Primary Care Data 2

1. Primary Care Data 2 Shelley Bradley, EMPHO Adapted from slides produced by Jacq Clarkson, Somerset PCT May 2008

2. Outline • Public Health Data • Brief descriptions (and health warnings!) • Practice profiles

3. Public Health Data • Populations (including Births) • Deprivation • Hospital activity • Mortality • Immunisations • Lifestyle • Screening • Prevalence • …

4. Populations • Denominators for rates • From GP lists, Census, ONS estimates and projections • Used for planning (eg Projecting Older People Population Information System POPPI) • Resource allocation units • Births (midwives, school intake, immunisations) • ASTRO-PUs (adjusted population numbers to act as denominators for prescribing activity)

5. Populations ASTRO-Pus (population adjusted for age and sex as base for prescribing data) Population

6. Mortality data • Every death is required by law to be registered. • Public Health Mortality File Data is distributed monthly and annually • Database containing information about deaths within different health authority boundaries. • It also includes details about people who died outside the health authority region in which they were normally resident. • Information is included on underlying cause of death , age and sex and home location. • Postcodes included can be aggregated to any geographical level, and rates can be calculated for specific areas, diseases and populations. • Does not include data for those outside the area.

7. Admissions data • Every person who is admitted to a hospital has information recorded about their stay.  • Hospital Admissions data includes information on diagnosis, operations, location, length of stay, age, sex, admission and discharge method. • The data is submitted to the Secondary Uses Service (SUS), which, as well as forwarding it to the commissioners, also copies the information to a database • At pre-arranged times during the year, SUS takes an extract from their database and sends it to HES. • Data on SUS will continue to change, but HES data is fixed as it was when that particular extract was taken. • Replaces the Contract Minimum Data Set (CMDS)

8. Admissions data- example

9. Prescribing data • PACT ( electronic Prescribing Analysis and Cost (ePACT.net)) • A service which allows real time on-line analysis of the previous sixty months prescribing data. • Data is updated on a monthly basis (5 weeks after the dispensing month) and can be selected according to: • Reporting period (i.e. month, quarter, year), • Prescribing organisation (e.g. practice, PCT) • BNF classification (chapter to presentation level) • Controlled drugs tag. • No individual patient details such as age, sex and postcode are available. • www.ppa.org.uk/education/measpres.htm gives a good outline on how this data can be used.

10. Prescribing data- example

11. Immunisations • Routinely recorded using COVER (Cover of Vaccination Evaluated Rapidly) • Recent change in schedules • Flu Vaccinations for those aged 65 and over and those with conditions putting them at risk from flu • Decline in MMR uptake following concerns over its safety. But if less than 95% of children are immunised against measles outbreaks will occur (concept of herd immunity) • PCT rates available from www.hpa.org.uk

12. Immunisations-example

13. Practice based commissioning (PbC) • A policy that aims to give more influence and control to GP practices in England over how money is spent on health care • PCTs are required to produce an information pack to help with the process • This should be from the public health perspective and not purely the financial • Hence the pack should present indicators that are meaningful, easy to understand and highlight inequalities the practice might want to address www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Practice-basedcommissioning/DH_4127126

14. PbC – what might go in the pack • Consult the users (but have a mock-up to work from, containing the sorts of indicators we have already talked about) • A comparison with the rest of the practices but preserve anonymity • A mechanism or text to help understanding (eg a flowchart of how to read the tables and graphs)

15. PbC - what might be done with the pack • Trial the “final” version with a pilot group of sites • From practice comments see what is still missing and if possible incorporate it • Identify commonality and report back to PCT commissioners (eg Falls Service needed, or Migrant workers not being routinely screened) • Encourage practices to do their own analysis, but be prepared to help! • Send routinely to practices (annually?)

16. Practice based commissioning-example • Derbyshire County PCT, produced profiles by practice and consortia (groups of practices) • Profiles created for each practice by different conditions e.g CHD, stroke, cancer • Also each indicator looked at across all practices in the PCT • Indicators used include; Qof, admissions, mortality and population data • Online tool on the PCT website

17. Practice profile for coronary heart disease

18. Practice profile for coronary heart disease

19. Practice Profiles limitations • The range of indicators included in packs will vary by PCT, as both the accessibility and quality of available indicators will be different for each PCT. • However it is likely that access will improve with the new SUS system settling down and the requirement for the collection of primary care information to inform National Service Framework performance monitoring.

20. Other resources for primary care Provides a useful document with and details of website with relevant information www.primary-care-db.org.uk

21. Other resources for primary care • User’s Guide to Data Collected in Primary Care in England: www.erpho.org.uk/Download/Public/12899/1/erpho%20Primary%20Care.pdf • Reports on: www.healthknowledge.org.uk/Health%20Information/HK%203c1.htm • London Health Observatory produce a quarterly report for each PCT, which monitors a range of indicators such as take up of screening services, immunisation uptake, participants in smoking