1. cunliffeanalytics Cancer indicator trend analysis NHS Luton CCG Summary of practice level cancer indicators 2010 to 2013 Version 1.0 March 2014

2. 2 Contents Page Introduction – purpose of the report4 Screening indicators5 Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Percentage of females aged 25–64 attending cervical screening within target period Percentage of persons aged 60–69 screened for bowel cancer within 6 months of invitation Screening indicator performance vs demographics Two week wait indicators21 Two Week Wait referral ratio Percentage of Two Week Wait referrals with cancer Percentage of new cancer cases treated which are Two Week Wait referrals Two week wait indicator performance vs demographics Emergency admission indicator31 Rate of emergency admissions with cancer per 100,000 population Rate of persons diagnosed with cancer via an emergency admission per 100,000 population Emergency admission indicator performance vs demographics Appendices43 Definitions for indicators and demographics.

3. 3 Introduction Purpose of the report The purpose of this report is to provide a three year summary of the key diagnosis and referral indicators for practices across Luton CCG. If you have any questions relating to the pack please contact james.perry@nhs.netjames.perry@nhs.net Eight key indicators are reviewed at CCG and practice level, highlighting how the activity rates have changed over the last four years, in relation to the current national targets and recommended ranges. The key indicators are: Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Percentage of females aged 25–64 attending cervical screening within target period Percentage of persons aged 60–69 screened for bowel cancer within 6 months of invitation Two Week Wait referral ratio Percentage of Two Week Wait referrals with cancer Percentage of new cancer cases treated which are Two Week Wait referrals Rate of emergency admissions with cancer per 100,000 population Rate of persons diagnosed with cancer via an emergency admission per 100,000 population Please note that this report is based on a small number of practices and therefore the CCG level percentages shown are sensitive to volatile changes. There is no data available for: Whipperley MC (Y02477) for 2010 for any indicator. GP led WIC (Y02463) for 2010 for any indicator. All practices for the ‘rate of persons diagnosed with cancer via an emergency admission per 100,000 population’, 2012. Acknowledgement CCG analysis of GP Cancer Profiles by East of England Strategic Clinical Network based on methodology and best practice recommendations first developed by Mount Vernon Cancer Network. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit 2010 to 2013 Maps contain: Ordnance Survey data © Crown copyright and database right 2012 Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012.

4. 4 Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Aim to be above the national target (70%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be influential here. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit Definition: The number of females aged 50-70 registered to the practice screened adequately within 6 months of invitation, divided by the total number of females aged 50-70 invited for screening in the previous 12 months. (See appendix for full definition) Indicator source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.

5. 5 2010201120122013 England mean average 74.4%74.7%74.3%73.3% CCG/PCT 1 mean average 69.3%72.5%71.8%69.3% CCG practice min 0.0% 25.0%0.0% CCG practice max 100.0%80.0%87.5%85.2% Practices above national target 2 10(28)11(31) Practices above national target (%) 35.7%35.5% Targets achieved for 4 years Summary statistics 1 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013., 2 National target > 70% CCG range and mean average Distribution of practice screening rates within the CCG Key  CCG/PCT 3 mean average CCG range 4 — National target >70% 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range for practices within the current CCG Key Targets achieved  4  3  2  1  0 Luton CCG’s average has remained below the national average for the last four years with just over a third of practices achieving the national target of 70%. Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012

6. 6 11 out of 31 practices within Luton CCG achieved the 70% target in 2013. 11 practices within the CCG failed to meet the target for the last three years. Three year profile (2011 to 2013) Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13

7. 7 Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Practice indicator scores Key  Year on year increase  Year on year decrease Above national target  Below national target National target > 70% 1 Percentage points Year on year rateAt or above target Difference over 4 years (pp 1 ) 20102011201220132010201120122013 E81018Woodland Ave66.7%  76.5%  55.6%  85.2%   18.5% E81075Kingfisher Practice64.3%  69.2%  79.5%  81.8%   17.5% E81632Barton Hills89.5%  78.8%  83.3%  79.5%  -10.0% E81040Sundon MC78.8%  72.7%  76.5%  78.4%  -0.4% E81025Oakley Surgery77.8%  33.3%  66.7%  75.8%   -2.0% E81076Pastures Way71.0%  33.3%  66.7%  75.6%   4.6% E81026Larkside Practice90.0%  75.3%  69.2%  75.1%   -14.9% E81016Lister House50.0%  68.0%  40.0%  75.0%   25.0% E8101339 Castle St74.7%  57.1%  36.4%  73.9%   -0.8% E81054Sundon Park HC73.2%  66.7%  87.5%  72.6%   -0.6% E81064Petros MC72.9%  61.5%  70.0%  71.1%   -1.8% E81005Bell House60.7%  74.8%  61.5%  68.8%   8.1% E81006Stopsley Village50.0%  72.5%  82.6%  67.8%   17.8% E81073Medici Practice66.6%  37.0%  50.0%  67.6%   1.0% E81063Conway MC58.3%  60.0%  25.0%  65.4%   7.1% E81032Lea Vale MC67.7%  40.5%  44.9%  64.3%   -3.4% E8161749 Ashcroft Rd100.0%  70.0%  77.3%  63.6%   -36.4% E81028Blenheim MC57.9%  62.5%  40.0%  62.4%   4.5% E81001Wenlock St64.4%  50.0%  71.4%  60.2%   -4.2% E81048Bute House64.4%  70.6%  75.0%  58.3%   -6.1% Y02477Whipperley MC-  63.6%  66.7%  56.7%   E81065Medina MC55.6%  31.3%  60.0%  56.6%   1.0% Y02464Moakes MC-  80.0%  60.2%  56.5%   E81633Neville Rd42.9%  66.7%  75.0%  56.3%   13.4% E81010Leagrave Surgery47.1%  75.2%  70.0%  50.0%   2.9% Y02463GP led WIC-  20.0%  45.0%  46.5%   E81041Gardenia Surgery29.4%  75.0%  69.2%  44.8%   15.4% E81612Hockwell Ring38.9%  66.7%  45.5%  42.9%   4.0% Y02332Kingsway HC70.0%  56.3%  58.1%  39.5%   -30.5% E816312A Malzeard Rd0.0%   52.2%  33.3%   E8161853 Leagrave Rd33.3%  50.0%   0.0%   -33.3% Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13

8. Percentage of females aged 25–64 attending cervical screening within target period Aim to be above the national target (80%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be influential here. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit Definition: The overall cervical screening coverage: the number of women registered at the practice screened adequately in the previous 42 months (if aged 24-49) or 66 months (if aged 50-64) divided by the number of eligible women on last day of review period. (See appendix for full definition) Indicator source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.

