closing the gap: finding the missing thousands · 2012. 3. 27. · systematically addressing health...

Health Inequalities National Support Team

Enhanced Support Programme

Closing the gap: finding the missing thousands

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Policy EstatesHR/Workforce CommissioningManagement IM&TPlanning/Performance FinanceClinical SocialCare/PartnershipWorkingDocument purpose BestPracticeGuidanceGateway reference 13672Title ClosingtheGap:FindingtheMissingThousands

Author TerryBlair-StevensPublication date 05Mar2010Target audience PCTCEs,NHSTrustCEs,CareTrustCEs,FoundationTrustCEs,Directors

ofPH,LocalAuthorityCEs

Circulation list SHACEs,MedicalDirectors,DirectorsofNursing,DirectorsofAdultSSs,PCTPECChairs,PCTChairs,NHSTrustBoardChairs,SpecialHACEs,DirectorsofHR,DirectorsofFinance,AlliedHealthProfessionals,GPs,CommunicationsLeads,EmergencyCareLeads,DirectorsofChildren’sSSs,VoluntaryOrganisations/NDPBs

Description OneinaseriesofMasterclassReportspublishedaspartofthe“Redoublingeffortstoachievethe2010nationalhealthinequalitieslifeexpectancytarget”resourcepack.

Cross ref SystematicallyAddressingHealthInequalities

Superseded docs N/A

Action required N/A

Timing N/AContact details HealthInequalitiesNationalSupportTeam

NationalSupportTeams(NSTs)WellingtonHouse133–155WaterlooRoadLondonSE18UG02079723377www.dh.gov.uk/hinst

For recipient’s use

Closingthegap:findingthemissingthousands

Systematic and scaled interventions by frontline services

(B)

Partnership, vision and strategy,

leadership and engagement (A)

Personal health

Community health

Population health

Systematic community engagement

(C)

Frontline service engagement with the community (D)

Population focus Optimal population outcome

Challenge to providers

10. Supported selfmanagement

9. Responsive services

7. Expressed demand

8. Equitable resourcing

6. Known population

needs

1. Known intervention

efficacy

13. Networks, leadership and coordination

5. Engaging the public

4. Accessibility

2. Local service effectiveness

3. Costeffectiveness

12. Balanced service portfolio

11. Adequate service volumes

Bentley C (2007). Systematically Addressing Health Inequalities, Health Inequalities National Support Team.

Foreword TheHealthInequalitiesNationalSupportTeam(HINST)haschosentoprioritisethistopic asoneofitsMasterclassesforthefollowingreasons:

• Asignificantproportionofthedisadvantagedelementsofpopulations,inSpearhead areasinparticular,arefailingtotakeadvantageofthebenefitsthatservicescanoffer. Thereasonsforthisarevariedandcomplex,andstrategiesforaddressingtheproblem needtobebasedonlocalintelligenceandinsight,andtheyalsoneedtobesystematic.

• Specifically,withinthe‘Christmastree’diagnosticitaddressesthefollowing components:

– accessibility(4)

– engagingthepublic(5)

– knownpopulationneeds(6)

– expresseddemand(7)

– responsiveservices(9).

• ActioninthisareaofworkwillcontributetotheQualityandProductivity Challengeby:

– engagingpeopleathighriskof,orwith,earlyestablisheddisease,toenablethemto accesseffectivepreventivestrategies.Thiscanhelppreventoratleastdefermajor (costly)impacts,e.g.strokes;renalfailure,blindnessandamputationsinpeoplewith diabetes.

• Successfuladoptionofprocessessimilartothoseoutlinedherewoulddemonstrate gooduseofWorldClassCommissioning(WCC)competencies:

– collaborationwithpartners(2)

– patientandpublicinvolvement(3)

– clinicalleadership(4)

– assessmentofneeds(5)

– procurementandcontracting.(9)

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BaCkgrouNd ‘Closingthegap:findingthemissingthousands’masterclassexploredsystematic approachestoincludingasmanypeopleaspossiblewithestablisheddiseaseontogeneral practiceregisters,andindoingsoclosingthegapbetweenactualandexpectednumbers onchronicdiseaseregisters,byusing:

• strategiestomatchactualnumberswithestimatesofexpectednumbersbypractice

• strategiesto‘sweattheasset’ofpracticerecordstoidentifypatientswithdisease

• avarietyof‘segmented’optionstoidentifypatientsinthecommunity,scaledup appropriately.

