MERSEYSIDE FAMILY DOCTOR ASSOCIATION GP EVENT

Saturday 14 November 2015

WHERE IS PRIMARY CARE GOING?

Katherine Sheerin

Chief Officer

NHS Liverpool Clinical Commissioning Group

Overview

LOCAL TRANSFORMATION

HEALTHY LIVERPOOL GENERAL PRACTICE SPECIFICATION

NATIONAL PERSPECTIVE

REFLECTION AND QUESTIONS

The Ultimate Goal and ContextHealthy Liverpool ProgrammeVision ‘a healthcare system in Liverpool that is person-centred,

supports people to stay well and provides the very best in care’

Outcomes Improving health outcomes for people in Liverpool relative to

the rest of England and reducing health inequalities within the city

Quality of healthcare is consistent and high quality New model of care which is clinically and financially

sustainable

3

£643m£83m

£29m

£84m £13m

£128m

£147m

£58m

LIVERPOOL

HEALTH SPEND

CCG PROGRAMMES

PRESCRIBING

CHILDREN’S SOCIAL CARE

PUBLIC HEALTH

ADULT SOCIAL CARE

LEISURE/PARKS GENERAL PRACTICE

OTHER PRIMARY CARE

SPECIALISED SERVICES

£37m

LIVING WELL

DIGITAL HEALTH

COMMUNITY TRANSFORMATION

URGENT CARE

MENTAL HEALTH

HEALTHY AGEING

LEARNING DISABILITIES CHILDREN

System Wide Transformation Programmes

Continuous Improvement Programmes

HOSPITAL TRANSFORMATION

CANCERLONG TERM CONDITIONS

HEALTHY LIVERPOOL PROGRAMME

Liverpool Community Care Model

Healthy Liverpool Community Care Programme Plan on a Page

Vision and Outcome Ambition for Healthy Liverpool

Improved Health Outcomes Deliver First Class ServicesDelivering a Sustainable

System

Preventing people from dying

prematurely

Enhancing quality of life

Delaying and reducing the need

for care and support

Community Care Outcome Domains

Ensuring that people have a positive experience of

care and support

Specialist Clinical Integration‘care closer to home’

Community Care Teams‘no wrong door’

Managing Complex Needs‘supporting the vulnerable’

Enablers: Digital Care Estates Proactive Care High Quality Primary Care Community Engagement Workforce Access

Neighbourhood Collaborative

‘maximising community assets’

Prevention of ill health, health protection and maintaining healthy

lifestyles

‘a health care system in Liverpool that is person-centred, supports people to stay well and provides the very best in care’

Neighbourhood Delivery

Establish Community Care Team in each

Neighbourhood

Community Diagnostics

Seven Day Access

Scale up use of Assistive Technologies

Common Assessment Framework

Early Help Support

Clinical Model for Care Homes and Community

Beds

Pathways of Care for Long Term Conditions

Eliminating Unwarranted Variation in Care

Mental Health Integration

Dementia Clinical Network

Transformed Cancer Services

Children’s Pathways of Care

Planned Care Redesign

End of Life Services

Integration of non-medical programmes

Directory of Service Live Well Liverpool

Community Grants

Support for the Homeless

Collaboration with Housing and Fire and Rescue

Services

Maximise use of Community Estate

Complex Alcohol and Addictions

Healthy Lung Initiative

Tackling Social Exclusion

Health Trainer Services

Severe Mental Illness

Children with Complex Needs

Learning Disability

Embedding Self-Care Shared Decision Making Prevention at Scale Early Detection and Diagnosis

Establish Centres for Wellbeing

Targeted Support for ‘Hard to Reach’ Groups

EXCELLENT GENERAL PRACTICE IS

FUNDAMENTAL TO DELIVERING HEALTHY

LIVERPOOL!!!

Liverpool General Practice Specification

Standards for all practices

Investment equalised

Differential resources at risk

Clear performance targets

Prevention

Early Identification

Improved Clinical Management

Use of Resources

Access

What have we achieved?

