Commissioning for Value Focus Pack. CCG: Heywood, Middleton & Rochdale Focus Area : Mental Health Programme Budget Category

Transcription

1 Commissioning for Value Focus Pack CCG: Heywood, Middleton & Rochdale Focus Area : Mental Health Programme Budget Category

2 What is a Deep Dive pack? CCGs have received a bespoke Commissioning for Value insights pack. These packs, sometimes referred to as Level packs, analyse data on spend and outcomes at a Programme Budget level across a wide range of programmes. Those packs identified candidate programmes which offered the most value in return for improvement work they answered the question of - where to look. Deep Dive packs further examine areas chosen by the CCGs in order to gain a deeper understanding of issues within specific programmes of work or clinical pathways - What to change. The structure and content of Deep Dive packs has evolved through work done by Right Care and Yorkshire and Humber PHO (now PHE Knowledge and Intelligence Team) working with CCGs in Derbyshire and Yorkshire and Humber. The packs are produced by GEM CSU analysts working with consultants in public health medicine from Solutions for Public Health (an NHS enterprise hosted by GEM CSU). 2

3 Contents. Background and context Aims of the packs - Slide 4 Packs as part of transformation process - Slide 5 2. Methodology Analysis methods - Slide 6 CCG Benchmarking and Opportunities - Slides CCG Analysis Mental Health the context for the deep dive analysis - Slides 3-4 Summary messages for pathway stages: Prevalence - Slides 5-7 Management in Primary Care - Slides 8-9 Management in Secondary Care - Slides 20-2 Mortality - Slide 22 Opportunity table for indicators in the bottom quintile of benchmark group - Slide Where to focus: Understanding practice variation - Slides All Practices: Indicators in the bottom quintile - Slides Top 3 Practices: Opportunities table - Slide Bringing it all together, National Guidance - Slides Annexes Annex Spine charts and opportunity tables - Slides Annex 2 CCG Cluster Classification - Slides Annex 3 Practice Cluster Classification - Slides Annex 4 Indicator List - Slides 4-42 Glossary - Slide 43 3

4 . Background and context Aims of the Packs The Commissioning for Value phase one packs, produced by NHSE, PHE and NHS Right Care, included an offer to work with CCGs to develop this Focus Pack, or deep dive. The deep dive looks at an agreed programme area to understand variation across the pathway, including GP practice benchmarking. Working with local intelligence teams, the deep dive will look to identify opportunities for improvement and support the CCG's discussion on methods of improving clinical pathways. Further support is available to use and explore the intelligence in this pack 4

5 . Background and context How these Packs Support Service Improvement NHSE GEM 5

6 2. Methodology Analysis Methods Analysed wide range of indicators from across the pathway focussing on risk factors, spend, primary and secondary care usage and quality Analysed wide range of national benchmarked data to identify indicators where CCG is below the average for its CCG cluster group (see Annex 2) Identified indicators where CCG is in worst quintile within its cluster group Analysed practice based variation to identify practices which consistently compare poorly against their national clusters Identified opportunities for value improvement and quantified potential impact Listed all the indicators where CGG is below average for CCG cluster Quantified opportunity for indicators in bottom quintile moving to the CCG Cluster average Quantified additional opportunities for indicators moving to the top 20% for the CCG Cluster Quantification does not mean that the saving or improvement can actually be made, but may however answer the question Is it going to be worth focussing on this area? Reviewed national evidence base to identify potential interventions linked to opportunities Pulled together examples of what works against opportunity areas across the pathway 6

7 2. Methodology CCG Benchmarking and Opportunities CCGs are compared using a benchmark cluster group of most similar CCGs in terms of age, ethnicity, deprivation and population density The benchmark cluster group is based on YHPHO CCG classification methodology and differs to those used in the phase packs. The definitions and constituent CCGs are in Annex 2 Indicators are ranked out of 00 within the CCG benchmark group. A rank of is taken as comparatively worse e.g. higher spend/higher prevalence/ higher admission rate/lower screening uptake/lower urgent referrals Indicators where the CCG is in the bottom quintile of the benchmark group (ranked -20) are highlighted in the summary analysis slides and summary opportunity table 7

8 Phase versus Phase 2 analysis Phase 2 analysis differs from Phase analysis Different clustering methods nearest 0 CCGs vs colour coded-cluster CCGs Phase, but not phase 2 method included population size as a clustering metric Different years of data 20/2 vs 202/3 for phase 2 Therefore analysis gives some slightly different results 8