Theidentificationofpatientswhoalreadyhave,orwhoareatriskofdeveloping, diseaseandsuccessfulmanagementoftheircondition/sarecrucialtoeffortstoreduce prematuremortality,morbidityandinequalitiesinhealth.Acriticalelementtoachieving optimalpopulationhealthoutcomesistoensurethatchronicdiseaseregistersare comprehensive,byaddressingthebarriersthatpreventpatientsfromcomingforward. Thismaybeeasiertoachieveinareaswherethereisminimalpopulationmovement.

Thereareanumberofpopulationdiseaseprevalenceformulae,whichestimatenumbers thatshouldbereflectedonregisters.Thedatatheyproduceprovideavaluableinsight intothepotentialtosavelivesbyprovidingabenchmarkbetweenestimatedpopulation diseaseprevalenceandnumbersondiseaseregistersinthelocalcontext.Recommended populationdiseaseprevalenceformulaeinclude:

• AssociationofPublicHealthObservatoriesdiseaseprevalencemodel– www.apho.org.uk/resource/view.aspx?RID=48308

• Yorkshire&HumberPublicHealthObservatoryPBSDiabetesPopulationPrevalence Model–Phase3–www.yhpho.org.uk/resource/item.aspx?RID=9905

ModelS oF MeCHaNISMS For ‘CloSINg THe gap’ The‘Masters’whoparticipatedintheMasterclassidentifiedthekeyelementsof theirprogrammesaimedatclosingthegap,includingwhathadbeensuccessful,the challengesandbarriersencountered,andtheleversusedtoovercomethese.Themodels outlinedaresummaries.Forfullerdetails,pleaseseetheMasters’presentationsat www.dh.gov.uk/hinst

Improving male life expectancy (MLE) in Birmingham

Keypoints:

• Atthestartofthisproject,in2005,lifeexpectancyformeninBirmingham wasnotimprovingasquicklyasthenationalaverage.Thelocalauthoritywas keentoaddressthebiggestissuesfacingthecityand,asaresult,atarget wasincludedintheLocalAreaAgreement(LAA)toclosethegaponmalelife expectancyby10%.

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• Dataanalysisindicatedthatdeathsfromcoronaryheartdisease(CHD)were affectingayoungerthanexpectedagegroupand,consequently,theproject targetedmenagedbetween40and65yearsinthe11mostdeprivedwards ofthecity.

• AlthoughrecordedprevalenceofCHDwashighestinthemoreaffluentareas, deathswerehigherinthemoredeprivedareas–thedifferencebeingthat fewerpeoplewereonCHDregistersinthedeprivedareasofthecityand werethereforenotreceivingappropriatetreatment.

• Figure1showstheprevalenceandFigure2themortalityrateforCHD formenunder75yearsacrossthecity.Themapsclearlydemonstratethe starkdifferencebetweenwheremenwhoareatriskofdyingprematurely ofCHDlive,basedonprimarycareQualityandOutcomesFramework (QOF)prevalencedata(Figure1),andactualmortalityratestakenfrom datainpublichealthmortalityfiles(Figure2).MappingCHDmortalityin thiswayhelpstotargetpreventiveinterventionsandservicesformeninthe neighbourhoodsandcommunitieswheretheyaremostneeded.

Figure 1: QoF prevalence for CHd by Super output area for men under 75 years in Birmingham

Figure 2: Mortality rates for CHd by Super output area for men under 75 years in Birmingham

• WorkwithfocusgroupssuggestedthatthelowlevelofGPregistrationwas duetoarangeoffactorsincludingdislikeofaccessingservices/beliefthatthe NHSwouldpassinformationtoothergovernmentbodies,lackofknowledge ofsymptomsandconcernabouttheimplicationsofbeingdiagnosed, e.g.lossoflivelihood.


