CVD: Primary Care Intelligence Packs

Transcription

1 CVD: Primary Care Intelligence Packs NHS North Manchester CCG June 207 Version

2 Contents. Introduction 3 2. CVD prevention The narrative The data 3 3. Hypertension 4. Stroke 5. Diabetes 6. Kidney 7. Heart The narrative 6 The data 7 The narrative 27 The data 28 The narrative 42 The data 43 The narrative 53 The data 54 The narrative 65 The data Outcomes 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

3 Introduction 3

4 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

5 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

6 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 0 most similar CCGs in terms of demography, ethnicity and deprivation. For information on the methodology used to calculate the 0 most similar CCGs please go to: The 0 most similar CCGs to NHS North Manchester CCG are: NHS Birmingham South and Central CCG NHS Heywood, Middleton and Rochdale CCG NHS Leeds South and East CCG NHS Salford CCG NHS Bolton CCG NHS Oldham CCG NHS Wolverhampton CCG NHS Bradford Districts CCG NHS Sandwell and West Birmingham CCG NHS Stoke On Trent CCG The majority of data used in the packs is taken from the 205/6 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 205/6 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

7 Why does variation matter? The variation that exists between demographically similar CCGs and between practices illustrates the local potential to improve care and outcomes for our patients Benchmarking is helpful because it highlights variation. Of course it has long been acknowledged that some variation is inevitable in the healthcare and outcomes experienced by patients. But John Wennberg, who has championed research into clinical variation over four decades and who founded the pioneering Dartmouth Atlas of Health Care, concluded that much variation is unwarranted ie it cannot be explained on the basis of illness, medical evidence, or patient preference, but is accounted for by the willingness and ability of doctors to offer treatment. A key observation about benchmarking data is that it does not tell us why there is variation. Some of the variation may be explained by population or case mix and some may be unwarranted. We will not know unless we investigate. Benchmarking may not be conclusive. Its strength lies not in the answers it provides but in the questions it generates for CCGs and practices. For example:. How much variation is there in detection, management, exception reporting and outcomes? 2. How many people would benefit if average performers improved to the level of the best performers? 3. How many people would benefit if the lowest performers matched the achievement of the average? 4. What are better performers doing differently in the way they provide services in order to achieve better outcomes? 5. How can the CCG support low and average performers to help them match the achievement of the best? 6. How can we build clinical leadership to drive quality improvement? 7 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 allows us to identify the practices that need support to implement the strategies adopted by low excepting practices.

8 Cluster methodology: your most similar practices Each practice has been grouped on the basis of demographic data into 5 national clusters. These demographic factors cover: deprivation (practice level) age profile (% < 5, % < 8, % 5-24, % 65+, % 75+, % 85+) ethnicity (% population of white ethnicity) practice population side These demographic factors closely align with those used to calculate the Similar 0 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 5 practice clusters is available here: 8

9 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% -0% -5% -20% WELLINGTON ROAD SURGERY EMERSONS GREEN MEDICAL CENTRE LEAP VALLEY MEDICAL CENTRE CHRISTCHURCH FAMILY MEDICAL CENTRE CONISTON MEDICAL PRACTICE FROME VALLEY MEDICAL CENTRE ST MARY STREET SURGERY Raw difference between the practice value and the average of the highest or lowest 50% of similar cluster practices KINGSWOOD HEALTH CENTRE CONCORD MEDICAL CENTRE KENNEDY WAY SURGERY BRADLEY STOKE SURGERY THE WILLOW SURGERY CLOSE FARM SURGERY The difference between the benchmark and the selected practices is displayed on this chart. The benchmark will PILNING SURGERY most likely be different for different practices as they are in different clusters, so the difference is the key measure COURTSIDE SURGERY here. If the practice performance is below the benchmark, the difference is applied to the denominator plus exceptions ALMONDSBURY to SURGERY demonstrate potential gains on a practice basis. The potential gains on a CCG basis are calculated based on the difference between the top 5 performing closest CCGs and the selected CCG, applied to the denominator plus exceptions. STOKE GIFFORD MEDICAL CENTRE ORCHARD MEDICAL CENTRE WEST WALK SURGERY THORNBURY HEALTH CENTRE - BURNEY 9 Potential opportunity if the practice value was to move to the average of the highest 50% of similar cluster practices Potential opportunity if the CCG value were to move to the average of the top 5 performing closest CCGs

10 CVD prevention 0

11 CVD prevention The NHS needs a radical upgrade in prevention if it is to be sustainable 5 year Forward View 204 This is because England faces an epidemic of largely preventable non-communicable diseases, such as heart disease and stroke, cancer, Type 2 diabetes and liver disease. Dietary risks Tobacco smoke High body-mass index High systolic blood pressure Alcohol and drug use High fasting plasma glucose High total cholesterol Low glomerular filtration rate Low physical activity Occupational risks Air pollution Low bone mineral density Child and maternal malnutrition Sexual abuse and violence Other environmental risks Unsafe sex Unsafe water/ sanitation/ handwashing HIV/AIDS and tuberculosis Diarrhea, lower respiratory & other common infectious diseases Neglected tropical diseases & malaria Maternal disorders Neonatal disorders Nutritional deficiencies Other communicable, maternal, neonatal, & nutritional diseases Neoplasms Cardiovascular diseases Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases Musculoskeletal disorders Other non-communicable diseases Transport injuries Unintentional injuries Self-harm and interpersonal violence Forces of nature, war, & legal intervention 0% % 2% 3% 4% 5% 6% 7% 8% 9% 0% % 2% Percent of total disability-adjusted life-years (DALYs) The Global Burden of Disease Study (next slide) shows us that the leading causes of premature mortality include diet, tobacco, obesity, raised blood pressure, physical inactivity and raised cholesterol. The radical upgrade in prevention needs population-level approaches. But it also needs interventions in primary care for individuals with behavioural and clinical risk factors. The size of the prevention problem 2/3 of adults are obese or overweight /3 of adults are physically inactive average smoking prevalence is 7% but is much higher in some communities in high risk conditions like atrial fibrillation, high blood pressure, diabetes and high ten year CVD risk score, up to half of all people do not receive preventive treatments that are known to be highly effective at preventing heart attacks and strokes around 90% of people with familial hypercholesterolaemia are undiagnosed and untreated despite their average 0 year reduction in life expectancy Social prescribing and wellbeing hubs offer new models for supporting behaviour change while reducing burden on general practice. The NHS Health Check is a systematic approach to identifying local people at high risk of CVD, offering behaviour change support and early detection of the high risk but often undiagnosed conditions such as hypertension, atrial fibrillation, CKD, diabetes and prediabetes. Question: What proportion of our local eligible population is receiving the NHS Health Check and how effective is the follow-up management of their clinical risk factors in primary care?

12 Global Burden of Disease Study 205 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% % 2% 3% 4% 5% 6% 7% 8% 9% 0% Percentage of total CVD disability-adjusted life-years (DALYs) 2

13 Estimated smoking prevalence (QOF) by CCG Comparison with demographically similar CCGs NHS North Manchester CCG 24.6% NHS Leeds South and East CCG NHS Salford CCG 23.8% 22.7% prevalence of 24.6% in NHS North Manchester CCG NHS Bradford Districts CCG 22.7% NHS Stoke On Trent CCG 22.6% NHS Heywood, Middleton and Rochdale CCG 22.2% NHS Oldham CCG 2.5% NHS Bolton CCG NHS Wolverhampton CCG NHS Sandwell and West Birmingham CCG 20.3% 20.2% 9.8% Note: It has been found that the proportion of patients recorded as smokers correlates well with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, tract NHS Birmingham South and Central CCG 8.7% 0% 5% 0% 5% 20% 25% 30% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 5+ who are recorded as current smokers) divided by GP practice s estimated number of patients 5+ 3

14 Estimated smoking prevalence (QOF) by GP practice GP Practice CCG BROOKDALE SURGERY P84062 WILLOWBANK SURGERY P84679 MP VICTORIA MILL Y0695 FERNCLOUGH SURGERY P84605 DAM HEAD MEDICAL CENTRE P84690 CHARLESTOWN MD Y02325 NEW ISLINGTON MEDICAL CENTRE P84064 DROYLSDEN RD FAMILY PRACTICE P84047 CONRAN MEDICAL CENTRE P84040 FIVE OAKS FAMILIY PRACTICE P84004 DR MOKASHI P84032 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 THE MAZHARI & KHAN PRACTICE P84637 BEACON MEDICAL CENTRE P84033 THE SINGH MEDICAL PRACTICE P84065 WHITLEY ROAD MEDICAL CENTRE P84054 THE NEVILLE FAMILY CENTRE P84663 SIMPSON MEDICAL PRACTICE Y02520 ST GEORGE'S MEDICAL CENTRE P84025 VALENTINE MEDICAL CENTRE P8409 NEWTON HEATH MEDICAL CENTRE P84070 FLORENCE HOUSE MEDICAL PRACTICE P84042 THE AVENUE MEDICAL CENTRE P84049 EASTLANDS MEDICAL CENTRE P8405 CORNERSTONE FAMILY PRACTICE P8404 WELLFIELD MEDICAL CENTRE P84074 LIME SQUARE MEDICAL CENTRE P84059 PARKVIEW MEDICAL CENTRE P84645 ARTANE MEDICAL CENTRE P8463 CHEETHAM HILL PRIMARY CARE CENTRE P84046 HAZELDENE MEDICAL CENTRE P84067 NEW COLLEGIATE MEDICAL CENTRE P84030 CITY HEALTH CENTRE Y02849 QUEENS MEDICAL CENTRE P84640 ALEESHAN MEDICAL CENTRE P84623 JOLLY MEDICAL CENTRE P % 35.0% 32.6% 32.5% 32.4% 3.6% 30.5% 29.8% 28.9% 28.5% 28.4% 28.3% 28.2% 28.% 28.0% 27.6% 27.5% 26.7% 26.4% 25.8% 24.3% 24.% 24.% 23.8% 23.7% 22.4% 22.2% 2.6% 2.0% 2.0% 8.6% 8.0% 5.2% 3.8% 3.5% 3.0% 0% 5% 0% 5% 20% 25% 30% 35% 40% 45% 40,080 people who are recorded as smokers in NHS North Manchester CCG GP practice range: 3.0% to 38.6% Note: This method is thought to be a reasonably robust method in estimating smoking prevalence for the majority of GP practices. However, caution is advised for extreme estimates of smoking prevalence and those with high numbers of smoking status not recorded and exceptions. 4

15 Hypertension 5

16 Hypertension The Global Burden of Disease Study confirmed high blood pressure as a leading cause of premature death and disability High blood pressure is common and costly it affects around a quarter of all adults the NHS costs of hypertension are around 2bn social costs are probably considerably higher 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 factor for chronic kidney disease and cognitive decline treatment is very effective every 0mmHg reduction in systolic blood pressure lowers risk of heart attack and stroke by 20% despite this 4 out of 0 adults with hypertension, over 5 and a half million people in England, remain undiagnosed and even when the condition is identified, treatment is often suboptimal, with blood pressure poorly controlled in about out of 3 individuals The Missing Millions On average, each CCG in England has 26,000 residents with undiagnosed hypertension these individuals are unaware of their increased cardiovascular risk and are untreated. What questions should we ask in our CCG?. for each indicator how wide is the variation in 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 average or below average to perform as well as the best in: detection of hypertension management of hypertension What might help? support practices to share audit data and systematically identify gaps and opportunities for improved detection and management of hypertension work with practices and local authorities to maximise uptake and follow up in the NHS Health Check support access to self-test BP stations in waiting rooms and to ambulatory blood pressure monitoring. commission community pharmacists to offer blood pressure measurement, diagnosis and management support, including support for adherence to medication 6

