2. Prescribing Support Unit ‘Shadow Information Centre’ Dave Roberts Unit Manager

3. Prescribing Support Unit Founded in 1996 Founded in 1996 Hosted by Hosted by Leeds Health Authority Leeds Health Authority West Yorkshire Strategic Health Authority West Yorkshire Strategic Health Authority Six full time staff Six full time staff Policy and Analytical Unit for the DH Policy and Analytical Unit for the DH Liaison role with the NHS Liaison role with the NHS Close ties with Close ties with Prescription Pricing Authority (PPA) Prescription Pricing Authority (PPA) National Prescribing Centre (NPC) National Prescribing Centre (NPC)

4. Prescribing Agenda Resource Allocation Resource Allocation Forecasting the drugs bill Forecasting the drugs bill Policy issues Policy issues Quality assessment Quality assessment Teaching/Training Teaching/Training

5. Health and Social Care Information Centre December 2004

6. Current Issues Too great a demand on the ‘front line’ Too great a demand on the ‘front line’ No national focus for information & knowledge management in clinical AND social care No national focus for information & knowledge management in clinical AND social care Does existing information really focus on what matters? Does existing information really focus on what matters? A ‘vision’ for information A ‘vision’ for information Sir Ian Kennedy - Bristol Royal Infirmary Inquiry report Sir Ian Kennedy - Bristol Royal Infirmary Inquiry report Sheila Leatherman - The Quest for Quality in the NHS Sheila Leatherman - The Quest for Quality in the NHS NHS Confederation NHS Confederation The Response The Response Creation of the Health and Social Care Information Centre

7. Arm’s Length Body Review Reduction in numbers of ALBs from 38 to 20 Reduction in numbers of ALBs from 38 to 20 Reductions in Posts by 25% by 2007-08 Reductions in Posts by 25% by 2007-08 Savings in expenditure of 10% by 2007-08 Savings in expenditure of 10% by 2007-08 ALBs will be expected to relocate away from South & East (Lyons Review) ALBs will be expected to relocate away from South & East (Lyons Review)

8. Arm’s Length Body Review Reports - Reconfiguring the Department of Health’s Arm’s Length Bodies and NHS Improvement Plan Reports - Reconfiguring the Department of Health’s Arm’s Length Bodies and NHS Improvement Plan Creation of the Information Centre as a Special Health Authority Creation of the Information Centre as a Special Health Authority Consisting of: Consisting of: ‘Information’ elements of the NHS Information Authority (NHS IA) ‘Information’ elements of the NHS Information Authority (NHS IA) Statistics & information policy functions of the Department of Health (DH) Statistics & information policy functions of the Department of Health (DH) IC to operate in shadow form until 31 March 2005 IC to operate in shadow form until 31 March 2005 Chairman and board appointments will be made as soon as possible Chairman and board appointments will be made as soon as possible 1 April 2005 – organisation established 1 April 2005 – organisation established Headquarters in Leeds Headquarters in Leeds

9. What is the Information Centre? Purpose: “to improve the quality and use of information and knowledge for the benefit of patients and service users” A joined-up system for health and social care information A joined-up system for health and social care information Provides national leadership and focus for data and information Provides national leadership and focus for data and information Is driven by wishes & requirements of those in the system Is driven by wishes & requirements of those in the system Works with all parts of the Health and Social Care System and NPfIT Works with all parts of the Health and Social Care System and NPfIT

10. Scope for the Information Centre Service Users Clinicians Managers Healthcare Commission SHA Social Care Commission (CSCI) NPSA Social care Professionals Public Registries Central Users Local Organisations Local Individuals Politicians Policy teams Public Health Government NHS Trusts Local Authorities Families Carers Royal Colleges

