Joint CCG/DMI reward
scheme 2013/14
Rebecca Dallmeyer
Linda Briant
Schemes for excellent diabetes care 2013/14
What do you need to do?
Lambeth
Payment
per
diabetes
patient
Attend 2 or more DMI learning events
Entry criteria
Complete practice action plan
£2
Complete and submit data National Diabetes Audit (NDA) or equivalent
Improve diabetes register receiving all 9 care processes by 10% compared to 2012/13 or meet 60%
£4
40% of diabetes register have a jointly agreed care plan (8CMD)
36% of diabetes register have a jointly agreed care plan with goal follow up (8HD)
£6
Improve diabetes register with an HbA1c<64mmol/mol by 10% compared to 2012/13 or meet 73%
May 2014
£0.03
£0.09
plus
additional
£0.30 for
care planning
£0.27
Improve diabetes register with BP<140/80 by 10% compared to 2012/13 or meet 67%
Improve diabetes register with cholesterol<5 by 10% compared to 2012/13 or meet 76%
£0.09
£0.30
20% of diabetes register have a jointly agreed care plan that has been reviewed (67L0 / 67L1)
Improve diabetes register with BP<150/90 by 10% compared to 2012/13 or meet 87%
Southwark
Payment
per
practice
register
£8
plus
additional
£0.42 for 
detection and
 HbA1c
>75mmol/mol
2
Practice support and tools
•DMI supported sign up to schemes and completion of practice action
plans
•Develop and implement tools to support improvement in general practice

Guidelines – diagnosis, HbA1c, blood pressure and cholesterol control
pathways

Local standardised practice IT system searches

IT templates (care planning)

Sharing performance data

Learning events

Clinical champions
•Working with community diabetes services to ensure spread of consistent
messages to support practices to manage more complex patients
May 2014
3
Unprecedented engagement
2012/13
•82 (85%) practices signed up by December 2012.
2013/14
•89 (96%) practices signed up by 31July 2013
•87 practices completed their action plan for improvement
by 31 July and a further 2 by 30 September
•100% practices submitted data to National Diabetes
Audit
May 2014
4
Learning Events
•89 practices attended two learning events
•43 practices attended more than two learning events
•Attendance remained consistent
•GP attendance made up of 53% of the delegation
•Positively evaluated, practical and relevant
“Really helpful session – case studies useful. The
algorithms will be really helpful in clinic – can’t wait to
share them with my colleagues.” Southwark GP
May 2014
5
Improve diabetes register receiving all 9 care
processes by 10% compared to 2012/13 or meet 60%
% of people on diabetes register receiving all
nine care processes
47.7%
Southwark
34.0%
2013/14
2012/13
44.5%
Lambeth
31.6%
0%
10%
20%
30%
40%
50%
60%
• 3,951 more people with diabetes received all 9 care processes in
2013/14 compared to the previous year
• Interim data shows most improvement in ACR, foot checks and
smoking status
May 2014
6
Collaborative care planning – comparison with
12/13 estimates
• While the 12/13 figures were extrapolated from partial data (practices who
completed last year’s reward scheme survey) and probably underestimate
the actual number, the latest data supports the perceived increase (both
anecdotal and from the patient questionnaire) in collaborative care plans
May 2014
7
Collaborative care planning
Collaborative Care Planning 2013/14
Collaborative Care Planning 2013/14
Lambeth
100%
Southwark
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
81%
40%
40%
65%
30%
20%
30%
41%
39%
20%
40%
38%
10%
10%
0%
0%
% with care plan
of which follow-up
Lambeth Achievement
Target
of which goal reviewed
% with care plan
of which follow-up
Southwark Achievement
Target
of which goal reviewed
• Please note that these figures are based on number of collaborative
care plans coded within practices
• Assessment of quality is included in Southwark CCG scheme in
2014/15
May 2014
8
Biological Outcomes
• The combined register size has grown by 23% since 2009/10; 16.6%
since 2010/11.
• While growth over the past year slowed to 3% (compared with 9% the
year before), this still represents around 800 additional patients on the
registers.
May 2014
9
HbA1c ≤ 64 mmol/mol control
• 868 additional patients controlled with HbA1c ≤ 64 mmol/mol
• These CQRS data are provisional and may be subject to change
following Practice validation and NHS England approval of achievement.
May 2014
10
HbA1c ≤ 64 mmol/mol control – Lambeth 2013/14
Lambeth - HbA1c <=64mmol/mol
90.0%
80.0%
70.0%
60.0%
2013/14
50.0%
40.0%
2012/13
13/14 Target
30.0%
20.0%
10.0%
0.0%
10 practices reached 13/14 target level in 2012/13; 13 practices have reached the target level in 2013/14
May 2014
11
HbA1c ≤ 64 mmol/mol control – Southwark 2013/14
Southwark - HbA1c <=64mmol/mol
90.0%
80.0%
70.0%
60.0%
2013/14
50.0%
40.0%
2012/13
13/14 Target
30.0%
20.0%
10.0%
0.0%
9 practices reached 13/14 target level in 2012/13; 21 practices have reached the target level in 2013/14
May 2014
12
BP≤150/90
• 906 patients controlled with BP ≤ 150/90
• These CQRS data are provisional and may be subject to change
following Practice validation and NHS England approval of achievement.
May 2014
13
BP≤140/80 mm Hg
• >2,000 patients controlled with BP ≤ 140/80
• These CQRS data are provisional and may be subject to change
following Practice validation and NHS England approval of achievement.
May 2014
14
Cholesterol ≤ 5 mmol/l
• 864 patients controlled with cholesterol ≤ 5 mmol/l
• These CQRS data are provisional and may be subject to change
following Practice validation and NHS England approval of achievement.
May 2014
15
Variation and control in Lambeth and Southwark
Variation Box Plots:
Maximum (Best performer)
Interquartile
Range
Top of 3rd Quartile
Median
Top of 1st Quartile
Minimum (Worst performer)
Southwark Interquartile Range
2010/11
2011/12
2012/13
2013/14
10.0
10.5
8.0
9.8
Lambeth Interquartile Range
2010/11
2011/12
2012/13
2013/14
7.9
7.5
7.1
7.1
• While Southwark’s improved performance on HbA1c control has
increased their inter-practice variation compared with 12/13, the
increase has been at the upper end of performance. Neither borough
has returned to the 10/11 levels of variation and both boroughs are
seeing the spread increase positively, toward the upper end of the
interquartile range.
May 2014
16
Lambeth 2014/15 reward scheme
May 2014
17