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Primary Care Commissioning Application User Guide for v88

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1. configuration and expenditure and the quality of primary care in the CCG in terms of patient experience access and clinical outcomes The full list of indicators is shown on page 17 of this guide in Appendix A and on the Indicator info tab of the application 1 3 The reports and analyses you can run using the PCC Application This section provides an overview of the different reports the PCC Application can provide Chapter 3 explains in more detail how to use the application to generate these reports When you open the PCC Application you will see that the screen is divided into four sections as illustrated in the screen shot below Figure 1 3 Primary Care Commissioning Application front page Primary Care Commissioning Application V88 Primary Medical Care GP Practice Reports View CCG dashboard GP practice indicator table View CCG profile GP practice dynamics View GP Practice Dashboard GP practice LTC prevalence by practice View GP practice profile GP practice LTC prevalence by LTC Select CCG or PCT ER GP practice correlation analysis Select your CCG CCG Reports CCG Input CCG indicator table Manual data input CCG dynamics Define custom peer group CCG comparison Aspiration scores input CCG LTC prevalence CCG defined indicators input CCG correlation analysis Each section contains links to different types of report in the application The Overview reports show you e View CCG Dashboard How your
2. 46 Figure 3 7 Adding CCG defined aspirations Input user defined aspirations CCG PCT level aspirations Indicator Measure A Reported prevalence of CHD Reported prevalence of Stroke Reported prevalence of Diabetes Reported prevalence of COPD Reported prevalence of Epilepsy Reported prevalence of Asthma Reported prevalence of Dementia Reported prevalence of Cancer Expected prevalence of CHD Expected prevalence of Stroke Expected prevalence of Diabetes Expected prevalence of COPD Expected prevalence of Epilepsy Expected prevalence of Asthma Expected prevalence of Obesity Registered patients 0 14 Registered patients 15 44 Registered patients 45 64 Registered patients 65 Registered patients Number of GP practices Registered patients practice Total number of GPs Overall experience of GP surgery calc GP Pract scatter _ 3 8 How to add CCG defined indicators In addition to the indicators which are pre defined in the application there is the capacity to add locally defined indicators for your practices This will allow you to use the analyses and profile functions in the application to create a single Reported prevalence of Hypertension Reported prevalence of Heart Failure Reported prevalence of Chronic Kidney Disease Reported prevalence of Atrial Fibrillation Reported prevalence of Mental Health Conditions Reported prevalence of obesity BMI gt 30 Expected prevalence
3. Expected prevalence of Stroke Expected prevalence of Hypertension Expected prevalence of Diabetes Expected prevalence of COPD Expected prevalence of Epilepsy Expected prevalence of Asthma Expected prevalence of Heart Failure Expected prevalence of Dementia Expected prevalence of Chronic Kidney Disease Expected prevalence of Atrial Fibrillation Expected prevalence of Obesity IMD Registered patients 0 14 Registered patients 15 44 Registered patients 45 64 Registered patients 65 Registered patients of practices in a PCT which are designated rural GPs 100 000 weighted registered patients Choice of GP gender available FTE GPs 100 000 registered patients Total number of GPs Number of FTE GPs of FTE GPs in PCT who are gt 55 years of age Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Score Percent Percent Percent Percent Number Percent Number Percent Number Number Number Percent Number view of the data you find relevant to your commissioning decisions Figure 3 8 CCG defined indicators tab where users can enter their own locally defined indicators Input user defined indicators Selected ccs Sia Wiatsias Indicators Indicator name Source and timeframe Unit Hi
4. South Manchester East Leicestershire and Rutland Bradford Districts Lincolnshire West Calderdale Nene Coastal and Countryside Bradford City South West Lincolnshire Blackpool Greater Huddersfield West Leicestershire Lancashire North North Kirklees Cannock Chase Fylde amp Wyre Great Yarmouth amp Leicester City East Staffordshire Waveney Nottingham City Herefordshire Hastings amp Rother Walsall Warwickshire North Isle of Wight Wolverhampton Redditch and Bromsgrove Kernow Barking amp Dagenham Shropshire South Devon and Torbay South East Staffs and Seisdon Peninsular South Warwickshire Thriving London Periphery South Worcestershire Industrial Hinterlands Bromley Stafford and Surrounds Darlington Durham Dales Easington Hillingdon Wyre Forest and Sedgefield Kingston Bedfordshire Gateshead Richmond Ipswich and East Suffolk North Durham Merton North East Essex South Tees Sutton North Norfolk South Tyneside Bracknell and Ascot Norwich Sunderland Slough South Norfolk Halton Windsor Ascot and Maidenhead West Norfolk Knowsley 81 West Suffolk South Sefton Ashford Southport and Formby London Suburbs Canterbury and Coastal St Helens Eastbourne Hailsham and Luton Seaford Tameside and Glossop Barnet Coastal West Sussex Hull Croydon Crawley Stoke on
5. Where do find this data This data needs to be collected by the CCG Some CCGs may have regular quarterly or semi annual returns that they require GP practices to complete Other CCGs have online systems that extract data directly from GP practices on a regular basis Many GP systems will be capable of generating a standard report with a count of appointments over the last year In certain circumstances it may be necessary to contact GP practices directly in order to obtain this information Elective referrals per 1 000 registered patients per month Why is this important It is often necessary for primary care physicians to refer patients to specialist secondary care treatment It is useful to compare elective referrals per 1 000 registered patients because it may identify situations where primary care capacity could be increased to reduce the level of referrals A high level of elective referrals does not imply that a GP is referring patients unnecessarily it merely indicates that the situation may need to be further investigated How is this defined The count of monthly referrals to secondary care that do not have to be completed in a specific time divided by the number of registered patients divided by 1 000 As mentioned above the average registered patients is the arithmetic mean of the average list size in the past twelve months Where do find this data This data is stored in the Hospital Episode Statisti
6. East West Devon 82 Appendix D Assessment of each GP practice s capabilities In addition to the routinely collected data described above the application allows you to record assessments of the management capabilities present in each of your GP practices in order to benchmark them and identify any perceived strengths or gaps This analysis can help provide a more complete view of the GP practice than analysis of the objective data alone can provide You can use the application to record assessments of each of your GP practices Practice manager skill Clinical leadership of lead partners Historic willingness of practice to improve An individual with close personal knowledge of the particular GP practice is best to undertake these assessments Ideally whoever is making these assessments will be able personally to identify each of the individuals mentioned i e practice manager and lead partner Additionally in order to make an assessment of the GP practice s historic willingness to improve it is important that the assessor has experience with the practice over time As a result in order to get the required inputs and manage all the GP practices it may be necessary to use a team of assessors The following table can be used to assess each GP practice with each GP receiving a 1 to 4 rating on the criteria in each row East of England SHA developed the definitions of the mindsets behaviours that demonstrate the di
7. You can also look at the relationship between expected and reported prevalence of Diabetes to see if you have an unmet need within your population 2 Developing the vision Where do you want to be Once you understand where you are you can then decide where you want to be This will differ for each practice and CCG dependent on local priorities the population served and the challenges to be overcome You can think about the patient offer and strategic service moves Example questions can include e What is a reasonable aspiration for your CCG practice should it be aspiring to be above average top quartile or top 10 e Who are the standout practices or CCGs you could learn from How the PCCA can help You could use the application to identify the three most improved practices in your CCG on the HbA1c indicator over the past year This could be a first step to identifying and sharing best practice 3 Making it happen How do you get there Once the aspiration has been set how will you reach it How will you monitor your progress and what may influence it This could include a whole range of approaches including providing transparent information increasing choice and capacity of the system and supporting performance development Example questions can include e What structural moves could make that might have an impact on HbA 1c results e What best practice is out there and how can we share it How the PCCA can help
8. You could use the application to check to see whether structural factors like increased capacity access or expenditure have a history of correlating with good results on HbA1C However you should always be aware that correlation does not mean causation the relationship may be a proxy for other drivers It is important to note a few things the application does not do It does not define Good The application has been built to help you assess the relative results of your CCG and your GP practices to support commissioning decisions based on the health needs of your population and what is working well for other CCGs with similar populations What you decide to use as the relevant benchmark to measure your results against is up to you whether it s the top 10 nationally the top 50 in your SHA or any other of the combinations included in the application There are no instances in the application of saying this number defines what good is it simply highlights areas where you may want to investigate further It does not require you to collect more data The application is built primarily on nationally published data relating to primary care such as QOF and the GP Patient Survey from Ipsos MORI The majority of the data that the application can process is already included If you already collect additional data locally there is the capacity to add them to the PCCA Some are pre defined in the application e g average appoint
9. locum GPs NHAIS System Exeter Registered The average The NHS The National September Annually patients number of Information Health 2012 practice patients Centre Applications registered per and practice in Infrastructure the PCT services NHAIS System Exeter Capacity 12 indicators Indicator Description Main Source Underlying Period Frequency Source of Update Total number The number of The NHS The National March Annually of GPs GPs registered to Information Health 2012 March a given practice or Centre Applications PCT and Infrastructure services NHAIS System 58 Exeter GPs 100 000 The number of The NHS The National Sept Annually weighted GPs registered to Information Health 2011 March registered a given practice or Centre Applications patients PCT divided by Department and the number of of Health Infrastructure registered services patients weighted NHAIS PBRA for health System needs Exeter Nuffield Trust GPs The number of The NHS The National March Annually 100 000 GPs registered to Information Health 2012 March registered a given practice or Centre Applications patients PCT divided by and the number of Infrastructure registered patients services NHAIS System Exeter GPs 100 000 The number of The NHS The National Sept Annually ONS GPs registered to Information Health 2011 March popu
10. Barnet Select indicator Reported prevalence of obesity BMI gt 30 All Data source The number of patients unadjusted on the QOF disease register aged 16 and over with a BMI greater than or O All equal to 30 in the previous 15 months The Quality Management and Analysis System QMAS 2011 12 Reported prevalence of obesity BMI gt 30 Percent High and High and decreasing 14 0 4 12206 increasing Fng Awg Low and Low and decreasing increasing 5 4 3 2 1 0 1 2 3 4 5 Year on year change Percentage Points To use this view you will need to enter values for four sets of fields e The name of your CCG or Practice Group in the Select a CCG or Practice Group field e Your choice of peer group for comparison in the Select peer group field this is where you can select your peer group or your Practice Group e Your choice of which values to display on the chart only your peers or all CCGs 32 e The relevant indicator Indicator field The CCG level Dynamics report will display a scatter plot with a circle for each CCG or Practice Group The CCGs or Practice Groups are positioned according to the change in their results since the last recording period and their overall results from the current reporting period The y axis shows the current value of the indicator whilst the x axis shows the difference between the current and the previous value Tho
11. Description Underlying Source Period Frequency of Update The GP Patient Survey Overall experience of making an The percentage of patients who have had a good Ipsos MORI July 2011 to March Biannually 62 appointment experience of 2012 making an appointment Ease of getting The percentage of The GP Ipsos MORI July Biannually through on the patients who Patient 2011 to phone found it easy to Survey March get through on the 2012 phone Frequency of The percentage of The GP Ipsos MORI July Biannually seeing patients with a Patient 2011 to preferred GP preferred GP who Survey March get to see their 2012 preferred GP most of the time Able to get an The percentage of The GP lpsos MORI July Biannually appointment to patients who were Patient 2011 to see or speak to able to book an Survey March someone appointment 2012 Satisfaction with The percentage of The GP lpsos MORI July Biannually opening hours patients who are Patient 2011 to satisfied with the Survey March opening hours of 2012 their GP surgery PCT average The number of PCT PCT N A N A appointments appointments gathered gathered registered booked during patient year core hours including DNA s divided by the average number of registered patients in a given year of practices The percentage of PCT PCT N A N A offering gt 35 practices that gather
12. Diabetes e Total number of GPs e Overall rating of GP soft skills COPD e GPs 100 000 weighted population weighted e Confidence and trust in GP Epilepsy e GPs 100 000 registered population un e Overall rating of nurse soft skills Asthma weighted e Confidence and trust in nurse j ion i b e GPs 100 000 registered ONS population un Access Chronic Kidney Disease Atrial Fibrillation Mental Health Obesity Cancer Expected prevalence of the same LTCs excluding cancer and mental health Adults who smoke Standardise mortality ratio all ages Standardise mortality ratio causes amenable to health care weighted Number of FTE GPs FTE Practice staff 1 000 registered patients GP Appointment slots 1 000 registered patients week Average nursing appointment slots 1 000 registered patients week Practice staff population weighted Choice of GP gender GPs gt 55 years of age Competition of practices whose lists are open and accepting new registrations practices offering gt 35 hours patient facing time week Avg appointments reg patient year Ease of getting through on the phone Frequency of seeing preferred GP Able to get an appointment to see or speak to someone Overall experience of making an appointment Satisfaction with opening hours Clinical Quality 21 QOF clinical outcome scores Average QOF Score Average QOF Score without Exceptions Average Clinical QOF scores QOF exception
13. Region PHO sources December of Hyper patients with Practice 2011 tension hypertension Model based on age sex and ethnicity Expected The expected NHS Multiple data 2008 09 Unknown prevalence number of Comparators sources of Diabetes patients aged over 17 with Diabetes Mellitus based on age sex and ethnicity Expected The expected Eastern Multiple data Published Unknown prevalence number of Region PHO sources December of COPD patients with Practice 2011 COPD based on Model age sex and ethnicity Expected The expected NHS Doncaster 2008 09 Unknown prevalence number of Comparators Model of Epilepsy patients aged 18 or over with epilepsy based on age sex and ethnicity Expected The expected NHS Doncaster 2008 09 Unknown prevalence number of Comparators Model of Asthma patients with asthma based on age sex and ethnicity 54 Expected The expected NHS Based on 2008 09 Unknown prevalence number of Comparators NEOERICA of Heart patients with research data Failure heart failure based on age sex and ethnicity Expected The expected NHS Doncaster 2008 09 Unknown prevalence number of Comparators Model of Dementia patients with dementia based on age sex and ethnicity Expected The expected NHS 2008 09 Unknown prevalence number of Comparators of Chronic patients aged 18 Kidney and over with Disease CKD US National Kidney Foundation Stage 3
14. Suggested technical configuration and known issues The application is designed to run as a standalone application on a standard PC However CCGs who add additional data to the application may want to ensure everyone in the CCG has access to the same data In this case CCGs may choose to save a single master copy on a shared server which can either be accessed by multiple users simultaneously or can be saved down to individual users PCs as updates are made available If a single copy on a server is used users should open Read Only copies to reduce the chance of accidentally overwriting CCG data Excel will offer this option when opening the file if there are other users already using the application The application is published in Excel 2003 and Excel 2010 Macro security settings should be set to Low or Medium If the setting is High the macros will automatically be disabled and the application will not work If you have trouble getting the application to open on your system a short term fix may be to turn off the Automatic Calculation feature of Excel This should be done without the PCC Application open Turning off Automatic Calculation is done by selecting Tools in Excel s top menu bar and scrolling down to select Options In the dialogue box that then opens select the Calculation tab On this tab select the option for Manual calculation Uncheck the Recalculate before sav
