLEAFORD MEDICAL GROUP C83023 506
VINE STREET SURGERY C83075 176
BILLINGHAY MEDICAL PRACTICE C83030 118
THE NEW SPRINGWELLS PRACTICE Y01652 166
MARKET CROSS SURGERY C83649 89
BELVOIR VALE SURGERY C82123 82
RUSKINGTON SURGERY C83013 191
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 Lincolnshire West CCG 68.4%
• 101 people with a new diagnosis* of hypertension with a CVD risk of 20% NHS South West Lincolnshire CCG 67.3% or higher in NHS South West Lincolnshire CCG • 68 (67.3%) people who are currently treated with statins NHS South Lincolnshire CCG 61.8% • 33 (32.7%) people who are exempted from treatment with statins • 0 (0%) additional people who are not currently treated with statins
NHS Lincolnshire East CCG 60.2%
England 66.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% *Using the QOF clinical indicator CVD-PP001 denominator plus exceptions
23 CVD: Primary Care Intelligence Packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with demographically similar CCGs
NHS Hambleton, Richmondshire and Whitby CCG 71.6%
NHS Newark & Sherwood CCG 70.9%
NHS South West Lincolnshire CCG 67.3%
NHS East Staffordshire CCG 65.8%
NHS West Suffolk CCG 64.3%
NHS Rushcliffe CCG 64.1%
NHS High Weald Lewes Havens CCG 61.9%
NHS South Lincolnshire CCG 61.8%
NHS South Cheshire CCG 60.8%
NHS South Worcestershire CCG 55.1%
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
THE WELBY PRACTICE C82076 1
RUSKINGTON SURGERY C83013 3 • in total, including exceptions, there SLEAFORD MEDICAL GROUP C83023 9 are 33 people who are not treated THE HARROWBY LANE SURGERY C83080 1 with statins WOOLSTHORPE SURGERY C83628 1 • GP practice range: 0.0% to 100.0%
THE NEW SPRINGWELLS PRACTICE Y01652 3
SWINGBRIDGE SURGERY C83008 4
MILLVIEW MEDICAL CENTRE C83011 2
BILLINGHAY MEDICAL PRACTICE C83030 1
ANCASTER SURGERY C83020 2
THE GLENSIDE COUNTRY PRACTICE C83024 2
LONG BENNINGTON SURGERY C83067 1
VINE STREET SURGERY C83075 1
ST. PETERS HILL SURGERY C83040 2
BELVOIR VALE SURGERY C82123
ST. JOHNS MEDICAL CENTRE C83048
COLSTERWORTH SURGERY C83053
MARKET CROSS SURGERY C83649
THE STACKYARD SURGERY C83653
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 South West Lincolnshire CCG 0.73
• the ratio of those diagnosed with atrial fibrillation versus those expected to NHS South Lincolnshire CCG 0.73 have atrial fibrillation is 0.73. This compares to 0.7 for England • this suggests that 73% of people with atrial fibrillation have been diagnosed. NHS Lincolnshire East CCG 0.72
NHS Lincolnshire West CCG 0.70
Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 2015/16 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence Network estimates produced in 2017. The England 0.70 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 South Cheshire CCG 0.80
NHS Hambleton, Richmondshire and Whitby CCG 0.76
NHS Newark & Sherwood CCG 0.75
NHS High Weald Lewes Havens CCG 0.74
NHS South West Lincolnshire CCG 0.73
NHS South Lincolnshire CCG 0.73
NHS South Worcestershire CCG 0.71
NHS East Staffordshire CCG 0.69
NHS South Norfolk CCG 0.69
NHS Rushcliffe CCG 0.68
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
SLEAFORD MEDICAL GROUP C83023 0.9
MARKET CROSS SURGERY C83649 0.9
THE WELBY PRACTICE C82076 0.8 • it is estimated that there are 3,971 people with undiagnosed atrial BELVOIR VALE SURGERY C82123 0.8 fibrillation in NHS South West SWINGBRIDGE SURGERY C83008 0.8 Lincolnshire CCG THE HARROWBY LANE SURGERY C83080 0.8 • GP practice range of observed to THE STACKYARD SURGERY C83653 0.8 expected atrial fibrillation prevalence THE NEW SPRINGWELLS PRACTICE Y01652 0.8 0.6 to 0.9
MILLVIEW MEDICAL CENTRE C83011 0.7
ANCASTER SURGERY C83020 0.7
THE GLENSIDE COUNTRY PRACTICE C83024 0.7
BILLINGHAY MEDICAL PRACTICE C83030 0.7
ST. PETERS HILL SURGERY C83040 0.7
ST. JOHNS MEDICAL CENTRE C83048 0.7
LONG BENNINGTON SURGERY C83067 0.7
VINE STREET SURGERY C83075 0.7
RUSKINGTON SURGERY C83013 0.6
COLSTERWORTH SURGERY C83053 0.6
WOOLSTHORPE SURGERY C83628 0.6
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 Lincolnshire West CCG 84.5% • 2,408 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS South West Lincolnshire CCG NHS South Lincolnshire CCG 83.4% • 1,982 (82.3%) people treated with anti-coagulation therapy • 137 (5.7%) people who are exceptions NHS South West Lincolnshire CCG 82.3% • 289 (12%) additional people with a recorded CHA2DS2-VASc score >= 2 who are not treated