17 Hypertension observed prevalence compared with expected prevalence by CCG Comparison with CCGs in the STP NHS Wigan Borough CCG 0.6 NHS Tameside And Glossop CCG NHS Stockport CCG NHS Trafford CCG NHS Bolton CCG NHS Heywood, Middleton And Rochdale CCG the ratio of those diagnosed with hypertension versus those expected to have hypertension is This compares to 0.59 for England this suggests that 56% of people with hypertension have been diagnosed NHS Oldham CCG 0.59 NHS Bury CCG 0.58 NHS Salford CCG 0.57 NHS North Manchester CCG 0.56 NHS South Manchester CCG 0.55 NHS Central Manchester CCG 0.5 England Ratio Note: this slide shows Hypertension prevalence estimates created using data from QOF hypertension registers 204/5 and Undiagnosed hypertension estimates for adults 6 years and older Department of Primary Care & Public Health, Imperial College London 7

18 Hypertension observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs NHS Stoke On Trent CCG 0.62 NHS Bradford Districts CCG 0.62 NHS Bolton CCG 0.59 NHS Heywood, Middleton and Rochdale CCG 0.59 NHS Sandwell and West Birmingham CCG 0.59 NHS Oldham CCG 0.59 NHS Wolverhampton CCG 0.59 NHS Leeds South and East CCG 0.58 NHS Salford CCG 0.57 NHS North Manchester CCG 0.56 NHS Birmingham South and Central CCG % 0% 20% 30% 40% 50% 60% 70% 8

19 Hypertension observed prevalence compared with expected prevalence by GP practice GP practice CCG THE AVENUE MEDICAL CENTRE P84049 DR MOKASHI P84032 JOLLY MEDICAL CENTRE P84684 FERNCLOUGH SURGERY P84605 WILLOWBANK SURGERY P84679 HAZELDENE MEDICAL CENTRE P84067 THE MAZHARI & KHAN PRACTICE P84637 ST GEORGE'S MEDICAL CENTRE P84025 DROYLSDEN RD FAMILY PRACTICE P84047 BROOKDALE SURGERY P84062 CONRAN MEDICAL CENTRE P84040 WELLFIELD MEDICAL CENTRE P84074 EASTLANDS MEDICAL CENTRE P8405 ALEESHAN MEDICAL CENTRE P84623 THE SINGH MEDICAL PRACTICE P84065 BEACON MEDICAL CENTRE P84033 WHITLEY ROAD MEDICAL CENTRE P84054 LIME SQUARE MEDICAL CENTRE P84059 NEWTON HEATH MEDICAL CENTRE P84070 NEW COLLEGIATE MEDICAL CENTRE P84030 PARKVIEW MEDICAL CENTRE P84645 FIVE OAKS FAMILIY PRACTICE P84004 VALENTINE MEDICAL CENTRE P8409 MP VICTORIA MILL Y0695 FLORENCE HOUSE MEDICAL PRACTICE P84042 CORNERSTONE FAMILY PRACTICE P8404 THE NEVILLE FAMILY CENTRE P84663 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 ARTANE MEDICAL CENTRE P8463 CHEETHAM HILL PRIMARY CARE CENTRE P84046 NEW ISLINGTON MEDICAL CENTRE P84064 QUEENS MEDICAL CENTRE P84640 CHARLESTOWN MD Y02325 SIMPSON MEDICAL PRACTICE Y02520 DAM HEAD MEDICAL CENTRE P84690 CITY HEALTH CENTRE Y it is estimated that there are 7,846 people with undiagnosed hypertension in NHS North Manchester CCG GP practice range of observed to expected hypertension prevalence 0.2 to Ratio 9

20 Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 2 months) is 50/90 mmhg or less by CCG Comparison with CCGs in the STP NHS Wigan Borough CCG 82.0% NHS Bury CCG NHS Stockport CCG NHS Tameside And Glossop CCG NHS Bolton CCG NHS Heywood, Middleton And Rochdale CCG NHS Salford CCG NHS Trafford CCG 8.9% 8.9% 8.4% 8.4% 8.0% 79.8% 79.7% 23,592 people with hypertension (diagnosed)* in NHS North Manchester CCG 8,423 (78.%) people whose blood pressure is <= 50/ (4%) people who are excepted from optimal control 4,23 (7.9%) additional people whose blood pressure is not <= 50/90 NHS Oldham CCG 79.7% NHS North Manchester CCG 78.% NHS Central Manchester CCG 76.8% NHS South Manchester CCG 75.0% England 79.6% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% *Using QOF clinical indicator HYP006 denominator plus exceptions 20

21 Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 2 months) is 50/90 mmhg or less by CCG Comparison with demographically similar CCGs NHS Stoke On Trent CCG 8.5% NHS Bolton CCG 8.4% NHS Heywood, Middleton and Rochdale CCG 8.0% NHS Birmingham South and Central CCG 80.2% NHS Salford CCG 79.8% NHS Oldham CCG 79.7% NHS Leeds South and East CCG 79.7% NHS Bradford Districts CCG 79.4% NHS Sandwell and West Birmingham CCG 78.5% NHS Wolverhampton CCG 78.4% NHS North Manchester CCG 78.% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 2

22 Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 2 months) is not 50/90 mmhg or less by GP practice No treatment Exceptions reported CITY HEALTH CENTRE Y02849 CORNERSTONE FAMILY PRACTICE P8404 FLORENCE HOUSE MEDICAL PRACTICE P84042 WELLFIELD MEDICAL CENTRE P84074 HAZELDENE MEDICAL CENTRE P84067 THE AVENUE MEDICAL CENTRE P84049 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 EASTLANDS MEDICAL CENTRE P8405 BEACON MEDICAL CENTRE P84033 NEWTON HEATH MEDICAL CENTRE P84070 FERNCLOUGH SURGERY P84605 DR MOKASHI P84032 PARKVIEW MEDICAL CENTRE P84645 LIME SQUARE MEDICAL CENTRE P84059 DROYLSDEN RD FAMILY PRACTICE P84047 WILLOWBANK SURGERY P84679 MP VICTORIA MILL Y0695 WHITLEY ROAD MEDICAL CENTRE P84054 THE MAZHARI & KHAN PRACTICE P84637 SIMPSON MEDICAL PRACTICE Y02520 ALEESHAN MEDICAL CENTRE P84623 VALENTINE MEDICAL CENTRE P8409 DAM HEAD MEDICAL CENTRE P84690 NEW COLLEGIATE MEDICAL CENTRE P84030 CHARLESTOWN MD Y02325 FIVE OAKS FAMILIY PRACTICE P84004 ARTANE MEDICAL CENTRE P8463 THE NEVILLE FAMILY CENTRE P84663 BROOKDALE SURGERY P84062 THE SINGH MEDICAL PRACTICE P84065 NEW ISLINGTON MEDICAL CENTRE P84064 JOLLY MEDICAL CENTRE P84684 CONRAN MEDICAL CENTRE P84040 CHEETHAM HILL PRIMARY CARE CENTRE P84046 ST GEORGE'S MEDICAL CENTRE P84025 QUEENS MEDICAL CENTRE P % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are 5,69 people whose blood pressure is not <= 50/90 GP practice range: 3.0% to 33.% 22

23 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 North Manchester CCG 84.2% NHS Central Manchester CCG NHS Oldham CCG NHS Tameside And Glossop CCG NHS Trafford CCG NHS Heywood, Middleton And Rochdale CCG NHS Salford CCG NHS South Manchester CCG 76.3% 74.8% 74.4% 7.8% 7.4% 70.5% 70.4% 95 people with a new diagnosis* of hypertension with a CVD risk of 20% or higher in NHS North Manchester CCG 80 (84.2%) people who are currently treated with statins (.6%) people who are exempted from treatment with statins 4 (4.2%) additional people who are not currently treated with statins NHS Bury CCG 68.2% NHS Bolton CCG 67.2% NHS Wigan Borough CCG 6.0% NHS Stockport CCG 60.% England 66.5% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% *Using the QOF clinical indicator CVD-PP00 denominator plus exceptions 23

24 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 North Manchester CCG 84.2% NHS Sandwell and West Birmingham CCG 79.4% NHS Bradford Districts CCG 76.4% NHS Wolverhampton CCG 75.0% NHS Oldham CCG 74.8% NHS Leeds South and East CCG 73.2% NHS Heywood, Middleton and Rochdale CCG 7.4% NHS Birmingham South and Central CCG 70.7% NHS Salford CCG 70.5% NHS Stoke On Trent CCG 68.8% NHS Bolton CCG 67.2% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 24

25 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 BROOKDALE SURGERY P84062 BEACON MEDICAL CENTRE P84033 LIME SQUARE MEDICAL CENTRE P84059 HAZELDENE MEDICAL CENTRE P84067 NEWTON HEATH MEDICAL CENTRE P84070 JOLLY MEDICAL CENTRE P84684 CHARLESTOWN MD Y02325 DR MOKASHI P84032 THE AVENUE MEDICAL CENTRE P84049 ARTANE MEDICAL CENTRE P8463 THE MAZHARI & KHAN PRACTICE P84637 FIVE OAKS FAMILIY PRACTICE P84004 WELLFIELD MEDICAL CENTRE P84074 VALENTINE MEDICAL CENTRE P8409 ST GEORGE'S MEDICAL CENTRE P84025 NEW COLLEGIATE MEDICAL CENTRE P84030 CONRAN MEDICAL CENTRE P84040 CORNERSTONE FAMILY PRACTICE P8404 CHEETHAM HILL PRIMARY CARE CENTRE P84046 DROYLSDEN RD FAMILY PRACTICE P84047 EASTLANDS MEDICAL CENTRE P8405 WHITLEY ROAD MEDICAL CENTRE P84054 NEW ISLINGTON MEDICAL CENTRE P84064 THE SINGH MEDICAL PRACTICE P84065 FERNCLOUGH SURGERY P84605 ALEESHAN MEDICAL CENTRE P84623 QUEENS MEDICAL CENTRE P84640 PARKVIEW MEDICAL CENTRE P84645 THE NEVILLE FAMILY CENTRE P84663 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 DAM HEAD MEDICAL CENTRE P84690 MP VICTORIA MILL Y0695 SIMPSON MEDICAL PRACTICE Y02520 CITY HEALTH CENTRE Y02849 WILLOWBANK SURGERY P84679 FLORENCE HOUSE MEDICAL PRACTICE P % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 3 in total, including exceptions, there are 5 people who are not treated with statins GP practice range: 0.0% to 00.0% 25

26 Stroke 26

27 Stroke prevention Only a half of people with known AF who then suffer a stroke have been anticoagulated before their stroke. Stroke is one of the leading causes of premature death and disability. Stroke is devastating for individuals and families, and accounts for a substantial proportion of health and social care expenditure. Atrial fibrillation increases the risk of stroke by a factor of 5, and strokes caused by AF are often more severe, with higher mortality and greater disability. Anticoagulation reduces the risk of stroke in people with AF by two thirds. Despite this, AF is underdiagnosed and under treated: up to a third of people with AF are unaware they have the condition and even when diagnosed inadequate treatment is common large numbers do not receive anticoagulants or have poor anticoagulant control. What questions should we ask in our CCG?. for each indicator how wide is the variation in detection, treatment 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 average and below average to perform as well as the best in detection of atrial fibrillation and stroke prevention with anticoagulation. What might help? increase opportunistic pulse checking especially in over 65s support practices to share audit data and systematically identify gaps and opportunities for improved detection and management of AF - eg GRASP-AF promote systematic use of CHADS-VASC and HASBLED to ensure those at high risk are offered stroke prevention promote systematic use of Warfarin Patient Safety Audit Tool to ensure optimal time in therapeutic range for people on warfarin develop local consensus statement on risk-benefit balance for anticoagulants, including the newer treatments (NOACs) work with practices and local authorities to maximise uptake and clinical follow up in the NHS Health Check commission community pharmacists to offer pulse checks, anticoagulant monitoring, and support for adherence to medication 27

