Prescribing Support Unit ‘Shadow Information Centre’

Dave Roberts Unit Manager

Prescribing Support Unit

Founded in 1996 Hosted by

Leeds Health Authority West Yorkshire Strategic Health Authority

Six full time staff Policy and Analytical Unit for the DH Liaison role with the NHS Close ties with

Prescription Pricing Authority (PPA) National Prescribing Centre (NPC)

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

Health and Social Care Information Centre

January 2005

Current Issues Too great a demand on the ‘front line’ No national focus for information & knowledge management in clinical

AND social care Does existing information really focus on what matters? A ‘vision’ for information

• Sir Ian Kennedy - Bristol Royal Infirmary Inquiry report • Sheila Leatherman - The Quest for Quality in the NHS • NHS Confederation The Response

Creation of the Health and Social Care Information Centre

Arm’s Length Body Review

Reduction in numbers of ALBs from 38 to 20

Reductions in Posts by 25% by 2007-08 Savings in expenditure of 10% by 2007-08 ALBs will be expected to relocate away

from South & East (Lyons Review)

Arm’s Length Body Review 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 Consisting of:

‘Information’ elements of the NHS Information Authority (NHS IA)

Statistics & information policy functions of the Department of Health (DH)

Prescribing Support Unit IC to operate in shadow form until 31 March 2005 Chairman and board appointments will be made as soon as possible 1 April 2005 – organisation established Headquarters in Leeds

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 Provides national leadership and focus for data and

information Is driven by wishes & requirements of those in the

system Works with all parts of the Health and Social Care System

and NPfIT

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

Key areas of work

Regulation and co-ordination of information requirements Mandating data collections and setting standards 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

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

Benefits Reduced bureaucracy and waste 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 • Patient-focused • Integrated information • Service improvements can be evidence based

Increased support and development of health informatics staff

Add value to the investment in technology led by NPfIT

PSU ‘Service’

Datasets

Prescribing Cost Analysis database National PPA electronic systems IMS Hospital Pharmacy database Quality, Prevalence and Indicator database New primary care user/data requirements

Quality and Outcomes Framework

GMS contract

Rewards for Quality

£1.3bn for the UK for quality in GMS and PMS Non-discretionary In addition to the global sum Payment for what many already do Work converts to points; points to payment 1050 maximum points

Modified by prevalence Modified by list size

Quality Points Available

Clinical indicators: 550 Patient experience: 100 Organisational indicators: 184 Additional services: 36 Other: 180 Total: 1050

Totals

Clinical Indicators

CHD including LVD etc 121

Stroke or transient ischaemic attack 31

Cancer 12

Hypothyroidism 8

Diabetes 99

Hypertension 105

Mental Health 41

Asthma 72

COPD 45

Epilepsy 16

Clinical Maximum 550

Quality points – Secondary prevention of CHD

register 6 patients with newly diagnosed angina who are referred 7 patients with record of smoking 7 patients who have been offered smoking cessation advice 4 patients with record of BP 7 patients with BP < 150/90 19 patients with record of cholesterol 7 patients with total cholesterol < 5 16 patients on anti-platelet therapy or anti-coagulant 7 patients on beta blocker 7 patients on ACE inhibitor 7 patients with influenza immunisation 7

Quality Management and Analysis System

QMAS is national IT solution to support QOF payments to practices

Extraction of practice indicator data to national QMAS database

Computation of practice scores Application of list size and prevalence

adjustment factors Feedback for practices, PCTs and SHAs Informs practice payment systems (NHAIS)

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

Potential Secondary Users

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

Potential Secondary Uses of QMAS Data (1)

Support surveillance and screening by Healthcare Commission.

Support new resource allocation methodologies 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

Resource allocation, forecasting and monitoring for primary care drugs bill

Potential Secondary Uses of QMAS Data (2)

Analysis of disease prevalence Monitoring of the gross investment guarantee DH and NHS Bank monitoring and risk

management of primary care finance DH implementation of QOF, eg analysis of

exception reporting DH monitoring of NSFs Medicines management and clinical governance

Introduction to QPID

Quality, Prevalence and Indicator Database

Why QPID?

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 provide analytical support around flexible access to QMAS data – no requirement for QMAS developers to deliver additional reporting tools

National analysis (eg prevalence)

Who is Developing QPID?

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

QPID project team drawn from PSU staff PSU will host the QPID database Web: www.psu.co.uk

Project Structure

Project Board (representation from IC, DH Policy, NPfIT, NHS)

Project Team Project Management User Issues Technical Issues Analytical Issues

Gateway Committee

QPID Project Stages

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

Note the need to prioritise delivery to users in early post-implementation phase

Accessing QPID Data

Users inform QPID team of high level requirements, and proposed use of data or information from QPID

User request considered by QPID Gateway Committee

Approved requests lead to detailed user specifications

QPID team and user sign agreement on provision and use of data before delivery

Access Criteria

Publication strategy will take account of freedom of information legislation

Criteria for release of data: PCT-level data available to all? Practice data only to be released as anonymised data

(relevant PCTs can be identified)? Protection for small numbers for some conditions at

practice level. Other criteria?

Conditions for Release of Data

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: Users must not pass raw data on to third

parties. Agreement on internal use or publication.

Charging for Users?

Charging policy to be determined ahead of analysis service launch in April 2005

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 charging for substantive pieces of

work Charging to cover marginal analysis costs, not data

collection

Contact

Potential users of QPID data should contact Dave Roberts at PSU to discuss potential high level requirements

dave.roberts@westyorks.nhs.uk

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.

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.

Other Data

Hospital Episode Statistics IMS Hospital Pharmacy data Consolidated databases

QResearch (EMIS practices IMS Mediplus (In Practice

systems) GPRD (Torex) THIN (Torex)

Other data from GP systems GP workload Public Health (smoking and

obesity) Diabetes (Diabetes-E and

NCASP)

The future

National data spine Secondary User

Service