15. System comprehensive exception QOF QMAS care plan reporting documented in allowed and the their records exception rate agreed between individuals their family and or carers as appropriate Average MH11 QOF measure The Quality The Quality 2011 12 Annually to 16 reported as and Management patients with published Outcomes and Analysis schizophrenia without Framework System bipolar affective exception QOF QMAS disorder and reporting other allowed and the psychoses who exception rate have a record of alcohol consumption BMI BP cholosterol hdl ratio BG in the preceding 15 months anda cervical screening in the preceding 5 years COPD 08 QOF measure The Quality The Quality 2011 12 Annually of patients with reported as and Management COPD who published Outcomes and Analysis have had without Framework System influenza exception QOF QMAS immunisation in reporting the preceding 1 allowed and the Sept to 31 exception rate March COPD 13 QOF measure The Quality The Quality 2011 12 Annually of patients with reported as and Management COPD who published Outcomes and Analysis have had a without Framework System review exception QOF QMAS undertaken by reporting 67 a healthcare professional including an assessment of breathlessness using the MRC dyspnoea score in the preceding allowed and the exception
16. Trent Ealing Horsham and Mid Sussex Wirral Enfield South Kent Coast North Tyneside Hounslow Swale Greenwich Thanet Harrow North Hampshire Manufacturing Towns Redbridge Fareham and Gosport Wigan Borough Waltham Forest South Eastern Hampshire Barnsley West Hampshire Bassetlaw Bath and North East Somerset Doncaster London Centre Gloucestershire North East Lincolnshire Camden North Somerset North Lincolnshire Hammersmith and Fulham Somerset Rotherham Islington South Gloucestershire Wakefield Tower Hamlets South Lincolnshire Erewash Wandsworth Castle Point and Rochford Hardwick West London K amp C and QPP Southend Mansfield amp Ashfield Central London Westminster High Weald Lewes Havens Newark amp Sherwood North Derbyshire Nottingham North amp East London Cosmopolitan New and Growing Towns Nottingham West City and Hackney Milton Keynes Rushcliffe Haringey East and North Hertfordshire Dudley Lambeth Thurrock North Staffordshire Lewisham West Essex Telford amp Wrekin As yet unknown Hartlepool and Stockton on Tees Greater Preston Cumbria Airedale Wharfedale and Craven Southern Derbyshire Birmingham South and Central Coventry and Rugby Sandwell and West Birmingham Solihull Cambridgeshire and Peterborough Herts Valleys Brent Dorset Birmingham CrossCity North East Hampshire and Farnham Wiltshire North
17. and Management history of TIA or published Outcomes and Analysis stroke whose without Framework System last measured exception QOF QMAS cholesterol is 5 reporting or less allowed and the exception rate STROKEO06 QOF measure The Quality The Quality 2011 12 Annually patients witha reported as and Management history of TIA or published Outcomes and Analysis stroke in whom without Framework System last BP is exception QOF QMAS 150 90 or less reporting allowed and the exception rate DM27 QOF measure The Quality The Quality 2011 12 Annually patients with reported as and Management diabetes in published Outcomes and Analysis whom last without Framework System HbA1c is 8 or exception QOF QMAS less reporting allowed and the exception rate DM31 QOF measure The Quality The Quality 2011 12 Annually patients with reported as and Management diabetes in published Outcomes and Analysis whom last BP is without Framework System 140 80 or less exception QOF QMAS reporting allowed and the exception rate 65 DM17 QOF measure The Quality The Quality 2011 12 Annually patients with reported as and Management diabetes whose published Outcomes and Analysis last measured without Framework System total cholesterol exception QOF QMAS is 5 or less reporting allowed and the exception rate EPILEPSY 08 QOF measure The Quality
18. chosen the CCG comparison view will display e Each CCGs or Practice Group s scores for each indicator in the group in the order specified in the drop down fields e A graphical comparison showing which CCG or Practice Group has a higher score in each listed indicator The goal of the CCG comparison view is to compare two CCGs or Practice Groups If they have similar health needs then this view can be used to assess whether they are achieving similar results on the given indicators The CCG Prevalence report compares reported prevalence to expected prevalence for the selected CCG or Practice Group Figure 3 2 3d The expected prevalence is a modelled outcome based on age gender deprivation and ethnicity for the CCGs population whilst the reported prevalence is the actual incidence of the disease as recorded by GPs on the QOF register Figure 3 2 3d CCG prevalence report comparing the reported to the expected prevalence of 12 medical conditions LTC prevalence report CCG level back to main menu Select CCG or PCT CCG Select a CCG or Practice Group Bamet view practice level Data sources Reported prevalence The Quality and Outcomes Framework QOF The Quality Management and Analysis System QMAS 2011 12 Expected prevalence NHS Comparators or APHO Reported Expected Reported Expected 5 10 15 20 25 No Indicator Unit prevalence prevalence _ Difference 1 Reported prevalence
19. empty and a third containing all practices in the CCG selected above and to the right of it Figure 3 1 1a How to assign practices to Practice Groups in the Input peer group tab Dadi tek nae een To add other practices select the PCT they are in and click on Load Practices select Yes in column for all to be added and click Add to Practice Group List To use the Practice grouping function you must first name the different Practice Groups starting in tt will then be added to the list on the right Load Practices cell P10 on this page and then assign practices to the Practice Groups selecting the correct drop down value in column H Your PCT must be selected on the Input PCT data tab for your practices to Select PCT ES aaao Practice be visible in columns L and M Group List GP Practice Practice GP Practice Include in Practice code GP Practice name Practice Groups code GP Practice name Groups P92001 SHARMA amp PARTNERS PG1 81002 GROVE ROAD SURGERY P92002 BRAITHWAITE SURGERY 1 681003 THE LIGHTHOUSE MEDICAL PRACTICE P92003 681004 DOWNLANDS MEDICAL CENTRE P92004 DR BURZA amp NINAN 681007 NEWICK HEALTH CENTRE P92005 ZAMAN amp ZAMAN PG 1681008 STONE CROSS SURGERY P92006 DR AHMAD amp PARTNERS P 81012 BRIDGESIDE SURGERY P92007 DR SPIELMANN amp PARTNERS G5 681016 QUAYSIDE MEDICAL PRACTICE P92008 DR SUNTHA amp PARTNERS 681017 SEASIDE MEDICAL CENTRE P92010 BEECH HILL MEDICAL PRACTICE 681019 BEAC
20. for the QOF Outcomes and Analysis Indicators clinical Framework System indicators within QOF QMAS the PCCA CHDO6 QOF measure The Quality The Quality 2011 12 Annually patients with reported as and Management CHD in whom published Outcomes and Analysis the last BP is without Framework System 150 90 or less exception QOF QMAS reporting allowed and the exception rate CHD 08 QOF measure The Quality The Quality 2011 12 Annually patients with reported as and Management CHD in whom published Outcomes and Analysis last measured without Framework System total cholesterol exception QOF QMAS is 5 or less reporting allowed and the exception rate 64 HF02 QOF measure The Quality The Quality 2011 12 Annually patients witha reported as and Management diagnosis of published Outcomes and Analysis heart failure without Framework System which has been exception QOF QMAS confirmed by an reporting echo or allowed and the specialist exception rate STROKE13 QOF measure The Quality The Quality 2011 12 Annually new patients reported as and Management with a stroke published Outcomes and Analysis who have been without Framework System referred for exception QOF QMAS further reporting investigation allowed and the exception rate STROKE08 QOF measure The Quality The Quality 2011 12 Annually patients witha reported as
21. for this release and the expected updates for the next release A summary of the changes made in V87 is also included Changes in this release V88 Data Updates Updated Breast Screening to March 2012 data Updated Workforce and Patient indicators to September 2012 data Added some CCG level data Adapted functionality to give users the option to view CCG as well as PCT level data Next release V89 expected November 2013 Data Updates e Update of GP Patient Survey data e Update to QOF 2012 13 data Changes in the previous release V87 Data Updates e Updated QOF data to 2011 12 1 Overview of PCC Application V88 Using the PCC Application you can access data and make comparisons quickly and easily It contains national data on over 100 different metrics indicators and has the facility for you to add your own data on key indicators as well as your own locally defined indicators Using the application you can see how your CCG sits on each of the indicators against all others nationally within your SHA within your ONS group or against the CCG peers that you select You can benchmark the GP practices within your CCG against other practices nationally with similar levels of deprivation and within their locally defined groups Practice Groups You can also look at changes in indicators over time and look for relationships between indicators This chapter provides an overview of the PCC Application explaining what
22. help manage long CHDO6 Exception Rate CHDO8 patients with CHD in whom last measured total CHDO8 without Exception Reporting HFO2 patients with a diagnosis of heart failure which has HF02 without Exception Reporting HFO2 Exception Rate STROKE13 new patients with a stroke who have been referred for STROKE13 without Exception Reporting STROKEOE without Exception Reporting STROKEO6 Exception Rate STROKEOS patients with a history of TIA or strake whose last STROKEOS without Exception Reporting DM27 patients with diabetes in whom last HbAtc is 8 or less DM27 without Exception Reporting DM31 patients with diabetes in whom last BP is 140 80 or less DM31 without Exception Reporting STROKE13 Exception Rate DM27 Exception Rate DM17 without Exception Reporting EPILEPSY08 without Exception Reporting EPILEPSY08 Exception Rate ASTHMAOS patients aged 8 and over diagnosed with having ASTHMAQS8 without Exception Reporting CKDO3 Exception Rate CANCERO3 Exception Rate Emergency admissions per 1 000 registered patients Average AGE attendances per 1 000 registered patients Influenza immunizations for over 65s MH10 patients on the register who have a comprehensive care Average of MH11 to 16 without Exception Reporting COPD13 without Exception Reporting COPD13 Exception rate SMOKEO4 patients w
23. in the same manner as the pre populated data but cannot be benchmarked nationally as only the data you have entered is available Figure 3 6b Adding additional practices to the application It is possible to add up to ten additional practices to the application Figure 3 66 as some recently formed practices may not be included in the default data These can be added manually in the table at the bottom of the Input CCG data screen Fill in the practice code and name and any locally collected data Click on the Input data for new practices button Removing pre defined data If you want to remove this data from the application clear the data in the columns required and select the data field from the drop down list This will remove all of the data in that column for those practices 3 7 How to enter a CCG aspiration value for an indicator If you have defined aspirations within your CCG for any of the application indicators you can enter these into the application so they display on the Indicator tables To enter a value switch to the Input CCG defined aspirations Figure 3 7 tab of the application scroll to the appropriate indicator and enter the value in the blue column to the right Note that if you want to display a different aspiration on the CCG level indicator table and the Practice level indicator table you can use the different columns on this page to enter two different values
24. number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of CHD unadjusted Outcomes and Analysis on the QOF Framework System disease QOF QMAS register with coronary heart disease Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Stroke unadjusted Outcomes and Analysis on the QOF Framework System disease QOF QMAS register with stroke or TIA Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Hyper unadjusted Outcomes and Analysis tension on the QOF Framework System disease QOF QMAS register with established Hypertension Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Diabetes unadjusted Outcomes and Analysis on the QOF Framework System disease QOF QMAS register aged 17 years and over with diabetes mellitus which states whether the patient has Type or Type Il diabetes 51 Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of COPD unadjusted Outcomes and Analysis on the QOF Framework System disease QOF QMAS register with COPD Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Epilepsy unadjusted Outcomes and Anal
25. of 86 1 with a percentile rank of 38 2 would mean that approximately 38 of the PCTs in the country are lower in this indicator while 62 are higher The default opening screen for this report shows the average of the percentile rank for all of the indicators in the each of the categories e The complete list of values within that category and their associated scores are displayed for the chosen CCG Practice Group The score for the CCG Practice Group will be displayed with colour coding depending on what percentile that score falls in The percentile bandings are described in the top right hand corner of the view e The complete set of data for the peer ranges of scores are also displayed including the median top 10 top 25 bottom 25 and bottom 10 These values change when different peer groups are selected in the drop down box From this view it is possible to navigate to two other views via links on the far right hand side of the page e Clicking on the Ranking link will navigate to the CCG Indicator Table view which is described below e Clicking on the Practices link will navigate you to the GP Indicator Table view which is also described below The CCG Profile shows all of the indicators in the application as well as the CCGs values on those indicators This view includes both national data and amalgamations totals or averages of practice level only data which you may have entered into the application If y
26. of CHD Percent 2 8 3 5 0 7 2 Reported prevalence of Stroke Percent E3 1 6 0 3 3 Reported prevalence of Hypertension Percent 11 9 21 9 10 0 4 Reported prevalence of Diabetes Percent 57 5 4 0 4 5 Reported prevalence of COPD Percent 1 1 2 8 1 8 6 Reported prevalence of Epilepsy Percent 0 6 0 9 0 3 7 Reported prevalence of Asthma Percent 46 9 1 4 5 8 Reported prevalence of Heart Failure Percent 0 6 13 D7 9 Reported prevalence of Dementia Percent 0 6 1 0 04 10 Reported prevalence of Chronic Kidney Disease Percent 3 1 78 48 11 Reported prevalence of Atrial Fibrillation Percent ee dal 0 0 12 Reported prevalence of obesity BMI gt 30 Percent 75 22 2 14 7 To use this view you need to enter one value in a field 34 Practice Group field The CCG Prevalence Report view will display The name of your CCG or Practice Group in the Select a CCG or The list of the 12 Long Term Conditions LTCs for which the expected and reported prevalence values are available A graphical prevalence for each LTC The values of the expected and reported prevalence representation of the expected and reported The aim of this view is to allow CCGs and Practice Groups to explore the level of undiagnosed or over diagnosed LTCs in the given area There are many reasons why these two numbers will differ it may be useful to explore these in detail The Correlation Analysis report is designed to test the correlation or lack thereof be
27. of Hypertension Expected prevalence of Heart Failure Expected prevalence of Dementia Expected prevalence of Chronic Kidney Disease Expected prevalence of Atrial Fibrillation of practices in a PCT which are designated rural Expenditure on emergency admissions per 1 000 registered Expenditure on first outpatient attendances per 1 000 registered Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Percent Number Percent Number Number Number Number Number Percent Support from local services or organisations to help manage long Percent Average QOF score for PCCA indicators Percent 3 data CCG defined indicator Input peer group Practice level aspirations back to main menu ndicator Reported prevalence of CHD Reported prevalence of Stroke Reported prevalence of Hypertension Reported prevalence of Diabetes Reported prevalence of COPD Reported prevalence of Epilepsy Reported prevalence of Asthma Reported prevalence of Heart Failure Reported prevalence of Dementia Reported prevalence of Chronic Kidney Disease Reported prevalence of Atrial Fibrillation Reported prevalence of Mental Health Conditions Reported prevalence of obesity BMI gt 30 Reported prevalence of Cancer Expected prevalence of CHD
28. patients to see a primary care physician outside of regular opening hours Walk in centres provide an alternative to A amp E for minor complaints It is useful to compare the number of WICs attendances because it may assist in identifying situations where the supply of primary care could be increased to reduce demand on these services A high level of WIC attendances may highlight a situation where those out of hours attendances could be treated inside regular hours How is this defined The number of attendances at Walk In Centres divided by the number of registered patients divided by 1 000 Where do find this data This data needs to be collected by the CCG Some CCGs may have regular quarterly or semi annual returns that they require GP practices to complete Other CCGs have online systems that extract data directly from GP practices on a regular basis In certain circumstances it may be necessary to contact GP practices directly in order to obtain this information Average Nursing appointment slots per 1 000 registered patients per week Why is this Average nursing appointment slots per 1 000 registered important patients per week is a measure of supply of appointments It gives a measure of supply to be compared to patient demand How is this This is defined as the number of appointments slots that are defined offered to patients in an average week divided by the registered patients to that practic
