Respiratory Services Right Care Optimisation Workshop Tuesday 10 November 2015

Right Care Messages Right Care deep dives, (unwarranted variation, using the evidence) Data extraction and processing, analysis and presentation Findings: The challenge, population, activity / spend, outcomes Opportunities: Who’s doing well? What does this all mean?

Right Care Philosophy “How can I explain this?” To Using evidence to move from: “How can I explain this?” To “What can I do to improve this?”

Deep Dive: Primary Care High prevalence of respiratory disease, but lower than expected rate of diagnosis Five of the six QoF measures in worst quintile: four related to COPD Completed reviews of Respiratory Disease in Primary Care also benchmarks poorly: COPD = 87% (lowest quintile) Asthma = 71% (lowest quintile) Influenza vaccinations for COPD patients and COPD patients with MRC scales recorded are in the lowest quintile.

NEW Devon: Primary Care and Public Health CCG is in the lowest quintile for recording smoking status and offering smoking cessation and support. http://southwest.devonformularyguidance.nhs.uk/formulary/chapters/3.-respiratory/chronic-obstructive-pulmonary-disease

NEW Devon: Inpatients for COPD by Practice

Deep Dive: Prescribing

NEW Devon: Prescribing Respiratory   Locality variance to national at BNF section Percentage above/below national (national = 100% therefore 90% = 10% below national and 110% = 10% above national) Period August 2014-July 2015 Data run: 07/10/2015 Eastern Northern Western NEW Devon CCG BNF Code BNF Name Variance Actual Cost Percentage variance to national Percentage variance to national 301 Bronchodilators -£552,261.50 76.45% -£15,212.57 98.55% £268,116.36 113.59% -£292,138.09 94.56% 302 Corticosteroids (Respiratory) -£215,949.70 95.75% -£69,738.92 96.93% £391,236.18 109.14% £126,823.09 101.09% 303 Cromoglycate,Rel,Leukotriene Antagonists -£18,148.78 69.02% -£4,525.50 82.72% £3,910.58 107.94% -£18,423.75 86.26% 304 Antihist, Hyposensit & Allergic Emergen -£95,299.89 73.05% -£28,239.24 82.13% -£43,917.42 85.23% -£164,577.86 79.66% 305 Resp Stimulants & Pulmonary Surfactants -£1.21 0% -£0.54 -£1.02 -£2.76 307 Mucolytics -£92,922.71 68.95% -£17,188.13 87.15% £128,238.79 150.94% £19,596.80 102.86% 308 Aromatic Inhalations -£91.58 28.80% -£32.06 44.24% -£71.52 33.90% -£195.17 33.69% 309 Cough Preparations -£2,743.08 70.33% -£593.84 85.63% -£2,513.27 67.69% -£5,675.25 73.18% 310 Systemic Nasal Decongestants -£1,980.71 38.67% -£866.08 40.02% -£1,181.81 56.50% -£3,966.95 46.32% 311 Antifibrotics -£64.21 -£28.70 -£54.01 -£146.93 -£979,463.36 -£136,425.59 £743,762.86 -£338,706.88

Deep Dive: A&E and Inpatients Overall admission rates towards low end of national and comparable CCGs In terms of spend: Non-elective spend and A&E spend are in the lowest quintile nationally (low spend) High average spell cost and length of stay in both Asthma and COPD suggesting high complexity.

Deep Dive: A Community opportunity?

Elective Inpatients Tonsillectomies, value of £1m spend, yet deemed a procedure of limited clinical value.

Deep Dive: What does this mean? High Primary Care prescribing perhaps not surprising given high prevalence. Opportunities could be achieved through improved clinical management processes in Primary Care Comparatively low % of regular reviews in Primary Care Improvement could also support realising benefits in prescribing Diagnosis ‘gap’ Closing this may mean more effective management of patients and control of admissions Poor performance on many smoking indicators Tackling this could mitigate future demand.

NEW Devon: What does this mean? Reconciliation between public health data, flu and pneumococal vaccinations, diagnosis and hospital presentations, by practice. Top “high fliers” by practice for targeted interventions Care bundles (prevention and supported discharge) Opportunities for community services Pharmacy reviews (Tonsillectomies).

Over to you Thank You