9 Phase Analysis based on comparison with 0 most similar CCGs NHS Bolton CCG NHS Oldham CCG NHS Bradford Districts CCG NHS Stoke on Trent CCG NHS South Tees CCG NHS Bury CCG NHS Tameside and Glossop CCG NHS Newcastle West CCG NHS Leeds South and East CCG NHS Walsall CCG 9

10 CCG cluster classification for Phase 2 The CCG Cluster groups are taken from YHPHO methodology, which groups together CCGs with similar populations. It is based on statistical cluster analysis (K-means analysis) including variables of age structure of the population, the population from Black and Asian ethnic groups, population density and deprivation. Cluster Classification Group Purple Blue Green Yellow Orange An older population living in rural areas and low deprivation levels A very young population with a high proportion of the population from Black and Asian ethnic groups and high levels of deprivation. A younger population with a high proportion of the population from Black and Asian ethnic groups and moderate levels of deprivation. A younger population with a higher than average proportion of the population from Black and Asian ethnic groups and moderate levels of deprivation. A population with an average age structure, average deprivation levels and a low population density. 0-9 years years years years 80+ years Population from Black ethnic groups Population from Asian ethnic groups Population density (persons per hectare) Average IMD 200 score 22.3% 22.0% 27.8% 2.9% 6.0% 0.5%.9% % 4.% 2.3% 9.0% 2.% 6.2% 3.6% % 42.0% 23.5% 0.4% 2.5% 6.7% 0.3% % 3.6% 24.5% 4.% 3.7% % 25.3% 27.9% 8.2% 4.5%.5% 4.6% 0

11 CCG cluster classification for Phase 2 Heywood, Middleton & Rochdale CCG is in the Yellow Cluster Group. The constituent CCG s are listed below. Code CCG Name Code CCG Name 00G NHS Newcastle North and East CCG 06P NHS Luton CCG 00H NHS Newcastle West CCG 07L NHS Barking and Dagenham CCG 00Q NHS Blackburn with Darwen CCG 07M NHS Barnet CCG 00Y NHS Oldham CCG 07V NHS Croydon CCG 0D NHS Heywood, Middleton and Rochdale CCG 07W NHS Ealing CCG 0G NHS Salford CCG 07X NHS Enfield CCG 0M NHS North Manchester CCG 07Y NHS Hounslow CCG 0N NHS South Manchester CCG 08A NHS Greenwich CCG 02R NHS Bradford Districts CCG 08E NHS Harrow CCG 03C NHS Leeds West CCG 08G NHS Hillingdon CCG 03F NHS Hull CCG 08J NHS Kingston CCG 03G NHS Leeds South and East CCG 08N NHS Redbridge CCG 03J NHS North Kirklees CCG 08R NHS Merton CCG 03N NHS Sheffield CCG 09H NHS Crawley CCG 04C NHS Leicester City CCG 0R NHS Portsmouth CCG 04F NHS Milton Keynes CCG 0T NHS Slough CCG 04K NHS Nottingham City CCG 0W NHS South Reading CCG 04X NHS Birmingham South and Central CCG 0X NHS Southampton CCG 05A NHS Coventry and Rugby CCG H NHS Bristol CCG 05L NHS Sandwell and West Birmingham CCG 3P NHS Birmingham Crosscity CCG 05Y NHS Walsall CCG 99A NHS Liverpool CCG 06A NHS Wolverhampton CCG

12 2. Methodology CCG Benchmarking and Opportunities An opportunity is calculated based on the CCG reaching the benchmark group average, and also reaching the 80 th percentile value, i.e. the best performing quintile, of the benchmark group Quantification does not mean that the saving or improvement can actually be made, but may however answer the question Is it going to be worth focussing on this area? Spine graphs and the full opportunity tables are in Annex A list of all indicators used is in Annex 4 A Glossary is available end slide 2

13 3. Mental Health Context for Deep Dive Analysis The Right Care Commissioning for Value phase pack highlighted that, compared to their comparator CCGs, Heywood, Middleton & Rochdale CCG had: Significantly higher recorded prevalence of severe mental health disorders Average recorded prevalence of depression and dementia Significantly higher spend on FHS prescribing Significantly higher rate of admissions to hospital for patients >74 years with a secondary diagnosis of dementia 3

14 3. Mental Health 202/3 Deep Dive Analysis The data in this pack is based on 202/3 whenever available and opportunities identified may now differ from the national CFV packs. Recorded prevalence of mental health and depression was in the highest quintile of the benchmark group and England The CCG was in the highest quintile in the benchmark group and England for prescribing spend in 202/3 Emergency hospital admissions for Dementia (65+ and 75+ years) and Schizophrenia were in the highest quintile in the benchmark group and England If the CCG were to move to the benchmark group average, the following improvements would be seen:.m reduction on prescribing spend 4