NHS Lincolnshire East CCG 81.1%
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 South West Lincolnshire CCG 82.3%
NHS Newark & Sherwood CCG 80.8%
NHS South Worcestershire CCG 78.9%
NHS Rushcliffe CCG 77.8%
NHS High Weald Lewes Havens CCG 77.8%
NHS South Norfolk CCG 77.4%
NHS South Cheshire CCG 77.3%
NHS East Staffordshire CCG 76.0%
NHS West Suffolk CCG 75.7%
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
THE NEW SPRINGWELLS PRACTICE Y01652 46
THE WELBY PRACTICE C82076 29 • in total, including exceptions, there SWINGBRIDGE SURGERY C83008 23 are 426 people with a recorded WOOLSTHORPE SURGERY C83628 5 CHA2DS2-VASc score >= 2 who are ST. JOHNS MEDICAL CENTRE C83048 39 not treated
COLSTERWORTH SURGERY C83053 6 • GP practice range: 8.4% to 33.3%
SLEAFORD MEDICAL GROUP C83023 75
THE STACKYARD SURGERY C83653 5
ST. PETERS HILL SURGERY C83040 60
BILLINGHAY MEDICAL PRACTICE C83030 16
THE HARROWBY LANE SURGERY C83080 13
LONG BENNINGTON SURGERY C83067 19
THE GLENSIDE COUNTRY PRACTICE C83024 9
BELVOIR VALE SURGERY C82123 9
VINE STREET SURGERY C83075 14
ANCASTER SURGERY C83020 19
RUSKINGTON SURGERY C83013 15
MILLVIEW MEDICAL CENTRE C83011 16
MARKET CROSS SURGERY C83649 8
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
10% 5% 0% -5% -10% -15% -20%
THE NEW SPRINGWELLS PRACTICE 25
THE WELBY PRACTICE 15 SWINGBRIDGE SURGERY 11 • using the GP cluster method of WOOLSTHORPE SURGERY 2 calculating potential gains, if each
COLSTERWORTH SURGERY 1 practice was to achieve as well as the upper quartile of its national cluster, THE STACKYARD SURGERY 1 then an additional 76 people would be ST. JOHNS MEDICAL CENTRE 7 treated ST. PETERS HILL SURGERY 6
BILLINGHAY MEDICAL PRACTICE 2
THE HARROWBY LANE SURGERY 1
SLEAFORD MEDICAL GROUP 5
LONG BENNINGTON SURGERY 0
THE GLENSIDE COUNTRY PRACTICE
BELVOIR VALE SURGERY
VINE STREET SURGERY
RUSKINGTON SURGERY
ANCASTER SURGERY
MILLVIEW MEDICAL CENTRE
MARKET CROSS SURGERY Details of this methodology are available on slide 9. Click here to view them.
34 CVD: Primary Care Intelligence Packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP
Below 150/90 Not below 150/90 Exceptions reported
NHS South Lincolnshire CCG 86.5% • 2,696 people with a history of stroke or TIA* in NHS South West Lincolnshire CCG NHS Lincolnshire West CCG 86.1% • 2,301 (85.3%) people whose blood pressure is <= 150 / 90 • 89 (3.3%) people who are exceptions • 306 (11.4%) additional people whose NHS South West Lincolnshire CCG 85.3% blood pressure is not <= 150 / 90
NHS Lincolnshire East CCG 84.4%
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 Worcestershire CCG 88.3%
NHS Rushcliffe CCG 86.7%
NHS South Lincolnshire CCG 86.5%
NHS West Suffolk CCG 85.5%
NHS Hambleton, Richmondshire and Whitby CCG 85.4%
NHS South West Lincolnshire CCG 85.3%
NHS South Norfolk CCG 84.8%
NHS South Cheshire CCG 84.0%
NHS Newark & Sherwood CCG 83.9%
NHS East Staffordshire CCG 83.8%
NHS High Weald Lewes Havens CCG 82.1%
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
WOOLSTHORPE SURGERY C83628 8
ST. PETERS HILL SURGERY C83040 68 • in total, including exceptions, there ANCASTER SURGERY C83020 41 are 395 people whose blood pressure SLEAFORD MEDICAL GROUP C83023 77 is not <= 150 / 90 MARKET CROSS SURGERY C83649 17 • GP practice range: 7.4% to 33.3%
THE WELBY PRACTICE C82076 16
THE STACKYARD SURGERY C83653 4
THE HARROWBY LANE SURGERY C83080 15
THE GLENSIDE COUNTRY PRACTICE C83024 8
COLSTERWORTH SURGERY C83053 6
SWINGBRIDGE SURGERY C83008 12
VINE STREET SURGERY C83075 18
BILLINGHAY MEDICAL PRACTICE C83030 11
ST. JOHNS MEDICAL CENTRE C83048 26
LONG BENNINGTON SURGERY C83067 14
MILLVIEW MEDICAL CENTRE C83011 21
THE NEW SPRINGWELLS PRACTICE Y01652 16
BELVOIR VALE SURGERY C82123 5
RUSKINGTON SURGERY C83013 12
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 South Lincolnshire CCG 94.0% • 1,837 people with a stroke shown to be non-haemorrhagic* in NHS South West Lincolnshire CCG NHS South West Lincolnshire CCG 92.5% • 1,700 (92.5%) people who are taking an anti-platetet agent or anti- coagulant • 85 (4.6%) people who are exceptions NHS Lincolnshire East CCG 91.6% • 52 (2.8%) additional people with no treatment
