Neighbourhood Profiles Picton Summer 2018 1 | Page READER INFORMATION Title Neighbourhood Profiles Team Liverpool CCG Business Intelligence Team; Liverpool City Council Public Health Epidemiology Team Author(s) Andrea Hutchinson, Sophie Kelly, and Kate Hodgkiss Contributor(s) Liverpool City Council Social Services Analysis Team; Liverpool Community Health Analysis Team Reviewer(s) Neighbourhood Clinical Leads; Locality Clinical Leads; Liverpol CCG Primary Care Team; Liverpool CCG Business Intelligence Team: Liverpool City Council Public Health Team; Liverpool Community Health Intelligence and Public Health Teams Circulated to Neighbourhood Clinical and Managerial Leads; Liverpool GP Bulletin; Liverpool CCG employees including Primary Care Team and Programme Managers; Adult Social Services (LCC); Public Health (LCC); Liverpool Community Health Version 1.0 Status Final Date of release July 2018 Review date To be confirmed Purpose The packs are intended to support Health and Social Care partners to understand the neighbourhoods they serve. They will support neighbourhoods in understanding health inequalities that may exist for their population and subsequently how they may want to configure services around patients. Description This series of reports contain intelligence about each of the reconfigured 12 General Practice Neighbourhoods in Liverpool. The information benchmarks each neighbourhood against its peers so they can understand the the relative need, management and service utilisation of people in their area. The pack contains information on wider determinants of health, health, social care and community services. Reference JSNA Documents The Joint Strategic Needs Assessment (JSNA) identifies the key issues affecting the health and wellbeing of local people, both now and in the future. The JSNA looks at the strategic needs of Liverpool, as well as issues such as inequalities between different populations who live in the city. It is the main source of information on health and wellbeing, and acts as a reference for commissioners and policy makers across the Health & Care system. All the JSNA material is available via: www.liverpool.gov.uk/jsna PCQF The Primary Care Quality Framework (PCQF) is a suite of indicators which are monitored on a monthly basis across all practices, neighbourhoods and localities in the city. It brings together indicators taken from various sources including QOF and GP spec. Many of the indicators are monitored using data extracted directly from practice systems, whilst others use hospital datasets or nationally published data. The aim of the framework is to improve quality and reduce variation in primary care. When practices identify that there may be scope for improvement against a particular indicator, they can choose to include it in their practice development plan. You can access the PCQF via Aristotle 2 | Page Contents 1. Potential Areas to Focus ..........................................................................................................................4 2. Introduction .............................................................................................................................................6 2.1 GP Practices .....................................................................................................................................6 2.2 Population Size .................................................................................................................................6 2.3 Registered Patient Ward Alignment ................................................................................................6 2.4 Service Provision ..............................................................................................................................7 2.5 Service Assets for Health and Wellbeing .........................................................................................9 3. Neighbourhood Map ............................................................................................................................. 12 4. Population Map..................................................................................................................................... 13 5. Comorbidities for People with Long Term Conditions .......................................................................... 15 6. Population Structure, Demographics, Risk Factors and Determinants of Health ................................. 16 7. Neighbourhood Health Profile .............................................................................................................. 16 See separate Metadata document for indicator definitions, sources and timeframes. 3 | Page 1. Potential Areas to Focus • Prevention A high take up of NHS Health Checks is important to identify early signs of poor health leading to opportunities for early interventions. The role of the NHS Health Check is to assess the patient’s level of risk of heart disease, stroke, kidney disease and diabetes, give feedback about that level of risk and provide information about how the patient can reduce their risk. Picton has the second lowest completion rate for NHS health checks (5 years cumulative) among the neighbourhoods. Smoking remains the biggest single cause of preventable mortality and morbidity in the world. Smoking prevalence is the fourth highest in Liverpool at 27%, equating to 9,679 people, while referrals for smoking cessation are significantly below the Liverpool average. People who consume alcohol above recommended levels are significantly less likely to be offered brief interventions (87.7% compared to 90.4% citywide). High blood pressure is the second biggest risk factor for premature death and disability yet is often preventable. People aged 45 and over are significantly less likely to have their blood pressure recorded compared to the Liverpool average, 88.8% compared to 91.1%, the lowest in the city. Uptake rates for seasonal flu vaccine are among the lowest in Liverpool. Compared to the Liverpool average, Picton has significantly lower rates of GP prescribed user dependent contraception and long acting reversible contraception (LARC) per 1,000 females aged 15-44. • Children Picton has a significantly higher proportion of children under 10 years old compared to the city level. The rate of troubled families is significantly above the Liverpool average. The percentage of children achieving the expected standard in reading, writing and mathematics at Key Stage 2 is the second lowest in the city. Around 38 children and young people (0-25 years) have a serious mental illness, the third highest level in Liverpool. Take up rates for childhood immunisations and vaccinations are among the lowest in Liverpool. • Mental Health Levels of unemployment in Picton are significantly above the Liverpool average, the psychosocial effects of which include may stigma, isolation and loss of self-worth leading to poorer mental health. Picton has both the highest prevalence of serious mental illness (SMI) and emergency admission rate for mental health in Liverpool. Smoking prevalence among people with SMI is significantly above the city average, while physical checks, documentation of a care plan, recording of blood pressuring and alcohol consumption, as well as cervical screening among people with SMI are among the lowest in Liverpool. The percentage of people on lithium therapy with a record of serum creatinine and TSH in the last 9 months is the lowest in the neighbourhoods. Adults in Picton who are newly diagnosed with depression are least likely to have their care reviewed after diagnosis (53.7% compared to 61.9% citywide). Violent crime in Picton is significantly above the city average. • CVD Secondary Prevention Atrial Fibrillation is the most common sustained cardiac arrhythmia and if left untreated is a significant risk factor for stroke and other morbidities. Increasing screening by pulse palpation for atrial fibrillation in people aged 65+ can help to prevent stroke. Pulse checks among people aged 65 years and over without an AF diagnosis are the second lowest in Liverpool (around 1,261 eligible people did not have a pulse check). People with AF are less likely to have their risk of stroke assessed using CHA2DS2-VASc system (64.4% compared to 80.8% citywide). Compared to the Liverpool average people with hypertension in Picton are significantly less to have their blood pressure controlled to less than 150/90 or have their physical activity recorded. Regular measurement of INR levels is an essential component in the management of patients receiving warfarin treatment; recording of INR for people on warfarin is the lowest in the city (89.0% compared to 96.3% citywide). • Long Term Conditions People aged 40+ years in Picton are significantly more likely to have at least three long term conditions (8.4% compared to 7.9% citywide). Prevalence of Diabetes, COPD, CKD (Stages 1-5) and Serious Mental Illness are significantly above the Liverpool average. Polypharmacy (10 or more prescriptions) is significantly above the city level. Diabetes prevalence is the highest in 4 | Page the city. Picton performs significantly worse than the Liverpool average for management of diabetes in primary care, with blood sugar control (HbA1c), recording of micro albumin, BMI and creatinine, foot checks among the lowest in Liverpool. Picton has the third lowest rates among the neighbourhoods for recording of FEV1 and annual reviews among people with COPD while the percentage of eligible persons with COPD