15 3. ANALYSIS Summary: Prevalence 2 / 5 indicators are in the bottom quintile of the benchmark group: Mental Health prevalence overall and, specifically, Depression prevalence 5

16 3. ANALYSIS Summary: Prevalence Compared to Phase, where prevalence of depression was average, prevalence from Phase 2 data shows that depression prevalence high (when compared to Phase 2 cluster group of CCGs). Link between poverty and mental health: those with low incomes are more likely to suffer from poor mental health and those with mental health problems are more likely to experience poverty: once incapacitated, an individual s socio economic status is likely to fall further 6

17 3. ANALYSIS Summary: Prevalence Both individual and neighbourhood deprivation increase risk of poor general and mental health. The rates of admission for acute psychiatric care tend to be higher in deprived areas. Poor physical health: living with serious mental health problems (schizophrenia and bipolar) increases risk of cardiovascular, chronic respiratory disease, diabetes, HCV, HIV) 7

18 3. ANALYSIS Summary: Management in Primary Care 3 / 27 indicators are in the bottom quintile of the benchmark group Total MH cost prescribed per 000 population Total MH items prescribed per 000 population Patients on the MH register with record of cervical screening test in last 5 years (Low) 8

19 Mental health Registers - primary care In order to carry out the reviews required, it is necessary to have a list of patients with severe long-term mental health problems. Practices would normally wish to consider including all patients with psychotic illness, patients treated under a care programme approach and patients requiring complex packages of care from a multi-disciplinary secondary care team. In England, this would include all patients being treated under the 'enhanced level' of the care programme approach. These are patients with multiple care needs, who often require inter-agency co-ordination, and may be at risk of disengaging themselves from services. Other practices may also wish to include on a register patients with long-term depression, as there is evidence that the sort of structured care applied to other chronic diseases may also benefit patients with depression. 9

20 3. ANALYSIS Summary: Management in secondary care 3 / 6 indicators are in the bottom quintile of the benchmark group. Emergency Admissions for dementia 65+ years Emergency Admissions for dementia 75+ years Emergency Admissions with schizophrenia and delusional disorders 20

21 The burden of care for dementia Compared to individuals without dementia, people who subsequently developed dementia have a significantly higher rate of hospital admissions for all causes. There are a number of disorders where pro-active care may have prevented hospitalisation including: bacterial pneumonia, CCF, UTI (account for 2/3 of all potentially preventable admissions) CQC evidence almost /3 people over 65 years will develop dementia in their lifetime Dementia prevalence likely to top million in next 0 years 2

22 3. ANALYSIS Summary: Mortality / 2 indicators are in the bottom quintile of the benchmark group: Mortality from suicide and injury undetermined DSR per 00,000 22

23 3. ANALYSIS CCG Indicators and Opportunities in the bottom quintile of the benchmark cluster group Pathway step Indicator CCG Value Benchmark Value Gain if CCG had same 'rate' as benchmark cluster of CCGs Benchmark average Prevalence MH prevalence % 0.9% 277 fewer cases Depression prevalence 7.8% 5.4% 3936 fewer cases Total MH Cost prescribed per 000 population 4,845 9, reduction Management in Primary Care Total MH Items prescribed per 000 population fewer items prescribed Patients on MH register with record of cervical screening test in last 5 years (MH 6) 85.5% 88.4% 7 additional patients managed Emergency admissions for dementia 65+ years DSR per fewer admissions Management in Secondary Care Emergency admissions for dementia 75+ years DSR per fewer admissions Emergency admissions with schizophrenia and delusional disorders DSR per 00, fewer admissions Mortality Mortality from suicide and injury undetermined DSR per 00, fewer deaths 23

24 4. Where to focus: Understanding practice variation Practices are compared using a benchmark cluster group of the most similar practices in terms of age, ethnicity, deprivation and population density. The practice cluster group definitions and constituent practices are in Annex 3. Practices are compared for all the indicators where data is available at practice level This information is presented here to form the basis of a discussion between the CCG, the CSU and Public Health about how further analysis could support practices in reducing unexplained practice variation The number of indicators where the practice is in the bottom quintile for the practice cluster has been compared on the next slide and the opportunities for the practices with the highest number of indicators in the bottom quintile has been quantified on the subsequent slide 24