28 Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with CCGs in the STP NHS Salford CCG 0.79 NHS Wigan Borough CCG NHS Trafford CCG NHS Stockport CCG NHS South Manchester CCG NHS Tameside And Glossop CCG the ratio of those diagnosed with atrial fibrillation versus those expected to have atrial fibrillation is This compares to 0.7 for England this suggests that 62% of people with atrial fibrillation have been diagnosed. NHS Bolton CCG 0.67 NHS Heywood, Middleton And Rochdale CCG 0.64 NHS Bury CCG 0.63 NHS North Manchester CCG 0.62 NHS Oldham CCG NHS Central Manchester CCG England Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 205/6 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence Network estimates produced in 207. The estimates were developed by applying age-sex specific prevalence rates as reported by Norberg et al (203) to GP population estimates from NHS Digital. Estimates reported are adjusted for age and sex of the local population. 28

29 Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with demographically similar CCGs NHS Salford CCG 0.79 NHS Stoke On Trent CCG 0.75 NHS Leeds South and East CCG 0.70 NHS Bradford Districts CCG 0.68 NHS Bolton CCG 0.67 NHS Wolverhampton CCG 0.65 NHS Heywood, Middleton and Rochdale CCG 0.64 NHS North Manchester CCG 0.62 NHS Oldham CCG 0.6 NHS Birmingham South and Central CCG 0.60 NHS Sandwell and West Birmingham CCG

30 Atrial fibrillation observed prevalence compared with expected prevalence by GP practice GP practice CCG FLORENCE HOUSE MEDICAL PRACTICE P84042 THE AVENUE MEDICAL CENTRE P84049 FIVE OAKS FAMILIY PRACTICE P84004 VALENTINE MEDICAL CENTRE P8409 DR MOKASHI P84032 EASTLANDS MEDICAL CENTRE P8405 WHITLEY ROAD MEDICAL CENTRE P84054 BROOKDALE SURGERY P84062 NEW ISLINGTON MEDICAL CENTRE P84064 THE SINGH MEDICAL PRACTICE P84065 WELLFIELD MEDICAL CENTRE P84074 PARKVIEW MEDICAL CENTRE P84645 THE NEVILLE FAMILY CENTRE P84663 ST GEORGE'S MEDICAL CENTRE P84025 BEACON MEDICAL CENTRE P84033 CONRAN MEDICAL CENTRE P84040 LIME SQUARE MEDICAL CENTRE P84059 HAZELDENE MEDICAL CENTRE P84067 NEWTON HEATH MEDICAL CENTRE P84070 THE MAZHARI & KHAN PRACTICE P84637 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 CHARLESTOWN MD Y02325 NEW COLLEGIATE MEDICAL CENTRE P84030 CORNERSTONE FAMILY PRACTICE P8404 DROYLSDEN RD FAMILY PRACTICE P84047 FERNCLOUGH SURGERY P84605 ARTANE MEDICAL CENTRE P8463 SIMPSON MEDICAL PRACTICE Y02520 CITY HEALTH CENTRE Y02849 CHEETHAM HILL PRIMARY CARE CENTRE P84046 WILLOWBANK SURGERY P84679 DAM HEAD MEDICAL CENTRE P84690 MP VICTORIA MILL Y0695 QUEENS MEDICAL CENTRE P84640 JOLLY MEDICAL CENTRE P84684 ALEESHAN MEDICAL CENTRE P it is estimated that there are 3,38 people with undiagnosed atrial fibrillation in NHS North Manchester CCG GP practice range of observed to expected atrial fibrillation prevalence 0. to Ratio 30

31 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 Bury CCG NHS Bolton CCG NHS Salford CCG NHS Tameside And Glossop CCG NHS Oldham CCG NHS Wigan Borough CCG NHS North Manchester CCG NHS Heywood, Middleton And Rochdale CCG NHS Stockport CCG NHS Central Manchester CCG NHS Trafford CCG NHS South Manchester CCG 85.8% 83.% 82.7% 80.9% 80.7% 80.4% 80.3% 79.7% 79.2% 78.3% 77.6% 77.4%,703 people with atrial fibrillation* with a CHA2DS2-VASc score >= 2 in NHS North Manchester CCG,367 (80.3%) people treated with anti-coagulation therapy 43 (8.4%) people who are exceptions 93 (.3%) additional people with a recorded CHA2DS2-VASc score >= 2 who are not treated England 77.9% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator AF007 denominator plus exceptions 3

32 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 Bolton CCG 83.% NHS Salford CCG 82.7% NHS Oldham CCG 80.7% NHS North Manchester CCG 80.3% NHS Heywood, Middleton and Rochdale CCG 79.7% NHS Bradford Districts CCG 79.5% NHS Sandwell and West Birmingham CCG 79.5% NHS Stoke On Trent CCG 79.0% NHS Leeds South and East CCG 74.3% NHS Birmingham South and Central CCG 74.% NHS Wolverhampton CCG 73.9% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 32

33 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 FERNCLOUGH SURGERY P84605 CHARLESTOWN MD Y02325 JOLLY MEDICAL CENTRE P84684 DR MOKASHI P84032 ST GEORGE'S MEDICAL CENTRE P84025 THE NEVILLE FAMILY CENTRE P84663 MP VICTORIA MILL Y0695 BROOKDALE SURGERY P84062 WELLFIELD MEDICAL CENTRE P84074 THE SINGH MEDICAL PRACTICE P84065 DROYLSDEN RD FAMILY PRACTICE P84047 CORNERSTONE FAMILY PRACTICE P8404 WILLOWBANK SURGERY P84679 FLORENCE HOUSE MEDICAL PRACTICE P84042 BEACON MEDICAL CENTRE P84033 NEWTON HEATH MEDICAL CENTRE P84070 FIVE OAKS FAMILIY PRACTICE P84004 THE MAZHARI & KHAN PRACTICE P84637 VALENTINE MEDICAL CENTRE P8409 PARKVIEW MEDICAL CENTRE P84645 NEW COLLEGIATE MEDICAL CENTRE P84030 NEW ISLINGTON MEDICAL CENTRE P84064 CONRAN MEDICAL CENTRE P84040 HAZELDENE MEDICAL CENTRE P84067 ARTANE MEDICAL CENTRE P8463 EASTLANDS MEDICAL CENTRE P8405 THE AVENUE MEDICAL CENTRE P84049 QUEENS MEDICAL CENTRE P84640 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 WHITLEY ROAD MEDICAL CENTRE P84054 LIME SQUARE MEDICAL CENTRE P84059 SIMPSON MEDICAL PRACTICE Y02520 CHEETHAM HILL PRIMARY CARE CENTRE P84046 ALEESHAN MEDICAL CENTRE P84623 DAM HEAD MEDICAL CENTRE P84690 CITY HEALTH CENTRE Y % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 8 in total, including exceptions, there are 336 people with a recorded CHA2DS2-VASc score >= 2 who are not treated GP practice range: 0.0% to 57.% 33

34 In patients with AF with a CHA2DS2-VASc score of 2 or more, the percentage treated with anti-coagulation therapy by GP practice opportunities compared to GP cluster 20% 0% 0% -0% -20% -30% -40% -50% FERNCLOUGH SURGERY CHARLESTOWN MD JOLLY MEDICAL CENTRE DR MOKASHI ST GEORGE'S MEDICAL CENTRE MP VICTORIA MILL THE NEVILLE FAMILY CENTRE BROOKDALE SURGERY WELLFIELD MEDICAL CENTRE THE SINGH MEDICAL PRACTICE using the GP cluster method of calculating potential gains, if each practice was to achieve as well as the upper quartile of its national cluster, then an additional 03 people would be treated THE AVENUE MEDICAL CENTRE QUEENS MEDICAL CENTRE ANCOATS URBAN VILLAGE MEDICAL PRACTICE WHITLEY ROAD MEDICAL CENTRE LIME SQUARE MEDICAL CENTRE SIMPSON MEDICAL PRACTICE CHEETHAM HILL PRIMARY CARE CENTRE DAM HEAD MEDICAL CENTRE ALEESHAN MEDICAL CENTRE CITY HEALTH CENTRE Details of this methodology are available on slide 9. Click here to view them. 34

35 Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 2 months) is 50/90 mmhg or less by CCG Comparison with CCGs in the STP Below 50/90 Not below 50/90 Exceptions reported NHS Bolton CCG NHS Stockport CCG NHS Tameside And Glossop CCG NHS Wigan Borough CCG NHS Heywood, Middleton And Rochdale CCG NHS Salford CCG NHS Bury CCG NHS Trafford CCG NHS Oldham CCG NHS North Manchester CCG NHS Central Manchester CCG NHS South Manchester CCG 87.% 87.% 86.4% 86.% 86.0% 85.2% 84.9% 84.2% 83.9% 83.2% 82.0% 78.8% 3,08 people with a history of stroke or TIA* in NHS North Manchester CCG 2,562 (83.2%) people whose blood pressure is <= 50 / 90 2 (3.6%) people who are exceptions 407 (3.2%) additional people whose blood pressure is not <= 50 / 90 England 83.8% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator STIA003 denominator plus exceptions 35

36 Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 2 months) is 50/90 mmhg or less by CCG Comparison with demographically similar CCGs Below 50/90 Not below 50/90 Exceptions reported NHS Bolton CCG 87.% NHS Heywood, Middleton and Rochdale CCG 86.0% NHS Salford CCG 85.2% NHS Birmingham South and Central CCG 85.0% NHS Stoke On Trent CCG 84.9% NHS Leeds South and East CCG 84.5% NHS Oldham CCG 83.9% NHS Sandwell and West Birmingham CCG 83.6% NHS Bradford Districts CCG 83.3% NHS North Manchester CCG 83.2% NHS Wolverhampton CCG 83.% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 36

37 Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 2 months) is not 50/90 mmhg or less by GP practice No treatment Exceptions reported CORNERSTONE FAMILY PRACTICE P8404 NEWTON HEATH MEDICAL CENTRE P84070 WELLFIELD MEDICAL CENTRE P84074 CITY HEALTH CENTRE Y02849 FLORENCE HOUSE MEDICAL PRACTICE P84042 HAZELDENE MEDICAL CENTRE P84067 DROYLSDEN RD FAMILY PRACTICE P84047 THE AVENUE MEDICAL CENTRE P84049 LIME SQUARE MEDICAL CENTRE P84059 THE MAZHARI & KHAN PRACTICE P84637 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 PARKVIEW MEDICAL CENTRE P84645 MP VICTORIA MILL Y0695 EASTLANDS MEDICAL CENTRE P8405 WHITLEY ROAD MEDICAL CENTRE P84054 FIVE OAKS FAMILIY PRACTICE P84004 DR MOKASHI P84032 NEW ISLINGTON MEDICAL CENTRE P84064 CONRAN MEDICAL CENTRE P84040 SIMPSON MEDICAL PRACTICE Y02520 BEACON MEDICAL CENTRE P84033 THE SINGH MEDICAL PRACTICE P84065 FERNCLOUGH SURGERY P84605 ARTANE MEDICAL CENTRE P8463 VALENTINE MEDICAL CENTRE P8409 ST GEORGE'S MEDICAL CENTRE P84025 WILLOWBANK SURGERY P84679 NEW COLLEGIATE MEDICAL CENTRE P84030 THE NEVILLE FAMILY CENTRE P84663 ALEESHAN MEDICAL CENTRE P84623 CHARLESTOWN MD Y02325 BROOKDALE SURGERY P84062 QUEENS MEDICAL CENTRE P84640 CHEETHAM HILL PRIMARY CARE CENTRE P84046 JOLLY MEDICAL CENTRE P84684 DAM HEAD MEDICAL CENTRE P % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are 59 people whose blood pressure is not <= 50 / 90 GP practice range: 2.8% to 27.9% 37

