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transcript
Cardiovascular intelligence pack
March 2015
Version 1.2
CCG: NHS EASTBOURNE, HAILSHAM AND
SEAFORD CCG
Contents 1. Introduction 3
2. CVD risk
• The narrative 9
• The data 10
3. Stroke
• The narrative 33
• The data 34
4. Diabetes
• The narrative 47
• The data 48
5. Kidney
• The narrative 54
• The data 55
6. Heart
• The narrative 65
• The data 66
7. Outcomes 84
8. Appendix 90
2 CVD Intelligence packs
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3 CVD Intelligence packs
Introduction
Dr Matt Kearney Dr Chris Arden
Prof Ahmet Fuat Dr Matt Fay
Dr Yassir Javaid Prof Kamlesh Khunti
Ms Jan Proctor –King Prof Ruth Chambers
Dr Clare Hawley Dr Kathryn Griffith
4 CVD Intelligence packs
This CVD Intelligence Pack has been compiled
by the National Cardiovascular Intelligence Network
in collaboration with GPs and nurses in primary care
From Data to Intelligence to Action
Why and How to use this CVD Intelligence Pack
Every year in England there are around 150,000 premature deaths. A quarter of premature deaths are due to
cardiovascular disease. Two thirds of premature deaths could be avoided through improved prevention, earlier
detection and better treatment. High quality primary care is crucial for improving outcomes in CVD because primary
care is where much prevention and most diagnosis and treatment is delivered.
This cardiovascular intelligence pack is a powerful resource for stimulating local conversations about quality
improvement in primary care. Across a number of vascular conditions, looking at prevention, diagnosis, care and
outcomes, the data allows comparison between CCGs and between practices.
This is not about performance management because we know that variation can have more than one interpretation.
But patients have a right to expect that we will ask challenging questions about how the best practices are achieving
the best and what average or below average achievers could do differently and how they could be supported to
perform as well as the best.
The intelligence pack has several sections – CVD prevention and hypertension, stroke and AF, diabetes, kidney and
heart disease and heart failure. Each section has one slide of narrative that makes the case and asks some questions.
This is followed by data for a number of indicators, each with benchmarked comparison between CCGs and between
practices.
Use the pack to identify where there is variation that needs exploring and to start asking challenging questions about
where and how quality could be improved. We suggest you then develop a local action plan for quality improvement –
this might include establishing communities of practice to build clinical leadership, use of audit tools to get a better
understanding of the gaps in care and outcomes, agreeing local protocols and consensus approaches, assessing
training and education needs, and exploring new ways of delivering care.
5 CVD Intelligence packs
6 CVD Intelligence packs
Data and methods
This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic clinical network (SCN) and
England. Where a CCG is in more than one SCN, it has been allocated to the SCN with the greatest geographical or
population coverage. The slide pack also compares the CCG to its 10 most similar CCGs in terms of demography, ethnicity
and deprivation. For information on the methodology used to calculate the 10 most similar CCGS please go to:
http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/
The 10 most similar CCGs to NHS Eastbourne, Hailsham and Seaford CCG are:
NHS Fylde & Wyre CCG
NHS Lincolnshire East CCG
NHS Isle of Wight CCG
NHS South Devon and Torbay CCG
NHS West Norfolk CCG
NHS Great Yarmouth and Waveney CCG
NHS North Norfolk CCG
NHS North Derbyshire CCG
NHS Wyre Forest CCG
NHS North Staffordshire CCG
The majority of data used in the packs are taken from the 2013/14 Quality and Outcomes Framework (QOF). Where this is
not the case, this is indicated in the slide. All GP practices that were included in the 2013/14 QOF are included. Full
source data are shown in the appendix.
For the majority of indicators, the additional number of people that would be treated if all practices were to achieve as well
as the average of the top achieving practices is calculated. This is calculated by taking an average of the intervention rates
(i.e. the denominator includes exceptions) for the best 50% of practices in the CCG and applying this rate to all practices in
the CCG. Note, this number is not intended to be proof of a realisable improvement; rather it gives an indication of the
magnitude of available opportunity.
Benchmarking is helpful because it highlights
variation. Of course it has long been
acknowledged that some variation is inevitable in
the healthcare and outcomes experienced by
patients.
However, John Wennberg, who has championed
research into clinical variation over four decades
and who founded the pioneering Dartmouth Atlas
of Health Care, concluded that much variation is
unwarranted ie it cannot be explained on the
basis of illness, medical evidence, or patient
preference and is accounted for by the
willingness and ability of doctors to offer
treatment.
The strength of benchmarking lies not in the answers it
provides but in the questions it generates for CCGs and
practices.
For example:
1. How much variation is there in detection, management,
exception reporting and outcomes?
2. How many people would benefit if average performers
improved to the level of the best performers?
3. How many people would benefit if the lowest performers
matched the achievement of the average?
4. What are better performers doing differently in the way
they provide services in order to achieve better outcomes?
5. How can the CCG support low and average performers to
help them match the achievement of the best?
A key observation about benchmarking data is that it does not tell us why there is variation.
Some of the variation may be explained by
population or case mix and some may be
unwarranted – we will not know unless we
investigate.
“Much variation is unwarranted –
it cannot be explained on the
basis of illness, medical evidence,
or patient preference”
There are legitimate reasons for exception-reporting. But …….
Excepting patients from indicators puts them at risk of not receiving optimal care and of having worse outcomes. It is also
likely to increase health inequalities. The substantial variation seen in exception reporting for some indicators suggests
that some practices are more effective than others at reaching their whole population. Benchmarking exception reporting
allows us to identify the practices that need support to implement the strategies adopted by low excepting practices.
Why Does Variation Matter?
CVD Prevention and Hypertension
8 CVD Intelligence packs
CVD Prevention
“The NHS needs a radical upgrade
in prevention if it is to be
sustainable”
5 year Forward View 2014
This is because England faces an
epidemic of largely preventable non-
communicable diseases, such as heart
disease, cancer, Type 2 diabetes and
liver disease.
The WHO Global Burden of Disease
Study (next slide) shows us that the
leading causes of premature mortality
are tobacco, raised blood pressure,
obesity, physical inactivity and poor
diet. The radical upgrade in prevention
needs population-level approaches.
But it also needs ongoing behaviour
change support and medical treatment
for individuals during their repeated
contacts with primary care.
The size of the prevention problem
• 2/3 of people are obese or overweight
• 1/3 of people are physically inactive
• 20% of people smoke but this rises to over 50% in
some communities
• 5 million people have undiagnosed and untreated
hypertension
• 40% of people with diagnosed hypertension receive
suboptimal treatment
• Only one in five people whose 10 year CVD risk
exceeds 20% receive statins
The NHS Health Check is a systematic approach to identifying local
people at high risk of CVD, offering behaviour change support and early
detection of hypertension, CKD, diabetes and pre-diabetes. Modelling
suggests that 75% uptake will lead to substantial reductions in premature
mortality.
What proportion of our local eligible population is receiving the NHS
Health Check and how effective is their follow up risk factor
management in primary care?
What questions should we ask in our CCG?
1. For each indicator how wide is the variation in achievement and exception
reporting?
2. How many people would benefit if all practices performed as well as the best?
3. How can we support practices who are average or below average to perform
as well as the best in:
• Identifying people who are obese, inactive or smokers
• Identifying and managing high CVD risk
• Identifying and managing high blood pressure
• Identifying and managing pre-diabetes
4. What is the quality of brief interventions we offer our patients?
5. How available are preventive services such as weight management and
smoking cessation?
Source: Murray CJL, Richards MA, Newton JN, et al. UK health performance: findings of the Global Burden of Disease Study 2010.
Lancet 2013;381:99-1020. DOI: http://dx.doi.org/10.1016/S0140-6736(13)60355-4
11 CVD Intelligence packs
Hypertension observed prevalence compared to expected prevalence by CCG
Graph
0.58 ratio of observed to expected
hypertension prevalence in NHS
Eastbourne, Hailsham And Seaford
CCG compared to 0.56 in England
This suggests that 58% of people
with hypertension have been
diagnosed
Comparison with CCGs in the SCN
Note: This slide compares the prevalence
of hypertension recorded in QOF in
2013/14 to the expected prevalence of
hypertension taken from the East of
England Public Health Observatory
modelled estimates produced in 2011. The
model was developed using data from the
2003-2004 Health Surveys for England
and takes into account age, sex, ethnicity,
smoking status and deprivation. 0.56
0.44
0.52
0.52
0.53
0.54
0.54
0.55
0.55
0.55
0.56
0.56
0.56
0.57
0.57
0.57
0.58
0.58
0.58
0.59
0.61
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70
England
NHS Brighton and Hove CCG
NHS East Surrey CCG
NHS Guildford and Waverley CCG
NHS Canterbury and Coastal CCG
NHS Crawley CCG
NHS North West Surrey CCG
NHS Coastal West Sussex CCG
NHS High Weald Lewes Havens CCG
NHS Surrey Downs CCG
NHS South Kent Coast CCG
NHS West Kent CCG
NHS Surrey Heath CCG
NHS Horsham and Mid Sussex CCG
NHS Hastings and Rother CCG
NHS Thanet CCG
NHS Ashford CCG
NHS Swale CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Medway CCG
NHS Dartford, Gravesham and Swanley CCG
ratio of observed to expected
12 CVD Intelligence packs
Hypertension observed prevalence compared to expected prevalence by CCG
Graph
Comparison with demographically similar CCGs
0.54
0.55
0.56
0.57
0.57
0.58
0.58
0.58
0.59
0.60
0.61
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70
NHS North Norfolk CCG
NHS South Devon and Torbay CCG
NHS Isle of Wight CCG
NHS Lincolnshire East CCG
NHS Great Yarmouth and Waveney CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS North Derbyshire CCG
NHS Fylde & Wyre CCG
NHS West Norfolk CCG
NHS Wyre Forest CCG
NHS North Staffordshire CCG
ratio of observed to expected
13 CVD Intelligence packs
Hypertension observed prevalence compared to expected prevalence by GP practice
Graph
It is estimated that there are 24,001
people with undiagnosed
hypertension in NHS Eastbourne,
Hailsham And Seaford CCG
GP practice range of observed to
expected hypertension prevalence:
0.32 to 0.72
0 0.2 0.4 0.6 0.8 1
Eastbourne Station Health Centre Y02816
Green Street Clinic G81032
Dr Barnes J D & Partners G81017
Dr Verghese & Partners G81002
Park Practice G81104
Dr Adoki & Ptnr Y00080
Dr Miller & Partners G81056
Dr Brown G C & Partners G81027
Dr Eyre & Partners G81003
Dr Williams & Partners G81050
Sovereign Practice G81022
Dr Barnes M H & Partners G81029
Dr Brown R D & Partners G81049
Dr Bedford-Turner & Partners G81004
Dr Pearce & Partners G81059
Dr Baig & Partners G81008
Dr Simmons G81634
Dr Edwards & Partner G81098
Dr Oezburun G81685
Dr Palit & Partners G81099
Dr Savvas S & Partner G81012
ratio of observed to expected
GP practice CCG
14 CVD Intelligence packs
Percentage of patients with hypertension whose last blood pressure reading (measured in