25 4. Where to focus: Understanding practice variation Practices will have less influence on management in secondary care than they do on management in primary care and this should be taken into account in the way CCGs interpret the information on practice variation Practices however, influence the referral to secondary care and also influence the availability of community care which in itself reduces secondary care admissions. Also avoidable causes (CCF, pneumonia, dehydration, UTI) of admissions for dementia are affected by care at the primary care level /community care. 25

26 4. Where to focus: Understanding practice variation Number of Mental Health indicators in the bottom quintile of the practice cluster The chart on the following slide shows the number of Mental Health indicators in the bottom quintile of the practice cluster. Each coloured bar represents a different set of indicators e.g. dark blue is prevalence. The specific indicators are then shown in the table on slides xx for the 3 practices with the highest total number of indicators in the bottom quintile Note, some of the data are based on small numbers. Statistical significance has not been tested and should not be inferred. The data are presented to identify potential areas of improvements rather than providing a definitive comparison of performance. 26

27 Dr HB Syed (P86609) 0 4. Where to focus: Understanding practice variation Windermere Surgery (P86620) Vicars Drive Surgery (P86002) Wellfield Health Centre (P86007) 7 Number of Mental Health indicators in the bottom quintile of the practice cluster Durnford Medical Centre (P8609) Littleborough Group Practice Family Practice (P86606) The Junction Surgery (P8600) Castleton Health Centre (P86009) Hopwood Medical Centre (P86023) Baillie Street Health Ctr (P8669) York House Surgery (P86605) Trinity Medical Centre (P86624) Mark Street Surgery (P86008) Edenfield Road Surgery (P86003) Woodside Medical Centre Longford Street Medical Centre Ashworth Street Surgery (P86006) Dr IK Babar (P8604) The Village Medical Ctr. (P86608) Stonefield Street Surgery (P86022) Peterloo Medical Centre (P86004) Pennine Surgery (P8602) The Dawes Family Practice Yorkshire St Surgery (P86005) Milnrow Village Practice (P8600) Inspire Medical Centre (P8607) Rochdale Road Medical Centre Tweedale Street Surgery (P8664) Heady Hill Surgery (P86602) Drake Street Surgery (P86622) Healey Surgery (P8603) Argyle Street Medical Ctr (P8606) Prevalence (3 indicators) Primary Care (2 indicators) Secondary Care (5 indicators) 27

28 Discussion around chart The top 3 practices shown have a very high levels deprivation (VHLD) score catchment area However, so do Healey and Argyle Street Medical practices! What are these two practices doing that is different from the three at top of chart? 4/33 practices have VHLD scattered through chart Littleborough Surgery has a low level of deprivation score but 9 indicators in the lowest quintile why? 28

29 4. Where to focus: Understanding practice variation The table shows the 3 GP practices with the highest total number of mental health indicators in the bottom quintile of the practice cluster group, as depicted on the previous slide. Opportunities for the practice to reach the cluster group average are shown against all of the indicators where applicable, and those highlighted in red are in the bottom quintile. Quantification does not mean that the saving or improvement can actually be made, but may however answer the question Is it going to be worth focussing on this area? Pathway step Indicator Dr HB Syed (P86609) * indicators in bottom quintile of practice cluster Windermere Surgery (P86620) *0 indicators in bottom quintile of practice cluster Vicars Drive Surgery (P86002) *9 indicators in bottom quintile of practice cluster Prevalence Primary Care Secondary Care MH prevalence fewer case no opportunities 2 fewer cases Dementia prevalence no opportunities no opportunities no opportunities Depression prevalence 28 fewer cases 40 fewer cases no opportunities MH Secondary care cost prescribed per 000 population 6,52 reduction 20,86 reduction 9,220 reduction MH Secondary care items prescribed per 000 population 700 fewer items prescribed 3679 fewer items prescribed no opportunities Patients on MH register with comprehensive care plan (MH 0) 6 additional patients managed 2 additional patients managed no opportunities Patients on MH register who have a record of alcohol consumption (MH ) 3 additional patients managed 8 additional patients managed no opportunities Patients on MH register who have a record of BMI (MH 2) 2 additional patients managed 7 additional patients managed no opportunities Patients on MH register who have a record of blood pressure (MH 3) 0 additional patients managed 7 additional patients managed 4 additional patients managed Patients on MH register with record of cervical screening test in last 5 years (MH 6) 2 additional patients managed no opportunities additional patient managed Patients aged 40 years and over with SMI with record of total cholesterol:hdl ratio (MH 9) 5 additional patients managed 3 additional patients managed 4 additional patients managed Patients aged 40 years with SMI with record of blood glucose or HbAc (MH 20) 5 additional patients managed 6 additional patients managed 4 additional patients managed Patients on the diabetes/chd register for whom case finding for depression has been undertaken (DEP ) 55 additional patients managed 22 additional patients managed 0 additional patients managed Patients with a new diagnosis of depression with assessment of severity at the time of diagnosis (DEP 6) no opportunities 4 additional patients managed additional patient managed Patients with new diagnosis of depression and assessment of severity with further assessment 2-2 weeks (inclusive) (DEP 7) 3 additional patients managed additional patients managed no opportunities Hospital admissions for dementia 65+ years DSR per 000 no admissions no opportunities no opportunities Hospital admissions for dementia 75+ years DSR per 000 no admissions no opportunities no opportunities Emergency hospital admissions for self harm DSR per 00,000 no admissions no opportunities 3 fewer admissions Emergency admissions with schizophrenia and delusional disorders DSR per 00,000 no opportunities 3 fewer admissions no opportunities Emergency admissions with mood affective disorders DSR per 00,000 no admissions no opportunities no opportunities 'Opportunities are shown as Fewer when, to reach the benchmark average, would represent X fewer cases/admissions/deaths'. Opportunities are shown as Extra/More Managed when, to reach the benchmark average would represent X additional patients reviewed 29

