What is the Primary Care Benchmarking Project?

• The new Primary Care Benchmarking Project is a tool that reports volumes of key marker tests, calculating testing rates per relevant patient group (where applicable) and analysing the impact of service usage on secondary care outcomes. – Test data collected for 27 key marker tests done for Primary Care– Data reported by Provider, by GP Practice, and by CCG– Data mapped to GP patient populations in a range of disease/condition

specific registered populations– Demographic factors such as deprivation index and age profiles– Number of admissions, number of bed days and cost of admissions

mapped from HES data to provide outcomes measures– Relevant guidance (eg NICE) included as targets/benchmarks, in addition

to the ability to include any locally agreed targets/benchmarks

What is it for?

• Enables labs to work with their customers and CSUs to:– Monitor service usage, eg volume of requests– Analyse the impact of appropriate requesting on patient outcomes– Inform demand management (optimisation!) strategy planning– Provide evidence around best practice– Monitor progress over time, assess the impact of any interventions

• Key points/objectives are as follows:– Joint working, creating a partnership between provider and customer– Have a positive impact on demand management strategies– Provide new data for research– Make pathology the centre of the patient care pathway, and turn it into

the hub of patient care and improvement

Story so far

• Began as a joint initiative between Keele and Leeds (YCHI) in 2007• Originally intended for NHS IC (now HSCIC) to host, but business

case fell through• Barnes Quality review work in 2013 identified that this project

would still be a valuable tool, particularly once the review was launched (which happened January 2014).

• KUBS funded pilot in 2013 took data from two sites – UHNS and Wolverhampton – to prove concept

• Now looking to roll out the pilot to interested labs in an ‘offline’ setting, with a view to assessing the viability of an online (and more automated) system further down the line

First of the ‘headline’ examples

• Early analyses of the data are already showing some interesting findings: – GP practices who request HbA1c tests within the recommended re-test

interval according to NICE guidelines (1-2 tests per year) have 15.3 less diabetes-related emergency admissions per 1,000 patients than practices who request outside of the guidance.

– They also have 88.6 less bed days (for diabetes-related emergency admissions) per 1,000 patients

– Their cost of emergency admissions for diabetes is £37 per patient lower than those who request outside of the guideline.

• There is a genuine incentive for HbA1c tests to be requested on time

• In some cases, additional work can lead to savings in secondary care

Variability and Trends

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HbA1c Tests Per Patient on Diabetes Register, Compared With NICE Guideline (Calculated to Monthly Equivalent) - Monthly Trend Data For Selected GP

PracticeSum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+)

Sum of Benchmark: HbA1c per diabetes patient (NICE Guideline) MONTHLY EQUIV

Linear (Sum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+))

Variability and Trends

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HbA1c Tests Per Patient on Diabetes Register, Compared With NICE Guideline (Calculated to Monthly Equivalent) - Monthly Trend Data For Selected GP

PracticeSum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+)

Sum of Benchmark: HbA1c per diabetes patient (NICE Guideline) MONTHLY EQUIV

Linear (Sum of Tests Per: Diabetes Mellitus (Diabetes) Register (ages 17+))

Analysis With Population Data

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GP5

581

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GP5

586

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608

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583

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611

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585

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Anonymised CCG 224

Diabetes Related Admissions Per 1,000 Patients Compared With Deprivation Score

Average of Diabetes Cost of Admissions Per Patient Average of GP Deprivation Score (IMD) Linear (Average of GP Deprivation Score (IMD))

Values

CCG Anonymised Name GP Anonymised Code

Average of Diabetes Cost of Admissions Per Patient Average of GP Deprivation Score (IMD)

