Profile of Leeds North Clinical Commissioning Group (CCG)

Profile of Leeds North Clinical Commissioning Group (CCG) Leeds North Why make this profile? These profiles aim to support CCGs in ensuring they are commissioning effective care in relation to the needs of their population. Different data sets - from lifestyles to long term conditions to hospital admissions and premature mortality - enable CCGs to consider how to improve care for their population. The addition of data on age profile, ethnicity, deprivation and population segmentation will help CCGs decide where and how to target proactive care and increase equitable access for their population. Comparisons with the rest of Leeds, variations across the CCG, and deprived parts of Leeds enable benchmarking. For broader impacts on health these profiles should be read alongside the published MSOA profile for the practice area. On a micro level these profiles will also support practices in caring for their patients. Changes to data availability during the NHS restructure mean that while data in this report is as recent as possible, it is not all from the same time period. This report is in two parts. Part 1 is about the people registered at the practices that belong to Leeds North CCG. Part 2 is about the geographical footprint which Leeds North CCG is responsible for. Part 1. The people registered with practices belonging to Leeds North CCG Demographics Leeds North CCG member practices 2 Population profile 3 GP recorded ethnicity 4 Acorn and Health Acorn 5 GP data Coronary heart disease 7 Chronic obstructive pulmonary disease 7 Diabetes 8 Smoking 8 Cancer 9 Obesity 9 All GP data for Leeds North 10 Admissions Inpatient emergency admissions 12 Outpatient first attendances 13 Emergency admissions: respiratory, circulatory, cancer 14 Mortality Early deaths 2002-17 Alcohol admissions 21 Part 2. Leeds North CCG area by footprint. Demographics Matching data to Leeds North CCG 22 MSOAs that are used in this report to represent this CCG 23 Population profile 24 GP recorded ethnicity 25 Pupil demographics 26 Child obesity 27 Levels of deprivation 28 Life expectancy Life expectancy -12 29 Mortality Early deaths 2004-2012 30 Glossary 34 This profile is designed to be viewed in colour. Colours have been chosen with Deuteranope and Protanope type colour vision deficiency in mind. Unfortunately the profile will not reproduce well in black and white. Maps: Ordnance Survey PSMA Data, Licence Number 100050507 (c) Crown Copyright 2011. All rights reserved February 25th 2014 1 Office of the Director of Public Health. LCC

Part 1. Profile of the Leeds North CCG practice population Practices in this report Cluster B86008 Surgery At Nursery Lane & Adel Pentagon B86010 Church View Surgery Kite B86013 The North Leeds Medical Practice Circle B86019 Rutland Lodge Medical Practice Triangle B86022 The Chapeloak Practice Triangle B86023 The Avenue Surgery Kite B86026 The Lodge Oval B86029 Westgate Surgery Kite B86031 Westfield Medical Centre Circle B86032 Bridge Street Medical Practice Kite B86033 Crossley Street Surgery Kite B86034 Spa Surgery Hexagon B86039 Allerton Medical Centre Oval B86046 Charles Street Surgery Kite B86049 Woodhouse Health Centre Triangle B86056 Shadwell Medical Centre Kite B86059 Meanwood Health Centre Pentagon B86066 The Street Lane Practice Kite B86070 Aireborough Family Practice Kite B86090 Woodlands Surgery Circle B86100 St Martins Practice Circle B86106 Foundry Lane Surgery Triangle B86107 Moorcroft Surgery Pentagon B86108 Chapeltown Health Centre Circle B86625 Wetherby Surgery Kite B86651 Hilton Road Surgery Circle B86654 Oakwood Surgery Pentagon B86666 Newton Surgery Square B86673 Bramham Medical Centre Hexagon B86674 Dyneley House None Y00848 Leeds Safe Haven Service None Y02002 One Medicare @ The Light None Practice clusters The Yorkshire and Humber Public Health Observatory clustered GP practices in England into ten classification groups in February 2011. The groups are designed to bring together practices with similar characteristics. The practices are listed with their cluster here. The following variables were used to group practices: age structure, percentage of practice population from Asian or Black ethnic groups, deprivation score for practice population (IMD ), rural classification. More information about these groupings at: www.yhpho.org.uk/resource/view.aspx?rid=104087 Square Practices With a smaller than average list size, a high percentage of the population aged under 15 years old and fewer aged 65 years or older. A very high proportion of the population from Asian ethnic groups and a higher than average proportion from Black ethnic groups and very high levels of deprivation. Circle Practices Have a high percentage under 15 years. Very high percentage of Black population and higher than average Asian population. High deprivation. Triangle Practices Practices with a high percentage of children (under 15 years old) and very high levels of deprivation. Rectangle Practices Practices with a very low percentage of people under 15 years and a lower proportion of older people (65 years and older). An above average proportion of the population from Asian and Black ethnic groups. Oval Practices Practices with a higher percentage of older people (aged 65 years and older) and slightly higher levels of deprivation. Pentagon Practices Practices with an average proportion of the population in younger and older age groups and generally low deprivation. Hexagon Practices Located in towns or urban fringe settlements with low deprivation and few people from Asian and Black ethnic groups. Octagon Practices Practices with a high percentage of the population aged 65 years and older and low levels of deprivation. Kite Practices Practices with large average list sizes, an average proportion of the population under 15 years old, a higher proportion aged 65 years and older and low levels of deprivation. Crescent Practices Located in villages, hamlets and isolated settlements with a small average list size and a higher proportion of the population aged 65 years and older. Few people from Asian and Black ethnic groups and low levels of deprivation. Some practices are not in clusters. February 25th 2014 2 Office of the Director of Public Health. LCC