30 5. Bringing it all together Where to focus, what could work, who should we speak to CCGs should consider what local intelligence is available to further triangulate with the intelligence in this pack. This may include: Practice variation analyses Reviewing referral protocols and guidelines Analysis from Acute Trust quality dashboard or other provider data Contract monitoring data Next step is to move from intelligence to action CCG needs to identify from the summary slides where to focus and what could work and which CCG may be an exemplar to follow There are also many resources available on to take forwards the improvement agenda. 30

31 5. National Guidance Quick Reference Guide. Self Harm. The short term physical and psychological management and secondary prevention of self harm in primary and secondary care. Clinical Guidelines 6 developed by the National Collaboration Centre for Mental Health. July Self Harm. NICE Quality Standard 34. June 203 Report of the National Audit of Schizophrenia (NAS) 202. Royal College of Psychiatrists. Commissioned by Healthcare Quality Improvement Partnership (HQIP) Dementia. NICE Clinical Guideline CG42. Dementia. NICE Quality Standard. August 20 3

32 5. National Guidance Supporting People to live well with dementia. NICE Quality Standard 30 April 203 Paying the Price. The cost of mental health care in England to Kings Fund 2008 Anxiety NICE Guideline 3. Jan and Anxiety NICE Quality Standard 53 Common Mental Health Disorders NICE May Depression in adults. NICE Quality Standard 8. March 20 Psychosis and Schizophrenia in adults. NICE Clinical Guideline 78. Feb

33 Annexes Annex Spine charts and opportunity tables Slides Annex 2 CCG Cluster Classification Slides Annex 3 Practice Cluster Classification Slide Annex 4 Indicator List Slides 4-42 Glossary Slide 43 33

34 Annex : Spine Charts Prevalence / Diagnosis Opportunities Worse Outcome Better Outcome Benchmark average Benchmark Top Quintile MH prevalence Dementia prevalence Reported numbers of dementia on GP registers as a percentage of estimated prevalence Depression prevalence Patients reporting long term MH problem fewer cases 59 fewer cases 0 fewer cases 343 fewer cases No Opportunity 25 additional patients recorded 3936 fewer cases 6087 fewer cases 2 fewer cases 5 fewer cases Mortality Worse outcome / Higher spend Better outcome / Low er spend Benchmark average Opportunities Benchmark Top Quintile Mortality from suicide and injury undetermined DSR per 00,000 Excess under 75 mortality rate in adults with serious mental illness DSR per 00,000 9 fewer deaths 32 fewer deaths fewer deaths 3 fewer deaths