9. 9 Luton CCG’s average has decreased over the last four years, remaining below the national average and national target of 80%. The number of practices within the CCG achieving the 80% target has decreased over the last four years. Summary statistics 2010201120122013 England mean average 75.4%75.6%75.3%74.0% CCG/PCT 1 mean average 73.5%73.3%72.5%70.6% CCG practice min 60.8%55.4%54.3%53.9% CCG practice max 87.8%88.0%86.1%84.5% Practices above national target 2 6(28)4(31) 3(31) Practices above national target (%) 21.4%12.9% 9.7% CCG range and mean average Distribution of practice screening rates within the CCG Note: Published year shown, 2010 refers to 3.5 or 5.5 year coverage for 2004/05Q3 to 2009/10, 2011: 2005/06Q3 to 2010/11, 2012: 2006/07Q3 to 2011/12, 2013: 2010/11 to 2012/13 Targets achieved for 4 years Key Targets achieved  4  3  2  1  0 Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012 Key  CCG/PCT 3 mean average CCG range 4 — National target >80% 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range for practices within the current CCG 1 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013., 2 National target > 80%

10. 10 Three out of 31 practices within Luton CCG achieved the 80% target in 2013. 26 practices within the CCG failed to meet the target for the last three years. Note: Published year shown, 2010 refers to 3.5 or 5.5 year coverage for 2004/05Q3 to 2009/10, 2011: 2005/06Q3 to 2010/11, 2012: 2006/07Q3 to 2011/12, 2013: 2010/11 to 2012/13 Three year profile (2011 to 2013)

11. 11 Key  Year on year increase  Year on year decrease Above national target  Below national target National target > 80% 1 Percentage points Percentage of females aged 25–64 attending cervical screening within target period Practice indicator scores Note: Published year shown, 2010 refers to 3.5 or 5.5 year coverage for 2004/05Q3 to 2009/10, 2011: 2005/06Q3 to 2010/11, 2012: 2006/07Q3 to 2011/12, 2013: 2010/11 to 2012/13 Year on year rateAt or above target Difference over 4 years (pp 1 ) 20102011201220132010201120122013 E81006Stopsley Village87.8%  88.0%  86.1%  84.5%  -3.3% E81054Sundon Park HC84.3%  86.5%  85.9%  84.2%  -0.1% E81075Kingfisher Practice83.4%  83.6%  81.5%  81.4%  -2.0% Y02477Whipperley MC-  74.3%  72.4%  79.3%   E8161749 Ashcroft Rd82.7%  78.6%  78.9%  78.1%   -4.6% E81005Bell House80.0%  78.9%  80.3%  77.3%   -2.7% Y02464Moakes MC-  77.8%  77.6%  76.8%   E81076Pastures Way76.1%  80.2%  79.4%  76.1%   0.0% E81001Wenlock St69.4%  72.9%  72.6%  75.0%   5.6% E81026Larkside Practice77.3%  76.8%  77.3%  74.9%   -2.4% E81040Sundon MC79.3%  78.9%  77.0%  74.5%   -4.8% E81018Woodland Ave76.4%  76.7%  76.6%  72.6%   -3.8% E81632Barton Hills74.9%  74.7%  74.4%  72.5%   -2.4% E81025Oakley Surgery72.3%  72.8%  73.5%  71.9%   -0.4% E81064Petros MC79.5%  78.2%  76.2%  71.7%   -7.8% E81612Hockwell Ring74.3%  76.6%  73.3%  71.5%   -2.8% E81041Gardenia Surgery71.0%  72.1%  74.6%  71.4%   0.4% E81063Conway MC78.8%  78.5%  76.5%  70.6%   -8.2% E81028Blenheim MC67.2%  67.8%  69.3%  69.9%   2.7% E81065Medina MC76.8%  73.8%  72.8%  69.6%   -7.2% E81633Neville Rd80.3%  78.0%  75.8%  69.0%   -11.3% E816312A Malzeard Rd74.5%  76.0%  70.7%  69.0%   -5.5% E81032Lea Vale MC60.8%  62.8%  66.3%  67.9%   7.1% E81073Medici Practice68.8%  71.2%   67.8%   -1.0% E81010Leagrave Surgery73.4%  72.6%  70.8%  67.8%   -5.6% E81048Bute House77.0%  74.6%  69.7%  67.1%   -9.9% E8161853 Leagrave Rd63.3%  59.4%  60.6%  61.7%   -1.6% Y02332Kingsway HC64.4%  68.2%  63.4%  61.2%   -3.2% E81016Lister House65.2%  63.1%  61.6%  57.8%   -7.4% Y02463GP led WIC-  55.4%  58.8%  54.5%   E8101339 Castle St61.0%  58.2%  54.3%  53.9%   -7.1%

12. 12 Percentage of persons, 60–69, screened for bowel cancer within 6 months of invitation Aim to be above the national target (60%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be influential here. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit Definition: The number of persons aged 60-69 registered to the practice screened adequately within 6 months of invitation, divided by the total number of females aged 60-69 invited for screening in the previous 12 months. (See appendix for full definition) Indicator source(s): Bowel Cancer Screening System (BCCS) via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.

13. 13 1 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013., 2 National target > 60% Key  CCG/PCT 3 mean average CCG range 4 — National target >60% 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range for practices within the current CCG 2010201120122013 England mean average 55.1%57.5%55.7%58.7% CCG/PCT 1 mean average 45.1%50.1%46.4%50.3% CCG practice min 8.3%12.0%12.8%22.0% CCG practice max 58.8%61.3%58.9%63.6% Practices above national target 2 0(28)1(31)0(31)3(31) Practices above national target (%) 0.0%3.2%0.0%9.7% Over the last four years, Luton CCG’s average has remained below the national target of 60% and below the national average. Summary statisticsCCG range and mean average Distribution of practice screening rates within the CCGTargets achieved for 4 years Key Targets achieved  4  3  2  1  0 Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13

14. 14 Three out of 31 practices within Luton CCG achieved the 60% target in 2013. 28 practices failed to meet the target for the last three years. Three year profile (2011 to 2013) Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13

