CVD: Primary Care Intelligence Packs NHS Wandsworth 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 Wandsworth CCG are: NHS Hammersmith and Fulham CCG NHS Merton CCG NHS Islington CCG NHS West London CCG NHS Haringey CCG NHS Ealing CCG NHS Brent CCG NHS Waltham Forest CCG NHS Bristol CCG NHS Hounslow 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 Haringey CCG 21.1%

NHS Bristol CCG 20.9% • prevalence of 16.4% in NHS Wandsworth CCG NHS Islington CCG 20.6%

NHS Waltham Forest CCG 19.7%

NHS Hammersmith and Fulham CCG 19.0%

NHS West London CCG 18.7%

NHS Brent CCG 16.9%

NHS Wandsworth CCG 16.4% Note: It has been found that the proportion of patients recorded as smokers correlates well NHS Hounslow CCG 16.2% with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, NHS Merton CCG 15.5% http://bmjopen.bmj.com/content/4/7/e005217.abs tract

NHS Ealing CCG 15.5% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are 0% 5% 10% 15% 20% 25% recorded as current smokers) divided by GP practice’s estimated number of patients 15+

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

GP Practice CCG

DANEBURY AVENUE SURGERY H85067 26.3% BATTERSEA FIELDS PRACTICE H85111 25.1% THE ALTON PRACTICE H85065 23.1% THE FALCON ROAD MEDICAL CENTRE H85002 22.9% MAYFIELD SURGERY H85006 22.3% • 53,220 people who are recorded as INNER PARK ROAD HEALTH CENTRE H85643 20.6% QUEENSTOWN ROAD MEDICAL PRACTICE H85003 20.4% smokers in NHS Wandsworth CCG THE ROEHAMPTON SURGERY H85008 20.3% CHATFIELD MEDICAL CENTRE H85047 20.2% • GP practice range: 0.6% to 26.3% TUDOR LODGE HEALTH CENTRE H85682 19.9% CLAPHAM JUNCTION MEDICAL PRACTICE H85088 19.0% THE PRACTICE FURZEDOWN H85695 18.8% STREATHAM PARK SURGERY H85052 18.8% THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 18.5% GRAFTON MEDICAL PARTNERS Y02423 18.5% BROCKLEBANK GROUP PRACTICE H85048 18.4% BRIDGE LANE GROUP PRACTICE H85045 18.4% TOOTING SOUTH MEDICAL CENTRE H85680 18.3% BALHAM HILL MEDICAL PRACTICE H85056 18.2% THE GREYSWOOD PRACTICE H85011 17.9% BEDFORD HILL FAMILY PRACTICE H85009 17.5% TRIANGLE SURGERY H85082 16.8% LAVENDER HILL GROUP PRACTICE H85069 16.6% WANDSWORTH MEDICAL CENTRE H85001 16.3% BEGG PRACTICE H85659 16.2% TRINITY MEDICAL CENTRE H85005 16.2% EARLSFIELD SURGERY H85041 15.8% TOOTING BEC SURGERY H85664 15.8% ST PAUL'S COTTAGE PRACTICE H85100 15.4% THE HAIDER PRACTICE H85075 14.3% BOLINGBROKE MEDICAL CENTRE (THMP) H85077 13.9% BALHAM HEALTH CENTRE H85637 13.5% THE HEATHBRIDGE PRACTICE H85061 13.1% DR KOONER AND PARTNERS H85007 12.9% PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 12.6% Note: This method is thought to be a reasonably OPEN DOOR SURGERY H85087 12.1% CHARTFIELD SURGERY Y01132 11.6% robust method in estimating smoking prevalence BALHAM PARK SURGERY H85066 11.5% for the majority of GP practices. However, BATTERSEA RISE GROUP PRACTICE H85049 10.7% ELBOROUGH STREET SURGERY H85057 10.5% caution is advised for extreme estimates of THURLEIGH ROAD PRACTICE H85114 8.8% smoking prevalence and those with high NIGHTINGALE HOUSE H85691 0.6% 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 Croydon CCG 0.57

• the ratio of those diagnosed with NHS Sutton CCG 0.57 hypertension versus those expected to have hypertension is 0.49. This compares to 0.59 for England NHS Kingston CCG 0.54 • this suggests that 49% of people with hypertension have been diagnosed

NHS Merton CCG 0.53

NHS Richmond CCG 0.53

NHS Wandsworth CCG 0.49

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

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

NHS Brent CCG 0.58

NHS Hounslow CCG 0.57

NHS Ealing CCG 0.57

NHS Waltham Forest CCG 0.56

NHS Haringey CCG 0.55

NHS Bristol CCG 0.54

NHS Merton CCG 0.53

NHS Hammersmith and Fulham CCG 0.51

NHS Islington CCG 0.50

NHS West London CCG 0.49

NHS Wandsworth CCG 0.49

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

OPEN DOOR SURGERY H85087 0.74 STREATHAM PARK SURGERY H85052 0.72 TUDOR LODGE HEALTH CENTRE H85682 0.62 DANEBURY AVENUE SURGERY H85067 0.61 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 0.60 TRINITY MEDICAL CENTRE H85005 0.56 • it is estimated that there are 31,953 EARLSFIELD SURGERY H85041 0.55 people with undiagnosed CHATFIELD MEDICAL CENTRE H85047 0.55 DR KOONER AND PARTNERS H85007 0.54 hypertension in NHS Wandsworth INNER PARK ROAD HEALTH CENTRE H85643 0.53 MAYFIELD SURGERY H85006 0.53 CCG BRIDGE LANE GROUP PRACTICE H85045 0.51 TRIANGLE SURGERY H85082 0.51 • GP practice range of observed to QUEENSTOWN ROAD MEDICAL PRACTICE H85003 0.50 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 0.49 expected hypertension prevalence BALHAM HEALTH CENTRE H85637 0.48 0.21 to 0.74 THE GREYSWOOD PRACTICE H85011 0.47 THE FALCON ROAD MEDICAL CENTRE H85002 0.47 BROCKLEBANK GROUP PRACTICE H85048 0.46 TOOTING SOUTH MEDICAL CENTRE H85680 0.46 GRAFTON MEDICAL PARTNERS Y02423 0.45 THE ALTON PRACTICE H85065 0.44 THE PRACTICE FURZEDOWN H85695 0.43 THE ROEHAMPTON SURGERY H85008 0.43 BATTERSEA FIELDS PRACTICE H85111 0.41 LAVENDER HILL GROUP PRACTICE H85069 0.41 BATTERSEA RISE GROUP PRACTICE H85049 0.39 ELBOROUGH STREET SURGERY H85057 0.38 BALHAM HILL MEDICAL PRACTICE H85056 0.37 BEDFORD HILL FAMILY PRACTICE H85009 0.35 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 0.35 ST PAUL'S COTTAGE PRACTICE H85100 0.35 THURLEIGH ROAD PRACTICE H85114 0.34 THE HEATHBRIDGE PRACTICE H85061 0.33 CHARTFIELD SURGERY Y01132 0.33 THE HAIDER PRACTICE H85075 0.32 BALHAM PARK SURGERY H85066 0.30 WANDSWORTH MEDICAL CENTRE H85001 0.28 BEGG PRACTICE H85659 0.27 TOOTING BEC SURGERY H85664 0.21 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 Richmond CCG 80.0%

• 32,039 people with hypertension NHS Kingston CCG 78.9% (diagnosed)* in NHS Wandsworth CCG • 25,019 (78.1%) people whose blood NHS Sutton CCG 78.6% pressure is <= 150/90 • 879 (2.7%) people who are excepted from optimal control NHS Croydon CCG 78.5% • 6,141 (19.2%) additional people whose blood pressure is not <= 150/90 NHS Wandsworth CCG 78.1%