Practice population profile April 2013 Leeds North Population registered with this CCG and living in Leeds: All: 193,702 Additional population of this CCG (living outside Leeds) is 8,691 Male: 96,540 Female: 97,162 The total combined populations (living anywhere) of people registered with Leeds GPs is 807,656, and 784,370 of these live within Leeds itself. There are small numbers of people in addition to this whose address is unknown. Population of Leeds North living in the most deprived fifth of Leeds 20% of the Leeds North registered population live in the most deprived fifth of the city (the Deprived Quintile). This represents 26% of the entire Deprived Quintile population. Population of Leeds by CCG: Leeds North 193,702 24.7% Leeds West 334,282 42.6% Leeds South East 256,386 32.7% CCG practice populations compared to Leeds and the deprived quintile of the Leeds resident and registered population. 85+ 80-84y 75-79y 70-74y 65-69y 60-64y 55-59y 50-54y 45-49y 40-44y 35-39y 30-34y 25-29y 20-24y 15-19y 10-14y 5-9y 0-4y Females Males 15% 10% 5% 0% 5% 10% 15% CCG patients Leeds Deprived Quintile This chart compares the CCG registered population to all patients, and the Deprived Quintile. Historically population charts are shaped like a pyramid. The base is wide and each age band above is narrower as there are proportionately fewer people in the older age groups. In modern western societies population pyramids are now typically narrower at the base due to a decline in the birth rate. The Leeds profile is shown as a black line and follows the expected pattern for a modern western population but with a larger than usual proportion of people in the university student age groups. The blue bars in this pyramid represent the CCG registered population. The orange dots represent the age structure of the Deprived Quintile population for comparison. Leeds North CCG has the smallest population of the three CCGs with almost 25% of the Leeds registered and resident population, and makes up over a quarter of the entire population living in the most deprived areas of Leeds. It has the largest geographical boundary in the city. Practice locations for this CCG. The coloured area is the combined contracted areas of these practices. February 25th 2014 3 Office of the Director of Public Health. LCC

GP recorded Ethnicity in CCG practices This data compares the ethnicity of the CCG practice adult populations, as recorded by practices in April 2013 (Q4 2012/13), with the Leeds GP registered adult population over the same period. The 'White British' category is not included in the chart as it usually dominates the data to such an extent that all other ethnic groups are hidden. By omitting 'White British' from the chart we can use a scale that uncovers detail in the smaller ethnic groups. Leeds North White British 53.2% 57.2% Other white background 7.7% 8.6% Pakistani or British Pakistani 4.1% 2.5% Black African 2.0% 2.1% Indian or British Indian 3.7% 1.9% Other Asian Background 1.8% 1.5% Other Ethnic Background 1.5% 1.1% Chinese 0.8% 0.9% Black Caribbean 1.3% 0.5% Other Black Background 1.0% 0.6% White Irish 0.6% 0.5% Bangladeshi or British Bangladeshi 0.6% 0.4% Mixed white and Black African 0.4% 0.4% Mixed white and Black Caribbean 0.8% 0.5% Other mixed background 0.5% 0.4% Mixed white and Asian 0.5% 0.3% 0% 5% 10% Not Recorded (30,200) 14.9% 16.6% Not Stated (7,071) 3.5% 2.5% Unknown (2,231) 1.1% 1.4% The CCG practice population differs from the Leeds pattern of ethnicity, with larger proportions of the 'Pakistani or British Pakistani' and 'Indian or British Indian' ethnic groups. It has a smaller proportion of the 'White British' and 'other white background' ethnic groups than Leeds. The comparison with Leeds is complicated by the fact that around a fifth of the population has no ethnicity recorded. This highlights the importance of improving data recording so that we can get the maximum information from the data available. Census data can give us a Leeds-wide picture of ethnicity, however it cannot be exactly broken down to a practice / CCG level. We know that the ethnic mix in Leeds is changing quickly. and so the census will not be a reliable benchmark for long. February 25th 2014 4 Office of the Director of Public Health. LCC

Acorn summary of CCG practices Leeds North Acorn is a nationwide population segmentation tool. It combines geography with demographics and lifestyle information, helping our understanding of where people live and their underlying characteristics and behaviour. This sheet compares the July 2013 Leeds resident population who are registered with this CCG, with the whole GP registered population of Leeds in terms of Acorn groups. For instance 21.2% of this CCG's population are in the 'Hard- Pressed' category, compared to 28.2% of the Leeds population. Acorn categories Patients Leeds Wealthy Achievers 55,825 28.6% 119,138 14.8% Urban Prosperity 35,630 18.3% 115,890 14.4% Comfortably Off 47,907 24.6% 224,621 27.9% Moderate Means 13,090 6.7% 110,733 13.7% Hard-Pressed 41,251 21.2% 226,802 28.2% Unclassified or unknown 1,207 0.6% 8,367 1.0% 0% 25% 50% Acorn groups Wealthy Executives 28,310 14.5% 47,532 5.9% Affluent Greys 6,992 3.6% 16,428 2.0% Flourishing Families 20,523 10.5% 55,178 6.8% Prosperous Professionals 14,840 7.6% 26,222 3.3% Educated Urbanites 13,943 7.2% 48,944 6.1% Aspiring Singles 6,847 3.5% 40,724 5.1% Starting Out 9,427 4.8% 37,845 4.7% Secure Families 24,285 12.5% 127,513 15.8% Settled Suburbia 5,653 2.9% 42,152 5.2% Prudent Pensioners 8,542 4.4% 17,111 2.1% Asian Communities 7,892 4.0% 22,253 2.8% Post Industrial Families 1,350 0.7% 22,578 2.8% Blue Collar Roots 3,848 2.0% 65,902 8.2% Struggling Families 24,225 12.4% 143,386 17.8% Burdened Singles 10,067 5.2% 57,204 7.1% High Rise Hardship 5,127 2.6% 21,186 2.6% Inner City Adversity 1,832 0.9% 5,026 0.6% Unclassified or unknown 1,207 0.6% 8,367 1.0% 0% 25% 50% Health Acorn groups (January 2012 data) Healthy 55,090 28.3% 279,212 34.7% Possible Future Concerns 82,340 42.2% 219,824 27.3% Future Problems 29,663 15.2% 153,272 19.0% Existing Problems 25,547 13.1% 140,972 17.5% Unclassified or unknown 1,453 0.7% 9,600 1.2% 0% 25% 50% The CCG registered population is very diverse with almost double the Leeds average of Wealthy Achievers and marginally more 'Urban Prosperity than the Leeds average. The rates for those classed as having Moderate Means or Hard-Pressed are significantly lower than the Leeds average This CCG has a low proportion of people in the Healthy group compared to the Leeds average and a much higher rate of people identified as having 'Possible Future Concerns'. For more information about Acorn, including the characteristics of the categories, groups and types listed here, visit http://www.caci.co.uk/acorn-classification.aspx and http://www.caci.co.uk/healthacorn.aspx February 25th 2014 5 Office of the Director of Public Health. LCC

