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High Blood Pressure in General Practice: Variation and Opportunities Liverpool CCG (v11)

High Blood Pressure in General Practice: Variation and Opportunities Liverpool CCG (v11). 5 th March 2019. NHS RightCare Intelligence: ‘Similar 10’ Methodology.

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High Blood Pressure in General Practice: Variation and Opportunities Liverpool CCG (v11)

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  1. High Blood Pressure in General Practice: Variation and OpportunitiesLiverpool CCG (v11) 5th March 2019

  2. NHS RightCare Intelligence: ‘Similar 10’ Methodology The NHS RightCare data packs compare a CCG to its 10 most demographically similar CCGs. Since most health conditions are linked to factors such as deprivation and age, NHS RightCare compares systems to their closest demographically similar geographies. This is to provide realistic comparisons, taking into account the need for healthcare of different populations. Also included are some examples of how your CCG benchmarks against neighbouring Cheshire and Merseyside CCGs. It should be noted that these packs were produced using readily available data and analysis. For this reason, relevant time periods are not consistent throughout and this will explain some discrepancies observed. However, it is anticipated that the overall findings will not have varied significantly over the short time periods involved.

  3. How to interpret the RightCare variation charts The chart at the top shows a national distribution of CCGs ranked from lowest value to highest value, left to right. The chart at the bottom shows each chosen CCG and the % variance from the lowest similar 5 CCGs. Red indicates an apparent unwarranted variation. Blue indicates that local interpretation is required

  4. National Ambitions for High Blood Pressure

  5. In this Liverpool High Blood Pressure data pack • Opportunities • Improve Care & Quality • Improve Health & Wellbeing • Variation • Between CCGs • ‘Similar 10’ • C&M CCGs • Within own CCG • Practice level data High BP data Detection/ diagnosis (prevalence) Treatment and control (including prescribing costs & local insights) Impacts of high BP (medical complications, hospital admissions, deaths, spend) Lifestyle factors (smoking, alcohol, obesity, physical inactivity)

  6. Detection and Diagnosis of High Blood Pressure in Liverpool CCG

  7. How much hypertension is diagnosed? (C&M CCGs compared)

  8. What proportion of actual high BP is known?

  9. Practice-level identification of high BP (Observed/ expected prevalence, 2016/17) Source: Cardiovascular Disease Primary Care Intelligence Packs. Public Health England. November 2018 * fingertips.phe.org.uk/profile/cardiovascular-disease-primary-care * The latest Primary Care Intelligence Packs do not include observed vs expected hypertension prevalence. These will be updated when a refreshed version of the hypertension prevalence model becomes available

  10. BP checks in last 5 years (C&M CCGs compared) Good coverage of BP testing but diagnosis gap remains - Why?

  11. Meeting the national ambition for detection (80%) Liverpool CCG need to find / diagnose a further 26,090 patients to meet the national ambition of 80% by 2029

  12. Opportunities for Liverpool: BP detection and diagnosis Case-finding: • Estimated number with undiagnosed high BP (British Heart Foundation, 2016/17)50,350patients • To meet national ambition of 80% detection by 2029 Liverpool needs to find 26,090 patients If reported prevalence increased by 1% • Liverpool would have an additional 5,328 patients on the hypertension register If reported prevalence increased to the level of similar CCGs (NHS RightCare Reported to Estimated Prevalence, 2017/18) • the hypertension register would increase by 2,552 patients

  13. Management and Control of High Blood Pressure in Liverpool Controlling high BP ‘to target’ Prescribing spend Other measures of quality BP care

  14. Measuring how well BP is controlled • Quality and Outcomes Framework (QoF): • Source of routinely available data but underestimates the scale of the challenge • Current QoF target BP is <150/90mmHg but plan is to align QoF with NICE BP targets • National Institute for Health and Care Excellence, NICE (‘gold standard’): • BP target lower at <140/90mmHg (varies with co-morbidities/age 80+) • Series of auditable NICE Quality Standards • Performance against NICE guidelines: Patchy knowledge • National Ambitions for high BP (launched Feb 2019) • Ambition: 80% known BP patients treated to NICE targets by 2029 • Nationally ~56% known BP patients treated to NICE targets • In Liverpool CCG ~41,000 known BP patients estimated to be treated to NICE targets • To meet the national ambition Liverpool CCG needs an estimated ~17,600 additional BP patients to be managed to NICE BP targets over the next 10 years