NHS Merton CCG 77.3%

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 Brent CCG 79.8%

NHS Hounslow CCG 78.8%

NHS Ealing CCG 78.7%

NHS Wandsworth CCG 78.1%

NHS Bristol CCG 77.8%

NHS Waltham Forest CCG 77.7%

NHS West London CCG 77.6%

NHS Merton CCG 77.3%

NHS Islington CCG 76.7%

NHS Haringey CCG 74.7%

NHS Hammersmith and Fulham CCG 74.3%

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

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

No treatment Exceptions reported

THE ROEHAMPTON SURGERY H85008 213 THE PRACTICE FURZEDOWN H85695 89 BALHAM PARK SURGERY H85066 287 DANEBURY AVENUE SURGERY H85067 117 DR KOONER AND PARTNERS H85007 344 • in total, including exceptions, there TOOTING SOUTH MEDICAL CENTRE H85680 207 EARLSFIELD SURGERY H85041 313 are 7,020 people whose blood THURLEIGH ROAD PRACTICE H85114 165 BATTERSEA RISE GROUP PRACTICE H85049 115 pressure is not <= 150/90 TUDOR LODGE HEALTH CENTRE H85682 165 BEDFORD HILL FAMILY PRACTICE H85009 191 • GP practice range: 8.3% to 33.3% BROCKLEBANK GROUP PRACTICE H85048 317 GRAFTON MEDICAL PARTNERS Y02423 719 THE FALCON ROAD MEDICAL CENTRE H85002 197 ELBOROUGH STREET SURGERY H85057 81 TRINITY MEDICAL CENTRE H85005 287 MAYFIELD SURGERY H85006 166 BALHAM HEALTH CENTRE H85637 39 LAVENDER HILL GROUP PRACTICE H85069 207 BRIDGE LANE GROUP PRACTICE H85045 340 THE HAIDER PRACTICE H85075 65 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 74 WANDSWORTH MEDICAL CENTRE H85001 143 THE ALTON PRACTICE H85065 69 BATTERSEA FIELDS PRACTICE H85111 154 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 127 THE GREYSWOOD PRACTICE H85011 186 CHARTFIELD SURGERY Y01132 167 ST PAUL'S COTTAGE PRACTICE H85100 79 INNER PARK ROAD HEALTH CENTRE H85643 58 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 269 CHATFIELD MEDICAL CENTRE H85047 225 BEGG PRACTICE H85659 35 BALHAM HILL MEDICAL PRACTICE H85056 23 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 21 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 132 STREATHAM PARK SURGERY H85052 130 TOOTING BEC SURGERY H85664 16 THE HEATHBRIDGE PRACTICE H85061 155 OPEN DOOR SURGERY H85087 266 TRIANGLE SURGERY H85082 60 NIGHTINGALE HOUSE H85691 7 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 Wandsworth CCG 76.5%

• 119 people with a new diagnosis* of NHS Sutton CCG 74.7% hypertension with a CVD risk of 20% or higher in NHS Wandsworth CCG • 91 (76.5%) people who are currently NHS Merton CCG 72.0% treated with statins • 28 (23.5%) people who are exempted from treatment with statins NHS Croydon CCG 70.8% • 0 (0%) additional people who are not currently treated with statins

NHS Kingston CCG 69.6%

NHS Richmond CCG 66.2%

England 66.5%

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

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

NHS Hammersmith and Fulham CCG 84.4%

NHS Ealing CCG 83.4%

NHS Hounslow CCG 78.4%

NHS Wandsworth CCG 76.5%

NHS West London CCG 76.0%

NHS Islington CCG 74.5%

NHS Haringey CCG 74.3%

NHS Waltham Forest CCG 72.5%

NHS Merton CCG 72.0%

NHS Brent CCG 70.1%

NHS Bristol CCG 68.1%

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

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

No treatment Exceptions reported

THE HAIDER PRACTICE H85075 1 BEDFORD HILL FAMILY PRACTICE H85009 2 BATTERSEA FIELDS PRACTICE H85111 2 WANDSWORTH MEDICAL CENTRE H85001 1 MAYFIELD SURGERY H85006 2 • in total, including exceptions, there ELBOROUGH STREET SURGERY H85057 2 TRIANGLE SURGERY H85082 1 are 28 people who are not treated THURLEIGH ROAD PRACTICE H85114 1 THE GREYSWOOD PRACTICE H85011 2 with statins BRIDGE LANE GROUP PRACTICE H85045 3 BALHAM PARK SURGERY H85066 3 • GP practice range: 0.0% to 100.0% BALHAM HEALTH CENTRE H85637 1 INNER PARK ROAD HEALTH CENTRE H85643 1 GRAFTON MEDICAL PARTNERS Y02423 2 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 1 OPEN DOOR SURGERY H85087 1 THE HEATHBRIDGE PRACTICE H85061 1 LAVENDER HILL GROUP PRACTICE H85069 1 THE FALCON ROAD MEDICAL CENTRE H85002 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 TRINITY MEDICAL CENTRE H85005 DR KOONER AND PARTNERS H85007 THE ROEHAMPTON SURGERY H85008 CHATFIELD MEDICAL CENTRE H85047 BROCKLEBANK GROUP PRACTICE H85048 BATTERSEA RISE GROUP PRACTICE H85049 STREATHAM PARK SURGERY H85052 THE ALTON PRACTICE H85065 DANEBURY AVENUE SURGERY H85067 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 ST PAUL'S COTTAGE PRACTICE H85100 BEGG PRACTICE H85659 TOOTING BEC SURGERY H85664 TOOTING SOUTH MEDICAL CENTRE H85680 TUDOR LODGE HEALTH CENTRE H85682 THE PRACTICE FURZEDOWN H85695 CHARTFIELD SURGERY Y01132 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 NIGHTINGALE HOUSE H85691 BALHAM HILL MEDICAL PRACTICE H85056 EARLSFIELD SURGERY H85041 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 Richmond CCG 0.65

• the ratio of those diagnosed with atrial NHS Sutton CCG 0.63 fibrillation versus those expected to have atrial fibrillation is 0.57. This compares to 0.7 for England NHS Kingston CCG 0.60 • this suggests that 57% of people with atrial fibrillation have been diagnosed.

NHS Merton CCG 0.58

NHS Wandsworth CCG 0.57

NHS Croydon CCG 0.54

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

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

NHS Bristol CCG 0.74

NHS Hammersmith and Fulham CCG 0.65

NHS Islington CCG 0.62

NHS Ealing CCG 0.61

NHS Hounslow CCG 0.59

NHS Merton CCG 0.58

NHS West London CCG 0.58

NHS Wandsworth CCG 0.57

NHS Haringey CCG 0.52

NHS Waltham Forest CCG 0.51

NHS Brent CCG 0.47

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

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

GP practice CCG

THE ROEHAMPTON SURGERY H85008 0.8 BRIDGE LANE GROUP PRACTICE H85045 0.8 DANEBURY AVENUE SURGERY H85067 0.8 MAYFIELD SURGERY H85006 0.7 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 0.7 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 0.6 • it is estimated that there are 5,211 TRINITY MEDICAL CENTRE H85005 0.6 DR KOONER AND PARTNERS H85007 0.6 people with undiagnosed atrial BEDFORD HILL FAMILY PRACTICE H85009 0.6 fibrillation in NHS Wandsworth CCG THE GREYSWOOD PRACTICE H85011 0.6 EARLSFIELD SURGERY H85041 0.6 • GP practice range of observed to CHATFIELD MEDICAL CENTRE H85047 0.6 BROCKLEBANK GROUP PRACTICE H85048 0.6 expected atrial fibrillation prevalence BATTERSEA RISE GROUP PRACTICE H85049 0.6 STREATHAM PARK SURGERY H85052 0.6 0.3 to 0.8 THE ALTON PRACTICE H85065 0.6 BALHAM PARK SURGERY H85066 0.6 LAVENDER HILL GROUP PRACTICE H85069 0.6 ST PAUL'S COTTAGE PRACTICE H85100 0.6 BATTERSEA FIELDS PRACTICE H85111 0.6 THURLEIGH ROAD PRACTICE H85114 0.6 INNER PARK ROAD HEALTH CENTRE H85643 0.6 TUDOR LODGE HEALTH CENTRE H85682 0.6 CHARTFIELD SURGERY Y01132 0.6 WANDSWORTH MEDICAL CENTRE H85001 0.5 THE FALCON ROAD MEDICAL CENTRE H85002 0.5 ELBOROUGH STREET SURGERY H85057 0.5 THE HEATHBRIDGE PRACTICE H85061 0.5 GRAFTON MEDICAL PARTNERS Y02423 0.5 BALHAM HILL MEDICAL PRACTICE H85056 0.4 THE HAIDER PRACTICE H85075 0.4 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 0.4 TRIANGLE SURGERY H85082 0.4 OPEN DOOR SURGERY H85087 0.4 BEGG PRACTICE H85659 0.4 TOOTING BEC SURGERY H85664 0.4 THE PRACTICE FURZEDOWN H85695 0.4 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 0.4 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 0.3 BALHAM HEALTH CENTRE H85637 0.3 TOOTING SOUTH MEDICAL CENTRE H85680 0.3 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio

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

NHS Sutton CCG 82.3% • 2,382 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS Richmond CCG 77.3% NHS Wandsworth CCG • 1,788 (75.1%) people treated with anti-coagulation therapy NHS Merton CCG 77.3% • 272 (11.4%) people who are exceptions • 322 (13.5%) additional people with a NHS Wandsworth CCG 75.1% recorded CHA2DS2-VASc score >= 2 who are not treated