General information about the GP data Collecting the GP data. The Office of the Director of Public Health Information Team run a quarterly collection of data from GP systems, forming a picture over time of conditions recorded by GPs across Leeds. The automated data collections note the most recent occurrences of specific disease codes in each patient's record as defined by the Quality Outcomes Framework (QOF). This routine data collection gives Leeds a much greater level of detail than standard QOF data and is a result of the trusting relationship we have developed with practices. Rates and prevalence are calculated with the date-relevant GP registered populations for those practices that partook in the data collection. Cancer. The main risk factors for cancer are: growing older, smoking, sun, ionising radiation and chemicals, some viruses, family history of cancer, alcohol, poor diet, lack of physical activity, or being overweight. Behaviours like smoking, poor diet, over consumption of alcohol and lack of physical activity are likely to be higher in more deprived communities. As educational attainment is lower in deprived communities, some people may be less familiar with early signs of cancer and less able to use a complicated system of care to their benefit. As a result some cancer patients present late which reduces the chances of curative treatment. Life expectancy for people with cancer is lower in more deprived communities despite a range of risk factors which suggest many cancers are potentially preventable. Coronary heart disease (CHD). Prevalence identified via the GP systems is often under recorded compared to the real prevalence in an area. CHD has a close association with deprivation as well as key lifestyle factors such as smoking, being overweight and excessive alcohol use. There is now a focus on systematic early diagnosis, via the NHS Health Check, offered to all those between the ages of 40 and 74. The purpose being that those people who are at high risk of CHD are managed appropriately. From a recent cardiovascular disease mortality audit within Leeds we know that being on a register such as the NHS Health Check has a positive effective on increasing both life expectancy and quality of life. Chronic obstructive pulmonary disease (COPD). A disease of the lungs and a key cause of premature mortality in Leeds. It is associated with deprivation and smoking. COPD is often identified late, reducing options for management to improve quality of life or to slow down the progression of the disease. Prevalence identified from GP systems is often under recorded. Diabetes. Diabetes consists of type 1 and 2. Type 2 is the most common and is strongly associated with obesity, other lifestyle factors, particular population groups and deprivation. Smoking. The use of tobacco is the primary cause of preventable disease and premature death. It is not only harmful to smokers but also to the people around them through the damaging effects of second-hand smoke. Smoking rates are much higher in some social groups, including those with the lowest incomes. These groups suffer the highest burden of smoking-related illness and death. This is the single biggest cause of inequalities in death rates between the richest and poorest in our communities. Levels of smoking have fallen since the 1960s but the decline has stopped and may be reversing. Obesity. The latest Health Survey for England data shows that nearly 1 in 4 adults, and over 1 in 10 children aged 2-10, are obese and the trend is set to increase. Obesity can have a severe impact on people s health. Around 10% of all cancer deaths among non-smokers are related to obesity. The risk of coronary artery disease and type 2 diabetes directly increases with increasing levels of obesity e.g. levels of type 2 diabetes are about 20 times greater for people who are very obese. These diseases shorten life expectancy. It is eating and physical activity habits that are primarily responsible for maintaining a healthy body weight. These are impacted by significant external influences such as environmental and social factors (e.g. changes in food production, motorised transport and work/home lifestyle patterns) contributing to the trend of increasing body weight. February 25th 2014 6 Office of the Director of Public Health. LCC

Coronary heart disease (CHD) / chronic obstructive pulmonary disease (COPD) Source: NHS Leeds GP data audits, quarterly -14 CHD age standardised rates (DSR) per 100,000 4,00 3,50 3,00 2,50 2,00 CCG Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 20111 2011/12 2012/13 13/14 2,560 2,526 2,553 2,557 2,534 2,528 2,498 2,479 2,455 2,453 2,439 2,451 2,392 2,371 2,899 2,885 2,876 2,854 2,832 2,810 2,795 2,777 2,748 2,732 2,724 2,689 2,674 2,649 3,597 3,625 3,566 3,563 3,449 3,411 3,394 3,433 3,456 3,437 3,413 3,401 3,390 3,394 The CHD DSR for the CCG is below the Leeds average and falling at about the same rate. The Deprived Quintile rates are levelling off. CHD is the major cause of premature death and disability in the UK. There are many modifiable risk factors, address these factors and the evidence is that we can have a considerable impact on the quality of life. Of the practices that comprise this CCG, Newton Surgery has the highest CHD DSR of 4,261 per 100,000 while Shadwell Medical Centre has the lowest CHD DSR with 1,769. COPD age standardised rates (DSR) per 100,000 3,00 2,50 2,00 1,50 1,00 CCG Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 20111 2011/12 2012/13 13/14 1,063 1,076 1,136 1,099 1,103 1,106 1,120 1,123 1,119 1,121 1,118 1,159 1,121 1,128 1,495 1,514 1,542 1,537 1,542 1,551 1,566 1,567 1,556 1,566 1,586 1,586 1,574 1,573 2,743 2,760 2,813 2,825 2,809 2,831 2,855 2,920 2,931 2,965 2,961 2,979 2,988 2,993 The COPD age standardised rate for the CCG is much lower than the Leeds average. The Deprived Quintile rates are rising very slowly. Of the practices that comprise this CCG, Foundry Lane Surgery has the highest COPD DSR of 3,318 per 100,000 while Shadwell Medical Centre has the lowest COPD DSR with 335. Due to the variations in deprivation across this CCG's population, we need also to take note of the evidence available at practice level when exploring need. This data is collected from practices quarterly and therefore only contains records where patients are presenting. Certain population groups are known to present late or not at all. Note: chart scales vary to reveal maximum detail, be careful with visual comparisons between charts. These rates are calculated from the data provided by the practices of this CCG, they include patients who may live outside Leeds. In these charts, the 95% confidence intervals are always shown for the CCG as error bars. Confidence intervals for Leeds and the Deprived Quintile are also shown, but only if they are significantly different to that of the CCG. Deprived Quintile: This is a slightly different measure of deprivation. The Deprived Quintile is the most deprived fifth of all MSOAs in Leeds. 'Deprived Leeds' as used elsewhere refers to the LSOAs in Leeds which are in the 10% most deprived in England - a more exact definition, but GP audit data is restricted to MSOA level and cannot be resolved to the finer level of detail LSOAs offer. February 25th 2014 7 Office of the Director of Public Health. LCC

