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Prescribing Support Unit ‘Shadow Information Centre’

Prescribing Support Unit ‘Shadow Information Centre’. Dave Roberts Unit Manager. Prescribing Support Unit. Founded in 1996 Hosted by Leeds Health Authority West Yorkshire Strategic Health Authority Six full time staff Policy and Analytical Unit for the DH Liaison role with the NHS

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Prescribing Support Unit ‘Shadow Information Centre’

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  1. Prescribing Support Unit‘Shadow Information Centre’ Dave Roberts Unit Manager

  2. Prescribing Support Unit • Founded in 1996 • Hosted by • Leeds Health Authority • West Yorkshire Strategic Health Authority • Six full time staff • Policy and Analytical Unit for the DH • Liaison role with the NHS • Close ties with • Prescription Pricing Authority (PPA) • National Prescribing Centre (NPC)

  3. Prescribing Agenda • Resource Allocation • Forecasting the drugs bill • Policy issues • Quality assessment • Teaching/Training

  4. Health and Social CareInformation Centre December 2004

  5. Current Issues • Too great a demand on the ‘front line’ • No national focus for information & knowledge management in clinical AND social care • Does existing information really focus on what matters? • A ‘vision’ for information • Sir Ian Kennedy - Bristol Royal Infirmary Inquiry report • Sheila Leatherman - The Quest for Quality in the NHS • NHS Confederation The Response Creation of the Health and Social Care Information Centre

  6. Arm’s Length Body Review • Reduction in numbers of ALBs from 38 to 20 • Reductions in Posts by 25% by 2007-08 • Savings in expenditure of 10% by 2007-08 • ALBs will be expected to relocate away from South & East (Lyons Review)

  7. Arm’s Length Body Review • Reports - Reconfiguring the Department of Health’s Arm’s Length Bodies and NHS Improvement Plan • Creation of the Information Centre as a Special Health Authority • Consisting of: • ‘Information’ elements of the NHS Information Authority (NHS IA) • Statistics & information policy functions of the Department of Health (DH) • IC to operate in shadow form until31 March 2005 • Chairman and board appointments will be made as soon as possible • 1 April 2005 – organisation established • Headquarters in Leeds

  8. What is the Information Centre? Purpose: “to improve the quality and use of information and knowledge for the benefit of patients and service users” • A joined-up system for health and social care information • Provides national leadership and focus for data and information • Is driven by wishes & requirements of those in the system • Works with all parts of the Health and Social Care System and NPfIT

  9. Scope for the Information Centre NPSA Politicians Policy teams Social Care Commission (CSCI) Public Health Royal Colleges Central Government Users Healthcare Commission Service Users Public Families Clinicians Local Local SHA Social care Individuals Organisations Registries Professionals NHS Trusts Managers Carers Local Authorities

  10. Key areas of work • Regulation and co-ordinationof information requirements • Mandating data collections and setting standards • Co-ordinating data collection across regulators/inspectors/others • Provision of information and knowledge management services i.e. collection, development, dissemination, standards, analysis, strategic information management • Acting as an agent to improve the scope, quality and use of information for the benefit of patients and service users and their care • National focus for education, training and development for information management

  11. Benefits • Reduced bureaucracy and waste • Easy, timely access to data sources, information and knowledge • Improved accuracy, scope, quality and use of information and knowledge for the good of patient care • Patient-focused • Integrated information • Service improvements can be evidence based • Increased support and development of health informatics staff • Add value to the investment in technology led by NPfIT

  12. Prescribing Data

  13. Prescribing Indicators - who needs them? • Department of Health for performance management and monitoring of NHS • SHAs to performance manage and support PCTs • PCTs to help identify issues for discussion with practices • PCTs for local monitoring e.g. prescribing incentive schemes • Healthcare Commission, National Patient Safety Agency, NICE

  14. Prescribing Indicators • Publication of Audit Commission report ‘A Prescription for Improvement - Towards More Rational Prescribing’ (1994) • PRU asked to produce a set of prescribing indicators (1995) • To be populated from prescription data • To benchmark HAs

  15. Cost per PU of Drugs of Limited Clinical Value • These preparations have only limited effectiveness and should be used sparingly • BNF classification - less suitable for prescribing

  16. Universal comparativeindicators Data source PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Prescribing Indicator HA/PCT Monitoring

  17. Using prescribing units Rather than use the number of patients we often use the total number of “prescribing units”, obtained by weighting the number of patients in different age and sex categories and adding these together. There are several different sort of units available

  18. ASTRO-PUs Age Sex Temporary Resident Originated Prescribing Units

  19. ASTRO(97)-PU cost weights

  20. STAR-PUs Specific Therapeutic group Age/sex Related Prescribing Units

  21. Weightings forCV STAR-PU

  22. Universal comparative indicators Weighted denominators e.g. ADQ/STAR-PU Data source PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Comparable Drug Utilisation e.g. Ulcer healing drugs Prescribing Indicator PCT Prescribing Lead HA/PCT Monitoring

  23. Prescribing indicators • Antibacterials • Items per STAR-PU • NIC per item • Ulcer healing drugs • ADQs per STAR-PU • NIC per ADQ • Oral NSAIDS • ADQs per STAR-PU • NIC per ADQ

  24. Prescribing Toolkit • Data at StHA, PCT and practice level • Available quarterly • Electronic prescribing information system provided over NHS net to: DH, PSU, StHAs, and PCTs • 12 prescribing indicators • 50+ comparators

