1. Populations or Pathways?
Liane Langdon
Anthony Lawton
NHS Leeds North CCG
Together
we’re better

2. Local Strategic Context – Leeds Joint Health and Well Being Strategy
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we’re better

3. What did we do with Commissioning for Value?
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we’re better

4. Use CFV but also locally what fits –
the life expectancy gap by cause of death
Together
we’re better

5. NHS LEEDS SOUTH AND EAST CCG
Local Data: GP audit and healthy living service referral data summarised by CCG
NHS LEEDS NORTH CCG
NHS LEEDS SOUTH AND EAST CCG
NHS LEEDS WEST CCG
Leeds
CHD
prevalence
3.3%
3.8%
3.1%
3.4%
Health checks uptake
60.2%
65.2%
51.5%
57.7%
Smoking
18.6%
27.0%
22.0%
22.7%
Smokers referred to smoking services (including prompted self referral)
9.0%
9.1%
4.2%
7.0%
Obesity
19.5%
25.7%
19.9%
21.7%
Recorded BMI
>30 referred to weight management service
2.2%
2.1%
1.5%
1.9%
Alcohol
Short screening (FAST or AUDIT-C)
6.3%
6.7%
Completed full AUDIT screening
1.1%
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 drinking
1.8%
0.4%
0.5%
Local Data

6. Local Data: Obesity prevalence
Obesity prevalence versus % weight management referrals
Local Data
Low obesity prevalence
High weight management referrals
High obesity prevalence
High weight management referrals
Practices which have high obesity prevalence and low percentage of weight management referrals :
(For a full list of all practice's see appendix 5)
Practice cluster
GP practice name
% Obese
Referrals
Pentagon
Dr Rickards A F & Partners
21.7%
0.9%
Triangle
Oakwood Lane Medical Practice
22.7%
1.7%
Kite
Dr Fellerman S M
21.3%
0.4%
Hexagon
Dr Brady & Partners
20.4%
0.6%
Charles Street Surgery
20.0%
Dr Pearson R E & Partners
25.7%
Dr Hall G I & Partners
19.5%
2.2%
Wetherby Surgery
1.6%
Circle
One Medicare Llp (Hilton Road)
23.1%
0.7%
Dr Nicholls J A J
26.7%*
0.0%
Low obesity prevalence
Low weight management referrals
High obesity prevalence
Low weight management referrals
* Statistically different to the CCG
Practices within the dotted line do not have statistically different level of obesity prevalence and % of weight management referrals to the CCG as a whole
Together
we’re better

7. Local Data: Smoking prevalence
Smoking prevalence versus % smoking referrals
Local Data
Low % smokers
High% smokers referred
High % smokers
High% smokers referred
Practices which have a high % of smokers and low percentage of smokers referred:
(For a full list of all practices see appendix 5)
Practice cluster
GP practice name
% Smoking
Smoking referrals
Triangle
Dr N Dumphy & Partners
30.3%
8.3%
Dr Iwantschak A & Partners
33.2%
4.7%
Dr Pg Darbyshire & Partners
29.1%
8.1%
Dr S J Brown & Partners
34.2%
1.4%
Dr S J K Renwick & Partners
34.1%
3.3%
Oval
Dr S M Laybourn & Partners
6.6%
Dr Boonin A S & Partners
39.9%
4.6%
Dr Bhandary L V & Partners
37.1%
3.4%
Dr Srivastava S K
Circle
Dr Y F S Wong
33.4%
3.8%
Dr A R Sooltan & Partner
31.5%
2.0%
Dr Ali S A
33.6%
5.3%
Lincoln Green Medical Centre
32.3%
6.9%
Dr H U Pai
37.4%
4.1%
No cluster
Shakespeare Medical Practice
27.8%
3.6%
Low % smokers
Low% smokers referred
High % smokers
Low % smokers referred
Practices within the dotted line do not have statistically different level of smoking prevalence and % of smoking referrals to the CCG as a whole
Together
we’re better

8. So Summary: Overarching messages for Leeds
Summary on a page
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)

9. Actions …………..
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 CCG
Whole pathway – flow and variation – LIQH.
CCG commissioning – using packs as part of prioritisation framework
Transformation work streams -Acute – elective care value approach; Integrated Care – Pathways work.
Together
we’re better

10. The LIQH approach
Together
we’re better

11. LIQH – 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.
COPD
support 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.
Together
we’re better

12. Pathways So, for pathways But, is this enough?
The data gives us some clear indication of pathways to consider
We have established clear programmes of work
But, is this enough?
Together
we’re better

13. Populations Great for quality improvement
But – is this enough for transformation?
What about complex populations?
CfV tells us where the challenges are
But we know that with populations, pathway approaches are not always enough
What can CfV do to inform work with the frail elderly?
Together
we’re better

14. Liberating CfV for Populations
What we did next:
Used the CfV intelligence
Used part of the £5 per head for primary care (£2.36)
Identified our target population – frail elderly 2%
Applied Outcomes Based Accountability to liberate practices to use CfV knowledge creatively to tackle an issue requiring transformation, not quality improvement
Look for contribution not attribution – asked practices to work in localities to give something a go
Together
we’re better

15. Overview of OBA
Outcome Based Accountability™ was first developed in the early 1990s by Mark Friedman
Principles:
SIMPLE
COMMON SENSE
PLAIN LANGUAGE
Together
we’re better

16. Definitions
OUTCOME
A condition of well-being for adults, children, families, communities
i.e. Being Healthy, Staying Safe, Safe Communities, Clean Environment
INDICATOR
A measure which helps to quantify the achievement of the outcome.
i.e. Rate of diagnosis of Dementia in Primary Care, Rate of teenage pregnancies
Population
ENDS
PERFORMANCE MEASURE
A measure of how well a program, service is working
Based on the 3 following questions:
How did we do?
How well did we do it?
Is anyone better off?
Performance
MEANS
Together
we’re better

17. Leaking Roof Experience: Measure: Story behind the baseline (causes):
Not OK
Experience:
? Fixed
Measure:
Turning the curve
Story behind the baseline (causes):
Partners:
What Works:
Action Plan:
Together
we’re better

18. What now?
Supported practices in locality groupings to identify meaningful local measures relating to how they are contributing to the issues identified within CfV
Practices are all enhancing community nursing – but in different ways
Measure and look for learning and impact – and share
Worry about contribution, not attribution
Do more of whatever works!
Together
we’re better

19. Questions