1. Respiratory Services Right Care Optimisation Workshop
Tuesday 10 November 2015

2. 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?

3. 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?”

4. 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.

5. NEW Devon: Primary Care and Public Health
CCG is in the lowest quintile for recording smoking status and offering smoking cessation and support.

6. NEW Devon: Inpatients for COPD by Practice

7. Deep Dive: Prescribing

8. 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

9. 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.

10. Deep Dive: A Community opportunity?

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

12. 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.

13. 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).

14. Over to you
Thank You