38 Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 2 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with CCGs in the STP Below 50/90 Not below 50/90 Exceptions reported NHS Stockport CCG NHS Oldham CCG NHS Bury CCG NHS Wigan Borough CCG NHS Bolton CCG NHS Heywood, Middleton And Rochdale CCG NHS Tameside And Glossop CCG NHS Trafford CCG NHS Salford CCG NHS Central Manchester CCG NHS North Manchester CCG NHS South Manchester CCG 93.7% 93.2% 92.8% 92.6% 92.6% 92.6% 92.5% 92.4% 92.% 92.% 9.% 9.0%,828 people with a stroke shown to be non-haemorrhagic* in NHS North Manchester CCG,666 (9.%) people who are taking an anti-platetet agent or anticoagulant 78 (4.3%) people who are exceptions 84 (4.6%) additional people with no treatment England 9.8% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator STIA007 denominator plus exceptions 38

39 Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 2 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Below 50/90 Not below 50/90 Exceptions reported NHS Oldham CCG 93.2% NHS Leeds South and East CCG 92.7% NHS Bolton CCG 92.6% NHS Heywood, Middleton and Rochdale CCG 92.6% NHS Birmingham South and Central CCG 92.5% NHS Stoke On Trent CCG 92.2% NHS Salford CCG 92.% NHS Wolverhampton CCG 92.% NHS Bradford Districts CCG 9.8% NHS Sandwell and West Birmingham CCG 9.3% NHS North Manchester CCG 9.% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 39

40 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 2 months that an anti-platelet agent, or an anti-coagulant is being taken by GP practice No treatment Exceptions reported CITY HEALTH CENTRE Y02849 WILLOWBANK SURGERY P84679 CORNERSTONE FAMILY PRACTICE P8404 ARTANE MEDICAL CENTRE P8463 EASTLANDS MEDICAL CENTRE P8405 WELLFIELD MEDICAL CENTRE P84074 DR MOKASHI P84032 FIVE OAKS FAMILIY PRACTICE P84004 CHARLESTOWN MD Y02325 DAM HEAD MEDICAL CENTRE P84690 FERNCLOUGH SURGERY P84605 ALEESHAN MEDICAL CENTRE P84623 THE NEVILLE FAMILY CENTRE P84663 DROYLSDEN RD FAMILY PRACTICE P84047 THE SINGH MEDICAL PRACTICE P84065 WHITLEY ROAD MEDICAL CENTRE P84054 THE AVENUE MEDICAL CENTRE P84049 MP VICTORIA MILL Y0695 HAZELDENE MEDICAL CENTRE P84067 NEWTON HEATH MEDICAL CENTRE P84070 CONRAN MEDICAL CENTRE P84040 PARKVIEW MEDICAL CENTRE P84645 VALENTINE MEDICAL CENTRE P8409 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 NEW COLLEGIATE MEDICAL CENTRE P84030 FLORENCE HOUSE MEDICAL PRACTICE P84042 LIME SQUARE MEDICAL CENTRE P84059 BEACON MEDICAL CENTRE P84033 ST GEORGE'S MEDICAL CENTRE P84025 BROOKDALE SURGERY P84062 NEW ISLINGTON MEDICAL CENTRE P84064 CHEETHAM HILL PRIMARY CARE CENTRE P84046 THE MAZHARI & KHAN PRACTICE P84637 QUEENS MEDICAL CENTRE P84640 JOLLY MEDICAL CENTRE P84684 SIMPSON MEDICAL PRACTICE Y % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are 62 people who are not taking an anti-platelet agent or anti-coagulant GP practice range: 0.0% to 33.3% 40

41 Diabetes 4

42 Diabetes prevention and management Diabetes costs the NHS 9.8 billion per year and the prevalence is rising Type 2 diabetes is often preventable People at high risk of developing type 2 diabetes can be identified through the NHS Health Check, and the disease can be prevented or delayed in many through intensive behaviour change support. Complications of diabetes are preventable Diabetes is a major cause of premature death and disability and greatly increases the risk of heart disease and stroke, kidney failure, amputations and blindness. 80% of NHS spending on diabetes goes on managing these complications, most of which could be prevented. There are 8 essential care processes, in addition to retinal screening, that together substantially reduce complication rates. Despite this, around a half of people with diabetes do not receive all 8 care processes, and there is widespread variation between CCGs and practices in levels of achievement Type 2 Diabetes in numbers diagnosed prevalence 3.0 million undiagnosed diabetes 900,000 non-diabetic hyperglycaemia (high risk of diabetes) 5 million What questions should we ask in our CCG?. for each indicator how wide is the variation in 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 average and below average to perform as well as the best in: detection of diabetes delivery of the 8 care processes and achievement of the 3 treatment targets identification and management of Non-diabetic hyperglycaemia What might help ensure universal participation by practices in the National Diabetes Audit (NDA) benchmark practice level data from the NDA and support practices to explore variation increase support for patient education and shared management maximise uptake of the NHS Health Check to aid detection of diabetes and Non Diabetic Hyperglycaemia maximise uptake of the NHS Diabetes Prevention Programme 42

43 Diabetes observed prevalence compared with expected prevalence by CCG Comparison with CCGs in the STP NHS Bolton CCG 0.89 NHS Heywood, Middleton And Rochdale CCG NHS Bury CCG NHS Wigan Borough CCG NHS Tameside And Glossop CCG NHS Oldham CCG ratio of observed to expected diabetes prevalence in NHS North Manchester CCG, compared to 0.77 in England this suggests 83% of people have been diagnosed NHS North Manchester CCG 0.83 NHS Salford CCG 0.8 NHS South Manchester CCG 0.80 NHS Trafford CCG 0.79 NHS Stockport CCG 0.74 NHS Central Manchester CCG England Note: This slide compares the prevalence of Diabetes recorded in QOF in 205/6 to the expected prevalence of Diabetes in 206 taken from the NCVIN diabetes prevalence model produced in

44 Diabetes observed prevalence compared with expected prevalence by CCG Comparison with demographically similar CCGs NHS Stoke On Trent CCG 0.89 NHS Bolton CCG 0.89 NHS Heywood, Middleton and Rochdale CCG 0.86 NHS Oldham CCG 0.85 NHS Bradford Districts CCG 0.84 NHS North Manchester CCG 0.83 NHS Birmingham South and Central CCG 0.83 NHS Leeds South and East CCG 0.82 NHS Sandwell and West Birmingham CCG 0.8 NHS Salford CCG 0.8 NHS Wolverhampton CCG

45 Diabetes prevalence by GP practice GP practice CCG JOLLY MEDICAL CENTRE P84684 ALEESHAN MEDICAL CENTRE P84623 QUEENS MEDICAL CENTRE P84640 WHITLEY ROAD MEDICAL CENTRE P84054 PARKVIEW MEDICAL CENTRE P84645 DROYLSDEN RD FAMILY PRACTICE P84047 THE AVENUE MEDICAL CENTRE P84049 NEW COLLEGIATE MEDICAL CENTRE P84030 CHEETHAM HILL PRIMARY CARE CENTRE P84046 WELLFIELD MEDICAL CENTRE P84074 BROOKDALE SURGERY P84062 VALENTINE MEDICAL CENTRE P8409 LIME SQUARE MEDICAL CENTRE P84059 FIVE OAKS FAMILIY PRACTICE P84004 FERNCLOUGH SURGERY P84605 FLORENCE HOUSE MEDICAL PRACTICE P84042 ARTANE MEDICAL CENTRE P8463 CONRAN MEDICAL CENTRE P84040 HAZELDENE MEDICAL CENTRE P84067 DR MOKASHI P84032 NEWTON HEATH MEDICAL CENTRE P84070 BEACON MEDICAL CENTRE P84033 THE MAZHARI & KHAN PRACTICE P84637 EASTLANDS MEDICAL CENTRE P8405 THE SINGH MEDICAL PRACTICE P84065 THE NEVILLE FAMILY CENTRE P84663 CORNERSTONE FAMILY PRACTICE P8404 ST GEORGE'S MEDICAL CENTRE P84025 NEW ISLINGTON MEDICAL CENTRE P84064 CHARLESTOWN MD Y02325 DAM HEAD MEDICAL CENTRE P84690 WILLOWBANK SURGERY P84679 SIMPSON MEDICAL PRACTICE Y02520 MP VICTORIA MILL Y0695 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 CITY HEALTH CENTRE Y % 2.3% 0.9% 8.9% 8.9% 8.9% 8.7% 8.4% 8.2% 8.0% 8.0% 7.8% 7.5% 7.5% 7.3% 7.2% 7.% 7.0% 6.9% 6.8% 6.8% 6.7% 6.6% 6.6% 6.4% 6.4% 6.4% 6.% 5.7% 5.6% 5.5% 5.5% 5.2% 4.9% 4.2% 0.9% 0% 2% 4% 6% 8% 0% 2% 4% 6% GP practice range of observed diabetes 0.9% to 4.4% there are an estimated 2,23 people with undiagnosed diabetes in NHS North Manchester CCG Note: The estimated number of undiagnosed people with diabetes has been calculated by multiplying the estimated prevalence rate to the 205/6 QOF list size and subtracting the number of people on the diabetes register. 45

46 Expected total prevalence of diabetes and non-diabetic hyperglycaemia Diabetes prevalence Expected non-diabetic hyperglycaemia prevalence Undiagnosed diabetes prevalence NHS Heywood, Middleton And Rochdale CCG NHS Oldham CCG NHS Bolton CCG NHS Tameside And Glossop CCG NHS Stockport CCG NHS Bury CCG NHS Wigan Borough CCG NHS Trafford CCG NHS Central Manchester CCG NHS North Manchester CCG 8.% 7.8% 8.0% 7.5% 6.2% 7.2% 7.% 6.4% 6.0% 7.0%.3%.4%.0%.3% 2.2%.2%.2%.7% 2.4%.4%.7%.5%.0%.%.3%.0%.0% 0.7% 9.8% 9.8% the estimated total prevalence of diabetes in NHS North Manchester CCG is 8.4% (diagnosed and undiagnosed) in addition, there are an estimated 9.8% of people in NHS North Manchester CCG who are at increased risk of developing diabetes (i.e. with non-diabetic hyperglycaemia) this means that 8.2% of the population in NHS North Manchester CCG are estimated to have diabetes, or at high risk of developing of diabetes NHS Salford CCG 6.2%.5% 9.9% NHS South Manchester CCG 5.9%.5% 9.4% England 6.5%.9%.2% 0% 5% 0% 5% 20% 25% Note: Prevalence estimates of non-diabetic hyperglycaemia were developed using Health Survey for England (HSE) data. Five years of HSE data were combined, The estimates take into account the age, ethnic group and estimated body mass index of the population. These estimates were produced using the GP registered population. 46