the preceding 9 months) is 150/90 mmHg or less by CCG
Graph
33,167 people with hypertension
(diagnosed)* in NHS Eastbourne,
Hailsham And Seaford CCG
26,053 (78.6%) people whose blood
pressure is <= 150/90
2,421 (7.3%) people who are
excepted from optimal control
4,693 (14.1%) additional people
whose blood pressure is not <=
150/90
Comparison with CCGs in the SCN
*Using QOF clinical indicator HYP002
denominator plus exceptions
79.2%
76.4%
76.4%
77.1%
77.7%
77.8%
78.6%
78.6%
78.7%
78.8%
78.8%
79.1%
79.1%
79.4%
79.7%
79.7%
79.8%
80.1%
81.3%
81.4%
81.5%
0% 20% 40% 60% 80% 100%
England
NHS Brighton and Hove CCG
NHS Coastal West Sussex CCG
NHS Surrey Downs CCG
NHS High Weald Lewes Havens CCG
NHS Guildford and Waverley CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Medway CCG
NHS Ashford CCG
NHS East Surrey CCG
NHS Thanet CCG
NHS Horsham and Mid Sussex CCG
NHS North West Surrey CCG
NHS Crawley CCG
NHS Dartford, Gravesham and Swanley CCG
NHS West Kent CCG
NHS Surrey Heath CCG
NHS South Kent Coast CCG
NHS Swale CCG
NHS Canterbury and Coastal CCG
NHS Hastings and Rother CCG
Below 150/90 Not below 150/90 Exceptions reported
15 CVD Intelligence packs
Percentage of patients with hypertension whose last blood pressure reading (measured in
the preceding 9 months) is 150/90 mmHg or less by CCG
Graph
Comparison with demographically similar CCGs
74.3%
77.0%
77.0%
77.7%
78.3%
78.3%
78.6%
78.8%
79.1%
79.9%
82.6%
0% 20% 40% 60% 80% 100%
NHS South Devon and Torbay CCG
NHS North Staffordshire CCG
NHS Great Yarmouth and Waveney CCG
NHS Lincolnshire East CCG
NHS West Norfolk CCG
NHS Wyre Forest CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS North Norfolk CCG
NHS North Derbyshire CCG
NHS Fylde & Wyre CCG
NHS Isle of Wight CCG
Below 150/90 Not below 150/90 Exceptions reported
16 CVD Intelligence packs
Percentage of patients with hypertension whose last blood pressure reading (measured in the
preceding 9 months) is not 150/90 mmHg or less by GP practice
Graph
In total, including exceptions, there
are 7,114 people whose blood
pressure is not <= 150/90
GP practice range: 13.1% to 36.7 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 1,856 people would have
their hypertension controlled
0% 5% 10% 15% 20% 25% 30% 35% 40%
Dr Edwards & Partner G81098
Dr Bedford-Turner & Partners G81004
Dr Verghese & Partners G81002
Green Street Clinic G81032
Dr Barnes J D & Partners G81017
Dr Oezburun G81685
Dr Baig & Partners G81008
Dr Williams & Partners G81050
Dr Palit & Partners G81099
Dr Pearce & Partners G81059
Dr Simmons G81634
Dr Savvas S & Partner G81012
Park Practice G81104
Dr Eyre & Partners G81003
Eastbourne Station Health Centre Y02816
Dr Brown G C & Partners G81027
Dr Brown R D & Partners G81049
Dr Miller & Partners G81056
Sovereign Practice G81022
Dr Adoki & Ptnr Y00080
Dr Barnes M H & Partners G81029
Not below 150/90 Exceptions reported
17 CVD Intelligence packs
New diagnosis of hypertension who have been given a CVD risk assessment whose
CVD risk exceeds 20% and treated with statins by CCG
Graph
152 people with a new diagnosis of
hypertension with a CVD risk of 20%
or higher in NHS Eastbourne,
Hailsham And Seaford CCG
104 (68.4%) people who are
currently treated with statins
43 (28.3%) people who are
excepted from treatment with statins
5 (3.3%) additional people who are
not currently treated with statins
Comparison with CCGs in the SCN
64.0%
43.0%
44.6%
49.0%
51.4%
57.6%
57.7%
58.2%
59.6%
61.1%
61.6%
61.9%
62.4%
64.3%
64.6%
65.3%
67.3%
68.4%
70.6%
71.0%
72.8%
0% 20% 40% 60% 80% 100%
England
NHS Hastings and Rother CCG
NHS High Weald Lewes Havens CCG
NHS East Surrey CCG
NHS Canterbury and Coastal CCG
NHS Guildford and Waverley CCG
NHS Ashford CCG
NHS Coastal West Sussex CCG
NHS North West Surrey CCG
NHS South Kent Coast CCG
NHS Thanet CCG
NHS Brighton and Hove CCG
NHS Medway CCG
NHS West Kent CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Horsham and Mid Sussex CCG
NHS Surrey Downs CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Surrey Heath CCG
NHS Crawley CCG
NHS Swale CCG
Treated No treatment Exceptions reported
18 CVD Intelligence packs
New diagnosis of hypertension who have been given a CVD risk assessment whose
CVD risk exceeds 20% and treated with statins by CCG
Graph
Comparison with demographically similar CCGs
53.4%
54.1%
58.7%
58.8%
60.9%
63.4%
63.5%
64.1%
64.5%
68.4%
68.5%
0% 20% 40% 60% 80% 100%
NHS North Staffordshire CCG
NHS Great Yarmouth and Waveney CCG
NHS Wyre Forest CCG
NHS North Norfolk CCG
NHS Fylde & Wyre CCG
NHS West Norfolk CCG
NHS North Derbyshire CCG
NHS South Devon and Torbay CCG
NHS Lincolnshire East CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Isle of Wight CCG
Treated No treatment Exceptions reported
19 CVD Intelligence packs
New diagnosis of hypertension who have been given a CVD risk assessment whose
CVD risk exceeds 20% and not treated with statins by GP practice
Graph
In total, including exceptions, there
are 48 people who are not currently
treated with statins
GP practice range: 0.0% to 100.0 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 30 people would be
treated
0% 20% 40% 60% 80% 100% 120%
Dr Adoki & Ptnr Y00080
Dr Edwards & Partner G81098
Dr Brown R D & Partners G81049
Dr Baig & Partners G81008
Park Practice G81104
Dr Pearce & Partners G81059
Dr Eyre & Partners G81003
Dr Palit & Partners G81099
Dr Bedford-Turner & Partners G81004
Dr Simmons G81634
Green Street Clinic G81032
Dr Barnes J D & Partners G81017
Sovereign Practice G81022
Dr Oezburun G81685
Dr Miller & Partners G81056
Dr Williams & Partners G81050
Dr Brown G C & Partners G81027
Dr Verghese & Partners G81002
Dr Savvas S & Partner G81012
Dr Barnes M H & Partners G81029
Eastbourne Station Health Centre Y02816
No treatment Exceptions reported
20 CVD Intelligence packs
Percentage of patients with a long term condition whose notes record smoking status
in the preceding 12 months by CCG
Graph
52,004 people with a long term
condition in NHS Eastbourne,
Hailsham And Seaford CCG
48,274 (92.8%) people whose notes
record a smoking status
419 (0.8%) people who are
excepted from smoking status
recording
3,311 (6.4%) additional people
whose notes do not record a
smoking status
Comparison with CCGs in the SCN
94.6%
92.8%
93.0%
93.3%
93.4%
93.4%
93.4%
93.7%
93.8%
93.8%
94.0%
94.2%
94.2%
94.3%
94.4%
94.4%
94.7%
94.9%
95.1%
95.2%
95.3%
0% 20% 40% 60% 80% 100%
England
NHS Eastbourne, Hailsham and Seaford CCG
NHS Brighton and Hove CCG
NHS Ashford CCG
NHS Medway CCG
NHS West Kent CCG
NHS High Weald Lewes Havens CCG
NHS Coastal West Sussex CCG
NHS Thanet CCG
NHS Guildford and Waverley CCG
NHS South Kent Coast CCG
NHS North West Surrey CCG
NHS Horsham and Mid Sussex CCG
NHS Surrey Downs CCG
NHS Surrey Heath CCG
NHS Dartford, Gravesham and Swanley CCG
NHS East Surrey CCG
NHS Hastings and Rother CCG
NHS Crawley CCG
NHS Swale CCG
NHS Canterbury and Coastal CCG
Recorded No record Exceptions reported
21 CVD Intelligence packs
Percentage of patients with a long term condition whose notes record smoking status
in the preceding 12 months by CCG
Graph
Comparison with demographically similar CCGs
91.8%
92.8%
93.1%
93.5%
94.0%
94.0%
94.0%
94.4%
95.1%
95.6%
95.8%
0% 20% 40% 60% 80% 100%
NHS South Devon and Torbay CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS North Staffordshire CCG
NHS West Norfolk CCG
NHS Lincolnshire East CCG
NHS Great Yarmouth and Waveney CCG
NHS Wyre Forest CCG
NHS North Norfolk CCG
NHS Isle of Wight CCG
NHS North Derbyshire CCG
NHS Fylde & Wyre CCG
Recorded No record Exceptions reported
22 CVD Intelligence packs
Percentage of patients with a long term condition whose notes do not record smoking
status in the preceding 12 months by GP practice
Graph
In total, including exceptions, there
are 3,730 people whose notes do not
record a smoking status
GP practice range: 2.8% to 18.2 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 1,524 people would have
their smoking status recorded
0% 5% 10% 15% 20%
Dr Edwards & Partner G81098
Dr Savvas S & Partner G81012
Dr Simmons G81634
Dr Verghese & Partners G81002
Dr Bedford-Turner & Partners G81004
Eastbourne Station Health Centre Y02816
Dr Barnes J D & Partners G81017
Dr Palit & Partners G81099
Dr Oezburun G81685
Green Street Clinic G81032
Dr Pearce & Partners G81059
Dr Baig & Partners G81008
Dr Brown G C & Partners G81027
Dr Miller & Partners G81056
Sovereign Practice G81022
Dr Eyre & Partners G81003
Park Practice G81104
Dr Williams & Partners G81050
Dr Brown R D & Partners G81049
Dr Barnes M H & Partners G81029
Dr Adoki & Ptnr Y00080
No record Exceptions reported
23 CVD Intelligence packs
Percentage of patients with a long term condition who are recorded as current smokers who
have a record of an offer of support and treatment within the preceding 12 months by CCG
Graph
6,869 people with a long term
condition who are recorded as a
smoker in NHS Eastbourne,
Hailsham And Seaford CCG
6,519 (94.9%) people who have a
record of an offer of support and
treatment
70 (1%) people who are excepted
from an offer of support and
treatment
280 (4.1%) additional people who
have no record of an offer of support
and treatment
Comparison with CCGs in the SCN
93.1%
60.2%
92.1%
92.4%
92.5%
93.2%
93.3%
93.6%
93.6%
93.8%
94.0%
94.0%
94.3%
94.4%
94.5%
94.6%
94.8%
94.9%
95.1%
95.1%
96.0%
0% 20% 40% 60% 80% 100%
England
NHS High Weald Lewes Havens CCG
NHS Ashford CCG
NHS Brighton and Hove CCG
NHS Crawley CCG
NHS Thanet CCG
NHS Horsham and Mid Sussex CCG
NHS Hastings and Rother CCG
NHS East Surrey CCG
NHS Medway CCG
NHS Coastal West Sussex CCG
NHS Guildford and Waverley CCG
NHS South Kent Coast CCG
NHS West Kent CCG
NHS Canterbury and Coastal CCG
NHS Dartford, Gravesham and Swanley CCG
NHS North West Surrey CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Swale CCG
NHS Surrey Heath CCG
NHS Surrey Downs CCG
Recorded No record Exceptions reported
24 CVD Intelligence packs
Percentage of patients with a long term condition who are recorded as current smokers who
have a record of an offer of support and treatment within the preceding 12 months by CCG
Graph
Comparison with demographically similar CCGs
84.3%
86.5%
88.1%
88.4%
89.8%
91.1%
94.3%
94.4%
94.9%
95.7%
96.5%
0% 20% 40% 60% 80% 100%
NHS North Staffordshire CCG
NHS South Devon and Torbay CCG
NHS Lincolnshire East CCG
NHS Great Yarmouth and Waveney CCG
NHS North Norfolk CCG
NHS West Norfolk CCG
NHS North Derbyshire CCG
NHS Fylde & Wyre CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Wyre Forest CCG
NHS Isle of Wight CCG
Recorded No record Exceptions reported
25 CVD Intelligence packs
Percentage of patients with a long term condition who are recorded as current smokers who do
not have a record of an offer of support and treatment within the preceding 12 months by GP
practice
Graph
In total, including exceptions, there
are 350 people who have no record
of an offer of support and treatment
GP practice range: 0.4% to 34.8 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 234 people would have a
record of an offer of support and
treatment
0% 5% 10% 15% 20% 25% 30% 35% 40%
Dr Brown G C & Partners G81027
Dr Pearce & Partners G81059
Dr Edwards & Partner G81098
Park Practice G81104
Dr Baig & Partners G81008
Dr Eyre & Partners G81003
Dr Williams & Partners G81050
Dr Bedford-Turner & Partners G81004
Dr Barnes J D & Partners G81017
Dr Verghese & Partners G81002
Dr Palit & Partners G81099
Green Street Clinic G81032
Dr Simmons G81634
Dr Barnes M H & Partners G81029
Dr Savvas S & Partner G81012
Eastbourne Station Health Centre Y02816
Dr Miller & Partners G81056
Dr Oezburun G81685
Sovereign Practice G81022
Dr Brown R D & Partners G81049
Dr Adoki & Ptnr Y00080
No record Exceptions reported
26 CVD Intelligence packs
Estimated smoking prevalence (QOF) by CCG
Graph
Prevalence of 17.4% in NHS
Eastbourne, Hailsham And Seaford
CCG
Comparison with demographically similar CCGs
Note: It has been found that the proportion
of patients recorded as smokers correlates
well with IHS smoking prevalence and is a
good estimate of the actual smoking
prevalence in local areas,
http://bmjopen.bmj.com/content/4/7/e00521
7.abstract
Definition: denominator of QOF clinical
indicator SMOKE004 ( number of patients
15+ who are recorded as current smokers)
divided by QOF clinical indicator
denominator of SMOK001 (estimated
number of patients 15+).