11. Key areas of work Regulation and co-ordination of information requirements Regulation and co-ordination of information requirements Mandating data collections and setting standards Mandating data collections and setting standards Co-ordinating data collection across regulators/inspectors/others Co-ordinating data collection across regulators/inspectors/others Provision of information and knowledge management services i.e. collection, development, dissemination, standards, analysis, strategic information management Provision of information and knowledge management services i.e. collection, development, dissemination, standards, analysis, strategic information management Acting as an agent to improve the scope, quality and use of information for the benefit of patients and service users and their care Acting as an agent to improve the scope, quality and use of information for the benefit of patients and service users and their care National focus for education, training and development for information management National focus for education, training and development for information management

12. Benefits Reduced bureaucracy and waste Reduced bureaucracy and waste Easy, timely access to data sources, information and knowledge Easy, timely access to data sources, information and knowledge Improved accuracy, scope, quality and use of information and knowledge for the good of patient care Improved accuracy, scope, quality and use of information and knowledge for the good of patient care Patient-focused Patient-focused Integrated information Integrated information Service improvements can be evidence based Service improvements can be evidence based Increased support and development of health informatics staff Increased support and development of health informatics staff Add value to the investment in technology led by NPfIT Add value to the investment in technology led by NPfIT

13. Prescribing Data

14. Prescribing Indicators - who needs them? Department of Health for performance management and monitoring of NHS Department of Health for performance management and monitoring of NHS SHAs to performance manage and support PCTs SHAs to performance manage and support PCTs PCTs to help identify issues for discussion with practices PCTs to help identify issues for discussion with practices PCTs for local monitoring e.g. prescribing incentive schemes PCTs for local monitoring e.g. prescribing incentive schemes Healthcare Commission, National Patient Safety Agency, NICE Healthcare Commission, National Patient Safety Agency, NICE

15. Prescribing Indicators Publication of Audit Commission report ‘A Prescription for Improvement - Towards More Rational Prescribing’ (1994) Publication of Audit Commission report ‘A Prescription for Improvement - Towards More Rational Prescribing’ (1994) PRU asked to produce a set of prescribing indicators (1995) PRU asked to produce a set of prescribing indicators (1995) To be populated from prescription data To be populated from prescription data To benchmark HAs To benchmark HAs

16. Cost per PU of Drugs of Limited Clinical Value These preparations have only limited effectiveness and should be used sparingly These preparations have only limited effectiveness and should be used sparingly BNF classification - less suitable for prescribing BNF classification - less suitable for prescribing

17. PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Prescribing Indicator Data source Universal comparative indicators HA/PCT Monitoring

18. Using prescribing units Rather than use the number of patients we often use the total number of “prescribing units”, obtained by weighting the number of patients in different age and sex categories and adding these together. Rather than use the number of patients we often use the total number of “prescribing units”, obtained by weighting the number of patients in different age and sex categories and adding these together. There are several different sort of units available There are several different sort of units available

19. ASTRO-PUs A ge S ex T emporary R esident O riginated P rescribing U nits

20. ASTRO(97)-PU cost weights

21. STAR-PUs S pecific T herapeutic group A ge/sex R elated P rescribing U nits

22. Weightings for CV STAR-PU

23. Weighted denominators e.g. ADQ/STAR-PU Comparable Drug Utilisation e.g. Ulcer healing drugs PCT Prescribing Lead PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Prescribing Indicator Data source Universal comparative indicators HA/PCT Monitoring

24. Prescribing indicators Antibacterials Antibacterials Items per STAR-PU Items per STAR-PU NIC per item NIC per item Ulcer healing drugs Ulcer healing drugs ADQs per STAR-PU ADQs per STAR-PU NIC per ADQ NIC per ADQ Oral NSAIDS Oral NSAIDS ADQs per STAR-PU ADQs per STAR-PU NIC per ADQ NIC per ADQ

25. Prescribing Toolkit Data at StHA, PCT and practice level Data at StHA, PCT and practice level Available quarterly Available quarterly Electronic prescribing information system provided over NHS net to: DH, PSU, StHAs, and PCTs Electronic prescribing information system provided over NHS net to: DH, PSU, StHAs, and PCTs 12 prescribing indicators 12 prescribing indicators 50+ comparators 50+ comparators

