CVD: Primary Care Intelligence Packs

CVD: Primary Care Intelligence Packs CCG: NHS Eastbourne, Hailsham and Seaford CCG April 2016 Version 1.0

Contents 1. Introduction 3 2. CVD prevention The narrative 9 The data 11 3. Hypertension 4. Stroke 5. Diabetes 6. Kidney 7. Heart The narrative 18 The data 19 The narrative 30 The data 31 The narrative 44 The data 45 The narrative 52 The data 53 The narrative 63 The data 64 8. Outcomes 82 9. Appendix 88 This document is valid only when viewed via the internet. If it is printed into hard copy or saved to another location, you must first check that the version number on your copy matches that of the one online. Printed copies are uncontrolled copies. 2 CVD: Primary Care Intelligence Packs

Introduction 3 CVD: Primary Care Intelligence Packs

This Intelligence Pack has been compiled by GPs and nurses and pharmacists in the Primary Care CVD Leadership Forum in collaboration with the National Cardiovascular Intelligence Network Matt Kearney Sarit Ghosh Kathryn Griffith George Kassianos Jo Whitmore Matthew Fay Chris Harris Jan Procter-King Yassir Javaid Ivan Benett Ruth Chambers Ahmet Fuat Mike Kirby Peter Green Kamlesh Khunti Helen Williams Quincy Chuhka Sheila McCorkindale Nigel Rowell Ali Morgan Stephen Kirk Sally Christie Clare Hawley Paul Wright Bruce Taylor Mike Knapton John Robson Richard Mendelsohn Chris Arden David Fitzmaurice 4 CVD: Primary Care Intelligence Packs

Local intelligence as a tool for clinicians and commissioners to improve outcomes for our patients Why should we use this CVD Intelligence Pack Every year in England there are around 150,000 premature deaths. A quarter of premature deaths are due to cardiovascular disease. Two thirds of premature deaths could be avoided through improved prevention, earlier detection and better treatment. High quality primary care is crucial for improving outcomes in CVD because primary care is where much prevention and most diagnosis and treatment is delivered. This cardiovascular intelligence pack is a powerful resource for stimulating local conversations about quality improvement in primary care. Across a number of vascular conditions, looking at prevention, diagnosis, care and outcomes, the data allows comparison between CCGs and between practices. This is not about performance management because we know that variation can have more than one interpretation. But patients have a right to expect that we will ask challenging questions about how the best practices are achieving the best and what average or below average achievers could do differently and how they could be supported to perform as well as the best. How to use the CVD Intelligence Pack The intelligence pack has several sections CVD prevention, hypertension, stroke and AF, diabetes, kidney and heart disease and heart failure. Each section has one slide of narrative that makes the case and asks some questions. This is followed by data for a number of indicators, each with benchmarked comparison between CCGs and between practices. Use the pack to identify where there is variation that needs exploring and to start asking challenging questions about where and how quality could be improved. We suggest you then develop a local action plan for quality improvement this might include establishing communities of practice to build clinical leadership, use of audit tools to get a better understanding of the gaps in care and outcomes, agreeing local protocols and consensus approaches, assessing training and education needs, and exploring new ways of delivering care. 5 CVD: Primary Care Intelligence Packs

Data and methods This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic clinical network (SCN) and England. Where a CCG is in more than one SCN, it has been allocated to the SCN with the greatest geographical or population coverage. The slide pack also compares the CCG to its 10 most similar CCGs in terms of demography, ethnicity and deprivation. For information on the methodology used to calculate the 10 most similar CCGs please go to: http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/ The 10 most similar CCGs to NHS Eastbourne, Hailsham and Seaford CCG are: NHS Fylde & Wyre CCG NHS Lincolnshire East CCG NHS Isle of Wight CCG NHS South Devon and Torbay CCG NHS West Norfolk CCG NHS Great Yarmouth and Waveney CCG NHS North Norfolk CCG NHS North Derbyshire CCG NHS North Staffordshire CCG NHS Wyre Forest CCG The majority of data used in the packs are taken from the 2014/15 Quality and Outcomes Framework (QOF). Where this is not the case, this is indicated in the slide. All GP practices that were included in the 2014/15 QOF are included. Full source data are shown in the appendix. For the majority of indicators, the additional number of people that would be treated if all practices were to achieve as well as the average of the top achieving practices is calculated. This is calculated by taking an average of the intervention rates (i.e. the denominator includes exceptions) for the best 50% of practices in the CCG and applying this rate to all practices in the CCG. Note, this number is not intended to be proof of a realisable improvement; rather it gives an indication of the magnitude of available opportunity. 6 CVD: Primary Care Intelligence Packs

Why Does Variation Matter? The variation that exists between demographically similar CCGs and between practices illustrates the local potential to improve care and outcomes for our patients Benchmarking is helpful because it highlights variation. Of course it has long been acknowledged that some variation is inevitable in the healthcare and outcomes experienced by patients. But John Wennberg, who has championed research into clinical variation over four decades and who founded the pioneering Dartmouth Atlas of Health Care, concluded that much variation is unwarranted i.e. it cannot be explained on the basis of illness, medical evidence, or patient preference but is accounted for by the willingness and ability of doctors to offer treatment. A key observation about benchmarking data is that it does not tell us why there is variation. Some of the variation may be explained by population or case mix and some may be unwarranted we will not know unless we investigate. Benchmarking may not be conclusive. Its strength lies not in the answers it provides but in the questions it generates for CCGs and practices. For example: 1. How much variation is there in detection, management, exception reporting and outcomes? 2. How many people would benefit if average performers improved to the level of the best performers? 3. How many people would benefit if the lowest performers matched the achievement of the average? 4. What are better performers doing differently in the way they provide services in order to achieve better outcomes? 5. How can the CCG support low and average performers to help them match the achievement of the best? 6. How can we build clinical leadership to drive quality improvement? There are legitimate reasons for exception-reporting. But. Excepting patients from indicators puts them at risk of not receiving optimal care and of having worse outcomes. It is also likely to increase health inequalities. The substantial variation seen in exception reporting for some indicators suggests that some practices are more effective than others at reaching their whole population. Benchmarking exception reporting allows us to identify the practices that need support to implement the strategies adopted by low excepting practices.