• Fivekeyinterventionswereidentified–reducesmoking,enhancedsecondary prevention,deliveryofprimaryprevention,improvedaccesstoprimarycare, andtargetingthoseathighestrisk.

• Armedwiththeknowledgeofthebarrierstoaccess,theMLEprogrammeset outtoaddresstheregistrationofthemissingthousands.

• SubstantialextrafundingwasmadeavailablethroughtheLocalStrategic Partnershipforanintensiveshort-termprogramme,whichenabledthe commitmentofdesignatedstaff.

• TheProgrammefollowedasystematicapproachbasedontheexpectedrate ofreturnoncomponentparts:

– Theprocessstartedwiththerecruitmentofanindependentcompany contractedtoworkwithGPrecords.Aftersomeinitialresistance,GPswere persuadedthat,onceaffordedaccess,thecompanywouldeffectivelybe doingsomeoftheirworkforthem,atsomeoneelse’sexpense.Arecord searchidentifiedthosewho:

■■ hadbeendiagnosed,butmissedofftheregister

■■ hadbeenidentifiedaspossiblecases,butwithoutconfirmeddiagnosis

■■ attendedthepractice,buttheissuehadnotbeenraisedwiththem despiteapparentriskfactors

■■ rarely,ifever,attendedthepractice.

(Otherprocesseswereusedtoidentifywhethersubstantialnumberswere notregisteredwithapractice.Thiswasfoundnottobethecase.)

– Patientsidentifiedasneedingfurtherscreeningordiagnosticworkwere thencontactedinseveralways,inthefollowingorder:

■■ invitationletterfromtheGPtoattendthepractice

■■ telephonecallfromthecallcentre

■■ visitfromoutreachstaff,e.g.HealthTrainer.

Thisfollow-upworkwasco-ordinatedbythesearchcontractor.

– Whilethissystematicrecords-basedsearchwasunderway,aframework ofoutreachmechanismswasalsoinitiated,usingavarietyofmethodsto contactthetargetpopulationawayfromformalmedicalcare.Theportfolio ofapproacheswasnotadhoc,butdesignedtocapturecertainsegmentsof thepopulationnotmakingfrequentcontactwithGPservices.

• Furtherreachwasachievedthrough29pharmacies,workinginthetargetareas, offeringheart‘MOTs’onadrop-inbasis,withreferralontoGPsforregistration andaction.

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• Aseriesofcampaigns(somedesignedbylocalmen),targetingspecific conditionsandhealth-relatedbehaviour,weredeveloped,e.g.bloodpressure andsmoking.‘Quickwins’werecomplementedbysustainedapproachessuch asthehealthcheckbus.Thistargetedmeninsupermarketsandothernon-healthlocations(e.g.healthcentres,footballclubsandchurches)including duringtheevenings,andprovedverysuccessful.Experiencesuggeststhatthe NHSlogo/brandwasimportantinencouragingmentoapproachandhave confidenceintheserviceprovidedevenifscreeningwasbeingofferedina non-NHSlocation.

• Telephonecontactwasanimportantmeansofencouragingmentoattend screeningsessions.Birminghamwasfortunateinhavingacallcentrethat couldbeusedforthispurposeandtosupportwiderprogrammesforthose withlong-termconditions,suchastelephonereminderstotakemedication.

• Resultsoftestsundertakenatscreeningclinicsweresenttothepatient’s GP.Itisknownthattherehasbeenanincreaseintheprescriptionofstatins followingtheproject,butnootherdatahadbeencollectedonfollow-up.

• Scalingupinterventionstotakeaccountofincreasednumbersonregisters hadworkforceimplications,asevenroutinefollow-upwasoftenoutsidethe capacityofapractice.Fewareashadaddressedwaysinwhichprofessionals couldbefreedfromroutineworktoallowthemtoconcentrateonmore specialisttasks.Forguidanceonworkforceplanningseethe‘Howto’guide, ‘Howtomodelneedanddevelopaworkforceplantomanagechronicdisease registersasanindustrialscaleprocess’.