NHS Croydon CCG 72.8%

NHS Kingston CCG 71.6%

England 77.9%

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

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

NHS Bristol CCG 79.1%

NHS Merton CCG 77.3%

NHS Hounslow CCG 76.9%

NHS Hammersmith and Fulham CCG 76.4%

NHS Ealing CCG 75.9%

NHS West London CCG 75.9%

NHS Waltham Forest CCG 75.7%

NHS Wandsworth CCG 75.1%

NHS Haringey CCG 71.1%

NHS Brent CCG 68.3%

NHS Islington CCG 66.4%

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

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

No treatment Exceptions reported

NIGHTINGALE HOUSE H85691 13 THE ROEHAMPTON SURGERY H85008 46 DANEBURY AVENUE SURGERY H85067 12 ELBOROUGH STREET SURGERY H85057 9 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 9 • in total, including exceptions, there THE PRACTICE FURZEDOWN H85695 4 BALHAM PARK SURGERY H85066 26 are 594 people with a recorded MAYFIELD SURGERY H85006 23 TRINITY MEDICAL CENTRE H85005 28 CHA2DS2-VASc score >= 2 who are STREATHAM PARK SURGERY H85052 15 LAVENDER HILL GROUP PRACTICE H85069 20 not treated PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 41 • GP practice range: 0.0% to 50.0% GRAFTON MEDICAL PARTNERS Y02423 41 BATTERSEA RISE GROUP PRACTICE H85049 10 THE HEATHBRIDGE PRACTICE H85061 27 THE FALCON ROAD MEDICAL CENTRE H85002 14 THE HAIDER PRACTICE H85075 3 BALHAM HEALTH CENTRE H85637 2 BEGG PRACTICE H85659 3 THURLEIGH ROAD PRACTICE H85114 16 CHARTFIELD SURGERY Y01132 21 CHATFIELD MEDICAL CENTRE H85047 20 TRIANGLE SURGERY H85082 6 WANDSWORTH MEDICAL CENTRE H85001 11 BRIDGE LANE GROUP PRACTICE H85045 36 THE GREYSWOOD PRACTICE H85011 15 TUDOR LODGE HEALTH CENTRE H85682 7 BROCKLEBANK GROUP PRACTICE H85048 19 EARLSFIELD SURGERY H85041 20 BATTERSEA FIELDS PRACTICE H85111 12 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 12 BEDFORD HILL FAMILY PRACTICE H85009 13 ST PAUL'S COTTAGE PRACTICE H85100 6 INNER PARK ROAD HEALTH CENTRE H85643 4 THE ALTON PRACTICE H85065 5 DR KOONER AND PARTNERS H85007 16 OPEN DOOR SURGERY H85087 7 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 1 TOOTING SOUTH MEDICAL CENTRE H85680 1 BALHAM HILL MEDICAL PRACTICE H85056 TOOTING BEC SURGERY H85664 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

THE ROEHAMPTON SURGERY 30

DANEBURY AVENUE SURGERY 7

THE PRACTICE FURZEDOWN 2 • using the GP cluster method of BOLINGBROKE MEDICAL CENTRE (THMP) 5 calculating potential gains, if each BALHAM PARK SURGERY 13 practice was to achieve as well as the MAYFIELD SURGERY 12 upper quartile of its national cluster, then an additional 201 people would ELBOROUGH STREET SURGERY 4 be treated STREATHAM PARK SURGERY 7

LAVENDER HILL GROUP PRACTICE 8

TRINITY MEDICAL CENTRE 11

ST PAUL'S COTTAGE PRACTICE 1

INNER PARK ROAD HEALTH CENTRE 1

THE ALTON PRACTICE 0

OPEN DOOR SURGERY

DR KOONER AND PARTNERS

CLAPHAM JUNCTION MEDICAL PRACTICE

TOOTING SOUTH MEDICAL CENTRE

THE JUNCTION HTH CTR-REGISTERED PATIENTS

TOOTING BEC SURGERY

BALHAM HILL 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 Richmond CCG 85.8% • 3,103 people with a history of stroke or TIA* in NHS Wandsworth CCG NHS Sutton CCG 83.6% • 2,559 (82.5%) people whose blood pressure is <= 150 / 90 • 87 (2.8%) people who are exceptions NHS Croydon CCG 83.6% • 457 (14.7%) additional people whose blood pressure is not <= 150 / 90

NHS Kingston CCG 83.4%

NHS Wandsworth CCG 82.5%

NHS Merton CCG 82.3%

England 83.8%

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

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

NHS Hounslow CCG 84.6%

NHS Brent CCG 84.2%

NHS Ealing CCG 82.9%

NHS Waltham Forest CCG 82.9%

NHS Wandsworth CCG 82.5%

NHS Merton CCG 82.3%

NHS Islington CCG 82.0%

NHS Bristol CCG 81.9%

NHS West London CCG 81.3%

NHS Hammersmith and Fulham CCG 80.3%

NHS Haringey CCG 78.9%

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

DANEBURY AVENUE SURGERY H85067 12 THE ROEHAMPTON SURGERY H85008 28 THE PRACTICE FURZEDOWN H85695 9 BATTERSEA FIELDS PRACTICE H85111 22 DR KOONER AND PARTNERS H85007 28 • in total, including exceptions, there BALHAM PARK SURGERY H85066 24 WANDSWORTH MEDICAL CENTRE H85001 16 are 544 people whose blood pressure TUDOR LODGE HEALTH CENTRE H85682 13 BALHAM HILL MEDICAL PRACTICE H85056 2 is not <= 150 / 90 BRIDGE LANE GROUP PRACTICE H85045 26 THE GREYSWOOD PRACTICE H85011 18 • GP practice range: 0.0% to 32.4% TRINITY MEDICAL CENTRE H85005 24 GRAFTON MEDICAL PARTNERS Y02423 53 THE FALCON ROAD MEDICAL CENTRE H85002 18 BEDFORD HILL FAMILY PRACTICE H85009 18 ELBOROUGH STREET SURGERY H85057 7 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 27 TRIANGLE SURGERY H85082 8 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 4 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 11 THURLEIGH ROAD PRACTICE H85114 10 BROCKLEBANK GROUP PRACTICE H85048 18 EARLSFIELD SURGERY H85041 16 NIGHTINGALE HOUSE H85691 5 CHATFIELD MEDICAL CENTRE H85047 18 LAVENDER HILL GROUP PRACTICE H85069 14 BATTERSEA RISE GROUP PRACTICE H85049 5 THE HAIDER PRACTICE H85075 2 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 12 THE ALTON PRACTICE H85065 5 OPEN DOOR SURGERY H85087 17 STREATHAM PARK SURGERY H85052 11 TOOTING SOUTH MEDICAL CENTRE H85680 5 THE HEATHBRIDGE PRACTICE H85061 16 MAYFIELD SURGERY H85006 8 INNER PARK ROAD HEALTH CENTRE H85643 3 ST PAUL'S COTTAGE PRACTICE H85100 4 BALHAM HEALTH CENTRE H85637 1 CHARTFIELD SURGERY Y01132 5 BEGG PRACTICE H85659 1 TOOTING BEC SURGERY H85664 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 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 Merton CCG 92.8% • 1,907 people with a stroke shown to be non-haemorrhagic* in NHS NHS Richmond CCG 91.8% Wandsworth CCG • 1,722 (90.3%) people who are taking an anti-platetet agent or anti- NHS Sutton CCG 91.5% coagulant • 142 (7.4%) people who are exceptions NHS Croydon CCG 91.3% • 43 (2.3%) additional people with no treatment