47 People with diabetes who had eight care processes by CCG 205/6 NHS Bury CCG 60.5% NHS Bolton CCG NHS Heywood, Middleton And Rochdale CCG NHS Salford CCG NHS Stockport CCG 60.2% 55.9% 55.2% 54.9% data on care processes and treatment targets are taken from the National Diabetes Audit (NDA) overall practice participation in the 205/6 audit was 8.4% in England NHS Oldham CCG NHS Central Manchester CCG NHS Wigan Borough CCG 54.4% 50.4% 49.8% in NHS North Manchester CCG, 36 out of 36 practices (00.0%) participated in the NDA NHS Tameside And Glossop CCG NHS Trafford CCG NHS North Manchester CCG NHS South Manchester CCG 47.7% 47.0% 47.0% 42.6% 47.0% of people with diabetes (of practices who participated in the audit) had the eight recommended care processes in NHS North Manchester CCG, compared to 52.6% in England England 52.6% 0% 0% 20% 30% 40% 50% 60% 70% 47

48 People with diabetes who had eight care processes by GP practice, 205/6 GP practice Average of practices in the CCG who participated in the audit MP VICTORIA MILL Y0695 BROOKDALE SURGERY P84062 CHEETHAM HILL PRIMARY CARE CENTRE P84046 SIMPSON MEDICAL PRACTICE Y02520 QUEENS MEDICAL CENTRE P84640 THE MAZHARI & KHAN PRACTICE P84637 LIME SQUARE MEDICAL CENTRE P84059 BEACON MEDICAL CENTRE P84033 FIVE OAKS FAMILIY PRACTICE P84004 WELLFIELD MEDICAL CENTRE P84074 DROYLSDEN RD FAMILY PRACTICE P84047 NEW ISLINGTON MEDICAL CENTRE P84064 JOLLY MEDICAL CENTRE P84684 DR MOKASHI P84032 NEW COLLEGIATE MEDICAL CENTRE P84030 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 PARKVIEW MEDICAL CENTRE P84645 EASTLANDS MEDICAL CENTRE P8405 DAM HEAD MEDICAL CENTRE P84690 HAZELDENE MEDICAL CENTRE P84067 THE NEVILLE FAMILY CENTRE P84663 NEWTON HEATH MEDICAL CENTRE P84070 CITY HEALTH CENTRE Y02849 CHARLESTOWN MD Y02325 FLORENCE HOUSE MEDICAL PRACTICE P84042 THE SINGH MEDICAL PRACTICE P84065 VALENTINE MEDICAL CENTRE P8409 CORNERSTONE FAMILY PRACTICE P8404 ST GEORGE'S MEDICAL CENTRE P84025 FERNCLOUGH SURGERY P84605 WHITLEY ROAD MEDICAL CENTRE P84054 ARTANE MEDICAL CENTRE P8463 CONRAN MEDICAL CENTRE P84040 THE AVENUE MEDICAL CENTRE P84049 WILLOWBANK SURGERY P84679 ALEESHAN MEDICAL CENTRE P % 73.7% 69.7% 69.6% 68.6% 68.5% 67.5% 67.0% 65.2% 62.9% 6.4% 53.% 52.7% 52.6% 48.6% 48.6% 48.0% 47.2% 46.4% 45.2% 44.0% 43.9% 4.9% 4.7% 4.6% 38.8% 37.5% 36.4% 28.3% 23.9% 2.2% 2.% 20.9% 4.% achievement - 8 care processes: in practices who provided data via the NDA, between 4.% and 74.7% of patients received all 8 care processes at least 5,803 people did not receive the eight care processes 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 48

49 People with diabetes who met all 3 treatment targets by CCG, 205/6 NHS Wigan Borough CCG 45.6% NHS Stockport CCG NHS Tameside And Glossop CCG NHS Bury CCG NHS Oldham CCG 43.7% 42.5% 4.4% 40.7% 40.% of people with diabetes (of practices who participated in the audit) met the three treatment targets in NHS North Manchester CCG, compared to 39.0% in England NHS Salford CCG 40.7% NHS Heywood, Middleton And Rochdale CCG 40.5% NHS Bolton CCG 40.4% NHS North Manchester CCG 40.% NHS South Manchester CCG 38.7% NHS Trafford CCG 37.8% NHS Central Manchester CCG 36.6% England 39.0% 0% 5% 0% 5% 20% 25% 30% 35% 40% 45% 50% 49

50 People with diabetes who met all 3 treatment targets by GP practice, 205/6 GP practice Average of practices in the CCG who participated in the audit FIVE OAKS FAMILIY PRACTICE P84004 NEW ISLINGTON MEDICAL CENTRE P84064 FERNCLOUGH SURGERY P84605 CHEETHAM HILL PRIMARY CARE CENTRE P84046 VALENTINE MEDICAL CENTRE P8409 BROOKDALE SURGERY P84062 DAM HEAD MEDICAL CENTRE P84690 QUEENS MEDICAL CENTRE P84640 ST GEORGE'S MEDICAL CENTRE P84025 SIMPSON MEDICAL PRACTICE Y02520 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 THE NEVILLE FAMILY CENTRE P84663 FLORENCE HOUSE MEDICAL PRACTICE P84042 DROYLSDEN RD FAMILY PRACTICE P84047 THE AVENUE MEDICAL CENTRE P84049 PARKVIEW MEDICAL CENTRE P84645 NEW COLLEGIATE MEDICAL CENTRE P84030 MP VICTORIA MILL Y0695 DR MOKASHI P84032 ARTANE MEDICAL CENTRE P8463 CORNERSTONE FAMILY PRACTICE P8404 CONRAN MEDICAL CENTRE P84040 BEACON MEDICAL CENTRE P84033 THE MAZHARI & KHAN PRACTICE P84637 WHITLEY ROAD MEDICAL CENTRE P84054 THE SINGH MEDICAL PRACTICE P84065 CHARLESTOWN MD Y02325 EASTLANDS MEDICAL CENTRE P8405 CITY HEALTH CENTRE Y02849 HAZELDENE MEDICAL CENTRE P84067 WELLFIELD MEDICAL CENTRE P84074 LIME SQUARE MEDICAL CENTRE P84059 NEWTON HEATH MEDICAL CENTRE P84070 JOLLY MEDICAL CENTRE P84684 WILLOWBANK SURGERY P84679 ALEESHAN MEDICAL CENTRE P % 52.2% 50.0% 48.% 47.9% 46.7% 46.2% 45.9% 45.0% 44.4% 42.7% 4.9% 4.6% 4.5% 4.2% 4.0% 40.8% 40.5% 40.4% 39.7% 39.4% 37.6% 37.6% 36.4% 34.6% 34.0% 33.8% 33.8% 32.% 3.3% 3.3% 30.0% 29.5% 9.4% achievement - 3 treatment targets: in practices who provided data via the NDA, between 9.4% and 53.9% of patients achieved all 3 treatment targets at least 5,989 people did not meet the three treatment targets 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 50

51 People with diabetes who met all 3 treatment targets by GP practice, 205/6 - opportunities compared to GP cluster 5% 0% 5% 0% -5% -0% -5% -20% -25% -30% JOLLY MEDICAL CENTRE HAZELDENE MEDICAL CENTRE LIME SQUARE MEDICAL CENTRE NEWTON HEATH MEDICAL CENTRE WELLFIELD MEDICAL CENTRE WHITLEY ROAD MEDICAL CENTRE CITY HEALTH CENTRE CHARLESTOWN MD EASTLANDS MEDICAL CENTRE THE SINGH MEDICAL PRACTICE using the GP cluster method of calculating potential gains, if each practice was to achieve as well as the upper quartile of its national cluster, then an additional 535 people would be treated ANCOATS URBAN VILLAGE MEDICAL PRACTICE SIMPSON MEDICAL PRACTICE BROOKDALE SURGERY QUEENS MEDICAL CENTRE VALENTINE MEDICAL CENTRE DAM HEAD MEDICAL CENTRE CHEETHAM HILL PRIMARY CARE CENTRE NEW ISLINGTON MEDICAL CENTRE FERNCLOUGH SURGERY FIVE OAKS FAMILIY PRACTICE Details of this methodology are available on slide 9. Click here to view them. 5

52 Kidney 52

53 Management of chronic kidney disease Chronic Kidney Disease can progress to kidney failure and it substantially increases the risk of heart attack and stroke. Late diagnosis of CKD is common. Around a third of people with CKD are undiagnosed. More opportunistic testing and improved uptake of the NHS Health Check will increase detection rates. Chronic Kidney Disease (CKD) is common. It is one of the commonest co-morbidities and affects a third of people over 75. In 200 it was estimated to cost the NHS around.5bn. Average length of stay in hospital tends to be longer and outcomes are considerably worse: approximately 7,000 excess strokes and 2,000 excess heart attacks occur each year in people with CKD compared to those without. Individuals with CKD are also at much higher risk of developing acute kidney injury when they have an intercurrent illness such as pneumonia Evidence based guidance from NICE highlights CVD risk reduction, good blood pressure control and management of proteinuria as essential steps to reduce the risk of cardiovascular events and progression to kidney failure. Despite this there is often significant variation between practices in achievement and exception reporting. What questions should we ask in our CCG?. for each indicator how wide is the variation in 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 average and below average to perform as well as the best in: detection of CKD more systematic delivery of evidence based care What might help Support practices to share audit data and systematically identify gaps and opportunities for improved detection and management of CKD. Promote uptake of and follow up from the NHS Health Check to aid detection and management of CKD Offer local training and education in the detection and management of CKD 53

54 Chronic kidney disease (CKD) observed prevalence (205/6) compared with expected prevalence (20) by CCG Comparison with CCGs in the STP NHS Bolton CCG 0.98 NHS Wigan Borough CCG NHS North Manchester CCG NHS Central Manchester CCG NHS Heywood, Middleton And Rochdale CCG NHS Bury CCG NHS Trafford CCG NHS Salford CCG the ratio of those diagnosed with chronic kidney disease versus those expected to have chronic kidney disease is This compares to 0.68 for England this suggests that 78% of people with chronic kidney disease have been diagnosed NHS South Manchester CCG 0.60 NHS Oldham CCG 0.59 NHS Tameside And Glossop CCG NHS Stockport CCG England Ratio Note: This slide compares the prevalence of CKD recorded in QOF in 205/6 to the expected prevalence of CKD produced by the University of Southampton in 20. A small number of CCGs have a ratio greater than. It is unlikely that all people with CKD will be diagnosed in any CCG and therefore a ratio greater than suggests that the figures are underestimating the true CKD prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures. 54

55 Chronic kidney disease (CKD) observed prevalence (205/6) compared with expected prevalence (20) by CCG Comparison with demographically similar CCGs NHS Bolton CCG 0.98 NHS North Manchester CCG 0.78 NHS Birmingham South and Central CCG 0.76 NHS Heywood, Middleton and Rochdale CCG 0.75 NHS Bradford Districts CCG 0.70 NHS Sandwell and West Birmingham CCG 0.69 NHS Wolverhampton CCG 0.67 NHS Leeds South and East CCG 0.67 NHS Stoke On Trent CCG 0.66 NHS Salford CCG 0.64 NHS Oldham CCG Ratio 55

