Oxfordshire Clinical Commissioning Group Oxfordshire Primary Care Commissioning Committee Date of Meeting: 4 August 2016 Paper No: 7 Title of Paper: General Practice Quality Report Purpose of Paper: This report aims to provide the committee with assurance as to the overall quality of general practice services in Oxfordshire. The paper reviews: General Practice High Level Quality Indicator Report; Approved CQC inspection reports; GP patient survey results. Action Required: For the committee to note the contents and make comments Author: Tony Summersgill, Quality Directorate
Oxfordshire Clinical Commissioning Group General Practice Quality Report Introduction This report aims to provide the committee with assurance as to the overall quality of general practice services in Oxfordshire. The paper reviews: General Practice High Level Quality Indicator Report; Compliance with Care Quality Commission (CQC) Standards; GP patient survey results. General Practice High Level Quality Indicator Report NHS England produces this general practice high-level quality indicator report for each CCG, which can be accessed via https://www.primarycare.nhs.uk/. The report covers areas of performance, patient safety, clinical effectiveness and patient experience and is detailed in appendix 1. The report has a summary of indicators for individual practices ranging from QOF results (quality and outcomes framework), clinical outcomes, prescribing data and patient access and satisfaction ratings. Practices are also given their individual data in a more detailed report at their annual practice visit by their locality GP. CCG s are expected to review the data, identify poorly performing practices and use the data to improve the quality of general practice. If a practice has six outlying indicators this triggers an alert to the CCG and NHS England. There are no practices within Oxfordshire who fall into this category and only two who are listed as having four outlying indicators. It should be noted that one of the two practices has now merged and the second is Luther Street Surgery, managed by Oxford Heath FT, who support the homeless and consequently have more difficulty in meeting some targets. This report is from data collated in July 2015 and this is the most up to date available. It does not highlight any widespread concerns over the quality of care in Oxfordshire. Compliance with Care Quality Commission (CQC) Standards Registration with the CQC means that a GP Practice is making a legal declaration that they meet all the CQC standards of quality and safety. Once a Practice is registered, the CQC has a duty to monitor and inspect the service to make sure the Practice is compliant with these standards. Where a Practice is non-compliant the CQC has a range of sanctions including withdrawing registration. The role of the CQC is to ensure that Practices in England provide people with safe, effective and high-quality care, and to encourage them to make improvements. The CCG works closely with the local CQC representative to share intelligence and promote best practice. The CQC use a system called Intelligent monitoring that draws on existing national data sources, and includes indicators covering a range of GP practice activity and 2
patient experience including: Quality and Outcomes Framework (QOF), GP Patient Survey (GPPS), electronic Prescribing Analysis and Costs (epact), Hospital Episode Statistics (HES) and HSCIC Indicator Portal (includes a wide range of health and social care metrics). This information allows the CQC to monitor the quality of service of practices, alerts them to concerns, and may lead to focussed inspections. Following an inspection the CQC rate Practices as: Outstanding, Good, Requires Improvement or Inadequate. It is the ambition of the CCG that all Oxfordshire Practices achieve Outstanding or Good Completed CQC inspections are listed below. As can be seen the majority of practices are rated as Good and three are Outstanding. Oxfordshire results are detailed below. Practices who have not been inspected or have not had their report published are not listed. 