NHS Wandsworth CCG 90.3%

NHS Kingston CCG 89.6%

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 Ealing CCG 93.0%

NHS Merton CCG 92.8%

NHS Hounslow CCG 91.8%

NHS Waltham Forest CCG 90.9%

NHS Bristol CCG 90.8%

NHS Brent CCG 90.4%

NHS Wandsworth CCG 90.3%

NHS Hammersmith and Fulham CCG 90.2%

NHS Islington CCG 89.1%

NHS Haringey CCG 88.3%

NHS West London CCG 87.3%

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

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

No treatment Exceptions reported

THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 1 TOOTING BEC SURGERY H85664 1 ELBOROUGH STREET SURGERY H85057 5 THE ALTON PRACTICE H85065 5 BATTERSEA RISE GROUP PRACTICE H85049 3 • in total, including exceptions, there THE HAIDER PRACTICE H85075 2 TRINITY MEDICAL CENTRE H85005 14 are 185 people who are not taking an TOOTING SOUTH MEDICAL CENTRE H85680 4 CHATFIELD MEDICAL CENTRE H85047 9 anti-platelet agent or anti-coagulant BALHAM HEALTH CENTRE H85637 2 THE FALCON ROAD MEDICAL CENTRE H85002 8 • GP practice range: 0.0% to 33.3% BEDFORD HILL FAMILY PRACTICE H85009 6 THE PRACTICE FURZEDOWN H85695 2 THE ROEHAMPTON SURGERY H85008 7 LAVENDER HILL GROUP PRACTICE H85069 7 TUDOR LODGE HEALTH CENTRE H85682 5 THE HEATHBRIDGE PRACTICE H85061 15 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 1 ST PAUL'S COTTAGE PRACTICE H85100 4 STREATHAM PARK SURGERY H85052 5 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 4 THE GREYSWOOD PRACTICE H85011 6 BATTERSEA FIELDS PRACTICE H85111 4 GRAFTON MEDICAL PARTNERS Y02423 16 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 5 BROCKLEBANK GROUP PRACTICE H85048 6 EARLSFIELD SURGERY H85041 6 DR KOONER AND PARTNERS H85007 7 MAYFIELD SURGERY H85006 4 DANEBURY AVENUE SURGERY H85067 1 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 6 CHARTFIELD SURGERY Y01132 4 BRIDGE LANE GROUP PRACTICE H85045 4 BALHAM PARK SURGERY H85066 3 WANDSWORTH MEDICAL CENTRE H85001 1 TRIANGLE SURGERY H85082 1 THURLEIGH ROAD PRACTICE H85114 1 BALHAM HILL MEDICAL PRACTICE H85056 OPEN DOOR SURGERY H85087 INNER PARK ROAD HEALTH CENTRE H85643 BEGG PRACTICE H85659 NIGHTINGALE HOUSE H85691 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 Sutton CCG 0.81 • 0.62 ratio of observed to expected diabetes prevalence in NHS NHS Kingston CCG 0.75 Wandsworth CCG, compared to 0.77 in England

NHS Merton CCG 0.74 • this suggests 62% of people have been diagnosed

NHS Croydon CCG 0.65

NHS Wandsworth CCG 0.62

NHS Richmond CCG 0.53

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

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

NHS Hounslow CCG 0.79

NHS Brent CCG 0.78

NHS Ealing CCG 0.76

NHS Merton CCG 0.74

NHS Bristol CCG 0.71

NHS Waltham Forest CCG 0.67

NHS Islington CCG 0.66

NHS Haringey CCG 0.65

NHS Wandsworth CCG 0.62

NHS Hammersmith and Fulham CCG 0.60

NHS West London CCG 0.56

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

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

GP practice CCG

NIGHTINGALE HOUSE H85691 17.4% OPEN DOOR SURGERY H85087 12.0% STREATHAM PARK SURGERY H85052 9.2% BALHAM HEALTH CENTRE H85637 9.2% THE ROEHAMPTON SURGERY H85008 7.6% • GP practice range of observed INNER PARK ROAD HEALTH CENTRE H85643 7.6% THE ALTON PRACTICE H85065 7.4% diabetes 1.1% to 17.4% DANEBURY AVENUE SURGERY H85067 7.3% THE PRACTICE FURZEDOWN H85695 7.3% • there are an estimated 8,649 people TRIANGLE SURGERY H85082 7.1% BOLINGBROKE MEDICAL CENTRE (THMP) H85077 6.8% with undiagnosed diabetes in NHS TRINITY MEDICAL CENTRE H85005 6.5% TOOTING SOUTH MEDICAL CENTRE H85680 6.1% Wandsworth CCG CHATFIELD MEDICAL CENTRE H85047 6.1% BALHAM HILL MEDICAL PRACTICE H85056 6.1% TUDOR LODGE HEALTH CENTRE H85682 5.8% THE GREYSWOOD PRACTICE H85011 5.8% MAYFIELD SURGERY H85006 5.7% GRAFTON MEDICAL PARTNERS Y02423 5.6% THE FALCON ROAD MEDICAL CENTRE H85002 5.4% CLAPHAM JUNCTION MEDICAL PRACTICE H85088 5.4% EARLSFIELD SURGERY H85041 5.1% BATTERSEA FIELDS PRACTICE H85111 4.6% DR KOONER AND PARTNERS H85007 4.2% QUEENSTOWN ROAD MEDICAL PRACTICE H85003 4.2% BROCKLEBANK GROUP PRACTICE H85048 4.2% THE HAIDER PRACTICE H85075 3.9% BRIDGE LANE GROUP PRACTICE H85045 3.9% BEDFORD HILL FAMILY PRACTICE H85009 3.5% LAVENDER HILL GROUP PRACTICE H85069 3.2% ST PAUL'S COTTAGE PRACTICE H85100 3.1% CHARTFIELD SURGERY Y01132 2.7% BATTERSEA RISE GROUP PRACTICE H85049 2.6% BALHAM PARK SURGERY H85066 2.3% BEGG PRACTICE H85659 2.3% THE HEATHBRIDGE PRACTICE H85061 2.2% ELBOROUGH STREET SURGERY H85057 2.0% TOOTING BEC SURGERY H85664 2.0% WANDSWORTH MEDICAL CENTRE H85001 2.0% PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 1.9% Note: The estimated number of undiagnosed THURLEIGH ROAD PRACTICE H85114 1.7% people with diabetes has been calculated by THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 1.1% multiplying the estimated prevalence rate to the 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 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 Croydon CCG 6.7% 3.6% 12.4% diabetes in NHS Wandsworth CCG is 7.0% (diagnosed and undiagnosed) NHS Merton CCG 6.0% 2.1% 10.9% • in addition, there are an estimated 9.0% of people in NHS Wandsworth NHS Sutton CCG 6.3% 1.5% 11.1% CCG who are at increased risk of developing diabetes (i.e. with non- diabetic hyperglycaemia) NHS Kingston CCG 4.9% 1.6% 9.6%

• this means that 16.0% of the NHS Richmond CCG 3.6% 3.2% 9.3% population in NHS Wandsworth CCG are estimated to have diabetes, or at high risk of developing of diabetes NHS Wandsworth CCG 4.3% 2.7% 9.0%

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 Kingston CCG 47.2%

• data on care processes and treatment NHS Sutton CCG 40.5% targets are taken from the National Diabetes Audit (NDA) • overall practice participation in the NHS Croydon CCG 39.7% 2015/16 audit was 81.4% in England

• in NHS Wandsworth CCG, 39 out of NHS Merton CCG 32.0% 44 practices (88.6%) participated in the NDA. Data is not available for the remaining practices NHS Wandsworth CCG 31.4%

• 31.4% of people with diabetes (of NHS Richmond CCG 26.4% practices who participated in the audit) had the eight recommended care processes in NHS Wandsworth 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

TRIANGLE SURGERY H85082 73.4% LAVENDER HILL GROUP PRACTICE H85069 72.4% TUDOR LODGE HEALTH CENTRE H85682 68.1% PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 67.4% • achievement - 8 care processes: in BRIDGE LANE GROUP PRACTICE H85045 59.6% BEDFORD HILL FAMILY PRACTICE H85009 58.7% practices who provided data via the QUEENSTOWN ROAD MEDICAL PRACTICE H85003 56.4% BATTERSEA RISE GROUP PRACTICE H85049 54.5% NDA, between 3.0% and 73.4% of OPEN DOOR SURGERY H85087 52.4% patients received all 8 care processes THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 47.2% MAYFIELD SURGERY H85006 46.2% THE HEATHBRIDGE PRACTICE H85061 42.4% BROCKLEBANK GROUP PRACTICE H85048 41.8% EARLSFIELD SURGERY H85041 38.3% • at least 8,741 people did not receive STREATHAM PARK SURGERY H85052 37.3% DR KOONER AND PARTNERS H85007 36.6% the eight care processes ST PAUL'S COTTAGE PRACTICE H85100 34.7% BATTERSEA FIELDS PRACTICE H85111 34.2% TOOTING BEC SURGERY H85664 34.0% TOOTING SOUTH MEDICAL CENTRE H85680 28.6% BEGG PRACTICE H85659 27.6% CHATFIELD MEDICAL CENTRE H85047 26.0% CLAPHAM JUNCTION MEDICAL PRACTICE H85088 23.3% DANEBURY AVENUE SURGERY H85067 21.0% THURLEIGH ROAD PRACTICE H85114 17.7% THE ALTON PRACTICE H85065 17.7% CHARTFIELD SURGERY Y01132 12.3% THE PRACTICE FURZEDOWN H85695 11.6% BALHAM PARK SURGERY H85066 10.7% GRAFTON MEDICAL PARTNERS Y02423 9.4% THE HAIDER PRACTICE H85075 8.5% THE GREYSWOOD PRACTICE H85011 8.1% WANDSWORTH MEDICAL CENTRE H85001 7.7% THE ROEHAMPTON SURGERY H85008 6.7% THE FALCON ROAD MEDICAL CENTRE H85002 5.1% TRINITY MEDICAL CENTRE H85005 5.0% BOLINGBROKE MEDICAL CENTRE (THMP) H85077 3.0% NIGHTINGALE HOUSE H85691 INNER PARK ROAD HEALTH CENTRE H85643 BALHAM HEALTH CENTRE H85637 ELBOROUGH STREET SURGERY H85057 BALHAM HILL MEDICAL PRACTICE H85056 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 Sutton CCG 40.2%

