Agreeing the methodology used to calculate weighted rates for CCG GP practice reporting Introduction The mid-nottinghamshire analytics team are currently reviewing the reporting methodology used to support GP practices in understanding how they compare to other practices and help identify areas in which they may be an outlier. To make the analysis as accurate as possible practice comparisons should use age and sex standardised rates to adjust for their differing population demographics. Age and sex standardisation is commonly used throughout the NHS and is also used in our local Nottinghamshire business intelligence tool, ehealthscope. This paper discusses if the CCG also wish to include other factors in the adjustment of weighted rates such as deprivation and other factors used nationally for allocating resources. The analytics team recommends the use of further adjustments but argues that a different methodology may be required to a make fair comparison between GP practices to that which is currently being used. The case for adjusting for deprivation and other factors Appendix 2 details the factors that are used in estimating practice need and allocating resources on a national level. These should be taken into account when creating a weighted population. Deprivation of the area can have an impact on a number of factors. Figure 1 shows the age/sex standardised rates for emergency admissions in the last 12 months. The chart has been ordered by deprivation to help show the correlation and impact that deprivation can have on the number of emergency admissions. Southwell has an IMD (Index of Multiple Deprivation) of 7.6 compared to Sandy Lane which has an IMD score of 38.0. Although IMD scores have a level of estimation they are our best way of indicating level of deprivation. The values for all GP practices are shown in appendix 1. Although other factors such as distance from hospital may impact practice rates, figure 1 should provide sufficient evidence that deprivation should be taken into account when making fair practice comparisons. Figure 2 shows the CCG comparison for Notts County CCGs which again shows the impact of deprivation on emergency admissions with Rushcliffe CCG having nearly half the rate of emergency admissions as Mansfield and Ashfield CCG.
Figure 1 Age/Sex standardised rates for emergency admissions ordered by deprivation Figure 2 Age/Sex standardised rates for emergency admissions ordered by deprivation
The case for not adjusting by using national practice allocations Practice name FCG locality Capitation Totals Weighted pop Figure 3 - % change from capitation to weighted population % change from Capitation to weighed populations Major Oak Medical Practice Newark & Sherwood North 6317 6988 10.6% Middleton Lodge Practice Newark & Sherwood North 12444 13650 9.7% Rainworth Health Centre Newark & Sherwood West 6045 6613 9.4% Hill View Surgery Newark & Sherwood West 2951 3223 9.2% Bilsthorpe Surgery Newark & Sherwood West 3032 3260 7.5% Sherwood Medical Partnership Newark & Sherwood North 14740 15039 2.0% Collingham Medical Centre Newark & Trent 6861 6990 1.9% Fountain Medical Centre Newark & Trent 14073 14290 1.5% Lombard Medical Centre Newark & Trent 17925 18127 1.1% Blidworth Surgery Newark & Sherwood West 11784 11696-0.7% Barnby Gate Surgery Newark & Trent 13741 13360-2.8% Southwell Medical Centre Newark & Sherwood West 12162 11240-7.6% Balderton Primary Care Centre Newark & Trent 5556 4905-11.7% Hounsfield Surgery Newark & Trent 3970 3352-15.6% If we decide to use weighted populations as published nationally then some GP practices will see big changes in their reported rates. Most notably is Hounsfield Surgery. Their weighted population is 15.6% lower than their actual list size and therefore significantly increases their reported activity rates. Bull Farm currently benefit by 34.7% as seen in figure 4. Practice name FCG locality Capitation Totals Weighted pop % change from Capitation to weighed Population Bull Farm PCRC Mansfield North 2761 3720 34.7% Mill View Surgery Mansfield South 8286 9799 18.3% Drs Ward, Pearce & Partners Mansfield South 5871 6931 18.1% Ashfield House (Annesley) Ashfield South 5995 7066 17.9% Kirkby Family Medical Centre Ashfield South 3760 4406 17.2% Harwood Close Surgery Ashfield North 5120 5991 17.0% Oakwood Surgery Mansfield North 13795 16103 16.7% Willowbrook Medical Practice Ashfield North 15036 17535 16.6% Lowmoor Road Surgery Ashfield South 5353 6212 16.1% Riverbank Medical Services Mansfield North 4241 4826 13.8% Figure 4 - highest % changes from capitation to weighted rates for M&A practices
Recommendations It is accepted that deprivation and other factors do have an impact on hospital activity and justify making adjustments for population demographics. It is recommended that we use the weighted population in future practice reporting. The national method for calculating weighted rates is the most robust method. Ryan Cope Head of Outcomes and Analytics 12 th April 2016 Post meeting note. A second version of this paper has been created following the N&S Activity and Finance Committee. 21/04/16.
Appendix 1 IMD scores for GP practice in Mid-Nottinghamshire Practice IMD Score Southwell 7.6 Hounsfield 11.2 Collingham 11.5 Balderton 15.0 Blidworth 15.4 Major Oak 17.2 Jacksdale 18.8 Selston 18.9 Fountain 21.5 Barnby Gate 21.8 Ashfield House 22.5 Bilsthorpe 23.3 Woodlands 24.0 Rainworth 25.3 Hillview 25.4 Lombard St 25.4 Sherwood MP 25.5 Orchard 26.6 Oakwood 27.8 Brierley Park 27.9 Middleton 28.1 Harwood Close 28.4 Roundwood 28.8 Kirkby Family MC 29.0 Kirkby HC 29.2 Kirkby CPCC 29.5 Healdswood 29.6 Lowmoor 29.6 Mill View 29.7 Willowbrook 30.1 Forest Medical 30.8 Riverbank 31.1 Meden Vale 31.4 ChurchWardPtnr 31.6 Kirkby HC Complex 32.4 Ashfield MC 32.7 Bull Farm 33.5 Pleasley 33.7 St Peters 33.9 Acorn 36.5 Sandy Lane 38.0
Appendix 2 The formula developed by ACRA (Advisory Committee on Resource Allocation) to estimate practice need is based on the below criteria. General and Acute (69.3% of total) A model based on GP practice registrations and patient need was built up from patient data calculated by the Nuffield Trust, taking account of nearly 400 variables for each age and sex group. Mental Health (14.2% of total) Use s the new mental health data set calculated by a team led by Manchester University and includes similar weightings to the General and Acute methodology Maternity (4.1% of total) Based on the number of births and need weighted cost per birth. This uses the Combining Age Related and Additional Need (CARAN) report model. This formula is derived by modelling the cost per birth and the number of births in each area Prescribing (12.4% of total) Uses the combination of age-gender weights and approach used in the former PCT formula which was taken from the Report of the Resource Allocation for Mental Health and Prescribing project (RAMP) to adjust for need over and above that due to age and gender.