28 Beaumont Street Oxford City Good Banbury Road Medical Centre Oxford City Good Botley Medical Centre Botley City Requires improvement Bury Knowle Health Centre City City Good Cowley Road Medical Practice Oxford City Good Dr HN Hammersley & Partners City City Good Dr Kenyon & Partners Oxford City Good Hollow Way Medical Centre City City Good Jericho Health Centre - Bogdanor Oxford City Good Luther Street Oxford City Outstanding Manor Surgery Oxford City Good South Oxford Health Centre City City Good The Leys Health Centre Oxford City Good Bloxham Surgery Banbury North Good Chipping Norton Health Centre Chipping North Good Norton Sibford Surgery Banbury North Good Wychwood Surgery Wychwood North Good Gosford Hill Medical Centre Kidlington North East Good Islip Surgery Islip North East Good Langford Medical Practice Bicester North East Good Montgomery-House Surgery Bicester North East Good North Bicester Surgery North east North East Requires improvement Chalgrove and Watlington Surgeries Watlington South East Good Dr C P Hughes and Partners Wallingford South East Good Morland House Surgery Wheatley South East Good Nettlebed Surgery Nettlebed South East Good Dr BJ Batty & Partners, Woodlands Medical Centre Didcot South West Requires improvement Dr GAM Burnett and Partners Reading South West Outstanding Dr Robertson and Partners Abingdon South West Requires improvement Malthouse Surgery Abingdon South West Good Oak Tree Partnership Didcot South West Good 3
Bampton Medical Practice Bampton West Good Windrush Medical Practice, Windrush Health West Outstanding Centre Witney The Practices rated as Requires Improvement have actions plans in place to improve their rating and will be shortly reinspected by the CQC; it should be noted that North Bicester Surgery will close at the end of September 2016. GP patient survey Access to appointments Outliers are defined using the Inter quartile Range (IQR). The IQR is the size of the 2 nd quartile or the difference between the 75 th percentile minus the 25 th percentile. Therefore it is the spread of the middle values. Using the IQR, data values which are substantially larger or smaller than the 75 th percentile or 25 th percentile respectively are referred to as Outliers. This data shows results of the GP patient survey at locality level it is the most recent data available and covers aggregated data collected July-September 2015 and January-March 2016. In all cases the CCG achievement is above the England average, although there are individual practices and localities that fall below this average. One practice is deemed an outlier in four out of the six indicators and one practice is an outlier in three out of six indicators. The Locality Co-ordinators will work with these practices to understand the reasons and take appropriate action. The CCG continues to commission improved access through the same day urgent hubs until such time as the new GP Access Fund is launched and commissioned and is working with localities to invest in primary care to ensure that is sustainable for the future. Conclusion Reviewing these indicators suggests GP primary care services compare well to national data and the majority of CQC inspections are rated as Good or above. The CCG need to continue to support a small number of Practices rated as Requires Improvement and / or vulnerable practices to ensure future CQC inspections are positive. The CCG should continue to work with primary care to improve access to services where possible. 4
This document is restricted for INTERNAL NHS USE ONLY General Practice High Level Indicators CCG Report: 10Q - NHS Oxfordshire CCG July 2015 for tony.summersgill@oxfordshireccg.nhs.uk - 1 -
CCG Report CCG Information CCG Name: 10Q - NHS Oxfordshire CCG Practices with 6 or more outliers 0 Commissioning The Commissioning DCO Region is: Q82 - SOUTH CENTRAL DCO REGION Demographics Indicator Name Period CCG Mean National Mean List Size Sep 2011 8647.96 7085.38 Carr Hill List Size Sep 2011 8142.57 7086.2 Annual Turnover Sep 2011 0.1 0.08 No of Male Patient Sep 2011 50% 50% No of Female Patients Sep 2011 50% 50% % of patients in a Nursing Home Sep 2011 0% 1% % of pts from a BME population Sep 2011 9% 16% % of pop. on Disability Living Sep 2011 3% 5% Patients aged 0-4 years Sep 2011 6% 6% Patients aged 5-14 years 2011-12 11% 11% Patients aged 15-44 years Nov 2011 42% 41% Patients aged 65-74 45-64 years 25% 9% 25% 9% Patients aged 75-84 years 5% 5% Patients aged 85 years or older 2% 2% Deprivation IMD 2010 12.76 23.85 IDACI 2010 0.12 0.23 IDAOPI 2010 0.12 0.23 If the CCG is in this range then the value is lower than the 25th Percentile If the CCG is in this range then the value is within the middle 50% If the CCG is in this range then the value is higher than the 75th Percentile If the CCG is in this range then the value is lower than the 10th Percentile The grey line represents the median value at national level The diamond represents the CCG value If the CCG is in this range then the value is higher than the 90th Percentile for tony.summersgill@oxfordshireccg.nhs.uk - 2 -