CVD Prevention 8 CVD: Primary Care Intelligence Packs

CVD Prevention The NHS needs a radical upgrade in prevention if it is to be sustainable 5 year Forward View 2014 This is because England faces an epidemic of largely preventable non-communicable diseases, such as heart disease and stroke, cancer, Type 2 diabetes and liver disease. Dietary risks Tobacco smoke High body-mass index High systolic blood pressure Alcohol and drug use High fasting plasma glucose High total cholesterol Low glomerular filtration rate Low physical activity Occupational risks Air pollution Low bone mineral density Child and maternal malnutrition Sexual abuse and violence Other environmental risks Unsafe sex Unsafe water/ sanitation/ handwashing HIV/AIDS and tuberculosis Diarrhea, lower respiratory & other common infectious diseases Neglected tropical diseases & malaria Maternal disorders Neonatal disorders Nutritional deficiencies Other communicable, maternal, neonatal, & nutritional diseases Neoplasms Cardiovascular diseases Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases Musculoskeletal disorders Other non-communicable diseases Transport injuries Unintentional injuries Self-harm and interpersonal violence Forces of nature, war, & legal intervention 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% Percent of total disability-adjusted life-years (DALYs) The Global Burden of Disease Study (next slide) shows us that the leading causes of premature mortality include diet, tobacco, obesity, raised blood pressure, physical inactivity and raised cholesterol. The radical upgrade in prevention needs population-level approaches. But it also needs ongoing behaviour change support and medical treatment for individuals during their frequent contacts with primary care. The size of the prevention problem 2/3 of people are obese or overweight 1/3 of people are physically inactive 20% of people smoke but this rises to over 50% in some communities Evidence based interventions are effective in tackling these behavioural risk factors Thousands of people in every CCG have undiagnosed or undertreated physiological risk factors such as hypertension, atrial fibrillation, chronic kidney disease, diabetes and non-diabetic hyperglycaemia The NHS Health Check is a systematic approach to identifying local people at high risk of CVD, offering behaviour change support and early detection of hypertension, CKD, diabetes and pre-diabetes. Modelling suggests that high uptake will lead to substantial reductions in premature mortality. Question: What proportion of our local eligible population is receiving the NHS Health Check and how effective is their follow-up management of risk factors in primary care?

Global Burden of Disease Study 2013 Leading causes of premature death and disability in England Expressed as a percentage of disability-adjusted life-years Dietary risks Tobacco smoke High body-mass index High systolic blood pressure Alcohol and drug use High fasting plasma glucose High total cholesterol Low glomerular filtration rate Low physical activity Occupational risks Air pollution Low bone mineral density Child and maternal malnutrition Sexual abuse and violence Other environmental risks Unsafe sex Unsafe water/ sanitation/ handwashing HIV/AIDS and tuberculosis Diarrhea, lower respiratory & other common infectious diseases Neglected tropical diseases & malaria Maternal disorders Neonatal disorders Nutritional deficiencies Other communicable, maternal, neonatal, & nutritional diseases Neoplasms Cardiovascular diseases Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders Mental & substance use disorders Diabetes, urogenital, blood, & endocrine diseases Musculoskeletal disorders Other non-communicable diseases Transport injuries Unintentional injuries Self-harm and interpersonal violence Forces of nature, war, & legal intervention 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% Percent of total disability-adjusted life-years (DALYs)

Estimated smoking prevalence (QOF) by CCG Comparison with demographically similar CCGs NHS Great Yarmouth and Waveney CCG 21.6% NHS Lincolnshire East CCG NHS West Norfolk CCG 21.0% 19.8% Prevalence of 17% in NHS Eastbourne, Hailsham and Seaford CCG NHS Isle of Wight CCG 19.1% NHS Wyre Forest CCG 19.1% NHS Fylde & Wyre CCG 18.5% NHS South Devon and Torbay CCG 18.3% NHS North Staffordshire CCG NHS Eastbourne, Hailsham and Seaford CCG NHS North Derbyshire CCG 17.4% 17.0% 16.8% Note: It has been found that the proportion of patients recorded as smokers correlates well with IHS smoking prevalence and is a good estimate of the actual smoking prevalence in local areas, http://bmjopen.bmj.com/content/4/7/e005217.abs tract NHS North Norfolk CCG 16.0% 0% 5% 10% 15% 20% 25% Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients 15+ who are recorded as current smokers) divided by GP practice s estimated number of patients 15+ 11 CVD: Primary Care Intelligence Packs

Estimated smoking prevalence (QOF) by GP practice GP Practice CCG Eastbourne Station Health Centre Y02816 Bolton Road Surgery G81027 Seaside Medical Centre G81017 Park Practice G81104 Crescent Medical Centre G81685 Sovereign Practice G81022 Manor Park Medical Centre G81049 Grove Road Surgery G81002 Bridgeside Surgery G81012 The Lighthouse Medical Practice G81003 Seaforth Farm Surgery G81059 Stone Cross Surgery G81008 Harbour Medical Practice Y00080 Seaford Health Centre G81029 Arlington Road Surgery G81050 Enys Road Surgery G81056 Green Street Clinic G81032 36.9% 23.7% 21.3% 20.1% 19.8% 19.2% 18.4% 18.3% 17.9% 17.9% 17.7% 16.5% 15.5% 14.9% 14.4% 13.8% 13.8% 27,507 people who are recorded as smokers in NHS Eastbourne, Hailsham and Seaford CCG GP practice range: 11.9% to 36.9% Dr S R Dickson And Partners G81004 13.6% Old School Surgery G81099 13.4% The Quintins Medical Centre G81098 13.2% Herstmonceux Surgery G81634 11.9% 0% 5% 10% 15% 20% 25% 30% 35% 40% Note: This method is thought to be a reasonably robust method in estimating smoking prevalence for the majority of GP practices. However, caution is advised for extreme estimates of smoking prevalence and those with high numbers of smoking status not recorded and exceptions. 12 CVD: Primary Care Intelligence Packs

Successful smoking quitters at 4 weeks, 2013/14 Comparison with CCGs in the SCN NHS East Surrey CCG NHS North West Surrey CCG NHS Surrey Heath CCG NHS Surrey Downs CCG 62.4% 62.4% 62.4% 62.4% NHS Guildford And Waverley CCG 61.5% NHS Brighton And Hove CCG 61.0% NHS Ashford CCG 52.1% NHS Canterbury And Coastal CCG 52.1% NHS Dartford, Gravesham And Swanley CCG 52.1% NHS South Kent Coast CCG 52.1% NHS Swale CCG 52.1% NHS Thanet CCG 52.1% NHS West Kent CCG 52.1% NHS Coastal West Sussex CCG 48.8% NHS Crawley CCG 48.8% NHS Horsham And Mid Sussex CCG 48.8% NHS Medway CCG 46.9% NHS Eastbourne, Hailsham And Seaford CCG 45.2% NHS Hastings And Rother CCG 45.2% NHS High Weald Lewes Havens CCG 45.2% England 51.3% 0% 10% 20% 30% 40% 50% 60% 70% 45.2% successful smoking quitters at 4 weeks in NHS Eastbourne, Hailsham and Seaford CCG compared to 51.3% in England Note: The local authority indicator, successful smoking quitters at 4 weeks from the Health and Social Care Information Centre, has been used as a basis for estimating CCG level smoking quitters. Where more than one local authority is contained within a CCG, the proportion of the local authority within the CCG has been allocated to the CCG and aggregated up to give CCG estimates. 13 CVD: Primary Care Intelligence Packs