• 38.9% of people with diabetes (of NHS Richmond CCG 39.8% practices who participated in the audit) met the three treatment targets in NHS Wandsworth CCG, compared to 39.0% in England NHS Kingston CCG 39.6%

NHS Merton CCG 39.3%

NHS Wandsworth CCG 38.9%

NHS Croydon CCG 37.9%

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

TOOTING BEC SURGERY H85664 59.1% OPEN DOOR SURGERY H85087 52.0% STREATHAM PARK SURGERY H85052 49.6% ST PAUL'S COTTAGE PRACTICE H85100 48.5% • achievement - 3 treatment targets: in PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 47.1% THE HEATHBRIDGE PRACTICE H85061 47.1% practices who provided data via the MAYFIELD SURGERY H85006 45.0% DANEBURY AVENUE SURGERY H85067 44.1% NDA, between 26.4% and 59.1% of BRIDGE LANE GROUP PRACTICE H85045 43.9% patients achieved all 3 treatment THURLEIGH ROAD PRACTICE H85114 41.1% CLAPHAM JUNCTION MEDICAL PRACTICE H85088 40.5% targets EARLSFIELD SURGERY H85041 40.5% TRINITY MEDICAL CENTRE H85005 39.4% GRAFTON MEDICAL PARTNERS Y02423 38.4% • at least 6,810 people did not meet the BOLINGBROKE MEDICAL CENTRE (THMP) H85077 38.1% CHATFIELD MEDICAL CENTRE H85047 38.1% three treatment targets CHARTFIELD SURGERY Y01132 37.8% BROCKLEBANK GROUP PRACTICE H85048 37.3% BATTERSEA FIELDS PRACTICE H85111 37.0% THE GREYSWOOD PRACTICE H85011 36.8% TRIANGLE SURGERY H85082 36.7% TOOTING SOUTH MEDICAL CENTRE H85680 36.5% WANDSWORTH MEDICAL CENTRE H85001 36.1% DR KOONER AND PARTNERS H85007 35.3% LAVENDER HILL GROUP PRACTICE H85069 35.1% BEDFORD HILL FAMILY PRACTICE H85009 35.0% TUDOR LODGE HEALTH CENTRE H85682 34.6% BEGG PRACTICE H85659 34.6% BALHAM PARK SURGERY H85066 33.9% THE ALTON PRACTICE H85065 32.8% QUEENSTOWN ROAD MEDICAL PRACTICE H85003 31.8% THE FALCON ROAD MEDICAL CENTRE H85002 31.6% THE HAIDER PRACTICE H85075 29.1% THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 29.0% THE PRACTICE FURZEDOWN H85695 28.0% BATTERSEA RISE GROUP PRACTICE H85049 26.4% THE ROEHAMPTON SURGERY H85008 26.4% NIGHTINGALE HOUSE H85691 INNER PARK ROAD HEALTH CENTRE H85643 BALHAM HEALTH CENTRE H85637 ELBOROUGH STREET SURGERY H85057 BALHAM HILL MEDICAL PRACTICE H85056 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%

THE ROEHAMPTON SURGERY 59

THE PRACTICE FURZEDOWN 26

THE HAIDER PRACTICE 18 • using the GP cluster method of BATTERSEA RISE GROUP PRACTICE 19 calculating potential gains, if each THE JUNCTION HTH CTR-REGISTERED PATIENTS 9 practice was to achieve as well as the THE FALCON ROAD MEDICAL CENTRE 47 upper quartile of its national cluster, then an additional 675 people would QUEENSTOWN ROAD MEDICAL PRACTICE 26 be treated BALHAM PARK SURGERY 35

THE ALTON PRACTICE 22

BEGG PRACTICE 9

THURLEIGH ROAD PRACTICE 2

MAYFIELD SURGERY 1

DANEBURY AVENUE SURGERY

BRIDGE LANE GROUP PRACTICE

STREATHAM PARK SURGERY

ST PAUL'S COTTAGE PRACTICE

THE HEATHBRIDGE PRACTICE

PUTNEYMEAD GROUP MEDICAL PRACTICE

OPEN DOOR SURGERY

TOOTING BEC SURGERY 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 Sutton CCG 0.62

NHS Croydon CCG 0.61 • the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney NHS Merton CCG 0.60 disease is 0.42. This compares to 0.68 for England • this suggests that 42% of people with NHS Richmond CCG 0.42 chronic kidney disease have been diagnosed

NHS Kingston CCG 0.42

NHS Wandsworth CCG 0.42

Note: This slide compares the prevalence of CKD recorded in QOF in 2015/16 to the expected prevalence of CKD produced by the University of Southampton in 2011. A small number of CCGs have a ratio greater than 1. It is unlikely that all England 0.68 people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 the figures are underestimating the true CKD Ratio prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures.

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

NHS Bristol CCG 0.87

NHS Merton CCG 0.60

NHS Hounslow CCG 0.56

NHS Hammersmith and Fulham CCG 0.55

NHS Waltham Forest CCG 0.52

NHS Islington CCG 0.51

NHS Haringey CCG 0.50

NHS Brent CCG 0.49

NHS Ealing CCG 0.43

NHS Wandsworth CCG 0.42

NHS West London CCG 0.40

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

NIGHTINGALE HOUSE H85691 25.8% OPEN DOOR SURGERY H85087 4.4% DANEBURY AVENUE SURGERY H85067 3.2% MAYFIELD SURGERY H85006 3.1% TUDOR LODGE HEALTH CENTRE H85682 2.9% • it is estimated that there are 6,474 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 2.6% BRIDGE LANE GROUP PRACTICE H85045 2.6% people with undiagnosed chronic EARLSFIELD SURGERY H85041 2.5% INNER PARK ROAD HEALTH CENTRE H85643 2.0% kidney disease in NHS Wandsworth BALHAM HEALTH CENTRE H85637 2.0% STREATHAM PARK SURGERY H85052 1.9% CCG THE ALTON PRACTICE H85065 1.9% DR KOONER AND PARTNERS H85007 1.9% • GP practice range of observed CKD: THE GREYSWOOD PRACTICE H85011 1.8% 0.2% to 25.8% TRIANGLE SURGERY H85082 1.8% BEDFORD HILL FAMILY PRACTICE H85009 1.8% CHATFIELD MEDICAL CENTRE H85047 1.7% THE HEATHBRIDGE PRACTICE H85061 1.6% TRINITY MEDICAL CENTRE H85005 1.6% PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 1.5% BROCKLEBANK GROUP PRACTICE H85048 1.4% TOOTING SOUTH MEDICAL CENTRE H85680 1.4% BATTERSEA RISE GROUP PRACTICE H85049 1.4% BATTERSEA FIELDS PRACTICE H85111 1.3% ST PAUL'S COTTAGE PRACTICE H85100 1.3% THE FALCON ROAD MEDICAL CENTRE H85002 1.3% CHARTFIELD SURGERY Y01132 1.3% THURLEIGH ROAD PRACTICE H85114 1.2% LAVENDER HILL GROUP PRACTICE H85069 1.1% GRAFTON MEDICAL PARTNERS Y02423 1.0% BOLINGBROKE MEDICAL CENTRE (THMP) H85077 0.9% THE PRACTICE FURZEDOWN H85695 0.9% THE ROEHAMPTON SURGERY H85008 0.8% ELBOROUGH STREET SURGERY H85057 0.8% BALHAM HILL MEDICAL PRACTICE H85056 0.7% BALHAM PARK SURGERY H85066 0.7% CLAPHAM JUNCTION MEDICAL PRACTICE H85088 0.6% Note: CCG estimates for the estimated TOOTING BEC SURGERY H85664 0.6% THE HAIDER PRACTICE H85075 0.6% number of people with CKD are based on WANDSWORTH MEDICAL CENTRE H85001 0.5% applying a proportion from a resident based BEGG PRACTICE H85659 0.3% THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 0.2% population estimate to a GP registered population. The characteristics of registered 0% 5% 10% 15% 20% 25% 30% 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 Merton CCG 78.3% • 4,769 people with CKD (diagnosed*) in NHS Wandsworth CCG NHS Richmond CCG 76.2% • 3,598 (75.4%) people whose blood pressure is <= 140 /85 • 333 (7%) people who are exceptions NHS Sutton CCG 75.6% • 838 (17.6%) additional people whose blood pressure is not <= 140 / 85