All A&E Attendances: Trust CatchmentYear

2009/10 109,505 86,178 693,835

2010/11 107,457 -2% 87,190 1% 713,560 2.80%

2011/12 107,985 0% 83,956 -4% 796,882 11.70%

2012/13 109,337 1% 86,380 3% 807,223 1.30%

2013/14 103,713 -5% 79,575 -8% 810,935 0.50%

2014/15 112,690 8.70% *113,239 Not comparable

847,080 4.50%

RLUBHT AHT Benchmark Trusts

Year

2009/10 57,944 99,013

2010/11 58,924 2% 97,335 -2%

2011/12 56,856 -4% 98,319 1%

2012/13 57,473 1% 102,226 4%

2013/14 56,120 -2% 101,163 -1%

2014/15 55,731 -0.7% 106,632 5%

Alder Hey Benchmark Trusts

Data Source: National AED Sitrep*Aintree A&E attendances increased during 2014/15 due to Walk in Centre activity being counted against AUH A&E

Acute Benchmarks Trusts: Bradford Teaching Hospital, St Helen’s and Knowsley Hospital, University Hospital of South Manchester, Salford Royal Foundation Trust, University Hospital of Birmingham Foundation Trust, Newcastle Upon Type Hospital Trust, Southport and Ormskirk Hospital Trust Childrens Benchmark Trusts: Sheffield Children's Hospital Trust, Birmingham Children's Foundation Trust

2014/15• Royal Liverpool Hospital reported a

8.7% increase in A&E activity during 2014/15 (112,690 attendances) compared to 2013/14 (103,713 attendances)

• Aintree Hospital’s increase in A&E activity during 2014/15 is not comparable to previous years due to walk in centre activity being counted against AUH.

• Peer providers of Royal Liverpool Hospital and Aintree Hospital reported a 4.5% increase in A&E attendances

• Alder Hey Children's hospital reported a 0.7% reduction in A&E attendance rates during 2014/15 compared to a 5% increase reported by peer providers

LCCG Data Source: General practice systems / immform returnEngland Data Source: http://www.phoutcomes.info/public-health-outcomes-framework

  Year 2011/12 2012/13 2013/14 2014/15%

Variance on 11/12

Patients aged >65

LCCG 77.80% 77.69% 76.92% 77.12% -0.68

England 74.00% 73.40% 73.20% 72.70% -1.30

Patients aged <65 at

risk

LCCG 54.90% 57.47% 57.94% 58.24% 3.34%

England 51.60% 51.30% 52.30% 50.30% -1.30

Influenza Vaccinations

Vacs up to age 2: DTaPIPV at 1 year, HibMenC at 2 yrs, MMR1 at 2 years, PCV1 at 2 yearsVacs up to age 5: DTAPIPV at 5 years, MMR2 at 5 years*England benchmarks estimated using data from http://www.hscic.gov.uk/pubs/immstats .

 

2011/12 2012/13 2013/14 2014/15 % Variance on 11/12

Year

Vaccs up to age 2

LCCG 95.40% 95.77% 94.45% 93.82% -1.58%

England* 93.73% 94.13% 94.13% 93.44% -0.29%

Vaccs up to age 5

LCCG 87.90% 92.31% 91.40% 89.61% 1.71%

England* 86.70% 88.30% 88.37% 88.58% 1.88%

Childhood Vaccinations

Data source: general practice systems

YearPatients

drinking over recommended

levels

Of those, number

offered brief intervention

% Offered brief intervention

Year on year % variance

2011/12 14146 11317 80.00% 5.00%

2012/13 14578 12624 86.60% 6.59%

2013/14 12393 11159 90.04% 3.44%

2014/15 11244 10347 92.04% 2.00%

Alcohol: brief interventions

Data source: general practice systems

Prevalence in patients aged 40+

CHD HFStroke /

TIAAF

Hypertension

COPD DiabetesTotal on selected registers

Actual varience from baseline year

(2012)

% varience from baseline

year (2012)

End Mar 12 17406 3458 7906 6416 58649 12698 19225 125758

End Mar 13 20679 3836 8516 7443 65289 14214 21940 141917 16159 12.8%

End Mar 14 18540 3923 8833 7747 65889 14379 24304 143615 17857 14.2%

End Mar 15 18235 3924 8882 8045 66674 14661 24993 145414 19656 15.6%

• Since baseline year (2012) Liverpool has reported a 15.6% increase in QOF disease registers

• As at March 2015 Liverpool’s disease register size stands at 145,414• The number of extra entries on the register does not necessarily equal 16159 (as

reported end of March 2013) additional new patients as 1 patient can be on multiple registers

Data Source: Local SUS data flow

Based on ACS admissions to RLBUHT, AHT, AHCH, ST H&K

Definition: ACS admissions for Angina, Asthma, Cellulitis, Congestive Heart Failure, COPD, Convulsions and epilepsy, Diabetic complications, ENT, Flu and Pneumo