15. 15 Key  Year on year increase  Year on year decrease Above national target  Below national target National target > 60% 1 Percentage points Percentage of persons, 60–69, screened for bowel cancer within 6 months of invitation Practice indicator scores Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Year on year rateAt or above target Difference over 4 years (pp 1 ) 20102011201220132010201120122013 E81006Stopsley Village58.8%  61.3%  58.9%  63.6%   4.8% E81075Kingfisher Practice53.5%  56.5%  56.3%  60.3%   6.8% E8161749 Ashcroft Rd51.0%  51.1%  57.2%  60.1%   9.1% E81633Neville Rd37.1%  50.0%  46.7%  58.7%   21.6% E81040Sundon MC54.4%  59.3%  55.3%  58.3%   3.9% E81010Leagrave Surgery50.0%  58.7%  51.7%  57.5%   7.5% E81632Barton Hills51.5%  50.9%  49.6%  56.7%   5.2% E81018Woodland Ave52.4%  58.3%  56.1%  56.6%   4.2% E81026Larkside Practice46.0%  56.6%  43.2%  56.1%   10.1% E81054Sundon Park HC38.5%  48.7%  43.8%  54.1%   15.6% E81005Bell House47.3%  50.5%  47.8%  53.5%   6.2% E81064Petros MC44.4%  51.5%  45.6%  53.1%   8.7% E8101339 Castle St45.9%  54.2%  46.5%  53.1%   7.2% E81025Oakley Surgery51.7%  51.6%  52.5%  50.4%   -1.3% E81032Lea Vale MC47.0%  50.7%  44.5%  48.4%   1.4% E81041Gardenia Surgery47.4%  48.6%  49.1%  45.4%   -2.0% E81048Bute House38.0%  45.9%  41.0%  43.1%   5.1% E81028Blenheim MC28.3%  39.2%  36.9%  42.3%   14.0% E81073Medici Practice34.9%  41.1%  40.5%  41.9%   7.0% Y02464Moakes MC-  48.5%  40.0%  41.5%   E81076Pastures Way44.8%  38.4%  43.4%  41.1%   -3.7% E81016Lister House39.9%  43.9%  45.7%  40.7%   0.8% E81612Hockwell Ring36.5%  42.3%  34.3%  39.8%   3.3% Y02463GP led WIC-  40.9%  28.6%  37.8%   E81001Wenlock St27.2%  37.1%  33.7%  36.9%   9.7% Y02332Kingsway HC27.2%  30.9%  30.1%  34.7%   7.5% Y02477Whipperley MC-  28.6%  37.5%  34.2%   E81063Conway MC21.8%  29.5%  26.2%  33.3%   11.5% E816312A Malzeard Rd21.3%  13.0%  12.8%  28.6%   7.3% E81065Medina MC20.4%  25.8%  25.0%  28.5%   8.1% E8161853 Leagrave Rd8.3%  12.0%  16.2%  22.0%   13.7%

16. 16 Screening indicator performance vs demographics Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Percentage of females aged 25–64 attending cervical screening within target period Percentage of persons aged 60–69 screened for bowel cancer within 6 months of invitation

17. 17 No clear relationship between practices within East and North Hertfordshire CCG achieving the screening targets and local demographics Number of practicesPopulation aged 65+Deprivation New cancer casesCancer deathsCancer prevalence

18. Two Week Wait referral ratio (Indirectly age standardised ) Aim to be referring within 20% of the England average two week wait referral rate. Rates outside this range may indicate over/under use of the two week wait referral route. You may wish to audit your referrals against NICE cancer referral guidance. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit Definition: The number of Two Week Wait referrals where cancer is suspected multiplied by 100,000 divided by the list size of the practice in question. Indicator source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database.

19. 19 Key CCG range 3 — Best practice range = 80% to 120% 3 Range for practices within the current CCG 1 Mean average for CCG/PCT not available 2 Best practice range = 80% to 120% The number of practices within Luton CCG achieving the best practice range (80% to 120%) has varied year on year. Summary statistics 2010201120122013 England mean average 100.0% CCG/PCT 1 mean average n/a CCG practice min 2.3%3.5%4.9%4.1% CCG practice max 148.2%135.7%167.6%141.0% Practices within best practice range 2 4(28)11(31)8(31)7(31) Practices within best practice range (%) 14.3%35.5%25.8%22.6% CCG range Distribution of practice referral ratios within the CCG Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Luton CCG practices achieving the best practice range for 4 years Key Targets achieved  4  3  2  1  0 Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012

20. 20 Seven out of 31 practices within Luton CCG were within the best practice range of 80% to 120% in 2013. 16 practices failed to achieve the best practice range for the last three years. Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Three year profile (2011 to 2013)

21. 21 Two Week Wait referral ratio Practice indicator scores Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Key  Year on year increase  Year on year decrease Within best practice range  Outside best practice range Best practice range = 80% to 120% 1 Percentage points Year on year rateAt or above target Difference over 4 years (pp 1 ) 20102011201220132010201120122013 Y02464Moakes MC-  70.3%  118.8%  141.0%   E81073Medici Practice66.2%  110.0%  94.8%  137.2%   71.0% E81026Larkside Practice148.2%  101.1%  99.9%  103.1%   -45.1% E81040Sundon MC62.5%  64.7%  76.9%  101.3%   38.8% E81064Petros MC112.2%  96.0%  100.2%  98.0%  -14.2% E81025Oakley Surgery83.3%  82.9%  72.4%  96.4%   13.1% E81632Barton Hills81.6%   101.2%  95.8%  14.2% Y02477Whipperley MC-  63.8%  167.6%  90.2%   Y02332Kingsway HC58.9%  85.2%  74.8%  87.9%   29.0% E8101339 Castle St64.3%  87.7%  78.0%  77.4%   13.1% E81010Leagrave Surgery79.5%  94.4%  97.4%  75.0%   -4.5% E81075Kingfisher Practice88.8%  78.6%  107.0%  71.2%   -17.6% E81005Bell House70.8%  57.8%  61.4%  68.4%   -2.4% E81054Sundon Park HC70.6%  114.1%  68.6%  66.9%   -3.7% E81018Woodland Ave58.9%  49.4%  73.2%  63.3%   4.4% E81028Blenheim MC41.0%  54.7%  64.2%  62.5%   21.5% E81006Stopsley Village70.3%  72.5%  53.5%  62.2%   -8.1% E816312A Malzeard Rd5.2%  4.2%  19.4%  60.6%   55.4% E81633Neville Rd70.0%  135.7%  128.1%  59.1%   -10.9% E81612Hockwell Ring38.8%  18.9%  29.4%  59.0%   20.2% E81048Bute House43.1%  31.9%  61.8%  58.8%   15.7% E81076Pastures Way66.3%  90.9%  96.8%  52.0%   -14.3% E8161749 Ashcroft Rd24.2%  23.2%  23.9%  51.7%   27.5% E81063Conway MC30.8%  44.4%  31.3%  51.0%   20.2% E81032Lea Vale MC73.8%  61.6%  65.5%  50.2%   -23.6% E81016Lister House51.2%  40.5%  42.6%  43.4%   -7.8% Y02463GP led WIC-  111.8%  34.7%  41.7%   E81041Gardenia Surgery43.6%  41.3%  36.8%  36.2%   -7.4% E81001Wenlock St2.6%  11.8%  8.5%  28.5%   25.9% E81065Medina MC2.3%  3.5%  10.5%  9.9%   7.6% E8161853 Leagrave Rd6.4%  28.3%  4.9%  4.1%   -2.3%

22. Percentage of Two Week Wait referrals with cancer Aim to have conversion rate between 8-14%. Rates outside this range may indicate over/under use of the two week wait referral route. You may wish to audit your referrals against NICE cancer referral guidance. There is no target number for referral as this depends on practice size and demographics. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit Definition: The ‘conversion rate’, i.e., the proportion of Two Week Wait referrals that are subsequently diagnosed with cancer: the number of new cancer cases treated in 2012/13 who were referred through the two week wait route divided by the total number of Two Week Wait referrals in 2012/13. Indicator source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database.