29. the application 3 5 How to collect your own data 3 5 1 Data routinely gathered by CCG for each GP practice 3 6 How to add pre defined data 3 7 How to enter a CCG aspiration value for an indicator 3 8 How to add CCG defined indicators 4 Who to contact for support or to give feedback 4 1 Suggested technical configuration and known issues 4 2 Using this application if you have a disability 4 3 Future releases and versions of the GP Services application Appendices Appendix A Complete list of data sources Appendix B Availability of data at practice PCT and CCG level Appendix C ONS groups Appendix D Assessment of each practice capabilities The context of the Primary Care Commissioning Application High expectations have been set for commissioners of primary medical care who commission to meet patient needs They are key to supporting and facilitating the change to the new structure of primary care commissioning as detailed in the White Paper Equity and Excellence while continuing to aim for 20 billion quality and productivity savings by 2014 5 PCTs have fundamentally changed how they commission primary care creating greater transparency rigour and active management of primary care At the same time they have developed an understanding the value achieved from their investment in primary care services and continuing to achieve shifts in the way care is delivered across the health service They have continued to do this
30. those ten practices based on the average improvement of the five most improved practices in the previous year The above is just one example of how the application could be used to improve commissioning A similar approach could be taken with any of the indicators allowing the CCG to understand the patient population better identify areas where structure may need to be changed and focus on areas where performance could be celebrated or improved 14 2 The Indicators in the PCC Application This chapter provides more detail on the indicators included in the PCC Application We begin by explaining how the indicators were chosen and then describe each category of indicator in detail 2 1 How the indicators were chosen The original list of indicators in the application was derived from two complementary processes First a top down analysis was conducted This analysis involved looking at the data needed to support the three steps in the process of improving commissioning mapping the baseline developing the vision and making it happen This indicator list was then refined by removing those indicators for which the data was unobtainable A bottom up analysis was conducted in tandem with the top down analysis to ensure the indicators reflected the needs of all PCTs This process involved drafting an initial list of indicators and reviewing that list with key stakeholders Over twenty stakeholders reviewed the indicator list inc
31. 014 SHA The application allows you to select your SHA as a peer group this compares you against CCGs that are part of the same management organisation and are your geographical neighbours SHA defined clusters If you are in East Midlands North West or London SHA your SHA has defined its own clusters You can choose to compare against peers within these clusters For a list of these clusters see Appendix D Note that if you choose this option but you do not have an SHA defined cluster you will be compared with PCTs outside of peer group which will not be insightful 20 21 e Practice Group This allows you to compare between practice groups this must be set up locally within the application to work For instructions on how to set up your practice groups see below To choose your peer group on any analysis or report sheet look for the blue drop down box near the top of the page labelled Compare results with and select the appropriate group On most pages this flows through from previous decisions A sample screenshot is shown below Figure 3 1 Figure 3 1 How to select a pre defined peer group CCG Dashboard Select to view CCG or PCT Select a CCG or Practice Group Compare results with All 211 CCG s Indicators in which you are SHA defined cluster Custom peer group Practice Group Expenditure on first outpatient Supportfrom local services or STROKE13 Exception Rate If none of the pre
32. 5 hours per week Where do find this data This data needs to be collected by the CCG Some CCGs obtain this data from regular quarterly or semi annual returns that they require GP practices to complete Other CCGs have online systems that obtain data directly from GP practices on a regular basis Given the previous emphasis on extended hours and enhanced services many CCGs will already have made efforts to collect this information from GP practices In certain circumstances it may be necessary to contact GP practices directly in order to obtain this information Choice of GP gender Why is this Choice of GP gender is important because patients both important male and female often express a preference fora GP of a particular gender How is this A GP practice provides a choice of GP gender if it has both a defined male and a female GP registered to that practice This field can be populated with a value of 1 meaning yes or O meaning no depending on whether or not the practice has both a male and a female doctor registered to that practice Where do The gender of each GP is recorded in the Exeter Payments find this data Database GP details such as age and gender have to be entered in order for payments to be processed through this database Number of full time equivalent GPs practice level Why is this important The measure of full time equivalent FTE GPs is a more accurate descript
33. 9 Sample PCT 51 G83019 Sample Practice 4014 Sample PCT 51 8 G83063 Sample Practice 4042 Sample PCT 51 Ge3027 Sample Practice 4020 Sample PCT 51 G83030 Sample Practice 4023 Sample PCT 51 G3068 Sample Practice 4047 Sample PCT 51 G83651 Sample Practice 4061 Sample PCT 61 G83058 Sample Practice 4038 Sample PCT 51 G83065 Sample Practice 4044 Sample PCT 51 Ge3663 Sample Practice 4066 Sample PCT 51 Ge3021 Sample Practice 4015 Sample PCT 51 Ge3012 Sample Practice 4009 Sample PCT 51 G83022 Sample Practice 4016 Sample PCT 51 G83001 Sample Practice 3933 Sample PCT 51 Ge3069 Sample Practice 4043 Sample PCT 51 G83635 Sample Practice 4055 Sample PCT 51 G83060 Sample Practice 4033 Sample PCT 51 G83668 Sample Practice 4067 Sample PCT 51 G83600 Sample Practice 4073 Sample PCT 51 G83673 Sample Practice 4070 Sample PCT 51 G23631 Sample Practice 4053 Sample PCT 51 G83015 Sample Practice 4010 Sample PCT 51 G83007 Sample Practice 4005 Sample PCT 51 Ge3031 Sample Practice 4024 Sample PCT 51 G836854 Sample Practice 4062 Sample PCT 51 G83658 Sample Practice 4065 Sample PCT 51 G83044 Sample Practice 4031 Sample PCT 61 G83016 Sample Practice 4011 Sample PCT 51 G33039 Sample Practice 4023 Sample PCT 5 G83067 Sample Practice 4046 Sample PCT 51 G83641 Sample Practice 4056 Sample PCT 51 G83042 Sample Practice 4029 Sample PCT 51 G83675 Sample Practice 4072 Sample PCT 51 G83633 Sample Practice 4054 Sample PCT 51 Ge3657 Sample Practice 4064 Sample PCT 51 Ge3017 Sample Practi
34. 99 OLD SCHOOL SURGERY P92607 MARTIN SM 681100 MERIDIAN SURGERY P92615 ESA BH 681102 BUXTED SURGERY 23 First select the CCG that contains the majority of your practices from the drop down list in cell H7 Adding practices outside of the PCT If you would like to add a practice or group of practices from outside of your CCG then first select the CCG the practices are in from the drop down list in cell T7 above the table Then click on the Load Practices button This will load all of the practices in that CCG into the box below Select yes from the drop down list next to the name of the practice that you are interested in and click on the Add to Practice Group List button The practice will now appear in the list in columns L and M at the bottom of the list of practice codes within your CCG This may take a couple of minutes depending on the number of practices being added If you want to add practices from additional CCGs simply select the next CCG from the drop down list and repeat the process above You can now assign the practices to a named group as described below Currently this is restricted to a maximum of 300 practices including those in your CCG If you want to remove any practices select No from the drop down list next to the name of the practices and click on the Add to Practice Group List button This will remove those practices from the list Setting up the Practice Groups
35. CCGs position on the output indicators contained in the application compared to other CCGs within your chosen peer group showing where you are comparatively strong 10 and where you have opportunities to improve View CCG Profile A comprehensive view of your CCGs scores on all the indicators in the application View GP Dashboard An overview of a practice s position on the output indicators in the application compared to other practices within your chosen peer group showing where they are comparatively strong and where they have opportunities to improve View GP Practice Profile A comprehensive view of the indicator scores for an individual practice within your CCG or your chosen peer group The CCG Reports provide more detailed analyses CCG Indicator Table How your CCG is ranked compared to other CCGs on any indicator you select as well as compared to any aspirations that you have set CCG Dynamics How the selected indicator has changed between the current and previous years for your CCG and your selected peer group CCG Comparison Gives a comparison of your CCG to another CCG peer group or nationally across all of the indicators in the application CCG Prevalence Gives a comparison of the expected and reported prevalence for your CCG across the twelve Long Term Conditions LTCs CCG Correlation Analysis Gives the facility to test for relationships between two different indicators within your selected peer grou
36. CGs More detail on the values for these indicators is provided on the CCG Profile as the CCG Dashboard is an overview As with all reports in the application there are links in the top right hand corner that allow you to navigate to other reports Additionally double clicking on a particular indicator will navigate you to the CCG Indicator Table report which will be discussed later in this document From this view you can click on the view CCG profile link in the top right hand corner to navigate to the CCG Profile The CCG Profile Figure 3 2 2b is a comprehensive view of your CCGs results on all the indicators in the application It lists all the indicators in the application in each category and displays it according to the results that the CCG has on each of those indicators Figure 3 2 2b CCG profile with colour coding to show the benchmarking against the chosen peer group CCG Profile back to main menu Select CCG or PCT CCG Top 10 Get data Top 10 25 Select a CCG or Practice Group arnet X Top 25 50 Bottom 10 50 Compare results with All 211 CCG s Bottom 10 view CCG dashboard Indicator Unit Value Percentile Top 10 Top 25 Top 50 Bottom 25 Bottom 10 Results Clinical quality CCG average percentile 45 3 Peer range Indicator Unit Value Percentile Top 10 Top 25 Top 50 Bottom 25 Botto
37. ON SURGERY P92011 DR SMITH amp PARTNERS 681021 SCHOOL HILL MEDICAL PRACTICE P92012 DR ANIS amp ANIS 1G81022 SOVEREIGN PRACTICE P92014 STANDISH MEDICAL PRACTICE 681024 ASHDOWN FOREST HEALTH CENTRE P92015 DR LYONS amp PARTNERS PGT 681027 BOLTON ROAD SURGERY P92016 DR HART amp PARTNERS 681029 SEAFORD MEDICAL PRACTICE P92017 DR MUNRO amp PARTNERS 81030 BELMONT SURGERY P92019 PEMBERTON SURGERY 681032 GREEN STREET CLINIC P92020 SIVAKUMAR amp PARTNER 681035 RIVER LODGE SURGERY P92021 DR BEZZINA amp PARTNERS 681037 THE MEADS SURGERY P92023 DR DUPER amp PARTNERS 1 G81040 WOODHILL SURGERY P92024 DR RUSSELL amp PARTNERS 81043 ROTHERFIELD SURGERY P92026 DR PATEL KAMATH amp PARTNERS 81045 ST ANDREWS SURGERY P92028 ELLIOT STREET SURGERY 1 681049 MANOR PARK MEDICAL CENTRE P92029 DR TRIVEDI amp TRIVEDI 681050 ARLINGTON ROAD SURGERY P92030 DR JD SEABROOK 681053 ROWE AVENUE SURGERY 25 P92031 ULLAH M 681055 SAXONBURY HOUSE SURGERY P92033 DR CP KHATRI 1G81056 ENYS ROAD SURGERY P92034 DR ASHWORTH amp PARTNERS 681059 SEAFORTH FARM SURGERY P92035 DR TOMAR amp PARTNER 1G81060 VICARAGE FIELD SURGERY P92038 SAXENA L 81061 CHAPEL STREET SURGERY P9204141 PITALIA SK 681086 BIRD IN EYE SURGERY P92042 DR THOMPSON amp RAWSON P 1G81088 HEATHFIELD SURGERY IP92602 THE FOXLEIGH FAMILY SURGERY G81097 MANOR OAK SURGERY P92605 DR R ANDERSON amp DR M AHMED 681098 QUINTIN MEDICAL CENTRE P92606 DOUBLET STEVWWART MPH 6810
38. Primary Care Commissioning Application User Guide for v88 May 2013 PREFACE Primary medical care is the linchpin of the NHS Eight billion pounds are spent on GP services every year and there are nearly a million GP consultations every day The White Paper Equity and Excellence outlines a vision for fundamentally improving the quality of care we are delivering in primary care whilst moving from a PCT led system to a clinician led system Commissioners may previously have had difficulty finding the data to inform evidence based commissioning the data is in many different locations and not always in a format useful for comparison benchmarking and analysis We have created the PCC Application and its user guide to help commissioners in their role in commissioning primary medical care and quality improvement The application is designed to support commissioners by collating information from several sources on primary care needs structure and profiles In previous releases of the application information has been available at the Primary Care Trust PCT level and practice level In this release some information at the Clinical Commissioning Group CCG level has been included alongside PCT and practice level In future the PCT level information will be removed to be entirely replaced by CCG level The application is intended to allow CCGs groups of practices and individual practices to better understand their current position
39. The Quality 2011 12 Annually patients over reported as and Management 18 on drug published Outcomes and Analysis treatment for without Framework System epilepsy who exception QOF QMAS have been reporting seizure free for allowed and the the last 12 exception rate months ASTHMA 08 QOF measure The Quality The Quality 2011 12 Annually patients reported as and Management aged 8 and published Outcomes and Analysis over diagnosed without Framework System with having exception QOF QMAS asthma from 1 reporting April 2006 with allowed and the measures of exception rate variability and reversibility CKD 03 QOF measure The Quality The Quality 2011 12 Annually patients on the reported as and Management CKD register in published Outcomes and Analysis whom last BP is without Framework System 140 85 or less exception QOF QMAS reporting allowed and the exception rate AF 04 QOF measure The Quality The Quality 2011 12 Annually patients with AF reported as and Management diagnosed after published Outcomes and Analysis 1 April 2008 without Framework System with ECG or exception QOF QMAS specialist reporting confirmed allowed and the diagnosis exception rate 66 MH10 of QOF measure The Quality The Quality 2011 12 Annually patients on the reported as and Management register who published Outcomes and Analysis havea without Framework
40. To use this function enter the names of your Practice Groups into the Practice Groups table This is currently restricted to a maximum of 20 Next using the drop down list next to the practices in your CCG and any additional practices you have added select the group that you would like to assign that practice to leave blank if you do not wish to assign it to any group Using the Practice Groups Comparison To compare against Practice Groups in any of the CCG reports you need to change two settings Figure 3 1 1b e Firstly select Practice Groups from the Compare results with drop down list e Then select your chosen Practice Group from the Select a CCG or Practice Group drop down menu Figure 3 1 1b How to compare Practice Groups Select a PCT or Practice Group Compare results with 20 Practice Groups The report will benchmark the selected Practice Group against all of the other Practice Groups that you have defined The selection will filter through to the rest of the application To move back to CCG comparisons select All or any 24 other peer group from the Compare results with drop down list and select your chosen CCG 3 2 How to run reports and analyses using the PCC Application 3 2 1 Setting which CCG to analyse When you open the application the default view Figure 3 2 1 is displayed First select whether you want to view PCT or CCG level information from the top drop do
41. Underlying Period Frequency Source Source of Update GP expenditure Total PCT local 2009 10 Annual and primary expenditure on spending care GP allocation reports prescriptions and prescription total expenditure costs as a percentage of total PCT expenditure GP Total PCT local 2009 10 Annual expenditure total expenditure on spending expenditure GP allocation as reports a percentage of total PCT 61 expenditure The GP allocation including payments for enhanced services but excluding prescription costs payments for extended hours or payments for premises for each practice divided by list size PCT gathered Funding patient primary medical care PCT gathered N A N A Total PCT expenditure weighted population Total PCT expenditure divided by the population of the PCT weighted by health needs This is the Normalised Practice Weighted Listsize PCT local spending reports Exeter 2009 10 Annual 2 year CAGR GP expenditure PCT local spending reports The historical annualised 2 year growth of total expenditure on GP allocation 2007 08 2009 10 Annual 2 year CAGR total expenditure PCT local spending reports The historical annualised 2 year growth of total expenditure 2007 08 2009 10 Annual Access 7 indicators Main Source Indicator