NHS Croydon CCG 75.5%

NHS Wandsworth CCG 75.4%

NHS Kingston CCG 75.4%

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

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

NHS Merton CCG 78.3%

NHS Islington CCG 76.0%

NHS Waltham Forest CCG 75.8%

NHS Ealing CCG 75.7%

NHS Wandsworth CCG 75.4%

NHS Brent CCG 75.3%

NHS Hounslow CCG 74.9%

NHS Bristol CCG 74.4%

NHS West London CCG 73.3%

NHS Haringey CCG 71.7%

NHS Hammersmith and Fulham CCG 70.3%

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

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

Not below 140/85 Exceptions reported

M H KHAN H85650 1 THE PRACTICE FURZEDOWN H85695 14 N WILLIAMS H85049 36 TRINITY MEDICAL CENTRE H85005 54 P J ILVES H85067 28 H S KOONER H85007 67 • in total, including exceptions, there BRIDGE LANE GROUP PRACTICE H85045 107 are 1,171 people whose blood ELBOROUGH STREET SURGERY H85057 11 A M ALISSA H85065 21 pressure is not <= 140 / 85 TUDOR LODGE HEALTH CENTRE H85682 48 C M KROLL H85069 40 • GP practice range: 0.0% to 100.0% THE GREYSWOOD PRACTICE H85011 39 BALHAM HEALTH CENTRE H85637 8 C RIBEIRO H85009 51 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 47 D H GORDON H85041 58 MAYFIELD PRACTICE H85006 39 A KUMAR AND PARTNER H85056 3 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 5 THE JUNCTION HEALTH CENTRE Y02946 2 NIGHTINGALE HOUSE H85691 11 CHATFIELD MEDICAL CENTRE H85047 35 M SHIRAZ H85680 29 K BEGG H85659 3 GRAFTON MEDICAL PARTNERS Y02423 68 BALHAM PARK SURGERY H85066 25 THURLEIGH ROAD PRACTICE H85114 6 CHARTFIELD SURGERY Y01132 28 STREATHAM PARK SURGERY H85052 15 S HAIDER H85075 5 BATTERSEA FIELDS PRACTICE H85111 22 DR OKONMAH AND PARTNERS H85002 16 THE HEATHBRIDGE PRACTICE H85061 41 G B M WINSTOCK H85048 31 PATEL D. & PARTNERS H85082 13 MITTAL V.K. & PARTNERS H85087 52 THE HERITAGE MEDICAL CENTRE H85077 7 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 52 THE ROEHAMPTON SURGERY H85008 6 ST PAUL'S COTTAGE PRACTICE H85100 11 DR S A BOBAK H85001 10 M G IYER H85643 6 TOOTING BEC SURGERY H85664 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

20% 10% 0% -10% -20% -30% -40% -50%

THE PRACTICE FURZEDOWN 10

N WILLIAMS 21

P J ILVES 15 • using the GP cluster method of A M ALISSA 11 calculating potential gains, if each TUDOR LODGE HEALTH CENTRE 25 practice was to achieve as well as the TRINITY MEDICAL CENTRE 24 upper quartile of its national cluster, then an additional 349 people would C M KROLL 20 be treated THE GREYSWOOD PRACTICE 19

H S KOONER 27

BRIDGE LANE GROUP PRACTICE 43

PATEL D. & PARTNERS 1

MITTAL V.K. & PARTNERS 1

THE HERITAGE MEDICAL CENTRE

ST PAUL'S COTTAGE PRACTICE

DR S A BOBAK

THE ROEHAMPTON SURGERY

G B M WINSTOCK

M G IYER

PUTNEYMEAD GROUP MEDICAL PRACTICE

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

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

NHS Wandsworth CCG 76.7% • 4,769 people with CKD (diagnosed*) in NHS Wandsworth CCG NHS Merton CCG 74.4% • 3,656 (76.7%) people who have a record of urine albumin:creatinine ratio test NHS Croydon CCG 73.9% • 215 (4.5%) people who are exceptions • 898 (18.8%) additional people who NHS Sutton CCG 71.8% have no record of urine albumin:creatinine ratio test

NHS Richmond CCG 71.6%

NHS Kingston CCG 71.2%

*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 Islington CCG 77.2%

NHS Bristol CCG 76.8%

NHS Wandsworth CCG 76.7%

NHS Haringey CCG 76.0%

NHS Ealing CCG 75.5%

NHS Waltham Forest CCG 74.7%

NHS Brent CCG 74.4%

NHS Merton CCG 74.4%

NHS Hounslow CCG 74.1%

NHS West London CCG 73.5%

NHS Hammersmith and Fulham CCG 69.6%

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

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

Not recorded Exceptions reported

M H KHAN H85650 1 NIGHTINGALE HOUSE H85691 43 THE PRACTICE FURZEDOWN H85695 13 ELBOROUGH STREET SURGERY H85057 16 H S KOONER H85007 89 THE ROEHAMPTON SURGERY H85008 15 • in total, including exceptions, there C RIBEIRO H85009 65 are 1,113 people who have no record CHATFIELD MEDICAL CENTRE H85047 47 TUDOR LODGE HEALTH CENTRE H85682 45 of urine albumin:creatinine ratio test M SHIRAZ H85680 36 BALHAM PARK SURGERY H85066 31 • GP practice range: 0.0% to 100.0% STREATHAM PARK SURGERY H85052 21 DR OKONMAH AND PARTNERS H85002 24 GRAFTON MEDICAL PARTNERS Y02423 83 C M KROLL H85069 35 TRINITY MEDICAL CENTRE H85005 38 A KUMAR AND PARTNER H85056 3 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 41 D H GORDON H85041 47 PATEL D. & PARTNERS H85082 16 MAYFIELD PRACTICE H85006 30 THE GREYSWOOD PRACTICE H85011 25 A M ALISSA H85065 12 BRIDGE LANE GROUP PRACTICE H85045 59 BATTERSEA FIELDS PRACTICE H85111 21 BALHAM HEALTH CENTRE H85637 5 P J ILVES H85067 14 DR S A BOBAK H85001 12 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 57 S HAIDER H85075 4 N WILLIAMS H85049 11 THE HEATHBRIDGE PRACTICE H85061 35 MITTAL V.K. & PARTNERS H85087 48 CHARTFIELD SURGERY Y01132 20 G B M WINSTOCK H85048 27 ST PAUL'S COTTAGE PRACTICE H85100 10 THE JUNCTION HEALTH CENTRE Y02946 1 THE HERITAGE MEDICAL CENTRE H85077 5 M G IYER H85643 4 THURLEIGH ROAD PRACTICE H85114 2 TOOTING BEC SURGERY H85664 1 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 1 K BEGG H85659 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 Sutton CCG 0.54%

• prevalence of 0.32% in NHS NHS Merton CCG 0.48% Wandsworth CCG compared to 0.76% in England