16.7
17.4
17.5
18.3
18.9
19.2
19.5
19.6
19.9
21.7
22.2
0.00 5.00 10.00 15.00 20.00 25.00
NHS North Norfolk CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS North Derbyshire CCG
NHS North Staffordshire CCG
NHS Fylde & Wyre CCG
NHS South Devon and Torbay CCG
NHS Isle of Wight CCG
NHS Wyre Forest CCG
NHS West Norfolk CCG
NHS Lincolnshire East CCG
NHS Great Yarmouth and Waveney CCG
prevalence %
27 CVD Intelligence packs
Estimated smoking prevalence (QOF) by GP practice
Graph
27,743 people who are recorded as
smokers in NHS Eastbourne,
Hailsham And Seaford CCG
GP practice range: 11.9% to 34.8%
Note: This method is thought to be a
reasonably robust method in estimating
smoking prevalence for the majority of GP
practices. However, caution is advised for
extreme estimates of smoking prevalence
and those with high numbers of smoking
status not recorded and exceptions. 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0
Dr Simmons G81634
Dr Edwards & Partner G81098
Dr Bedford-Turner & Partners G81004
Dr Williams & Partners G81050
Dr Palit & Partners G81099
Dr Miller & Partners G81056
Green Street Clinic G81032
Dr Barnes M H & Partners G81029
Dr Adoki & Ptnr Y00080
Dr Baig & Partners G81008
Dr Verghese & Partners G81002
Dr Pearce & Partners G81059
Dr Eyre & Partners G81003
Dr Oezburun G81685
Dr Brown R D & Partners G81049
Dr Savvas S & Partner G81012
Sovereign Practice G81022
Park Practice G81104
Dr Barnes J D & Partners G81017
Dr Brown G C & Partners G81027
Eastbourne Station Health Centre Y02816
prevalence %
GP practice CCG
28 CVD Intelligence packs
Successful smoking quitters at 4 weeks, 2013/14
45.2% successful smoking quitters at
4 weeks in NHS Eastbourne,
Hailsham And Seaford CCG
compared to 51.3% in England
Graph
Comparison with CCGs in the SCN
Note: The local authority indicator,
successful smoking quitters at 4 weeks from
the Health and Social Care Information
Centre, has been used as a basis for
estimating CCG level smoking quitters.
Where more than one local authority is
contained within a CCG, the proportion of
the local authority within the CCG has been
allocated to the CCG and aggregated up to
give CCG estimates.
51.3
45.2
45.2
45.2
46.9
48.8
48.8
48.8
52.1
52.1
52.1
52.1
52.1
52.1
52.1
61.0
61.5
62.4
62.4
62.4
62.4
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
England
NHS High Weald Lewes Havens CCG
NHS Hastings and Rother CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Medway CCG
NHS Horsham and Mid Sussex CCG
NHS Crawley CCG
NHS Coastal West Sussex CCG
NHS West Kent CCG
NHS Thanet CCG
NHS Swale CCG
NHS South Kent Coast CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Canterbury and Coastal CCG
NHS Ashford CCG
NHS Brighton and Hove CCG
NHS Guildford and Waverley CCG
NHS Surrey Heath CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS East Surrey CCG
percentage
29 CVD Intelligence packs
Excess weight (overweight or obese) in adults, 2012
65.0% of adults with excess weight
in NHS Eastbourne, Hailsham And
Seaford CCG compared to 63.8% in
England
Graph
Comparison with CCGs in the SCN
Note: Local authority prevalence estimates
of excess weight from the Active People
Survey, Sport England, have been used as
a basis for estimating CCG level prevalence
estimates of excess weight. Where more
than one local authority is contained within
a CCG, the proportion of the local authority
within the CCG has been allocated to the
CCG and aggregated up to give CCG
estimates.
63.8
49.2
60.8
60.8
60.8
60.8
60.9
64.4
64.4
64.4
64.6
64.6
64.6
64.6
64.6
64.6
64.6
65.0
65.0
65.0
66.1
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
England
NHS Brighton and Hove CCG
NHS Surrey Heath CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS East Surrey CCG
NHS Guildford and Waverley CCG
NHS Horsham and Mid Sussex CCG
NHS Crawley CCG
NHS Coastal West Sussex CCG
NHS West Kent CCG
NHS Thanet CCG
NHS Swale CCG
NHS South Kent Coast CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Canterbury and Coastal CCG
NHS Ashford CCG
NHS High Weald Lewes Havens CCG
NHS Hastings and Rother CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Medway CCG
percentage
30 CVD Intelligence packs
Percentage of inactive adults, 2013
28.0% of adults who are inactive in
NHS Eastbourne, Hailsham And
Seaford CCG compared to 28.3% in
England
Graph
Comparison with CCGs in the SCN
Note: Local authority percentage estimates
of inactive adults from the Active People
Survey, Sport England, have been used as
a basis for estimating CCG level percentage
estimates of inactive adults. Where more
than one local authority is contained within
a CCG, the proportion of the local authority
within the CCG has been allocated to the
CCG and aggregated up to give CCG
estimates.
28.3
21.6
23.6
23.6
23.6
23.6
23.7
26.3
26.3
26.3
26.8
26.8
26.8
26.8
26.8
26.8
26.8
28.0
28.0
28.0
33.8
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0
England
NHS Brighton and Hove CCG
NHS Surrey Heath CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS East Surrey CCG
NHS Guildford and Waverley CCG
NHS Horsham and Mid Sussex CCG
NHS Crawley CCG
NHS Coastal West Sussex CCG
NHS West Kent CCG
NHS Thanet CCG
NHS Swale CCG
NHS South Kent Coast CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Canterbury and Coastal CCG
NHS Ashford CCG
NHS High Weald Lewes Havens CCG
NHS Hastings and Rother CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Medway CCG
percentage
31 CVD Intelligence packs
NHS Health Check offer and uptake, 2013/14
Graph 17.3% of people were
offered an NHS Health
Check in NHS Eastbourne,
Hailsham And Seaford
CCG compared to 18.4%
in England
Graph2
57.2% of people received
an NHS Health Check of
those offered in NHS
Eastbourne, Hailsham And
Seaford CCG compared to
49% in England
Comparison with CCGs in the SCN % of people offered an NHS Health check % of people received an NHS Health check
of those offered
Note: Local authority indicators
NHS Health Check offer and
uptake have been used as a
basis for estimating CCG level
NHS Health Check offer and
uptake. Where more than one
local authority is contained within
a CCG, the proportion of the
local authority within the CCG
has been allocated to the CCG
and aggregated up to give CCG
estimates.
18.4
2.0
2.0
2.0
2.0
2.4
9.3
13.4
13.4
13.4
17.3
17.3
17.3
21.4
21.4
21.4
21.4
21.4
21.4
21.4
22.6
0 5 10 15 20 25
England
NHS Surrey Heath CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS East Surrey CCG
NHS Guildford and Waverley CCG
NHS Brighton and Hove CCG
NHS Horsham and Mid Sussex CCG
NHS Crawley CCG
NHS Coastal West Sussex CCG
NHS High Weald Lewes Havens CCG
NHS Hastings and Rother CCG
NHS Eastbourne, Hailsham andSeaford CCG
NHS West Kent CCG
NHS Thanet CCG
NHS Swale CCG
NHS South Kent Coast CCG
NHS Dartford, Gravesham andSwanley CCG
NHS Canterbury and Coastal CCG
NHS Ashford CCG
NHS Medway CCG
percentage
49.0
34.7
34.7
34.7
34.7
34.7
34.7
34.7
42.2
42.2
42.2
42.2
42.7
44.6
44.6
44.6
50.3
57.2
57.2
57.2
60.3
0 10 20 30 40 50 60 70
England
NHS West Kent CCG
NHS Thanet CCG
NHS Swale CCG
NHS South Kent Coast CCG
NHS Dartford, Gravesham andSwanley CCG
NHS Canterbury and Coastal CCG
NHS Ashford CCG
NHS Surrey Heath CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS East Surrey CCG
NHS Guildford and Waverley CCG
NHS Horsham and Mid Sussex CCG
NHS Crawley CCG
NHS Coastal West Sussex CCG
NHS Medway CCG
NHS High Weald Lewes Havens CCG
NHS Hastings and Rother CCG
NHS Eastbourne, Hailsham andSeaford CCG
NHS Brighton and Hove CCG
percentage
Stroke
32 CVD Intelligence packs
It is estimated that if Atrial Fibrillation
was adequately treated, around 7000
strokes would be prevented and 2100
lives saved every year.
Stroke is one of the leading causes of
premature death and disability. Stroke
is devastating for individuals and families
and accounts for a substantial proportion
of health and social care expenditure.
Secondary prevention of stroke
For people who have had a stroke anti-
platelet treatment and good control of blood
pressure are key to reducing the risk of a
further stroke
What might help
• Roll out of GRASP-AF to identify people with AF who are undertreated
• Promoting use of electronic templates with decision support tools –
CHADS-VASC and HASBLED
• Roll out of Warfarin Patient Safety Audit Tool to ensure optimal time in
therapeutic range for people on warfarin
• Dissemination of latest evidence on risk-benefit balance for
anticoagulants including the newer treatments (NOACs)
• Ensure appropriate clinical follow up for individuals found to have an
irregular pulse during the NHS Health Check
What questions should we ask in our CCG?
1. For each indicator how wide is the variation in achievement and
exception reporting?
2. How many people would benefit if all practices performed as well
as the best?
3. How can we support practices who are average and below
average to perform as well as the best in:
• Detection of atrial fibrillation
• Management of hypertension in people who have had a
previous stroke or TIA
• Anti-platelet or anti-coagulant treatment in people who
have had a previous stroke or TIA
Atrial fibrillation increases the risk of stroke
by about 6 fold, and strokes caused by AF are
often more severe with higher mortality and
greater disability. Anticoagulation substantially
reduces the risk of stroke in people with AF.
Despite this, AF is underdiagnosed and under
treated. Around 25-30% of people with AF are
unaware they have the condition and less
than a half of patients are adequately treated
– many do not receive anticoagulants and of
those who do, many are undertreated.
Only 30% of people with known AF
admitted with stroke are on anticoagulant
treatment at the time of their stroke.