35 Annex : Spine Charts Primary Care Opportunities Worse outcome Better outcome Benchmark average Benchmark Top Quintile Total MH Cost prescribed per 000 population Total MH Items prescribed per 000 population Patients on MH register with comprehensive care plan (MH 0) Patients on MH register who have a record of alcohol consumption (MH ) Patients on MH register who have a record of BMI (MH 2) Patients on MH register who have a record of blood pressure (MH 3) Patients on MH register with record of cervical screening test in last 5 years (MH 6) Patients on lithium therapy with a record of serum creatinine and TSH (MH 7) Patients on lithium therapy with a record of lithium levels in the therapeutic range (MH 8) Patients aged 40 years and over with SMI with record of total cholesterol:hdl ratio (MH 9) Patients aged 40 years with SMI with record of blood glucose or HbAc (MH 20) Total MH Exceptions Patients diagnosed with dementia whose care has been reviewed (DEM 2) Patients with new diagnosis of dementia with record of FBC; calcium; glucose; renal, liver and thyroid Total Dementia Exceptions Patients on the diabetes/chd register for whom case finding for depression has been undertaken Patients with a new diagnosis of depression with assessment of severity at the time of diagnosis Patients with new diagnosis of depression and assessment of severity with further assessment 2-2 Total Depression Exceptions People with mental illness and or disability in settled accommodation Improving access to psychological therapies - recovery rate reduction reduction 698 fewer items prescribed fewer items prescribed 58 additional patients managed 07 additional patients managed No Opportunity 29 additional patients managed 5 additional patients managed 45 additional patients managed 2 additional patients managed 49 additional patients managed 7 additional patients managed 3 additional patients managed additional patients managed 8 additional patients managed 4 additional patients managed 5 additional patients managed No Opportunity 24 additional patients managed No Opportunity 36 additional patients managed No Opportunity No Opportunity 5 additional patients managed 9 additional patients managed 8 additional patients managed 9 additional patients managed No Opportunity 6 fewer exceptions 85 additional patients managed 380 additional patients managed No Opportunity No Opportunity 97 additional patients managed 245 additional patients managed No Opportunity 52 fewer exceptions No Opportunity 5 additional patients 22 additional patients 98 additional patients 35

36 Annex : Spine Charts Primary Care Worse outcome Better outcome Benchmark average Opportunities Benchmark Top Quintile MH Total Outpatient Attendances per 000 MH First Outpatient Attendances per 000 Adult MH Total Outpatient Attendances per 000 Adult MH First Outpatient Attendances per 000 No Opportunity No Opportunity No Opportunity No Opportunity 2877 fewer attendances 94 fewer attendances 224 fewer attendances 56 fewer attendances Old Age Psychiatry Total Outpatient Attendances per 000 No Opportunity 325 fewer attendances Old Age Psychiatry First Outpatient Attendances per fewer attendances No Opportunity Secondary Care Worse outcome / Higher spend Better outcome / Low er spend Benchmark average Opportunities Benchmark Top Quintile Bed days >74 years with a secondary diagnosis of dementia Emergency admissions for dementia 65+ years DSR per 000 Emergency admissions for dementia 75+ years DSR per 000 Emergency hospital admissions for self harm DSR per 00,000 mergency admissions with schizophrenia and delusional disorders DSR per 00,000 Emergency admissions with mood affective disorders DSR per 00,000 No Opportunity 9 fewer bed days 95 fewer admissions 322 fewer admissions 80 fewer admissions 327 fewer admissions 30 fewer admissions 273 fewer admissions 84 fewer admissions 289 fewer admissions 28 fewer admissions 628 fewer admissions

37 Annex 2: CCG cluster classification The CCG Cluster groups are taken from YHPHO methodology, which groups together CCGs with similar populations. It is based on statistical cluster analysis (K-means analysis) including variables of age structure of the population, the population from Black and Asian ethnic groups, population density and deprivation. Cluster Classification Group Purple Blue Green Yellow Orange 0-9 years years years years 80+ years Population from Black ethnic groups Population from Asian ethnic groups Population density (persons per hectare) Average IMD 200 score An older population living in rural areas and low deprivation levels 22.3% 22.0% 27.8% 2.9% 6.0% 0.5%.9% A very young population with a high proportion of the population from Black and Asian ethnic groups and high levels of deprivation. 26.4% 4.% 2.3% 9.0% 2.% 6.2% 3.6% A younger population with a high proportion of the population from Black and Asian ethnic groups and moderate levels of deprivation. 2.6% 42.0% 23.5% 0.4% 2.5% 6.7% 0.3% A younger population with a higher than average proportion of the population from Black and Asian ethnic groups and 26.0% 3.6% 24.5% 4.% 3.7% 6.7% 7.7% moderate levels of deprivation. A population with an average age structure, average deprivation levels and 24.2% 25.3% 27.9% 8.2% 4.5%.5% 4.6% a low population density. 37