23. 23 Key  CCG/PCT 3 mean average CCG range 4 — Best practice range = 8% to 14% 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range for practices within the current CCG 1 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013., 2 Best practice range = 8% to 14% Luton CCG’s average has remained within the best practice range of 8% to 14% for the last four years. The maximum for the range of values has reduced over the last three years. Summary statistics 2010201120122013 England mean average 11.2%10.9%10.6%10.0% CCG/PCT 1 mean average 13.3%10.3%12.5%11.6% CCG practice min 0.0% CCG practice max 100.0% 44.4%37.5% Practices within best practice range 2 13(28)10(31)9(31)14(31) Practices within best practice range (%) 46.4%32.3%29.0%45.2% CCG range and mean average Distribution of practice referrals within the CCG Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Luton CCG practices achieving the best practice range over 4 years Key Targets achieved  4  3  2  1  0 Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012

24. 24 14 of the 31 practices within Luton CCG achieved the best practice range of 8% to 14% in 2013. 10 practices failed to achieve the best practice range for the last three years. Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13. Three year profile (2011 to 2013) 100%

25. 25 Key  Year on year increase  Year on year decrease Within best practice range  Outside best practice range Best practice range = 8% to 14% 1 Percentage points Percentage of Two Week Wait referrals with cancer Practice indicator scores Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13. Year on year rateAt or above target Difference over 4 years (pp 1 ) 20102011201220132010201120122013 E81001Wenlock St200.0%  40.0%  25.0%  37.5%   -162.5% E81065Medina MC0.0%    37.5%   E81016Lister House13.6%  15.4%  17.8%  25.9%   12.3% E81040Sundon MC11.7%  14.1%  11.8%  19.5%   7.8% E81006Stopsley Village13.8%  17.1%  18.9%  18.3%   4.5% E81041Gardenia Surgery11.4%  19.4%  14.3%  17.5%   6.1% E81018Woodland Ave16.2%  11.0%  21.9%  15.3%   -0.9% E81612Hockwell Ring8.7%  23.1%  21.7%  14.5%   5.8% E81032Lea Vale MC12.7%  10.2%  13.3%  13.6%  0.9% E81048Bute House18.2%  16.2%  17.5%  13.2%   -5.0% E81005Bell House13.1%  13.4%  13.5%  13.1%  0.0% E81633Neville Rd6.3%  5.6%  5.1%  13.0%   6.7% E81064Petros MC12.2%  9.4%  12.8%  12.2%  0.0% E8161749 Ashcroft Rd47.1%  26.3%  33.3%  11.5%   -35.6% Y02463GP led WIC-  10.5%  44.4%  11.1%   E81632Barton Hills9.5%  9.4%  8.9%  11.0%  1.5% E81010Leagrave Surgery14.9%  10.3%  11.9%  10.9%   -4.0% E816312A Malzeard Rd0.0%  100.0%  0.0%  10.5%   E8101339 Castle St14.9%  5.4%  14.1%  9.9%   -5.0% E81025Oakley Surgery14.5%  6.6%  16.7%  8.9%   -5.6% E81075Kingfisher Practice20.4%  11.8%  7.6%  8.7%   -11.7% E81028Blenheim MC10.9%  2.9%  6.7%  8.6%   -2.3% Y02464Moakes MC-  0.0%  8.0%  7.3%   E81073Medici Practice5.6%  7.0%  9.6%  7.0%   1.4% E81026Larkside Practice13.8%  7.5%  4.2%  5.5%   -8.3% E81054Sundon Park HC5.4%  5.5%  2.8%  4.9%   -0.5% E81076Pastures Way8.3%  5.3%  10.4%  4.8%   -3.5% Y02332Kingsway HC14.3%  12.5%  6.1%  3.1%   -11.2% E81063Conway MC10.0%  0.0%  18.5%  1.9%   -8.1% Y02477Whipperley MC-  9.1%  7.9%  0.0%   E8161853 Leagrave Rd100.0%  0.0%     -100.0%

26. Percentage of new cancer cases treated which are Two Week Wait referrals Aim to be above the line and have more of your cancer cases diagnosed through the two week wait referral route. Consider doing the RCGP cancer diagnosis audit. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit Definition: The proportion of new cancer cases treated who were referred through the Two Week Wait route. Indicator source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database.

27. 27 Luton CCG’s average has remained around the national target of 40%, but below the national average, for the last four years. Summary statistics 2010201120122013 England mean average 42.9%45.3%46.5%47.7% CCG/PCT 1 mean average 40.2%35.3%41.9%41.6% CCG practice min 0.0% CCG practice max 67.9%72.7%80.0%85.7% Practices above recommended min. 2 14(28)11(31)16(31)15(31) Practices above recommended min. (%) 50.0%35.5%51.6%48.4% CCG range and mean average Distribution of new cancer cases (as a proportion of TWW) within the CCG Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Luton CCG practices achieving the recommended minimum of 40% over 4 years Key Targets achieved  4  3  2  1  0 Key  CCG/PCT 3 mean average CCG range 4 — Recommended minimum = 40% 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range for practices within the current CCG 1 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013., 2 Recommended minimum = 40% Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012

28. 28 15 out of 31 practices within Luton CCG achieved the recommended minimum of 40% in 2013. Five practices failed to achieve 40% for the last three years Three year profile (2011 to 2013) Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13

29. 29 Key  Year on year increase  Year on year decrease Above recommended minimum  Below recommended minimum Recommended minimum = 40% 1 Percentage points Percentage of new cancer cases treated which are Two Week Wait referrals Practice indicator scores Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Year on year rateAt or above target Difference over 4 years (pp 1 ) 20102011201220132010201120122013 E81001Wenlock St28.6%  50.0%  11.1%  85.7%   57.1% E816312A Malzeard Rd0.0%  50.0%  0.0%  66.7%   E81632Barton Hills38.1%  30.0%  46.2%  65.4%   27.3% E81040Sundon MC28.1%  40.6%  48.3%  60.0%   31.9% E81633Neville Rd50.0%   40.0%  60.0%  10.0% E81048Bute House50.0%  23.1%  46.7%  60.0%   10.0% E81016Lister House42.9%  35.3%  36.4%  53.8%   10.9% E81075Kingfisher Practice67.9%  52.4%  40.7%  52.6%  -15.3% E81018Woodland Ave41.5%  32.4%  55.6%  52.1%   10.6% E81006Stopsley Village37.5%  44.9%  36.8%  51.9%   14.4% E81064Petros MC50.0%  52.4%  58.6%  50.0%  0.0% E81028Blenheim MC31.3%  13.3%  35.3%  42.9%   11.6% E81026Larkside Practice63.3%  32.0%  33.3%  42.1%   -21.2% E81612Hockwell Ring15.4%  30.0%  35.7%  42.1%   26.7% Y02463GP led WIC-  50.0%  80.0%  40.0%   E81032Lea Vale MC48.9%  35.4%  46.4%  39.4%   -9.5% E81010Leagrave Surgery45.2%  38.2%  43.6%  38.9%   -6.3% E81005Bell House34.1%  32.5%  42.9%  38.8%   4.7% E81073Medici Practice19.2%  40.0%  39.0%  36.8%   17.6% E8101339 Castle St45.5%  28.6%  43.5%  31.4%   -14.1% E81025Oakley Surgery45.5%  23.8%  54.5%  31.3%   -14.2% E81065Medina MC0.0%    30.0%   Y02464Moakes MC-  0.0%  50.0%  27.3%   E81041Gardenia Surgery25.8%  33.3%  22.2%  26.9%   1.1% E8161749 Ashcroft Rd36.4%  62.5%  38.1%  24.1%   -12.3% Y02332Kingsway HC60.0%  72.7%  30.8%  23.1%   -36.9% E81076Pastures Way23.1%  27.3%  53.8%  20.0%   -3.1% E81054Sundon Park HC25.0%  23.1%  11.1%  14.3%   -10.7% E81063Conway MC50.0%  0.0%  38.5%  7.1%   -42.9% Y02477Whipperley MC-  33.3%  42.9%  0.0%   E8161853 Leagrave Rd50.0%  0.0%     -50.0%