Practices with 6 or more outliers The following practices have been identified as having 6 or more points which are considered outliers. for tony.summersgill@oxfordshireccg.nhs.uk - 3 -
Emergency Cancer admissions per 100 population K84063 - EAST OXFORD HEALTH CENTRE - Value:27.03, Numerator:30, Denominator:111 for tony.summersgill@oxfordshireccg.nhs.uk - 4 -
Appropriate use of the two week wait for tony.summersgill@oxfordshireccg.nhs.uk - 5 -
Emergency Admissions per 1,000 population K84066 - LUTHER STREET MEDICAL PRACTICE - Value:543.42, Numerator:219, Denominator:403 for tony.summersgill@oxfordshireccg.nhs.uk - 6 -
A&E attendances per 1,000 population for tony.summersgill@oxfordshireccg.nhs.uk - 7 -
Emergency CHD admissions per 100 patients on disease register K84605-9 KING EDWARD STREET - Value:19.23, Numerator:5, Denominator:26 for tony.summersgill@oxfordshireccg.nhs.uk - 8 -
Emergency Asthma admissions per 100 patients on disease register Y02754 - BANBURY HEALTH CENTRE - Value:6.31, Numerator:14, Denominator:222 for tony.summersgill@oxfordshireccg.nhs.uk - 9 -
Emergency Diabetes admissions per 100 patients on disease register K84006 - EYNSHAM MEDICAL GROUP - Value:3.76, Numerator:24, Denominator:639 Y02754 - BANBURY HEALTH CENTRE - Value:5.21, Numerator:5, Denominator:96 for tony.summersgill@oxfordshireccg.nhs.uk - 10 -
Emergency COPD admissions per 100 patients on disease register K84004 - DR ANSCOMBE AND PARTNERS - Value:20.42, Numerator:49, Denominator:240 K84024 - WINDRUSH SURGERY - Value:26.45, Numerator:32, Denominator:121 K84031 - THE LEYS HEALTH CENTRE - Value:23.56, Numerator:49, Denominator:208 K84040 - HORSEFAIR SURGERY - Value:25.49, Numerator:52, Denominator:204 for tony.summersgill@oxfordshireccg.nhs.uk - 11 -
Emergency Admissions for Dementia per 100 registered population for tony.summersgill@oxfordshireccg.nhs.uk - 12 -
ACS admissions composite (to match Commissioning Outcomes Framework Indicator) per 1000 population K84066 - LUTHER STREET MEDICAL PRACTICE - Value:64.52, Numerator:26, Denominator:403 for tony.summersgill@oxfordshireccg.nhs.uk - 13 -
DM 31: The percentage of patients with diabetes in whom the last blood pressure is 140/80 or less for tony.summersgill@oxfordshireccg.nhs.uk - 14 -
AF 07: K84038 - MONTGOMERY HOUSE SURGERY - Value:74%, Numerator:87, Denominator:117 for tony.summersgill@oxfordshireccg.nhs.uk - 15 -
CS01: The percentage of patients aged from 25 to 64 whose notes record that a cervical smear has been performed in the last five years K84004 - DR ANSCOMBE AND PARTNERS - Value:71%, Numerator:2639, Denominator:3706 for tony.summersgill@oxfordshireccg.nhs.uk - 16 -
DM 17: The percentage of patients with diabetes whose last measured total cholesterol within the previous 15 months is 5mmol/l or less for tony.summersgill@oxfordshireccg.nhs.uk - 17 -
DM27: The percentage of patients with diabetes in whom the last IFCC-HbA1c is 64 mmol/mol (equivalent to HbA1c of 8% in DCCT for tony.summersgill@oxfordshireccg.nhs.uk - 18 -
CHD 8: The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the previous 15 months) for tony.summersgill@oxfordshireccg.nhs.uk - 19 -
Health checks for people with serious mental illness K84051 - WHITE HORSE MEDICAL PRACTICE - Value:33%, Numerator:24, Denominator:73 K84078 - JERICHO HEALTH CENTRE (BOGDANOR) - Value:56%, Numerator:22, Denominator:39 K84620 - WOOD FARM HEALTH CENTRE - Value:50%, Numerator:7, Denominator:14 K84624 - OAK TREE HEALTH CENTRE - Value:54%, Numerator:25, Denominator:46 for tony.summersgill@oxfordshireccg.nhs.uk - 20 -
Flu Vaccinations - Over 65 Coverage for tony.summersgill@oxfordshireccg.nhs.uk - 21 -
Flu Vaccinations - At risk coverage K84040 - HORSEFAIR SURGERY - Value:40%, Numerator:595, Denominator:1479 for tony.summersgill@oxfordshireccg.nhs.uk - 22 -
DM 21: The percentage of patients with diabetes who have a record of retinal screening in the previous 15 months K84021 - BANBURY ROAD MEDICAL CENTRE - Value:64%, Numerator:101, Denominator:157 K84043 - WOODLANDS MEDICAL CENTRE - Value:75%, Numerator:347, Denominator:464 for tony.summersgill@oxfordshireccg.nhs.uk - 23 -