Keylessonsfromtheprojectintermsofwhatcouldhavebeendonedifferently:

• Datasharing–sharingdatawasproblematic.Agreementforatwo-way movementofdatabetweenthePrimaryCareTrust(PCT)projectandGPs wouldbeuseful.

• Qualitycontrol–appropriatemeasuresneedtobeinplace,particularlywhere workiscontractedout.Touchscreenscanavoidsomeoftheproblemsfound withpaperrecordingmethods.

• Cost–costsperpatientwerehigherthanexpected,partlyduetounexpected consumables.

• EngagingGPs–supportofGPsiscrucialandtheyneedtobeinvolvedin discussionsfromtheoutset.Asystematicapproachthataddressesallthe potentialproblemareasshouldhelptoensurethatpractitionersarewilling toparticipate.VisitingpracticestotalkpersonallytoGPsandtheirstaffoften paiddividends.

• Sustainability–considerationshouldbegiventowhethertheimpactofthe projectcanbesustainedoverthemediumandlongerterm.

• Follow-up–waysofensuringthattheresultsofscreeningarefollowedup appropriatelyshouldbefactoredintotheproject.


PrimarycareQOFdataaloneisnotsufficienttogainacomprehensivepictureof wheremenwhoareatriskofdyingprematurelyfromCHDlive.Foradditional insightintostrategiesforidentifyingthoseatriskofprematuredeathfrom cardiovasculardisease(CVD)(includingCHD),pleaseseethe‘Howto’guide, ‘Howtoundertakearetrospectivecardio-vasculardiseasemortalityauditto supportmoresystematicdeliveryofsecondaryprevention’.

ToseethefullpresentationonimprovingmalelifeexpectancyinBirmingham seewww.dh.gov.uk/hinst

Vascular checks in Bolton – industrially scaled and systematically applied

Keypoints:

• InspiredbytheHINSTdiagnosticvisitin2007,partnersinBoltonaimedto stepupmomentuminthedrivetoreduceprematuremortalityandreduce healthinequalities.LifeexpectancyinBoltonwastwoyearsbelowthe nationalaveragewithaninternalgapof15years(asmeasuredbymiddle SuperOutputArea).1Oneofthepriorityareastheyfocusedonwasprimary preventionofCVD.

• TheBigBoltonHealthCheckwasakeyfacetoftheprogrammetoincrease lifeexpectancy,targetingeveryone45yearsandolderandofferingfree healthchecks.

• AlargescalelocalmediacampaignsupportedtheBigBoltonHealthCheck andencouragedpeopletoconsulttheirGPdirectly.InadditionHealthTrainers assessedpeopleinavarietyofcommunitysettings,includingworkplaces, supermarkets,pubs,bettingshopsandmosques.Thiswassupportedbynear patienttesting.

• A‘PrimaryPreventionofCHD’incentiveschemewasintroduced,challenging GPstoimprovetheirpositionby10–20%.Anexponentiallyscaledpayment systemwasusedtoencouragemaximalachievementofassessments.The paymentamountsandpercentageachievementthresholdsforprimary preventionofCHDbygeneralpracticesinBoltonareoutlinedinFigure3and thelogarithmicscaleisrepresentedinFigure4.Of55generalpractices,10 didnotparticipateandforafurther12dataqualitywaspoor.Inall,31%of patientsonthelistwereassessed.

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Figure 3: Bolton primary prevention of CHd logarithmic payment incentivisation

30%

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Figure 4: Bolton primary prevention of CHd exponential incentivisation scale

Logarithmic incentivisation

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• Boltonproducedataxonomyofgeneralpracticesthatclusteredthosewith similardemographicstogether(seeappendix1).Datashowednotonly theperformanceofindividualpractices,butalsohowtheycomparedwith theirpeergroup.Consequently,practicescouldnolongerarguethatthey were‘different’.Thedatawasusedtoidentifywhathadworkedwellrather thanfocusingonlyonoutliers–showingthemwhatcouldbedoneand encouragingthemtodoit.Avarietyofincentiveswereusedtoachieve this.Thesystemwasacceptedbypracticesasnonewantedtobeseentobe performingworsethantheirpeergroup.