NHS Lincolnshire West CCG 90.6%
England 91.8%
0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA007 denominator plus exceptions
38 CVD: Primary Care Intelligence Packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported
NHS South Lincolnshire CCG 94.0%
NHS Hambleton, Richmondshire and Whitby CCG 93.9%
NHS Newark & Sherwood CCG 93.0%
NHS West Suffolk CCG 92.9%
NHS Rushcliffe CCG 92.8%
NHS South West Lincolnshire CCG 92.5%
NHS High Weald Lewes Havens CCG 92.2%
NHS South Worcestershire CCG 92.1%
NHS East Staffordshire CCG 91.5%
NHS South Norfolk CCG 91.5%
NHS South Cheshire CCG 88.9%
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
THE NEW SPRINGWELLS PRACTICE Y01652 18
COLSTERWORTH SURGERY C83053 5 • in total, including exceptions, there ST. JOHNS MEDICAL CENTRE C83048 20 are 137 people who are not taking an THE GLENSIDE COUNTRY PRACTICE C83024 5 anti-platelet agent or anti-coagulant THE HARROWBY LANE SURGERY C83080 6 • GP practice range: 0.0% to 15.9%
THE WELBY PRACTICE C82076 5
ST. PETERS HILL SURGERY C83040 22
SLEAFORD MEDICAL GROUP C83023 24
MARKET CROSS SURGERY C83649 4
SWINGBRIDGE SURGERY C83008 4
LONG BENNINGTON SURGERY C83067 4
VINE STREET SURGERY C83075 6
BILLINGHAY MEDICAL PRACTICE C83030 2
ANCASTER SURGERY C83020 5
MILLVIEW MEDICAL CENTRE C83011 4
RUSKINGTON SURGERY C83013 2
BELVOIR VALE SURGERY C82123 1
WOOLSTHORPE SURGERY C83628
THE STACKYARD SURGERY C83653
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 Lincolnshire East CCG 0.87 • 0.83 ratio of observed to expected diabetes prevalence in NHS South West Lincolnshire CCG, compared to NHS South Lincolnshire CCG 0.84 0.77 in England • this suggests 83% of people have been diagnosed
NHS South West Lincolnshire CCG 0.83
NHS Lincolnshire West CCG 0.82
Note: This slide compares the prevalence of Diabetes recorded in QOF in 2015/16 to the expected prevalence of Diabetes in 2016 taken England 0.77 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 1.0
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 South West Lincolnshire CCG 0.83
NHS East Staffordshire CCG 0.81
NHS Newark & Sherwood CCG 0.80
NHS South Cheshire CCG 0.80
NHS South Worcestershire CCG 0.79
NHS West Suffolk CCG 0.73
NHS South Norfolk CCG 0.71
NHS Rushcliffe CCG 0.70
NHS Hambleton, Richmondshire and Whitby CCG 0.66
NHS High Weald Lewes Havens CCG 0.64
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
BILLINGHAY MEDICAL PRACTICE C83030 8.8%
RUSKINGTON SURGERY C83013 8.6% • GP practice range of observed COLSTERWORTH SURGERY C83053 8.0% diabetes 5.5% to 8.8% MILLVIEW MEDICAL CENTRE C83011 8.0% • there are an estimated 1,578 people THE NEW SPRINGWELLS PRACTICE Y01652 8.0% with undiagnosed diabetes in NHS
LONG BENNINGTON SURGERY C83067 7.9% South West Lincolnshire CCG
ST. PETERS HILL SURGERY C83040 7.7%
THE HARROWBY LANE SURGERY C83080 7.5%
SWINGBRIDGE SURGERY C83008 7.5%
VINE STREET SURGERY C83075 7.4%
SLEAFORD MEDICAL GROUP C83023 7.2%
ANCASTER SURGERY C83020 7.1%
THE GLENSIDE COUNTRY PRACTICE C83024 7.1%
WOOLSTHORPE SURGERY C83628 7.0%
THE STACKYARD SURGERY C83653 6.8%
MARKET CROSS SURGERY C83649 6.2%
ST. JOHNS MEDICAL CENTRE C83048 5.9%
BELVOIR VALE SURGERY C82123 5.7% Note: The estimated number of undiagnosed THE WELBY PRACTICE C82076 5.5% people with diabetes has been calculated by 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 NHS Lincolnshire East CCG 8.8% 1.3% 12.9% diabetes in NHS South West Lincolnshire CCG is 8.8% (diagnosed and undiagnosed) • in addition, there are an estimated NHS South Lincolnshire CCG 7.3% 1.4% 12.3% 12.2% of people in NHS South West Lincolnshire CCG who are at increased risk of developing diabetes NHS South West Lincolnshire CCG 7.3% 1.5% 12.2% (i.e. with non-diabetic hyperglycaemia) • this means that 21.0% of the population in NHS South West NHS Lincolnshire West CCG 6.7% 1.4% 11.3% Lincolnshire 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 Survey for England (HSE) data. Five years of England 6.5% 1.9% 11.2% 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 South Lincolnshire CCG 63.1% • data on care processes and treatment targets are taken from the National Diabetes Audit (NDA) NHS Lincolnshire West CCG 62.2% • overall practice participation in the 2015/16 audit was 81.4% in England