42. a has been entered a CCG average is calculated below the indicator descriptions where appropriate Figure 3 6a Input CCG data tab entering pre defined locally collected data Input data for additional indicators Select CCG or PCT GBBT Riedole Wharedale and Craven J gt N d Select a CCG Select to update A Collect data currently in Input data for new the tool practices back to main menu Indicators Average GP appointment slots Average nursing appointment slots Enter new practices Choice of GP gender available Number of FTE GPs of GPs in PCT who are gt 55 years of age 1 000 registered patients week 1 000 registered patients week An indicator of whether a GP practice has both a male and a female GP registered to that practice The National Health Applications and Infrastructure services NHAIS System Exeter Sept 2012 Number of full time equivalent GPs based on PCT returns GP Census Sept 2012 The PCT average of all the GP practice level counts of appointments slots offered by a GP in an average week divided by the patients registered to that practice divided by 1 000 PCT gathered N A The PCT average of all the GP practice level counts of appointments slots offered by a nurse in an average week divided by the patients registered to that practice divided by 1 000 PCT gathered N CCG level data GP practice na
43. ade to ensure the accuracy of the data and undertake quality assurance however there is a strong reliance on the quality of the published datasets and an assumption that the published data is correct If you find that your data is incorrect e Firstly check the published data source This can be found either in Appendix A or in the Indicator Info worksheet e If the published data is incorrect contact the publisher of that dataset e If the published data is correct please contact us so that we can correct the error in the PCCA Additionally every effort has been made to gather the most up to date datasets available but in some cases the most recent publication dates from a year or more ago Many indicators can not be added to the PCCA until the results are published e g QOF in October however if users have access to their data earlier they can add it to the locally defined indicators until the full results are published The full list of data sources and the time period covered by each dataset are listed in Appendix A It does not provide your data to the DH The application is a standalone Excel file with no internet capabilities and will not transmit any data you enter into it to the DH or anywhere else It does not provide any exemption against Freedom of Information FOI requests Information entered into this application is likely to be considered held for FOI purposes and thus subject to FOI requests It does n
44. aged over 65 and Infrastructure services NHAIS System Exeter Registered Total registered The NHS The National Sept Annually Patients patients within a Information Health 2012 March given PCT or Centre Applications practice and Infrastructure services NHAIS System Exeter Weighted Total registered Department The National Sept Annually Patient patients within a of Health Health 2011 March Listsize given PCT or Exeter Applications practice weighted and for health need Infrastructure Person Based services Resource NHAIS Allocation System Exeter PBRA and Nuffield Trust Population The estimated The Office of The Office of May Unknown growth annualised National National 2010 57 CAGR growth of resident Statistics Statistics 2010 15 population from 2010 to 2015 of The percentage Ipsos MORI Office for 2011 Unknown practices in of practices in the National based a PCT which PCT which are Statistics ONS on are designated as 2001 designated rural Census rural data Configuration 2 indicators Indicator Description Main Source Underlying Period Frequency Source of Update Number of The number of The NHS The National September Annually GP GP practices in Information Health 2012 practices a given PCT Centre Applications Excludes Walk and in Centres and Infrastructure practices run by services
45. aiting for engage with sometimes CCG CCG drives change performance performance proactively management management to initiate conversations Practice proactively approaches CCG and other practices to share ideas and seek help 84
46. allowing you to look for relationships or lack of relationships between practice size and practice results Capacity These indicators measure the number of GPs and primary care staff in the system in absolute and per population numbers There is the option to add locally collected data such as the number of appointment slots available per 1000 registered patients per week These indicators can give a picture of the capacity of your system and allow you to profile against peers and look for relationships with results or spend indicators Capability This section has been removed from the PCCA however the detail of the standardised approach that is used is available in Appendix D Note East of England SHA developed the definitions for the different capability levels Competition This indicator records those practices in your CCG that have open lists and are accepting new registrations It is included to enable you to look for a relationship or a lack of relationship between increased patient choice and improved results Expenditure These indicators measure your primary care expenditure They 17 are included to enable you to look for relationships with several aspects of your spend including total GP spend with and without prescriptions and growth in spend RESULTS INDICATORS These indicators describe the outcomes from the primary care system from a patient viewpoint Patient experience These indicators meas
47. as clear to the CCG that a handful of practices were scoring significantly worse than the others Using the correlation analysis on the PPC Application the CCG was able to show that the results of these practices were not correlated to any underlying factors e g BME and that the practices had not shown improvement on these metrics 12 At this point the CCG began to think about next steps possibly including coordinating communications between practices who were performing well and the identified practices Figure 1 4 GP practices on HbA1c control Indicator table GP practice level ck to main menu Please select yourPCT smpe PCTS Top 10 __ 55 4 Bottom 25 Select GP practice Fillpractices within POT 45 peer practices in PCT Top 25 43 0 Bottom 10 Select indicator category Results Clinical qualit Median 44 5 Please select an Indicator M patients with diabetes in whom last lois 7 5 orless il Aspiration Oe PCT indicator table Data source A QOF indicator without exceptions removed The Quality Management and Analysis System QMAS Apr 07 to Mar 08 Tap 65 o Average Rank Code GP practice PCT Aspiration 1 G83628 Sample Practice 4051 Sample PCT 51 G83655 Sample Practice 4063 Sample PCT 51 G33034 Sample Practice 4026 Sample PCT 51 G83013 Sample Practice 4009 Sample PCT 51 G83003 Sample Practice 4001 Sample PCT 51 Ge2026 Sample Practice 401
48. ber is good i e QOF scores and lower where a low number is good i e QOF exception rates For some indicators i e WTE GPs population neither very high nor very low is inherently good in these cases the higher number is included as better for charting purposes but should not be seen to be evaluative Airedale Wharfedale and _ Indicator Unit Craven Difference Average QOF score for PCCA indicators Percent 84 6 CHDOS patients with CHD in whom last BP is 150 90 or less CHDO6 without Exception Reporting Percent Percent CHDO6 Exception Rate Percent CHD0O8 patients with CHD in whom last measured total cholesterol is 5 or less CHDO8 without Exception Reporting Percent Percent CHD08 Exception Rate Percent HF02 patients with a diagnosis of heart failure which has been confirmed by an echo or specialist HFO2 without Exception Reporting Percent Percent HF 02 Exception Rate Percent To use this view you need to enter five sets of values e Your choice of peer group to potentially compare with in the Filter by peer group field e The name of your CCG or Practice Group in the Select a CCG or 33 Practice Group field e The name of the CCG to compare to in the Compare to CCG field e The category of indicators that you would like to view in the indicator group field e The indicators can be sorted by using the options in the Sort by field When these values are
49. care professional including an assessment of breathlessness using the MRC dyspnoea score in the preceding 15 months yes yes yes CS01 of female patients aged 25 64 whose notes record that a cervical smear has been performed in the last 5 years yes yes yes Health Interventions Influenza immunisation 65 and over yes yes yes Influenza immunisation at risk yes yes yes Breast Screening yes Cervical Screening yes MMR immunisation yes Pneumococcal immunisation yes Expenditure Cost Effectiveness OOH attendances 1 000 registered patients month Prescription rate for generic PPIs yes yes use of generics yes yes Elective referrals 1 000 registered patients month Average WIC attendances 1 000 registered patients month A amp E attendances 1 000 registered patients yes yes yes First outpatient attendances 1 000 registered patients yes yes yes Emergency admissions 1 000 registered patients yes yes yes Expenditure on emergency admissions yes yes yes 79 1 000 registered patients Expenditure on First Outpatient attendances yes yes yes 1 000 registered patients BCBV indicator for generic stating yes prescription rate Patient Experience Overall experience of GP surgery yes yes yes Support from l
50. ce 4012 Sample PCT 51 GS3670 Sample Practice 4068 Sample PCT 51 G23674 Sample Practice 4071 Sample PCT 51 G83647 Sample Practice 4060 Sample PCT 51 G83644 Sample Practice 4053 Sample PCT 51 BGP Pract dynamics ff GP Pract prevalence g GP Prac Developing the Vision CCG visioning for HbA1c The PCC Application also helped the CGG to define a vision for the future The CCC decided that it wanted to move into the top 10 of CCGs on this metric Entering this value into the CCG aspirations worksheet the CCG was able to use the practice indicator table to identify which practices needed to improve and begin to think about the scale of change required Making it Happen Identifying next steps for HbA1c Following the CCGs progress in using the application and coming to conclusions the CCG elected to develop a LES based on several steps e Identifying the five practices that had improved the most on their HbAic metric in the past year e Interviewing practice managers and clinicians to identify and codify the practices that led to the improvement 13 e Identifying the ten practices on the HbA1c metric that did not significantly improve in the past year e Developing and delivering a communications and training programme to those practices with the aim of making significant improvement in the next year e Setting a year on year improvement aspiration as a percentage improvement not an absolute HbAic number for
51. cs HES database CCGs are able to access the HES database and download the number of referrals for each of their practices with the code for elective referrals for all the specialities Out of hours attendances per 1 000 registered patients month Why is this important As with elective referrals it is often necessary for patients to see a primary care physician outside of regular opening hours It is useful to compare the number of out of hours attendances because it may assist in identifying situations where the supply of primary care could be increased to reduce the level of out of hours attendances A high level of out of hours attendances may highlight a situation where those out of hours attendances could be treated inside regular hours 43 How is this defined The number of attendances at out of hours services divided by the number of registered patients divided by 1 000 Where do find this data This data needs to be collected by the CCG Some CCGs may have regular quarterly or semi annual returns that they require GP practices to complete Other CCGs have online systems that extract data directly from GP practices on a regular basis In certain circumstances it may be necessary to contact GP practices directly in order to obtain this information WIC attendances per 1 000 registered patients per month Why is this important As with elective referrals it is often necessary for
52. ct a GP practice Select your chosen practice from the drop down list There is an additional report in the Practice level section of the application the GP practice prevalence 2 report This gives additional detail on the prevalence of LTCs Select any of the 12 LTCs and see a list of all of the practices within your chosen peer group along with their expected and reported prevalence for that condition This view can help you identify which specific practices may be driving the differences between expected and reported prevalence on that condition 3 3 How to print these analyses All of the tabs in the application have been built to be print ready using Excel s Set Print Area function You should not need to do any additional formatting 3 4 Entering your own data to the application Why add in your own data Not every indicator that you may find useful is currently included in any nationally collected and published dataset and therefore may not have been pre populated in the application There will also be local priorities for which indicators may not have been provided However you can add data for these indicators for the GP practices within your CCG to allow you to undertake 37 additional analyses There is a set of pre defined indicators that the application has been built to hold which are listed below Detailed descriptions of the data as well as possible local sources follow this introduction The data for the
53. d Analysis Fibrillation on the QOF Framework System disease QOF QMAS register with atrial fibrillation Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Cancer unadjusted Outcomes and Analysis on the QOF Framework System disease QOF QMAS register with cancer Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Mental unadjusted Outcomes and Analysis Health on the QOF Framework System Conditions disease QOF QMAS register with schizophrenia bipolar disorder and other psychoses Reported The number of The Quality The Quality 2011 12 Annually prevalence patients aged 16 and Management Sept of Obesity and over witha Outcomes and Analysis BMI gt 30 BMI greater than Framework System or equal to 30 in QOF QMAS the previous 15 months 53 Expected The expected Eastern Multiple data Published Unknown prevalence number of Region PHO sources December of patients with Practice 2011 CHD coronary heart Model disease based on age sex and ethnicity Expected The expected Eastern Multiple data Published Unknown prevalence number of Region PHO sources December of Stroke patients with Practice 2011 stroke or TIA Model based on age sex and ethnicity Expected The expected Eastern Multiple data Published Unknown prevalence number of
54. defined options is a suitable peer group you can create your own Define custom peer group To set up a custom peer group in the model To use this sheet your PCT must be selected on the Input PCT data switch to the tab marked Input peer group All CCGs are listed on the left of the page see pei penne figure to the left Define the peer group by ee switching the drop down next to your chosen roe Teaching peers to yes and ensuring all other CCGs Barnet a have only a blank blue cell to the right of their Barking and Dagenham char Tonis names Ma toyren This group can be changed at any time a Neahurcnstie When you return to analysis select Custom Bassetlaw Pmt Teaching peer group to view results for just the CCGs in Salford Teaching Feta cay eoeta your selected group seco Some approaches to consider for determining Fansa which CCGs to include in a custom peer group ved include Darlington Your PCT as selected on Input PCT data tab Number of additional PCTs in custom peer group ct scatter GP Pract baskets GP Pract trend inaut PET dat e Those with a similar population in terms of IMD BME and or age Some CCGs will find it useful to define peers with similar populations based on IMD BME age or other indicators If you wish to define a peer group along these lines open the CCG indicator table tab 22 make sure All CCGs are selected as a peer gr
55. e box and click the OK button This will require users of the application to press the F9 button to produce any reports or analysis after making a change i e selecting a new CCG or practice in a drop down box This should lower the memory required by the application thereby making it work more effectively A longer term solution may be to add more memory RAM to the computer 4 2 Using this application if you have a disability 49 Any user with a disability having difficulty using this application should contact the Primary Care Improvement team for support on pciteam dh gsi gov uk 4 3 Future releases and versions of the PCC Application The current version of the application has been built to support primary medical care commissioning based largely on nationally published data The application is being developed further to add functionality and indicators based on feedback from CCGs and practices as to what would best support them in commissioning primary care and support the transition to the new system The next update is due in November 2013 which will include updates for GPPS and QOF data If you would like to give feedback on the current or planned versions of the application please email the support team at pciteam dh gsi gov uk 50 APPENDIX A Complete list of data sources Health status 29 indicators Indicator Description Main Source Underlying Period Frequency Source of Update Reported The