30. 30 Two week wait indicator performance vs demographics Two Week Wait referral ratio (Indirectly age standardised ) Percentage of Two Week Wait referrals with cancer Percentage of new cancer cases treated which are Two Week Wait referrals

31. 31 Practices within Luton CCG achieving the best practice and recommended ranges for Two Week Waits, tend to have a higher proportion of new cancer cases Number of practicesPopulation aged 65+Deprivation New cancer casesCancer deathsCancer prevalence

32. Rate of emergency admissions with cancer, per 100,000 population Aim to minimize the number of cancer patients requiring emergency admissions. Try to proactively manage cases. Consider using the RCGP Significant Event Audit to reflect on cases. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit Definition: The number of persons admitted to hospital as an inpatient or day-case via an emergency admission multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons. Indicator source(s): Hospital Episode Statistics (HES) data for 1st March 2012 to 29th February 2013 was taken from the UKACR “Cancer HES” offload originally sourced from the NHS Information Centre for Health and Social Care HES dataset.

33. 33 The number of practices within Luton CCG below the recommended maximum of 481 increased year on year, leading to a decrease in the CCG average to below the recommended maximum in 2013. Summary statistics 2010201120122013 England mean average 691583587481 CCG/PCT 1 mean average 555464485346 CCG practice min 76775549 CCG practice max 866977848618 Practices below recommended max. 2 9(28)17(31)13(31)25(31) Practices below recommended max. (%) 32.1%54.8%41.9%80.6% CCG range and mean average Distribution of admission rates within the CCG Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Luton CCG practices achieving recommended maximum rate of 481 over 4 years Key Targets achieved  4  3  2  1  0 Key  CCG/PCT 3 mean average CCG range 4 — Recommended maximum = 481 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range for practices within the current CCG 1 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013., 2 Recommended maximum = 481 (National average in 2013) Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012

34. 34 25 out of 31 practices in Luton CCG were below the recommended maximum of 481 in 2013. Four practices failed to achieve the maximum of 481 target for the last three years Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Three year profile (2011 to 2013)

35. 35 Key  Year on year increase  Year on year decrease Below recommended maximum  Above recommended maximum Recommended maximum = 481 (national average in 2013) Rate of emergency admissions with cancer per 100,000 population Practice indicator scores Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Year on year rateAt or above target Difference over 4 years 20102011201220132010201120122013 E81065Medina MC334  137  104  49  -285 E8161853 Leagrave Rd542  427  604  60   -482 Y02477Whipperley MC-  977  844  153   Y02463GP led WIC-  277  236  167   E81063Conway MC76  189  199  174  98 Y02464Moakes MC-  139  55  195   E81633Neville Rd302  313  592  199   -103 E81076Pastures Way491  855  528  205   -286 E81016Lister House651  295  282  221   -430 E816312A Malzeard Rd376  77  150  224  -152 E81612Hockwell Ring274  188  237  230  -44 E81032Lea Vale MC581  403  450  235   -346 E81048Bute House434  208  278  244  -190 E81075Kingfisher Practice426  525  347  265   -161 E81001Wenlock St499  343  535  266   -233 E81026Larkside Practice521  518  734  285   -236 E81028Blenheim MC544  256  313  299   -245 E81073Medici Practice864  467  562  303   -561 E81005Bell House643  664  626  389   -254 E81041Gardenia Surgery575  427  550  407   -168 E81006Stopsley Village713  772  848  417   -296 E8101339 Castle St491  436  604  445   -46 E81025Oakley Surgery632  902  519  469   -163 E81018Woodland Ave669  537  543  470   -199 Y02332Kingsway HC407  494  374  475   68 E81040Sundon MC699  578  595  500   -199 E81054Sundon Park HC317  391  497  503   186 E8161749 Ashcroft Rd652  501  555  505   -147 E81064Petros MC637  499  471  526   -111 E81632Barton Hills643  739  726  575   -68 E81010Leagrave Surgery866  706  632  618   -248

36. Rate of persons diagnosed with cancer via an emergency admission, per 100,000 persons Aim to have as few emergency presentations of cancer and more of the cases detected through managed referral routes. Consider using the RCGP significant Event Audit to reflect on cases and using Risk Assessment Tools to help guide investigation and referral. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit NOTE: DEFINITION AND DATA SOURCE CHANGED IN 2013 Definition: Proportion of persons diagnosed via an emergency, managed referral or other route (2010 to 2012) recalculated as a rate per 100,000 persons, Number of persons diagnosed via an emergency route multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons (2013) Indicator source(s): Routes to Diagnosis project database (2010 to 2012), Hospital Episode Statistics (2013)

37. 37 Luton CCG’s average has decreased over the last three years to a level below the recommended maximum of 74 in 2013. It has remained below the national average for the last four years. Summary statistics 2010201120122013 England mean average 8910710574 CCG/PCT 1 mean average 77817859 CCG practice min 00-0 CCG practice max 149167-136 Practices below recommended max 2 13(28)15(31)-24(31) Practices below recommended max (%) 46.4%48.4%-77.4% CCG range and mean average Distribution of persons diagnosed with cancer (via an emergency admission), within the CCG Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Luton CCG practices achieving recommended maximum of 74 over three available years Note: 2012 data not available for individual practices across all CCGs Key Targets achieved  3  2  1  0 Key  CCG/PCT 3 mean average CCG range 4 — Recommended maximum = 74 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range for practices within the current CCG Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012 1 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013., 2 Recommended maximum = 74 (national average in 2013)

38. 38 24 out of 31 practices in Luton CCG were below the recommended maximum of 74 in 2013 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Three year profile (2011 to 2013)