Stroke Prevention
34 CVD Intelligence packs
Atrial fibrillation observed prevalence compared to expected prevalence by CCG
Graph
Comparison with CCGs in the SCN
Note: This slide compares the prevalence of
atrial fibrillation recorded in QOF in 2013/14
to the estimated prevalence of atrial
fibrillation, taken from National
Cardiovascular Intelligence Network
estimates produced in 2015. The estimates
were developed by applying age-sex
specific prevalence rates as reported by
Norberg et al (2013) to GP population
estimates from the Health and Social Care
Information Centre. Estimates reported are
adjusted for age and sex of the local
population.
0.78 ratio of observed to expected
atrial fibrillation prevalence in NHS
Eastbourne, Hailsham And Seaford
CCG compared to 0.65 in England
This suggests that 78% of people
with atrial fibrillation have been
diagnosed
0.65
0.58
0.62
0.62
0.62
0.63
0.64
0.65
0.66
0.66
0.67
0.67
0.67
0.68
0.70
0.71
0.72
0.72
0.72
0.78
0.88
0.00 0.20 0.40 0.60 0.80 1.00
England
NHS Surrey Heath CCG
NHS Medway CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS Swale CCG
NHS Brighton and Hove CCG
NHS Horsham and Mid Sussex CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Crawley CCG
NHS Guildford and Waverley CCG
NHS High Weald Lewes Havens CCG
NHS Coastal West Sussex CCG
NHS Thanet CCG
NHS Hastings and Rother CCG
NHS East Surrey CCG
NHS South Kent Coast CCG
NHS West Kent CCG
NHS Canterbury and Coastal CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Ashford CCG
ratio of observed to expected
35 CVD Intelligence packs
Atrial fibrillation observed prevalence compared to expected prevalence by CCG
Graph
Comparison with demographically similar CCGs
0.60
0.63
0.68
0.68
0.69
0.69
0.71
0.71
0.73
0.74
0.78
0.00 0.20 0.40 0.60 0.80 1.00
NHS Isle of Wight CCG
NHS Great Yarmouth and Waveney CCG
NHS Fylde & Wyre CCG
NHS Wyre Forest CCG
NHS Lincolnshire East CCG
NHS North Norfolk CCG
NHS North Staffordshire CCG
NHS North Derbyshire CCG
NHS West Norfolk CCG
NHS South Devon and Torbay CCG
NHS Eastbourne, Hailsham and Seaford CCG
ratio of observed to expected
36 CVD Intelligence packs
Atrial fibrillation observed prevalence compared to expected prevalence by GP practice
Graph
It is estimated that there are 1,504
people with undiagnosed atrial
fibrillation in NHS Eastbourne,
Hailsham And Seaford CCG
GP practice range of observed to
expected atrial fibrillation prevalence:
0.31 to 1.07
0 0.2 0.4 0.6 0.8 1
Eastbourne Station Health Centre Y02816
Dr Oezburun G81685
Dr Adoki & Ptnr Y00080
Sovereign Practice G81022
Dr Brown R D & Partners G81049
Dr Verghese & Partners G81002
Dr Barnes J D & Partners G81017
Dr Bedford-Turner & Partners G81004
Dr Miller & Partners G81056
Dr Brown G C & Partners G81027
Dr Barnes M H & Partners G81029
Dr Pearce & Partners G81059
Green Street Clinic G81032
Park Practice G81104
Dr Baig & Partners G81008
Dr Edwards & Partner G81098
Dr Palit & Partners G81099
Dr Williams & Partners G81050
Dr Savvas S & Partner G81012
Dr Eyre & Partners G81003
Dr Simmons G81634
ratio of observed to expected
GP practice CCG
37 CVD Intelligence packs
In patients with AF with a CHADS2 > 1, the percentage treated with anti-coagulation therapy by
CCG
Graph
3,154 people with atrial fibrillation
with a CHADS2 score > 1 in NHS
Eastbourne, Hailsham And Seaford
CCG
2,258 (71.6%) people treated with
anti-coagulation therapy
434 (13.8%) people who are
exceptions
462 (14.6%) additional people with a
recorded CHADS2 score > 1 who
are not treated
Comparison with CCGs in the SCN
69.1%
58.3%
64.9%
66.0%
69.3%
69.4%
69.6%
69.9%
70.6%
70.8%
70.9%
71.4%
71.6%
71.7%
72.1%
72.6%
73.0%
73.5%
74.4%
76.0%
76.8%
0% 20% 40% 60% 80% 100%
England
NHS Brighton and Hove CCG
NHS Horsham and Mid Sussex CCG
NHS Coastal West Sussex CCG
NHS High Weald Lewes Havens CCG
NHS North West Surrey CCG
NHS Thanet CCG
NHS Crawley CCG
NHS Canterbury and Coastal CCG
NHS South Kent Coast CCG
NHS West Kent CCG
NHS East Surrey CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Hastings and Rother CCG
NHS Swale CCG
NHS Ashford CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Surrey Downs CCG
NHS Guildford and Waverley CCG
NHS Medway CCG
NHS Surrey Heath CCG
Optimal management No treatment Exceptions reported
38 CVD Intelligence packs
In patients with AF with a CHADS2 > 1, the percentage treated with anti-coagulation therapy by
CCG
Graph
Comparison with demographically similar CCGs
64.9%
65.7%
66.1%
66.2%
67.5%
67.7%
68.2%
69.8%
71.1%
71.6%
73.6%
0% 20% 40% 60% 80% 100%
NHS Isle of Wight CCG
NHS Great Yarmouth and Waveney CCG
NHS Fylde & Wyre CCG
NHS Wyre Forest CCG
NHS North Staffordshire CCG
NHS West Norfolk CCG
NHS North Derbyshire CCG
NHS North Norfolk CCG
NHS Lincolnshire East CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS South Devon and Torbay CCG
Optimal management No treatment Exceptions reported
39 CVD Intelligence packs
In patients with AF with a CHADS2 > 1, the percentage not treated with anti-
coagulation therapy by GP practice
Graph
In total, including exceptions, there
are 896 people with a recorded
CHADS2 score > 1 who are not
treated
GP practice range: 12.5% to 43.3 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 200 people would be
treated
0% 10% 20% 30% 40% 50%
Dr Oezburun G81685
Dr Adoki & Ptnr Y00080
Green Street Clinic G81032
Dr Pearce & Partners G81059
Sovereign Practice G81022
Dr Barnes J D & Partners G81017
Dr Baig & Partners G81008
Dr Bedford-Turner & Partners G81004
Dr Edwards & Partner G81098
Park Practice G81104
Dr Eyre & Partners G81003
Dr Brown R D & Partners G81049
Dr Palit & Partners G81099
Dr Simmons G81634
Dr Williams & Partners G81050
Dr Savvas S & Partner G81012
Dr Verghese & Partners G81002
Eastbourne Station Health Centre Y02816
Dr Barnes M H & Partners G81029
Dr Brown G C & Partners G81027
Dr Miller & Partners G81056
No treatment Exceptions reported
40 CVD Intelligence packs
Percentage of patients with a history of stroke whose last blood pressure reading
(measured in the preceding 12 months) is 150/90 mmHg or less by CCG
Graph
4,841 patients with a history of
stroke or TIA* in NHS Eastbourne,
Hailsham And Seaford CCG
4,112 (84.9%) people whose blood
pressure is <= 150 / 90
293 (6.1%) people who are
exceptions
436 (9%) additional people whose
blood pressure is not <= 150 / 90
Comparison with CCGs in the SCN
*Using the QOF clinical indicator
STIA003 denominator plus exceptions
85.5%
82.7%
83.7%
84.3%
84.5%
84.5%
84.6%
84.7%
84.8%
84.9%
84.9%
85.0%
85.1%
85.2%
85.3%
85.8%
85.8%
86.1%
86.4%
87.9%
87.9%
0% 20% 40% 60% 80% 100%
England
NHS Coastal West Sussex CCG
NHS Brighton and Hove CCG
NHS Surrey Downs CCG
NHS Guildford and Waverley CCG
NHS Medway CCG
NHS South Kent Coast CCG
NHS Crawley CCG
NHS Horsham and Mid Sussex CCG
NHS Thanet CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS West Kent CCG
NHS High Weald Lewes Havens CCG
NHS Dartford, Gravesham and Swanley CCG
NHS East Surrey CCG
NHS Ashford CCG
NHS North West Surrey CCG
NHS Canterbury and Coastal CCG
NHS Surrey Heath CCG
NHS Swale CCG
NHS Hastings and Rother CCG
Below 150/90 Not below 150/90 Exceptions reported
41 CVD Intelligence packs
Percentage of patients with a history of stroke whose last blood pressure reading
(measured in the preceding 12 months) is 150/90 mmHg or less by CCG
Graph
Comparison with demographically similar CCGs
81.5%
83.6%
84.0%
84.0%
84.0%
84.4%
84.8%
84.9%
84.9%
85.3%
86.3%
0% 20% 40% 60% 80% 100%
NHS South Devon and Torbay CCG
NHS West Norfolk CCG
NHS Isle of Wight CCG
NHS North Norfolk CCG
NHS North Staffordshire CCG
NHS Lincolnshire East CCG
NHS Wyre Forest CCG
NHS Great Yarmouth and Waveney CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS North Derbyshire CCG
NHS Fylde & Wyre CCG
Below 150/90 Not below 150/90 Exceptions reported
42 CVD Intelligence packs
Percentage of patients with a history of stroke whose last blood pressure reading (measured
in the preceding 12 months) is not 150/90 mmHg or less by GP practice
Graph
In total, including exceptions, there
are 729 people whose blood
pressure is not <= 150 / 90
GP practice range: 5.7% to 29.2 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 240 people would have
their blood pressure controlled
0% 5% 10% 15% 20% 25% 30% 35%
Dr Bedford-Turner & Partners G81004
Dr Savvas S & Partner G81012
Dr Barnes J D & Partners G81017
Dr Palit & Partners G81099
Dr Verghese & Partners G81002
Dr Baig & Partners G81008
Dr Williams & Partners G81050
Eastbourne Station Health Centre Y02816
Dr Oezburun G81685
Dr Simmons G81634
Green Street Clinic G81032
Dr Edwards & Partner G81098
Dr Pearce & Partners G81059
Dr Brown G C & Partners G81027
Dr Eyre & Partners G81003
Dr Miller & Partners G81056
Sovereign Practice G81022
Park Practice G81104
Dr Adoki & Ptnr Y00080
Dr Brown R D & Partners G81049
Dr Barnes M H & Partners G81029
Not below 150/90 Exceptions reported
43 CVD Intelligence packs
Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who
have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is
being taken by CCG
Graph
3,447 people with a stroke shown to
be non-haemorrhagic, in NHS
Eastbourne, Hailsham And Seaford
CCG
3,190 (92.5%) anti-platelet agent, or
an anti-coagulant is being taken
177 (5.1%) people who are
exceptions
80 (2.3%) additional people with no
treatment
Comparison with CCGs in the SCN
91.3%
84.8%
88.6%
89.2%
89.4%
89.7%
90.2%
90.4%
90.4%
90.7%
90.8%
91.1%
91.2%
91.4%
91.4%
91.7%
92.5%
92.6%
92.6%
92.7%
93.4%
0% 20% 40% 60% 80% 100%
England
NHS High Weald Lewes Havens CCG
NHS Surrey Downs CCG
NHS East Surrey CCG
NHS Guildford and Waverley CCG
NHS Medway CCG
NHS Ashford CCG
NHS Brighton and Hove CCG
NHS Coastal West Sussex CCG
NHS Swale CCG
NHS North West Surrey CCG
NHS Horsham and Mid Sussex CCG
NHS Canterbury and Coastal CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Surrey Heath CCG
NHS West Kent CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Hastings and Rother CCG
NHS South Kent Coast CCG
NHS Thanet CCG
NHS Crawley CCG
Optimal management No treatment Exceptions reported
44 CVD Intelligence packs
Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who
have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is
being taken by CCG
Graph
Comparison with demographically similar CCGs
89.5%
89.9%
90.2%
90.4%
90.9%
91.1%
91.6%
92.1%
92.3%
92.3%
92.5%
0% 20% 40% 60% 80% 100%
NHS Great Yarmouth and Waveney CCG
NHS North Norfolk CCG
NHS Fylde & Wyre CCG
NHS Isle of Wight CCG
NHS Wyre Forest CCG
NHS South Devon and Torbay CCG
NHS Lincolnshire East CCG
NHS West Norfolk CCG
NHS North Staffordshire CCG
NHS North Derbyshire CCG
NHS Eastbourne, Hailsham and Seaford CCG
Optimal management No treatment Exceptions reported
45 CVD Intelligence packs
Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who do
not have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is
being taken by GP practice
Graph
In total, including exceptions, there
are 257 people with no treatment
GP practice range: 0.0% to 15.0 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 135 people would be
treated
0% 2% 4% 6% 8% 10% 12% 14% 16%
Eastbourne Station Health Centre Y02816
Dr Oezburun G81685
Dr Edwards & Partner G81098
Sovereign Practice G81022
Dr Brown R D & Partners G81049
Dr Verghese & Partners G81002
Dr Savvas S & Partner G81012
Dr Bedford-Turner & Partners G81004
Dr Simmons G81634
Dr Palit & Partners G81099
Park Practice G81104
Dr Eyre & Partners G81003
Dr Barnes M H & Partners G81029
Dr Barnes J D & Partners G81017
Dr Baig & Partners G81008
Green Street Clinic G81032
Dr Pearce & Partners G81059
Dr Williams & Partners G81050
Dr Brown G C & Partners G81027
Dr Adoki & Ptnr Y00080
Dr Miller & Partners G81056
No treatment Exceptions reported
Diabetes
46 CVD Intelligence packs
Diabetes is very expensive using up
10% of the NHS budget at around
£10bn per year. It is also often
preventable.
