PRIMIS in Partnership: Cambridgeshire Hertfordshire

1. PRIMIS in Partnership: CambridgeshireHertfordshire Dawn Friend and Trish McHugh Gloria Wilkie

2. Working collaboratively in Peterborough! Dawn Friend, Primary Care Information Manager Trish McHugh, Primary Care Collaborative Manager Greater Peterborough Primary Care Partnership

3. Greater Peterborough Primary Care Partnership (GP PCP) • South Peterborough PCT • 14 practices • North Peterborough PCT • 18 practices • Now GP PCP, a ‘merged management team’ (Jan 2003) along with Adult Social Care

4. PRIMIS in Peterborough • Started 2000 (Cambridgeshire project) • All 32 practices participating • Early focus on CHD, diabetes, asthma • Recommended Read codes • Agreed templates & audits • nww.cambsprimis.nhs.uk

5. What is the National Primary Care Collaborative (NPCC) ? • 1st National Primary Care Development Team (NPDT) programme • Delivering improvements to primary care access (using the Advanced Access model) and the management of people with established CHD • Launched June 2000, with 80 PCTs initially selected • Now over 5000 practices engaged covering >31 million patients • Largest health quality improvement programme in the world

6. South Peterborough Phase I site Joined Mar 2001, with 5 core practices 4 ‘spread’ practices signed up Jan 2002 Trish joined as Project Manager Oct 2002 North Peterborough Phase II site Joined in 2002 with 4 core practices 4 ‘spread’ practices now signing up Trish recently taken over the management of this phase NPCC in Peterborough

7. IS Practical Pragmatic Focussed IS NOT Time-consuming Academic Elaborate Measurement in NPCC Measurement for learning, not measurement for judgement PDSA cycles

8. CHD measures (Phase I) • Aspirin: % CHD patients on aspirin including OTC (unless contraindicated) • Statins: % CHD patients under 75 that have a cholesterol > 5mmol on statins (unless contraindicated) • Beta-blockers: % CHD patients has an MI in past 12 months on beta-blockers (unless contraindicated) • BP: % CHD patients with a BP < 140/85

9. Lessons learnt from Phase I pilot • 5 pilot practices’ CHD measures • very variable results - different practices, different searches • guidance tricky to interpret, searches tricky to build • Not comparable with PRIMIS CHD data • eg MI & beta blockers • Too late to help standardise for pilot • NPCC emphasis on improvement

10. Phase I ‘spread’ & Phase II CHD measures • Got in early • Sat down together • Reviewed NPDT guidance • Not so straightforward!

11. Phase I vs. Phase II • Different reporting systems and deadlines • Changes in data measures • BP Phase I <140/85 Phase II <150/90 • Statin Phase I <75s only Phase II all ages

12. Phase I ‘spread’ & Phase II CHD measures • Dawn produced ‘crib sheet’ • Suggested search criteria • Read codes • Exception codes (contraindicated/declined etc)

13. CHD ‘crib sheet’

14. Out in the practices • Help to set up system searches • to produce CHD measures • to target patients! • Review Read coding • Update CHD templates • Helpful tools - calculator

16. Working together on CHD • Joint CHD meetings in all practices • PRIMIS CHD feedback • Collaborative measures • Specialist nursing team • Identify & discuss recording, coding, organisational, staffing issues and support needs in one meeting

17. Ongoing support for Phases I & II • Evolving searches for CHD measures • new Read codes • Practices wanting to expand their recording • not indicated, not tolerated • Rolling along nicely… and then…

18. … Phase III !

19. Phase III site allocation Pilot involves 20 PCTs and over 100 practices

20. Phase III • Focus on Diabetes and Chronic Obstructive Pulmonary Disease (COPD) • Baseline data September 2003 • 4 Diabetes measures and 3 COPD • Rolling out to every PCT in 2004…

21. Phase III measures Diabetes • % of people with diabetes with a last recorded HbA1c of <7.5 within the previous 12 months • % of people with diabetes with a last recorded cholesterol reading of <5 mmol within the previous 12 months • % of people with diabetes with a last recorded BP reading of <140/80 within the previous 12 months • % of people with diabetes with a retinopathy screening recorded within the previous 15 months COPD • % of COPD patients who have received spirometry to confirm diagnosis • % of COPD patients with smoking status recorded within previous 12 months • No. of acute admissions for respiratory illness in COPD patients in the previous 12 months

22. Partnership working for Phase III • Early and ongoing communication • Interpreting NPDT guidance

23. NPDT guidance for COPD (example) • How do I measure the % of COPD patients who have received spirometry to confirm diagnosis? • Using the COPD register, count the number of patients identified as having received spirometry andthen calculate this as a percentage of the total number of patients on the COPD register. • We suggest the use of the following READ codes to populate the COPD register: H36., H37., H38., together with H3z. for those for whom it may be difficult to carry out a spirometry on such as the elderly, housebound, those with poor technique and those with a severe disability.