Excess weight (overweight or obese) in adults, 2012-2014 Comparison with CCGs in the SCN NHS Thanet CCG NHS Ashford CCG NHS Dartford, Gravesham And Swanley CCG NHS Swale CCG 68.4% 67.5% 67.4% 67.4% NHS Medway CCG 66.8% NHS South Kent Coast CCG 65.2% NHS Crawley CCG 65.0% NHS Hastings And Rother CCG 65.0% NHS Coastal West Sussex CCG 64.5% NHS Eastbourne, Hailsham And Seaford CCG 64.4% NHS Surrey Heath CCG 64.3% NHS High Weald Lewes Havens CCG 64.2% NHS West Kent CCG 63.4% NHS East Surrey CCG 63.0% NHS North West Surrey CCG 61.6% NHS Canterbury And Coastal CCG 61.2% NHS Horsham And Mid Sussex CCG 61.0% NHS Surrey Downs CCG 60.8% NHS Guildford And Waverley CCG 58.7% NHS Brighton And Hove CCG 52.4% England 64.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 64.4% of adults with excess weight in NHS Eastbourne, Hailsham and Seaford CCG compared to 64.6% in England Note: Local authority prevalence estimates of excess weight from the Active People Survey, Sport England, have been used as a basis for estimating CCG level prevalence estimates of excess weight. Where more than one local authority is contained within a CCG, the proportion of the local authority within the CCG has been allocated to the CCG and aggregated up to give CCG estimates. 14 CVD: Primary Care Intelligence Packs

Percentage of inactive adults, 2014 Comparison with CCGs in the SCN NHS Thanet CCG NHS Swale CCG NHS Canterbury And Coastal CCG NHS Crawley CCG 34.5% 32.4% 30.6% 30.6% NHS Medway CCG 29.6% NHS Ashford CCG 29.1% NHS Hastings And Rother CCG 28.7% NHS South Kent Coast CCG 27.4% NHS Coastal West Sussex CCG 27.4% NHS Eastbourne, Hailsham And Seaford CCG 27.3% NHS Dartford, Gravesham And Swanley CCG 27.0% NHS West Kent CCG 25.7% NHS High Weald Lewes Havens CCG 24.8% NHS North West Surrey CCG 23.8% NHS Brighton And Hove CCG 23.1% NHS Horsham And Mid Sussex CCG 22.0% NHS Surrey Downs CCG 21.8% NHS East Surrey CCG 20.9% NHS Guildford And Waverley CCG 20.3% NHS Surrey Heath CCG 19.1% England 27.7% 0% 5% 10% 15% 20% 25% 30% 35% 40% 27.3% of adults who are inactive in NHS Eastbourne, Hailsham and Seaford CCG compared to 27.7% in England Note: Local authority percentage estimates of inactive adults from the Active People Survey, Sport England, have been used as a basis for estimating CCG level percentage estimates of inactive adults. Where more than one local authority is contained within a CCG, the proportion of the local authority within the CCG has been allocated to the CCG and aggregated up to give CCG estimates. 15 CVD: Primary Care Intelligence Packs

NHS Health Check offer and uptake, 2014/15 % of eligible people offered a NHS Health check NHS Eastbourne, NHS Hastings And Rother NHS High Weald Lewes NHS Ashford CCG NHS Canterbury And NHS Dartford, Gravesham NHS South Kent Coast CCG NHS Swale CCG NHS Thanet CCG NHS West Kent CCG NHS Medway CCG NHS Coastal West Sussex NHS Crawley CCG NHS Horsham And Mid NHS Brighton And Hove NHS Guildford And NHS East Surrey CCG NHS North West Surrey NHS Surrey Heath CCG NHS Surrey Downs CCG England 26.2% 26.2% 26.2% 23.8% 23.8% 23.8% 23.8% 23.8% 23.8% 23.8% 19.8% 15.6% 15.6% 15.6% 10.2% 6.4% 6.0% 6.0% 6.0% 6.0% 19.7% 0% 5% 10%15%20%25%30% 16 CVD: Primary Care Intelligence Packs Comparison with CCGs in the SCN % of eligible people receiving a NHS Health check NHS Eastbourne, NHS Hastings And Rother NHS High Weald Lewes NHS Ashford CCG 12.3% 12.3% 12.3% 10.1% NHS Canterbury And 10.1% NHS Dartford, Gravesham NHS South Kent Coast CCG NHS Swale CCG NHS Thanet CCG NHS West Kent CCG NHS Medway CCG NHS Brighton And Hove NHS Coastal West NHS Crawley CCG NHS Horsham And Mid NHS Guildford And NHS East Surrey CCG NHS North West Surrey NHS Surrey Heath CCG NHS Surrey Downs CCG England 10.1% 10.1% 10.1% 10.1% 10.1% 9.1% 7.8% 7.6% 7.6% 7.6% 5.0% 4.9% 4.9% 4.9% 4.9% 9.6% 0% 2% 4% 6% 8% 10%12% 14% 100% of the eligible population should be invited for a Health Check over 5 years. In 2014/15 26.2% of eligible people were offered a NHS Health Check in NHS Eastbourne, Hailsham and Seaford CCG compared to 19.7% in England 12.3% of eligible people received a NHS Health Check in NHS Eastbourne, Hailsham and Seaford CCG compared to 9.6% in England Note: Local authority indicators for number of NHS Health Check offered and received have been used as a basis for estimating CCG level NHS Health Check offered and received. Where more than one local authority is contained within a CCG, the proportion of the local authority within the CCG has been allocated to the CCG and aggregated up to give CCG estimates.

Hypertension 17 CVD: Primary Care Intelligence Packs

Hypertension The Global Burden of Disease Study confirmed high blood pressure as a leading cause of premature death and disability High blood pressure is common and costly It affects around a quarter of all adults The NHS costs of hypertension are around 2bn Social costs are probably considerably higher What do we know? At least half of all heart attacks and strokes are caused by high blood pressure and it is a major risk factor for chronic kidney disease and cognitive decline Treatment is very effective at lowering blood pressure and at improving outcomes Despite this 4 out of 10 adults with hypertension, around 5 million people in England, remain undiagnosed And even when the condition is identified, treatment is often suboptimal, with blood pressure poorly controlled in one in three individuals The Missing Millions On average each CCG in England has 25,000 residents with undiagnosed hypertension these individuals are unaware of their increased cardiovascular risk and are untreated. What questions should we ask in our CCG? 1. For each indicator how wide is the variation in achievement and exception reporting? 2. How many people would benefit if all practices performed as well as the best? 3. How can we support practices who are average or below average to perform as well as the best in: Detection of hypertension Management of hypertension What might help? Support practices in systematic audit of detection and management of hypertension. Work with practices and local authorities to maximise uptake and follow up in the NHS Health Check Support access to self-test BP stations in waiting rooms and to ambulatory blood pressure monitoring. Consider commissioning community pharmacists to offer blood pressure checking and support for adherence to medication 18 CVD: Primary Care Intelligence Packs

Hypertension observed prevalence compared to expected prevalence by CCG Comparison with CCGs in the SCN NHS Medway CCG NHS Dartford, Gravesham And Swanley CCG NHS Swale CCG NHS Ashford CCG 0.60 0.60 0.58 0.58 NHS Eastbourne, Hailsham And Seaford CCG 0.58 NHS Hastings And Rother CCG 0.57 NHS South Kent Coast CCG 0.57 NHS Horsham And Mid Sussex CCG 0.57 NHS Thanet CCG 0.57 NHS Surrey Heath CCG 0.57 NHS West Kent CCG 0.56 NHS North West Surrey CCG 0.55 NHS Surrey Downs CCG 0.55 NHS Coastal West Sussex CCG 0.55 NHS High Weald Lewes Havens CCG 0.55 NHS Crawley CCG 0.54 NHS Canterbury And Coastal CCG 0.54 NHS Guildford And Waverley CCG 0.52 NHS East Surrey CCG 0.52 NHS Brighton And Hove CCG 0.44 England 0.56 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Ratio 0.58 ratio of observed to expected hypertension prevalence in NHS Eastbourne, Hailsham and Seaford CCG compared to 0.56 in England. This suggests that 58% of people with hypertension have been diagnosed. Note: This slide compares the prevalence of hypertension recorded in QOF in 2014/15 to the expected prevalence of hypertension taken from the East of England Public Health Observatory modelled estimates produced in 2011. The model was developed using data from the 2003-2004 Health Surveys for England and takes into account age, sex, ethnicity, smoking status and deprivation. 19 CVD: Primary Care Intelligence Packs