• in NHS South West Lincolnshire NHS Lincolnshire East CCG 52.3% CCG, 14 out of 19 practices (73.7%) participated in the NDA. Data is not available for the remaining practices
NHS South West Lincolnshire CCG 44.6%
• 44.6% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS South West Lincolnshire CCG, compared to 52.6% in England
England 52.6%
0% 10% 20% 30% 40% 50% 60% 70%
47 CVD: Primary Care Intelligence Packs People with diabetes who had eight care processes by GP practice, 2015/16
GP practice Average of practices in the CCG who participated in the audit
ANCASTER SURGERY C83020 81.5%
BELVOIR VALE SURGERY C82123 80.4% • achievement - 8 care processes: in
LONG BENNINGTON SURGERY C83067 72.8% practices who provided data via the NDA, between 14.0% and 81.5% of THE GLENSIDE COUNTRY PRACTICE C83024 67.2% patients received all 8 care processes MARKET CROSS SURGERY C83649 63.2%
BILLINGHAY MEDICAL PRACTICE C83030 60.5% • at least 2,927 people did not receive THE NEW SPRINGWELLS PRACTICE Y01652 56.2% the eight care processes VINE STREET SURGERY C83075 54.6%
RUSKINGTON SURGERY C83013 48.1%
WOOLSTHORPE SURGERY C83628 32.5%
THE STACKYARD SURGERY C83653 25.8%
SLEAFORD MEDICAL GROUP C83023 21.2%
THE HARROWBY LANE SURGERY C83080 14.3%
ST. JOHNS MEDICAL CENTRE C83048 14.0%
COLSTERWORTH SURGERY C83053
ST. PETERS HILL SURGERY C83040
MILLVIEW MEDICAL CENTRE C83011
SWINGBRIDGE SURGERY C83008
THE WELBY PRACTICE C82076
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 Lincolnshire East CCG 42.3% • 38.5% of people with diabetes (of practices who participated in the audit) met the three treatment targets NHS South Lincolnshire CCG 41.6% in NHS South West Lincolnshire CCG, compared to 39.0% in England
NHS Lincolnshire West CCG 40.8%
NHS South West Lincolnshire CCG 38.5%
England 39.0%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
49 CVD: Primary Care Intelligence Packs People with diabetes who met all 3 treatment targets by GP practice, 2015/16
GP practice Average of practices in the CCG who participated in the audit
THE GLENSIDE COUNTRY PRACTICE C83024 49.2%
RUSKINGTON SURGERY C83013 46.9% • achievement - 3 treatment targets: in
MARKET CROSS SURGERY C83649 46.7% practices who provided data via the NDA, between 28.9% and 49.2% of SLEAFORD MEDICAL GROUP C83023 42.1% patients achieved all 3 treatment LONG BENNINGTON SURGERY C83067 41.4% targets VINE STREET SURGERY C83075 40.5% • at least 3,001 people did not meet the THE HARROWBY LANE SURGERY C83080 37.8% three treatment targets THE NEW SPRINGWELLS PRACTICE Y01652 35.5%
BILLINGHAY MEDICAL PRACTICE C83030 34.8%
BELVOIR VALE SURGERY C82123 33.6%
THE STACKYARD SURGERY C83653 32.9%
WOOLSTHORPE SURGERY C83628 32.8%
ST. JOHNS MEDICAL CENTRE C83048 31.8%
ANCASTER SURGERY C83020 28.9%
COLSTERWORTH SURGERY C83053
ST. PETERS HILL SURGERY C83040
MILLVIEW MEDICAL CENTRE C83011
SWINGBRIDGE SURGERY C83008
THE WELBY PRACTICE C82076
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
5% 0% -5% -10% -15% -20%
ANCASTER SURGERY 72
THE STACKYARD SURGERY 11 • using the GP cluster method of ST. JOHNS MEDICAL CENTRE 78 calculating potential gains, if each practice was to achieve as well as the WOOLSTHORPE SURGERY 8 upper quartile of its national cluster, BELVOIR VALE SURGERY 18 then an additional 315 people would be treated BILLINGHAY MEDICAL PRACTICE 33
THE NEW SPRINGWELLS PRACTICE 37
THE HARROWBY LANE SURGERY 20
VINE STREET SURGERY 21
LONG BENNINGTON SURGERY 13
SLEAFORD MEDICAL GROUP 4
MARKET CROSS SURGERY
RUSKINGTON SURGERY
THE GLENSIDE COUNTRY 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 Lincolnshire East CCG 1.05
• the ratio of those diagnosed with chronic kidney disease versus those NHS Lincolnshire West CCG 1.00 expected to have chronic kidney disease is 0.98. This compares to 0.68 for England • this suggests that 98% of people with NHS South West Lincolnshire CCG 0.98 chronic kidney disease have been diagnosed
NHS South Lincolnshire CCG 0.93
Note: This slide compares the prevalence of CKD recorded in QOF in 2015/16 to the expected prevalence of CKD produced by the University of Southampton in 2011. A small number of CCGs England 0.68 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 0.2 0.4 0.6 0.8 1.0 1.2 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.