56. e divided by 1 000 The average number of appointments per week is ideally measured over the past month and collected on a weekly or monthly basis It is the arithmetic mean of the total number of appointments offered in the last month divided by the number of weeks in the month Collection over a short recent time frame ensures that any growth in supply is reflected Many CCGs record average monthly list size for each of their practices which can be used as the measure of registered patients 44 Where do find this data This data needs to be collected by the CCG Some CCGs may have regular quarterly or semi annual returns that they require GP practices to complete Other CCGs have online systems that extract data directly from GP practices ona regular basis In certain circumstances it may be necessary to contact GP practices directly in order to obtain this information 3 6 How to add pre defined data The data can be entered into the application through the Input CCG Data Figure 3 6a tab Ensure that you have selected your CCG from the drop down list at the top as this does not automatically change with the rest of the application The GP practices are ordered by GP practice code on the left hand side of the screen with the list of indicators in the columns across the top For ease of input of data it is possible to copy and paste columns of data ordered by GP practice code into this screen and once dat
57. ed gathered hours patient facing time week offer more that 35 hours per week when a patient can book an appointment with a doctor including both booked appointments and emergency appointments but excluding clinics and extended hours appointments 63 Clinical Quality 26 Indicators Indicator Description Main Source Underlying Period Frequency Source of Update Average QOF An average of The Quality The Quality 2011 12 Annually score for PCCA the clinical QOF and Management Indicators indicators in the Outcomes and Analysis application Framework System QOF QMAS Overall Clinical An average of The Quality The Quality 2011 12 Annually QOF Score allnon boolean and Management clinical QOF Outcomes and Analysis scores Framework System QOF QMAS Average QOF Average of the The Quality The Quality 2011 12 Annually score without clinical QOF and Management exception scores in the Outcomes and Analysis reporting for application with Framework System PCCA no exception QOF QMAS Indicators reporting allowed Overall Clinical The effective The Quality The Quality 2011 12 Annually exception rate exception rates and Management across all Outcomes and Analysis clinical Framework System indicators QOF QMAS Average The average The Quality The Quality 2011 12 Annually Exception Rate exception rate and Management for PCCA
58. education skills and training barriers to housing and services crime and disorder and living environment The GP Practice IMD is attributed using the practice registered population Department of Health Communities and Local Government 2010 Expected every three Years BME The percentage of estimated resident population who are not white i e are Black Asian Chinese or Mixed Race The Office of National Statistics The Office of National Statistics 2007 Unknown Registered The percentage of registered patients The NHS Information The National Health Sept 2012 Annually March 56 patients 0 14 who are aged 0 Centre Applications 14 and Infrastructure services NHAIS System Exeter The percentage of The NHS The National Sept Annually Registered registered patients Information Health 2012 patients 15 who are aged 15 Centre Applications 44 44 and Infrastructure services NHAIS System Exeter The percentage The NHS The National Sept Annually Registered of registered Information Health 2012 March patients 45 patients who are Centre Applications 65 aged 45 65 and Infrastructure services NHAIS System Exeter The percentage The NHS The National Sept Annually Registered of registered Information Health 2012 March patients 65 patients who are Centre Applications
59. egistered patients Department and PBRA of Health Infrastructure services NHAIS System Exeter Nuffield Trust FTE Practice The number of The NHS GP Census March Annually staff 1 000 FTE practice staff Information The National 2012 March registered per 1 000 Centre Health patients registered patients Applications and Infrastructure services NHAIS System Exeter Choice of GP An indicator of Exeter or The National March Annually gender whether a GP PCT Health 2012 available practice has both gathered Applications amale anda and 60 female GP Infrastructure registered to that services practice NHAIS System Exeter of FTE GPs The percentage of PCT The Health March Annually in PCT who GPs in the PCT gathered and Social 2012 are gt 55 that are over 55 Care years of age years of age at Information the chosen date Centre Competition 1 indicator Indicator Description Main Source Underlying Period Frequency Source of Update of practices A practice is PCT PCT gathered N A N A whose lists considered to be gathered are open and open to new accepting new registrations if an registrations individual previously not registered to that practice but within that practice s catchment area is able to register to that practice s patient list Expenditure 6 indicators Indicator Description Main
60. entify high and low scoring practices and look for possible drivers of results These reports mostly look and function the same as the CCG reports however there are some differences in selecting the options Figure 3 2 4 shows the selection options at the top of the majority of the GP reports you must select three settings 36 Figure 3 2 4 The selection options for the GP reports Indicator table GP practice level Select peer group All Select a CCG or Practice Group Barnet Get data Select a GP practice 188 THE PRACTICE Select indicator category Results Clinical quality Select an Indicator Overall Clinical QOF score v Data source An average of ALL non boolean clinical QOF scores The Quality Management and Analysis System QMAS 2011 12 Select your peer group You can select from 3 options here e CCG PCT will compare the practice to all practices within the CCG PCT e Practice Group will compare the practice to all practices within the defined Practice Group e IMD will compare the practice to around 40 other practices nationally who have a similar deprivation level Select a CCG or Practice Group If you have chosen to compare the practice within its CCG PCT or Practice Group you should select the chosen CCG or Practice Group from the drop down list If you have selected IMD as the peer group you will need to select the CCG your chosen practice is in first Please sele
61. er 1 000 registered patients First The number of NHS Hospital Episode 2010 Annually Outpatient all First Comparators Statistics attendances Outpatient 1 000 attendances registered mandatory patients PbR activity per 1 000 registered patients Emergency The rate of NHS Hospital Episode 2010 Annually Admissions Emergency Comparators Statistics 1 000 Admissions registered per 1 000 patients registered patients Expenditure Average NHS Hospital Episode 2010 Annually on emergency expenditure Information Statistics admissions on emergency Centre 1 000 admissions registered per 1 000 patients registered patients Expenditure Average NHS Hospital Episode 2010 Annually on First expenditure Information Statistics Outpatients on first Centre attendances outpatient per 1 000 attendances registered per 1 000 patients registered patients 712 Average OOH The count of PCT PCT gathered N A N A attendances monthly gathered 1 000 attendances to registered GP clinics patients outside of month normal hours divided by the number of registered patients divided by 1 000 Average WIC The count of PCT PCT gathered N A N A attendances monthly gathered 1 000 attendances at registered walk in patients centres month divided by the number of patients divided by 1 000 Average The count of PCT PCT gathered N A N A elective monthly gathered refer
62. etrics and funding Using the application total expenditure can be compared with other outcomes such as the number of FTE GPs or specific clinical outcomes How is this The GP allocation including payments for enhanced services defined but excluding prescription costs payments for extended hours or payments for premises for each practice divided by list size Where do The CCG finance department or shared services find this data department may hold this information Average GP appointment slots per 1 000 registered patients per week Why is this important Average appointment slots per 1 000 registered patients per week is a core measure of supply of appointments It is the most critical access metric allowing supply to be compared to patient demand How is this defined This is defined as the number of appointments slots that are offered to patients in an average week divided by the registered patients to that practice divided by 1 000 The average number of appointments per week is ideally measured over the past month and collected on a weekly or monthly basis It is the arithmetic mean of the total number of appointments offered in the last month divided by the number of weeks in the month Collection over a short recent time frame ensures that any growth in supply is reflected Many CCGs record average monthly list size for each of their practices which can be used as the measure of registered patient
63. fferent skill levels in each category in 2008 Poor 1 Average 2 Above Good 4 average 3 Practice Individual Practice Practice Business manager who lacks the administrator manager who manager who skill capability to who sorts out has a uses data and coordinate daily business applications to the administrative mindset with continuously administration tasks but an strive for of a GP lacks the understanding operational practice business of operational access mindset improvement improvement and who is able to influence and enact change 83 Clinical Treats his Treats his Is fully aware Is taking full leadership patients and patients of the ownership of of lead has limited no supporting practice s organisational partners interest in the colleagues is access system results of the somewhat operational improvement practice asa aware of results access whole operational possesses quality patient access good experience results but technical and has limited understanding proactively understanding of how to leads change of how to improve improve Historic Practice has Practice Practice Practice is willingness not shown responds in quickly actively of practice any sign of time to CCG responds to driving to improve improvement performance CCG improvement and is requests and performance and change unwilling to improves requests and not w
64. fined CCG data for each of their GP practices e CGG Defined indicators 3 5 1 Data routinely gathered by CCG for each GP practice The application provides for 12 data points to be gathered from internal teams 38 or IT systems within the CCG and entered into the application The data may be entered directly into the application We outline below the 12 metrics and provide further information on why they are important how they are defined and where the data can be found 39 Percentage of practices offering gt 35 patient facing clinical hours per week Why is this important The number of patient facing clinical hours rather than simply opening hours is a key driver of access to GP services How is this defined The patient facing clinical hours is the number of core hours per week that a patient can book an appointment with a doctor This includes booked appointments and emergency appointments but excludes clinics as they are not bookable by all patients and extended hours The CCG should decide whether or not this includes bookable telephone slots For example a specific practice may offer booked and emergency appointments from 8 30pm to 12 30pm and 1 30pm to 5 30pm Monday to Friday You should consider this practice to offer 8 hours of patient facing clinical hours per day for 5 days per week which is 40 hours of patient facing Clinical hours per week Therefore this practice would be offering gt 3
65. gh or low value is better Indicator type ILKLEY MOOR MEDICAL PRACTICE Input data Retrieve data Clear all data Data will only display correctly if all the indicator fields are filled in 47 To add data switch to the CCG defined indicators Figure 3 8 tab and select your CCG if it is not already selected A list of your practices should be visible on the left side of the sheet Decide on a name for your indicator and enter the data You will need to specify several things about the data to be consistent with the rest of the application including The data source When the data was collected The unit of the data i e percent Whether a high value or a low value is optimal This choice determines how relative values of data are presented for example whether the highest value on an indicator would put a practice into the top 10 or bottom 10 of your practices e Whether the indicator is an context to your local health care system something like BME an outcome something like a QOF clinical outcome score or an input something like GP capacity or expenditure This choice determines which indicators can be analysed in relation to which others Currently the application can only accept numerical indicators if you would like to enter in a Yes No indicator i e Practice has a diagnostic suite you can use 1 for yes and 0 for no Once the data has been entered clic
66. hile cancer screening is not performed directly by GPs it is seen as relevant to GP performance since the GP may see themselves as charged with maintaining the health of their population These indicators will help you look for relationships or lack of relationships between effective health interventions and needs capacity and expenditure Cost effective use of the NHS system These indicators measure how efficiently a CCG or GP practice uses resources outside the GP practice Three indicators record how often generics are prescribed in different settings and four indicators measure the use of the rest of the NHS system by patients in a practice or CCG allowing you to check for relationships between access capacity expenditure needs and using the rest of the system cost effectively 18 2 3 Indicator availability at CCG PCT or GP practice level Wherever possible data has been included at GP practice level Some indicators are only nationally available at the CCG or PCT level for these you may wish to enter any practice level data you have to enable more detailed analysis see Chapter 3 for an explanation of how to do this Additionally some indicators are not currently available in any form at national level To enable the application to analyse these indicators you will have to add them yourself For detailed instructions on how to do this see Chapter 3 19 3 Using the PCC Application This chapter explains how t
67. including demographics needs and primary medical care structure We have defined several indicators that users may choose to add into the application and have incorporated the functionality to add locally defined indicators However this application is not meant to mandate new forms of routinely collected data The application is designed to be used easily and quickly by all CCGs and practices We look forward to any questions or feedback on how this application could be improved Please reach us via email on citeam dh gsi gov uk Outline of this User Guide Preface The context of Primary Care Commissioning Application What has changed in V88 1 Overview of PCC Application v88 1 1 What the application does does not do 1 2 The indicators included in the PCC Application 1 3 The reports and analyses you can run using the PCC Application 1 4 Using the application to commission and manage primary care 2 The Indicators in the PCC Application 2 1 How the indicators were chosen 2 2 Further detail on the indicators 2 3 Indicator availability at CCG PCT or GP practice level 3 Using the PCC Application 3 1 How to define and add peer groups for comparative analysis 3 2 How to run reports and analyses using the GP Services application 3 2 1 Setting which CCG PCT to analyse 3 2 2 Running Overview reports 3 2 3 Running CCG reports 3 2 4 Running GP practice reports 3 3 How to print these analyses 3 4 Entering your own data to
68. ion of the capacity of a given GP practice than simply the number of GPs at the practice This is due to the high variance in GP patient facing hours How is this defined One full time equivalent GP is a GP who is contracted or works for 8 or more sessions per week a session is defined 40 as approximately 4 hours and 10 minutes A GP who works 8 or more sessions a week is defined as 1 FTE any who work less are calculated as a proportion of that value e g a GP working 4 sessions a week 4 8 would be classed as 0 5 FTE The number of FTEs in a given practice is the sum of the these values e g 4 GPs of which 2 do 9 sessions and 2 do 4 sessions 1 1 05 0 5 3 FTE Where do find this data NHS Information Centre Exeter Percentage of GPs over 55 yrs of age Why is this important This is important for planning capacity of primary medical care into the future A high number of GPs over 55 years of age implies that unless younger GPs are brought into the practice and the patch the capacity of the GP practice and the patch overall may fall in the coming years affecting the CCGs subsequent ability to deliver primary medical care How is this defined This field can be populated with the number of GPs in the practice that are over 55 years of age as of the 30th September 2012 to match the CCG level data from Exeter at this date Where do find this data GP age is availab
69. ircles and the CCGs not in the peer group will be shown as empty circles The CCGs or Practice Group scores on the two indicators selected determine each circle s position on the graph Supporting information on the graph is also supplied including information and advice on interpreting this information A line of best fit is drawn for all the circles which represents the overall trend of all the circles there may be no overall trend but a line will still be drawn Additionally statistical values including the R squared value and the correlation are displayed The full description of how to interpret the statistical values is displayed in the How to interpret box on this view It is important to note that correlation does not imply causation This means that just because there is a line of best fit that is sloping upwards it does not mean that one indicator causes a specific value in the other indicator These graphs need to be interpreted with caution because they only show correlation at best and not causation Care should also be taken when there are only a few data points on the graph 3 2 4 Running GP practice Reports blue tabs e GP practice Indicator table e GP practice Dynamics e GP practice Prevalence e GP practice Prevalence 2 e GP practice Scatter These reports allow you to drill down to individual GP practices to review specific indicators and to conduct different types of analysis to id