• Forfurtherinsightintoestablishingtaxonomiesofpracticepleaseseethe ‘Howto’guide,‘HowtodevelopaTaxonomyofGeneralMedicalPracticesto supportandencourageperformancedevelopment’.

• Practicesalsoreceivedamonthlyauditreportoftheirperformanceonarange ofkeymeasuresforthemanagementofconditionsrelatedtoCHD–see Figure5.

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Figure 6: percentage of patients assessed for primary prevention of CHd before the Big Bolton Health Check programme was introduced

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Figure 7: percentage of patients assessed for primary prevention of CHd after the Big Bolton Health Check programme was introduced

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Learningpoints:

• Information–Regularreportswerevitalforboththepracticesandtheproject team.

• Dataquality–Assumenothing,ensuresearchesaresystematic,andprovide thenecessarysupportandtrainingtorunthem.

• Clinicalengagementisessential–Ittakestimetobuildgoodworking relationships,tounderstandthevariabilityanddynamicsofeachpractice andtoidentifyaleadineachpractice.Thecultureandethosdetermine success.GPsarenotfundamentallyopposedtoinitiativeslikethis,butthe approachneedstobepitchedappropriatelytoensuretheircommitment.The philosophyofvisitingindividualpracticesisbeingappliedtootherprojects.

• Outreach–Althoughthemarketingexercisewassuccessful,wellreceived andprovidedinformationbacktopractices,itwasatacostandledto someduplication.Withhindsight,alargescalemarketingcampaignatthe beginning,followedbysmallertargetedoutreachactivities,wouldbebetter, withpracticesthemselvesrunningeventsandidentifyingpatients.

• HealthTrainers–Theuseofthisgroupofstaffwasvitalastheyoffered anadaptable,flexibleresource.Otherareasmightprefertousehealthcare assistantstofulfilthisrole.ThekeyissuewastotrytorecruitHealth Trainersfromlocalcommunities.AlthoughHealthTrainershadtakenthe measurementsatscreening,theresultshadbeeninterpretedbyGPsor practicenurses.

• Marketing–Thebrandingusedwasappealingandeasilyrecognised,but relativelyexpensiveagainstthetotalprogrammecost.

• ThePrimaryPreventionofCHDincentiveschemewassuccessful.

• Nearpatienttesting–Laboratorysupportwastheonlyinputfromsecondary care.Ifrunagain,theprojectwouldsecureincreasedsupportfromthelabs.

• Clinicalgovernance–Moretrainingandsupportwereneededonwhatto dowithpatientsontheregisters.Outcomesweremonitoredtoensurethat patientsreceivedtherightcare.However,practicescanhittheirQOFtargets evenwherepatients’conditionsarepoorlycontrolled.Boltonisthereforenow movingtoscoringpracticesandincentivisingthemtomovebeyondQOFasa meansofaddressingthisanomaly.

• Selecttheprojectteamcarefullytoensurememberssharethesameambition.

• Ifservicesareavailable,peoplewillcome–Concernsthathealthinequalities wouldbewidenedduetoaffluentpatientsfloodingthesystemproved unfounded.Practicesindeprivedareasincreasedtheirworkthroughout theproject.

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• Oncethenumbersscreenedexceedthe80%or90%thresholditisnecessary toaddressthereasonswhytheremainderdonotattend.Solutionscanbe assimpleasrunningsessionsoutsideworkinghoursanddealingwithurban mythssuchas‘I’mhealthysoI’mnotatrisk’.

Insummary,torunaprojectlikethisyouneedaclinicalleader,aprojectteam, anincentivescheme,peergroupclusteranalysis,practicevisits,HealthTrainers, targetedoutreach,andpublicity–allofwhichareequallyimportant.