28. Weighted denominators e.g. ADQ/STAR-PU Comparable Drug Utilisation e.g. Ulcer healing drugs PCT Prescribing Lead Disease Management e.g Patients heart failure receiving ACE inhibitor GP Clinical Systems data e.g. QMAS PCT Clinical Governance Lead PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Prescribing Indicator Data source Universal comparative indicators HA/PCT Monitoring

29. Quality and Outcomes Framework GMS contract

30. Rewards for Quality £1.3bn for the UK for quality in GMS and PMS £1.3bn for the UK for quality in GMS and PMS Non-discretionary Non-discretionary In addition to the global sum In addition to the global sum Payment for what many already do Payment for what many already do Work converts to points; points to payment Work converts to points; points to payment 1050 maximum points 1050 maximum points Modified by prevalence Modified by prevalence Modified by list size Modified by list size

31. Quality Points Available Clinical indicators: 550 Clinical indicators: 550 Patient experience: 100 Patient experience: 100 Organisational indicators: 184 Organisational indicators: 184 Additional services: 36 Additional services: 36 Other: 180 Other: 180 Total: 1050 Total: 1050

32. Totals Clinical Indicators CHD including LVD etc 121 Stroke or transient ischaemic attack 31 Cancer12 Hypothyroidism8 Diabetes99 Hypertension105 Mental Health 41 Asthma72 COPD45 Epilepsy16 Clinical Maximum 550

33. Quality points – Secondary prevention of CHD register6 register6 patients with newly diagnosed angina who are referred 7 patients with newly diagnosed angina who are referred 7 patients with record of smoking7 patients with record of smoking7 patients who have been offered smoking cessation advice4 patients who have been offered smoking cessation advice4 patients with record of BP7 patients with record of BP7 patients with BP < 150/9019 patients with BP < 150/9019 patients with record of cholesterol7 patients with record of cholesterol7 patients with total cholesterol < 516 patients with total cholesterol < 516 patients on anti-platelet therapy or anti-coagulant7 patients on anti-platelet therapy or anti-coagulant7 patients on beta blocker7 patients on beta blocker7 patients on ACE inhibitor7 patients on ACE inhibitor7 patients with influenza immunisation7 patients with influenza immunisation7

34. Quality Management and Analysis System QMAS is national IT solution to support QOF payments to practices QMAS is national IT solution to support QOF payments to practices Extraction of practice indicator data to national QMAS database Extraction of practice indicator data to national QMAS database Computation of practice scores Computation of practice scores Application of list size and prevalence adjustment factors Application of list size and prevalence adjustment factors Feedback for practices, PCTs and SHAs Feedback for practices, PCTs and SHAs Informs practice payment systems (NHAIS) Informs practice payment systems (NHAIS)

35. Other achievement data – web interface QMAS – Inputs and Outputs QMAS Central Server PCT Payment Agency NHAIS Confirm Achievement Automated “Manual” Achievement data from clinical system GP Practice BACS Payment

36. Potential Secondary Users DH branches (eg NSFs, finance) DH branches (eg NSFs, finance) NHS Bank (QOF risk management) NHS Bank (QOF risk management) Healthcare Commission Healthcare Commission Public health organisations Public health organisations NICE NICE Academic researchers Academic researchers

37. Potential Secondary Uses of QMAS Data (1) Support surveillance and screening by Healthcare Commission. Support surveillance and screening by Healthcare Commission. Support new resource allocation methodologies Support new resource allocation methodologies Support monitoring by public health organisations and integration of epidemiology in service planning and delivery Support monitoring by public health organisations and integration of epidemiology in service planning and delivery Facilitation of the Research and Development arm of the new Information Centre at the DH Facilitation of the Research and Development arm of the new Information Centre at the DH Resource allocation, forecasting and monitoring for primary care drugs bill Resource allocation, forecasting and monitoring for primary care drugs bill