Diabetes is an urgent public health issue.
Since 1996 the number of people living with
diabetes in England has more than doubled and
has now reached 3.2 million. Of these, 500,000
remain undiagnosed.
What might help
• Practice level performance on delivery of the 8 care processes is
measured in the National Diabetes Audit (NDA)
• Promote participation by all practices in the NDA
• Obtain and benchmark practice level data from the NDA (this
important local data is currently only available on request to
CCGs
• Ensure support for patient education, shared management and
technology enabled support
• Promote uptake of the NHS Health Check to aid detection of
diabetes and pre-diabetes
• Establish local prevention pathways for the delivery of evidence
based interventions to people with ‘pre-diabetes’
What questions should we ask in our CCG?
1. For each indicator how wide is the variation in achievement and
exception reporting?
2. How many people would benefit if all practices performed as well
as the best?
3. How can we support practices who are average and below
average to perform as well as the best in:
• Detection of diabetes
• Delivery of the 8 care processes
• Identification and management of ‘pre-diabetes
Type 2 diabetes is often preventable
People at high risk of developing type 2
diabetes can be identified through the NHS
Health Check and the disease could be
prevented in 30-60% through appropriate
behaviour change support.
Complications of diabetes are preventable
Diabetes is a major cause of premature death
and disability and greatly increases the risk of
heart disease and stroke, kidney failure,
amputations and blindness. 80% of NHS
spending on diabetes goes on managing these
complications, most of which could be
prevented.
There are 8 essential care processes, in
addition to retinal screening, that together
substantially reduce complication rates.
Despite this, around a third of people with
diabetes do not receive all 8 care processes,
and there is widespread variation between
CCGs and practices in levels of achievement.
Diabetes Prevention and Management
48 CVD Intelligence packs
Diabetes observed prevalence compared to expected prevalence by CCG
Graph
0.75 ratio of observed to expected
diabetes prevalence in NHS
Eastbourne, Hailsham And Seaford
CCG compared to 0.85 in England
This suggests that 75% of people
with diabetes have been diagnosed
Comparison with CCGs in the SCN
Note: This slide compares the prevalence of
Diabetes recorded in QOF in 2013/14 to the
expected prevalence of Diabetes taken from
the Diabetes prevalence model produced in
2012.
The expected prevalence of diabetes is
based on best available data but there is an
element of uncertainty around the figures
especially in smaller areas. A small number
of CCGs have a ratio greater than 1. It is
unlikely that all people with diabetes will be
diagnosed in any CCG and therefore a ratio
greater than 1 suggests that the figures are
underestimating the true diabetes prevalence
in the area. These ratios should be taken as
an indication of the comparative scale of
undiagnosed diabetes rather than absolute
figures.
0.85
0.67
0.67
0.70
0.74
0.75
0.75
0.77
0.78
0.80
0.80
0.80
0.82
0.83
0.86
0.87
0.87
0.88
0.89
0.99
1.01
0.00 0.20 0.40 0.60 0.80 1.00 1.20
England
NHS Guildford and Waverley CCG
NHS Brighton and Hove CCG
NHS Surrey Downs CCG
NHS High Weald Lewes Havens CCG
NHS East Surrey CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Hastings and Rother CCG
NHS Horsham and Mid Sussex CCG
NHS Surrey Heath CCG
NHS North West Surrey CCG
NHS Canterbury and Coastal CCG
NHS West Kent CCG
NHS Coastal West Sussex CCG
NHS Ashford CCG
NHS Dartford, Gravesham and Swanley CCG
NHS South Kent Coast CCG
NHS Thanet CCG
NHS Crawley CCG
NHS Medway CCG
NHS Swale CCG
ratio of observed to expected
49 CVD Intelligence packs
Diabetes observed prevalence compared to expected prevalence by CCG
Graph
Comparison with demographically similar CCGs
0.75
0.76
0.80
0.82
0.85
0.89
0.91
0.94
0.97
0.97
1.00
0.00 0.20 0.40 0.60 0.80 1.00 1.20
NHS Eastbourne, Hailsham and Seaford CCG
NHS South Devon and Torbay CCG
NHS Isle of Wight CCG
NHS North Norfolk CCG
NHS Fylde & Wyre CCG
NHS North Derbyshire CCG
NHS Great Yarmouth and Waveney CCG
NHS Wyre Forest CCG
NHS West Norfolk CCG
NHS North Staffordshire CCG
NHS Lincolnshire East CCG
ratio of observed to expected
50 CVD Intelligence packs
Diabetes prevalence by GP practice
Graph
It is estimated that there are 3,185
people with undiagnosed diabetes in
NHS Eastbourne, Hailsham And
Seaford CCG
GP practice range of observed
diabetes: 3.0% to 7.7%
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0
Eastbourne Station Health Centre Y02816
Dr Miller & Partners G81056
Dr Verghese & Partners G81002
Green Street Clinic G81032
Dr Simmons G81634
Dr Barnes J D & Partners G81017
Dr Williams & Partners G81050
Dr Brown G C & Partners G81027
Dr Palit & Partners G81099
Dr Adoki & Ptnr Y00080
Dr Brown R D & Partners G81049
Dr Edwards & Partner G81098
Sovereign Practice G81022
Dr Eyre & Partners G81003
Dr Barnes M H & Partners G81029
Park Practice G81104
Dr Savvas S & Partner G81012
Dr Baig & Partners G81008
Dr Pearce & Partners G81059
Dr Bedford-Turner & Partners G81004
Dr Oezburun G81685
prevalence %
GP practice CCG
51 CVD Intelligence packs
People with diabetes who had the eight recommended care processes by CCG, 2012/13
Graph
30.4% of people with diabetes had
the eight recommended care
processes in NHS Eastbourne,
Hailsham And Seaford CCG
compared to 59.5% in England
At least 4,143 people did not receive
the 8 care processes
Comparison with CCGs in the SCN
Note: This slide uses data from the
National Diabetes Audit (NDA)
No data is available for the following
CCGs: Camden, Harrogate and rural
district, Mid Essex and Southampton
59.5
30.4
39.5
40.7
43.8
44.4
46.7
48.6
50.2
50.2
53.1
55.6
58.8
59.2
65.3
65.7
66.9
67.0
67.9
68.3
68.3
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0
England
NHS Eastbourne, Hailsham and Seaford CCG
NHS Dartford, Gravesham and Swanley CCG
NHS High Weald Lewes Havens CCG
NHS Horsham and Mid Sussex CCG
NHS Medway CCG
NHS North West Surrey CCG
NHS West Kent CCG
NHS Crawley CCG
NHS Surrey Downs CCG
NHS East Surrey CCG
NHS Coastal West Sussex CCG
NHS Swale CCG
NHS Brighton and Hove CCG
NHS Guildford and Waverley CCG
NHS Surrey Heath CCG
NHS Canterbury and Coastal CCG
NHS Thanet CCG
NHS Ashford CCG
NHS Hastings and Rother CCG
NHS South Kent Coast CCG
percentage
52 CVD Intelligence packs
People with diabetes who had eight care processes by GP practice, 2012/13
Graph
• Practice comparison will show how
much potential there is for local
improvement.
• Practice level data from the National
Diabetes Audit can only be made
available on request by CCGs. To
request the data, email
diabetes@hscic.gov.uk
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0
Dr Verghese & Partners G81002
Dr Eyre & Partners G81003
Dr Bedford-Turner & Partners G81004
Dr Baig & Partners G81008
Dr Savvas S & Partner G81012
Dr Barnes J D & Partners G81017
Sovereign Practice G81022
Dr Brown G C & Partners G81027
Dr Barnes M H & Partners G81029
Green Street Clinic G81032
Dr Brown R D & Partners G81049
Dr Williams & Partners G81050
Dr Miller & Partners G81056
Dr Pearce & Partners G81059
Dr Edwards & Partner G81098
Dr Palit & Partners G81099
Park Practice G81104
Dr Simmons G81634
Dr Oezburun G81685
Dr Adoki & Ptnr Y00080
Eastbourne Station Health Centre Y02816
percentage
GP practice CCG
No data available. Practice level data from the National Diabetes
Audit can only be made available on request by CCGs.
Kidney
53 CVD Intelligence packs
Chronic Kidney Disease can
progress to kidney failure and it
substantially increases the risk of
heart attack and stroke.
Chronic Kidney Disease (CKD) is common.
It is one of the commonest co-morbidities and
affects a third of people over 65. In 2010 it was
estimated to cost the NHS around £1.5bn.
Average length of stay in hospital tends to be
longer and outcomes are considerably worse:
approximately 7,000 excess strokes and 12,000
excess heart attacks occur each year in people
with CKD compared to those without.
Individuals with CKD are also at much higher
risk of developing acute kidney injury when they
have an intercurrent illness such as pneumonia.
What might help
• Promote participation by all practices in the National
CKD Audit
• Obtain and benchmark practice level data from the
National CKD Audit
• Promote uptake of and follow up from the NHS
Health Check to aid detection and management of
CKD
• Local training and education in the detection and
management of CKD
What questions should we ask in our CCG?
1. For each indicator how wide is the variation in achievement and
exception reporting?
2. How many people would benefit if all practices performed as well
as the best?
3. How can we support practices who are average and below
average to perform as well as the best in:
• Detection of CKD
• More systematic delivery of evidence based care
Late diagnosis of CKD is common.
Around a third of people with CKD are
undiagnosed. More opportunistic testing
and improved uptake of the NHS Health
Check will increase detection rates.
Evidence based guidance from NICE
identifies CVD risk reduction, good blood
pressure control and management of
proteinuria as essential steps to reduce the risk
of cardiovascular events and progression to
kidney failure. Despite this there is often
significant variation between practices in
achievement and exception reporting.
Management of Chronic Kidney Disease
55 CVD Intelligence packs
Chronic kidney disease (CKD) observed prevalence (2012/13) compared to
expected prevalence (2011) by CCG
Graph 0.76 ratio of observed to expected
CKD prevalence in NHS Eastbourne,
Hailsham And Seaford CCG
compared to 0.7 in England
This suggests that 76% of people
with chronic kidney disease have
been diagnosed
Comparison with CCGs in the SCN
Note: This slide compares the prevalence of
CKD recorded in QOF in 2012/13 to the
expected prevalence of CKD produced by the
University of Southampton in 2011. A small
number of CCGs have a ratio greater than
1. It is unlikely that all people with CKD will be
diagnosed in any CCG and therefore a ratio
greater than 1 suggests that the figures are
underestimating the true CKD prevalence in
the area. These ratios should be taken as an
indication of the comparative scale of
undiagnosed CKD rather than absolute
figures.