  15. BP control to QoF target (C&M CCGs compared)

  16. BP Control: Comparing Liverpool with 10 similar CCGs

  17. % High BP patients not managed to <150/90mmHg(by practice) Using QOF 17/18 Source: Cardiovascular Disease Primary Care Intelligence Packs. Public Health England. February 2019 fingertips.phe.org.uk/profile/cardiovascular-disease-primary-care

  18. Other measures of Quality: Local insights into common areas of variation and uncertainty Control QoF (150/90) vs NICE (140/90) targets Diagnosis Use of Ambulatory/ Home BP Monitoring Recording of stage 1 hypertension New patient Investigations Assessment for target organ damage: • Blood tests • Urine • Eyes • ECG Management • Lack of equipment   • Investigation of <40’s • Assessing CVD/Q risk • Lifestyle advice • Setting BP targets • Recall methodology • Annual review content • Exception reporting Coding: Notstandardised Practice-level data: unaware of performance/benchmarking Skill mix and workforce development in general practice Models of care: working with system partners, capacity-building

  19. Primary care prescribing: High blood pressure and cholesterol medications

  20. Liverpool Primary Care Prescribing Spend: BP medication (Spend is often preventative spend)

  21. Liverpool Primary Care Prescribing Spend: CHD

  22. Liverpool Primary Care Prescribing Spend: Stroke

  23. Statin prescribing for high CVD risk BP patients (C&M CCGs compared)

  24. Opportunities for Liverpool: BP treatment & control • Improve control of known BP patients: • To meet the national ambition of 80% control by 2029, Liverpool CCG needs an estimated ~17,600 additional BP patients to be managed to NICE BP targets • If Liverpool CCG matches performance of similar CCGs (high BP control to current QoF target) 446more patients will be controlled to 150/90mmHg • Reduce practice-level variation in control: • % patients not controlled to 150/90mmHg ranges from 7.5% to 38.6% • Address issues highlighted locally regarding variation and uncertainty in BP care

  25. Impacts of High BP On PatientsOn Services

  26. The National Cost of High Blood Pressure

  27. Coronary Heart Disease Prevalence

  28. Coronary Heart Disease Admission Rate (C&M CCGs compared)

  29. CHD Inpatient Spend and Bed Days

  30. CHD Premature Mortality Rate (C&M CCGs compared)

  31. Atrial Fibrillation (AF) Prevalence

  32. Inpatient Bed Days for Abnormal Heart Rhythm

  33. Stroke Prevalence

  34. Stroke admission rates (C&M CCGs compared)

  35. Stroke spend and bed days

  36. Premature stroke mortality (C&M CCGs compared)

  37. Chronic Kidney Disease Prevalence

  38. Dementia Prevalence

  39. Opportunities to Make Every Contact Count (MECC) in general practice

  40. Adult Obesity in Liverpool (compared with C&M CCGs)

  41. Adult obesity prevalence

  42. Adult Smoking Prevalence (compared with C&M CCGs)

  43. Adult Smoking Prevalence

  44. Alcohol-specific admissions

  45. Physically inactive adults

  46. High Blood PressureKey Opportunities for Liverpool CCG Improve care quality (diagnosis & control)Improve health and wellbeing

  47. Opportunities to improve Care Quality Improve detection & diagnosis Estimated number with undiagnosed high BP (British Heart Foundation, 2016/17)50,350patients To meet national ambition of 80% detection by 2029 Liverpool needs to find 26,090 patients Reduce practice-level variation in detection (varies from 26% to 66%) Improve treatment to target (Control) To meet the national ambition of 80% control by 2029, Liverpool CCG needs an estimated ~17,600 additional BP patients to be managed to NICE BP targets If Liverpool CCG matches performance of similar CCGs (high BP control to current QoF target) 446more patients will be controlled to 150/90mmHg Reduce practice-level variation in % patients not controlled to 150/90mmHg (ranges from 8% to 39%)

  48. Opportunities to improve Health & Wellbeing Reduce lifestyle risk factors Lifestyle factors contributing to high BP and CVD risk are common, e.g. Harmful alcohol intake Smoking Obesity Prevent complications of high BP Prevalence of CKD and dementia are higher than similar CCGs Prevent early deaths Premature mortality rate is higher than national average for stroke and CHD

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