  25. Universal comparative indicators Weighted denominators e.g. ADQ/STAR-PU GP Clinical Systems data e.g. QMAS Disease Management e.g Patients heart failure receiving ACE inhibitor Comparable Drug Utilisation e.g. Ulcer healing drugs PCT Prescribing Lead PCT Clinical Governance Lead Data source PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Prescribing Indicator HA/PCT Monitoring

  26. Quality and Outcomes Framework GMS contract

  27. Rewards for Quality • £1.3bn for the UK for quality in GMS and PMS • Non-discretionary • In addition to the global sum • Payment for what many already do • Work converts to points; points to payment • 1050 maximum points • Modified by prevalence • Modified by list size

  28. Quality Points Available • Clinical indicators: 550 • Patient experience: 100 • Organisational indicators: 184 • Additional services: 36 • Other: 180 • Total: 1050

  29. Quality points – Secondary prevention of CHD • register6 • patients with newly diagnosed angina who are referred 7 • patients with record of smoking 7 • patients who have been offered smoking cessation advice 4 • patients with record of BP 7 • patients with BP < 150/90 19 • patients with record of cholesterol 7 • patients with total cholesterol < 5 16 • patients on anti-platelet therapy or anti-coagulant 7 • patients on beta blocker 7 • patients on ACE inhibitor 7 • patients with influenza immunisation 7

  30. Quality Management and Analysis System • QMAS is national IT solution to support QOF payments to practices • Extraction of practice indicator data to national QMAS database • Computation of practice scores • Application of list size and prevalence adjustment factors • Feedback for practices, PCTs and SHAs • Informs practice payment systems (NHAIS)

  31. Automated GP Practice “Manual” Achievement data from clinical system BACS Payment Other achievement data – web interface QMAS Central Server NHAIS Confirm Achievement Payment Agency PCT QMAS – Inputs and Outputs

  32. Potential Secondary Users • DH branches (eg NSFs, finance) • NHS Bank (QOF risk management) • Healthcare Commission • Public health organisations • NICE • Academic researchers

  33. Potential Secondary Uses of QMAS Data (1) • Support surveillance and screening by Healthcare Commission. • Support new resource allocation methodologies • Support monitoring by public health organisations and integration of epidemiology in service planning and delivery • Facilitation of the Research and Development arm of the new Information Centre at the DH • Resource allocation, forecasting and monitoring for primary care drugs bill

  34. Potential Secondary Uses of QMAS Data (2) • Analysis of disease prevalence • Monitoring of the gross investment guarantee • DH and NHS Bank monitoring and risk management of primary care finance • DH implementation of QOF, eg analysis of exception reporting • DH monitoring of NSFs • Medicines management and clinical governance

  35. Introduction to QPID Quality, Prevalence and Indicator Database

  36. Why QPID? • To make QMAS data available to a wider set of potential users in DH and NHS • To enable access to QMAS data without affecting scope of QMAS project • To provide analytical support around flexible access to QMAS data – no requirement for QMAS developers to deliver additional reporting tools • National analysis (eg prevalence)

  37. Who is Developing QPID? • Prescribing Support Unit (PSU) on behalf of DH and in collaboration with NPfIT • PSU will be part of new Health and Social Care Information Centre (IC), and is based in Leeds • QPID project team drawn from PSU staff • PSU will host the QPID database • Web: www.psu.co.uk

  38. Project Structure • Project Board (representation from IC, DH Policy, NPfIT, NHS) • Project Team • Project Management • User Issues • Technical Issues • Analytical Issues • Gateway Committee

  39. QPID Project Stages • Stage 1 (to April 2005): establish QPID database and develop analytical and user processes • Stage 2 (from April 2005): implement analysis service for QPID users • Note the need to prioritise delivery to users in early post-implementation phase

  40. Accessing QPID Data • Users inform QPID team of high level requirements, and proposed use of data or information from QPID • User request considered by QPID Gateway Committee • Approved requests lead to detailed user specifications • QPID team and user sign agreement on provision and use of data before delivery

  41. Access Criteria • Publication strategy will take account of freedom of information legislation • Criteria for release of data: • PCT-level data available to all? • Practice data only to be released as anonymised data (relevant PCTs can be identified)? • Protection for small numbers for some conditions at practice level. • Other criteria?

  42. Conditions for Release of Data • Conditions of release to be drafted and agreed with users. • To be informed by good practice, such as conditions around release of HES data, eg: • Users must not pass raw data on to third parties. • Agreement on internal use or publication.

  43. Charging for Users? • Charging policy to be determined ahead of analysis service launch in April 2005 • Some information to be published free of charge by IC • Project to determine level of requests that can be met free of charge • Project to determine charging for substantive pieces of work • Charging to cover marginal analysis costs, not data collection

  44. Smoking Indicators in QOF • For CHD, stroke, hypertension, diabetes, COPD and asthma, there is QOF reporting (points) for: • Recording of smoking status (usually in last 15 months) • A record of smoking cessation advice given (usually in last 15 months)

  45. Smoking Indicators in QOF • QOF points available for recording of smoking status of all patients aged 15-75: • Indicator ‘Records 10’ requires 55% • Indicator ‘Records 16’ requires 75% • QOF points available if practice has a strategy to support smoking cessation, including literature and therapy (‘Information 5’)

  46. Obesity in QOF • No specific obesity indicators except recording of BMI for diabetes patients • But contract notes that obesity is a significant risk for CHD and hypertension patients, and expects annual assessment • Of lifestyle risks such as obesity, alcohol, inactivity and smoking, contract reporting focuses on smoking

  47. Contact • Potential users of QPID data should contact Dave Roberts at PSU to discuss potential high level requirements • dave.roberts@westyorks.nhs.uk

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