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 West Lincolnshire CCG 0.98
NHS South Lincolnshire CCG 0.93
NHS Rushcliffe CCG 0.90
NHS Newark & Sherwood CCG 0.82
NHS South Worcestershire CCG 0.78
NHS South Cheshire CCG 0.75
NHS East Staffordshire CCG 0.67
NHS South Norfolk CCG 0.65
NHS High Weald Lewes Havens CCG 0.62
NHS Hambleton, Richmondshire and Whitby CCG 0.57
NHS West Suffolk CCG 0.52
0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio
55 CVD: Primary Care Intelligence Packs CKD prevalence by GP practice, 2015/16
GP practice CCG
MILLVIEW MEDICAL CENTRE C83011 10.5%
RUSKINGTON SURGERY C83013 9.3% • it is estimated that there are 174 ANCASTER SURGERY C83020 8.7% people with undiagnosed chronic BILLINGHAY MEDICAL PRACTICE C83030 8.3% kidney disease in NHS South West VINE STREET SURGERY C83075 7.8% Lincolnshire CCG
LONG BENNINGTON SURGERY C83067 7.5% • GP practice range of observed CKD: 2.2% to 10.5% THE NEW SPRINGWELLS PRACTICE Y01652 7.3%
SWINGBRIDGE SURGERY C83008 7.3%
THE GLENSIDE COUNTRY PRACTICE C83024 7.2%
ST. PETERS HILL SURGERY C83040 6.6%
SLEAFORD MEDICAL GROUP C83023 6.4%
BELVOIR VALE SURGERY C82123 6.0%
THE WELBY PRACTICE C82076 5.8%
MARKET CROSS SURGERY C83649 4.7%
COLSTERWORTH SURGERY C83053 4.6%
THE HARROWBY LANE SURGERY C83080 4.6%
ST. JOHNS MEDICAL CENTRE C83048 3.2% Note: CCG estimates for the estimated number of people with CKD are based on WOOLSTHORPE SURGERY C83628 2.7% applying a proportion from a resident based THE STACKYARD SURGERY C83653 2.2% population estimate to a GP registered population. The characteristics of registered 0% 2% 4% 6% 8% 10% 12% 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 South Lincolnshire CCG 77.4% • 6,939 people with CKD (diagnosed*) in NHS South West Lincolnshire CCG • 5,125 (73.9%) people whose blood NHS Lincolnshire West CCG 76.0% pressure is <= 140 /85 • 591 (8.5%) people who are exceptions • 1,223 (17.6%) additional people NHS Lincolnshire East CCG 75.2% whose blood pressure is not <= 140 / 85
NHS South West Lincolnshire CCG 73.9%
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 Rushcliffe CCG 76.7%
NHS South Worcestershire CCG 76.5%
NHS East Staffordshire CCG 76.1%
NHS Hambleton, Richmondshire and Whitby CCG 75.2%
NHS South Cheshire CCG 75.0%
NHS West Suffolk CCG 74.8%
NHS South West Lincolnshire CCG 73.9%
NHS South Norfolk CCG 73.7%
NHS High Weald Lewes Havens CCG 71.5%
NHS Newark & Sherwood CCG 71.5%
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
DR WOODING C83628 16
DR WELSH AND PARTNERS C83008 130 • in total, including exceptions, there THE HARROWBY LANE SURGERY C83080 70 are 1,814 people whose blood DR THOMPSON AND PARTNERS C82076 82 pressure is not <= 140 / 85 COLSTERWORTH SURGERY C83053 34 • GP practice range: 19.6% to 51.6%
DR PULLINGER AND PARTNERS C83067 127
THE STACKYARD SURGERY C83653 10
ANCASTER SURGERY C83020 179
BELVOIR VALE SURGERY C82123 45
ST. PETERS HILL SURGERY C83040 248
ST. JOHNS MEDICAL CENTRE C83048 96
DR RAY AND PARTNERS C83024 43
DR BHANDAL AND PARTNERS C83023 224
MARKET CROSS SURGERY C83649 36
DR PATEL AND PARTNERS C83075 95
RUSKINGTON SURGERY C83013 90
BILLINGHAY MEDICAL PRACTICE C83030 61
THE NEW SPRINGWELLS PRACTICE Y01652 76
DR VIJAYAN AND PARTNERS C83011 152
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
0% -5% -10% -15% -20% -25% -30% -35% -40%
DR WOODING 10
DR WELSH AND PARTNERS 70 THE HARROWBY LANE SURGERY 38 • using the GP cluster method of COLSTERWORTH SURGERY 16 calculating potential gains, if each
DR PULLINGER AND PARTNERS 61 practice was to achieve as well as the upper quartile of its national cluster, DR THOMPSON AND PARTNERS 39 then an additional 467 people would THE STACKYARD SURGERY 5 be treated BELVOIR VALE SURGERY 15
ANCASTER SURGERY 49
ST. PETERS HILL SURGERY 55
DR RAY AND PARTNERS 10
ST. JOHNS MEDICAL CENTRE 18
MARKET CROSS SURGERY 7
DR PATEL AND PARTNERS 15
RUSKINGTON SURGERY 15
DR BHANDAL AND PARTNERS 22
BILLINGHAY MEDICAL PRACTICE 6
THE NEW SPRINGWELLS PRACTICE 7
DR VIJAYAN AND PARTNERS 8 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 South West Lincolnshire CCG 83.9% • 6,939 people with CKD (diagnosed*) in NHS South West Lincolnshire CCG • 5,825 (83.9%) people who have a NHS Lincolnshire West CCG 78.3% record of urine albumin:creatinine ratio test • 219 (3.2%) people who are exceptions NHS South Lincolnshire CCG 77.9% • 895 (12.9%) additional people who have no record of urine albumin:creatinine ratio test
NHS Lincolnshire East CCG 73.3%
*Using the QOF clinical indicator CKD004 England 75.4% denominator plus exceptions. Note: as the CKD004 indicator was removed from the QOF in 15/16 this is historic data 0% 20% 40% 60% 80% 100% taken from the 2014/15 QOF.