56 CKD prevalence by GP practice, 205/6 GP practice CCG DROYLSDEN RD FAMILY PRACTICE P84047 THE AVENUE MEDICAL CENTRE P84049 ST GEORGE'S MEDICAL CENTRE P84025 THE MAZHARI & KHAN PRACTICE P84637 HAZELDENE MEDICAL CENTRE P84067 BROOKDALE SURGERY P84062 CONRAN MEDICAL CENTRE P84040 NEW COLLEGIATE MEDICAL CENTRE P84030 VALENTINE MEDICAL CENTRE P8409 THE SINGH MEDICAL PRACTICE P84065 ARTANE MEDICAL CENTRE P8463 FLORENCE HOUSE MEDICAL PRACTICE P84042 PARKVIEW MEDICAL CENTRE P84645 THE NEVILLE FAMILY CENTRE P84663 NEW ISLINGTON MEDICAL CENTRE P84064 WHITLEY ROAD MEDICAL CENTRE P84054 EASTLANDS MEDICAL CENTRE P8405 FERNCLOUGH SURGERY P84605 BEACON MEDICAL CENTRE P84033 CHEETHAM HILL PRIMARY CARE CENTRE P84046 WELLFIELD MEDICAL CENTRE P84074 FIVE OAKS FAMILIY PRACTICE P84004 DR MOKASHI P84032 CORNERSTONE FAMILY PRACTICE P8404 NEWTON HEATH MEDICAL CENTRE P84070 QUEENS MEDICAL CENTRE P84640 LIME SQUARE MEDICAL CENTRE P84059 CHARLESTOWN MD Y02325 SIMPSON MEDICAL PRACTICE Y02520 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 MP VICTORIA MILL Y0695 JOLLY MEDICAL CENTRE P84684 DAM HEAD MEDICAL CENTRE P84690 ALEESHAN MEDICAL CENTRE P84623 WILLOWBANK SURGERY P84679 CITY HEALTH CENTRE Y % 5.7% 5.3% 4.9% 4.9% 4.2% 4.% 4.% 3.8% 3.8% 3.7% 3.7% 3.5% 3.4% 3.2% 3.2% 3.% 3.% 3.0% 2.8% 2.7% 2.7% 2.7% 2.6% 2.6% 2.5% 2.3% 2.2% 2.0%.9%.5%.2%.0% 0.8% 0.6% 0.3% 0% % 2% 3% 4% 5% 6% 7% it is estimated that there are,399 people with undiagnosed chronic kidney disease in NHS North Manchester CCG GP practice range of observed CKD: 0.3% to 5.9% Note: CCG estimates for the estimated number of people with CKD are based on applying a proportion from a resident based population estimate to a GP registered population. The characteristics of registered and resident populations may vary in some CCGs, and local interpretation is required. 56

57 Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 2 months) is 40/85 mmhg or less by CCG, 204/5 Comparison with CCGs in the STP Below 40/85 Not below 40/85 Exceptions reported NHS Wigan Borough CCG NHS Heywood, Middleton And Rochdale CCG NHS Stockport CCG NHS Bury CCG NHS Tameside And Glossop CCG NHS Salford CCG NHS Bolton CCG NHS Trafford CCG NHS Oldham CCG NHS North Manchester CCG NHS South Manchester CCG NHS Central Manchester CCG 8.% 79.6% 79.4% 78.% 78.% 77.6% 77.2% 76.2% 74.9% 73.3% 72.5% 7.2% 5,029 people with CKD (diagnosed*) in NHS North Manchester CCG 3,688 (73.3%) people whose blood pressure is <= 40 / (9.4%) people who are exceptions 869 (7.3%) additional people whose blood pressure is not <= 40 / 85 England 74.4% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator CKD002 denominator plus exceptions. Note: as the CKD002 indicator was removed from the QOF in 5/6 this is historic data taken from the 204/5 QOF. 57

58 Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 2 months) is 40/85 mmhg or less by CCG, 204/5 Comparison with demographically similar CCGs Below 40/85 Not below 40/85 Exceptions reported NHS Heywood, Middleton and Rochdale CCG 79.6% NHS Stoke On Trent CCG 78.3% NHS Salford CCG 77.6% NHS Bolton CCG 77.2% NHS Leeds South and East CCG 75.6% NHS Birmingham South and Central CCG 75.5% NHS Oldham CCG 74.9% NHS Sandwell and West Birmingham CCG 74.5% NHS Bradford Districts CCG 73.6% NHS North Manchester CCG 73.3% NHS Wolverhampton CCG 73.0% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 58

59 Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 2 months) is not 40/85 mmhg or less by GP practice, 204/5 Not below 40/85 Exceptions reported DROYLSDEN ROAD FAMILY PRACTICE P84047 DR N SAEED & PARTNER P84059 CITY HEALTH CENTRE Y02849 DR G M O'SHEA & PARTNERS P84673 DR K VICKERS & PARTNERS P84054 DR I P SINGH & PARTNER P8405 VICTORIA MILL MEDICAL PRACTICE Y0695 DR S N AHMED & PARTNER P84070 CHARLESTOWN MEDICAL PRACTICE Y02325 DR A V MOKASHI & PARTNERS P84032 DR E E RODGER & PARTNERS P84067 DR L MCGROGAN & PARTNERS P84049 DR V AGGARWAL & PARTNERS P8404 DR P A DIXON & PARTNERS P84074 DR G M KHAN P84623 FLORENCE HOUSE MEDICAL PRACTICE P84042 DR J S FALLON & PARTNERS P8409 DR T M CHAUHAN & PARTNERS P84033 ARTANE MEDICAL CENTRE P8463 SIMPSON MEDICAL PRACTICE Y02520 DR M R WHITING & PARTNERS P84030 DR V P SINGH & PARTNER P84065 DR S SALEH & PARTNER P84605 DR V NATHOO & PARTNERS P84004 DR K M SYED & PARTNER P84040 BROOKDALE SURGERY P84062 DR S S JOLLY & PARTNER P84684 DR M CAPLAN & PARTNERS P84645 DR M NORTHFIELD P84025 THE VILLAGE SURGERY P84663 DR W ALI P84064 DR H K MAZHARI & PARTNER P84637 DR A BOKHARI & PARTNERS P84046 DR H GATOFF & PARTNER P84690 DR M K RIZWAN P84679 DR Q ZAMAN & PARTNER P % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are,34 people whose blood pressure is not <= 40 / 85 GP practice range: 6.% to 46.4% 59

60 Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 2 months) is not 40/85 mmhg or less by GP practice, 204/5 opportunities compared to GP cluster 5% 0% 5% 0% -5% -0% -5% -20% -25% -30% -35% DROYLSDEN ROAD FAMILY PRACTICE DR N SAEED & PARTNER CITY HEALTH CENTRE DR G M O'SHEA & PARTNERS DR K VICKERS & PARTNERS DR I P SINGH & PARTNER VICTORIA MILL MEDICAL PRACTICE DR S N AHMED & PARTNER DR A V MOKASHI & PARTNERS CHARLESTOWN MEDICAL PRACTICE using the GP cluster method of calculating potential gains, if each practice was to achieve as well as the upper quartile of its national cluster, then an additional 533 people would be treated DR S S JOLLY & PARTNER DR M CAPLAN & PARTNERS DR M NORTHFIELD THE VILLAGE SURGERY DR W ALI DR H K MAZHARI & PARTNER DR H GATOFF & PARTNER DR A BOKHARI & PARTNERS DR M K RIZWAN DR Q ZAMAN & PARTNER 2 0 Details of this methodology are available on slide 9. Click here to view them. 60

61 Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 2 months by CCG, 204/5 Comparison with CCGs in the STP Recorded Not recorded Exceptions reported NHS Bolton CCG NHS Wigan Borough CCG NHS Stockport CCG NHS Central Manchester CCG NHS Tameside And Glossop CCG NHS Salford CCG NHS Oldham CCG NHS Heywood, Middleton And Rochdale CCG NHS Trafford CCG NHS North Manchester CCG NHS Bury CCG NHS South Manchester CCG 80.5% 80.4% 79.9% 79.8% 79.8% 79.3% 79.% 78.5% 78.2% 77.5% 76.6% 7.9% 5,029 people with CKD (diagnosed*) in NHS North Manchester CCG 3,899 (77.5%) people who have a record of urine albumin:creatinine ratio test 7 (3.4%) people who are exceptions 959 (9.%) additional people who have no record of urine albumin:creatinine ratio test England 75.4% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator CKD004 denominator plus exceptions. Note: as the CKD004 indicator was removed from the QOF in 5/6 this is historic data taken from the 204/5 QOF. 6

62 Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 2 months by CCG, 204/5 Comparison with demographically similar CCGs Recorded Not recorded Exceptions reported NHS Bolton CCG 80.5% NHS Salford CCG 79.3% NHS Stoke On Trent CCG 79.2% NHS Oldham CCG 79.% NHS Heywood, Middleton and Rochdale CCG 78.5% NHS North Manchester CCG 77.5% NHS Birmingham South and Central CCG 77.0% NHS Sandwell and West Birmingham CCG 76.8% NHS Wolverhampton CCG 76.6% NHS Leeds South and East CCG 75.8% NHS Bradford Districts CCG 75.5% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 62

63 Percentage of patients on the CKD register whose notes do not have a record of a urine albumin: creatinine ratio test in the preceding 2 months by GP practice, 204/5 Not recorded Exceptions reported DR V AGGARWAL & PARTNERS P8404 DR N SAEED & PARTNER P84059 DR M CAPLAN & PARTNERS P84645 DROYLSDEN ROAD FAMILY PRACTICE P84047 DR S N AHMED & PARTNER P84070 DR M K RIZWAN P84679 DR J S FALLON & PARTNERS P8409 DR L MCGROGAN & PARTNERS P84049 DR K VICKERS & PARTNERS P84054 DR E E RODGER & PARTNERS P84067 CHARLESTOWN MEDICAL PRACTICE Y02325 DR A V MOKASHI & PARTNERS P84032 DR S SALEH & PARTNER P84605 DR V P SINGH & PARTNER P84065 FLORENCE HOUSE MEDICAL PRACTICE P84042 BROOKDALE SURGERY P84062 DR I P SINGH & PARTNER P8405 ARTANE MEDICAL CENTRE P8463 DR G M O'SHEA & PARTNERS P84673 THE VILLAGE SURGERY P84663 DR T M CHAUHAN & PARTNERS P84033 DR K M SYED & PARTNER P84040 DR M NORTHFIELD P84025 DR P A DIXON & PARTNERS P84074 DR G M KHAN P84623 DR M R WHITING & PARTNERS P84030 DR S S JOLLY & PARTNER P84684 DR V NATHOO & PARTNERS P84004 DR H GATOFF & PARTNER P84690 SIMPSON MEDICAL PRACTICE Y02520 CITY HEALTH CENTRE Y02849 DR W ALI P84064 VICTORIA MILL MEDICAL PRACTICE Y0695 DR A BOKHARI & PARTNERS P84046 DR Q ZAMAN & PARTNER P84640 DR H K MAZHARI & PARTNER P % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are,30 people who have no record of urine albumin:creatinine ratio test GP practice range: 9.5% to 54.% 63

64 Heart 64

65 Management of Heart Disease Premature death and disability in people with CHD can be reduced significantly by systematic evidence based management in primary care Coronary Heart Disease is one of the principal causes of premature death and disability. The key elements of management for an individual who has already had a heart attack or angina are symptom control and secondary prevention of further cardiovascular events and premature mortality. There is robust evidence to support the use of anti-platelet treatment, statins, beta-blockers and angiotensin 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 and exception reporting at practice level shows that there is often considerable potential for improving management and outcomes. Heart failure is a common and an important complication of coronary heart disease and other conditions. Appropriate treatment including up-titration of ace inhibitors and beta blockers in heart failure due to LVSD can significantly improve symptom control and quality of life, and improve outcomes for patients. Despite this, around a quarter of people with heart failure are undetected and untreated. And amongst those who are diagnosed, there is significant variation in the quality of care. What questions should we ask in our CCG?. for each indicator how wide is the variation in 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 average and below average to perform as well as the best in: more systematic delivery of evidence based care for people with CHD improved detection and management of heart failure What might help. roll out of GRASP-Heart Failure audit tool that identifies people with heart failure who are undiagnosed or under treated 2. education for health professionals to promote evidence based management of CHD and high quality measurement of blood pressure 3. ensure access to rapid access diagnostic clinics and specialist support for management of angina and heart failure 4. ensure access to cardiac rehab for individuals with CHD and heart failure 65