NHS Croydon CCG 0.47%

NHS Richmond CCG 0.46%

NHS Kingston CCG 0.45%

NHS Wandsworth CCG 0.32%

England 0.76%

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

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

NHS Bristol CCG 0.64%

NHS Brent CCG 0.54%

NHS Hounslow CCG 0.51%

NHS Haringey CCG 0.50%

NHS Islington CCG 0.49%

NHS Merton CCG 0.48%

NHS Waltham Forest CCG 0.46%

NHS Ealing CCG 0.46%

NHS Hammersmith and Fulham CCG 0.41%

NHS West London CCG 0.40%

NHS Wandsworth CCG 0.32%

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

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

GP practice CCG

NIGHTINGALE HOUSE H85691 6.5% STREATHAM PARK SURGERY H85052 1.1% INNER PARK ROAD HEALTH CENTRE H85643 0.8% BALHAM HILL MEDICAL PRACTICE H85056 0.7% DANEBURY AVENUE SURGERY H85067 0.6% • 1,231 people with diagnosed heart OPEN DOOR SURGERY H85087 0.5% CHATFIELD MEDICAL CENTRE H85047 0.4% failure in NHS Wandsworth CCG BALHAM HEALTH CENTRE H85637 0.4% BOLINGBROKE MEDICAL CENTRE (THMP) H85077 0.4% • GP practice range: 0.0% to 6.5% THE ROEHAMPTON SURGERY H85008 0.4% BRIDGE LANE GROUP PRACTICE H85045 0.4% TRIANGLE SURGERY H85082 0.4% QUEENSTOWN ROAD MEDICAL PRACTICE H85003 0.4% TRINITY MEDICAL CENTRE H85005 0.4% BEDFORD HILL FAMILY PRACTICE H85009 0.4% MAYFIELD SURGERY H85006 0.4% EARLSFIELD SURGERY H85041 0.4% THE HEATHBRIDGE PRACTICE H85061 0.4% DR KOONER AND PARTNERS H85007 0.3% BATTERSEA FIELDS PRACTICE H85111 0.3% LAVENDER HILL GROUP PRACTICE H85069 0.3% THE GREYSWOOD PRACTICE H85011 0.3% THE FALCON ROAD MEDICAL CENTRE H85002 0.3% THE PRACTICE FURZEDOWN H85695 0.3% GRAFTON MEDICAL PARTNERS Y02423 0.3% BATTERSEA RISE GROUP PRACTICE H85049 0.3% CLAPHAM JUNCTION MEDICAL PRACTICE H85088 0.3% TUDOR LODGE HEALTH CENTRE H85682 0.3% BALHAM PARK SURGERY H85066 0.3% PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 0.3% TOOTING SOUTH MEDICAL CENTRE H85680 0.3% CHARTFIELD SURGERY Y01132 0.3% THE HAIDER PRACTICE H85075 0.2% TOOTING BEC SURGERY H85664 0.2% BROCKLEBANK GROUP PRACTICE H85048 0.2% THE ALTON PRACTICE H85065 0.2% BEGG PRACTICE H85659 0.2% ST PAUL'S COTTAGE PRACTICE H85100 0.2% THURLEIGH ROAD PRACTICE H85114 0.2% WANDSWORTH MEDICAL CENTRE H85001 0.2% ELBOROUGH STREET SURGERY H85057 0.1% THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%

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

NHS Richmond CCG 90.8% • 430 people with heart failure* with LVSD in NHS Wandsworth CCG NHS Kingston CCG 88.7% • 371 (86.3%) people treated with ACE- I or ARB • 59 (13.7%) people who are NHS Sutton CCG 88.1% exceptions • 0 (0%) additional people who are not treated with ACE-I or ARB NHS Merton CCG 87.3%

NHS Wandsworth CCG 86.3%

NHS Croydon CCG 85.7%

England 84.7%

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

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

NHS Hounslow CCG 91.5%

NHS Ealing CCG 91.5%

NHS Waltham Forest CCG 88.7%

NHS Brent CCG 88.4%

NHS Merton CCG 87.3%

NHS Wandsworth CCG 86.3%

NHS Hammersmith and Fulham CCG 84.8%

NHS Bristol CCG 83.6%

NHS Haringey CCG 83.3%

NHS West London CCG 82.7%

NHS Islington CCG 81.7%

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

WANDSWORTH MEDICAL CENTRE H85001 2 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 4 STREATHAM PARK SURGERY H85052 9 BALHAM PARK SURGERY H85066 6 THE FALCON ROAD MEDICAL CENTRE H85002 4 • in total, including exceptions, there TRINITY MEDICAL CENTRE H85005 1 THE HAIDER PRACTICE H85075 1 are 59 people who are not treated TUDOR LODGE HEALTH CENTRE H85682 1 ELBOROUGH STREET SURGERY H85057 1 with ACE-I or ARB TRIANGLE SURGERY H85082 2 THE PRACTICE FURZEDOWN H85695 1 • GP practice range: 0.0% to 40.0% GRAFTON MEDICAL PARTNERS Y02423 6 BRIDGE LANE GROUP PRACTICE H85045 5 BATTERSEA FIELDS PRACTICE H85111 2 BEDFORD HILL FAMILY PRACTICE H85009 1 CHATFIELD MEDICAL CENTRE H85047 5 LAVENDER HILL GROUP PRACTICE H85069 2 CHARTFIELD SURGERY Y01132 1 THE HEATHBRIDGE PRACTICE H85061 2 MAYFIELD SURGERY H85006 1 BROCKLEBANK GROUP PRACTICE H85048 1 OPEN DOOR SURGERY H85087 1 DR KOONER AND PARTNERS H85007 THE ROEHAMPTON SURGERY H85008 THE GREYSWOOD PRACTICE H85011 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 EARLSFIELD SURGERY H85041 BATTERSEA RISE GROUP PRACTICE H85049 BALHAM HILL MEDICAL PRACTICE H85056 THE ALTON PRACTICE H85065 DANEBURY AVENUE SURGERY H85067 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 ST PAUL'S COTTAGE PRACTICE H85100 THURLEIGH ROAD PRACTICE H85114 BALHAM HEALTH CENTRE H85637 INNER PARK ROAD HEALTH CENTRE H85643 BEGG PRACTICE H85659 TOOTING BEC SURGERY H85664 TOOTING SOUTH MEDICAL CENTRE H85680 NIGHTINGALE HOUSE H85691 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 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 Croydon CCG 84.6% • 371 people with heart failure* with LVSD treated with ACE-I/ARB in NHS NHS Wandsworth CCG 82.2% Wandsworth CCG • 305 (82.2%) people treated with ACE- I/ARB and BB NHS Merton CCG 79.9% • 48 (12.9%) people who are exceptions • 18 (4.9%) additional people who are NHS Richmond CCG 78.9% not treated with ACE-I/ARB and BB

NHS Sutton CCG 75.0%

NHS Kingston CCG 74.0%

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 Ealing CCG 83.6%

NHS Islington CCG 82.9%

NHS Hounslow CCG 82.8%

NHS Brent CCG 82.5%

NHS Wandsworth CCG 82.2%

NHS Haringey CCG 81.4%

NHS Bristol CCG 81.2%

NHS Merton CCG 79.9%

NHS Waltham Forest CCG 74.5%

NHS Hammersmith and Fulham CCG 74.0%

NHS West London CCG 73.4%

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

QUEENSTOWN ROAD MEDICAL PRACTICE H85003 4 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 1 BEGG PRACTICE H85659 1 TOOTING BEC SURGERY H85664 2 CHARTFIELD SURGERY Y01132 3 • in total, including exceptions, there NIGHTINGALE HOUSE H85691 2 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 4 are 66 people who are not treated THE ROEHAMPTON SURGERY H85008 3 BATTERSEA FIELDS PRACTICE H85111 3 with ACE-I or ARB BATTERSEA RISE GROUP PRACTICE H85049 2 DANEBURY AVENUE SURGERY H85067 1 • GP practice range: 0.0% to 66.7% LAVENDER HILL GROUP PRACTICE H85069 3 GRAFTON MEDICAL PARTNERS Y02423 7 BALHAM PARK SURGERY H85066 3 THE GREYSWOOD PRACTICE H85011 1 EARLSFIELD SURGERY H85041 1 STREATHAM PARK SURGERY H85052 4 BRIDGE LANE GROUP PRACTICE H85045 5 BEDFORD HILL FAMILY PRACTICE H85009 1 OPEN DOOR SURGERY H85087 3 DR KOONER AND PARTNERS H85007 2 THE HEATHBRIDGE PRACTICE H85061 3 CHATFIELD MEDICAL CENTRE H85047 4 BROCKLEBANK GROUP PRACTICE H85048 2 THE FALCON ROAD MEDICAL CENTRE H85002 1 WANDSWORTH MEDICAL CENTRE H85001 TRINITY MEDICAL CENTRE H85005 MAYFIELD SURGERY H85006 BALHAM HILL MEDICAL PRACTICE H85056 ELBOROUGH STREET SURGERY H85057 THE ALTON PRACTICE H85065 THE HAIDER PRACTICE H85075 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 TRIANGLE SURGERY H85082 ST PAUL'S COTTAGE PRACTICE H85100 THURLEIGH ROAD PRACTICE H85114 BALHAM HEALTH CENTRE H85637 INNER PARK ROAD HEALTH CENTRE H85643 TOOTING SOUTH MEDICAL CENTRE H85680 TUDOR LODGE HEALTH CENTRE H85682 THE PRACTICE FURZEDOWN H85695 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 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 Richmond CCG 90.2% • 5,412 people with coronary heart disease* in NHS Wandsworth CCG NHS Merton CCG 89.5% • 4,818 (89%) people whose blood pressure <= 150 / 90 • 138 (2.5%) people who are NHS Wandsworth CCG 89.0% exceptions • 456 (8.4%) additional people whose blood pressure is not <= 150 / 90 NHS Croydon CCG 88.9%