Diabetes / smoking Source: NHS Leeds GP data audits, quarterly -14 Diabetes age standardised rates (DSR) per 100,000 6,00 5,50 5,00 4,50 4,00 3,50 3,00 this CCG Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 20111 2011/12 2012/13 13/14 3,360 3,417 3,468 3,473 3,529 3,514 3,548 3,596 3,711 3,753 3,758 3,854 3,786 3,877 3,489 3,541 3,628 3,600 3,635 3,646 3,680 3,708 3,790 3,821 3,883 3,864 3,905 4,001 5,031 5,131 5,186 5,220 5,165 5,148 5,275 5,314 5,556 5,613 5,652 5,644 5,737 5,874 The diabetes age standardised rate for the CCG is very slightly lower than the Leeds average and tracking it closely as it rises. The Deprived Quintile rates are rising steadily. Of the practices that comprise this CCG, Newton Surgery has the highest diabetes DSR of 14,033 per 100,000 while Church View Surgery has the lowest diabetes DSR with 2,022. Smoking age standardised rates (DSR) per 100,000 CCG 34,00 32,00 30,00 28,00 26,00 24,00 22,00 20,00 18,00 Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 20111 2011/12 2012/13 13/14 18,962 19,031 19,028 19,044 19,045 19,133 19,113 18,738 18,773 18,720 18,628 18,655 18,285 18,224 22,922 22,793 23,089 23,112 23,154 23,054 23,135 23,057 22,914 22,805 22,701 23,021 22,270 21,662 33,589 33,422 33,950 34,123 34,187 34,117 34,148 34,113 33,860 33,735 33,575 31,922 33,308 33,032 The smoking age standardised rate for the CCG is lower than the Leeds average and dropping very slowly. The Deprived Quintile rate is falling slowly. Of the practices that comprise this CCG, Foundry Lane Surgery has the highest smoking DSR of 40,325 per 100,000 while Church View Surgery has the lowest smoking DSR with 11,346. Due to the variations in deprivation across this CCG's population, we need also to take note of the evidence available at practice level when exploring need. This data is collected from practices quarterly and therefore only contains records where patients are presenting. Certain population groups are known to present late or not at all. Accurate smoking data is dependant on GPs recording patient status regularly. The Q4 2012-13 smoking data shows a temporary dip. This is an artifact of the data collection caused when some queries did not run correctly at practices which happened to have high smoking prevalence. Note: chart scales vary to reveal maximum detail, be careful with visual comparisons between charts. These rates are calculated from the data provided by the practices of this CCG, they include patients who may live outside Leeds. In these charts, the 95% confidence intervals are always shown for the CCG as error bars. Confidence intervals for Leeds and the Deprived Quintile are also shown, but only if they are significantly different to that of the CCG. Deprived Quintile: This is a slightly different measure of deprivation. The Deprived Quintile is the most deprived fifth of all MSOAs in Leeds. 'Deprived Leeds' as used elsewhere refers to the LSOAs in Leeds which are in the 10% most deprived in England - a more exact definition, but GP audit data is restricted to MSOA level and cannot be resolved to the finer level of detail LSOAs offer. February 25th 2014 8 Office of the Director of Public Health. LCC