Hypertension observed prevalence compared to expected prevalence by CCG Comparison with demographically similar CCGs NHS North Staffordshire CCG 0.61 NHS Wyre Forest CCG 0.61 NHS West Norfolk CCG 0.60 NHS Fylde & Wyre CCG 0.60 NHS North Derbyshire CCG 0.59 NHS Eastbourne, Hailsham and Seaford CCG 0.58 NHS Lincolnshire East CCG 0.57 NHS Great Yarmouth and Waveney CCG 0.57 NHS Isle of Wight CCG 0.56 NHS South Devon and Torbay CCG 0.56 NHS North Norfolk CCG 0.55 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 Ratio 20 CVD: Primary Care Intelligence Packs

Hypertension observed prevalence compared to expected prevalence by GP practice GP practice CCG Bridgeside Surgery G81012 Crescent Medical Centre G81685 Old School Surgery G81099 The Quintins Medical Centre G81098 Stone Cross Surgery G81008 Seaforth Farm Surgery G81059 Dr S R Dickson And Partners G81004 Seaford Health Centre G81029 Arlington Road Surgery G81050 Manor Park Medical Centre G81049 Sovereign Practice G81022 Park Practice G81104 The Lighthouse Medical Practice G81003 Herstmonceux Surgery G81634 Enys Road Surgery G81056 Bolton Road Surgery G81027 Harbour Medical Practice Y00080 Seaside Medical Centre G81017 Grove Road Surgery G81002 Green Street Clinic G81032 Eastbourne Station Health Centre Y02816 0.70 0.68 0.67 0.63 0.62 0.61 0.60 0.59 0.59 0.58 0.58 0.58 0.58 0.57 0.53 0.53 0.51 0.50 0.50 0.49 0.33 It is estimated that there are 24,595 people with undiagnosed hypertension in NHS Eastbourne, Hailsham and Seaford CCG GP practice range of observed to expected hypertension prevalence 0.33 to 0.7 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Ratio 21 CVD: Primary Care Intelligence Packs

Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmhg or less by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported NHS Hastings And Rother CCG NHS Crawley CCG NHS Canterbury And Coastal CCG NHS Swale CCG NHS West Kent CCG NHS North West Surrey CCG NHS Dartford, Gravesham And Swanley CCG NHS Horsham And Mid Sussex CCG NHS Guildford And Waverley CCG NHS Thanet CCG NHS Medway CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Surrey Heath CCG NHS South Kent Coast CCG NHS Ashford CCG NHS East Surrey CCG NHS High Weald Lewes Havens CCG NHS Brighton And Hove CCG NHS Surrey Downs CCG NHS Coastal West Sussex CCG 82.4% 81.5% 81.5% 80.8% 80.6% 80.3% 80.1% 80.1% 79.4% 79.4% 79.4% 79.1% 79.1% 79.1% 78.8% 78.1% 78.0% 77.5% 77.2% 77.0% 33,496 people with hypertension (diagnosed)* in NHS Eastbourne, Hailsham and Seaford CCG 26,512 (79.1%) people whose blood pressure is <= 150/90 1,876 (5.6%) people who are excepted from optimal control 5,108 (15.2%) additional people whose blood pressure is not <= 150/90 England 80.4% 0% 20% 40% 60% 80% 100% *Using QOF clinical indicator HYP006 denominator plus exceptions 22 CVD: Primary Care Intelligence Packs

Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmhg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported NHS Isle of Wight CCG 84.2% NHS North Norfolk CCG 81.9% NHS Lincolnshire East CCG 81.5% NHS Wyre Forest CCG 81.5% NHS North Derbyshire CCG 80.8% NHS West Norfolk CCG 80.7% NHS Fylde & Wyre CCG 80.6% NHS North Staffordshire CCG 80.5% NHS Eastbourne, Hailsham and Seaford CCG 79.1% NHS Great Yarmouth and Waveney CCG 78.8% NHS South Devon and Torbay CCG 78.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 23 CVD: Primary Care Intelligence Packs

Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmhg or less by GP practice No treatment Exceptions reported Harbour Medical Practice Y00080 265 Sovereign Practice G81022 Enys Road Surgery G81056 Seaford Health Centre G81029 Eastbourne Station Health Centre Y02816 Bolton Road Surgery G81027 Park Practice G81104 The Lighthouse Medical Practice G81003 Seaforth Farm Surgery G81059 Old School Surgery G81099 350 560 499 448 44 222 350 1070 758 In total, including exceptions, there are 6,984 people whose blood pressure is not <= 150/90 GP practice range: 12.0% to 31.3% If all practices were to achieve as well as the average of the best achieving practices, then an additional 1,584 people would have their hypertension controlled Grove Road Surgery G81002 222 Manor Park Medical Centre G81049 225 Crescent Medical Centre G81685 71 Arlington Road Surgery G81050 407 Seaside Medical Centre G81017 271 Herstmonceux Surgery G81634 Bridgeside Surgery G81012 174 86 Stone Cross Surgery G81008 Dr S R Dickson And Partners G81004 The Quintins Medical Centre G81098 Green Street Clinic G81032 312 324 148 178 0% 5% 10% 15% 20% 25% 30% 35% 24 CVD: Primary Care Intelligence Packs

The percentage of patients aged 79 or under with hypertension in whom the last recorded blood pressure reading (measured in the preceding 9 months) is 140/90 mmhg or less by GP practice Treated No treatment Exceptions reported Crescent Medical Centre G81685 Seaside Medical Centre G81017 Herstmonceux Surgery G81634 Stone Cross Surgery G81008 Park Practice G81104 Harbour Medical Practice Y00080 Enys Road Surgery G81056 Sovereign Practice G81022 Seaford Health Centre G81029 Eastbourne Station Health Centre Y02816 Old School Surgery G81099 The Quintins Medical Centre G81098 Seaforth Farm Surgery G81059 Arlington Road Surgery G81050 Manor Park Medical Centre G81049 Green Street Clinic G81032 Bolton Road Surgery G81027 Bridgeside Surgery G81012 Dr S R Dickson And Partners G81004 The Lighthouse Medical Practice G81003 Grove Road Surgery G81002 70.4% 63.3% 61.7% 57.0% 56.6% 49.1% 45.1% 43.8% 42.2% 0% 20% 40% 60% 80% 100% All practices were invited to provide retired QOF data to the HSCIC showing the number of patients with hypertension achieving the NICE recommended treatment target of 140/90 mmhg. In NHS Eastbourne, Hailsham and Seaford CCG, 15 out of 21 (71.4%) practices agreed to provide this data. Across these 15 practices, there are 5,227 people whose blood pressure is not <= 140/90 25 CVD: Primary Care Intelligence Packs