NHS Sutton CCG 87.9%

NHS Kingston CCG 87.7%

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 Brent CCG 89.8%

NHS Merton CCG 89.5%

NHS Wandsworth CCG 89.0%

NHS Waltham Forest CCG 88.9%

NHS Ealing CCG 88.0%

NHS Hounslow CCG 87.9%

NHS Islington CCG 87.2%

NHS Bristol CCG 86.9%

NHS West London CCG 86.5%

NHS Haringey CCG 85.7%

NHS Hammersmith and Fulham CCG 83.9%

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

THE ROEHAMPTON SURGERY H85008 44 THE PRACTICE FURZEDOWN H85695 14 TRINITY MEDICAL CENTRE H85005 44 EARLSFIELD SURGERY H85041 28 BALHAM PARK SURGERY H85066 22 • in total, including exceptions, there DANEBURY AVENUE SURGERY H85067 9 BROCKLEBANK GROUP PRACTICE H85048 29 are 594 people whose blood pressure TOOTING SOUTH MEDICAL CENTRE H85680 16 THE FALCON ROAD MEDICAL CENTRE H85002 19 is not <= 150 / 90 ELBOROUGH STREET SURGERY H85057 8 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 19 • GP practice range: 0.0% to 27.0% STREATHAM PARK SURGERY H85052 17 GRAFTON MEDICAL PARTNERS Y02423 65 CLAPHAM JUNCTION MEDICAL PRACTICE H85088 6 BEDFORD HILL FAMILY PRACTICE H85009 17 THURLEIGH ROAD PRACTICE H85114 11 DR KOONER AND PARTNERS H85007 22 BALHAM HILL MEDICAL PRACTICE H85056 3 LAVENDER HILL GROUP PRACTICE H85069 13 MAYFIELD SURGERY H85006 12 BALHAM HEALTH CENTRE H85637 4 CHATFIELD MEDICAL CENTRE H85047 19 TUDOR LODGE HEALTH CENTRE H85682 13 BRIDGE LANE GROUP PRACTICE H85045 25 BATTERSEA FIELDS PRACTICE H85111 13 THE ALTON PRACTICE H85065 8 TRIANGLE SURGERY H85082 10 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 21 THE HAIDER PRACTICE H85075 3 BATTERSEA RISE GROUP PRACTICE H85049 5 THE GREYSWOOD PRACTICE H85011 12 NIGHTINGALE HOUSE H85691 2 CHARTFIELD SURGERY Y01132 8 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 5 INNER PARK ROAD HEALTH CENTRE H85643 4 OPEN DOOR SURGERY H85087 13 BEGG PRACTICE H85659 1 WANDSWORTH MEDICAL CENTRE H85001 4 ST PAUL'S COTTAGE PRACTICE H85100 2 THE HEATHBRIDGE PRACTICE H85061 4 TOOTING BEC SURGERY H85664 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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

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

THE ROEHAMPTON SURGERY 32

THE PRACTICE FURZEDOWN 11

TRINITY MEDICAL CENTRE 24 • using the GP cluster method of BALHAM PARK SURGERY 13 calculating potential gains, if each DANEBURY AVENUE SURGERY 5 practice was to achieve as well as the THE FALCON ROAD MEDICAL CENTRE 11 upper quartile of its national cluster, then an additional 224 people would TOOTING SOUTH MEDICAL CENTRE 9 be treated EARLSFIELD SURGERY 13

QUEENSTOWN ROAD MEDICAL PRACTICE 10

CLAPHAM JUNCTION MEDICAL PRACTICE 3

BATTERSEA RISE GROUP PRACTICE

PUTNEYMEAD GROUP MEDICAL PRACTICE

OPEN DOOR SURGERY

WANDSWORTH MEDICAL CENTRE

INNER PARK ROAD HEALTH CENTRE

BEGG PRACTICE

ST PAUL'S COTTAGE PRACTICE

THE HEATHBRIDGE PRACTICE

THE JUNCTION HTH CTR-REGISTERED PATIENTS

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

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

NHS Wandsworth CCG 93.0% • 5,412 people with coronary heart disease* in NHS Wandsworth CCG NHS Kingston CCG 92.9% • 5,031 (93%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant NHS Merton CCG 92.9% • 173 (3.2%) people who are exceptions • 208 (3.8%) additional people who are NHS Richmond CCG 92.4% not taking aspirin, an alternative anti- platelet therapy, or an anti-coagulant

NHS Croydon CCG 92.2%

NHS Sutton CCG 91.4%

England 91.8%

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

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

NHS Brent CCG 93.3%

NHS Wandsworth CCG 93.0%

NHS Merton CCG 92.9%

NHS Ealing CCG 92.8%

NHS Islington CCG 92.0%

NHS Waltham Forest CCG 92.0%

NHS Bristol CCG 91.8%

NHS Hounslow CCG 91.8%

NHS Haringey CCG 91.4%

NHS West London CCG 88.4%

NHS Hammersmith and Fulham CCG 87.9%

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

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

No treatment Exceptions reported

CLAPHAM JUNCTION MEDICAL PRACTICE H85088 11 THE JUNCTION HTH CTR-REGISTERED PATIENTS Y02946 1 THE ROEHAMPTON SURGERY H85008 27 THE PRACTICE FURZEDOWN H85695 8 TRINITY MEDICAL CENTRE H85005 32 • in total, including exceptions, there CHATFIELD MEDICAL CENTRE H85047 23 BATTERSEA RISE GROUP PRACTICE H85049 7 are 381 people are not taking aspirin, THE FALCON ROAD MEDICAL CENTRE H85002 14 BALHAM HEALTH CENTRE H85637 4 an alternative anti-platelet therapy, or BATTERSEA FIELDS PRACTICE H85111 13 TUDOR LODGE HEALTH CENTRE H85682 11 an anti-coagulant BALHAM PARK SURGERY H85066 12 • GP practice range: 0.0% to 22.5% THE HAIDER PRACTICE H85075 3 LAVENDER HILL GROUP PRACTICE H85069 10 CHARTFIELD SURGERY Y01132 11 STREATHAM PARK SURGERY H85052 10 BALHAM HILL MEDICAL PRACTICE H85056 2 NIGHTINGALE HOUSE H85691 2 PUTNEYMEAD GROUP MEDICAL PRACTICE H85012 17 BRIDGE LANE GROUP PRACTICE H85045 17 QUEENSTOWN ROAD MEDICAL PRACTICE H85003 10 ELBOROUGH STREET SURGERY H85057 4 TRIANGLE SURGERY H85082 7 DR KOONER AND PARTNERS H85007 13 THE ALTON PRACTICE H85065 5 MAYFIELD SURGERY H85006 7 EARLSFIELD SURGERY H85041 10 INNER PARK ROAD HEALTH CENTRE H85643 4 DANEBURY AVENUE SURGERY H85067 3 THE GREYSWOOD PRACTICE H85011 8 GRAFTON MEDICAL PARTNERS Y02423 24 BROCKLEBANK GROUP PRACTICE H85048 9 TOOTING SOUTH MEDICAL CENTRE H85680 5 BOLINGBROKE MEDICAL CENTRE (THMP) H85077 4 THE HEATHBRIDGE PRACTICE H85061 10 THURLEIGH ROAD PRACTICE H85114 4 WANDSWORTH MEDICAL CENTRE H85001 4 BEDFORD HILL FAMILY PRACTICE H85009 5 OPEN DOOR SURGERY H85087 9 ST PAUL'S COTTAGE PRACTICE H85100 1 BEGG PRACTICE H85659 TOOTING BEC SURGERY H85664 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 Wandsworth CCG England 900

800 • in NHS Wandsworth CCG, the hospital admission rate for coronary 700 heart disease in 2015/16 was 496.2 (838) 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 Wandsworth CCG England 250

• in NHS Wandsworth CCG, the hospital admission rate for stroke in 200 2015/16 was 208.7 (341) 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 Wandsworth CCG England

116.4% Angina 136.8% • The risk of a stroke was 90.7% higher and the risk of a heart attack was 82.9% 82.9% higher compared to people Heart Attack 108.6% without diabetes. The risk of a major amputation was 330.1% higher. 115.8% Heart failure 150.0%

90.7% Stroke 81.3%

330.1% Major amputation 445.8%

686.3% Minor amputation 753.5%

247.0% 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 Wandsworth CCG England 90

80 • in NHS Wandsworth CCG, the early mortality rate for coronary heart 70 disease in 2013-15 was 45.8, 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 Wandsworth CCG England 35

• in NHS Wandsworth CCG, the early 30 mortality rate for stroke in 2013-15 was 16.6, compared to 13.6 for England 25

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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