Cancer / obesity (BMI>30) in the 16+ population Source: NHS Leeds GP data audits, quarterly -14 Cancer age standardised rates per 100,000 this CCG 2,50 2,40 2,30 2,20 2,10 2,00 1,90 1,80 1,70 1,60 1,50 Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 20111 2011/12 2012/13 13/14 2,040 2,072 2,110 2,117 2,129 2,153 2,187 2,225 2,253 2,281 2,308 2,330 2,360 2,377 2,116 2,147 2,181 2,199 2,205 2,233 2,261 2,283 2,311 2,327 2,348 2,369 2,367 2,392 1,874 1,925 1,950 1,965 1,969 1,969 1,994 2,047 2,094 2,063 2,155 2,145 2,150 2,172 The DSR for cancer for this CCG is comparable to the Leeds average but climbing slightly faster. The Deprived Quintile rate is rising quite quickly. Of the practices that comprise this CCG, Woodhouse Health Centre has the highest cancer DSR of 3,300 per 100,000 while Newton Surgery has the lowest cancer DSR with 1,314. Low rates in the deprived quintile are considered to be a result of later presentation and higher mortality rates than less deprived parts of Leeds. The data can only reflect diagnosed cases in living patients. Obesity age standardised rates per 100,000 (within those with a recorded BMI) this CCG 27,00 26,00 25,00 24,00 23,00 22,00 21,00 20,00 19,00 18,00 Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 20111 2011/12 2012/13 13/14 18,821 18,824 18,820 18,803 18,840 18,820 18,908 19,000 19,069 19,021 18,995 19,142 18,983 18,906 20,925 20,887 21,020 21,130 21,250 21,202 21,309 21,407 21,571 21,578 21,694 22,179 21,734 21,750 25,498 25,445 25,603 25,726 25,863 25,863 25,863 25,876 26,045 26,058 25,984 26,101 25,969 25,917 The obesity DSR for this CCG is lower than the Leeds average and static, whereas Leeds is rising slowly. The Deprived Quintile rate is high and steady. Obesity rates are calculated against those patients who have a BMI recorded and includes only the most recent recording - whenever it was made. Of the practices that comprise this CCG, Foundry Lane Surgery has the highest obesity DSR of 26,592 per 100,000 while One Medicare @ The Light has the lowest obesity DSR with 13,267. Due to the variations in deprivation across this CCG's population, we need also to take note of the evidence available at practice level when exploring need. This data is collected from practices quarterly and therefore only contains records where patients are presenting. Certain population groups are known to present late or not at all. Note: chart scales vary to reveal maximum detail, be careful with visual comparisons between charts. These rates are calculated from the data provided by the practices of this CCG, they include patients who may live outside Leeds. In these charts, the 95% confidence intervals are always shown for the CCG as error bars. Confidence intervals for Leeds and the Deprived Quintile are also shown, but only if they are significantly different to that of the CCG. Deprived Quintile: This is a slightly different measure of deprivation. The Deprived Quintile is the most deprived fifth of all MSOAs in Leeds. 'Deprived Leeds' as used elsewhere refers to the LSOAs in Leeds which are in the 10% most deprived in England - a more exact definition, but GP audit data is restricted to MSOA level and cannot be resolved to the finer level of detail LSOAs offer. February 25th 2014 9 Office of the Director of Public Health. LCC

GP audit data, practice rankings by DSR, Q2 2013-2014 This page displays practices in ranked order by the most recent DSR (Q2 2013-14) for cancer, CHD, COPD, diabetes, obesity and cancer. All practices in Leeds are shown in grey, the practices in this CCG are highlighted in blue. Leeds, the deprived quintile, and the CCG rate are overlaid as horizontals. CHD COPD 5000 4000 3000 2000 1000 0 5000 4000 3000 2000 1000 0 Diabetes Smoking 20000 15000 10000 5000 0 50000 40000 30000 20000 10000 0 Cancer Obesity 3500 3000 2500 2000 1500 1000 500 0 35000 30000 25000 20000 15000 10000 5000 0 Note: chart scales vary to reveal maximum detail, be careful with visual comparisons between charts. These rates are calculated from the data provided by the practices of this CCG, they include patients who may live outside Leeds. Deprived Quintile: This is a slightly different measure of deprivation. The Deprived Quintile is the most deprived fifth of all MSOAs in Leeds. 'Deprived Leeds' as used elsewhere refers to the LSOAs in Leeds which are in the 10% most deprived in England - a more exact definition, but GP audit data is restricted to MSOA level and cannot be resolved to the finer level of detail LSOAs offer. February 25th 2014 10 Office of the Director of Public Health. LCC

Summary of GP recorded data for this CCG Source: NHS Leeds GP data audits, quarterly 2011-14 Age standardised rates per 100,000 for this CCG only GP recorded conditions for this CCG, are displayed in the table below for the last two years. The quarter two data for 2012-13 and 2013-14 are used in the chart to compare change between years. CHD COPD Diabetes Smoking Cancer Obesity Q3 2,498 1,120 3,548 19,113 2,187 18,908 Q4 11-12 2,479 1,123 3,596 18,738 2,225 19,000 Q1 2,455 1,119 3,711 18,773 2,253 19,069 Q2 12-13 2,453 1,121 3,753 18,720 2,281 19,021 Q3 2,439 1,118 3,758 18,628 2,308 18,995 Q4 2,451 1,159 3,854 18,655 2,330 19,142 Q1 2,392 1,121 3,786 18,285 2,360 18,983 Q2 13-14 2,371 1,128 3,877 18,224 2,377 18,906 Changes in age standardised rates between quarter 2 in 2012/13 and quarter 2 2013/14 6% 4% 2% % change 0% -2% -4% CCG Leeds Deprived quintile -6% CHD COPD Diabetes Smoking Cancer Obesity -3.3% 0.6% 3.3% -2.7% 4.2% -0.6% -3.0% 0.4% 4.7% -5.0% 2.8% 0.8% -1.3% 0.9% 4.6% -2.1% 5.3% -0.5% Over the past four quarters the CCG is following a broadly similar pattern to Leeds overall. Leeds however is showing a greater percentage drop in smoking rates than the CCG. Also notable is the rise in cancer rates in this CCG and the Deprived Quintile - larger increases than seen in Leeds overall. Diabetes rates though in this CCG have seen a slower increase than in Leeds or Deprived Leeds. February 25th 2014 11 Office of the Director of Public Health. LCC

