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Commissioning for Value 24 th March 2015 Dr Stephen Liversedge NHS Bolton CCG.

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Presentation on theme: "Commissioning for Value 24 th March 2015 Dr Stephen Liversedge NHS Bolton CCG."— Presentation transcript:

1 Commissioning for Value 24 th March 2015 Dr Stephen Liversedge NHS Bolton CCG

2 Commissioning for Value in Primary Care in Bolton Where we looked What we changed How we changed it Examples – CKD – At risk of Diabetes

3 Background Big Bolton Health Check ,000 83% of population over 45 years Established ‘Triple Aim’ Industrial scaling, Systematically applied Transparent sharing of data Modest incentivisation Help, Education, and Support for practices

4 Where we looked Concentrated on 7 Health Outcome areas – CVD – Diabetes – Respiratory Disease – Mental Health – Child and Maternal Health – Cancer – Alcohol Peer CCG comparisons – Oldham, HMR, Tameside, Walsall Atlas of Variation, QOF data But mainly interrogation of Practice data – No exception reporting

5 Peer Cluster RED CLUSTER BME Ethnicity > 50%; High deprivation scores RED CLUSTER BME Ethnicity > 50%; High deprivation scores ORANGE and YELLOW CLUSTERS BME Ethnicity > 12%; Ranked on deprivation scores ORANGE and YELLOW CLUSTERS BME Ethnicity > 12%; Ranked on deprivation scores BLUE and GREEN CLUSTERS White; Ranked on deprivation scores BLUE and GREEN CLUSTERS White; Ranked on deprivation scores INDIGO CLUSTER White; low deprivation scores INDIGO CLUSTER White; low deprivation scores

6 Primary Prevention of CVD

7 What we changed Individual practice performance when at variance to peers Atrial fibrillation registers – 3100 in 2009 – 3757 in 2011 Heart failure registers – 1579 in 2009 – 2096 in 2011 CKD registers AUDIT C programme – 96,363 completed Best care indicators – ‘Beyond QOF’ – CHD – Diabetes – COPD – Asthma – Heart failure – CKD

8 How we changed it Transparent sharing of Data Leadership Education programme - every month Practice visits - multiple LES schemes

9 Examples CKD – Early identification – Education – Pathway developed – Best care process Diabetes – Early identification – Education – Best care process – Prevention

10 CKD Prevalence

11 CKD prevalence

12 Register size Total with proteinuria Total without proteinuria QoF target BP 140/85 With proteinuria NICE target 130/80 With proteinuria NICE target 130/80 Without proteinuria NICE target 140/90

13 Best Care in CKD

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15 NHS Bolton Nephrology Referrals per 1,000 patients March 2009March

16 Actual Diabetes Prevalence in Bolton 16,725

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21 Why work with IGT patients? Tsunami of Type 2 Diabetes on the horizon Patients with IGT are 5-10 times more likely to develop Type 2 diabetes In the absence of any intervention - 50% of IGT patients will develop Type 2 Diabetes in 5-10 years

22 Blood sugar/ HbA1c screening Coded as “at risk of diabetes” Total at risk register

23 IGT Project A Small Scale Study 134 IGT patients 6 month comprehensive Health Trainer intervention Follow up GTT at 6 month sign off from intervention

24 Evaluation – 2010 IGT/at risk of diabetes (Small scale study) 2010 Sample size134 Follow up bloods – 2 hour blood sugar in Glucose Tolerance Test (GTT) 6 months Results Reverted back to normal 2 hour blood sugar in GTT47% Reduced 2 hour blood sugar in GTT18% Overall Improvements in 2 hour blood sugar in GTT65% No change in 2 hour blood sugar in GTT 7% Increased 2 hour blood sugar in GTT/developed diabetes28%

25 Other Achievements Weight Change Average weight reduction 2.75kg Weight change No.% No change1512 Weight gain2318 Weight loss8970 TOTAL127

26 Other Achievements Waist Measurement Average reduction in waist circumference 2.88cm Change in waist circumference No.% No change13 Increase2221 Reduction6966 TOTAL104

27 Other Achievements BP Average change in blood pressure of 5.1/2.1 mmHg

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29 IGT/at risk of diabetes registers

30 Evaluation – 2013 IGT/at risk of diabetes (Small scale study 2013 Sample size134 Follow up bloods – HbA1c12 months Results Reverted back to normal HbA1c (≤38 mmol)42% Reduced HbA1c40% Overall Improvements in HbA1c82% No change in HbA1c14% Increased HbA1c/developed diabetes 4%

31 Supporting IGT/at risk of diabetes patients IGT register March 2014 – 19,989 Increasing demand on the Health Trainer Service Primary Care fully engaged – patients referred directly from GP or Practice Nurse Targeted lifestyle interventions involving weight loss strategies and dietary modification and/or physical activity are cost effective Estimated Cost - £123 per patient

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34 The future Commissioning for Value in Primary Care The Bolton Quality Contract An investment of £3.4 million 19 standards including – Access – Prescribing – Demand Management – Health Improvement – Screening 40 KPIs including – Reduction in A/E attendances – Reduction in referrals – Reduction in follow-ups – Reduction in prescribing


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