AF Prevalence ratio K84015 - NETTLEBED SURGERY - Value:0.98, Numerator:108, Denominator:110.15 K84051 - WHITE HORSE MEDICAL PRACTICE - Value:0.94, Numerator:276, Denominator:294.45 for tony.summersgill@oxfordshireccg.nhs.uk - 24 -
CHD Prevalence ratio K84004 - DR ANSCOMBE AND PARTNERS - Value:0.53, Numerator:369, Denominator:697.13 K84031 - THE LEYS HEALTH CENTRE - Value:0.46, Numerator:248, Denominator:534.69 for tony.summersgill@oxfordshireccg.nhs.uk - 25 -
COPD Prevalence ratio K84605-9 KING EDWARD STREET - Value:0.09, Numerator:6, Denominator:69.85 for tony.summersgill@oxfordshireccg.nhs.uk - 26 -
Asthma Prevalence ratio K84013 - ST BARTHOLEMEWS MEDICAL CENTRE - Value:0.39, Numerator:733, Denominator:1889.64 K84051 - WHITE HORSE MEDICAL PRACTICE - Value:0.98, Numerator:930, Denominator:948.86 K84078 - JERICHO HEALTH CENTRE (BOGDANOR) - Value:0.17, Numerator:104, Denominator:599.98 for tony.summersgill@oxfordshireccg.nhs.uk - 27 -
Diabetes Prevalence ratio for tony.summersgill@oxfordshireccg.nhs.uk - 28 -
COPD 15: The percentage of all patients with COPD diagnosed after 1st April 2011 in whom the diagnosis has been confirmed by post for tony.summersgill@oxfordshireccg.nhs.uk - 29 -
ASTHMA 8: The percentage of patients aged eight and over diagnosed as having asthma from 1 April 2006 with measures of variability or K84044 - MANOR SURGERY - Value:74%, Numerator:125, Denominator:170 K84605-9 KING EDWARD STREET - Value:69%, Numerator:31, Denominator:45 for tony.summersgill@oxfordshireccg.nhs.uk - 30 -
Overall Exception Rate K84009 - BURY KNOWLE HEALTH CENTRE - Value:12%, Numerator:46.05, Denominator:392.61 K84038 - MONTGOMERY HOUSE SURGERY - Value:10%, Numerator:50.82, Denominator:485.95 K84062 - WOODLANDS SURGERY - Value:11%, Numerator:24.74, Denominator:220.19 for tony.summersgill@oxfordshireccg.nhs.uk - 31 -
Long/Intermediate Insulin Analogues K84023 - BERINSFIELD HEALTH CENTRE - Value:37%, Numerator:250, Denominator:683 K84066 - LUTHER STREET MEDICAL PRACTICE - Value:46%, Numerator:16, Denominator:35 for tony.summersgill@oxfordshireccg.nhs.uk - 32 -
Ezetimibe as a proportion of all Lipid modifying drugs for tony.summersgill@oxfordshireccg.nhs.uk - 33 -
Improving Access to Psychological Therapies for tony.summersgill@oxfordshireccg.nhs.uk - 34 -
Antibacterial Items/Star Pu K84013 - ST BARTHOLEMEWS MEDICAL CENTRE - Value:0.11, Numerator:4158, Denominator:36341 K84066 - LUTHER STREET MEDICAL PRACTICE - Value:0.71, Numerator:411, Denominator:578 K84078 - JERICHO HEALTH CENTRE (BOGDANOR) - Value:0.13, Numerator:1570, Denominator:11739 K84620 - WOOD FARM HEALTH CENTRE - Value:0.09, Numerator:251, Denominator:2697 for tony.summersgill@oxfordshireccg.nhs.uk - 35 -
Cephalosporins & Quinolones % Items for tony.summersgill@oxfordshireccg.nhs.uk - 36 -
Hypnotics ADQ/Star Pu for tony.summersgill@oxfordshireccg.nhs.uk - 37 -
NSAIDs Ibuprofen & Naproxen % Items K84024 - WINDRUSH SURGERY - Value:47%, Numerator:789, Denominator:1675 K84040 - HORSEFAIR SURGERY - Value:68%, Numerator:3681, Denominator:5437 for tony.summersgill@oxfordshireccg.nhs.uk - 38 -
Overall experience of GP surgery for tony.summersgill@oxfordshireccg.nhs.uk - 39 -
Ease of getting through to someone at GP surgery on the phone for tony.summersgill@oxfordshireccg.nhs.uk - 40 -
Overall experience of making an appointment for tony.summersgill@oxfordshireccg.nhs.uk - 41 -
DEP 6: Percentage of patients with depression, who have had an assessment of severity at the time of diagnosis. for tony.summersgill@oxfordshireccg.nhs.uk - 42 -
MH13: Percentage of patients with Schizophrenia, Bipolar affective disorder and other psychosis who have a record of blood pressure in K84032 - BARTLEMAS SURGERY - Value:69%, Numerator:84, Denominator:121 K84051 - WHITE HORSE MEDICAL PRACTICE - Value:68%, Numerator:52, Denominator:77 K84624 - OAK TREE HEALTH CENTRE - Value:67%, Numerator:31, Denominator:46 for tony.summersgill@oxfordshireccg.nhs.uk - 43 -
MH19: Percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder and other psychoses who for tony.summersgill@oxfordshireccg.nhs.uk - 44 -
MH20: The percentage of patients aged 40 years and over with schizophrenia, bipolar affective disorder and other psychoses who Generated 28 on 28-7-2016 Jul 2016 17:52 for tony.summersgill@oxfordshireccg.nhs.uk - 45 -