The QOF 2013/14 data for CKD has a coding
issue around episodes which has led to an
underreporting of CKD. Therefore, 2012/13
QOF has been used to ensure accuracy.
0.70
0.56
0.57
0.58
0.60
0.62
0.62
0.66
0.68
0.68
0.69
0.69
0.72
0.72
0.73
0.73
0.75
0.76
0.76
0.85
1.27
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40
England
NHS Surrey Downs CCG
NHS Coastal West Sussex CCG
NHS Hastings and Rother CCG
NHS Guildford and Waverley CCG
NHS East Surrey CCG
NHS Horsham and Mid Sussex CCG
NHS North West Surrey CCG
NHS Surrey Heath CCG
NHS Canterbury and Coastal CCG
NHS High Weald Lewes Havens CCG
NHS West Kent CCG
NHS South Kent Coast CCG
NHS Swale CCG
NHS Medway CCG
NHS Thanet CCG
NHS Ashford CCG
NHS Brighton and Hove CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Crawley CCG
NHS Dartford, Gravesham and Swanley CCG
ratio of observed to expected
56 CVD Intelligence packs
Chronic kidney disease (CKD) observed prevalence (2012/13) compared to
expected prevalence (2011) by CCG
Graph
Comparison with demographically similar CCGs
0.55
0.65
0.66
0.68
0.71
0.76
0.77
0.86
0.89
0.95
1.02
0.00 0.20 0.40 0.60 0.80 1.00 1.20
NHS Isle of Wight CCG
NHS North Staffordshire CCG
NHS South Devon and Torbay CCG
NHS West Norfolk CCG
NHS North Norfolk CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Great Yarmouth and Waveney CCG
NHS Wyre Forest CCG
NHS North Derbyshire CCG
NHS Lincolnshire East CCG
NHS Fylde & Wyre CCG
ratio of observed to expected
57 CVD Intelligence packs
CKD prevalence by GP practice, 2012/13
Graph
It is estimated that there are 3,054
people with undiagnosed chronic
kidney disease in NHS Eastbourne,
Hailsham And Seaford CCG
GP practice range of observed CKD:
0.6% to 12.4%
Note: CCG estimates for the estimated
number of people with CKD are based on
applying a proportion from a resident
based population estimate to a GP
registered population. The characteristics
of registered and resident populations
may vary in some CCGs, and local
interpretation is required. 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0
Eastbourne Station Health Centre Y02816
Dr Barnes J D & Partners G81017
Dr Adoki & Ptnr Y00080
Dr Miller & Partners G81056
Dr Oezburun G81685
Dr Brown R D & Partners G81049
Dr Brown G C & Partners G81027
Green Street Clinic G81032
Dr Simmons G81634
Dr Verghese & Partners G81002
Park Practice G81104
Dr Pearce & Partners G81059
Sovereign Practice G81022
Dr Edwards & Partner G81098
Dr Savvas S & Partner G81012
Vicarage Field Practice G81060
Dr Eyre & Partners G81003
Dr Barnes M H & Partners G81029
Dr Palit & Partners G81099
Dr Baig & Partners G81008
Dr Williams & Partners G81050
Dr Bedford-Turner & Partners G81004
prevalence %
GP practice CCG
58 CVD Intelligence packs
Percentage of patients on the CKD register whose last blood pressure reading (measured in
the preceding 12 months) is 140/85 mmHg or less by CCG, 2012/13
Graph
9,839 people with CKD (diagnosed)*
in NHS Eastbourne, Hailsham And
Seaford CCG
6,926 (70.4%) people whose blood
pressure is <= 140 / 85
772 (7.8%) people who are
exceptions
2,141 (21.8%) additional people
whose blood pressure is not <= 140 /
85
Comparison with CCGs in the SCN
*Using the QOF clinical indicator
CKD03 denominator plus exceptions
71.6%
66.4%
68.5%
68.9%
69.1%
69.1%
69.4%
69.8%
70.4%
70.4%
70.6%
71.1%
71.5%
71.6%
71.8%
71.9%
72.0%
72.8%
73.2%
74.5%
75.6%
0% 20% 40% 60% 80% 100%
England
NHS Coastal West Sussex CCG
NHS Horsham and Mid Sussex CCG
NHS Thanet CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Surrey Downs CCG
NHS East Surrey CCG
NHS High Weald Lewes Havens CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS West Kent CCG
NHS South Kent Coast CCG
NHS Crawley CCG
NHS Surrey Heath CCG
NHS Guildford and Waverley CCG
NHS Canterbury and Coastal CCG
NHS Hastings and Rother CCG
NHS Brighton and Hove CCG
NHS North West Surrey CCG
NHS Ashford CCG
NHS Medway CCG
NHS Swale CCG
Below 140/85 Not below 140/85 Exceptions reported
59 CVD Intelligence packs
Percentage of patients on the CKD register whose last blood pressure reading (measured in
the preceding 12 months) is 140/85 mmHg or less by CCG, 2012/13
Graph
Comparison with demographically similar CCGs
66.4%
68.8%
69.4%
69.7%
69.8%
70.2%
70.4%
70.7%
71.7%
72.7%
73.0%
0% 20% 40% 60% 80% 100%
NHS South Devon and Torbay CCG
NHS North Derbyshire CCG
NHS Wyre Forest CCG
NHS West Norfolk CCG
NHS North Norfolk CCG
NHS North Staffordshire CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Fylde & Wyre CCG
NHS Great Yarmouth and Waveney CCG
NHS Lincolnshire East CCG
NHS Isle of Wight CCG
Below 140/85 Not below 140/85 Exceptions reported
60 CVD Intelligence packs
Percentage of patients on the CKD register whose last blood pressure reading (measured in
the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2012/13
Graph
In total, including exceptions, there
are 2,913 people whose blood
pressure is not <= 140 / 85
GP practice range: 16.8% to 46.2 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 382 people would have
their blood pressure controlled
0% 10% 20% 30% 40% 50%
Dr Bedford-Turner & Partners G81004
Dr Brown R D & Partners G81049
Dr Palit & Partners G81099
Dr Barnes J D & Partners G81017
Dr Oezburun G81685
Dr Pearce & Partners G81059
Dr Simmons G81634
Dr Baig & Partners G81008
Dr Edwards & Partner G81098
Park Practice G81104
Green Street Clinic G81032
Dr Verghese & Partners G81002
Vicarage Field Practice G81060
Sovereign Practice G81022
Dr Savvas S & Partner G81012
Dr Eyre & Partners G81003
Dr Williams & Partners G81050
Dr Brown G C & Partners G81027
Dr Miller & Partners G81056
Dr Barnes M H & Partners G81029
Dr Adoki & Ptnr Y00080
Eastbourne Station Health Centre Y02816
Not below 140/85 Exceptions reported
61 CVD Intelligence packs
Percentage of patients on the CKD register whose notes have a record of a urine albumin:
creatinine ratio test in the preceding 12 months by CCG, 2012/13
Graph
9,839 people with CKD (diagnosed)*
in NHS Eastbourne, Hailsham And
Seaford CCG
7,911 (80.4%) people who have a
record of a urine albumin: creatinine
ratio test
516 (5.2%) people who are
exceptions
1,412 (14.4%) additional people
who have no record of a urine
albumin: creatinine ratio test
Comparison with CCGs in the SCN
*Using the QOF clinical indicator
CKD06 denominator plus exceptions
78.8%
69.7%
72.5%
73.1%
73.3%
73.6%
74.2%
75.9%
76.0%
76.4%
76.7%
76.8%
77.9%
78.1%
78.1%
78.7%
80.4%
81.2%
81.2%
81.2%
82.2%
0% 20% 40% 60% 80% 100%
England
NHS Coastal West Sussex CCG
NHS Surrey Downs CCG
NHS Swale CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Horsham and Mid Sussex CCG
NHS North West Surrey CCG
NHS Brighton and Hove CCG
NHS High Weald Lewes Havens CCG
NHS Ashford CCG
NHS Crawley CCG
NHS Surrey Heath CCG
NHS East Surrey CCG
NHS Thanet CCG
NHS West Kent CCG
NHS Guildford and Waverley CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Medway CCG
NHS Canterbury and Coastal CCG
NHS Hastings and Rother CCG
NHS South Kent Coast CCG
Recorded Not recorded Exceptions reported
62 CVD Intelligence packs
Percentage of patients on the CKD register whose notes have a record of a urine albumin:
creatinine ratio test in the preceding 12 months by CCG, 2012/13
Graph
Comparison with demographically similar CCGs
71.9%
75.0%
77.1%
78.2%
78.3%
79.1%
79.9%
80.1%
80.4%
80.5%
82.9%
0% 20% 40% 60% 80% 100%
NHS South Devon and Torbay CCG
NHS North Norfolk CCG
NHS West Norfolk CCG
NHS Wyre Forest CCG
NHS Fylde & Wyre CCG
NHS Lincolnshire East CCG
NHS Isle of Wight CCG
NHS North Derbyshire CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Great Yarmouth and Waveney CCG
NHS North Staffordshire CCG
Recorded Not recorded Exceptions reported
63 CVD Intelligence packs
Percentage of patients on the CKD register whose notes do not have a record of a urine
albumin: creatinine ratio test in the preceding 12 months by GP practice, 2012/13
Graph
In total, including exceptions, there
are 1,928 people who have no
record of a urine albumin: creatinine
ratio test
GP practice range: 10.8% to 43.6 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 416 people who have a
record of a urine albumin: creatinine
ratio test
0% 10% 20% 30% 40% 50%
Dr Palit & Partners G81099
Dr Edwards & Partner G81098
Vicarage Field Practice G81060
Green Street Clinic G81032
Eastbourne Station Health Centre Y02816
Dr Baig & Partners G81008
Dr Bedford-Turner & Partners G81004
Dr Verghese & Partners G81002
Sovereign Practice G81022
Dr Brown R D & Partners G81049
Dr Simmons G81634
Dr Brown G C & Partners G81027
Dr Savvas S & Partner G81012
Dr Miller & Partners G81056
Dr Barnes M H & Partners G81029
Dr Pearce & Partners G81059
Park Practice G81104
Dr Barnes J D & Partners G81017
Dr Oezburun G81685
Dr Eyre & Partners G81003
Dr Williams & Partners G81050
Dr Adoki & Ptnr Y00080
Not recorded Exceptions reported
Heart
64 CVD Intelligence packs
Premature death and disability in
people with CHD can be reduced
significantly by systematic evidence
based management in primary care
Coronary Heart Disease is one of the principal causes of
premature death and disability. The key elements of
management for an individual who already has had a heart attack
or angina are symptom control and secondary prevention of
further cardiovascular events and premature mortality. There is
robust evidence to support the use of anti-platelet treatment,
statins, beta-blockers and angiotensin converting enzyme
inhibitors or angiotensin receptor blockers. There is also robust
evidence to support good control of blood pressure. Each of these
interventions is incentivised in QOF but variation in achievement
and exception reporting at practice level shows that there is often
considerable potential for improving management and outcomes.
What might help
1. Roll out of GRASP-Heart Failure audit tool
that identifies people with heart failure who
are undiagnosed or under treated
2. Education for health professionals to
promote evidence based management of
CHD and high quality measurement of
blood pressure
3. Education and training to support delivery
of behaviour change interventions for CVD
risk reduction in primary care
4. Ensure access to rapid access diagnostic
clinics and specialist support for
management of angina and heart failure
5. Ensure access to cardiac rehab for
individuals with CHD and heart failure
What questions should we ask in our CCG?
1. For each indicator how wide is the variation
in achievement and exception reporting?
2. How many people would benefit if all
practices performed as well as the best?