66 Heart failure prevalence by CCG Comparison with CCGs in the STP NHS Wigan Borough CCG.03% NHS Stockport CCG NHS Salford CCG NHS Bury CCG 0.94% 0.94% 0.89% prevalence of 0.6% in NHS North Manchester CCG compared to 0.76% in England NHS Trafford CCG 0.87% NHS Heywood, Middleton And Rochdale CCG 0.85% NHS Tameside And Glossop CCG 0.83% NHS Bolton CCG 0.78% NHS Oldham CCG 0.77% NHS South Manchester CCG 0.65% NHS North Manchester CCG 0.6% NHS Central Manchester CCG 0.55% England 0.76% 0.0% 0.2% 0.4% 0.6% 0.8%.0%.2% 66

67 Heart failure prevalence by CCG Comparison with demographically similar CCGs NHS Salford CCG 0.94% NHS Wolverhampton CCG 0.88% NHS Heywood, Middleton and Rochdale CCG 0.85% NHS Bradford Districts CCG 0.82% NHS Leeds South and East CCG 0.80% NHS Stoke On Trent CCG 0.80% NHS Bolton CCG 0.78% NHS Oldham CCG 0.77% NHS Sandwell and West Birmingham CCG 0.68% NHS North Manchester CCG 0.6% NHS Birmingham South and Central CCG 0.60% 0.0% 0.% 0.2% 0.3% 0.4% 0.5% 0.6% 0.7% 0.8% 0.9%.0% 67

68 Heart failure prevalence by GP practice GP practice CCG THE NEVILLE FAMILY CENTRE P84663 NEW ISLINGTON MEDICAL CENTRE P84064 THE AVENUE MEDICAL CENTRE P84049 WELLFIELD MEDICAL CENTRE P84074 CONRAN MEDICAL CENTRE P84040 DR MOKASHI P84032 PARKVIEW MEDICAL CENTRE P84645 DROYLSDEN RD FAMILY PRACTICE P84047 ARTANE MEDICAL CENTRE P8463 BROOKDALE SURGERY P84062 HAZELDENE MEDICAL CENTRE P84067 CORNERSTONE FAMILY PRACTICE P8404 WHITLEY ROAD MEDICAL CENTRE P84054 BEACON MEDICAL CENTRE P84033 LIME SQUARE MEDICAL CENTRE P84059 VALENTINE MEDICAL CENTRE P8409 FIVE OAKS FAMILIY PRACTICE P84004 FLORENCE HOUSE MEDICAL PRACTICE P84042 WILLOWBANK SURGERY P84679 NEW COLLEGIATE MEDICAL CENTRE P84030 FERNCLOUGH SURGERY P84605 THE SINGH MEDICAL PRACTICE P84065 EASTLANDS MEDICAL CENTRE P8405 THE MAZHARI & KHAN PRACTICE P84637 ST GEORGE'S MEDICAL CENTRE P84025 NEWTON HEATH MEDICAL CENTRE P84070 SIMPSON MEDICAL PRACTICE Y02520 MP VICTORIA MILL Y0695 JOLLY MEDICAL CENTRE P84684 CHEETHAM HILL PRIMARY CARE CENTRE P84046 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 CHARLESTOWN MD Y02325 QUEENS MEDICAL CENTRE P84640 ALEESHAN MEDICAL CENTRE P84623 DAM HEAD MEDICAL CENTRE P84690 CITY HEALTH CENTRE Y02849.%.0%.0% 0.9% 0.9% 0.9% 0.8% 0.8% 0.8% 0.8% 0.8% 0.8% 0.7% 0.7% 0.7% 0.6% 0.6% 0.6% 0.6% 0.6% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.4% 0.4% 0.4% 0.4% 0.3% 0.3% 0.2% 0.2% 0.0% 0.2% 0.4% 0.6% 0.8%.0%.2%,267 people with diagnosed heart failure in NHS North Manchester CCG GP practice range: 0.0% to.% 68

69 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 Oldham CCG NHS North Manchester CCG NHS Heywood, Middleton And Rochdale CCG NHS Bury CCG NHS South Manchester CCG NHS Central Manchester CCG NHS Wigan Borough CCG 90.5% 89.0% 88.2% 88.0% 86.9% 86.3% 86.0% 47 people with heart failure* with LVSD in NHS North Manchester CCG 37 (89%) people treated with ACE-I or ARB 43 (0.3%) people who are exceptions 3 (0.7%) additional people who are not treated with ACE-I or ARB NHS Tameside And Glossop CCG 85.6% NHS Stockport CCG 85.5% NHS Bolton CCG 85.% NHS Trafford CCG 84.8% NHS Salford CCG 83.6% England 84.7% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator HF003 denominator plus exceptions 69

70 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 Oldham CCG 90.5% NHS Stoke On Trent CCG 89.% NHS North Manchester CCG 89.0% NHS Heywood, Middleton and Rochdale CCG 88.2% NHS Sandwell and West Birmingham CCG 87.2% NHS Bolton CCG 85.% NHS Salford CCG 83.6% NHS Birmingham South and Central CCG 83.4% NHS Leeds South and East CCG 82.6% NHS Wolverhampton CCG 8.7% NHS Bradford Districts CCG 8.4% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 70

71 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 DR MOKASHI P84032 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 PARKVIEW MEDICAL CENTRE P84645 FERNCLOUGH SURGERY P84605 VALENTINE MEDICAL CENTRE P8409 EASTLANDS MEDICAL CENTRE P8405 LIME SQUARE MEDICAL CENTRE P84059 WELLFIELD MEDICAL CENTRE P84074 THE AVENUE MEDICAL CENTRE P84049 FLORENCE HOUSE MEDICAL PRACTICE P84042 ST GEORGE'S MEDICAL CENTRE P84025 HAZELDENE MEDICAL CENTRE P84067 CONRAN MEDICAL CENTRE P84040 CORNERSTONE FAMILY PRACTICE P8404 SIMPSON MEDICAL PRACTICE Y02520 FIVE OAKS FAMILIY PRACTICE P84004 NEW COLLEGIATE MEDICAL CENTRE P84030 BEACON MEDICAL CENTRE P84033 CHEETHAM HILL PRIMARY CARE CENTRE P84046 DROYLSDEN RD FAMILY PRACTICE P84047 WHITLEY ROAD MEDICAL CENTRE P84054 BROOKDALE SURGERY P84062 NEW ISLINGTON MEDICAL CENTRE P84064 THE SINGH MEDICAL PRACTICE P84065 NEWTON HEATH MEDICAL CENTRE P84070 ALEESHAN MEDICAL CENTRE P84623 ARTANE MEDICAL CENTRE P8463 THE MAZHARI & KHAN PRACTICE P84637 QUEENS MEDICAL CENTRE P84640 THE NEVILLE FAMILY CENTRE P84663 WILLOWBANK SURGERY P84679 JOLLY MEDICAL CENTRE P84684 DAM HEAD MEDICAL CENTRE P84690 MP VICTORIA MILL Y0695 CHARLESTOWN MD Y02325 CITY HEALTH CENTRE Y % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are 46 people who are not treated with ACE-I or ARB GP practice range: 0.0% to 33.3% 7

72 Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with CCGs in the STP Treatment No treatment Exceptions reported NHS South Manchester CCG NHS Wigan Borough CCG NHS Central Manchester CCG NHS Trafford CCG NHS North Manchester CCG NHS Stockport CCG NHS Salford CCG 88.4% 87.5% 87.% 83.0% 82.5% 8.3% 80.4% 37 people with heart failure* with LVSD treated with ACE-I/ARB in NHS North Manchester CCG 306 (82.5%) people treated with ACE- I/ARB and BB 47 (2.7%) people who are exceptions 8 (4.9%) additional people who are not treated with ACE-I/ARB and BB NHS Tameside And Glossop CCG 79.8% NHS Bury CCG 78.8% NHS Bolton CCG 77.5% NHS Heywood, Middleton And Rochdale CCG 76.0% NHS Oldham CCG 75.7% England 77.7% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator HF004 denominator plus exceptions 72

73 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 Leeds South and East CCG 84.7% NHS Stoke On Trent CCG 82.5% NHS North Manchester CCG 82.5% NHS Salford CCG 80.4% NHS Bolton CCG 77.5% NHS Heywood, Middleton and Rochdale CCG 76.0% NHS Oldham CCG 75.7% NHS Wolverhampton CCG 75.7% NHS Bradford Districts CCG 73.3% NHS Sandwell and West Birmingham CCG 70.6% NHS Birmingham South and Central CCG 70.3% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 73

74 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 FERNCLOUGH SURGERY P84605 DROYLSDEN RD FAMILY PRACTICE P84047 WHITLEY ROAD MEDICAL CENTRE P84054 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 DR MOKASHI P84032 PARKVIEW MEDICAL CENTRE P84645 LIME SQUARE MEDICAL CENTRE P84059 HAZELDENE MEDICAL CENTRE P84067 SIMPSON MEDICAL PRACTICE Y02520 THE AVENUE MEDICAL CENTRE P84049 VALENTINE MEDICAL CENTRE P8409 WELLFIELD MEDICAL CENTRE P84074 BEACON MEDICAL CENTRE P84033 NEW COLLEGIATE MEDICAL CENTRE P84030 CONRAN MEDICAL CENTRE P84040 CORNERSTONE FAMILY PRACTICE P8404 NEW ISLINGTON MEDICAL CENTRE P84064 FIVE OAKS FAMILIY PRACTICE P84004 ST GEORGE'S MEDICAL CENTRE P84025 FLORENCE HOUSE MEDICAL PRACTICE P84042 CHEETHAM HILL PRIMARY CARE CENTRE P84046 EASTLANDS MEDICAL CENTRE P8405 BROOKDALE SURGERY P84062 THE SINGH MEDICAL PRACTICE P84065 NEWTON HEATH MEDICAL CENTRE P84070 ALEESHAN MEDICAL CENTRE P84623 ARTANE MEDICAL CENTRE P8463 THE MAZHARI & KHAN PRACTICE P84637 QUEENS MEDICAL CENTRE P84640 THE NEVILLE FAMILY CENTRE P84663 WILLOWBANK SURGERY P84679 JOLLY MEDICAL CENTRE P84684 DAM HEAD MEDICAL CENTRE P84690 MP VICTORIA MILL Y0695 CHARLESTOWN MD Y02325 CITY HEALTH CENTRE Y % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 8 2 in total, including exceptions, there are 65 people who are not treated with ACE-I or ARB GP practice range: 0.0% to 66.7% 74

75 Percentage of patients with CHD whose blood pressure reading (measured in the preceding 2 months) is 50/90 mmhg or less by CCG Comparison with CCGs in the STP Below 50/90 Not below 50/90 Exceptions reported NHS Stockport CCG NHS Wigan Borough CCG NHS Bury CCG NHS Heywood, Middleton And Rochdale CCG NHS Tameside And Glossop CCG NHS Bolton CCG NHS Oldham CCG 9.% 90.6% 90.4% 90.2% 90.% 90.% 89.2% 5,83 people with coronary heart disease* in NHS North Manchester CCG 5,098 (87.4%) people whose blood pressure <= 50 / (3.3%) people who are exceptions 540 (9.3%) additional people whose blood pressure is not <= 50 / 90 NHS Trafford CCG 88.4% NHS Salford CCG 87.9% NHS Central Manchester CCG 87.8% NHS North Manchester CCG 87.4% NHS South Manchester CCG 83.5% England 88.2% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator CHD002 denominator plus exceptions 75