New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with CCGs in the SCN Treated No treatment Exceptions reported NHS Surrey Heath CCG NHS Swale CCG NHS Medway CCG NHS Horsham And Mid Sussex CCG NHS South Kent Coast CCG NHS East Surrey CCG NHS Hastings And Rother CCG NHS Crawley CCG NHS North West Surrey CCG NHS Dartford, Gravesham And Swanley CCG NHS Guildford And Waverley CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Brighton And Hove CCG NHS Coastal West Sussex CCG NHS West Kent CCG NHS Canterbury And Coastal CCG NHS Surrey Downs CCG NHS Ashford CCG NHS Thanet CCG NHS High Weald Lewes Havens CCG 85.7% 76.5% 74.2% 69.3% 68.2% 68.1% 67.9% 67.9% 66.7% 65.9% 65.7% 65.4% 65.1% 60.5% 60.5% 60.0% 58.8% 57.6% 57.1% 50.5% 104 people with a new diagnosis* of hypertension with a CVD risk of 20% or higher in NHS Eastbourne, Hailsham and Seaford CCG 68 (65.4%) people who are currently treated with statins 34 (32.7%) people who are exempted from treatment with statins 2 (1.9%) additional people who are not currently treated with statins England 67.7% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CVD-PP001 denominator plus exceptions 26 CVD: Primary Care Intelligence Packs

New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with demographically similar CCGs Treated No treatment Exceptions reported NHS Lincolnshire East CCG 69.3% NHS West Norfolk CCG 67.9% NHS Great Yarmouth and Waveney CCG 65.7% NHS Eastbourne, Hailsham and Seaford CCG 65.4% NHS North Staffordshire CCG 64.8% NHS Isle of Wight CCG 63.6% NHS South Devon and Torbay CCG 62.3% NHS North Derbyshire CCG 61.2% NHS Wyre Forest CCG 60.8% NHS North Norfolk CCG 54.9% NHS Fylde & Wyre CCG 51.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 27 CVD: Primary Care Intelligence Packs

New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and not treated with statins by GP practice No treatment Exceptions reported Bridgeside Surgery G81012 1 Sovereign Practice G81022 Old School Surgery G81099 Dr S R Dickson And Partners G81004 Seaside Medical Centre G81017 Green Street Clinic G81032 The Quintins Medical Centre G81098 The Lighthouse Medical Practice G81003 Grove Road Surgery G81002 1 7 2 1 1 5 5 2 In total, including exceptions, there are 36 people who are not treated with statins GP practice range: 0.0% to 100.0% If all practices were to achieve as well as the average of the best achieving practices, then an additional 33 people would be treated Seaford Health Centre G81029 3 Park Practice G81104 Seaforth Farm Surgery G81059 6 2 Stone Cross Surgery G81008 Bolton Road Surgery G81027 Manor Park Medical Centre G81049 Arlington Road Surgery G81050 Enys Road Surgery G81056 Herstmonceux Surgery G81634 Crescent Medical Centre G81685 Harbour Medical Practice Y00080 Eastbourne Station Health Centre Y02816 0% 20% 40% 60% 80% 100% 120% 28 CVD: Primary Care Intelligence Packs

Stroke 29 CVD: Primary Care Intelligence Packs

Stroke Prevention Less than half of people with known AF admitted with stroke are on anticoagulant treatment at the time of their stroke. Stroke is one of the leading causes of premature death and disability. Stroke is devastating for individuals and families and accounts for a substantial proportion of health and social care expenditure. What questions should we ask in our CCG? 1. For each indicator how wide is the variation in achievement and exception reporting? 2. How many people would benefit if all practices performed as well as the best? 3. How can we support practices who are average and below average to perform as well as the best in: Detection of atrial fibrillation Stroke prevention with anticoagulation Atrial fibrillation increases the risk of stroke by a factor of 5, and strokes caused by AF are often more severe with higher mortality and greater disability. Anticoagulation substantially reduces the risk of stroke in people with AF. Despite this, AF is underdiagnosed and under treated: up to a third of people with AF are unaware they have the condition and even when diagnosed inadequate treatment is common large numbers do not receive anticoagulants or have poor anticoagulant control. What might help? Increase opportunistic pulse checking especially in the over 65s Roll out GRASP-AF to identify people with AF who are undertreated Promote use of CHADS-VASC and HASBLED Roll out of Warfarin Patient Safety Audit Tool to ensure optimal time in therapeutic range for people on warfarin Disseminate latest evidence on risk-benefit balance for anticoagulants including the newer treatments (NOACs) Work with practices and local authorities to maximise uptake and follow up in the NHS Health Check 30 CVD: Primary Care Intelligence Packs

Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with CCGs in the SCN NHS Ashford CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Canterbury And Coastal CCG NHS West Kent CCG 0.88 0.78 0.72 0.72 NHS South Kent Coast CCG 0.72 NHS East Surrey CCG 0.71 NHS Hastings And Rother CCG 0.70 NHS Thanet CCG 0.68 NHS Coastal West Sussex CCG 0.67 NHS High Weald Lewes Havens CCG 0.67 NHS Guildford And Waverley CCG 0.67 NHS Crawley CCG 0.66 NHS Dartford, Gravesham And Swanley CCG 0.66 NHS Horsham And Mid Sussex CCG 0.65 NHS Brighton And Hove CCG 0.64 NHS Swale CCG 0.63 NHS North West Surrey CCG 0.62 NHS Surrey Downs CCG 0.62 NHS Medway CCG 0.62 NHS Surrey Heath CCG 0.58 England 0.65 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio 0.78 ratio of observed to expected atrial fibrillation prevalence in NHS Eastbourne, Hailsham and Seaford CCG compared to 0.65 in England. This suggests that 78% of people with atrial fibrillation have been diagnosed. Note: This slide compares the prevalence of atrial fibrillation recorded in QOF in 2013/14 to the estimated prevalence of atrial fibrillation, taken from National Cardiovascular Intelligence Network estimates produced in 2015. The estimates were developed by applying age-sex specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from the Health and Social Care Information Centre. Estimates reported are adjusted for age and sex of the local population. 31 CVD: Primary Care Intelligence Packs

Atrial fibrillation observed prevalence compared to expected prevalence by CCG Comparison with demographically similar CCGs NHS Eastbourne, Hailsham and Seaford CCG 0.78 NHS South Devon and Torbay CCG 0.74 NHS West Norfolk CCG 0.73 NHS North Derbyshire CCG 0.71 NHS North Staffordshire CCG 0.71 NHS North Norfolk CCG 0.69 NHS Lincolnshire East CCG 0.69 NHS Wyre Forest CCG 0.68 NHS Fylde & Wyre CCG 0.68 NHS Great Yarmouth and Waveney CCG 0.63 NHS Isle of Wight CCG 0.60 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Ratio 32 CVD: Primary Care Intelligence Packs