3. How can we support practices who are
average and below average to perform as
well as the best in:
• More systematic delivery of evidence
based care for people with CHD
• Improved detection and management
of heart failure
Heart failure is a common and an important complication
of coronary heart disease and other conditions. Again there is
good evidence that appropriate treatment including up-
titration of ace inhibitors and beta blockers in heart failure
due to LVSD can significantly improve symptom control and
quality of life, and improve outcomes for patients. Despite
this, around a quarter of people with heart failure are
undetected and untreated. And amongst those who are
diagnosed, there is significant variation in the quality of care.
Management of Heart Disease
66 CVD Intelligence packs
Heart failure prevalence by CCG
Graph
Prevalence of 1.0% in NHS
Eastbourne, Hailsham And Seaford
CCG compared to 0.7% in England
Comparison with CCGs in the SCN
0.7
0.5
0.5
0.5
0.5
0.5
0.5
0.6
0.6
0.6
0.6
0.6
0.6
0.7
0.7
0.7
0.7
0.8
0.8
1.0
1.0
0.00 0.20 0.40 0.60 0.80 1.00 1.20
England
NHS Surrey Heath CCG
NHS Guildford and Waverley CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Brighton and Hove CCG
NHS East Surrey CCG
NHS West Kent CCG
NHS Ashford CCG
NHS Crawley CCG
NHS Canterbury and Coastal CCG
NHS South Kent Coast CCG
NHS Medway CCG
NHS Horsham and Mid Sussex CCG
NHS Swale CCG
NHS High Weald Lewes Havens CCG
NHS Thanet CCG
NHS Coastal West Sussex CCG
NHS Hastings and Rother CCG
NHS Eastbourne, Hailsham and Seaford CCG
prevalence %
67 CVD Intelligence packs
Heart failure prevalence by CCG
Graph
Comparison with demographically similar CCGs
0.7
0.7
0.9
0.9
1.0
1.0
1.0
1.0
1.0
1.1
1.4
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60
NHS North Staffordshire CCG
NHS South Devon and Torbay CCG
NHS Isle of Wight CCG
NHS West Norfolk CCG
NHS Great Yarmouth and Waveney CCG
NHS North Derbyshire CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Wyre Forest CCG
NHS Lincolnshire East CCG
NHS North Norfolk CCG
NHS Fylde & Wyre CCG
prevalence %
68 CVD Intelligence packs
Heart failure prevalence by GP practice
Graph
1,866 people with diagnosed heart
failure in NHS Eastbourne, Hailsham
And Seaford CCG
GP practice range: 0.3% to 1.5%
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6
Eastbourne Station Health Centre Y02816
Dr Adoki & Ptnr Y00080
Dr Barnes J D & Partners G81017
Dr Brown R D & Partners G81049
Green Street Clinic G81032
Park Practice G81104
Dr Savvas S & Partner G81012
Sovereign Practice G81022
Dr Verghese & Partners G81002
Dr Simmons G81634
Dr Miller & Partners G81056
Dr Brown G C & Partners G81027
Dr Barnes M H & Partners G81029
Dr Palit & Partners G81099
Dr Baig & Partners G81008
Dr Williams & Partners G81050
Dr Bedford-Turner & Partners G81004
Dr Eyre & Partners G81003
Dr Oezburun G81685
Dr Pearce & Partners G81059
Dr Edwards & Partner G81098
prevalence %
GP practice CCG
69 CVD Intelligence packs
Percentage of patients with heart failure due to left ventricular systolic dysfunction
(LVSD) who are treated with ACE-I / ARB by CCG
Graph
821 people with heart failure with
LVSD in NHS Eastbourne, Hailsham
And Seaford CCG
730 (88.9%) treated with ACE-I or
ARB
91 (11.1%) people who are
exceptions
0 (0%) additional people who are not
treated with ACE-I or ARB
Comparison with CCGs in the SCN
86.7%
81.3%
81.5%
82.8%
83.2%
83.7%
84.6%
85.6%
85.9%
86.0%
86.3%
86.9%
87.1%
87.8%
87.9%
88.5%
88.9%
89.9%
89.9%
90.1%
90.9%
0% 20% 40% 60% 80% 100%
England
NHS Coastal West Sussex CCG
NHS Ashford CCG
NHS Brighton and Hove CCG
NHS Thanet CCG
NHS Surrey Downs CCG
NHS North West Surrey CCG
NHS Swale CCG
NHS Hastings and Rother CCG
NHS Surrey Heath CCG
NHS South Kent Coast CCG
NHS Canterbury and Coastal CCG
NHS High Weald Lewes Havens CCG
NHS Horsham and Mid Sussex CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Medway CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS West Kent CCG
NHS East Surrey CCG
NHS Guildford and Waverley CCG
NHS Crawley CCG
Treated No treatment Exceptions reported
70 CVD Intelligence packs
Percentage of patients with heart failure due to left ventricular systolic dysfunction
(LVSD) who are treated with ACE-I / ARB by CCG
Graph
Comparison with demographically similar CCGs
81.7%
82.4%
83.7%
84.9%
85.5%
87.0%
88.9%
89.0%
89.4%
89.9%
90.4%
0% 20% 40% 60% 80% 100%
NHS Great Yarmouth and Waveney CCG
NHS North Norfolk CCG
NHS West Norfolk CCG
NHS North Derbyshire CCG
NHS South Devon and Torbay CCG
NHS Lincolnshire East CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS North Staffordshire CCG
NHS Wyre Forest CCG
NHS Fylde & Wyre CCG
NHS Isle of Wight CCG
Treated No treatment Exceptions reported
71 CVD Intelligence packs
Graph
Percentage of patients with heart failure due to left ventricular systolic dysfunction
(LVSD) who are not treated with ACE-I / ARB by GP practice
In total, including exceptions, there
are 91 people who are not treated
with ACE-I or ARB
GP practice range: 0.0% to 25.0 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 62 people would be
treated
0% 5% 10% 15% 20% 25% 30%
Dr Adoki & Ptnr Y00080
Dr Oezburun G81685
Dr Miller & Partners G81056
Dr Brown R D & Partners G81049
Dr Brown G C & Partners G81027
Dr Verghese & Partners G81002
Sovereign Practice G81022
Dr Edwards & Partner G81098
Dr Bedford-Turner & Partners G81004
Green Street Clinic G81032
Dr Eyre & Partners G81003
Park Practice G81104
Dr Barnes M H & Partners G81029
Dr Baig & Partners G81008
Dr Williams & Partners G81050
Dr Barnes J D & Partners G81017
Dr Pearce & Partners G81059
Dr Simmons G81634
Eastbourne Station Health Centre Y02816
Dr Savvas S & Partner G81012
Dr Palit & Partners G81099
No treatment Exceptions reported
72 CVD Intelligence packs
Graph
Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who
are treated with ACE-I / ARB and BB by CCG
728 people with heart failure with
LVSD treated with ACE-I / ARB in
NHS Eastbourne, Hailsham And
Seaford CCG
502 (69%) treated with ACE-I / ARB
and BB
180 (24.7%) people who are
exceptions
46 (6.3%) additional people who are
not treated with ACE-I / ARB and BB
Comparison with CCGs in the SCN
74.3%
63.6%
68.3%
69.0%
69.2%
70.9%
71.8%
71.8%
72.9%
73.8%
74.0%
74.6%
74.9%
75.1%
75.7%
75.8%
78.8%
78.9%
79.8%
79.8%
80.8%
0% 20% 40% 60% 80% 100%
England
NHS High Weald Lewes Havens CCG
NHS Surrey Downs CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS South Kent Coast CCG
NHS Brighton and Hove CCG
NHS Hastings and Rother CCG
NHS Ashford CCG
NHS West Kent CCG
NHS East Surrey CCG
NHS Canterbury and Coastal CCG
NHS Horsham and Mid Sussex CCG
NHS Guildford and Waverley CCG
NHS Coastal West Sussex CCG
NHS Thanet CCG
NHS Medway CCG
NHS Crawley CCG
NHS Surrey Heath CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Swale CCG
NHS North West Surrey CCG
Treated No treatment Exceptions reported
73 CVD Intelligence packs
Graph
Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who
are treated with ACE-I / ARB and BB by CCG
Comparison with demographically similar CCGs
63.1%
63.3%
67.7%
69.0%
69.6%
71.3%
72.2%
73.5%
74.1%
80.2%
86.4%
0% 20% 40% 60% 80% 100%
NHS North Norfolk CCG
NHS South Devon and Torbay CCG
NHS West Norfolk CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Isle of Wight CCG
NHS Great Yarmouth and Waveney CCG
NHS Wyre Forest CCG
NHS Lincolnshire East CCG
NHS North Derbyshire CCG
NHS North Staffordshire CCG
NHS Fylde & Wyre CCG
Treated No treatment Exceptions reported
74 CVD Intelligence packs
Graph
Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who
are not treated with ACE-I / ARB and BB by GP practice
In total, including exceptions, there
are 226 people who are not treated
with ACE-I / ARB and BB
GP practice range: 0.0% to 70.0 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 82 people would be
treated
0% 10% 20% 30% 40% 50% 60% 70% 80%
Dr Adoki & Ptnr Y00080
Dr Oezburun G81685
Dr Barnes J D & Partners G81017
Dr Savvas S & Partner G81012
Dr Simmons G81634
Sovereign Practice G81022
Dr Pearce & Partners G81059
Dr Baig & Partners G81008
Dr Barnes M H & Partners G81029
Dr Verghese & Partners G81002
Dr Eyre & Partners G81003
Dr Bedford-Turner & Partners G81004
Green Street Clinic G81032
Park Practice G81104
Dr Palit & Partners G81099
Dr Edwards & Partner G81098
Dr Williams & Partners G81050
Dr Brown G C & Partners G81027
Dr Miller & Partners G81056
Eastbourne Station Health Centre Y02816
Dr Brown R D & Partners G81049
No treatment Exceptions reported
75 CVD Intelligence packs
Graph
Percentage of patients with CHD whose blood pressure reading (measured in the
preceding 12 months) is 150/90 mmHg or less by CCG
8,156 people with coronary heart
disease* in NHS Eastbourne,
Hailsham And Seaford CCG
7,115 (87.2%) people whose blood
pressure <= 150/90
452 (5.5%) people who are
exceptions
589 (7.2%) additional people whose
blood pressure is not <= 150/90
Comparison with CCGs in the SCN
*Using the QOF clinical indicator
CHD002 denominator plus exceptions
88.9%
86.4%
86.8%
87.2%
87.6%
87.8%
87.9%
87.9%
88.2%
88.4%
88.4%
88.5%
88.8%
88.8%
88.9%
88.9%
89.1%
89.3%
89.6%
90.4%
91.0%
0% 20% 40% 60% 80% 100%
England
NHS Coastal West Sussex CCG
NHS Brighton and Hove CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Surrey Downs CCG
NHS High Weald Lewes Havens CCG
NHS Medway CCG
NHS East Surrey CCG
NHS Crawley CCG
NHS Horsham and Mid Sussex CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Guildford and Waverley CCG
NHS North West Surrey CCG
NHS South Kent Coast CCG
NHS Ashford CCG
NHS West Kent CCG
NHS Canterbury and Coastal CCG
NHS Thanet CCG
NHS Surrey Heath CCG
NHS Swale CCG
NHS Hastings and Rother CCG
Below 150/90 Not below 150/90 Exceptions reported
76 CVD Intelligence packs
Graph
Percentage of patients with CHD whose blood pressure reading (measured in the
preceding 12 months) is 150/90 mmHg or less by CCG
Comparison with demographically similar CCGs
85.3%
87.0%
87.2%
87.5%
87.6%
87.9%
88.3%
88.4%
88.4%
89.3%
89.4%
0% 20% 40% 60% 80% 100%
NHS South Devon and Torbay CCG
NHS North Staffordshire CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS West Norfolk CCG
NHS Lincolnshire East CCG
NHS Great Yarmouth and Waveney CCG
NHS North Norfolk CCG
NHS Wyre Forest CCG
NHS Isle of Wight CCG
NHS North Derbyshire CCG
NHS Fylde & Wyre CCG
Below 150/90 Not below 150/90 Exceptions reported
77 CVD Intelligence packs
Graph
Percentage of patients with CHD whose blood pressure reading (measured in the
preceding 12 months) is not 150/90 mmHg or less by GP practice
In total, including exceptions, there
are 1,041 people whose blood
pressure is not <= 150/90
GP practice range: 2.5% to 27.5 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 459 people would have