Alistofthekeylearningpointsforissuesthatwereinstrumentaltothesuccess ofthevascularchecksprogrammeinBoltonareoutlinedinappendix2.Forthe fullBoltonpresentationonIndustrially Scaled and Systematically Applied Approaches to Implementing a Vascular Checks Programmewww.dh.gov.uk/hinst

Closing the gap – a health equity audit approach in Nottingham

Inordertosweattheassetofgeneralpracticediseaseregistersitisimportant tooptimisethenumberofpatientswhoareinreceiptofregularassessments andcare.Reducinginappropriateexceptionsandexemptionstoaminimum arecrucialtoachievingthis.Inrecognitionoftheimportanceoftheissue, HINSTcommissionedNHSNottinghamCitytoexaminewhycertainvulnerable groupsweresystematicallyexcludedfromQOFchronicdiseaseregisters. Preliminaryfindingswerepresentedandwillbefollowedinduecourseby fullypublishedresults.


key learNINg poINTS FroM dISCuSSIoN groupS

• engage gps–IdentifywaysofempoweringGPstoplaytheirpart.Cliniciansliketo dealwithotherclinicians.Practicevisitsbyaseniorpersoncanbeveryhelpful.

• Taxonomy/clusters of practices–Showpracticeshowtheycomparewithpeers. Practicesdon’tlikebeingoutliers.Needstobedonelocallyratherthanatthenational level.Drivingupperformanceinprimarycareiscritical.NeedtomovebeyondQOF. Offeranalyticalsupporttogrouppractices.Buddyingofpracticesmayhelpwith taxonomy.

• Needgoodanalysistounderstandtheproblemandcommissionarangeofservices. Inequalitiesneedtobebuiltintopredictivemodelling.

• Clinical leadership–Donotrelyonasingleleader.Projectmanageralsokey.Needa clinicallyastutemanagerandamanageriallyastuteclinician.Identifylocalchampionsif noobviouscandidate.

• ownership–Byeveryone.Needclearvisionandobjectives.Board-levelinvolvement important.Partnershipapproachmaybemoreappropriateinsomecircumstances. UserangeofstaffincludingHealthTrainersandusethemflexibly.

• Financial incentives–Needtoberight.Plansneedtobebackedbyevidenceofcost effectiveness.

• Balancebetweenincentivisationandclinical governance.Needtogetthe‘dayjob’ rightbeforeofferinganyincentives.

• Makeuseofnationalinformationoninformation governance,e.g.RoyalCollegeof GeneralPractitioners(RCGP),BritishMedicalAssociation(BMA),protocolsforsharing informationwithintheNHS.

• use screening as an opportunitytoofferarangeofinterventions–maynotsee peopleagain.Usevascularcheckstoidentifyotherissues.

• go to where people are–Askpracticeswheretheirpopulationsshop,etc.Valueof telephoneoutreach.Getcommunicationright–knowyouraudience.

MaSTerS’ reCoMMeNdaTIoNS

• Ensureintegrationandperformancemanagementofwhatiscommissioned–notjust amatteroffindingpeoplebutensuringservicesareinplacetosupportthemandthat thefundsgoingintothoseservicesareperformancemanaged.

• AllPCTsshouldreviewtheircriteriaforexemptionreportingandtakeactiontoreduce thistoaminimum.

• PrevalencedataneedstobeaccuratesothatGPsknowwhattheyareworking towards.

• Itispossibletogetpeopleonregistersandtheevidenceisthat,oncethere,itcan makeabigdifferencetopeopleatpopulationlevel.Beingonachronicdiseaseregister isgoodforyourhealthasyourdiseasewillbebettermanaged.