70. it is designed to do and what it does not do An outline of the indicators that are included in the application and the reports that the application can provide is followed by a worked example of a CCG investigating its results in managing diabetes 1 1 What the application does and does not do The PCC Application has been created to provide you with insights to support commissioning decisions and highlight opportunities for quality improvement There are three key questions to be explored 1 Mapping the baseline Where are you now Where do you stand now in comparison with your peers and which areas you may want to target for improvement What are the needs of your population and what needs to change It is often useful to have an understanding of what areas are a priority for you before you start using the PCCA for the first time This helps to focus your enquiry whilst developing your understanding of what the PCCA does and how you can best use it Example questions can include e How effective are we at maintaining the health of our diabetic population compared to CCGs that have similar populations e Are these results spread equally across the GP practices Are there outliers we should focus on How the PCCA can help Using the application you can perform several analyses on diabetes management for example you can look at the QOF measure of HbA1C under 8 and see if you are in the lowest or highest quartile of CCGs in England
71. ith any CHD stroke or TIA hypertension back to main menu Double click on an indicator to view ranking report view CCG profile Expenditure on emergency Average exception rate of MH11 to 6 admissions per 1 000 registered 1 CHDO8 Exception Rate STROKEDS Exception Rate Average exception rate for PCCA indicators DM17 Exception Rate ASTHMAOS Exception Rate Overall Clinical exception rate MH10 without Exception Reporting MH10 Exception rate COPDO8 Exception rate To use this view you need to set or check two values e Ensure that Groups that fall into each banding e g Top 10 Top 10 25 etc as listed next to each of those bandings e Where the selected CCG Practice Groups sits on each results indicator in the application Each indicator in the application will be listed under the relevant banding to indicate the position of the selected CCG Practice Groups on that indicator e lf the number of CCGs or Practice Groups in a peer group is lower than 20 the percentiles may not be statistically valid due to the high influence 26 of outliers In this case some or all of the indicators will be shown in grey text rather than black The goal of the CCG Dashboard is to provide an overview of all the indicators in one worksheet The aim is for you to see on all the critical metrics situations where you are above or below the average level when compared to your peer C
72. ithout exception reporting yes yes yes Average QOF Exception rate yes yes yes Average QOF exception rate for PCCA Indicators yes yes yes CHDO6 patients with CHD in whom the last BP is 150 90 or less yes yes yes CHD08 patients with CHD in whom measured total cholesterol is 5 or less yes yes yes HF02 patients with a diagnosis of heart failure which has been confirmed by an echo or specialist yes yes yes STROKE13 new patients with a stroke who have been referred for further investigation yes yes yes STROKEO6 patients with a history of TIA or stroke whose last measured cholesterol is 5 or less yes yes yes STROKEO8 patients with a history of TIA or stroke whose last measured cholesterol is 5 or less yes yes yes DM27 patients with diabetes in whom last HbA1c is 8 or less yes yes yes DM31 patients with diabetes in whom last BP is 140 80 or less yes yes yes DM17 patients with diabetes whose last measured total cholesterol is 5 or less yes yes yes EPILEPSY08 patients over 18 on drug treatment for epilepsy who have been seizure free for the last 12 months yes yes yes ASTHMAO8 patients aged 8 and over diagnosed with have asthma yes yes yes CKDO3 patients on the CKD register in whom last BP is 140 85 or less ye
73. k on the Input Data button and the data will be loaded into the data sheets behind the application This may take a few minutes dependant on the volume of data being added If you would like to correct or change the data simply enter the new value and click on the Input Data button To add data for another CCG select the CCG from the drop down list in the Input CCG Data sheet and add the data against the practices for that CCG Click on the Input Data button and it will also be loaded into the data sheets The current version of the application can only present results for your most recent set of data even if you have historical data available it cannot track changes over time for CCG defined indicators Removing locally defined data To remove locally added data from the application click on the Clear ALL Data button This will clear all of the locally defined data from the data sheets 48 4 Who to contact for support or to give feedback Your experience with the application should be a positive one and we are able to provide limited technical support for issues with the application We are also interested in your feedback on the application which we will use to shape future releases We can be reached for either technical support or feedback via email at pciteam dh gsi gov uk PLEASE NOTE that your local IT team should be your first line of support for e Printing issues e General Excel issues 4 1
74. lation a given PCT Centre Applications divided by the Office of and ONS population National Infrastructure Statistics services NHAIS System Exeter ONS Number of Number of full The NHS GP Census March Annually FTE GPs time equivalent Information 2012 March GPs based on Centre PCT returns FTE GPs The number of The NHS GP Census March Annually 100 000 FTE GPs information The National 2012 March registered registered toa Centre Health patients given PCT or Applications practice divided and by registered Infrastructure patients services NHAIS System Exeter 59 Average GP The PCT average PCT PCT gathered N A N A appointment of all the GP gathered slots 1 000 practice level registered counts of patients appointments week slots offered by a GP in an average week divided by the patients registered to that practice divided by 1 000 Average The PCT average PCT PCT gathered N A N A nursing of all the GP gathered appointment practice level slots 1 000 counts of registered appointments patients slots offered by a week nurse in an average week divided by the patients registered to that practice divided by 1 000 FTE Practice The number of The NHS GP Census Sept Annually staff 1 000 FTE practice staff Information The National 2011 March weighted per 1 000 Centre Health registered weighted Exeter Applications patients r
75. le in the Exeter Payments Database GP details such as age and gender have to be entered in order for payments to be processed through this database Practice is open and accepting new registrations Why is this important Understanding the number of practices that will accept new patients is important for planning the capacity of primary medical care in the future as well as for ensuring competition How is this defined This indicator is populated with a value of 1 or 0 depending on whether the practice list is open to new registrations A practice is considered to be open to new registrations if an individual previously not registered to that practice but within that practice s catchment area is able to register with that practice s patient list Where do find this data PMS and GMS contracts require that GP practices notify their CCG if the status of the patient list changes The information is therefore likely to be available in the GP Commissioning department Additionally some CCGs have departments that respond to calls from members of the public who are unable to register on patient lists These services can be used to track if a patient list is closed at a particular GP practice 41 Funding patient primary medical care Why is this It is important to benchmark the total expenditure per practice important in order to understand the correlations between results m
76. le report displays e The ranked list of all CCGs or Practice Groups for the selected indicator with your CCG or Practice Group highlighted in yellow e The detail behind the score in terms of median bottom 25 and top 25 in the fields at the top right hand corner of the report e A full description of the indicator the data source and the time period that this data relates to directly above the indicator table graph 31 On this report the median and the top 25 value are also displayed as lines over the graph Additionally if you have a CCG defined aspiration for this indicator the application can reflect this Entering an aspiration for the indicator on the Input CCG defined aspirations tab will add a red dashed vertical line to this chart to show where your aspiration sits For detail on entering CCG aspirations see page 45 of this guide To download the data behind this report click on the Get Data button at the top this will copy the data for all CCGs or Practice Groups for the selected indicator into a new spreadsheet The next CCG report is the CCG Dynamics report Figure 3 2 3b which compares current results with the previous results Figure 3 2 3b CCG dynamics report showing the change in the specified indicator since the previous reporting period CCG level Dynamics back to main menu Select CCG or PCT Ece Select a CCG or Practice Group Bamet Compare results with All Display Peer group only
77. luding GP representatives academics and PCTs Their feedback on each of the indicators was scored and the resulting higher scoring indicators were included in the application The indicators have been continually updated based on user requirements and feedback to support the changes in the commissioning landscape 2 2 Further detail on the indicators The indicators are separated into three broad sets the needs of the local population the structure of the primary care system in the CCG including GP configuration and expenditure and the profile of primary care in the CCG in terms of areas such as patient experience access and clinical outcomes Wherever possible the application includes data at both the CCG and GP practice level For some indicators data is currently unavailable at CCG level therefore data is also included at PCT level For indicators where only CCG or PCT is available there is the option to add data at the GP practice level if you have it A list of which indicators are available in the application at each level is included in the Appendix B Needs Health Status Reported prevalence of LTCS Structure Configuration Number of GP practices Results Patient Experience Overall experience of GP surgery CHD e Registered patients practice e Support from local services or organisations Stroke to help manage long term health condition Hypertension Capacity e Impression of waiting time at surgery
78. m 10 View All clinical indicators Overall Clinical QOF score Percent 1 10 9 88 9 88 5 87 9 87 1 86 2 Ranking Practices Overall Clinical exception rate Percent 77 3 4 5 5 0 5 6 6 1 6 7 Ranking Practices PCCA Indicators Average QOF score for PCCA indicators Percent 3 9 0 85 0 84 3 83 4 82 4 81 4 Ranking Practices Average QOF score without Exception Percent 4 Reporting for PCCA indicators 23 7 79 0 78 0 76 9 76 0 751 Ranking Practices Average exception rate for PCCA indicators Percent 81 5 6 1 6 7 7 5 8 6 9 2 Ranking Practices Coronary Heart Disease CHDO6 patients with CHD in whom last Percent 6 BPis 150 90 orless 33 91 5 91 0 90 1 89 2 88 4 Ranking Practices CHDO6 without Exception Reporting Percent 5 2 89 6 88 6 87 7 86 7 85 8 Ranking Practices CHDO6 Exception Rate Percent 8 38 4 1 8 2 2 2 5 3 0 3 6 Ranking Practices CHDO8 patients with CHD in whom last Percent 9 measured total cholesterol is 5 or less 10 4 83 4 81 7 80 2 78 6 771 Ranking Practices As with the previous view to use this view you need to set two values 27 e The name of your CCG in the Select a CCG or Practice Group field e Your choice of peer group for comparison in the Compare results with field This report displays both the CCG Practice Group value and a percentile score for each indicator in the application For example on the clinical quality QOF indicator patients with CHD and last BP 150 90 or less a value
79. me GP practice code 82007 TOWNHEAD SURGERY CROSSHILLS GROUP PRACTICE FISHER MEDICAL CENTRE DYNELEY HOUSE SURGERY GRASSINGTON MEDICAL CENTRE ILKLEY amp WHARFEDALE MEDICAL PRACTICE SILSDEN GROUP PRACTICE LINGHOUSE MEDICAL CENTRE GRANGE PARK SURGERY FARFIELD GROUP PRACTICE HOLYCROFT SURGERY HAWORTH MEDICAL PRACTICE KILMENY SURGERY OAKWORTH HEALTH CENTRE ONE MEDICARE NORTH STREET ADDINGHAM SURGERY K by BMEDICAL PRA Once the data has been entered select the data to be entered from the drop down list at the top This will load the selected data into the data sheet behind 45 the application which may take a few minutes depending on the volume of data being added If you wish to correct or change the data just replace the value with the new or corrected value and select the data field from the drop down list This you want to upload all the data then select All from the select to update drop down menu If you have data for more than one CCG simply change the CCG in the drop down list enter the new data and select the data field as above To extract the data already entered change to the chosen CCG and click on the Collect data currently in tool button The data for the selected CCG will be loaded back into this sheet for examination After data is entered it will be accessible through the other screens Data on GP practices entered for your CCG can be manipulated through the other screens
80. ment slots per 1 000 registered patients per week others can be defined by the user However the application will function and deliver insight without any additional data It does not tell you the root cause of an issue The application will help you identify areas where you may want to look deeper e g low results on a particular indicator across your CCG for example or in a few specific practices However the application is not designed to tell you what is driving the results It should be used as a starting point for discussions that lead to insights and actions It does not provide real time data The current version of the application includes published data this data is not updated automatically Updates to the application are currently carried out approximately three times a year often linked to when new data becomes available These data and the functional improvements do not flow automatically into the current version of the application Similarly you can add your own data to the application but the application is not built to be connected to systems to enable a real time flow of operational data into the PCCA It does not provide independent validation of the data in the application This data has been compiled and derived from previously existing and published datasets Some validation and checks have taken place derived data has been quality assured but no further data collection has been done Every attempt has been m
81. nually 70 Influenza Immunisation for at risk patients Percentage of patients aged between 6 months and 65 years vaccinated with the Seasonal Flu Vaccine Immform Immform 2010 11 Annually Cost effectiveness 11 indicators Indicator Description Main Source Underlying Source Period Frequency of Update BCBV indicator for prescribing for lipid modification The number of prescription items for simvastatin and pravastatin expressed as a percentage total number of prescription items for all statins including combinations of exetimibe with statins Excludes all other lipid regulating drugs The NHS Institute for Innovation and Improvement ePact net April June 2009 Quarterly 6 month lag Prescription rate for generic PPIs The number of prescription items for low cost PPls expressed as a percentage of the total number of prescriptions for all PPIs ePACT ePACT 2009 10 On request 71 use of The number of ePACT ePACT 2009 10 On request generics prescription items for low cost drugs expressed as a percentage of the total number of prescriptions for all drugs Average A amp E The number of NHS Hospital Episode 2010 Annually attendances Accident and Comparators Statistics 1 000 Emergency registered attendances patients p
82. o use the PCC Application to run reports select comparator groups and add your own data It covers the following topics 3 1 e How to define your own peer group at practice and CCG level for comparative analysis below e How to run reports and analyses using the PCC application p 25 e How to add your own data to the application p 37 e How to enter a CCG aspiration value for an indicator p 45 e How to add your own CCG defined indicators to the application p 46 How to define and add peer groups for comparative analysis While comparisons against every CCG in the country or every practice within your CCG can be useful comparisons with CCGs or practices that you see as your peers may deliver more insight in some cases The PCC Application includes several pre defined peer groups for you to choose from and includes the option to define your own peer group The CCG PCT defined peer groups are as follows ONS Group The Office of National Statistics ONS clusters all PCTs into groups based on a combination of 42 variables aimed at clustering together PCTs with similar populations The variables used to match PCTs together include statistics on age ethnicity gender housing family structure and employment Appendix C includes a full list of these groups We have calculated ONS groups for CCGs based on the PCT classifications this was possible for all but 16 CCGs Classifications are expected to be updated by ONS in 2