Year Non-elective admissions

% Variance (on previous year)

2011/12 6667 -11.47%

2012/13 6776 1.63%

2013/14 6590 -1.59%

2014/15 7328 11.19%

Variance 11/12 to 14/15 661 9.19%

Non-Elective ACS Admissions: LCCG

Data Source: Dr FosterNational ACS definition for 19 Ambulatory Care Sensitive ConditionsBenchmark: North of England Commissioning Region

Non-Elective ACS Admissions trends

LCCGRate per 1,000

LCCGTotal ACS

admissions

Ranking(Out of 68 CCGs, 1 =

Best)

North of England Commissioning

Region Rate2009/10 21.9 11,268 68 21.12010/11 24.7 11,912 64 19.72011/12 19.6 9,603 35 19.32012/13 19.5 9,669 23 202013/14 19.5 9,685 27 19.82014/15 21.4 10,620 31 21.1

2014/15• LCCG reported a slight

increase in ACS admission rates in 2014/15 with a rate of 21.4 per 1,000 population

• Based on historical data LCCG have moved from reporting the highest ACS admission rates in 2009/10, ranked 68 out of 68 CCGs within North of England Region to being ranked 31 out of 68 in 2014/15

Data Source: Local Sus data

Definition is GP referred (03) first outpatient attendances to Dermatology, T&O, Gynaecology, Rheumatology, ENT, Gastroenterology, Vascular Surgery and Urology (using TFC to define speciality)

Data source: Local SUS dataflow*Includes activity at ICATS, MCAS, RheuCAS but does not include those in primary care such as H Pylori testing, minor surgeryBased on activity at RLBUHT, AHT, AHCH, St H&K

Year GP Ref’d first OP atts*

% Variance (on previous

year)

GP Ref’d first OP atts plus assessment

services* atts

% Variance (on previous

year)

2011/12 43113 -8.73% 72403 -5.01%

2012/13 41338 -4.12% 69338 -4.23%

2013/14 42432 2.65% 66863 -3.57%

2014/15 38625 -8.97% 63997 -4.29%

Var 11/12 to 14/15 -4488 -10.41% -8406 -11.61%

GP Referred first outpatient attendances: LCCG

Prescribing Cost

• Prescribing cost increased by 2% (£1,829,924) during 2014/15 compared to 2013/14 for Liverpool CCG

• Cost variance reduced from 4% increase in costs reported in 2013/14 to 2% increase in cost reported in 2014/15

• Liverpool increase in prescribing cost during 2014/15 is reported to be lower than North West and National increase

Datasrouce: EPACT

YearPrescribing outturn

Variance on previous year

% VarianceNorth West %

VarianceNational %

Variance

2010/11 £87,958,7362011/12 £85,333,373 -£2,625,362 -3%2012/13 £79,422,452 -£5,910,921 -7% -4%2013/14 £82,437,116 £3,014,665 4% 3% 3%2014/15 £84,267,040 £1,829,924 2% 3% 3%

Datasrouce: EPACT

Prescribing trends

*ASTRO PU figures included above are different to those previously reported due to ASTRO PUweightings changing. North West changed to Merseyside Area Team in 2012/13 therefore coding changed and as such old North West data is not available 2012/13 and before for comparison

Diabetes 9 care processes

YearLCCG

% Receiving 9 care processes

Highest performingpractice

Lowest performingpractice

% Performance Varience

(highest performing practice - Lowest

performing practice

2012/13 42.4% 77.9% 20.0% 58.0%

2013/14 58.3% 91.6% 15.3% 76.3%

2014/15 65.1% 96.0% 10.8% 85.2%

Overall Var 12/13 to 14/15 22.7% 18.1% -9.2% 27.2%

Datasrouce: EMIS

• Overall performance has increased by 22.7% since 2012/13• Performance variance across the city has increased by 27.2%• The increase in performance variance is due to higher performing

practices increasing their rates and lower performing practices reducing their rates

EXCELLENT GENERAL PRACTICE IS

FUNDAMENTAL TO DELIVERING HEALTHY LIVERPOOL – BUT IS

THIS ENOUGH?

NATIONAL PERSPECTIVE

• FIVE YEAR FORWARD VIEW

• NEW CARE MODELS – ‘VANGUARDS’

• SEVEN DAY PRIMARY CARE SERVICE

• RCGP ‘BLUEPRINT’

THOUGHTS AND QUESTIONS