their blood pressure controlled
0% 5% 10% 15% 20% 25% 30%
Dr Oezburun G81685
Dr Simmons G81634
Green Street Clinic G81032
Dr Bedford-Turner & Partners G81004
Dr Edwards & Partner G81098
Dr Palit & Partners G81099
Dr Barnes J D & Partners G81017
Dr Verghese & Partners G81002
Dr Savvas S & Partner G81012
Dr Pearce & Partners G81059
Dr Baig & Partners G81008
Dr Williams & Partners G81050
Dr Eyre & Partners G81003
Dr Brown G C & Partners G81027
Park Practice G81104
Sovereign Practice G81022
Dr Miller & Partners G81056
Eastbourne Station Health Centre Y02816
Dr Adoki & Ptnr Y00080
Dr Brown R D & Partners G81049
Dr Barnes M H & Partners G81029
Not below 150/90 Exceptions reported
78 CVD Intelligence packs
Graph
Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an
alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG
8,156 people with coronary heart
disease* in NHS Eastbourne,
Hailsham And Seaford CCG
7,508 (92.1%) people with a record
that aspirin, an alternative anti-
platelet therapy, or an anti-coagulant
is being taken
365 (4.5%) people who are
exceptions
283 (3.5%) additional people who
are not treated
Comparison with CCGs in the SCN
*Using the QOF clinical indicator
CHD005 denominator plus exceptions
91.4%
89.8%
90.0%
90.0%
90.7%
90.7%
91.0%
91.1%
91.2%
91.4%
91.4%
91.5%
91.5%
91.8%
91.9%
92.1%
92.6%
92.6%
92.7%
92.8%
93.3%
0% 20% 40% 60% 80% 100%
England
NHS Coastal West Sussex CCG
NHS Brighton and Hove CCG
NHS Swale CCG
NHS Surrey Downs CCG
NHS Horsham and Mid Sussex CCG
NHS High Weald Lewes Havens CCG
NHS Crawley CCG
NHS East Surrey CCG
NHS Medway CCG
NHS North West Surrey CCG
NHS Guildford and Waverley CCG
NHS Canterbury and Coastal CCG
NHS South Kent Coast CCG
NHS Ashford CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Surrey Heath CCG
NHS West Kent CCG
NHS Thanet CCG
NHS Hastings and Rother CCG
Optimal management No treatment Exceptions reported
79 CVD Intelligence packs
Graph
Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an
alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG
Comparison with demographically similar CCGs
89.3%
89.4%
89.8%
90.3%
90.6%
91.2%
91.4%
91.4%
91.6%
91.8%
92.1%
0% 20% 40% 60% 80% 100%
NHS West Norfolk CCG
NHS Lincolnshire East CCG
NHS South Devon and Torbay CCG
NHS Great Yarmouth and Waveney CCG
NHS North Norfolk CCG
NHS North Staffordshire CCG
NHS Isle of Wight CCG
NHS Wyre Forest CCG
NHS Fylde & Wyre CCG
NHS North Derbyshire CCG
NHS Eastbourne, Hailsham and Seaford CCG
Optimal management No treatment Exceptions reported
80 CVD Intelligence packs
Graph
Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an
alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice
In total, including exceptions, there
are 648 people who are not treated
GP practice range: 2.5% to 16.4 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 170 people would be
treated
0% 5% 10% 15% 20%
Dr Oezburun G81685
Dr Simmons G81634
Sovereign Practice G81022
Dr Palit & Partners G81099
Dr Bedford-Turner & Partners G81004
Dr Baig & Partners G81008
Dr Brown R D & Partners G81049
Dr Barnes M H & Partners G81029
Eastbourne Station Health Centre Y02816
Dr Savvas S & Partner G81012
Dr Eyre & Partners G81003
Park Practice G81104
Dr Barnes J D & Partners G81017
Green Street Clinic G81032
Dr Edwards & Partner G81098
Dr Pearce & Partners G81059
Dr Williams & Partners G81050
Dr Verghese & Partners G81002
Dr Brown G C & Partners G81027
Dr Adoki & Ptnr Y00080
Dr Miller & Partners G81056
No treatment Exceptions reported
81 CVD Intelligence packs
Graph
The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an
alternative anti-platelet therapy, beta-blocker and statin by CCG
604 people with a history of
myocardial infarction
304 (50.3%) people treated with
ACEi / ARB aspirin or an alternative
anti-platelet therapy, beta-blocker
and statin
295 (48.8%) people who are
exceptions
5 (0.8%) additional people who are
not on quadruple therapy
Comparison with CCGs in the SCN
70.2%
50.3%
60.6%
63.2%
63.5%
64.6%
65.9%
66.2%
66.8%
66.8%
68.4%
68.5%
68.7%
69.1%
71.1%
71.9%
72.9%
73.1%
73.7%
74.1%
75.3%
0% 20% 40% 60% 80% 100%
England
NHS Eastbourne, Hailsham and Seaford CCG
NHS Ashford CCG
NHS Thanet CCG
NHS Coastal West Sussex CCG
NHS Brighton and Hove CCG
NHS Surrey Downs CCG
NHS East Surrey CCG
NHS Canterbury and Coastal CCG
NHS South Kent Coast CCG
NHS West Kent CCG
NHS High Weald Lewes Havens CCG
NHS Horsham and Mid Sussex CCG
NHS Hastings and Rother CCG
NHS Guildford and Waverley CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Medway CCG
NHS Surrey Heath CCG
NHS Swale CCG
NHS Crawley CCG
NHS North West Surrey CCG
Optimal management No treatment Exceptions reported
82 CVD Intelligence packs
Graph
The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an
alternative anti-platelet therapy, beta-blocker and statin by CCG
Comparison with demographically similar CCGs
50.3%
61.9%
62.2%
65.0%
66.9%
68.0%
68.1%
69.2%
69.9%
71.0%
74.1%
0% 20% 40% 60% 80% 100%
NHS Eastbourne, Hailsham and Seaford CCG
NHS South Devon and Torbay CCG
NHS North Norfolk CCG
NHS West Norfolk CCG
NHS Isle of Wight CCG
NHS North Derbyshire CCG
NHS North Staffordshire CCG
NHS Wyre Forest CCG
NHS Great Yarmouth and Waveney CCG
NHS Lincolnshire East CCG
NHS Fylde & Wyre CCG
Optimal management No treatment Exceptions reported
83 CVD Intelligence packs
Graph
The percentage of patients with a history of MI not currently treated with an ACE-I / ARB, aspirin or
an alternative anti-platelet therapy, beta-blocker and statin by GP practice
In total, including exceptions, there
are 300 people who are not on
quadruple therapy
GP practice range: 0.0% to 96.7 %
If all practices were to achieve as
well as the average of the best
achieving practices, then an
additional 168 people would be
treated
0% 20% 40% 60% 80% 100% 120%
Dr Oezburun G81685
Dr Verghese & Partners G81002
Dr Barnes J D & Partners G81017
Dr Savvas S & Partner G81012
Dr Palit & Partners G81099
Dr Edwards & Partner G81098
Dr Baig & Partners G81008
Park Practice G81104
Dr Bedford-Turner & Partners G81004
Sovereign Practice G81022
Dr Brown G C & Partners G81027
Dr Williams & Partners G81050
Dr Miller & Partners G81056
Dr Pearce & Partners G81059
Dr Brown R D & Partners G81049
Dr Eyre & Partners G81003
Dr Simmons G81634
Dr Barnes M H & Partners G81029
Eastbourne Station Health Centre Y02816
Green Street Clinic G81032
Dr Adoki & Ptnr Y00080
No treatment Exceptions reported
Some data on outcomes for people with
cardiovascular disease
84 CVD Intelligence packs
85 CVD Intelligence packs
Graph
Hospital admissions for myocardial infarction for all ages 2002/03 – 2012/13
In NHS Eastbourne, Hailsham And
Seaford CCG, the hospital admission
rate for myocardial infarction in
2012/13 was 561.4 (1,253
admissions) compared to 575.1 for
England
Source: Hospital Episode Statistics (HES), 2002/03 - 2012/13, Copyright © 2015, Re‐used with the permission of The Health and Social Care
Information Centre. All rights reserved
0
100
200
300
400
500
600
700
800
900
1,000
2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/13
Age s
tandard
ised r
ate
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England
86 CVD Intelligence packs
Graph
Hospital admissions for stroke for all ages 2002/03 – 2012/13
In NHS Eastbourne, Hailsham And
Seaford CCG, the hospital admission
rate for stroke in 2012/13 was 155.3
(386 admissions) compared to 179.1
for England
Source: Hospital Episode Statistics (HES), 2002/03 - 2012/13, Copyright © 2015, Re‐used with the permission of The Health and Social Care
Information Centre. All rights reserved
0
20
40
60
80
100
120
140
160
180
200
2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
Age s
tandard
ised r
ate
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England
87 CVD Intelligence packs
Graph
Additional risk of complications for people with diabetes, three year follow up, 2012/13
The risk of a stroke was 48% higher
and the risk of a heart attack was
56.4% higher compared to people
without diabetes. The risk of a major
amputation was 360.2% higher.
Note: This slide uses data from the
National Diabetes Audit (NDA)
293.0%
753.5%
445.8%
81.3%
150.0%
108.6%
136.8%
344.6%
550.0%
360.2%
48.0%
137.6%
56.4%
113.9%
0% 100% 200% 300% 400% 500% 600% 700% 800%
RRT
Minor amputation
Major amputation
Stroke
Heart failure
Heart Attack
Angina
NHS Eastbourne, Hailsham and Seaford CCG England
88 CVD Intelligence packs
Graph
Deaths from myocardial infarction, under 75s
In NHS Eastbourne, Hailsham And
Seaford CCG, the early mortality rate
for myocardial infarction in 2010-12
was 37.1 (an average of 66 deaths a
year) compared to 45.1 for England
Source: Office for National Statistics (ONS) mortality data 2002 - 2012
Note: The early mortality rate for 2010-12
is an average of the early mortality rates for
2010, 2011 and 2012.
0
10
20
30
40
50
60
70
80
90
2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12
Age s
tandard
ised r
ate
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England
89 CVD Intelligence packs
Graph
Deaths from stroke, under 75s
In NHS Eastbourne, Hailsham And
Seaford CCG, the early mortality rate
for stroke in 2010-12 was 13.7 (an
average of 23 deaths a year)
compared to 14.8 for England
Source: Office for National Statistics (ONS) mortality data 2002 - 2012
Note: The early mortality rate for 2010-12
is an average of the early mortality rates for
2010, 2011 and 2012.
0
5
10
15
20
25
30
2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12
Age s
tandard
ised r
ate
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England
90 CVD Intelligence packs
Appendix
Data sources
• Quality and Outcomes Framework (QOF), 2012/13 and 2013/14, Copyright © 2015, re-used with the permission of the
Health and Social Care Information Centre. All rights reserved
• Active people survey, Sport England, 2012 and 2013
• East of England Public Health Observatory modelled estimates 2011
• CKD Prevalence model, G.Aitken, University of Southampton
• Diabetes Prevalence model, National Cardiovascular Intelligence Network
• NHS Stop smoking services Copyright © 2014, Health and Social Care Information Centre
• NHS Health checks, 2013/14
• Norberg J, Bäckström S , Jansson J-H, Johansson L. Estimating the prevalence of atrial fibrillation in a general population
using validated electronic health data. Clin Epidemiol 2013 ; 5 475 – 81.
• National Diabetes Audit, 2012/13
• Hospital Episode Statistics (HES), 2002/03 - 2012/13, Copyright © 2015, Re‐used with the permission of The Health and
Social Care Information Centre. All rights reserved
• Office for National Statistics (ONS) mortality data 2002 - 2012
91 CVD Intelligence packs
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