COPD in Hardwick CCG Produced November 2015 by :

premature deaths due to respiratory disease in 201342

patients with COPD March 2015

estimated patients with COPD

estimated patients undiagnosed with COPD

NO flu vaccNO spirometry

(9.9%)

(80.0%)

(10.0%)

QOF performance - March 2015

3.01%

1.91%

3.06%

2.74%

NHS Hardwick CCG East Midlands

% COPD Prevalence - March 2015 Estimated % COPD prevalence1.41%

1.43%

1.64%

1.69%

1.75%

1.76%

1.83%

1.87%

1.89%

1.98%

2.07%

2.09%

2.09%

2.16%

2.24%

2.35%

2.51%

2.83%

3.01%

1.91%

0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50%

NHS Rushcliffe CCG

NHS Leicester City CCG

NHS Nottingham City CCG

NHS East Leicestershire and Rutland CCG

NHS Nene CCG

NHS West Leicestershire CCG

NHS Southern Derbyshire CCG

NHS Nottingham North & East CCG

NHS South West Lincolnshire CCG

NHS South Lincolnshire CCG

NHS Nottingham West CCG

NHS Lincolnshire West CCG

NHS Newark & Sherwood CCG

NHS North Derbyshire CCG

NHS Erewash CCG

NHS Mansfield & Ashfield CCG

NHS Lincolnshire East CCG

NHS Corby CCG

NHS Hardwick CCG

East Midlands

% COPD Prevalence - March 2015

30.5

35.9

42

41.6

38.6

2009

2010

2011

2012

2013

Premature Mortality Rate from COPD/Respiratory 2009 - 2013

84change in COPD patients

on QOF registers between March 2014 & March 2015

Review with MRC dyspnoea scale

(77.9%)

(71.1%)

(81.4%)

Diagnosis confirmed by spirometry

FEV1 record

Flu immunisation

Estimate by ERPHO, 2011

Exceptions

(11.9%)

(13.7%)

(2.8%)

(10.2%)

(15.1%)

(15.8%)

ExceptionsNO FEV1

Exceptions

NO MRC dyspnoea scale

Exceptions

3,080 3,131 51

9697

773

368313

2,399

423

466

2,191

86488

2,506

Hardwick CCG - COPD QOF performance by Practice - March 2015

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

C810

50 T

HE V

ILLAG

E SU

RG

C810

55 N

ORT

H W

INGF

IELD

MED

CTR

C816

58 W

ELLB

ECK

DRIV

E SUR

G

C810

99 LI

MES

MED

CTR

C816

55 F

RIEN

DLY

FAM

ILY S

URG

C810

29 S

TAFF

A HE

ALTH

C810

08 B

LUE

DYKE

S SUR

G

C816

61 B

LACK

WEL

L MED

CTR

C810

33 S

HIRE

S HEA

LTHC

ARE

C810

95 E

MM

ETT

CARR

SUR

G

C810

56 C

LAY

CROS

S MED

CTR

C810

96 C

RAGS

HEA

LTH

CARE

C816

38 C

ASTL

E ST

REET

MED

CTR

C816

47 S

T LA

WRE

NCE

ROAD

SUR

G

C810

11 C

RESW

ELL &

LANG

WI

C816

33 G

RASS

MO

OR SU

RG

CCG

Aver

age

COPD diagnosis confirmed by spirometry

Exceptions %

No Spirometry %

Spirometry %

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

C816

58 W

ELLB

ECK

DRIV

E SUR

G

C816

61 B

LACK

WEL

L MED

CTR

C810

95 E

MM

ETT

CARR

SUR

G

C816

38 C

ASTL

E ST

REET

MED

CTR

C816

33 G

RASS

MO

OR SU

RG

C816

55 F

RIEN

DLY

FAM

ILY S

URG

C810

55 N

ORT

H W

INGF

IELD

MED

CTR

C810

50 T

HE V

ILLAG

E SU

RG

C810

33 S

HIRE

S HEA

LTHC

ARE

C810

29 S

TAFF

A HE

ALTH

C810

08 B

LUE

DYKE

S SUR

G

C810

99 LI

MES

MED

CTR

C816

47 S

T LA

WRE

NCE

ROAD

SUR

G

C810

96 C

RAGS

HEA

LTH

CARE

C810

56 C

LAY

CROS

S MED

CTR

C810

11 C

RESW

ELL &

LANG

WI

CCG

Aver

age

Had a review including an assessment of breathlessness using MRC dyspnoea scale in preceding 12 months