61 CVD: Primary Care Intelligence Packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with demographically similar CCGs Recorded Not recorded Exceptions reported
NHS South West Lincolnshire CCG 83.9%
NHS Rushcliffe CCG 81.0%
NHS Hambleton, Richmondshire and Whitby CCG 78.3%
NHS South Lincolnshire CCG 77.9%
NHS South Norfolk CCG 77.4%
NHS East Staffordshire CCG 76.9%
NHS Newark & Sherwood CCG 76.8%
NHS South Worcestershire CCG 76.7%
NHS South Cheshire CCG 75.3%
NHS High Weald Lewes Havens CCG 73.0%
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
THE HARROWBY LANE SURGERY C83080 84
MARKET CROSS SURGERY C83649 39 • in total, including exceptions, there ST. JOHNS MEDICAL CENTRE C83048 87 are 1,114 people who have no record DR WOODING C83628 7 of urine albumin:creatinine ratio test DR RAY AND PARTNERS C83024 40 • GP practice range: 7.3% to 42.9%
DR PATEL AND PARTNERS C83075 89
BELVOIR VALE SURGERY C82123 32
ST. PETERS HILL SURGERY C83040 175
THE STACKYARD SURGERY C83653 6
DR THOMPSON AND PARTNERS C82076 42
THE NEW SPRINGWELLS PRACTICE Y01652 62
DR WELSH AND PARTNERS C83008 57
DR PULLINGER AND PARTNERS C83067 57
COLSTERWORTH SURGERY C83053 14
DR BHANDAL AND PARTNERS C83023 134
ANCASTER SURGERY C83020 65
RUSKINGTON SURGERY C83013 39
BILLINGHAY MEDICAL PRACTICE C83030 28
DR VIJAYAN AND PARTNERS C83011 57
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 Lincolnshire East CCG 1.08%
• prevalence of 1.08% in NHS South West Lincolnshire CCG compared to NHS South West Lincolnshire CCG 1.08% 0.76% in England
NHS South Lincolnshire CCG 1.01%
NHS Lincolnshire West CCG 0.78%
England 0.76%
0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2%
66 CVD: Primary Care Intelligence Packs Heart failure prevalence by CCG Comparison with demographically similar CCGs
NHS South West Lincolnshire CCG 1.08%
NHS South Lincolnshire CCG 1.01%
NHS South Cheshire CCG 0.98%
NHS Hambleton, Richmondshire and Whitby CCG 0.95%
NHS Newark & Sherwood CCG 0.94%
NHS South Worcestershire CCG 0.93%
NHS West Suffolk CCG 0.83%
NHS South Norfolk CCG 0.82%
NHS East Staffordshire CCG 0.80%
NHS Rushcliffe CCG 0.78%
NHS High Weald Lewes Havens CCG 0.73%
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
ST. PETERS HILL SURGERY C83040 2.2%
MILLVIEW MEDICAL CENTRE C83011 1.6% • 1,424 people with diagnosed heart LONG BENNINGTON SURGERY C83067 1.6% failure in NHS South West VINE STREET SURGERY C83075 1.4% Lincolnshire CCG MARKET CROSS SURGERY C83649 1.2% • GP practice range: 0.3% to 2.2%
BILLINGHAY MEDICAL PRACTICE C83030 0.9%
THE NEW SPRINGWELLS PRACTICE Y01652 0.9%
SLEAFORD MEDICAL GROUP C83023 0.9%
THE STACKYARD SURGERY C83653 0.9%
ANCASTER SURGERY C83020 0.8%
RUSKINGTON SURGERY C83013 0.8%
WOOLSTHORPE SURGERY C83628 0.8%
THE HARROWBY LANE SURGERY C83080 0.8%
ST. JOHNS MEDICAL CENTRE C83048 0.7%
SWINGBRIDGE SURGERY C83008 0.7%
COLSTERWORTH SURGERY C83053 0.6%
THE WELBY PRACTICE C82076 0.5%
BELVOIR VALE SURGERY C82123 0.4%
THE GLENSIDE COUNTRY PRACTICE C83024 0.3%
0.0% 0.5% 1.0% 1.5% 2.0% 2.5%
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 South West Lincolnshire CCG 87.3% • 654 people with heart failure* with LVSD in NHS South West Lincolnshire CCG NHS Lincolnshire East CCG 86.1% • 571 (87.3%) people treated with ACE- I or ARB • 83 (12.7%) people who are exceptions NHS Lincolnshire West CCG 83.0% • 0 (0%) additional people who are not treated with ACE-I or ARB
NHS South Lincolnshire CCG 79.9%
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 South Cheshire CCG 87.5%
NHS South West Lincolnshire CCG 87.3%
NHS South Norfolk CCG 85.9%
NHS Rushcliffe CCG 85.5%
NHS Newark & Sherwood CCG 84.6%
NHS South Worcestershire CCG 84.5%
NHS High Weald Lewes Havens CCG 82.7%
NHS East Staffordshire CCG 80.6%
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
THE WELBY PRACTICE C82076 3
WOOLSTHORPE SURGERY C83628 1 • in total, including exceptions, there THE STACKYARD SURGERY C83653 1 are 83 people who are not treated THE HARROWBY LANE SURGERY C83080 1 with ACE-I or ARB ST. JOHNS MEDICAL CENTRE C83048 3 • GP practice range: 0.0% to 33.3%
THE NEW SPRINGWELLS PRACTICE Y01652 2
BILLINGHAY MEDICAL PRACTICE C83030 2