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appeNdIx 1 Bolton taxonomy of general practice performance on preventing heart disease

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p1 1,966 285 14.5% 16.8% 233 81.8% 73.8% 58 24.9% 19.0%

p2 1,655 222 13.4% 16.8% 182 82.0% 73.8% 34 18.7% 19.0%

p3 2,427 423 17.4% 16.8% 232 54.8% 73.8% 57 24.6% 19.0%

p4 2,593 346 13.3% 16.8% 236 68.2% 73.8% 33 14.0% 19.0%

p5 1,779 414 23.3% 16.8% 249 60.1% 73.8% 72 28.9% 19.0%

p6 1,601 244 15.2% 16.8% 131 53.7% 73.8% 17 13.0% 19.0%

p7 5,163 861 16.7% 16.8% 807 93.7% 73.8% 94 11.6% 19.0%

p8 1,970 432 21.9% 16.8% 312 72.2% 73.8% 87 27.9% 19.0%

p9 2,640 631 23.9% 22.8% 303 48.0% 72.3% 108 35.6% 32.6%

p10 2,098 0 0.0% 22.8% 0 N/A 72.3% 0 N/A 32.6%

p11 2,221 544 24.5% 22.8% 458 84.2% 72.3% 146 31.9% 32.6%

p12 5,632 1,417 25.2% 22.8% 792 55.9% 72.3% 199 25.1% 32.6%

p13 7,514 1,792 23.8% 22.8% 1,620 90.4% 72.3% 393 24.3% 32.6%

p14 4,015 1,054 26.3% 22.8% 839 79.6% 72.3% 329 39.2% 32.6%

p15 2,613 534 20.4% 22.8% 424 79.4% 72.3% 142 33.5% 32.6%

p16 3,625 1,023 28.2% 22.8% 630 61.6% 72.3% 358 56.8% 32.6%

p17 2,318 439 18.9% 22.8% 305 69.7% 72.3% 76 24.8% 32.6%

p18 8,937 2,650 29.7% 30.0% 1,350 50.9% 68.9% 321 23.8% 26.5%

p19 2,376 764 32.2% 30.0% 464 60.7% 68.9% 155 33.4% 26.5%

p20 2,019 570 28.2% 30.0% 382 67/0% 68.9% 114 29.8% 26.5%

p21 4,124 1,186 28.8% 30.0% 925 78.1% 68.9% 362 39.1% 26.5%

p22 2,376 736 31.0% 30.0% 685 93.1% 68.9% 205 29.9% 26.5%

p23 4,459 1,359 30.5% 30.0% 677 49.8% 68.9% 144 21.3% 26.5%

p24 4,206 1,053 25.0% 30.0% 981 93.2% 68.9% 281 28.6% 26.5%

p25 5,240 1,672 31.9% 30.0% 1,347 80.6% 68.9% 327 24.3% 26.5%

p26 4,834 1,582 32.7% 30.0% 1,163 73.5% 68.9% 202 17.4% 26.5%

p27 5,598 1,597 28.5% 30.5% 1,085 67.9% 60.5% 327 34.3% 29.0%

p28 13,317 3,723 28.0% 30.5% 2,022 54.3% 60.5% 410 20.3% 29.0%

p29 3,399 1.030 30.3% 30.5% 796 77.3% 60.5% 294 36.9% 29.0%

p30 6,738 2,015 29.9% 30.5% 1,315 65.3% 60.5% 327 18.0% 29.0%

p31 18,37 741 40.3% 30.5% 556 75.0% 60.5% 189 34.0% 29.0%

p32 6,786 1,848 27.2% 30.5% 1,011 45.7% 60.5% 340 33.6% 29.0%

p33 5,953 2,062 34.6% 30.5% 1,421 68.9% 60.5% 526 37.0% 29.0%

p34 5,986 2,114 35.3% 30.5% 948 44.8% 60.5% 285 30.1% 29.0%

p35 4,768 1,696 35.6% 33.1% 981 57.8% 53.5% 343 35.0% 26.9%

p36 9,886 3,118 31.5% 33.1% ,1,054 33.8% 53.5% 174 16.5% 26.9%

p37 10,103 3,172 31.4% 33.1% 1,662 52.4% 53.5% 443 26.7% 26.9%

p38 4,169 1,250 30.0% 33.1% 940 75.2% 53.5% 241 25.6% 26.9%

p39 5,369 1,700 31.7% 33.1% 1,004 59.1% 53.5% 378 37.6% 26.9%

p40 3,409 1,147 33.6% 33.1% 784 68.4% 53.5% 212 27.0% 26.9%

p41 2,051 646 31.5% 33.1% 503 77.9% 53.5% 161 32.0% 26.9%

p42 7,740 2,614 33.6% 33.1% 1,033 39.5% 53.5% 174 16.8% 26.9%

p43 13,198 4,766 36.1% 33.1% 2,796 58.7% 53.5% 772 27.6% 26.9%

p44 7,649 3,117 40.8% 36.3% 1,405 45.1% 61.2% 370 26.3% 24.8%

p45 2,576 983 38.2% 36.3% 514 52.3% 61.2% 154 30.0% 24.8%