76 Percentage of patients with CHD whose blood pressure reading (measured in the preceding 2 months) is 50/90 mmhg or less by CCG Comparison with demographically similar CCGs Below 50/90 Not below 50/90 Exceptions reported NHS Birmingham South and Central CCG 90.4% NHS Heywood, Middleton and Rochdale CCG 90.2% NHS Bolton CCG 90.% NHS Stoke On Trent CCG 89.9% NHS Oldham CCG 89.2% NHS Bradford Districts CCG 88.2% NHS Salford CCG 87.9% NHS Leeds South and East CCG 87.6% NHS North Manchester CCG 87.4% NHS Sandwell and West Birmingham CCG 87.0% NHS Wolverhampton CCG 86.8% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 76

77 Percentage of patients with CHD whose blood pressure reading (measured in the preceding 2 months) is not 50/90 mmhg or less by GP practice Not below 50/90 Exceptions reported HAZELDENE MEDICAL CENTRE P84067 CORNERSTONE FAMILY PRACTICE P8404 WELLFIELD MEDICAL CENTRE P84074 NEWTON HEATH MEDICAL CENTRE P84070 DROYLSDEN RD FAMILY PRACTICE P84047 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 THE AVENUE MEDICAL CENTRE P84049 DR MOKASHI P84032 FIVE OAKS FAMILIY PRACTICE P84004 PARKVIEW MEDICAL CENTRE P84645 LIME SQUARE MEDICAL CENTRE P84059 EASTLANDS MEDICAL CENTRE P8405 FERNCLOUGH SURGERY P84605 SIMPSON MEDICAL PRACTICE Y02520 DAM HEAD MEDICAL CENTRE P84690 THE NEVILLE FAMILY CENTRE P84663 BROOKDALE SURGERY P84062 THE MAZHARI & KHAN PRACTICE P84637 FLORENCE HOUSE MEDICAL PRACTICE P84042 VALENTINE MEDICAL CENTRE P8409 WHITLEY ROAD MEDICAL CENTRE P84054 BEACON MEDICAL CENTRE P84033 MP VICTORIA MILL Y0695 JOLLY MEDICAL CENTRE P84684 ARTANE MEDICAL CENTRE P8463 THE SINGH MEDICAL PRACTICE P84065 CHARLESTOWN MD Y02325 ST GEORGE'S MEDICAL CENTRE P84025 CHEETHAM HILL PRIMARY CARE CENTRE P84046 NEW COLLEGIATE MEDICAL CENTRE P84030 CONRAN MEDICAL CENTRE P84040 CITY HEALTH CENTRE Y02849 QUEENS MEDICAL CENTRE P84640 NEW ISLINGTON MEDICAL CENTRE P84064 WILLOWBANK SURGERY P84679 ALEESHAN MEDICAL CENTRE P % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are 733 people whose blood pressure is not <= 50 / 90 GP practice range: 3.% to 24.0% 77

78 Percentage of patients with CHD whose blood pressure reading (measured in the preceding 2 months) is not 50/90 mmhg or less by GP practice opportunities compared to GP cluster 5% 0% -5% -0% -5% -20% HAZELDENE MEDICAL CENTRE CORNERSTONE FAMILY PRACTICE WELLFIELD MEDICAL CENTRE NEWTON HEATH MEDICAL CENTRE ANCOATS URBAN VILLAGE MEDICAL PRACTICE DROYLSDEN RD FAMILY PRACTICE THE AVENUE MEDICAL CENTRE DR MOKASHI FIVE OAKS FAMILIY PRACTICE SIMPSON MEDICAL PRACTICE using the GP cluster method of calculating potential gains, if each practice was to achieve as well as the upper quartile of its national cluster, then an additional 348 people would be treated CHEETHAM HILL PRIMARY CARE CENTRE THE SINGH MEDICAL PRACTICE NEW COLLEGIATE MEDICAL CENTRE ST GEORGE'S MEDICAL CENTRE CONRAN MEDICAL CENTRE CITY HEALTH CENTRE NEW ISLINGTON MEDICAL CENTRE QUEENS MEDICAL CENTRE ALEESHAN MEDICAL CENTRE WILLOWBANK SURGERY 2 Details of this methodology are available on slide 9. Click here to view them. 78

79 Percentage of patients with CHD with a record in the preceding 2 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 Oldham CCG NHS Heywood, Middleton And Rochdale CCG NHS Central Manchester CCG NHS Bury CCG NHS Stockport CCG NHS North Manchester CCG NHS Trafford CCG NHS Tameside And Glossop CCG 93.6% 93.4% 93.4% 93.% 93.0% 92.8% 92.6% 92.4% 5,83 people with coronary heart disease* in NHS North Manchester CCG 5,40 (92.8%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant 76 (3%) people who are exceptions 245 (4.2%) additional people who are not taking aspirin, an alternative antiplatelet therapy, or an anti-coagulant NHS Salford CCG 92.4% NHS Bolton CCG 92.4% NHS Wigan Borough CCG 9.6% NHS South Manchester CCG 90.5% England 9.8% 0% 20% 40% 60% 80% 00% *Using the QOF clinical indicator CHD005 denominator plus exceptions 79

80 Percentage of patients with CHD with a record in the preceding 2 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 Oldham CCG 93.6% NHS Heywood, Middleton and Rochdale CCG 93.4% NHS Birmingham South and Central CCG 93.4% NHS Bradford Districts CCG 92.9% NHS North Manchester CCG 92.8% NHS Stoke On Trent CCG 92.6% NHS Leeds South and East CCG 92.5% NHS Salford CCG 92.4% NHS Bolton CCG 92.4% NHS Wolverhampton CCG 9.6% NHS Sandwell and West Birmingham CCG 90.7% 0% 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% 80

81 Percentage of patients with CHD without a record in the preceding 2 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice No treatment Exceptions reported EASTLANDS MEDICAL CENTRE P8405 BROOKDALE SURGERY P84062 CORNERSTONE FAMILY PRACTICE P8404 FERNCLOUGH SURGERY P84605 DROYLSDEN RD FAMILY PRACTICE P84047 WELLFIELD MEDICAL CENTRE P84074 DR MOKASHI P84032 MP VICTORIA MILL Y0695 CHARLESTOWN MD Y02325 THE AVENUE MEDICAL CENTRE P84049 FIVE OAKS FAMILIY PRACTICE P84004 HAZELDENE MEDICAL CENTRE P84067 WILLOWBANK SURGERY P84679 LIME SQUARE MEDICAL CENTRE P84059 WHITLEY ROAD MEDICAL CENTRE P84054 THE NEVILLE FAMILY CENTRE P84663 VALENTINE MEDICAL CENTRE P8409 ANCOATS URBAN VILLAGE MEDICAL PRACTICE P84673 THE SINGH MEDICAL PRACTICE P84065 BEACON MEDICAL CENTRE P84033 NEW COLLEGIATE MEDICAL CENTRE P84030 FLORENCE HOUSE MEDICAL PRACTICE P84042 NEWTON HEATH MEDICAL CENTRE P84070 SIMPSON MEDICAL PRACTICE Y02520 PARKVIEW MEDICAL CENTRE P84645 ST GEORGE'S MEDICAL CENTRE P84025 JOLLY MEDICAL CENTRE P84684 ARTANE MEDICAL CENTRE P8463 QUEENS MEDICAL CENTRE P84640 DAM HEAD MEDICAL CENTRE P84690 CHEETHAM HILL PRIMARY CARE CENTRE P84046 NEW ISLINGTON MEDICAL CENTRE P84064 THE MAZHARI & KHAN PRACTICE P84637 CONRAN MEDICAL CENTRE P84040 ALEESHAN MEDICAL CENTRE P84623 CITY HEALTH CENTRE Y % 0% 20% 30% 40% 50% 60% 70% 80% 90% 00% in total, including exceptions, there are 42 people are not taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant GP practice range: 0.0% to 3.7% 8

82 Some data on outcomes for people with cardiovascular disease 82

83 Age standardised rate (per 00,000) Hospital admissions for coronary heart disease for all ages 2002/03 205/6 NHS North Manchester CCG England in NHS North Manchester CCG, the hospital admission rate for coronary heart disease in 205/6 was 74.9 (746) compared to for England /032003/042004/052005/062006/072007/082008/092009/0200/20/2202/3203/4204/5205/6 Source: Hospital Episode Statistics (HES), 2002/03-205/6, Copyright 207, Re used with the permission of NHS Digital. All rights reserved 83

84 Age standardised rate (per 00,000) Hospital admissions for stroke for all ages 2002/03 205/6 NHS North Manchester CCG England in NHS North Manchester CCG, the hospital admission rate for stroke in 205/6 was 279 (27) compared to 72.8 for England /032003/042004/052005/062006/072007/082008/092009/0200/20/2202/3203/4204/5205/6 Source: Hospital Episode Statistics (HES), 2002/03-205/6, Copyright 207, Re used with the permission of NHS Digital. All rights reserved 84

85 Additional risk of complications for people with diabetes, three year follow up, 203/4 NHS North Manchester CCG England Angina Heart Attack Heart failure 73.7% 36.8% 63.6% 08.6% 93.9% 50.0% The risk of a stroke was 4.2% higher and the risk of a heart attack was 63.6% higher compared to people without diabetes. The risk of a major amputation was 36.8% higher. Stroke 4.2% 8.3% Major amputation 36.8% 445.8% Minor amputation 392.0% 753.5% RRT 25.7% 293.0% 85 0% 00% 200% 300% 400% 500% 600% 700% 800% Note: This slide uses data from the National Diabetes Audit (NDA)

86 Age standardised rate (per 000,000) Deaths from coronary heart disease, under 75s NHS North Manchester CCG England in NHS North Manchester CCG, the early mortality rate for coronary heart disease in was 96.2, compared to 40.6 for England Source: Office for National Statistics (ONS) mortality data

87 Age standardised rate (per 00,000) Deaths from stroke, under 75s NHS North Manchester CCG England in NHS North Manchester CCG, the early mortality rate for stroke in was 30.9, compared to 3.6 for England Source: Office for National Statistics (ONS) mortality data

88 Data sources Appendix Quality and Outcomes Framework (QOF), 205/6, Copyright 206, re-used with the permission of NHS Digital. All rights reserved Non-diabetic hyperglycaemia prevalence estimates, NCVIN, PHE: Diabetes prevalence estimates, NCVIN, PHE: CKD Prevalence model, G.Aitken, University of Southampton, Hypertension prevalence estimates for local CCG populations. Created using data from: QOF hypertension registers 204/5 and; Undiagnosed hypertension estimates for adults 6 years and older Department of Primary Care & Public Health, Imperial College London NHS Stop smoking services Copyright 204, 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 203 ; National Diabetes Audit, 203/4 and 205/6, Copyright 206, re-used with the permission of NHS Digital. All rights reserved Hospital Episode Statistics (HES), 2002/03-205/6, Copyright 207, Re used with the permission of NHS Digital. All rights reserved Office for National Statistics (ONS) mortality data , Copyright 207, Re-used with the permission of the Office for National Statistics. All rights reserved 88

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