38. Potential Secondary Uses of QMAS Data (2) Analysis of disease prevalence Analysis of disease prevalence Monitoring of the gross investment guarantee Monitoring of the gross investment guarantee DH and NHS Bank monitoring and risk management of primary care finance DH and NHS Bank monitoring and risk management of primary care finance DH implementation of QOF, eg analysis of exception reporting DH implementation of QOF, eg analysis of exception reporting DH monitoring of NSFs DH monitoring of NSFs Medicines management and clinical governance Medicines management and clinical governance

39. Introduction to QPID Quality, Prevalence and Indicator Database

40. Why QPID? To make QMAS data available to a wider set of potential users in DH and NHS To make QMAS data available to a wider set of potential users in DH and NHS To enable access to QMAS data without affecting scope of QMAS project To enable access to QMAS data without affecting scope of QMAS project To provide analytical support around flexible access to QMAS data – no requirement for QMAS developers to deliver additional reporting tools To provide analytical support around flexible access to QMAS data – no requirement for QMAS developers to deliver additional reporting tools National analysis (eg prevalence) National analysis (eg prevalence)

41. Who is Developing QPID? Prescribing Support Unit (PSU) on behalf of DH and in collaboration with NPfIT Prescribing Support Unit (PSU) on behalf of DH and in collaboration with NPfIT PSU will be part of new Health and Social Care Information Centre (IC), and is based in Leeds PSU will be part of new Health and Social Care Information Centre (IC), and is based in Leeds QPID project team drawn from PSU staff QPID project team drawn from PSU staff PSU will host the QPID database PSU will host the QPID database Web: www.psu.co.uk Web: www.psu.co.ukwww.psu.co.uk

42. Project Structure Project Board (representation from IC, DH Policy, NPfIT, NHS) Project Board (representation from IC, DH Policy, NPfIT, NHS) Project Team Project Team Project Management Project Management User Issues User Issues Technical Issues Technical Issues Analytical Issues Analytical Issues Gateway Committee Gateway Committee

43. QPID Project Stages Stage 1 (to April 2005): establish QPID database and develop analytical and user processes Stage 1 (to April 2005): establish QPID database and develop analytical and user processes Stage 2 (from April 2005): implement analysis service for QPID users Stage 2 (from April 2005): implement analysis service for QPID users Note the need to prioritise delivery to users in early post-implementation phase Note the need to prioritise delivery to users in early post-implementation phase

44. Accessing QPID Data Users inform QPID team of high level requirements, and proposed use of data or information from QPID Users inform QPID team of high level requirements, and proposed use of data or information from QPID User request considered by QPID Gateway Committee User request considered by QPID Gateway Committee Approved requests lead to detailed user specifications Approved requests lead to detailed user specifications QPID team and user sign agreement on provision and use of data before delivery QPID team and user sign agreement on provision and use of data before delivery

45. Access Criteria Publication strategy will take account of freedom of information legislation Publication strategy will take account of freedom of information legislation Criteria for release of data: Criteria for release of data: PCT-level data available to all? PCT-level data available to all? Practice data only to be released as anonymised data (relevant PCTs can be identified)? Practice data only to be released as anonymised data (relevant PCTs can be identified)? Protection for small numbers for some conditions at practice level. Protection for small numbers for some conditions at practice level. Other criteria? Other criteria?

46. Conditions for Release of Data Conditions of release to be drafted and agreed with users. Conditions of release to be drafted and agreed with users. To be informed by good practice, such as conditions around release of HES data, eg: To be informed by good practice, such as conditions around release of HES data, eg: Users must not pass raw data on to third parties. Users must not pass raw data on to third parties. Agreement on internal use or publication. Agreement on internal use or publication.

