1. Diabetes data update 2013 Greg.fell@bradford.gov.uk Jonathan.stansbie@bradford.gov.uk

2. What we did was simple. Routinely available data QOF - 07/08 to 11/12 Admits – Public Health Analysis of HES Px – Epact. 2011/12

3. Point 1 - prevalence Growth in prevalence Variation in prevalence

4. Prevalence is based on over 17+ population Prevalence continues to increase, 5.6% in 2007/08 increasing to 6.9% in 2011/12 32,291 cases in 2011/12, growth in diagnosed prevalence of 29% in last 5 years Substantial variation in prevalence of diagnosed diabetes at practice level, ranging from 0.4% to 13%

5. Prevalence varies across practices Prevalence highest in City CCG Growth highest in Bradford CCG

6. Not all diabetes is diagnosed 83.6% of diabetes is diagnosed, a slightly higher proportion in Bradford & Craven than England average Prevalence is expected to grow to 10.4% by 2030, higher than England average

7. Point 2 – Trends in QoF achievement Improvement in Cholesterol achievement Variation in achievement

8. Cholesterol control (DM17) achievement has increased slightly. Exceptions have also increased Highest achievement in AWC CCG, but also highest exceptions Variation in achievement by practice ranging from 66.7% to 96.2%

9. Point 3 – IFCC-HbA1c achievement DM26, 27 & 28 – The percentage of patients with diabetes in whom the last IFCC-HbA1c is 59, 64 or 75 mmol/mol or less in the preceding 15 months respectively

10. Lower achievement in DM26 Variation in achievement between practices

11. Higher exceptions in DM26 Variation in achievement between practices

12. Point 4 – glycaemic and macro vascular indicators City CCG consistently exception code more patients for glycaemic indicators Airedale, Wharfedale and Craven CCG consistently exception code more patients for macro vascular indicators

13. Micro vascular Macro vascular

14. Point 5 – Achievement and exception coding for indicators with the most points DM26 – 17 points DM28 – 10 points DM31 – 10 points

17. Point 6 – HBA1C achievement and prescribing spend Of the top 10 highest achieving practices for DM26 (HBA1C 50 mmol or less), half are in the lowest 50% spending practices for DM meds. None of the top 10 spending practices is in the top 10 achieving practices

18. Spend / DM patient (medicines) and glycaemia control

19. Point 7 – prescribing costs The prescribing bill for all anti diabetes medication is approx. £3.5m. There is significant spend per head variation

20. We spend £53 per diabetic patient per year on testing strips,£1.4m per year Variation in practice spend per patient Prescribing data for AWC does not include the 5 Craven practices

21. Point 8 – admissions Diabetes admissions are mainly recorded as a secondary diagnosis Annual episodes of care for diabetic foot disease in adults with diabetes are low

22. 507 admissions with a primary diagnosis of diabetes, 17,591 with a primary or secondary diagnosis Diabetes admissions with ketoacidosis account for nearly a third of all primary dx admissions, only 1% of primary or secondary diagnosis Highest admission rate for primary or secondary diagnosis in AWC CCG, however lower proportion of these admissions are for stoke & mi or ketoacidosis

23. 1,200 episodes of inpatient care for diabetic foot disease Highest rates for diabetic foot disease are within AWC CCG 175 episodes of care where an amputation was performed Highest rates for amputation are within Bradford CCG Rates are lower than England average for all CCG’s for both diabetic foot disease and amputations

24. Point 9- characteristics of lower achieving practices Funnel plots used to show outliers for DM26 (HB1AC) and DM31(BP)

25. Significantly low achieving practices are predominantly in younger, more deprived practices with a high South Asian population 9 out of the 12 practices are in City CCG

26. Less clear picture 3 practices from AWC, 8 from Bradford CCG, 4 from City CCG Variety of practices with different age, deprivation and ethnic breakdowns