p46 9,611 3,416 35.5% 36.3% 1,956 57.3% 61.2% 535 27.4% 24.8%

p47 19,711 6m787 34.4% 36.3% 4,472 65.9% 61.2% 870 19.5% 24.8%

p48 12,424 4,494 36.2% 36.3% 2,500 55.6% 61.2% 568 22.7% 24.8%

p49 7,460 2,751 36.9% 36.3% 2,060 74.9% 61.2% 621 30.1% 24.8%

p50 4,222 1,479 35.0% 36.3% 1,020 69.0% 61.2% 262 25.7% 24.8%

p51 4,663 1,569 33.6% 36.3% 1,023 65.2% 61.2% 276 27.0% 24.8%

p52 9,696 3,730 38.5% 36.3% 1,962 52.6% 61.2% 567 28.9% 24.8%

p53 2,714 1,130 41.6% 36.3% 733 64.9% 61.2% 246 33.6% 24.8%

p54 4,805 1,572 32.7% 36.3% 1,343 85.4% 61.2% 240 17.9% 24.8%

286,239 88,500 30.9% 54,628 61.7% 14,574 26.7%

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appeNdIx 2 Key learning points from the vascular checks programme in Bolton

Workstreams

Information • Regularreportsvitalforpracticeandprojectteam

• Adaptinformationdependingonoutcomes

• Interpretationofinformationisvariable

• Projectteammustfocusoninformationandactaccordingly

Clinical engagement

• ClinicalLeadershipisessential

• Timetobuildrelationships

• Understandyourprimarycare

• Getaleadineachpractice

• Cultureandethosdeterminesthesuccess

HealthTrainers • Vital

• Moveableresource

• Adaptable

• Flexible

• Resilient

• Enthusiastic

Nearpatienttesting • One-stopshop

• Helpswithneedlephobics

• Training/qualityassuranceissues

• Cost

• Laboratorysupport

LocallyEnhanced Scheme

• Grabsattention

• Different–logarithmicincentivisation

• Acknowledgesworkalreadydone

• Acknowledgesitgetsharder

• Nostringsattached

• Aimsfor100%

Dataquality • Assumenothing

• Ensuresearchesaresystematic

• Supportisnecessaryforrunningsearches

• Trainingrequirementsexposed

• Capacityofdataqualityfacilitators

14


15

Workstreams

Outreachwork • Goodmarketingexercise

• Wellreceivedeverywhere

• Dataqualityandtransfer

• Costissue

• Duplication

• Targetedoutreachthemosteffective

Marketing • Branding–appealing,recognised,catchy

• Launcheventsuccess

• Publicity

• Mediainvolvement

• Banners

• Cost

Clinicalgovernance • Riskcalculationtools

• Managementofriskregisterpatients

• Training

• Support

• NationalInstituteforHealthandClinicalExcellence(NICE)guidance


auTHor aNd aCkNowledgeMeNTS Written by:

TerryBlair-Stevens,AssociateDeliveryManager,with AnneHolroyd,EffectivePracticeManager HealthInequalitiesNationalSupportTeam [email protected]

Acknowledgements:

JeanelleDeGruchy,DeputyDirectorofPublicHealth NHSNottinghamCity

JohnGrayland,ProgrammeManager–ChronicDiseaseManagement NHSBirminghamEastandNorth

StephenLiversedge,PECChairandGP NHSBolton

Ifyouwantmoreinformationontheexamplescontainedinthisguidepleasecontact [email protected]

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closing the gap: finding the missing thousands · 2012. 3. 27. · systematically addressing health...

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