24. Identified potential coding issues • COPD register “We suggest the use of the following READ codes to populate the COPD register: H36., H37., H38., together with H3z. “ • Different to nGMS at the time • Spirometry recording • No Read code for COPD admission • Diabetes HbA1c results • Batch data conversions to cope with local PMIP changes

25. Partnership working for Phase III • Early and ongoing communication • Interpreting NPDT guidance • Identified potential coding issues • Created Phase III ‘crib sheet’ & calculator

26. Phase III ‘crib sheet’

28. Visits to Phase III practices • Dawn & Trish • Help to set up searches • Validate baseline measures • Discuss coding issues • Build a COPD template • Raise Trish’s awareness

29. Working together works well! • Pooling knowledge/skills • Good registers, recording, templates in place (headstart for nGMS!) • Linking in to PRIMIS training & support • “I know a man who can”…

30. Working together – practice example • Practice reverted to manual trawl for figures. “BP <140/80 search not right”. 31 pats, not 20. • Dawn met with practice nurse to investigate. Checked search – seemed to be fine • So why the different results? BP target is less than 140/80 (20 pats) not less than or equal to 140/80 (31 pats) • Information management - PRIMIS

31. Practice example: PDSA cycle for data quality check

32. Diabetes measures

33. COPD measures

34. Thank you… Questions??? Dawn Friend & Trish McHugh Greater Peterborough Primary Care Partnership dawn.friend@greaterpboropcp.nhs.uk nww.cambsprimis.nhs.uk trish.mchugh@greaterpboropcp.nhs.uk www.npdt.org

35. DQ STRATEGY IN HERTS Gloria Wilkie Project Development Manager Hertfordshire Health Informatics Service

36. DQ STRATEGY IN HERTS • Heart of strategy to modernise the NHS ~ effective use of information management & IT • LIS - Information for Health Programme • Aims & Role of PRIMIS in Herts: • Extend level of usage, quality and consistency • Improve patient care • Facilitate effective data for health promotion, clinical audit, clinical governance, referral monitoring, Himp targets • Assist in meeting NSF standards and reporting

37. HERTS DISEASE PREVALENCE DATA 02/03

38. IHD PREVALENCE IN HERTS 02/03

39. AIMS OF DQ STRATEGY IN HERTS • Continue to extend levels of usage • New ways of developing & sharing data • Improve holistic approach to patient care using integrated information technology • Guide PCTs & Practices in effective use of data • Assist PCTs to meet national standards & GMS 2 • Set up clearly defined progress reporting structures

40. Secure Funding Develop Plan to share Meet with PCTs Agree 2 year DQ strategy Set DQ targets Develop standards Investigate new solutions Incorporate DQ/EPR/ICRS Review DQ NSF targets Pilot PCO clinical and managed service solution Review Year 1 ACTION PLAN

41. Identifying PCT Lead Duplication/Triplication Information gathering Retaining DQ Facilitators Streamlining collection Information Security Training Raised levels of awareness Initiated clinical & management discussion Highlighted need for PCT responsibility/resource NSF DQ Initiatives PCT Strategies & Action Plans developed ISSUES PROGRESS

42. Improvement in patient care through the effective use of information technology Practice and PCT audit and review of the quality of care provided Integrated planning of services Support for the Health Improvement Programme Monitoring trends in disease incidence and prevalence OUTCOMES & BENEFITS

43. OUTCOMES & BENEFITS • Locally sensitive commissioning • Improving the effectiveness of NSF reporting and clinical audit • Usenew GP contract to engage practices • Setting up clearly defined reporting structures

44. WHO IS COLLECTING? PRIMIS PRESCRIBING ADVISER CHD COLLABORATIVE DIABETIC NURSE ACCESS FACILITATOR AUDIT OFFICER WHAT IS BEING COLLECTED? HOW IS IT BEING COLLECTED? WHAT IS DATA USED FOR? FOR WHOM? HOW OFTEN? PCT DATA FLOWS

45. DEVELOPMENT DAY

46. DEVELOPMENT DAY

47. THE FUTURE • INCORPORATE A DQ STRATEGY AS AN ESSENTIAL COMPONENENT IN PLANS FOR ACHIEVING ……….

48. TARGET FOR THE FUTURE • 2008 EPR AND INTEGRATED CARE RECORDS SERVICE

49. DQ IN HERTFORDSHIRE CONTACT gloria.wilkie@his-herts.nhs.uk Tel: 01707 390855 extn 2084