1. Atrial Fibrillation Project, SSNAP July to September 2013 and QOF Indicators 2012/2013
Dartford, Gravesham and Swanley CCG

2. South East Coast SCN -Atrial Fibrillation Project
Earlier detection and anticoagulation optimisation of patients with atrial fibrillation
First step will be agreement on recommendation of NICE anticoagulation guidelines as best practice. New NICE Guidance will be published on the 11th June 2014
Task to Finish Group being established to implement the NICE guidance
Will be followed by the development of a best practice model for earlier detection and management
SSNAP Data – July to September 2013 most up to date
QOF Data from 2012/13 most up to date
Uses CHADS2 scoring. This will be replaced by CHADSVASC in NICE Guidance

3. SSNAP Data – July to September 2013
Nationally 19.8% of Stroke patients had previous AF. SEC is 20.5 %.Range in SEC is 12.7 to 35.5%
Best practice is anticoagulant prescribing for AF
Nationally 24.5% of Stroke patients with AF were not previously prescribed anticoagulants or anti-platelets. SEC is 26.8%. Range is 7.7 % to 40%
Nationally 32.5 % of Stroke patients with AF were previously prescribed anticoagulants only. SEC is 31.4%. Range is 0 – 70%

4. SSNAP Data – July to September 2013

7. QOF Atrial Fibrillation Indicators – 2012/13 by CCG
Four Indicators
Prevalence (percentage on QOF AF Register/practice population)
AF05 – Percentage on AF register who have had a CHADS2 score in the previous 15 months (except those whose previous score was greater than 1)
AF06 – In those with a CHADS2 score higher than 1 in last 15 months– those who are on anti-coagulants or anti-platelets (minus exceptions)
AF07 – In those with a CHADS2 score higher than 1 in last 15 months – those who are on anti-coagulants (minus exceptions)
Any correlation between QOF CCG indicator results and AF stroke admissions and prescribing? E.g. High stroke admissions with AF in local hospitals and low anticoagulant prescribing for those admissions and low prevalence and low anticoagulant prescribing (for the known AF’s) in CCG data

8. AF Prevalence by CCG in Kent

9. AF05 by CCG in Kent

10. AF06 by CCG in Kent

11. AF07 by CCG in Kent

12. QOF Atrial Fibrillation Indicators – 2012/13 by Practice
What to look for
Does the prevalence look low for this practice population and demographics? All other indicators are based on this. Low numbers may mean that some AF patients have not been diagnosed
AF05 – Low rates will indicate that the practice isn’t routinely assessing those on the AF Register for CHADS2 and changes to their risk
AF06 – Best practice is for those with identified AF to be on anticoagulant therapy not anti-platelet therapy. Compare rates with AFO7. High rates on AF06 but lower rates on AF07 indicates a high usage of anti-platelet therapy .
AF07 - Best practice is for those with identified AF to be on anticoagulant therapy . Compare with prevalence and AF05 - high rates but low prevalence and low routine assessment may indicate that only small numbers are being managed well

13. GP Practice Codes in Dartford, Gravesham and Swanley CCG
BENNETT WAY SURGERY
G82088
DEVON ROAD SURGERY
G82809
DOWNS WAY MEDICAL PRACTICE
G82206
DR ARORA R P
G82028
DR JONES D I & PARTNERS
G82221
DR LANGLEY S H & PARTNER
G82032
DR MORAN S G & PARTNERS
G82073
DR MOUNTY J P & PARTNERS
G82722
DR MUTHAPPAN A K
G82212
DR PATEL B C & PARTNERS
G82197
DR PATEL M M & PARTNER
G82690
DR PILLARISETTI S C
G82062
DR SHAH S U D
G82006
DR SHIMMINS C J & PARTNERS
G82648
DR SINGH J
G82743
DR VASUDAVEN B & PARTNER
G82218
FARNINGHAM SURGERY
G82780
GRAVESEND MEDICAL CENTRE
G82048
HORSMAN'S PLACE SURGERY
G82156
IVY BOWER SURGERY
G82097
JUBILEE MEDICAL GROUP
G82143
LOWFIELD MEDICAL CENTRE
G82639
MAPLE PRACTICE
G82808
OAKFIELDS HEALTH CENTRE
G82067
OLD ROAD WEST
G82185
REDWOOD PRACTICE
G82122
SWANSCOMBE HEALTH
G82647
TEMPLE HILL SURGERY
G82096
THE FORGE SURGERY
G82044
THE GATEWAY MEDICAL PRACTICE
G82225
THE OAKS
G82056
THE ORCHARD PRACTICE
G82021
THE SHRUBBERY
G82124
WEST KINGSDOWN MEDICAL CENTRE
G82805
Y02826
WHITE HORSE SURGERY

14. Prevalence by Practice compared to KSS (Red line) and England (Green Line)

15. AFO5 by Practice compared to KSS (Red line) and England (Green Line)

16. AFO6 by Practice compared to KSS (Red line) and England (Green Line)

17. AFO7 by Practice compared to KSS (Red line) and England (Green Line)