Adding local value to
Commissioning for Value
Lucy Jackson
Consultant in Public Health
Leeds City Council
What did we do with Commissioning
for value?
• Ensured it made sense locally.
• Choose issue for a local reason too.
• Added local data – to add to the pathway and
triangulate.
• Wider footprint of Leeds but local too - 3 CCGs agreed
on the same 2 areas.
• Brought all players together – Clinicians; CCG
commissioners; Local Public Health with PHE. Citywide
and within each CCG to work through.
• Ownership of approach - Conversations with clinical
fora in each CCG – does this make sense , prioritise
actions?
Local Strategic Context –
Leeds Joint Health and Well Being Strategy
Vision - Leeds will be a healthy and caring city
for all ages
Principle - People who are the poorest will
improve their health the fastest
Outcome one - People will live longer and
have healthier lives
Use CFV but also locally what fits - the life
expectancy gap by cause of death
Scarf chart showing the
breakdown of the life
expectancy gap between
Leeds as a whole and
England as a whole, by
cause of death, 2009-2011
4
Local Data: GP audit and healthy living
service referral data summarised by CCG
prevalence
CHD
Health checks uptake
prevalence
Smoking
Obesity
Smokers referred to smoking services
(including prompted self referral)
prevalence
Recorded BMI
>30 referred to weight management service
Short screening (FAST or AUDIT-C)
Completed full AUDIT screening
Alcohol
Screened as positive
(Hazardous/harmful/dependant drinkers)
Brief intervention (in GP practice)
Scoring 20+ on AUDIT who have been referred
for specialist advice for dependant drinking
Leeds
3.3%
3.8%
3.1%
3.4%
60.2%
65.2%
51.5%
57.7%
18.6%
27.0%
22.0%
22.7%
9.0%
9.1%
4.2%
7.0%
19.5%
25.7%
19.9%
21.7%
2.2%
2.1%
1.5%
1.9%
6.3%
7.0%
6.7%
6.7%
1.1%
0.7%
4.1%
2.3%
9.9%
21.5%
34.9%
30.8%
4.5%
6.7%
9.0%
8.7%
1.1%
1.8%
0.4%
0.5%
Local Data
NHS LEEDS
NHS LEEDS SOUTH AND
NORTH CCG EAST CCG
NHS
LEEDS
WEST
CCG
5
Local Data: Obesity prevalence
Obesity prevalence versus % weight management referrals
Low obesity prevalence
High weight
management referrals
High obesity prevalence
High weight
management referrals
Practices which have high obesity
prevalence and low percentage of
weight management referrals :
(For a full list of all practice's see
appendix 5)
Practice
cluster
Low obesity prevalence
Low weight
management referrals
High obesity prevalence
Low weight
management referrals
Practices within the dotted line do not have statistically
different level of obesity prevalence and % of weight
management referrals to the CCG as a whole
GP practice name
% Obese Referrals
Pentagon
21.7%
0.9%
Triangle
22.7%
1.7%
Kite
21.3%
0.4%
Hexagon
20.4%
0.6%
Kite
20.0%
1.7%
Triangle
25.7%
0.4%
Pentagon
19.5%
2.2%
Kite
22.7%
1.6%
Circle
23.1%
0.7%
Hexagon
26.7%*
0.0%
* Statistically different to the CCG
6
Local Data: Smoking prevalence
Low % smokers
High% smokers referred
High % smokers
High% smokers referred
Practices which have a high % of smokers
and low percentage of smokers referred:
(For a full list of all practices see
appendix
5)
Practice
%
Smoking
cluster
Low % smokers
Low% smokers referred
High % smokers
Low % smokers referred
Practices within the dotted line do not have
statistically different level of smoking prevalence
and % of smoking referrals to the CCG as a whole
GP practice name
Smoking referrals
Triangle
30.3%
8.3%
Triangle
33.2%
4.7%
Triangle
29.1%
8.1%
Triangle
34.2%
1.4%
Triangle
34.1%
3.3%
Oval
30.3%
6.6%
Triangle
39.9%
4.6%
Triangle
37.1%
3.4%
Oval
33.2%
1.4%
Circle
33.4%
3.8%
Circle
31.5%
2.0%
Oval
33.6%
5.3%
Triangle
32.3%
6.9%
Triangle
37.4%
4.1%
No cluster
27.8%
3.6%
Local Data
Smoking prevalence versus % smoking referrals
7
Overarching messages for Leeds -CVD
Summary:







Public health focus on prevention; specifically smoking
prevalence (Leeds South & East and Leeds West) smoking
cessation (All) and Obesity (Leeds South & East)
Significant benefit to patients if improvement to Primary
Care management indicators were made (All)
High emergency admissions for CVD (Leeds South & East),
costs (Leeds North and Leeds South & East) and lengths of
stay (All)
High costs for CHD emergency admissions (Leeds North
and Leeds South & East) and high costs for CHD elective
admissions (Leeds South & East)
High emergency admissions for Heart Failure and Stroke
(Leeds South & East and Leeds West)
High costs for Angiography procedures (All), CABG
procedures (All) and Angioplasty procedures (Leeds West)
High lengths of stay for Angiography procedures (Leeds
West)
8
Respiratory Summary






Public health focus on prevention; specifically smoking
prevalence (Leeds South & East and Leeds West) and
smoking cessation (All)
Significant benefit to patients if improvement to Primary
Care management indicators were made (All)
High emergency admissions for Influenza & Pneumonia
(Leeds South & East and Leeds West)
High COPD emergency readmissions (Leeds South & East
and Leeds West)
High costs for Respiratory (All), COPD (Leeds North and
Leeds West), Asthma (Leeds South & East), Upper
Respiratory (Leeds South & East) and Other Acute lower
(Leeds South & East and Leeds West) emergency
admissions
High lengths of stay for Upper Respiratory (Leeds South &
East) and Other Acute Lower (Leeds North and Leeds South
& East)
Significant variation in corticosteroids prescribing between
practices (All)
Summary on a page

9
Actions …………..
• Public Health – challenge to jointly re look at
commissioning of healthy living services key priority for
the Council.
• Primary care – variation target work with key practices
and embed into engagement schemes in each CCG
• Whole pathway – flow and variation – LIQH.
• CCG commissioning – using packs as part of
prioritisation framework
• Transformation work streams -Acute – elective care
value approach; Integrated Care – Pathways work; PYLL
trajectories.
The LIQH approach
LIQH – focussed areas
CVD
□ improving the management of chest pain;
□ optimise outcomes and quality of care for people requiring
interventions/ treatment for suspected/confirmed arrhythmia
and to prevent inappropriate use of secondary services.
□ to improve the physical and psychological health of patients’
post-MI with new or existing anxiety / depression.
COPD
□ support people with COPD to manage their own condition and to
reduce the likelihood and impact of exacerbations;
□ reduction in variation of approach to COPD patients in crisis;
□ Improving the early and accurate diagnosis of COPD whilst
improving patient experience.