38 Annex 2: CCG cluster classification Heywood, Middleton & Rochdale CCG is in the Yellow Cluster Group. The constituent CCG s are listed below. Code CCG Name Code CCG Name 00G NHS Newcastle North and East CCG 06P NHS Luton CCG 00H NHS Newcastle West CCG 07L NHS Barking and Dagenham CCG 00Q NHS Blackburn with Darwen CCG 07M NHS Barnet CCG 00Y NHS Oldham CCG 07V NHS Croydon CCG 0D NHS Heywood, Middleton and Rochdale CCG 07W NHS Ealing CCG 0G NHS Salford CCG 07X NHS Enfield CCG 0M NHS North Manchester CCG 07Y NHS Hounslow CCG 0N NHS South Manchester CCG 08A NHS Greenwich CCG 02R NHS Bradford Districts CCG 08E NHS Harrow CCG 03C NHS Leeds West CCG 08G NHS Hillingdon CCG 03F NHS Hull CCG 08J NHS Kingston CCG 03G NHS Leeds South and East CCG 08N NHS Redbridge CCG 03J NHS North Kirklees CCG 08R NHS Merton CCG 03N NHS Sheffield CCG 09H NHS Crawley CCG 04C NHS Leicester City CCG 0R NHS Portsmouth CCG 04F NHS Milton Keynes CCG 0T NHS Slough CCG 04K NHS Nottingham City CCG 0W NHS South Reading CCG 04X NHS Birmingham South and Central CCG 0X NHS Southampton CCG 05A NHS Coventry and Rugby CCG H NHS Bristol CCG 05L NHS Sandwell and West Birmingham CCG 3P NHS Birmingham Crosscity CCG 05Y NHS Walsall CCG 99A NHS Liverpool CCG 06A NHS Wolverhampton CCG 38

39 Annex 3: Practice cluster classification The practice cluster groups are taken from YHPHO methodology, which groups together practices with similar populations. It is based on statistical cluster analysis (K-means analysis) including variables of age structure of the population, the population from Black and Asian ethnic groups, rural classification and deprivation. A total of 8074 GP practices were grouped into ten classification groups. A small number of practices (354 covering.% of the population) did not have sufficient data to allocate them to a classification group 39

40 Annex 3: Practice cluster classification The practice cluster groups are taken from YHPHO methodology, which groups together practices with similar populations. It is based on statistical cluster analysis (K-means analysis) including variables of age structure of the population, the population from Black and Asian ethnic groups, rural classification and deprivation. A total of 8074 GP practices were grouped into ten classification groups. A small number of practices (354 covering.% of the population) did not have sufficient data to allocate them to a classification group Practices in Heywood, Middleton & Rochdale CCG and the practice cluster benchmark group Practice Cluster Name Kite Oval Practice Code P86003 P8608 P8600 P86004 P86005 P86007 P86008 P86009 P8600 P860 P8605 P8609 P8602 P86605 P86622 Practice Name Edenfield Road Surgery Littleborough Group Practice Milnrow Village Practice Peterloo Medical Centre Yorkshire St Surgery Wellfield Health Centre Mark Street Surgery Castleton Health Centre The Junction Surgery Longford Street Medical Centre Rochdale Road Medical Centre Durnford Medical Centre Pennine Surgery York House Surgery Drake Street Surgery Practice Cluster Name Pentagon Square Triangle Practice Code P86022 P86023 P86608 P86624 P8604 P8607 P86609 P8664 P8669 P86002 P86006 P8602 P8603 P8606 P86026 P86602 P86606 P86620 Practice Name Stonefield Street Surgery Hopwood Medical Centre The Village Medical Ctr. Trinity Medical Centre Dr IK Babar Inspire Medical Centre Dr HB Syed Tweedale Street Surgery Baillie Street Health Ctr Vicars Drive Surgery Ashworth Street Surgery Woodside Medical Centre Healey Surgery Argyle Street Medical Ctr The Dawes Family Practice Heady Hill Surgery Family Practice Windermere Surgery 40