Year Low Volume Practice Flag (Select 'No' To Exclude LVs) Test Name

Analysis With Population Data

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GP5

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610

GP5

714

GP5

747

GP5

712

GP5

727

GP5

751

GP5

740

GP5

711

GP5

745

GP5

593

GP5

744

GP5

704

GP5

718

GP5

721

GP5

725

GP5

739

GP5

592

GP5

734

GP5

608

GP5

752

GP5

707

GP5

743

GP5

589

GP5

748

GP5

585

GP5

597

GP5

755

GP5

717

GP5

594

GP5

733

GP5

749

GP5

738

GP5

753

GP5

722

GP5

710

GP5

598

GP5

604

GP5

728

GP5

599

GP5

582

GP5

741

GP5

737

GP5

595

GP5

709

GP5

713

GP5

588

GP5

716

GP5

754

GP5

705

GP5

580

GP5

715

GP5

735

GP5

706

GP5

583

GP5

719

GP5

607

GP5

600

GP5

611

GP5

603

GP5

596

GP5

723

GP5

746

GP5

724

GP5

731

GP5

729

GP5

581

GP5

605

GP5

726

GP5

736

GP5

756

GP5

586

GP5

591

GP5

579

GP5

606

GP5

601

GP5

720

GP5

587

GP5

732

GP5

730

GP5

590

GP5

708

An

on

Thyroid Function Tests Per Patient on Hypothyroidism Register Compared With Percentage of Population Over 65

Average of Tests Per: Hypothyroidism Register Average of GP % Over 65 Linear (Average of GP % Over 65)

Values

GP Anonymised Code

Average of Tests Per: Hypothyroidism Register Average of GP % Over 65

Year Low Volume Practice Flag (Select 'No' To Exclude LVs) Test Name CCG Anonymised Name

Variability

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GP5

738

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736

GP5

586

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611

GP5

592

GP5

732

GP5

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GP5

729

GP5

717

GP5

588

GP5

743

GP5

722

GP5

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GP5

724

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GP5

714

GP5

735

GP5

745

GP5

741

GP5

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GP5

726

GP5

609

GP5

599

GP5

591

GP5

601

GP5

583

GP5

706

GP5

728

GP5

603

GP5

747

GP5

709

GP5

720

GP5

731

GP5

595

GP5

739

GP5

723

GP5

746

GP5

607

GP5

604

GP5

756

GP5

598

GP5

744

GP5

597

GP5

594

GP5

730

GP5

715

GP5

740

GP5

590

GP5

593

GP5

606

GP5

582

GP5

737

GP5

596

GP5

589

GP5

721

GP5

733

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734

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Test

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Lithium Tests Per Patient on Mental Health (Bipolar) Register, Compared With Number of Bipolar Related Secondary Care Emergency Admissions

Average of Tests Per: Mental Health Register Average of Mental health - Bipolar Admissions Linear (Average of Tests Per: Mental Health Register)

Variability

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GP5

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GP5

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GP5

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GP5

743

GP5

593

GP5

756

GP5

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GP5

735

GP5

718

GP5

744

GP5

749

GP5

594

GP5

585

GP5

722

GP5

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GP5

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GP5

607

GP5

740

GP5

716

GP5

712

GP5

747

GP5

704

GP5

727

GP5

753

GP5

719

GP5

592

GP5

738

GP5

582

GP5

596

GP5

579

GP5

580

GP5

737

GP5

707

GP5

715

GP5

708

GP5

717

GP5

754

GP5

599

GP5

591

GP5

603

GP5

711

GP5

733

GP5

725

GP5

604

GP5

705

GP5

589

GP5

732

GP5

714

GP5

734

GP5

752

GP5

586

GP5

721

GP5

608

GP5

736

GP5

748

GP5

606

GP5

609

GP5

746

GP5

601

GP5

731

GP5

723

GP5

611

GP5

729

GP5

597

GP5

590

GP5

720

GP5

587

GP5

706

GP5

713

GP5

583

GP5

588

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605

GP5

724

GP5

628

GP5

581

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Variability In Number of Vitamin D Tests Per 1,000 Patients (Compared with FBC Tests Per 1,000 Patients)

Vitamin D Full Blood Count

What will the outputs be?

• Proposed short summary report, one-page RAG coded dashboard, varies by target audience– One for each GP practice– One at CCG level– One at lab level

• Analysis tools provided so that further ‘drilling down’ into the data can be done in order to answer specific queries– Full training provided, of course!