83. ocal services or organisations yes yes yes to help manage long term health condition Impression of waiting time at surgery yes yes yes Overall rating of GP soft skills yes yes yes Confidence and trust in GP yes yes yes Overall rating of nurse soft skills yes yes yes Confidence and trust in nurse yes yes yes 80 Appendix C CCG ONS Groups Regional Centres Newham Bexley Newcastle North and East Southwark Havering Newcastle West Medway Salford Swindon Leeds North Prospering Smaller Towns Basildon and Brentwood Leeds West Northumberland Leeds South and East Bury Prospering Southern Sheffield Chorley and South Ribble England Brighton amp Hove Eastern Cheshire Mid Essex Dartford Gravesham and Portsmouth South Cheshire Swanley Southampton Stockport East Surrey Bristol Trafford Guildford and Waverley Liverpool Vale Royal North West Surrey Warrington Surrey Heath West Cheshire Chiltern Centres with Industry West Lancashire Newbury and District Blackburn with Darwen East Riding of Yorkshire North amp West Reading Hambleton Richmondshire Bolton and Whitby Oxfordshire Central Manchester Harrogate and Rural District South Reading Oldham Scarborough and Ryedale Aylesbury Vale East Lancashire Vale of York Wokingham Heywood Middleton amp Rochdale Lincolnshire East Surrey Downs North Manchester Corby West Kent
84. ores Input You can add your own aspiration levels for any indicator in the application to increase the application s utility as a customisable profile dashboard e CCG Defined Indicators Input You can add up to 20 locally defined indicators to explore local priorities 1 4 Using the application to commission and manage primary care The example below shows how you may use the PCC Application to commission and manage primary medical care It follows a CCG working to improve diabetes care and shows how the CCG used the application along all three stages of commissioning It is not an exhaustive example but serves to illustrate the range of ways the application can be used the insights that can be gained from doing so and the further analysis that may be required afterwards Mapping the Baseline CCG results on HbA1c control As commissioners you need to understand how your CCG is performing on key metrics The PCC Application allows you to identify your CCGs starting point for many nationally collected indicators Reviewing results on patients with diabetes with last HbAic 7 5 or less our sample CCG discovered from the dashboard report that it was in the bottom 10 on HbAic control When the CCG identified this they decided to explore further to understand if any particular practices were driving this The primary care commissioning team ran a report ranking GP practices on HbA1c control Figure 1 4 Looking at this it w
85. ot offer an evaluation of all indicators In most cases the application is informative rather than evaluative For example it is not necessarily optimal to be in the highest quartile of soend on primary care This will depend on the particular needs of the patient population in the region and the current service specification and structure Where there are correlations in the data it does not imply causation The application will allow you to look for relationships between indicators which may show the co incidence of a high input i e expenditure and a positive output i e a high QOF clinical outcome score You should not assume a direct causal link but look further into why this might be true rather than assuming that increased expenditure will always lead to a higher QOF score on that indicator 1 2 The indicators included in the PCC Application The application includes over 100 metrics or indicators the majority of which are sourced from nationally published or nationally held data Users also have the opportunity to add data for 12 indicators which are not always nationally available but which experience shows can help support commissioning insights There is also the opportunity to add up to 20 locally defined indicators that have particular relevance to local priorities The indicators are separated into three categories the needs of the local population the structure of the primary care system in the CCG including GP
86. ots 1 000 registered patients week Average nursing appointment slots 1 000 registered patients week Choice of GP gender available yes Number of FTE GPs yes yes yes GPs 100 000 registered patients yes yes yes FTE GPs 100 000 registered patients yes yes yes GPs 100 000 ONS population FTE Practice Staff 1 000 Registered patients yes FTE Practice Staff 1 000 Weighted patients of FTE GPs in PCT who are gt 55 years of age yes Configuration Number of GP practices yes yes Average patient per practice yes yes Capabilty Clinician Leadership Track record of improvement Practice Management Competition of practices whose lists are open and accepting new registrations yes Access Ease of getting through on the phone yes yes yes Frequency of seeing preferred GP yes yes yes Able to get an appointment to see or speak to someone yes yes yes Overall experience of making an appointment yes yes yes Satisfaction with opening hours yes yes yes Average Appointments registered patient year of practices offering gt 35 hours patient facing time week yes yes yes Quality Average Clinical QOF score yes yes yes 77 Average QOF score for PCCA indicators with and w
87. ou are interested in downloading the data behind the report for further analysis click on the Get Data button at the top right of the page This will put the CCG or Practice Group level data for all CCGs or Practice Groups into a new spreadsheet The GP Practice Dashboard shows similar information at practice level for each practice in the defined peer group Figure 3 2 2c The peer groups for GP practices now available in all reports are 28 CCG PCT Compares the selected practice to all practices within the CCG or PCT Practice Groups Compares the selected practice to all practices within the defined Practice Group to define Practice Groups see the section on Peer Groups above IMD Compares the selected practice to the 40 closest practices nationally who have a similar deprivation level 29 Figure 3 2 2c Selection of peer groups for GP reports GP Practice Dashboard Select your peer group CCG Select a CCG or Practice Group pct Practice Group Select a GP practice Ww 69 GP practices To use the CCG PCT and Practice Group functions e Choose your CCG PCT or Practice Group from the Select a CCG or Practice Group drop down list e Select your chosen GP practice from the Please select a GP practice list The report now shows the practice benchmarked against all of the practices within the chosen peer group To use the IMD peer group set up and select your chosen practice then select IMD f
88. oup and select an indicator you believe could show a CCG that has a similar population to you Make a note of which CCGs have similar values to yours for example the five CCGs above and below your CCG on the table Next switch the view to another indicator you believe is representative of CCG population Such as BME and run the same exercise CCGs which are near you on both indicators may be reasonable peers to profile against e CCGs which are both in your SHA and your ONS Group CCGs in your SHA may share relevant characteristics of geography and management structure CCGs which are in your ONS Group as defined above may also share common characteristics Combining these two sets to find CCGs which share all of these characteristics may create a useful peer group To do this review the list of ONS Groups included in the appendix find your group and note the CCGs in that group which are also in your CCGs SHA If you would like to compare between Practice Groups rather than PCTs or CCGs you will need to define your practice groups 3 1 1 Setting up Practice Groups for comparison To compare groups of practices in the different CCG reports on all of the indicators in the practice you will need to define the practice groups in the Input peer group tab In the Input peer group tab Figure 3 1 1a you have three tables to use the first with a list of all the practices in your CCG a second entitled Practice Groups which will be
89. p The GP practice Reports provide the same analyses as the CCG reports but provide them at the practice level GP Indicator Table How the GP practices in your CCG compare to each other on any indicator you select GP Dynamics How the selected indicator has changed between the current and the previous year for GP practices in your CCG GP Practice Prevalence Gives a comparison of the expected and reported prevalence for any practice across the twelve LTCs GP Practice Prevalence 2 Gives a comparison of the expected and reported prevalence for all of your practices across the selected LTC GP Correlation Analysis Gives the facility to show how any two indicators are related to each other for all practices in a CCG The CCG Input tabs allow you to enter your own data to increase the relevance of the application beyond that which the nationally published or collected data can provide as well as provide the flexibility in the application e Manual Data Input You can enter data on up to 12 defined indicators relevant to primary care which are not currently published nationally but may be available locally e Define Custom Peer Group There are two facilities within this tab The first allows you to choose which CCGs that you want to compare yourself against if none of the pre defined peer groups give you a representative set The second provides the opportunity to group practices together into Practice Groups e Aspiration Sc
90. r Long Term Conditions LTCs as well as the reported prevalence of mental health and cancer adults who smoke and standardised mortality ratio for all ages These indicators allow you to a measure yourself against peers with similar health populations and b highlight the conditions on which your population has the highest prevalence where you may want to focus your commissioning resources Socioeconomics These indicators measure demographic information including age ethnicity population size and growth urbanity rurality and Index of Multiple Deprivation IMD They allow you to compare results between true peers i e CCGs and practices that have similar populations and socioeconomic challenges STRUCTURE INDICATORS These indicators describe the structure of your system for providing primary medical care and are the aspects of primary care that can be controlled more directly through your commissioning decisions Some of these indicators can be altered more quickly while others take longer to influence Structural indicators allow you to a see how you compare to your peers in the way you are commissioning primary care in your CCG and b look for relationships between structure and results that could give insight into how you could improve your results by changing your structure The structural indicators are separated into six categories Configuration These indicators measure the number of GP practices and practice size
91. rals elective 1 000 referrals to registered secondary patients care divided month by the number of patients divided by 1 000 Patient Experience 7 indicators Indicator Description Main Source Underlying Period Frequency Source of Update Overall The The GP Ipsos MORI July Biannually experience of percentage of Patient 2011 to GP surgery patients who Survey March have had a 2012 good overall experience at the GP surgery Overall rating The The GP Ipsos MORI July Biannually of GP soft percentage of Patient 2011 to skills patients Survey March 73 satisfied with the soft skills of their doctor 2012 Confidence and trust in GP The percentage of patients who have confidence and trust in their GP The GP Patient Survey Ipsos MORI July 2011 to March 2012 Biannually Overall rating of nurse soft skills The percentage of patients satisfied with the soft skills of the nurses The GP Patient Survey Ipsos MORI July 2011 to March 2012 Biannually Confidence and trust in nurse The percentage of patients who have confidence and trust in a nurse The GP Patient Survey Ipsos MORI July 2011 to March 2012 Biannually Impression of waiting times at surgery The percentage of patients satisfied with the amount of time they had to wait at the GP surgery before their appointment The GP Patient Survey Ipso
92. rate 15 months SMOKE 04 QOF measure The Quality The Quality 2011 12 Annually patients with reported as and Management any of the published Outcomes and Analysis following without Framework System conditions exception QOF QMAS CHD stroke or reporting TIA HT allowed and the diabetes exception rate COPD CKD asthma or mental health conditions whose notes record that smoking advice or referral has been offered within the previous 15 months DEM 02 of QOF measure The Quality The Quality 2011 12 Annually patients reported as and Management diagnosed with published Outcomes and Analysis dementia without Framework System whose care has exception QOF QMAS been reviewed reporting inthe previous allowed and the 15 months exception rate CANCER 03 QOF measure The Quality The Quality 2011 12 Annually patients with reported as and Management cancer published Outcomes and Analysis diagnosed in without Framework System the last 18 exception QOF QMAS months who reporting have a patient review recorded as occurring within 6 months of the practice receiving allowed and the exception rate 68 confirmation of diagnosis CS 01 of QOF measure The Quality The Quality 2011 12 Annually female patients reported as and Management aged 25 64 published Outcomes and Analy
93. rate ACS Emergency admission rates Health Interventions e Breast Screening Expenditure e Cervical Screening e GP spend total spend inc prescriptions e Influenza Immunisations Socioeconomics e GP spend total spend excl prescriptions e MMR immunisation IMD e 2 yr CAGR historical primary care spend e Pneumococcal Immunisation BME e 2 yr CAGR historical total spend e registered patients aged 0 14 registered patients aged 15 44 registered patients aged 45 65 registered patients aged 65 Registered Patients Weighted Patient Listsize Population growth Practice classed as rural Total PCT Expenditure weighted population Below we describe each category of data in turn Cost Effective use of the System BCBV Indicator for lipid modification prescription rate Prescription rate of generic PPIs use of generics A amp E attendances 1000 reg patients Year First outpatient attendances 1000 reg patients Year Influenza immunisation for those aged 65 and over Influenza immunisation for those at risk OOH attendances 1000 reg patients Month WIC attendances 1000 reg patients Month Elective referrals 1000 reg patients Month NEEDS INDICATORS These indicators measure the needs of your population The needs indicators are separated into two categories Health Needs These indicators measure the condition of your population s 16 health They include both reported and expected prevalence of twelve majo
94. riance is explained by this relationship If R is 0 5 50 of the data s behaviour can be explained by this relationship A low R means 517 that the relationship bears no explanatory value even though it may be gt significant 46 7 s CAUTION Correlation only indicates relationship between indicators but NOT 417 causality There may be additional factors that are the main influence Correlation only measures linear relationships If you don t see a recognizable linear trend within the blue data points correlation and R are 36 7 T T not reliable 34 44 54 64 74 8 4 If you observe outliers treat results with care Outliers have a big impact art 7 on the correlation over or underestimating the real relationship Overall Clinical exception rate ercent To use this view you will need to enter four sets of values Practice Group field 35 The name of your CCG or Practice Group in the Select a CCG or e Your choice of peer group for comparison in the Select your peer group field this is where you can select Practice Groups e Your choice of which values to display on the chart only your peers or all CCGs e An indicator to be mapped on the x axis of the graph and an indicator to be mapped on the y axis of the graph on this view The Correlation analysis view will display a scatter plot with a circle for each CCG or Practice Group The CCGs in the selected peer group will be shown as filled c
95. rom the Select your peer group drop down list The GP practice profile has the same functionality as the CCG Profile with the peer groups as for the GP practice dashboard described above The Get Data button will download data for all practices within that peer group 3 2 3 Running CCG Reports orange tabs e CCG Indicator table e CCG Dynamics e CCG Comparison e CCG Prevalence e CCG Scatter These six reports allow you to drill down into your CCG or Practice Group s results on specific indicators and to conduct different types of analysis to identify higher and lower scores and possible drivers of results The CCG Indicator Table Figure 3 2 3a report provides more detail by listing for a given indicator all the CCGs or Practice Groups in ranked order on that score 30 Figure 3 2 3a CCG Indicator showing the list of CCGs in ranked order on the selected indicator score Indicator table CCG level back to main menu Get data Select CCG or PCT CCG Select a CCG or Practice Group Barnet Rank 53 211 Top 10 6 9 Bottom 25 11 8 Compare results with All Value 8 6 Top25 8 6 Bottom 10 13 5 Select an indicator category Results Clinical quality Median 10 2 Select an indicator COPD13 Exception rate x Aspiration back to CCG dashboard J 0 back to CCG profile Data so
96. s Where do find this data This data needs to be collected by the CCG Some CCGs may have regular quarterly or semi annual returns that they require GP practices to complete Other CCGs have online systems that extract data directly from GP practices on a regular basis In certain circumstances it may be necessary to contact GP practices directly in order to obtain this information Average appointments per registered patient per year Why is this important Average number of appointments per registered patient per year is a comparative measure of demand placed upon a GP practice by the registered population assuming supply is sufficient This metric can highlight surprising patterns of demand potentially driven by undersupply or over utilisation of other services e g A amp E 42 How is this defined This indicator is defined as the number of appointments booked during core hours divided by the average number of registered patients in a given year DNAs should be counted in the number of booked appointments The number of appointments per year is a historical record of the appointments offered over the past twelve months The average number of registered patients is more difficult to measure however many CCGs record average monthly list size for each of their practices The arithmetic mean of the average list size in the past twelve months is a measure of annual average list size