39. 39 Key  Year on year increase  Year on year decrease Below recommended maximum  Above recommended maximum Recommended maximum = 74 (national average in 2013 ) Rate of persons diagnosed with cancer via an emergency admission, per 100,000 persons Practice indicator scores Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Year on year rateAt or above target Difference over 4 years 20102011201220132010201120122013 E816312A Malzeard Rd0  0   0   0 E81075Kingfisher Practice77  79   12   -65 E81016Lister House28  15   14   -14 E81065Medina MC0  39   16   E81076Pastures Way47  93   22   -25 E81063Conway MC25  63   24   E81040Sundon MC121  55   27   -94 E8101339 Castle St95  99   34   -61 E81633Neville Rd86  134   39   -47 E81026Larkside Practice149  76   45   -104 E81028Blenheim MC65  86   45   -20 E81073Medici Practice65  81   46   -19 E81064Petros MC97  115   47   -50 E81048Bute House40  65   48   8 Y02477Whipperley MC-  0   51   E81612Hockwell Ring78  76   53   -25 Y02463GP led WIC-  0   55   E81018Woodland Ave67  167   58   -9 E8161853 Leagrave Rd120  61   60   -60 Y02332Kingsway HC0  46   62   E81001Wenlock St133  34   66   -67 E81025Oakley Surgery22  68   67   45 E81054Sundon Park HC75  120   67   -8 E81032Lea Vale MC112  92   69   -43 E81041Gardenia Surgery96  102   75   -21 E81632Barton Hills47  63   75   28 E81006Stopsley Village84  86   87   3 Y02464Moakes MC-  69   97   E81005Bell House96  53   126   30 E81010Leagrave Surgery129  93   131   2 E8161749 Ashcroft Rd42  83   136   94

40. Emergency admission indicator performance vs demographics Rate of emergency admissions with cancer per 100,000 population Rate of persons diagnosed with cancer via an emergency admission

41. 41 Practices within Luton CCG achieving the emergency admission recommended rates tend to have a lower proportion of the population aged 65+, higher levels of deprivation, a lower proportion of new cancer cases, cancer deaths and cancer prevalence. Number of practicesPopulation aged 65+Deprivation New cancer casesCancer deathsCancer prevalence

42. APPENDIX Indicator definitions

43. 43 Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Aim to be above the national target (70%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be influential here. Indicator definition Number: The number of females aged 50 to 70 registered to the practice who were screened adequately within 6 months of invitation. Rate or proportion: 1-year screening uptake %: the number of females registered to the practice aged 50-70 invited for screening in the previous 12 months who were screened within 6 months of invitation divided by the total number of females aged 50-70 invited for screening in the previous 12 months. Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2013, and covers the period 2010/11-2012/13. Binomial confidence intervals are calculated using the Wilson score method 1. Source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme. Interpretation: This indicator measures the fraction of women invited in a specified period who are screened within 6 months of their invitation date. Due details of local implementation the number of women invited for screening in the previous year may be low (for example if screening is carried out by mobile units which revisit each area once in a screening round). Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

44. 44 Percentage of females aged 25–64 attending cervical screening within target period Aim to be above the national target (80%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be influential here. Indicator definition Number: The number of women registered at the practice screened adequately in the previous 42 months (if aged 24-49) or 66 months (if aged 50-64) Rate or proportion: The overall cervical screening coverage: the number of women registered at the practice screened adequately in the previous 42 months (if aged 24-49) or 66 months (if aged 50-64) divided by the number of eligible women on last day of review period. Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2013, and covers the period 2007/08Q3-2012/13. Binomial confidence intervals are calculated using the Wilson score method 1. Source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme. Interpretation: Women aged 25-49 are invited for routine screening every 3 years and women aged 50-64 are invited for routine screening every 5 years. This indicator gives a combined coverage for the full age range so that it counts women aged 25-49 screened within a period of 3.5 years and women aged 50-64 within a period of 5.5 years prior to the report date and combines the counts to give the final measure. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

45. 45 Percentage of persons, 60–69, screened for bowel cancer within 6 months of invitation Aim to be above the national target (60%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be influential here. Indicator definition Number: The number of persons aged 60 to 69 registered to the practice who were screened adequately within 6 months of invitation. Rate or proportion: Screening uptake %: the number of persons aged 60-69 invited for screening in the previous 12 months who were screened adequately following an initial response within 6 months of invitation divided by the total number of persons aged 60-69 invited for screening in the previous 12 months. Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2013, and covers the period 2010/11Q3-2012/13. Binomial confidence intervals are calculated using the Wilson score method 1. Source(s): Data was extracted from the Bowel Cancer Screening System (BCCS) via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme. Interpretation: This indicator measures the fraction of people invited who have been screened adequately following an initial response within 6 months of their invitation date. Caution should be used in interpreting the data as not all CCGs had full implementation of the programme in the recorded period. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

46. 46 Two Week Wait referral ratio (indirectly age standardised) Aim to be referring within 20% of the England average two week wait referral rate. Rates outside this range may indicate over/under use of the two week wait referral route. You may wish to audit your referrals against NICE cancer referral guidance. Indicator definition Number: The number of Two Week Wait (GP urgent) referrals where cancer is suspected for patients registered at the practice in question in 2012/13. Rate or proportion: The crude rate of referral: the number of Two Week Wait referrals where cancer is suspected multiplied by 100,000 divided by the list size of the practice in question. Method: Patient level Cancer Waiting Times (CWT) data (including patient identifiers) was downloaded from the NHS England Cancer Waiting Times Database by the Knowledge and Intelligence Team (East Midlands). Each patient was traced to a GP Practice using the Open Exeter Batch Tracing Service. Two Week Wait Referrals were identified for patients with a date first seen on the CWT database in 2012/13. All records with a ‘Referral Priority Type’ of 3 (Two Week Wait) were counted, excluding patients referred for non-cancer breast symptoms. Poisson confidence intervals are calculated using Byar’s approximation 1. Source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database. Interpretation: The number of Two Week Wait referrals with a suspicion of cancer, whether or not cancer was subsequently diagnosed. This indicator may be expected to be higher in practices with an unusually high proportion of persons of 65+ years of age, due to the higher incidence of cancer at these ages. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