• Quarterly (or monthly if there is a genuine need) updates of workload data to get up-to-date trend monitoring information

• GP workshops/interactive sessions to ensure data are having a positive impact

Select GP Practice: X12345

ANONYMISED GP SURGERY

1 Anonymous Avenue, Anonymous Town, Staffordshire

STx xXX

NHS NORTH STAFFORDSHIRE CCG (05G) *National represents only the data in the system at time of publication

General Information X12345

NHS NORTH STAFFORDSHIRE

CCG (05G) National*

NHS NORTH STAFFORDSHIRE

CCG (05G) National*Practice Population Served 6,326 5,702 6,071 10.9% 4.2%Deprivation Index 28.53 34.29 28.09 -16.8% 1.6%% Patients With Long Standing Conditions 68.6% 58.3% 57.4% 17.6% 19.6%% Patients Under 18 17.6% 21.8% 20.7% -19.5% -15.0%% Patients Over 65 20.1% 16.2% 17.6% 24.2% 14.2%% Patients Over 75 8.8% 7.3% 8.0% 20.4% 10.9%% Patients Over 85 2.1% 2.0% 2.2% 2.8% -6.7%

Diabetes X12345

NHS NORTH STAFFORDSHIRE

CCG (05G) National*

NHS NORTH STAFFORDSHIRE

CCG (05G) National*Patients on Diabetes Mellitus (Diabetes) Register (17+) 448 324 345 38.1% 29.8%HbA1c Tests per Patient on DM Register 1.63 2.19 2.35 -25.6% -30.5%Microalbumin Tests per Patient on DM Register 0.74 1.45 1.48 -48.8% -49.9%Cholesterol Tests per Patient on DM Register 0.06 0.29 0.28 -77.5% -77.3%Number of Diabetes Related Emergency Admissions 106 79 80 33.6% 32.4%Number of Bed Days: Diabetes Related Emergency Admissions 694 515 523 34.9% 32.8%Bed Days Per Admission: Diabetes Related Emergency Admissions 6.55 6.50 6.43 0.7% 1.8%Total Cost: Diabetes Related Emergency Admissions £285,880 £212,222 £215,376 34.7% 32.7%

Cardiovascular Disease X12345

NHS NORTH STAFFORDSHIRE

CCG (05G) National*

NHS NORTH STAFFORDSHIRE

CCG (05G) National*Patients on Cardiovascular Disease Register 156 182 187 -14.4% -16.7%Cholesterol Tests per Patient on Cardiovascular Disease Register 0.18 0.65 0.58 -71.5% -68.0%HDL Tests per Patient on Cardiovascular Disease Register 6.46 5.92 6.68 9.2% -3.2%Triglycerides Tests per Patient on Cardiovascular Disease Register 1.88 3.30 2.75 -42.8% -31.4%Number of Cardiovascular Disease Related Emergency Admissions 255 200 208 27.6% 22.9%Number of Bed Days: Cardiovascular Disease Related Emergency Admissions 1,671 1,257 1,302 32.9% 28.3%Bed Days Per Admission: Cardiovascular Disease Related Emergency Admissions 6.55 6.36 6.23 3.0% 5.2%Total Cost: Cardiovascular Disease Related Emergency Admissions £688,260 £520,468 £539,286 32.2% 27.6%

Chronic Kidney Disease X12345Patients on Chronic Kidney Disease Register 214 173 198 23.9% 7.8%Microalbumin Tests per Patient on Chronic Kidney Disease Register 1.56 2.93 2.84 -46.8% -45.1%Number of Chronic Kidney Disease Related Emergency Admissions 47 30 32 57.5% 49.1%Number of Bed Days: Chronic Kidney Disease Related Emergency Admissions 488 262 284 86.3% 71.8%Bed Days Per Admission: Chronic Kidney Disease Related Emergency Admissions 10.38 8.86 8.82 17.2% 17.7%Total Cost: Chronic Kidney Disease Related Emergency Admissions £191,660 £104,423 £112,997 83.5% 69.6%

Heart Failure X12345Patients on Heart Failure Register 31 45 47 -30.4% -34.7%BNP Tests per Patient on Heart Failure Register 0.39 0.88 1.07 -55.8% -63.9%Cholesterol Tests per Patient on Heart Failure Register 0.93 1.95 2.77 -52.4% -66.4%Number of Heart Failure Related Emergency Admissions 43 32 34 36.2% 27.6%Number of Bed Days: Heart Failure Related Emergency Admissions 375 303 327 23.6% 14.7%Bed Days Per Admission: Heart Failure Related Emergency Admissions 8.72 9.66 9.61 -9.8% -9.3%Total Cost: Heart Failure Related Emergency Admissions £149,620 £119,956 £129,128 24.7% 15.9%

