Presentation on theme: "Adding local value to Commissioning for Value"— Presentation transcript:
1Adding local value to Commissioning for Value Lucy JacksonConsultant in Public HealthLeeds City Council
2What did we do with Commissioning for value? Ensured it made sense locally.Choose issue for a local reason too.Added local data – to add to the pathway and triangulate.Wider footprint of Leeds but local too - 3 CCGs agreed on the same 2 areas.Brought all players together – Clinicians; CCG commissioners; Local Public Health with PHE. Citywide and within each CCG to work through.Ownership of approach - Conversations with clinical fora in each CCG – does this make sense , prioritise actions?
3Local Strategic Context – Leeds Joint Health and Well Being Strategy Vision - Leeds will be a healthy and caring city for all ages Principle - People who are the poorest will improve their health the fastest Outcome one - People will live longer and have healthier lives
4Use CFV but also locally what fits - the life expectancy gap by cause of death Scarf chart showing the breakdown of the life expectancy gap between Leeds as a whole and England as a whole, by cause of death,How to put GP referrals in hereWill NHS comparators activity be different from the spend?
5NHS LEEDS SOUTH AND EAST CCG Local Data: GP audit and healthy living service referral data summarised by CCGNHS LEEDS NORTH CCGNHS LEEDS SOUTH AND EAST CCGNHS LEEDS WEST CCGLeedsCHDprevalence3.3%3.8%3.1%3.4%Health checks uptake60.2%65.2%51.5%57.7%Smoking18.6%27.0%22.0%22.7%Smokers referred to smoking services (including prompted self referral)9.0%9.1%4.2%7.0%Obesity19.5%25.7%19.9%21.7%Recorded BMI>30 referred to weight management service2.2%2.1%1.5%1.9%AlcoholShort screening (FAST or AUDIT-C)6.3%6.7%Completed full AUDIT screening1.1%0.7%4.1%2.3%Screened as positive (Hazardous/harmful/dependant drinkers)9.9%21.5%34.9%30.8%Brief intervention (in GP practice)4.5%8.7%Scoring 20+ on AUDIT who have been referred for specialist advice for dependant drinking1.8%0.4%0.5%Local DataLocal agreement with all GPs in Leeds to audit their data
6Local Data: Obesity prevalence Obesity prevalence versus % weight management referralsLow obesity prevalenceHigh weight management referralsHigh obesity prevalenceHigh weight management referralsPractices which have high obesity prevalence and low percentage of weight management referrals :(For a full list of all practice's see appendix 5)Practice clusterGP practice name% ObeseReferralsPentagon21.7%0.9%Triangle22.7%1.7%Kite21.3%0.4%Hexagon20.4%0.6%20.0%25.7%19.5%2.2%1.6%Circle23.1%0.7%26.7%*0.0%Mapped prevalence and referral dataLow obesity prevalenceLow weight management referralsHigh obesity prevalenceLow weight management referrals* Statistically different to the CCGPractices within the dotted line do not have statistically different level of obesity prevalence and % of weight management referrals to the CCG as a whole
7Local Data: Smoking prevalence Smoking prevalence versus % smoking referralsLocal DataLow % smokersHigh% smokers referredHigh % smokersHigh% smokers referredPractices which have a high % of smokers and low percentage of smokers referred:(For a full list of all practices see appendix 5)Practice clusterGP practice name% SmokingSmoking referralsTriangle30.3%8.3%33.2%4.7%29.1%8.1%34.2%1.4%34.1%3.3%Oval6.6%39.9%4.6%37.1%3.4%Circle33.4%3.8%31.5%2.0%33.6%5.3%32.3%6.9%37.4%4.1%No cluster27.8%3.6%Low % smokersLow% smokers referredHigh % smokersLow % smokers referredPractices within the dotted line do not have statistically different level of smoking prevalence and % of smoking referrals to the CCG as a whole
8Overarching messages for Leeds -CVD Summary: Public health focus on prevention; specifically smoking prevalence (Leeds South & East and Leeds West) smoking cessation (All) and Obesity (Leeds South & East)Significant benefit to patients if improvement to Primary Care management indicators were made (All)High emergency admissions for CVD (Leeds South & East), costs (Leeds North and Leeds South & East) and lengths of stay (All)High costs for CHD emergency admissions (Leeds North and Leeds South & East) and high costs for CHD elective admissions (Leeds South & East)High emergency admissions for Heart Failure and Stroke (Leeds South & East and Leeds West)High costs for Angiography procedures (All), CABG procedures (All) and Angioplasty procedures (Leeds West)High lengths of stay for Angiography procedures (Leeds West)
9Respiratory Summary Summary on a page Public health focus on prevention; specifically smoking prevalence (Leeds South & East and Leeds West) and smoking cessation (All)Significant benefit to patients if improvement to Primary Care management indicators were made (All)High emergency admissions for Influenza & Pneumonia (Leeds South & East and Leeds West)High COPD emergency readmissions (Leeds South & East and Leeds West)High costs for Respiratory (All), COPD (Leeds North and Leeds West), Asthma (Leeds South & East), Upper Respiratory (Leeds South & East) and Other Acute lower (Leeds South & East and Leeds West) emergency admissionsHigh lengths of stay for Upper Respiratory (Leeds South & East) and Other Acute Lower (Leeds North and Leeds South & East)Significant variation in corticosteroids prescribing between practices (All)Summary on a page
10Actions …………..Public Health – challenge to jointly re look at commissioning of healthy living services key priority for the Council.Primary care – variation target work with key practices and embed into engagement schemes in each CCGWhole pathway – flow and variation – LIQH.CCG commissioning – using packs as part of prioritisation frameworkTransformation work streams -Acute – elective care value approach; Integrated Care – Pathways work; PYLL trajectories.
12LIQH – focussed areas CVD improving the management of chest pain; optimise outcomes and quality of care for people requiring interventions/ treatment for suspected/confirmed arrhythmia and to prevent inappropriate use of secondary services.to improve the physical and psychological health of patients’ post-MI with new or existing anxiety / depression.COPDsupport people with COPD to manage their own condition and to reduce the likelihood and impact of exacerbations;reduction in variation of approach to COPD patients in crisis;Improving the early and accurate diagnosis of COPD whilst improving patient experience.