Inpatient emergency admissions (rates per 100,000 population) note: chart scales vary considerably to reveal detail in each age group Source: HES data Emergency admissions 0-14 years 2011 CCG 5,738 6,632 7,730 10,275 Leeds 6,129 6,797 8,331 10,660 registered this CCG 2011 11,00 10,00 9,00 8,00 7,00 6,00 5,00 Emergency admissions 15-65 years CCG 6,623 7,225 6,858 6,683 Leeds 7,040 7,792 7,598 7,526 registered 2011 8,00 7,50 7,00 6,50 6,00 Emergency admissions 65+ years CCG 24,377 25,503 26,838 27,043 Leeds 27,650 28,449 29,803 30,283 registered 2011 32,00 30,00 28,00 26,00 24,00 Emergency admissions all ages CCG 9,469 9,794 10,134 10,226 Leeds 10,127 10,446 10,842 11,083 registered 2011 12,00 11,00 10,00 9,00 8,00 For 0-14 years the rate for the CCG is increasing markedly, which reflects the direction for Leeds. For 15-65 years the rate for the CCG reflects the trend for Leeds but at a much lower level. For 65+ years the rate for the CCG is lower than the Leeds average although both are rising. For all ages the CCG rate is lower than the rate for Leeds but rising at a similar rate. All specialty and case types: Inpatient Emergency - Accident and Emergency Dept / Inpatient Emergency - Bed Bureau / Inpatient Emergency - Consultant Outpatient Clinic / Inpatient Emergency / General Practitioner / Inpatient Emergency - Other. Rates are calculated against practice populations from January in-years. Membership of CCG projected as of April 2012. Years are calendar years. "Leeds" is all patients. February 25th 2014 12 Office of the Director of Public Health. LCC

Outpatient first attendances (rates per 100,000) note: chart scales vary considerably to reveal detail in each age group Source: HES data Outpatient first attendances 0-14 years 2011 CCG 16,175 18,270 18,897 21,778 Leeds 17,227 18,412 18,651 22,186 registered this CCG 2011 23,00 21,00 19,00 17,00 15,00 Outpatient first attendances 15-65 years CCG 22,633 28,078 30,511 34,914 Leeds 21,860 26,723 28,856 33,968 registered 2011 38,00 33,00 28,00 23,00 18,00 Outpatient first attendances 65+ years CCG 54,153 74,260 78,582 86,789 Leeds 53,062 71,280 74,598 85,109 registered 2011 87,00 82,00 77,00 72,00 67,00 62,00 57,00 52,00 Outpatient first attendances all ages CCG 26,377 33,444 35,808 40,505 Leeds 25,606 31,705 33,736 39,186 registered 2011 39,00 34,00 29,00 24,00 This CCG had a total of 77,829 first outpatient attendances in the 2011 calendar year. This represents 25.2% of all first outpatient attendances in Leeds, whereas the CCG registered population makes up 24% of the population. For 0-14 years the rate for the CCG is comparable to the rate for Leeds. For 15-65, 65+ years, and the all ages group, the rate for the CCG is slightly higher than the rate for Leeds and following a similar pattern. Outpatient attendance: Attendances are sums of first attendances per practice, aggregated to CCG level using membership of CCG projected as of April 2012. Practice populations used to calculate rates are from January in-years. Years are calendar years. "Leeds" is all patients. February 25th 2014 13 Office of the Director of Public Health. LCC

Emergency hospital admissions for respiratory problems Emergency respiratory admission age standardised rates per 100,000 (DSR) for the under 75s in this CCG are averaged in five year bands. They are compared with the same data for all patients and the most deprived fifth of Leeds. Some patients live outside Leeds but if registered at Leeds practices they are included in the data. Relevant CCG Deprived Leeds 1,35 1,25 1,15 1,05 95 85 75 65 55 All emergency admissions (respiratory) 676 678 701 716 1,202 1,188 1,234 1,285 781 773 793 823 In the chart to the right, all Leeds practices are ranked by their most recent DSR for respiratory admissions, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Foundry Lane Surgery' with 1,427, and the lowest is 'The Avenue Surgery' with a DSR of 442. 3,00 2,50 2,00 1,50 1,00 50 All practices ranked by Q4 2006- admissions Male admissions 1,35 1,25 1,15 1,05 95 85 75 65 55 1,35 1,25 1,15 1,05 95 85 75 65 55 Female admissions 730 724 755 763 CCG 619 630 645 668 1,281 1,252 1,264 1,295 Deprived Leeds 1,131 1,132 1,216 1,285 833 824 839 863 729 723 747 782 The emergency hospital admissions due to respiratory disease for North Leeds CCG is below that of Leeds, and well below that of Deprived Leeds. It has been slowly climbing at more or less the same rate as Leeds. Both male and female DSRs for emergency admissions due to respiratory problems are below the Leeds rate. Both are following a similar slow upward trend to Leeds. Interestingly, Deprived Leeds is showing a relatively steep rise for female admissions which is not reflected in the Leeds or CCG rates though. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. February 25th 2014 14 Office of the Director of Public Health. LCC

Emergency hospital admissions for circulatory problems Emergency circulatory related admission age standardised rates per 100,000 (DSR) for the under 75s in this CCG are averaged in five year bands. They are compared with the same data for all patients and the most deprived fifth of Leeds. Some patients live outside Leeds but if registered at Leeds practices they are included in the data. 95 85 75 65 55 45 35 25 All emergency admissions (circulatory) Relevant CCG Deprived Leeds 496 448 418 387 865 789 727 660 544 507 479 451 In the chart to the right,all Leeds practices are ranked by their most recent DSR for circulatory admissions, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Newton Surgery' with 817, and the lowest is 'Church View Surgery' with a DSR of 258. 2,50 2,00 1,50 1,00 50 All practices ranked by Q4 2006- admissions Male admissions Female admissions 95 85 75 65 55 45 35 25 95 85 75 65 55 45 35 25 557 497 473 460 CCG 438 401 363 315 959 882 833 769 Deprived Leeds 768 691 614 543 660 614 587 559 429 402 372 343 Emergency admission DSRs for circulatory disease within the North Leeds CCG population have been falling steadily. The Leeds rate has been dropping at a similar rate and is just above that of the CCG. The Deprived Leeds DSR has been falling more quickly but is still well above the CCG and Leeds. Male emergency admissions within North Leeds CCG are falling slowly and are below those of Leeds. For women in North Leeds CCG the rate is very similar to that of Leeds and falling at a similar rate. In both cases Deprived Leeds rates are much higher and falling more quickly. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. February 25th 2014 15 Office of the Director of Public Health. LCC