RUSKINGTON SURGERY C83013 2
LONG BENNINGTON SURGERY C83067 8
THE GLENSIDE COUNTRY PRACTICE C83024 1
ST. PETERS HILL SURGERY C83040 38
MILLVIEW MEDICAL CENTRE C83011 4
ANCASTER SURGERY C83020 2
VINE STREET SURGERY C83075 8
SLEAFORD MEDICAL GROUP C83023 4
SWINGBRIDGE SURGERY C83008 2
MARKET CROSS SURGERY C83649 1
BELVOIR VALE SURGERY C82123
COLSTERWORTH SURGERY C83053
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 South West Lincolnshire CCG 79.2% • 571 people with heart failure* with LVSD treated with ACE-I/ARB in NHS South West Lincolnshire CCG NHS Lincolnshire East CCG 76.7% • 452 (79.2%) people treated with ACE- I/ARB and BB • 77 (13.5%) people who are exceptions NHS Lincolnshire West CCG 75.0% • 42 (7.4%) additional people who are not treated with ACE-I/ARB and BB
NHS South Lincolnshire CCG 72.4%
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 Hambleton, Richmondshire and Whitby CCG 81.3%
NHS South West Lincolnshire CCG 79.2%
NHS Newark & Sherwood CCG 78.9%
NHS West Suffolk CCG 78.7%
NHS South Worcestershire CCG 74.4%
NHS East Staffordshire CCG 74.1%
NHS High Weald Lewes Havens CCG 72.9%
NHS South Lincolnshire CCG 72.4%
NHS South Cheshire CCG 72.0%
NHS Rushcliffe CCG 71.8%
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
WOOLSTHORPE SURGERY C83628 1
RUSKINGTON SURGERY C83013 5 • in total, including exceptions, there THE WELBY PRACTICE C82076 2 are 119 people who are not treated THE GLENSIDE COUNTRY PRACTICE C83024 2 with ACE-I or ARB COLSTERWORTH SURGERY C83053 1 • GP practice range: 0.0% to 50.0%
LONG BENNINGTON SURGERY C83067 14
ANCASTER SURGERY C83020 4
ST. PETERS HILL SURGERY C83040 53
MILLVIEW MEDICAL CENTRE C83011 5
MARKET CROSS SURGERY C83649 4
ST. JOHNS MEDICAL CENTRE C83048 2
SWINGBRIDGE SURGERY C83008 5
SLEAFORD MEDICAL GROUP C83023 8
VINE STREET SURGERY C83075 12
THE NEW SPRINGWELLS PRACTICE Y01652 1
BELVOIR VALE SURGERY C82123
BILLINGHAY MEDICAL PRACTICE C83030
THE HARROWBY LANE SURGERY C83080
THE STACKYARD SURGERY C83653
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
74 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the STP Below 150/90 Not below 150/90 Exceptions reported
NHS South Lincolnshire CCG 91.0% • 5,582 people with coronary heart disease* in NHS South West Lincolnshire CCG NHS Lincolnshire West CCG 89.4% • 4,982 (89.3%) people whose blood pressure <= 150 / 90 • 150 (2.7%) people who are exceptions NHS South West Lincolnshire CCG 89.3% • 450 (8.1%) additional people whose blood pressure is not <= 150 / 90
NHS Lincolnshire East CCG 87.4%
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 Worcestershire CCG 91.5%
NHS Rushcliffe CCG 91.1%
NHS South Lincolnshire CCG 91.0%
NHS Hambleton, Richmondshire and Whitby CCG 91.0%
NHS South West Lincolnshire CCG 89.3%
NHS South Norfolk CCG 88.6%
NHS West Suffolk CCG 88.5%
NHS South Cheshire CCG 88.5%
NHS Newark & Sherwood CCG 87.8%
NHS East Staffordshire CCG 87.7%
NHS High Weald Lewes Havens CCG 86.0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
76 CVD: Primary Care Intelligence Packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice
Not below 150/90 Exceptions reported
SWINGBRIDGE SURGERY C83008 43
THE HARROWBY LANE SURGERY C83080 28 • in total, including exceptions, there LONG BENNINGTON SURGERY C83067 37 are 600 people whose blood pressure COLSTERWORTH SURGERY C83053 11 is not <= 150 / 90 ANCASTER SURGERY C83020 60 • GP practice range: 5.0% to 20.7%
ST. JOHNS MEDICAL CENTRE C83048 66
WOOLSTHORPE SURGERY C83628 6
THE WELBY PRACTICE C82076 22
ST. PETERS HILL SURGERY C83040 101
BELVOIR VALE SURGERY C82123 15
BILLINGHAY MEDICAL PRACTICE C83030 26
RUSKINGTON SURGERY C83013 32
SLEAFORD MEDICAL GROUP C83023 67
MARKET CROSS SURGERY C83649 15
THE GLENSIDE COUNTRY PRACTICE C83024 10
MILLVIEW MEDICAL CENTRE C83011 26
THE STACKYARD SURGERY C83653 3
VINE STREET SURGERY C83075 14
THE NEW SPRINGWELLS PRACTICE Y01652 18
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
4% 2% 0% -2% -4% -6% -8% -10% -12% -14% -16%
SWINGBRIDGE SURGERY 30
THE HARROWBY LANE SURGERY 16 LONG BENNINGTON SURGERY 19 • using the GP cluster method of COLSTERWORTH SURGERY 6 calculating potential gains, if each