Atrial fibrillation observed prevalence compared to expected prevalence by GP practice GP practice CCG Herstmonceux Surgery G81634 The Lighthouse Medical Practice G81003 Bridgeside Surgery G81012 Arlington Road Surgery G81050 Old School Surgery G81099 The Quintins Medical Centre G81098 Stone Cross Surgery G81008 Park Practice G81104 Seaforth Farm Surgery G81059 Green Street Clinic G81032 Seaford Health Centre G81029 Bolton Road Surgery G81027 Enys Road Surgery G81056 Dr S R Dickson And Partners G81004 Seaside Medical Centre G81017 Grove Road Surgery G81002 Manor Park Medical Centre G81049 Sovereign Practice G81022 Harbour Medical Practice Y00080 Crescent Medical Centre G81685 Eastbourne Station Health Centre Y02816 1.07 0.89 0.86 0.85 0.84 0.84 0.80 0.78 0.78 0.78 0.77 0.76 0.75 0.73 0.72 0.70 0.70 0.68 0.65 0.64 0.33 It is estimated that there are 1,504 people with undiagnosed atrial fibrillation in NHS Eastbourne, Hailsham and Seaford CCG GP practice range of observed to expected atrial fibrillation prevalence 0.33 to 1.07 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio 33 CVD: Primary Care Intelligence Packs

In patients with AF with a CHADS 2 > 1, the percentage treated with anti-coagulation therapy by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported NHS Surrey Heath CCG NHS Medway CCG NHS Surrey Downs CCG NHS Ashford CCG NHS Guildford And Waverley CCG NHS East Surrey CCG NHS Swale CCG NHS Dartford, Gravesham And Swanley CCG NHS Eastbourne, Hailsham And Seaford CCG NHS West Kent CCG NHS Hastings And Rother CCG NHS High Weald Lewes Havens CCG NHS Thanet CCG NHS South Kent Coast CCG NHS North West Surrey CCG NHS Canterbury And Coastal CCG NHS Crawley CCG NHS Coastal West Sussex CCG NHS Horsham And Mid Sussex CCG NHS Brighton And Hove CCG 81.1% 80.7% 78.9% 78.4% 78.4% 78.3% 77.9% 77.2% 76.7% 76.6% 76.2% 76.2% 75.4% 75.0% 75.0% 74.9% 73.2% 72.4% 71.8% 65.3% 3,177 people with atrial fibrillation* with a CHADS2 score > 1 in NHS Eastbourne, Hailsham and Seaford CCG 2,436 (76.7%) people treated with anti-coagulation therapy 268 (8.4%) people who are exceptions 473 (14.9%) additional people with a recorded CHADS2 score > 1 who are not treated England 74.3% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator AF004 denominator plus exceptions 34 CVD: Primary Care Intelligence Packs

In patients with AF with a CHADS 2 > 1, the percentage treated with anti-coagulation therapy by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported NHS South Devon and Torbay CCG 78.0% NHS Eastbourne, Hailsham and Seaford CCG 76.7% NHS Lincolnshire East CCG 75.8% NHS North Staffordshire CCG 74.4% NHS North Derbyshire CCG 74.2% NHS North Norfolk CCG 72.7% NHS Fylde & Wyre CCG 72.3% NHS Wyre Forest CCG 71.7% NHS West Norfolk CCG 71.2% NHS Isle of Wight CCG 70.3% NHS Great Yarmouth and Waveney CCG 69.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 35 CVD: Primary Care Intelligence Packs

In patients with AF with a CHADS 2 > 1, the percentage not treated with anticoagulation therapy by GP practice No treatment Exceptions reported Enys Road Surgery G81056 51 Grove Road Surgery G81002 Bolton Road Surgery G81027 Bridgeside Surgery G81012 Arlington Road Surgery G81050 Herstmonceux Surgery G81634 Seaford Health Centre G81029 Manor Park Medical Centre G81049 Old School Surgery G81099 Stone Cross Surgery G81008 14 102 24 50 49 68 22 21 40 In total, including exceptions, there are 741 people with a recorded CHADS2 score > 1 who are not treated GP practice range: 0.0% to 40.2% If all practices were to achieve as well as the average of the best achieving practices, then an additional 236 people would be treated Park Practice G81104 29 The Lighthouse Medical Practice G81003 69 The Quintins Medical Centre G81098 25 Dr S R Dickson And Partners G81004 Sovereign Practice G81022 37 45 Crescent Medical Centre G81685 6 Seaside Medical Centre G81017 Seaforth Farm Surgery G81059 21 40 Green Street Clinic G81032 24 Harbour Medical Practice Y00080 4 Eastbourne Station Health Centre Y02816 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 36 CVD: Primary Care Intelligence Packs

Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmhg or less by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported NHS Swale CCG NHS Hastings And Rother CCG NHS North West Surrey CCG NHS Canterbury And Coastal CCG NHS Guildford And Waverley CCG NHS South Kent Coast CCG NHS West Kent CCG NHS High Weald Lewes Havens CCG NHS Thanet CCG NHS Horsham And Mid Sussex CCG NHS Surrey Heath CCG NHS Medway CCG NHS Eastbourne, Hailsham And Seaford CCG NHS East Surrey CCG NHS Dartford, Gravesham And Swanley CCG NHS Crawley CCG NHS Ashford CCG NHS Surrey Downs CCG NHS Brighton And Hove CCG NHS Coastal West Sussex CCG 88.6% 85.6% 85.5% 84.7% 84.3% 84.1% 83.9% 83.9% 83.9% 83.9% 83.8% 83.5% 83.3% 83.1% 82.8% 82.4% 82.3% 81.6% 81.3% 81.1% 4,848 people with a history of stroke or TIA* in NHS Eastbourne, Hailsham and Seaford CCG 4,037 (83.3%) people whose blood pressure is <= 150 / 90 256 (5.3%) people who are exceptions 555 (11.4%) additional people whose blood pressure is not <= 150 / 90 England 84.3% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA003 denominator plus exceptions 37 CVD: Primary Care Intelligence Packs

Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmhg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported NHS North Derbyshire CCG 85.4% NHS Wyre Forest CCG 84.5% NHS Isle of Wight CCG 84.5% NHS Lincolnshire East CCG 84.5% NHS North Staffordshire CCG 83.7% NHS West Norfolk CCG 83.6% NHS Fylde & Wyre CCG 83.5% NHS North Norfolk CCG 83.5% NHS Eastbourne, Hailsham and Seaford CCG 83.3% NHS Great Yarmouth and Waveney CCG 82.8% NHS South Devon and Torbay CCG 82.2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 38 CVD: Primary Care Intelligence Packs

Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmhg or less by GP practice No treatment Exceptions reported Sovereign Practice G81022 91 Bolton Road Surgery G81027 Seaford Health Centre G81029 Eastbourne Station Health Centre Y02816 Park Practice G81104 Seaforth Farm Surgery G81059 Crescent Medical Centre G81685 Manor Park Medical Centre G81049 Grove Road Surgery G81002 Enys Road Surgery G81056 24 123 4 41 78 7 33 35 33 In total, including exceptions, there are 811 people whose blood pressure is not <= 150 / 90 GP practice range: 5.9% to 26.7% If all practices were to achieve as well as the average of the best achieving practices, then an additional 237 people would have their blood pressure controlled Harbour Medical Practice Y00080 The Lighthouse Medical Practice G81003 81 17 Arlington Road Surgery G81050 53 Old School Surgery G81099 Seaside Medical Centre G81017 37 30 Green Street Clinic G81032 Herstmonceux Surgery G81634 Dr S R Dickson And Partners G81004 39 30 8 The Quintins Medical Centre G81098 16 Stone Cross Surgery G81008 25 Bridgeside Surgery G81012 6 0% 5% 10% 15% 20% 25% 30% 39 CVD: Primary Care Intelligence Packs

Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported NHS South Kent Coast CCG NHS Thanet CCG NHS West Kent CCG NHS Dartford, Gravesham And Swanley CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Surrey Heath CCG NHS Canterbury And Coastal CCG NHS Hastings And Rother CCG NHS North West Surrey CCG NHS Crawley CCG NHS Ashford CCG NHS Horsham And Mid Sussex CCG NHS High Weald Lewes Havens CCG NHS Swale CCG NHS Medway CCG NHS East Surrey CCG NHS Brighton And Hove CCG NHS Coastal West Sussex CCG NHS Guildford And Waverley CCG NHS Surrey Downs CCG 93.0% 93.0% 92.9% 92.9% 92.5% 92.0% 92.0% 91.9% 91.9% 91.8% 91.4% 91.3% 91.1% 91.1% 91.0% 90.6% 90.5% 90.1% 89.2% 88.5% 3,412 people with a stroke shown to be non-haemorrhagic* in NHS Eastbourne, Hailsham and Seaford CCG 3,155 (92.5%) people who are taking an anti-platetet agent or anticoagulant 184 (5.4%) people who are exceptions 73 (2.1%) additional people with no treatment England 91.7% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator STIA007 denominator plus exceptions 40 CVD: Primary Care Intelligence Packs

Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported NHS North Staffordshire CCG 93.5% NHS Wyre Forest CCG 93.3% NHS West Norfolk CCG 92.9% NHS North Derbyshire CCG 92.9% NHS Eastbourne, Hailsham and Seaford CCG 92.5% NHS South Devon and Torbay CCG 92.3% NHS Lincolnshire East CCG 92.0% NHS Isle of Wight CCG 92.0% NHS North Norfolk CCG 91.3% NHS Great Yarmouth and Waveney CCG 91.1% NHS Fylde & Wyre CCG 89.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 41 CVD: Primary Care Intelligence Packs

Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who do not have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by GP practice No treatment Exceptions reported Enys Road Surgery G81056 24 Arlington Road Surgery G81050 Bolton Road Surgery G81027 Stone Cross Surgery G81008 Seaford Health Centre G81029 Park Practice G81104 Green Street Clinic G81032 Grove Road Surgery G81002 Sovereign Practice G81022 Dr S R Dickson And Partners G81004 14 16 10 15 20 27 7 18 38 In total, including exceptions, there are 257 people who are not taking an anti-platelet agent or anti-coagulant GP practice range: 2.4% to 18.6% If all practices were to achieve as well as the average of the best achieving practices, then an additional 93 people would be taking an antiplatelet agent or anti-coagulant Seaforth Farm Surgery G81059 20 Harbour Medical Practice Y00080 5 Crescent Medical Centre G81685 Eastbourne Station Health Centre Y02816 1 1 Manor Park Medical Centre G81049 Seaside Medical Centre G81017 9 6 Bridgeside Surgery G81012 Herstmonceux Surgery G81634 3 2 Old School Surgery G81099 The Lighthouse Medical Practice G81003 7 11 The Quintins Medical Centre G81098 3 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20% 42 CVD: Primary Care Intelligence Packs

Diabetes 43 CVD: Primary Care Intelligence Packs

Diabetes Prevention and Management Diabetes is estimated to cost the NHS 5.6 billion per year. It is also often preventable. Type 2 Diabetes in numbers Diagnosed prevalence 2.9 million Non-diabetic hyperglycaemia (high risk) 5 million Data from the Health Survey for England suggests a further 2.4% of adults have undiagnosed diabetes and that approximately 30% of all diabetes is undiagnosed Type 2 diabetes is often preventable People at high risk of developing type 2 diabetes can be identified through the NHS Health Check and the disease could be prevented in 30-60% through appropriate behaviour change support. Complications of diabetes are preventable Diabetes is a major cause of premature death and disability and greatly increases the risk of heart disease and stroke, kidney failure, amputations and blindness. 80% of NHS spending on diabetes goes on managing these complications, most of which could be prevented. There are 8 essential care processes, in addition to retinal screening, that together substantially reduce complication rates. Despite this, around a third of people with diabetes do not receive all 8 care processes, and there is widespread variation between CCGs and practices in levels of achievement. What questions should we ask in our CCG? 1. For each indicator how wide is the variation in achievement and exception reporting? 2. How many people would benefit if all practices performed as well as the best? 3. How can we support practices who are average and below average to perform as well as the best in: Detection of diabetes Delivery of the 8 care processes Identification and management of Non-diabetic hyperglycaemia What might help Promote participation by all practices in the National Diabetes Audit (NDA) Benchmark practice level data from the NDA and support practices to explore variation Increase support for patient education and shared management Maximise uptake of the NHS Health Check to aid detection of diabetes and Non Diabetic Hyperglycaemia Maximise uptake of the NHS Diabetes Prevention Programme

Diabetes observed prevalence by CCG Comparison with CCGs in the SCN NHS Swale CCG NHS Thanet CCG NHS South Kent Coast CCG NHS Medway CCG NHS Coastal West Sussex CCG NHS Hastings And Rother CCG NHS Dartford, Gravesham And Swanley CCG NHS Crawley CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Ashford CCG NHS Canterbury And Coastal CCG NHS North West Surrey CCG NHS West Kent CCG NHS High Weald Lewes Havens CCG NHS Surrey Heath CCG NHS Horsham And Mid Sussex CCG NHS East Surrey CCG NHS Surrey Downs CCG NHS Guildford And Waverley CCG NHS Brighton And Hove CCG 7.2% 7.1% 7.1% 6.9% 6.7% 6.6% 6.3% 6.3% 6.3% 6.2% 5.9% 5.6% 5.5% 5.4% 5.4% 5.2% 5.1% 4.8% 4.4% 4.1% 6.3% observed diabetes prevalence in NHS Eastbourne, Hailsham and Seaford CCG, compared to 6.4% in England. England 6.4% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 45 CVD: Primary Care Intelligence Packs

Diabetes observed prevalence by CCG Comparison with demographically similar CCGs NHS Lincolnshire East CCG 8.5% NHS West Norfolk CCG 8.0% NHS Wyre Forest CCG 7.6% NHS Great Yarmouth and Waveney CCG 7.4% NHS North Staffordshire CCG 7.3% NHS Fylde & Wyre CCG 6.9% NHS North Derbyshire CCG 6.8% NHS North Norfolk CCG 6.7% NHS Isle of Wight CCG 6.6% NHS South Devon and Torbay CCG 6.6% NHS Eastbourne, Hailsham and Seaford CCG 6.3% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 46 CVD: Primary Care Intelligence Packs

