1. Brighton and Hove PPMA Preventing Premature Mortality Audit Dr James Simpkin Clinical Facilitator BHPPMA james.simpkin@nhs.net

2. Background Method Findings Summary New services & changes to practice < 75years – CVD – Stroke – COPD – Diabetes Aim: Identify modifiable factors Focus resources Target preventable deaths

3. Method All GPs in B&H Electronic data Clinical review – GP – Patient specifics/factors – Detail/’fill the gaps’ Age < 75 651 ONS Deaths 603 (93%) B&H Resident 569 (87%) Electronic Data 503 (77%) Clinical Review

4. Deeper understanding Highlighted recurrent themes Linked the statistics with real lives Explored complexity of patients medical care Offered explanation not seen by data extraction

5. Results – Themes Alcohol Cancer & lung cancer Isolated/ vulnerable Missed opportunities End stage disease Multi-morbidity Obesity Smoking Sudden deaths Mental health

6. Smoking High smoking prevalence Premature deaths more marked with current smokers Low uptake of smoking cessation Small number receiving NRT Link with alcohol

7. Sudden death Cardiovascular and cerebrovascular events Cancer & lung cancer Aggressive nature of lung cancer Majority with COPD  Preventable risk factor = SMOKING

8. Alcohol misuse Median age of death lower Poor coding for alcohol misuse Missed opportunities – Referral – Brief intervention Links with – Multimorbidity – Smoking – Mental health

9. Mental health Depression Overlap with isolation, smoking (>50%), alcohol misuse

10. Vulnerable and isolated patients Complex physical, social, emotional factors Infrequent attenders – high levels of telephone or home visit contacts Mental health, multimorbidity, smoking (>40%), alcohol problems High exception reporting

11. Multi-morbidity High prevalence ≥2 organ disease – diabetes & CKD Complex pts in 1 ary care Mental health & isolation End stage disease Poor recognition of end stage disease – heart failure – COPD – renal failure Multiple admissions Inadequate advanced care planning

12. Obesity 61% overweight/obese Severe & morbid Comorbidity – diabetes – CVD Missed coding & therapeutic opportunities Incorrect diagnosis/coding – poor recall/follow up – impact on optimisation of treatment

13. Summary Clustering of themes Smoking Hard to reach patients Complexity Coding and exception reporting

14. New Locally Commissioned Services Stop Smoking Service – domiciliary Alcohol identification and brief advice NHS Health check – deprivation, systematic approach Palliative care – community care, preferred place of care, care planning Mental health COPD

15. Changes to practice Equity of care citywide – collaborative, surgery clusters – innovation Proactive care – new models of care – risk profiling Health trainers

16. Transformation Collective change Re-think and re-fresh Focus our interventions Move from reactive to pro-active care