WOOLSTHORPE SURGERY 3 practice was to achieve as well as the upper quartile of its national cluster, THE WELBY PRACTICE 10 then an additional 185 people would ANCASTER SURGERY 24 be treated ST. JOHNS MEDICAL CENTRE 25
ST. PETERS HILL SURGERY 31
BELVOIR VALE SURGERY 5
BILLINGHAY MEDICAL PRACTICE 8
RUSKINGTON SURGERY 6
MARKET CROSS SURGERY 2
THE GLENSIDE COUNTRY PRACTICE 0
MILLVIEW MEDICAL CENTRE
THE STACKYARD SURGERY
SLEAFORD MEDICAL GROUP
VINE STREET SURGERY
THE NEW SPRINGWELLS 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 South Lincolnshire CCG 92.6% • 5,582 people with coronary heart disease* in NHS South West Lincolnshire CCG NHS South West Lincolnshire CCG 92.0% • 5,137 (92%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant • 185 (3.3%) people who are NHS Lincolnshire West CCG 91.1% exceptions • 260 (4.7%) additional people who are not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant NHS Lincolnshire East CCG 90.6%
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 Rushcliffe CCG 93.5%
NHS West Suffolk CCG 93.0%
NHS South Worcestershire CCG 92.9%
NHS South Lincolnshire CCG 92.6%
NHS Newark & Sherwood CCG 92.1%
NHS South West Lincolnshire CCG 92.0%
NHS South Norfolk CCG 91.7%
NHS South Cheshire CCG 91.6%
NHS High Weald Lewes Havens CCG 91.4%
NHS East Staffordshire CCG 91.0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
80 CVD: Primary Care Intelligence Packs Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice
No treatment Exceptions reported
COLSTERWORTH SURGERY C83053 10
THE WELBY PRACTICE C82076 21 • in total, including exceptions, there SLEAFORD MEDICAL GROUP C83023 94 are 445 people are not taking aspirin, THE NEW SPRINGWELLS PRACTICE Y01652 40 an alternative anti-platelet therapy, or ST. JOHNS MEDICAL CENTRE C83048 54 an anti-coagulant
RUSKINGTON SURGERY C83013 36 • GP practice range: 2.0% to 12.8%
BELVOIR VALE SURGERY C82123 13
SWINGBRIDGE SURGERY C83008 17
ST. PETERS HILL SURGERY C83040 67
THE HARROWBY LANE SURGERY C83080 13
LONG BENNINGTON SURGERY C83067 16
MARKET CROSS SURGERY C83649 10
THE GLENSIDE COUNTRY PRACTICE C83024 7
BILLINGHAY MEDICAL PRACTICE C83030 12
WOOLSTHORPE SURGERY C83628 2
ANCASTER SURGERY C83020 15
VINE STREET SURGERY C83075 7
MILLVIEW MEDICAL CENTRE C83011 10
THE STACKYARD SURGERY C83653 1
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
81 CVD: Primary Care Intelligence Packs Some data on outcomes for people with cardiovascular disease
82 CVD: Primary Care Intelligence Packs Hospital admissions for coronary heart disease for all ages 2002/03 – 2015/16
NHS South West Lincolnshire CCG England 900
800 • in NHS South West Lincolnshire CCG, the hospital admission rate for 700 coronary heart disease in 2015/16 was 404.8 (544) compared to 527.9 for England 600
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 South West Lincolnshire CCG England 200
180 • in NHS South West Lincolnshire CCG, the hospital admission rate for 160 stroke in 2015/16 was 114.6 (153) compared to 172.8 for England 140
120
100
80
60 Age standardised standardised Age (per rate 100,000)
40
20
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 South West Lincolnshire CCG England
131.2% Angina 136.8% • The risk of a stroke was 93% higher and the risk of a heart attack was 124.2% 124.2% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 430.7% higher. 130.6% Heart failure 150.0%
93.0% Stroke 81.3%
430.7% Major amputation 445.8%
627.9% Minor amputation 753.5%
193.1% RRT 293.0%
0% 100% 200% 300% 400% 500% 600% 700% 800% Note: This slide uses data from the National Diabetes Audit (NDA)
85 CVD: Primary Care Intelligence Packs Deaths from coronary heart disease, under 75s
NHS South West Lincolnshire CCG England 90
80 • in NHS South West Lincolnshire CCG, the early mortality rate for 70 coronary heart disease in 2013-15 was 41.5, 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 South West Lincolnshire CCG England 30
• in NHS South West Lincolnshire 25 CCG, the early mortality rate for stroke in 2013-15 was 9, 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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