47. 47 Percentage of Two Week Wait referrals with cancer Aim to have conversion rate between 8-14%. Rates outside this range may indicate over/under use of the two week wait referral route. You may wish to audit your referrals against NICE cancer referral guidance. There is no target number for referral as this depends on practice size and demographics. Indicator definition Number: The number of Two Week Wait referrals treated for cancer for patients registered at the practice in question. Rate or proportion: The ‘conversion rate’, i.e., the proportion of Two Week Wait referrals that are subsequently diagnosed with cancer: the number of new cancer cases treated in 2012/13 who were referred through the two week wait route divided by the total number of Two Week Wait referrals in 2012/13. Method: Patient level Cancer Waiting Times data (including patient identifiers) was downloaded from the NHS England Cancer Waiting Times Database by the Knowledge and Intelligence Team (East Midlands). Each patient was traced to a GP Practice using the Open Exeter Batch Tracing Service. Patients on the CWT database who had received a cancer diagnosis were identified as those patients receiving a first treatment in 2012/13, i.e. with ‘Cancer Treatment Event Type’ of 01 (First definitive treatment for a new primary cancer) or 07 (First treatment for metastatic disease following an unknown primary). It was not possible to directly identify which referrals were subsequently diagnosed with cancer. Therefore, the proportion of referrals diagnosed with cancer was calculated by dividing the number of patients receiving a first treatment in 2012/13 who were referred through the two week wait route by the number of two week wait referrals. Most of the Two Week Wait referrals first seen in 2012/13 who were diagnosed with cancer will have started treatment in 2012/13 but a small number will have started treatment in 2012/13 and a small number of patients who started treatment in 2012/13 will have been first seen in 2011/12. For a very small number of practices, this may result in a ‘conversion rate’ of more than 100% being calculated. Binomial confidence intervals are calculated using the Wilson score method 1. Source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database. Interpretation: The number of Two Week Wait referrals with a suspicion of cancer, in which cancer was subsequently diagnosed. The proportion is the ‘conversion rate’ for the practice. This varies by cancer type and so will depend on the case-mix of cancers diagnosed in persons registered at the practice. Either an unusually high or an unusually low conversion rate may merit further investigation. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

48. 48 Percentage of new cancer cases treated which are Two Week Wait referrals Aim to be above the line and have more of your cancer cases diagnosed through the two week wait referral route. Consider doing the RCGP cancer diagnosis audit. Indicator definition Number: The number of patients registered at the practice who have a date of first treatment in 2012/13 on the cancer waiting times system. Rate or proportion: The proportion of new cancer cases treated who were referred through the Two Week Wait route. This is calculated as the number of persons referred as a Two Week Wait referral who were subsequently diagnosed with cancer divided by the total number of patients registered at the practice who have a date of first treatment in 2012/13 on the cancer waiting times system. Method: Patient level Cancer Waiting Times data (including patient identifiers) was downloaded from the NHS England Cancer Waiting Times Database by the Knowledge and Intelligence Team (East Midlands). Each patient was traced to a GP Practice using the Open Exeter Batch Tracing Service. Binomial confidence intervals are calculated using the Wilson score method 1. Source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database. Interpretation: This indicator shows the proportion of cancers that were first diagnosed following a two week wait referral. This varies by cancer type and so will depend on the case-mix of cancers diagnosed in persons registered at the practice. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

49. 49 Rate of emergency admissions with cancer, per 100,000 population Aim to minimize the number of cancer patients requiring emergency admissions. Try to proactively manage cases. Consider using the RCGP Significant Event Audit to reflect on cases. Indicator definition Number: The number of persons admitted to hospital as an inpatient or day-case via an emergency admission, with a diagnostic code that includes cancer. Rate or proportion: The number of persons admitted to hospital as an inpatient or day-case via an emergency admission multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons. Method: All emergency admissions with an invasive, in-situ, uncertain or unknown behaviour, or benign brain cancer (ICD-10 C00-C97, D00-D09, D33, and D37-48) present in any of the first three diagnostic fields were extracted from the inpatient HES database. Source(s): Hospital Episode Statistics (HES) data for 1st March 2012 to 28th February 2013 was taken from the UKACR “Cancer HES” offload originally sourced from the NHS Information Centre for Health and Social Care HES dataset. Interpretation: The number and crude rate per 100,000 persons of emergency in-patient or day-case admissions, sourced from HES data, with a diagnosis that includes cancer. These may occur at any stage of the cancer pathway and will include persons diagnosed with cancer in prior years. This indicator may be expected to be higher in practices with an unusually high fraction of persons of 65+ years of age, due to the higher incidence of cancer at these ages. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013)

50. 50 Aim to have as few emergency presentations of cancer and more of the cases detected through managed referral routes. Consider using the RCGP significant Event Audit to reflect on cases and using Risk Assessment Tools to help guide investigation and referral. Indicator definition Number: Number of persons diagnosed via an emergency route, as defined by the Routes to Diagnosis project methodology 1 Rate or proportion: Number of persons diagnosed via an emergency route multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons Method: The data for the pool of patients diagnosed with cancer (ICD-10 C00-C97 excluding C44) in 2008 cancer registry records was examined. These were linked at a patient level to the Routes to Diagnosis In brief, the Routes to Diagnosis project method was that data sources of Screening, Inpatient HES, Outpatient HES, and Cancer Waiting Times were used to trace the history of each patient diagnosed with cancer in the year 2008. Patient histories in the datasets above prior to diagnosis were used to categorise the route that the patient took to arrive at the point of diagnosis. Eight main routes were defined in the Routes to Diagnosis project, these are aggregated into three broad routes in these Practice Profiles – Emergency Presentation, Managed Presentation, and Other Presentation. Emergency presentations are those initiated by an emergency event of some type, Managed Presentations consist of those following a routine or Two week Wait referral from a GP, Other Presentations are those via screening, death certificate only, Inpatient Elective, Other outpatients, and Unknown. See the Routes to Diagnosis Project for further information 1. Binomial confidence intervals are calculated using the Wilson score method 2. Source(s): Routes to Diagnosis project database. Interpretation: The number of persons who present as an emergency. The rate is the estimated fraction of all presentations that are emergencies, though patients who were diagnosed with multiple independent cancers in the same year were excluded. Aggregated data may give slightly different totals for England than previously published as it applies only to those patients who can be traced to a practice database. Rate of persons diagnosed with cancer via an emergency admission (2010 to 2012) Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012) 1 Routes to Diagnosis methodology, available online at: http://www.ncin.org.uk/publications/routes_to_diagnosis.aspxhttp://www.ncin.org.uk/publications/routes_to_diagnosis.aspx 2 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