47. Charging for Users? Charging policy to be determined ahead of analysis service launch in April 2005 Charging policy to be determined ahead of analysis service launch in April 2005 Some information to be published free of charge by IC Some information to be published free of charge by IC Project to determine level of requests that can be met free of charge Project to determine level of requests that can be met free of charge Project to determine charging for substantive pieces of work Project to determine charging for substantive pieces of work Charging to cover marginal analysis costs, not data collection Charging to cover marginal analysis costs, not data collection

48. Smoking Indicators in QOF For CHD, stroke, hypertension, diabetes, COPD and asthma, there is QOF reporting (points) for: For CHD, stroke, hypertension, diabetes, COPD and asthma, there is QOF reporting (points) for: Recording of smoking status (usually in last 15 months) Recording of smoking status (usually in last 15 months) A record of smoking cessation advice given (usually in last 15 months) A record of smoking cessation advice given (usually in last 15 months)

49. Smoking Indicators in QOF QOF points available for recording of smoking status of all patients aged 15-75: QOF points available for recording of smoking status of all patients aged 15-75: Indicator ‘Records 10’ requires 55% Indicator ‘Records 10’ requires 55% Indicator ‘Records 16’ requires 75% Indicator ‘Records 16’ requires 75% QOF points available if practice has a strategy to support smoking cessation, including literature and therapy (‘Information 5’) QOF points available if practice has a strategy to support smoking cessation, including literature and therapy (‘Information 5’)

50. Obesity in QOF No specific obesity indicators except recording of BMI for diabetes patients No specific obesity indicators except recording of BMI for diabetes patients But contract notes that obesity is a significant risk for CHD and hypertension patients, and expects annual assessment But contract notes that obesity is a significant risk for CHD and hypertension patients, and expects annual assessment Of lifestyle risks such as obesity, alcohol, inactivity and smoking, contract reporting focuses on smoking Of lifestyle risks such as obesity, alcohol, inactivity and smoking, contract reporting focuses on smoking

51. Contact Potential users of QPID data should contact Dave Roberts at PSU to discuss potential high level requirements Potential users of QPID data should contact Dave Roberts at PSU to discuss potential high level requirements dave.roberts@westyorks.nhs.uk dave.roberts@westyorks.nhs.uk dave.roberts@westyorks.nhs.uk

52. BROADER STRATEGY ON OBESITY: Obesity status amongst the GP Registered Population aged 15 to 75 Years Detailed Descriptor: Obesity status among people aged 15 to 75 years, as recorded in GP records Units: Expressed as: Line 1:Total number of people aged 15 to 75 years on GP register, recorded as having a BMI of 30 or greater in the last 15 months. Line 2:Total number of people aged 15 to 75 years on GP register, with a BMI recorded in the last 15 months. Line 3:Total number of people aged 15 to 75 years on GP register.

53. SMOKING STATUS AMONGST THE POPULATION AGED 15 TO 75 YEARS Detailed Descriptor: Smoking status among people aged 15 to 75 years, as recorded in GP records Units: Line 1:Number of people aged 15 to 75 years on a GP register, recorded as being a smoker in the last 15 months. Line 2:Number of people aged 15 to 75 years on a GP register, with a smoking status recorded in the last 15 months. Line 3:Total number of people aged 15 to 75 years on a GP register.

54. Weighted denominators e.g. ADQ/STAR-PU Comparable Drug Utilisation e.g. Ulcer healing drugs PCT Prescribing Lead Disease Management e.g Patients heart failure receiving ACE inhibitor GP Clinical Systems data e.g. QMAS PCT Clinical Governance Lead Patient Specific Data e.g. Contra indications Individual patient records NCRS (National data Spine) Practice self audit PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Prescribing Indicator Data source Universal comparative indicators HA/PCT Monitoring

55. Weighted denominators e.g. ADQ/STAR-PU Comparable Drug Utilisation e.g. Ulcer healing drugs PCT Prescribing Lead Disease Management e.g Patients heart failure receiving ACE inhibitor GP Clinical Systems data e.g. QMAS PCT Clinical Governance Lead Patient Specific Data e.g. Contra indications Individual patient records NCRS National data Spine Practice self audit PACT Data e.g. NIC/PU Drug Utilisation e.g. Drugs of limited therapeutic value Prescribing Indicator Data source Universal comparative indicators HA/PCT Monitoring Resource intensity Degree of simplicity in collection / availability of indicator Quality / value of indicator

56. The future National data spine National data spine Secondary User Service Secondary User Service