Exceptions %

No Review %

Review %

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

C810

55 N

ORT

H W

INGF

IELD

MED

CTR

C816

58 W

ELLB

ECK

DRIV

E SUR

G

C810

96 C

RAGS

HEA

LTH

CARE

C810

99 LI

MES

MED

CTR

C810

08 B

LUE

DYKE

S SUR

G

C810

95 E

MM

ETT

CARR

SUR

G

C816

61 B

LACK

WEL

L MED

CTR

C810

29 S

TAFF

A HE

ALTH

C810

11 C

RESW

ELL &

LANG

WI

C816

47 S

T LA

WRE

NCE

ROAD

SUR

G

C816

38 C

ASTL

E ST

REET

MED

CTR

C810

33 S

HIRE

S HEA

LTHC

ARE

C810

50 T

HE V

ILLAG

E SU

RG

C816

55 F

RIEN

DLY

FAM

ILY S

URG

C816

33 G

RASS

MO

OR SU

RG

C810

56 C

LAY

CROS

S MED

CTR

CCG

Aver

age

Influenza immunisation in the preceding 1 August to 31 March

Exceptions %

No Flu Immunisation %

Flu Immunisation %

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

C816

58 W

ELLB

ECK

DRIV

E SUR

G

C810

50 T

HE V

ILLAG

E SU

RG

C816

38 C

ASTL

E ST

REET

MED

CTR

C816

55 F

RIEN

DLY

FAM

ILY S

URG

C810

95 E

MM

ETT

CARR

SUR

G

C810

55 N

ORT

H W

INGF

IELD

MED

CTR

C816

33 G

RASS

MO

OR SU

RG

C810

33 S

HIRE

S HEA

LTHC

ARE

C810

29 S

TAFF

A HE

ALTH

C810

99 LI

MES

MED

CTR

C810

08 B

LUE

DYKE

S SUR

G

C816

61 B

LACK

WEL

L MED

CTR

C810

96 C

RAGS

HEA

LTH

CARE

C810

56 C

LAY

CROS

S MED

CTR

C810

11 C

RESW

ELL &

LANG

WI

C816

47 S

T LA

WRE

NCE

ROAD

SUR

G

CCG

Aver

age

A record of FEV1 in the preceding 12 months

Exceptions %

No FEV1 Record %

FEV1 Record %

Patients with a MRC Dyspnoea ≥ 3 in last 12 months with a record of oxygen saturation value 84.1 - 100.0% Practice Range

COPD Admissions - Hardwick CCG

% of admissions <=1 day LOS % of admissions <=2 days LOS death with a LoS <2 days in 2014-15

CCG

East Midlands average 50.6% 65.2% 1.5%

CCG Range 32.9% to 76.6% 44.7% to 82.1% 0% to 3.9%

COPD admissions (primary diagnosis)

2012-13 2013-14 2014-15

13.8%

10.7%

12.7%

% of readmissions within 30 days

2012-13 2013-14 2014-15

34.1%

24.9% 25.1%

% of readmissions within 90 days

2012-13 2013-14 2014-15

78.9 86.8

92.7 102.0 103.2 106.4 107.0

112.4 115.8 121.8 122.3 122.7 123.0 125.4 127.2 130.1 135.2

148.0 149.5

NHS

Not

tingh

am W

est C

CG

NHS

New

ark

& S

herw

ood

CCG

NHS

Ere

was

h CC

G

NHS

Sou

th W

est L

inco

lnsh

ire C

CG

NHS

Sou

th L

inco

lnsh

ire C

CG

NHS

Rus

hclif

fe C

CG

NHS

Lin

coln

shire

Wes

t CCG

NHS

Wes

t Lei

cest

ersh

ire C

CG

NHS

Man

sfie

ld &

Ash

field

CCG

NHS

Eas

t Lei

cest

ersh

ire a

nd R

utla

ndCC

G

NHS

Lin

coln

shire

Eas

t CCG

NHS

Har

dwic

k CC

G

NHS

Not

tingh

am N

orth

& E

ast C

CG

NHS

Sou

ther

n De

rbys

hire

CCG

NHS

Nor

th D

erby

shire

CCG

NHS

Cor

by C

CG

NHS

Nen

e CC

G

NHS

Lei

cest

er C

ity C

CG

NHS

Not

tingh

am C

ity C

CG

COPD admission rate per 1,000 COPD population (12 months to March 2015)

CCG East Midlands

184

37

15 8 6 2

1 2 3 4 5 6 plus

Frequency of COPD admissions per patient in 12 months to March 2015

52.3% 67.4%

Average length of stay = East Midlands = 5.9CCG Range = 4.8 – 7.3

patients had only 1 admission

0.0%

384289 378

5.7 days

184

Hardwick CCG – COPD – Smoking, Oxygen and Prescribing data

Developed by London Respiratory Network and London School of Economics the pyramid of value gives estimates ofcost per quality adjusted life year gained for COPD interventions

QALY = quality adjusted life years

No current evidence for Telemonitoring

Use GRASP COPD or ask your prescribing adviser.

Pyramid of value for COPD interventions

Telehealth for chronic disease

£92,000/QALY

Triple Therapy £7,000 -

£187,000/QALY

LABA £8,000/QALY

Tiotropium £7,000/QALY

Pulmonary Rehabilitation £2,000 - 8,000/QALY

Stop Smoking Support with pharmacotherapy £2,000/QALY

Flu vaccination £1,000/QALY in “at risk” population

Reference : Zaid Zoumot et al. Thorax doi: 10.1136/thoraxjnl-2014-205667

National COPD Audit of Pulmonary Rehabilitation - Organisational Audit, November 2015

Smoking & smoking cessation data by Local Authority

Number of patients NOT receivedinfluenza immunisation

Inhaled corticosteroids accounts for 8% of total prescribing spend in East Midlands in 2014-15

02 £1,4

99

£1,5

72

£1,6

12

£1,6

51

£1,7

08

£1,7

11

£1,7

68

£1,7

73

£1,8

25

£1,8

80

£1,8

81

£1,8

87

£1,8

94

£1,9

24

£1,9

73

£1,9

74 £2

,128

£2,1

70

£2,2

76

£1,8

48

£0

£500

£1,000

£1,500

£2,000

£2,500

Inhaled corticosteroid - Net Ingredient Cost (NIC) 2014-15 per STAR-PU

Smoking data by Local Authority

Oxygen for patients with COPD - October 2014 to Sept 2015

Inhaled corticosteroid Expenditure 2014-15

£1,256,595

Inhaled corticosteroid NIC 2014-15 per STAR-PU

£1,708£26.76

87

28.08

£82,417

EnglandSmoking Prevalence in adults - current smokers (2014)

Better Similar

18.0%

28.0%

2,829

Worse

Smoking Prevalence in adults in routine and manual occupations - current smokers (2014)

Successful quitters at 4 weeks per 100,000 smokers (2014-15)

Derbyshire

19.9%

31.5%

1,559

compared to England average

31.08