41 Annex 4: Full indicator list Pathway Step Indicator/Data Source Year Prevalence MH prevalence QOF (NHS IC) 202/3 Prevalence Dementia prevalence QOF (NHS IC) 202/3 Prevalence Reported numbers of dementia on GP registers as a percentage of estimated prevalence QOF/CFV Packs 202/3 Prevalence Depression prevalence QOF (NHS IC) 202/3 Prevalence Patients reporting long term MH problem National GP Survey 202/3 Primary Care Total MH Cost prescribed per 000 population NHS Comparators (NHS IC) 202/3 Primary Care Total MH Items prescribed per 000 population NHS Comparators (NHS IC) 202/3 Primary Care Patients on MH register with comprehensive care plan (MH 0) QOF (NHS IC) 202/3 Primary Care Patients on MH register who have a record of alcohol consumption (MH ) QOF (NHS IC) 202/3 Primary Care Patients on MH register who have a record of BMI (MH 2) QOF (NHS IC) 202/3 Primary Care Patients on MH register who have a record of blood pressure (MH 3) QOF (NHS IC) 202/3 Primary Care Patients on MH register with record of cervical screening test in last 5 years (MH 6) QOF (NHS IC) 202/3 Primary Care Patients on lithium therapy with a record of serum creatinine and TSH (MH 7) QOF (NHS IC) 202/3 Primary Care Patients on lithium therapy with a record of lithium levels in the therapeutic range (MH 8) QOF (NHS IC) 202/3 Primary Care Patients aged 40 years and over with SMI with record of total cholesterol:hdl ratio (MH 9) QOF (NHS IC) 202/3 Primary Care Patients aged 40 years with SMI with record of blood glucose or HbAc (MH 20) QOF (NHS IC) 202/3 Primary Care Total MH Exceptions QOF (NHS IC) 202/3 Primary Care Patients diagnosed with dementia whose care has been reviewed (DEM 2) QOF (NHS IC) 202/3 Primary Care Patients with new diagnosis of dementia with record of FBC; calcium; glucose; renal, liver and thyroid function; serum vitamin B2 and folate (DEM 4) QOF (NHS IC) 202/3 Primary Care Total Dementia Exceptions QOF (NHS IC) 202/3 4

42 Annex 4: Full indicator list (cont.) Pathway Step Indicator/Data Source Year Primary Care Patients on the diabetes/chd register for whom case finding for depression has been undertaken (DEP ) QOF (NHS IC) 202/3 Primary Care Patients with a new diagnosis of depression with assessment of severity at the time of diagnosis (DEP 6) QOF (NHS IC) 202/3 Primary Care Patients with new diagnosis of depression and assessment of severity with further assessment QOF (NHS IC) 2-2 weeks (inclusive) (DEP 7) 202/3 Primary Care Total Depression Exceptions QOF (NHS IC) 202/3 Primary Care People with mental illness and or disability in settled accommodation CFV Packs 20/2 Primary Care Improving access to psychological therapies - recovery rate CFV Packs 20/2 Primary Care MH Total Outpatient Attendances per 000 NHS Comparators (NHS IC) 202/3 Primary Care MH First Outpatient Attendances per 000 NHS Comparators (NHS IC) 202/3 Primary Care Adult MH Total Outpatient Attendances per 000 NHS Comparators (NHS IC) 202/3 Primary Care Adult MH First Outpatient Attendances per 000 NHS Comparators (NHS IC) 202/3 Primary Care Old Age Psychiatry Total Outpatient Attendances per 000 NHS Comparators (NHS IC) 202/3 Primary Care Old Age Psychiatry First Outpatient Attendances per 000 NHS Comparators (NHS IC) 202/3 Secondary Care Bed days >74 years with a secondary diagnosis of dementia CFV Packs 20/2 Secondary Care Hospital admissions for dementia 65+ years DSR per 000 HES 20/2 Secondary Care Hospital admissions for dementia 75+ years DSR per 000 HES 202/3 Secondary Care Emergency hospital admissions for self harm DSR per 00,000 HES 202/3 Secondary Care Emergency admissions with schizophrenia and delusional disorders DSR per 00,000 HES 202/3 Secondary Care Emergency admissions with mood affective disorders DSR per 00,000 HES 202/3 Mortality Mortality from suicide and injury undetermined DSR per 00,000 CFV Packs 202/3 Mortality Excess under 75 mortality rate in adults with serious mental illness DSR per 00,000 CFV Packs 202/3 42

43 Glossary QOF Exceptions : Total exceptions across all management indicators Mental Health Outpatient Attendances: Treatment specialty Outpatient Data Considerations: Data quality, completeness and submissions varies between mental health providers and this can impact on the interpretation of mental health comparators. Variation in outpatient attendance rates per 000 population ranges from < attendance per 000 population to >400 attendances per 000 population. Rates that are <5 per 000 for new outpatients and <20 for total outpatients per 000 population should be viewed with caution. Spend and Admissions: The rate in terms of activity and Payment by Results (PbR) tariff based cost per 000 practice population. Denominator data: Population based on GP list data. Numerator data: Count of completed spells and sum of PbR tariff. Excludes activity not covered by mandatory PbR Tariffs. DSR per 00,000: Directly age standardised rate calculated by taking the age-specific crude rates and applying them to the European Standard Population. Age-standardised rates take into account the variation in the age structures of populations Emergency admissions with schizophrenia and delusional disorders: F20-F29 Emergency admissions with mood affective disorders: F30-F39 Emergency admissions Self-Harm: Underlying diagnosis of X60-X84 Emergency admissions Dementia: F00-F03 43