51. 51 Aim to have as few emergency presentations of cancer and more of the cases detected through managed referral routes. Consider using the RCGP significant Event Audit to reflect on cases and using Risk Assessment Tools to help guide investigation and referral. Indicator definition Number: Number of persons diagnosed via an emergency route, as defined by a first admission with a cancer code in the patient's HES record which is an emergency. Rate or proportion: Number of persons diagnosed via an emergency route multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons. Method: Each person with a inpatient HES record containing a cancer diagnostic code (ICD-10 C00-C97 excl C44) in one of the first three diagnostic fields is identified. This cohort is deduplicated by matching to previous years HES records and cancer registration records. Any duplicates are removed 15 and the remaining patients can be considered the remainder are an estimate of the members of the cohort of patients diagnosed with a new cancer in the period of interest. The numbers by practice are counted by allocating the patients to a practice according the practice as recorded by inpatient HES. The emergency status of the diagnostic episode is taken from the ADMETH field. Source(s): Hospital Episode Statistics, The Health and Social Care Information Centre. Copyright © [2013], re-used with the permission of the Health and Social Care Information Centre. All rights reserved. Interpretation: Emergency presentation is linked to lower short term survival in newly diagnosed patients. However is strongly affected by case-mix: more emergency presentations can be expected in older practice populations and the mix of tumour types is also highly significant (for example, lung cancers have a higher fraction of emergency presentations while breast cancers have a low fraction of emergency presentations). More emergency presentations can therefore be expected in practices with an older or more deprived population. Note: Aggregated data may give slightly different totals for England than previously published as it applies only to those patients who can be traced to a practice. The “Rapid” Routes to Diagnosis emergency data remain experimental, and are a proxy indicator. They are used to provide more timely data, but are not as rigorous as the figures found in Routes to Diagnosis. As such the figures may differ from other published sources and care should be taken in their interpretation. Rate of persons diagnosed with cancer via an emergency admission (2013) Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013)

52. APPENDIX Demographic definitions

53. 53 Practice Population aged 65+ Indicator definition Number: The number of persons registered at the practice aged 65+. Rate or proportion: The percentage of persons registered at the practice aged 65+, defined by the number of persons registered at the practice divided by the list size of the practice. Method: Data is taken from the Attribution Dataset, extracted April 2012. The number of persons aged 65+ is the sum across the population in the 65-69, 70-74, 75-79, 80-84, and 85+ age-bands. The fraction of the practice population aged 65+ is calculated by dividing the number aged 65+ by the list size of the practice sourced from the 2012/13 QOF data. Binomial confidence intervals are calculated using the Wilson score method 1. Interpretation: The percentage of the population over the age of 65 may be expected to have a significant effect on the burden of cancer in the practice population. The percentage of the population is taken as at April 2012 and will not reflect changes since then. Source(s): Data sourced from the Attribution Dataset provided by the South East Public Health Observatory. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

54. 54 Socio-economic deprivation Indicator definition Number: The estimated quintile of deprivation of the practice. Rate or proportion: The estimated income domain score for the practice, which is the percentage of the practice list that is income deprived1. Method: Index of Multiple Deprivation (IMD) scores for each deprivation domain have been estimated for each practice by the English Public Health Observatories using the Index of Multiple Deprivation (IMD) 2010 by Lower Super Output Area (LSOA) 2. Briefly, the overall socio-economic deprivation of the practice is estimated by averaging the socio-economic deprivation of each person on the practice list based on their LSOA of residence. Practices were ranked nationally by Income Domain score and allocated into equal population quintiles (1 being coded as the most affluent quintile, and 5 as the most deprived quintile). Binomial confidence intervals are calculated using the Wilson score method 3. Interpretation: Several common cancers have a known dependence on the socio-economic status of the population. A more deprived population may be expected to have a higher incidence rate of lung cancer but lower incidence rates of prostate and breast cancer. Source(s): Data provide by the English Public Health Observatories. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 The English Indices of Deprivation 2010. Communities and Local Government. Available online at: http://www.communities.gov.uk/publications/corporate/statistics/indices2010 http://www.communities.gov.uk/publications/corporate/statistics/indices2010 2 GP practice IMD 2007 – Calculation Notes, South East Public Health Observatory, 2010. 3 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

55. 55 New cancer cases Indicator definition Number: The number of persons diagnosed with any invasive cancer excluding non-melanoma skin cancer (ICD-10 C00- C97, excluding C44) in 2011. Rate or proportion: The crude incidence rate per 100,000 persons: the number of new cases diagnosed multiplied by 100,000 divided by the practice list size. Method: All invasive cancers diagnosed in 2011 registered by cancer registries and present in the 2010 Office of National Statistics analysis dataset were included. These patients were matched to a GP surgery by tracing them by NHS number to find their current and previous practice. Persons were allocated to their practice at their time of diagnosis. If this was not possible (for example, due to the patient having moved practice more than once in the time between diagnosis and trace) they were not included. The resultant total number of cancer diagnoses across England is 93% of the Office of National Statistics total number of cases for the country. Source(s): Office of National Statistics 2011. Each patient was traced to a GP Practice using the NHS Personal Demographics Service. Interpretation: This indicator gives the number of new cases and incidence rate of invasive cancer (excluding non-melanoma skin cancer) in the practice population, as estimated from cancer registry data for calendar year 2011. Cancer registry data includes persons diagnosed solely through their death certificate or who died shortly after an emergency presentation in secondary care, so may be larger than number of persons known to the practice. However, as 7% of cases could not be traced to a specific practice and are not included numbers at an individual practice may be undercounted by approximately this much. Numbers of cases may also fluctuate year to year meaning that caution should be used in comparing this indicator to other indicators such as the number of new cancer cases treated in 2012/13 taken from the Cancer Waiting Times database. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013)

56. 56 Cancer deaths Indicator definition Number: The number of deaths with an underlying cause of death which is any invasive cancer (ICD-10 C00-C97) in 2011/12. Rate or proportion: The crude mortality rate per 100,000 persons: the number of deaths due to invasive cancer multiplied by 100,000 divided by the practice list size. Method: Records of all deaths in England occurring in 2011/12 were downloaded from the Primary Care Mortality Database. These were filtered on the Underlying Cause of Death by ICD-10 code to exclude all deaths not due to invasive cancer (ICD- 10 C00-C97)) and aggregated to GP Practices using the built-in practice codes. Binomial confidence intervals are calculated using the Wilson score method 1. Source(s): The Primary Care Mortality Database, which is a collaborative project between the Office of National Statistics and the Information Centre. Interpretation: This indicator gives the number of cancer deaths and crude mortality rate in the practice. Numbers of cases may fluctuate year to year meaning that caution should be used in comparing this indicator to other indicators such as the number of new cancer cases in 2010. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457

57. 57 Prevalent cancer cases Indicator definition Number: The number of persons registered on the practice cancer register. Rate or proportion: The proportion of persons on the practice cancer register: the number of persons on the practice cancer register divided by the practice list size. Method: Data is taken from the QOF dataset without further processing. Binomial confidence intervals are calculated using the Wilson score method 1. Source(s): Data sourced from the cancer prevalence field of the QOF 2012/13 data 2. Interpretation: The prevalence data is taken from QOF data for 12/13, and originally sourced from each practice’s cancer register. Recording methodology varies by practice and may underestimate the true cancer prevalence. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 1 APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457www.apho.org.uk/resource/view.aspx?RID=48457 2 2011/12 QOF data. Available online at: http://www.ic.nhs.uk/webfiles/publications/002_Audits/QOF_2011-12/Practice_Tables/QOF1112_Pracs_Prevalence.xlshttp://www.ic.nhs.uk/webfiles/publications/002_Audits/QOF_2011-12/Practice_Tables/QOF1112_Pracs_Prevalence.xls