Emergency hospital admissions for cancer Emergency cancer related admission age standardised rates per 100,000 (DSR) for the under 75s in this CCG are averaged in five year bands. They are compared with the same data for all patients and the most deprived fifth of Leeds. Some patients live outside Leeds but if registered at Leeds practices they are included in the data. 30 28 26 24 22 20 18 16 14 12 10 All emergency admissions (cancer) Relevant CCG Deprived Leeds 168 170 165 169 229 229 225 227 188 189 182 185 In the chart to the right, all Leeds practices are ranked by their most recent DSR for cancer admissions, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Hilton Road Surgery' with 320, and the lowest is 'Church View Surgery' with a DSR of 95. 40 35 30 25 20 15 10 5 All practices ranked by Q4 2006- admissions Male admissions 30 28 26 24 22 20 18 16 14 12 10 30 28 26 24 22 20 18 16 14 12 10 Female admissions 176 175 169 168 CCG 161 166 163 171 264 261 249 246 Deprived Leeds 195 197 200 208 208 206 195 194 169 174 172 178 Emergency hospital admissions due to cancer are more or less constant with small fluctuations following the Leeds DSR pattern. Deprived Leeds shows similar DSR patterns but of a higher amount. DSRs for male cancer admissions from North Leeds CCG are lower than those for Leeds. Female admission rates are very close to those of Leeds. In both cases the DSR for Deprived Leeds is higher. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. February 25th 2014 16 Office of the Director of Public Health. LCC

Early deaths from all causes All cause mortality in the under 75s. Standardised rates per 100,000 are averaged in five year bands. The CCG registered population is compared with the same data for all patients, and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. More recent data is available in part 2 of this report. 2002 / 2006 In the chart to the right, all Leeds practices are ranked by their most recent all cause mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Foundry Lane Surgery' with 465, and the lowest is 'Bramham Medical Centre' with 116. Male under 75 all cause mortality DSR 2002 / 2006 Relevant CCG Deprived Leeds 65 60 55 50 45 40 35 30 25 20 15 65 60 55 50 45 40 35 30 25 20 15 2,00 1,80 1,60 1,40 1,20 1,00 80 60 40 20 All cause mortality, under 75s. DSR All practices ranked by Q4 2006- mortality DSR 264 258 246 239 231 492 479 472 460 450 305 294 284 274 266 Female under 75 all cause mortality DSR 2002 / 2006 320 308 295 287 277 CCG 211 203 199 192 186 608 599 584 563 550 Deprived Leeds 371 354 356 352 344 378 361 346 331 323 237 229 223 219 211 65 60 55 50 45 40 35 30 25 20 15 All cause mortality for under 75s within the population of Leeds North CCG is slightly below that of Leeds and declining at a similar rate. The DSR for Deprived Leeds is also falling gently, but is much higher than this CCG and Leeds. The male CCG DSR is tracking below the Leeds rate, for women in the CCG the DSR is closer to that of Leeds but still below it. In both cases Deprived Leeds has a much higher DSR than the CCG, but for women the mortality DSR in Deprived Leeds is close to that of men in Leeds in general. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. February 25th 2014 17 Office of the Director of Public Health. LCC

Early deaths from respiratory disease Respiratory mortality in the under 75s. Standardised rates per 100,000 are averaged in five year bands. The CCG registered population is compared with the same data for all patients, and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. More recent data is available in part 2 of this report. 2002 / 2006 Relevant CCG Deprived Leeds 10 9 8 7 6 5 4 3 2 1 Respiratory mortality, under 75s. DSR 23 21 20 21 21 56 53 52 53 52 29 27 27 26 25 In the chart to the right, all Leeds practices are ranked by their most recent respiratory mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Foundry Lane Surgery' with 60, and the lowest is 'Church View Surgery' with 7. 10 9 8 7 6 5 4 3 2 1 All practices ranked by latest respiratory mortality DSR Male under 75 respiratory mortality DSR 2002 / 2006 10 9 8 7 6 5 4 3 2 1 Female under 75 respiratory mortality DSR 2002 / 2006 27 26 26 25 24 CCG 18 16 16 17 17 65 64 62 62 63 Deprived Leeds 46 42 43 45 42 35 32 31 30 31 24 22 22 22 20 10 9 8 7 6 5 4 3 2 1 Mortality for under 75s from lung disease within Leeds North CCG is more or less level, and well below that of Leeds. The Deprived Leeds DSR is much higher. The male CCG mortality DSR is well below that of Leeds and falling slowly. For women in Leeds North the rate is almost exactly the same as that of Leeds, and falling very slowly. In both cases the CCG is far below the Deprived Leeds DSR. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. February 25th 2014 18 Office of the Director of Public Health. LCC

Early deaths from heart disease Circulatory mortality in the under 75s. 25 Standardised rates per 100,000 are averaged in five year bands. The CCG registered 20 population is compared with the same data for all patients, and the 15 most deprived fifth of Leeds. Some Leeds 10 registered patients live outside Leeds but if registered at Leeds practices they are 5 included in the data. More recent data is available in part 2 of this report. 2002 / 2006 Relevant CCG Deprived Leeds Circulatory mortality, under 75s. DSR 72 68 65 63 61 145 140 135 129 125 89 84 79 75 71 In the chart to the right, all Leeds practices are ranked by their most recent circulatory mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Westfield Medical Centre' with 138, and the lowest is 'Newton Surgery' with 28. 25 20 15 10 5 All practices ranked by latest circulatory mortality DSR Male under 75 circulatory mortality DSR 25 25 Female under 75 circulatory mortality DSR 20 20 15 15 10 10 5 5 2002 / 2006 2002 / 2006 101 95 88 86 84 CCG 46 43 43 42 39 200 196 186 175 171 Deprived Leeds 89 83 82 81 77 125 118 109 103 98 54 51 49 48 45 Circulatory disease within North Leeds CCG is falling steadily, at the same rate as, and slightly below that of Leeds. Deprived Leeds is following the same trend but at a far higher rate. Male and female circulatory disease mortality in North Leeds CCG match their Leeds equivalents closley. However the male and female situations are different enough for the female Deprived Leeds DSR to be below that of the male Leeds and CCG DSRs. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. February 25th 2014 19 Office of the Director of Public Health. LCC