97. s yes yes AF04 patients with AF diagnosed after 1 April 2006 with ECG or specialist confirmed diagnosis yes yes yes CANCERO3 patients with cancer diagnosed in the last 18 months who have a patient review recorded as occurring within 6 months of the practice receiving confirmation of diagnosis yes yes yes DEM02 of patients diagnosed with dementia whose care has been reviewed in the previous 15 months yes yes yes SMOKE04 patients with any of the following conditions CHD stroke or TIA HT diabetes COPD CKD asthma or mental health conditions whose notes record yes yes yes 78 that smoking advice or referral has been offered within the previous 15 months MH10 of patients on the register who have a comprehensive care plan documented in their records agreed between individuals their family and or carers as appropriate yes yes yes Average of MH11 to 16 patients with schizophrenia bipolar affective disorder and other psychoses who have a record of alcohol consumption BMI BP cholosterol hdl ratio BG in the preceding 15 months and a cervical screening in the preceding 5 years yes yes yes COPD08 of patients with COPD who have had influenza immunisation in the preceding 1 Sept to 31 March yes yes yes COPD13 of patients with COPD who have had a review undertaken by a health
98. s Mori July 2011 to March 2012 Biannually Support from local services or organisations to help manage long term health condition The percentage of patients with a long term health condition who are satisfied with the support they have recieved from local services or organisations to help manage their condition in the last 6 The GP Patient Survey Ipsos Mori July 2011 to March 2012 Biannually 74 months Data supplied by E The The central authoritative source of Information health and social care information Centre for health and social care Copyright 2011 Re used with the permission of The Health and Social Care Information Centre All rights reserved 75 Appendix B Availability of data at CCG PCT and GP practice level Data available Indicator CCG PCT GP Practice Health Status Reported prevalence of CHD yes yes yes Reported prevalence of Stroke yes yes yes Reported prevalence of Hypertension yes yes yes Reported prevalence of Diabetes yes yes yes Reported prevalence of COPD yes yes yes Reported prevalence of Epilepsy yes yes yes Reported prevalence of Asthma yes yes yes Reported prevalence of Heart Failure yes yes yes Reported prevalence of Dementia yes yes yes Reported prevalence of Chronic Kidney yes
99. se in the top half of the graph have values above the average and those in the right half of the graph have increased in value For indicators where a higher value is perceived as better those in the top right are seen as best practice and those in the bottom right are seen as lagging and falling further behind For indicators where lower values are seen as better those in the top right are high and increasing and the bottom left as low and decreasing The goal of this view is to indicate not only how CCGs or Practice Groups are performing currently but also how their current results have changed from the last reporting period In addition to comparing all CCGs it is also possible to compare two specific CCGs on the CCG Comparison report Figure 3 2 3c The CCG Comparison report allows a direct comparison between two defined CCGs on all or groups of indicators in the application Figure 3 2 3c CCG Comparison report comparing the selected CCG or Practice Group with another chosen CCG or peer group CCG comparison back to main menu Select CCG or PCT CCG Select a CCG or Practice Group Barnet Filter by peer group All Indicator group Results Clinical quality Compare to CCG or Practice Group Airedale Wharfedale and Craven Sort by indicator list Tol Barnet is better Airedale Wharfedale and Craven is k Note Better is defined as higher where a high num
100. se indicators can be used for analyses similar to the pre populated nationally available data e Average practices offering patient facing clinical hours gt 35 hours per week e Choice of GP gender e Number of FTEs practice level e Percentage of GPs over 55 yrs of age e Practice is open and accepting new registrations e Funding patient primary medical care e Average GP appointment slots 1 000 registered patients week e Average nursing appointment slots 1 000 registered patients week e Average appointments per registered patient per year e Elective referrals per 1 000 registered patients per month e Out of hours attendances per 1 000 registered patients per month e Walk in Centre attendances per 1 000 registered patients per month It is important to note that any data input into the application will remain within the local version of the application and it will not be uploaded or collected centrally by the DH Data entered by CCGs is solely for CCG use within the CCG Lastly the goal of the application is not to burden you with additional data collection The indicators included as suggested CCG gathered data have been chosen in part because they are viewed to be easily obtainable by CCGs There is no requirement to collect the data unless you believe it will help you commission care more effectively 3 5 How to collect your own data There are two types of data that can be entered into the PCC Application e Pre De
101. sis whose notes without Framework System record that a exception QOF QMAS cervical smear reporting has been allowed and the performed in exception rate the last 5 years Health Interventions 6 indicators Indicator Description Main Underlying Source Period Frequency Source of Update Breast The The NHS Annual returns from 3 Years Annually Screening percentage of Information PCTs and breast to January women aged Centre screening units March 53 64 KC62 KC63 2012 screened by breast screening programmes Cervical The The NHS Returns from PCTs 5 years Annually Screening percentage of Information and clinics to September women aged Centre KC53 KC61 KC65 March 25 64 11 screened by Cervical screening programmed in the past 5 years Influenza The The NHS Returns from PCTs 2010 11 Annually immunisation percentage of Information KC50 Immform for those aged persons aged Centre 65 and over 65 and over PCT immunised Immform against practice influenza MMR The The NHS Returns from PCTs 2010 11 Annually Immunisation percentage of Information KC50 children Centre immunised for measles mumps and rubella by their 2 69 birthday Pneumococcal immunisation The percentage of children immunised for pneumococcal disease by their 1 birthday The NHS Information Centre Returns from PCTs KC50 2010 11 An
102. st overview of where a CCG or GP practice stands across the outcome indicators in the application The top left hand link on the default view takes you to the CCG Dashboard The CCG Dashboard Figure 3 2 2a is designed to display the rankings for a given CCG on all of the national output indicators in the application within one view It places each of the indicators in the application into a category i e Top 10 according to where the CCG sits on each of those indicators compared to the selected peer group Figure 3 2 2a CCG Dashboard where the CCG or Practice Group sits in the 5 categories for each indicator CCG Dashboard Select to view CCG or PCT Select a CCG or Practice Group Compare results with Indicators in which you are Expenditure on first outpatient attendances per 1 000 registered Overall experience of GP surgery Average QOF score for PCCA indicators CHDO6 patients with CHD in whom last BP is 150 90 or less CHDO6 without Exception Reporting STROKEO6 patients with a history of TIA or stroke in whom AF04 patients with AF diagnosed after 1 April 2008 with Ease of getting through on the phone Overall experience of making an appointment Satisfaction with opening hours COPDO8 patients with COPD who have had influenza CCG Barnet All X p11 CCG s Top 25 50 54 CCGs Support from local services or organisations to
103. to 5 CKD based on age sex and ethnicity Expected The expected NHS 2008 09 Unknown prevalence number of Comparators of Atrial patients with Fibrillation atrial fibrillation based on age sex and ethnicity Expected The expected NHS 2008 09 Unknown prevalence number of Comparators of Obesity patients with a BMI greater than or equal to 30 based on age sex and ethnicity Adults who Proportion of London Health Survey 2006 Unknown smoke adults who Health for England 2008 smoke Observatory LHO Standardised An Indirectly The National The Office for 2010 Annual mortality standardised Centre for National ratio All ratio SMR of Health Statistics Causes mortality from all Outcomes causes Scaled Development to the national NCHOD average of 2010 55 Standardised mortality ratio Amenable to Health Care An Indirectly standardised ratio SMR of mortality from causes considered amenable to health care Scaled to the national average of 2010 The National Centre for Health Outcomes Development NCHOD The Office for National Statistics 2010 Annual Socioeconomics 10 indicators Indicator Description Main Source Underlying Source Period Frequency of Update IMD The index of multiple deprivation derived from seven domains of deprivation income employment health deprivation and disability
104. tween two indicators Figure 3 2 3e Figure 3 2 3e Correlation analysis report showing the relationship between the two selected indicators care should always be taken in interpreting this Correlation analysis CCG level back to main menu Select CCG or PCT CCG Select a CCG or Practice Group Barnet Compare results with All Display Bamet X axis indicator Overall Clinical exception rate All Y axis indicator Frequency of seeing preferred GP O All Frequency of seeing preferred GP Percent Correlation RZ All 0 04 0 00 Not significant 81 7 All only 0 04 0 00 Not significant 167 i Ce i F te 1 Check for significance If the correlation is significant you can be TF sta e t io 95 sure that this relationship exists and is not observed by chance If it ada Tod ode hr t is not significant you can not assume that there is a relationship ee Korte Som 5 66 7 te Fe ag sR Be SF s estes 2 Determine direction of correlation A positive correlation indicates hat higher values occur together in both indicators A negative correlation ce e ty that hig g g 61 7 Pee Pet te 2 means that one indicator tends to have lower values if the other has higher i wut e t values and vice versa ot ot O er 56 7 4 se oe 3 Determine strength of correlation The R measures what percentage e of the data s va
105. urce view GP practices The exception rate of the QOF indicator COPD13 The Quality Management and Analysis System QMAS 2011 12 a Top 25 s 00 50 10 0 15 0 20 0 miele Rank CCG Value Aspiration value 1 Corby 3 8 SS 2 Richmond 46 T 3 Greenwich 47 z 4 Wyre Forest 4g e 5 City and Hackney 5 6 6 Darlington 5 6 7 North East Lincolnshire 5 6 8 Camden 5 8 9 North amp West Reading 59 SS 10 Basildon and Brentwood 6 0 SSS 11 Sutton 6 1 12 Barking amp Dagenham 6 2 SEs 13 Castle Point and Rochford 6 2 es 14 North Lincolnshire 6 2 15 Merton 6 2 16 Wolverhampton 6 3 17 Dudley 6 4 18 Tower Hamlets 6 5 SSS 19 Durham Dales Easington and Sedgefield 6 7 SI 20 North Durham 6 8 es 21 Knowsley 69 22 Lambeth 6 9 23 Enfield 7 0 24 Solihull 7 0 25 Harrogate and Rural District 7 4 26 West London K amp C and QPP 74 Se 27 Kernow 75 SS 28 Islington 75 as 29 West Lancashire 76 a 30 Coventry and Rugby 76 To use this view you need to choose values from the blue drop down menus on the page e The name of your CCG or Practice Group in the Select a CCG or Practice Group field e Your choice of peer group for comparison in the Filter by peer group field This is where you can select your Practice Group for comparison e Both the indicator category and the relevant indicator in the Select indicator category and the Please select an Indicator fields Once these choices have been made the CCG Indicator Tab
106. ure patient satisfaction with aspects of the patient experience They will help you profile comparable CCGs and review the results of your practices and to look for relationships between satisfaction and expenditure capacity and needs indicators Access These indicators come from patient surveys designed to capture patients satisfaction levels concerning five aspects of GP access There is the option to add locally collected data such as the average number of appointments per registered patients per year They will help you profile comparable CCGs and review the results of your practices These indicators allow you to look for relationships between access and other results related structural and needs related indicators Clinical quality These indicators measure clinical outcomes for several long term conditions and ACS emergency admission rates intended to capture emergency admissions that could have been avoided There are three measures for each QOF outcome e Published QOF achievement the QOF achievement used for payment e QOF achievement with no exception reporting allowed exceptions are added back in to assess the actual proportion of the register achieving this measure e The exception rate Average indicators for these three measures are also included Health interventions These indicators measure the frequency of breast and cervical cancer screening and immunisation against influenza MMR and pneumonia W
107. whilst supporting the emerging Clinical Commissioning Groups CCGs in developing their new role A key aspect of delivering good primary care is capturing understanding and systematically using data to inform commissioning decisions This application has been developed to enable effective assessment and commissioning of GP services The application e Gathers existing primary medical care data analyses it and presents it in an easily interpreted format e Presents analysis on current and future population needs and supports commissioners planning to adjust primary care capacity to meet those needs e Presents a set of indicators e g on access clinical quality enabling benchmarking at practice practice groups and CCG level e Allows CCGs to enter additional data about their practices to enable more detailed comparisons and insights The application is designed to generate insights that will allow commissioners to e Assess their commissioning needs and develop strategies of how best to meet them e Identify areas where the CCG and practices are performing well relative to peers and highlight areas that may need further attention The rest of this document explains the data the application contains and provides an overview of the analyses you can perform using it Detailed instructions on using the application are included in Chapter 3 What has changed in V88 The list below summarises the changes and updates made to the data
108. wn box Then select your PCT or CCGs name in the second drop down box by clicking on the box and choosing from the list displayed Note that when opening the application you should click the Enable Macros choice in the dialog box Excel opens while starting up the application The Select CCG or PCT and Select your CCG PCT drop down box will appear on all sheets in the application however once you have selected your choices on the Main Menu these will flow through to other sheets The exception to this is the tabs where you input your own data where you will have to select your CCG separately go to the Input CCG Data tab and select your chosen CCG from the drop down list Figure 3 2 1 The default view when opening the application Primary Care Commissioning Application V88 Primary Medical Care GP Practice Reports View CCG dashboard GP practice indicator table View CCG profile GP practice dynamics View GP Practice Dashboard GP practice LTC prevalence by practice View GP practice profile GP practice LTC prevalence by LTC Select CCG or PCT Ecco GP practice correlation analysis Select your CCG CCG Reports CCG Input CCG indicator table Manual data input CCG dynamics Define custom peer group CCG comparison Aspiration scores input CCG LTC prevalence CCG defined indicators input CCG correlation analysis 25 3 2 2 Running Overview reports maroon tabs These reports give the application s broade
109. yes yes Disease Reported prevalence of Atrial Fibrillation yes yes yes Reported prevalence of Mental health yes yes yes Reported prevalence of Cancer yes yes yes Reported prevalence of obesity BMI gt 30 yes yes yes Expected prevalence of CHD yes yes yes Expected prevalence of Stroke yes yes yes Expected prevalence of Hypertension yes yes yes Expected prevalence of Diabetes yes yes yes Expected prevalence of COPD yes yes yes Expected prevalence of Epilepsy yes yes yes Expected prevalence of Asthma yes yes yes Expected prevalence of Heart Failure yes yes yes Expected prevalence of dementia yes yes yes Expected prevalence of Chronic Kidney yes yes yes Disease Expected prevalence of Atrial Fibrillation yes yes yes Expected prevalence of obesity BMI gt 30 yes yes yes Adults who smoke yes Standardised Mortality Ratio all causes yes Standardised Mortality Ratio conditions yes amenable to health care Socioeconomics IMD attributed yes population aged 0 14 yes yes yes population aged 15 44 yes yes yes population aged 45 65 yes yes yes population aged gt 65 yes yes yes 76 Registered Patients yes yes yes Weighted registered patients PBRA yes of practices that are rural yes yes BME yes Population growth ONS yes Capacity Total Number of GPs yes yes yes GPs 100 000 weighted registered patients Yes Average GP appointment sl
110. ysis on the QOF Framework System disease QOF QMAS register aged 18 and over receiving drug treatment for epilepsy Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Asthma unadjusted Outcomes and Analysis on the QOF Framework System disease QOF QMAS register with asthma excluding patients with asthma who have been prescribed no asthma related drugs in the previous 12 months Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Heart unadjusted Outcomes and Analysis Failure on the QOF Framework System disease QOF QMAS register with heart failure Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of dementia unadjusted Outcomes and Analysis on the QOF Framework System disease QOF QMAS register diagnosed with dementia 52 Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Chronic unadjusted Outcomes and Analysis Kidney on the QOF Framework System Disease disease QOF QMAS register aged 18 years and over with CKD US National Kidney Foundation Stage 3 to 5 CKD Reported The number of The Quality The Quality 2011 12 Annually prevalence patients and Management Sept of Atrial unadjusted Outcomes an

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