Thyroid Disease X12345Patients on Hypothyroidism Register 212 173 189 22.8% 12.4%TSH Tests per Patient on Hypothyroidism Register 2.58 6.51 5.94 -60.4% -56.6%Free T4 Tests per Patient on Hypothyroidism Register 0.11 0.30 0.29 -61.9% -60.5%Number of Thyroid Disease Related Emergency Admissions 38 24 25 58.1% 50.4%Number of Bed Days: Thyroid Disease Related Emergency Admissions 295 168 179 75.7% 64.4%Bed Days Per Admission: Thyroid Disease Related Emergency Admissions 7.76 6.82 6.84 13.8% 13.4%Total Cost: Thyroid Disease Related Emergency Admissions £119,120 £68,602 £73,192 73.6% 62.8%

Stroke X12345

Average data for: M83005 compared with:

KUBS Primary Care Benchmarking GP DataSummary Data for 2013

www.keele.ac.uk/benchmarking

Average data for: M83005 compared with:

Average data for: M83005 compared with:

How to report back to GPs?

How to report back to GPs?(both MUST be completed)

Actual Values

Key: U&E (or equivalent) Requests from A&E Your Lab ANON ANON ANON ANON Mean Your Lab Min 1stQ Median 3rdQ Max Mean Target Turnaround Time 60 60 60 60 120 72 60 60 60 60 60 120 64 Proportion of Target Met 71.00% 75.00% 93.00% 95.00% 97.60% 86.32% 71.00% 71.00% 90.00% 93.00% 95.70% 100.00% 91.39%

(Key: red=highest, green=lowest. This in no way implies that one is necessarily better than another)

% difference: your lab compared to..

U&E (or equivalent) Requests from A&E Your Lab ANON ANON ANON ANON Mean Your Lab Min 1stQ Median 3rdQ Max MeanTarget Turnaround Time 60 0% 0% 0% -50.0% -16.7% 60 0% 0% 0% 0% -50.0% -5.6%Proportion of Target Met 71.00% -5.3% -23.7% -25.3% -27.3% -17.7% 71.00% 0% -21.1% -23.7% -25.8% -29.0% -22.3%

(eg +10% means your lab is 10% higher than the lab or measure (eg mean) in question)

Three-year sample dataU&E (or equivalent) Requests from A&E Your Lab ANON ANON ANON ANON Mean Your Lab Min 1stQ Median 3rdQ Max Mean

2012/13 60 60 60 60 120 72 60 60 60 60 60 120 64Target Turnaround Time 2011/12 60 120 90 60 120 90 60 55 60 60 60 120 66

2010/11 60 120 90 22 120 82 60 22 60 60 120 120 802012/13 71.00% 75.00% 93.00% 95.00% 97.60% 86.32% 71.00% 71.00% 90.00% 93.00% 95.70% 100.00% 91.39%

Proportion of Target Met 2011/12 83.00% 90.00% 98.80% 95.00% 98.20% 93.00% 83.00% 49.23% 88.70% 93.63% 96.56% 100.00% 90.97%2010/11 83.70% 90.00% 98.50% 97.00% 98.00% 93.44% 83.70% 53.79% 87.01% 95.90% 99.30% 100.00% 90.91%

Your Peer Group Entire Group

Figure 4: Turnaround Times for U&E Requests from A&ESelected Lab: Cambridge University Hospitals NHS Foundation Trust

Your Peer Group Entire Group

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How to report back to GPs?

• Needs to be short and to the point– No time to analyse more data or read in-depth reports

• Relevant comparisons need to be made– Within ‘peer group’– Within CCG– Within wider/national context?

• Workshops/interactive sessions need to involve representatives from the laboratory and CCG/CSU

• Who sends the data to GPs? – Keele to send direct?– Labs provided with the tools to engage with their own GPs/CSUs?

Will it make a difference?

• The next 12 months will tell us! – Pilot continuing with North Staffs and Wolverhampton

• Data to be presented to CSUs and GPs• Monitor improvements/changes over the course of the pilot

– Recommendation has been made within Lancashire CSU for their laboratories to join the pilot

– Extending the pilot out to other interested labs

• GP workshops at UHNS seemed to make a difference regarding requesting practice as part of the INTERCEPT study, suggesting that engagement between laboratory and customer (using data and evidence) makes a difference

Feedback

• Any feedback, suggestions and questions would be most welcome!

• Contact me for further information on d.holland@keele.ac.uk or 01782 733277.