Early deaths from cancer Cancer mortality in the under 75s. Standardised rates per 100,000 are averaged in five year bands. The CCG registered population is compared with the same data for all patients, and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. More recent data is available in part 2 of this report. 2002 / 2006 Relevant CCG Deprived Leeds 19 17 15 13 11 9 7 5 Cancer mortality, under 75s. DSR 106 103 101 96 94 161 160 162 159 161 119 116 114 111 110 In the chart to the right, all Leeds practices are ranked by their most recent cancer mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Hilton Road Surgery' with 270, and the lowest is 'Bramham Medical Centre' with 44. 30 25 20 15 10 5 All practices ranked by latest cancer mortality DSR Male under 75 cancer mortality DSR 2002 / 2006 19 17 15 13 11 9 7 5 Female under 75 cancer mortality DSR 2002 / 2006 119 113 108 104 100 CCG 95 95 95 89 88 184 182 179 175 175 Deprived Leeds 138 139 145 143 147 133 128 126 121 120 105 105 104 102 100 19 17 15 13 11 9 7 5 The cancer mortality DSR for North Leeds CCG is falling slowly and positioned below that of Leeds overall. Deprived Leeds is much higher than this CCG. The male cancer mortality DSR is falling and has always been below that of Leeds. The female DSR is falling very slowly, and again is slightly below Leeds. Neither the male or female DSRs are very close to their respective Deprived Leeds counterparts. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. February 25th 2014 20 Office of the Director of Public Health. LCC

Alcohol admissions - 2012 All Leeds practices are ranked below by alcohol specific and attributable admissions. Practices that are a member of this CCG are highlighted in blue. patients (black line) and CCG rate (blue line) are included for comparison. Rank charts show combined male and female admissions; the bar charts alongside compare the CCG data for both genders against Leeds. Confidence interval bars are shown for practices in this CCG. Alcohol specific admissions (directly age standardised rates per 100,000) 5,00 4,50 4,00 3,50 3,00 2,50 2,00 1,50 1,00 50 Practices ranked by all specific admissions All practices Leeds Practices in this CCG CCG 5,00 4,50 4,00 3,50 3,00 2,50 2,00 1,50 1,00 50 CCG per 100,000 Leeds per 100,000 All Males Females 520 695 347 675 894 451 Alcohol attributable admissions* (directly age standardised rates per 100,000) 5,00 4,50 4,00 3,50 3,00 2,50 2,00 1,50 1,00 50 Practices ranked by all attributable admissions 5,00 4,00 3,00 2,00 1,00 All Males Females CCG per 100,000 1,701 2,154 1,291 Leeds per 100,000 1,981 2,511 1,491 The misuse of alcohol is associated with a wide range of chronic health conditions such as liver disease, hypertension, some cancers, impotence and mental health problems. It has a direct association with accidents, criminal offending, domestic violence and risky sexual behaviour. It also has hidden impacts on educational attainment and workplace productivity. For this CCG, the Dyneley House practice has the highest specific admissions DSR, however this is a specialised practice with very low population numbers. The next highest practice in this CCG is Foundry Lane Surgery, which also has the highest rate of alcohol attributable admissions. Church View Surgery has the lowest specific and attributable rates in the CCG. Source: SUS admissions, NWPHO alcohol admissions fractions. *Attributable admissions are calculated, not counted. For more information see www.nwph.net/nwpho/publications/alcoholattributablefractions.pdf February 25th 2014 21 Office of the Director of Public Health. LCC

Part 2. Matching data to the Leeds North CCG footprint. CCGs have a geographical footprint covering an area of Leeds, the boundaries of which reach to the outer edges of the city, and internally meet each other, leaving no part of Leeds without CCG 'ownership. Each electoral ward is allocated to a particular CCG as shown on the map below. Wards allocated to CCGs Most health data in this report comes from the practices that are members of this CCG. Some data though isn't available in this form, so another way is needed to allocate it to a specific CCG. The data is available by 108 small chunks of land called Middle Super Output Areas (MSOAs) and so the CCG is allocated MSOAs that match as closely as possible the wards it is responsible for. An MSOA is attributed to a ward if the geographical centre of the MSOA falls within the ward area. In November 2011 MSOAs were modified nationally, changes in Leeds were small with no effect on data at CCG level but some MSOAs were combined with a new total of 107 in the city. Some recent data is only available at MSOA level, not practice level. The map below shows the MSOAs allocated to CCGs on that basis. The two maps are very similar. This second part of the report uses MSOAs to calculate data for the CCG areas as opposed to data from the CCG practice population (which was in part 1). These MSOAs are listed overleaf. (CCG boundaries have also been defined by smaller geographical areas called LSOAs (Lower Super output Areas) as part of the NHS Commissioning Boards national process. Data in this report is not available at LSOA level) MSOAs allocated to CCGs About MSOAs (Middle Super Output Areas): These are geographic areas designed to improve the reporting of small area statistics in England and Wales. There are 108 MSOAs in Leeds (107 since November 2011). MSOAs are built from groups of Lower Super Output Areas (LSOAs). The minimum population of an MSOA is 5,000 and the mean is 7,200 (when originally generated). February 25th 2014 22 Office of the Director of Public Health. LCC