Adding local value to Commissioning for Value Lucy Jackson Consultant in Public Health Leeds City Council

What 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?

Local 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

Use 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, 2009-2011 How to put GP referrals in here Will NHS comparators activity be different from the spend?

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 Local agreement with all GPs in Leeds to audit their data

Local Data: Obesity prevalence Obesity prevalence versus % weight management referrals 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 21.7% 0.9% Triangle 22.7% 1.7% Kite 21.3% 0.4% Hexagon 20.4% 0.6% 20.0% 25.7% 19.5% 2.2% 1.6% Circle 23.1% 0.7% 26.7%* 0.0% Mapped prevalence and referral data 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

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 30.3% 8.3% 33.2% 4.7% 29.1% 8.1% 34.2% 1.4% 34.1% 3.3% Oval 6.6% 39.9% 4.6% 37.1% 3.4% Circle 33.4% 3.8% 31.5% 2.0% 33.6% 5.3% 32.3% 6.9% 37.4% 4.1% No cluster 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

Overarching 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)

Respiratory 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 admissions High 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

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; PYLL trajectories.

The LIQH approach

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. to improve the physical and psychological health of patients’ post-MI with new or existing anxiety / depression. 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.