Diabetes prevalence by GP practice GP practice CCG Crescent Medical Centre G81685 Dr S R Dickson And Partners G81004 Bridgeside Surgery G81012 Seaforth Farm Surgery G81059 Seaford Health Centre G81029 Stone Cross Surgery G81008 Park Practice G81104 Sovereign Practice G81022 The Lighthouse Medical Practice G81003 Manor Park Medical Centre G81049 The Quintins Medical Centre G81098 Old School Surgery G81099 Harbour Medical Practice Y00080 Arlington Road Surgery G81050 Seaside Medical Centre G81017 Bolton Road Surgery G81027 Herstmonceux Surgery G81634 Grove Road Surgery G81002 Green Street Clinic G81032 Enys Road Surgery G81056 Eastbourne Station Health Centre Y02816 7.9% 7.4% 7.4% 7.3% 7.1% 7.1% 7.0% 6.9% 6.8% 6.5% 6.3% 5.8% 5.7% 5.7% 5.6% 5.6% 4.9% 4.9% 4.9% 4.1% 3.0% GP practice range of observed diabetes 3.0% to 7.9% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 47 CVD: Primary Care Intelligence Packs

Prevalence estimates of non-diabetic hyperglycaemia NHS Eastbourne, Hailsham And Seaford CCG NHS Hastings And Rother CCG NHS High Weald Lewes Havens CCG NHS South Kent Coast CCG 12.9% 12.6% 12.1% 12.0% NHS Thanet CCG 11.9% NHS Surrey Downs CCG 11.5% NHS Horsham And Mid Sussex CCG 11.4% NHS West Kent CCG 11.1% NHS Dartford, Gravesham And Swanley CCG 11.1% NHS Surrey Heath CCG 11.0% NHS North West Surrey CCG 11.0% NHS Canterbury And Coastal CCG 10.9% NHS Ashford CCG 10.9% NHS East Surrey CCG 10.9% NHS Swale CCG 10.7% NHS Medway CCG 10.6% NHS Crawley CCG 10.4% NHS Brighton And Hove CCG 8.4% NHS Guildford And Waverley CCG 10.8% NHS Coastal West Sussex CCG 12.5% England 11.2% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% Non-diabetic hyperglycaemia, also known as pre-diabetes or impaired glucose regulation, refers to raised blood glucose levels, but not in the diabetic range. People with nondiabetic hyperglycaemia are at increased risk of developing Type 2 diabetes. The estimated prevalence of nondiabetic hyperglycaemia in NHS Eastbourne, Hailsham and Seaford CCG is 12.9%, compared to 11.2% in England. Note: Prevalence estimates of non-diabetic hyperglycaemia were developed using Health Survey for England (HSE) data. Five years of HSE data were combined, 2009-2013. The estimates take into account the age, ethnic group and estimated body mass index of the population. These estimates were produced using the GP registered population. 48 CVD: Primary Care Intelligence Packs

People with diabetes who had eight care processes by GP practice, 2014/15 GP practice Average of practices in the CCG who participated in the audit Stone Cross Surgery G81008 Herstmonceux Surgery G81634 Park Practice G81104 Seaford Health Centre G81029 Green Street Clinic G81032 Old School Surgery G81099 Manor Park Medical Centre G81049 Sovereign Practice G81022 Seaforth Farm Surgery G81059 Bolton Road Surgery G81027 Eastbourne Station Health Centre Y02816 Arlington Road Surgery G81050 The Lighthouse Medical Practice G81003 Grove Road Surgery G81002 Bridgeside Surgery G81012 Harbour Medical Practice Y00080 Crescent Medical Centre G81685 The Quintins Medical Centre G81098 Enys Road Surgery G81056 Seaside Medical Centre G81017 Dr S R Dickson And Partners G81004 75.3% 74.3% 71.5% 70.6% 67.3% 67.2% 62.7% 59.9% 56.3% 56.0% 55.3% 47.2% 47.1% 37.7% 36.3% Data on care processes and treatment targets are taken from the National Diabetes Audit (NDA). Overall practice participation in the 2014/15 audit was 54.9% in England. Within CCGs participation varied between 0% to 100%. In NHS Eastbourne, Hailsham and Seaford CCG, 15 out of 21 practices (71.4%) participated in the NDA. Data is not available for the remaining practices. Achievement - 8 care processes: in practices who provided data via the NDA, between 36.3% and 75.3% of patients received all 8 care processes. 0% 10% 20% 30% 40% 50% 60% 70% 80% 49 CVD: Primary Care Intelligence Packs

People with diabetes who met all 3 treatment targets by GP practice, 2014/15 GP practice Average of practices in the CCG who participated in the audit Herstmonceux Surgery G81634 Stone Cross Surgery G81008 Old School Surgery G81099 Eastbourne Station Health Centre Y02816 Grove Road Surgery G81002 Seaford Health Centre G81029 Sovereign Practice G81022 The Lighthouse Medical Practice G81003 Green Street Clinic G81032 Park Practice G81104 Bridgeside Surgery G81012 Arlington Road Surgery G81050 Manor Park Medical Centre G81049 Bolton Road Surgery G81027 Seaforth Farm Surgery G81059 Harbour Medical Practice Y00080 Crescent Medical Centre G81685 The Quintins Medical Centre G81098 Enys Road Surgery G81056 Seaside Medical Centre G81017 Dr S R Dickson And Partners G81004 54.6% 49.2% 47.8% 45.5% 45.3% 45.0% 43.0% 42.9% 41.6% 41.1% 40.0% 39.0% 38.6% 38.3% 37.0% Data on care processes and treatment targets are taken from the National Diabetes Audit (NDA). Overall practice participation in the 2014/15 audit was 54.9% in England. Within CCGs participation varied between 0% to 100%. In NHS Eastbourne, Hailsham and Seaford CCG, 15 out of 21 practices (71.4%) participated in the NDA. Data is not available for the remaining practices. Achievement - 3 treatment targets: in practices who provided data via the NDA, between 37.0% and 54.6% of patients achieved all 3 treatment targets. 0% 10% 20% 30% 40% 50% 60% 50 CVD: Primary Care Intelligence Packs

Kidney 51 CVD: Primary Care Intelligence Packs

Management of Chronic Kidney Disease Chronic Kidney Disease can progress to kidney failure and it substantially increases the risk of heart attack and stroke. Late diagnosis of CKD is common. Around a third of people with CKD are undiagnosed. More opportunistic testing and improved uptake of the NHS Health Check will increase detection rates. Chronic Kidney Disease (CKD) is common. It is one of the commonest co-morbidities and affects a third of people over 75. In 2010 it was estimated to cost the NHS around 1.5bn. Average length of stay in hospital tends to be longer and outcomes are considerably worse: approximately 7,000 excess strokes and 12,000 excess heart attacks occur each year in people with CKD compared to those without. Individuals with CKD are also at much higher risk of developing acute kidney injury when they have an intercurrent illness such as pneumonia. Evidence based guidance from NICE identifies CVD risk reduction, good blood pressure control and management of proteinuria as essential steps to reduce the risk of cardiovascular events and progression to kidney failure. Despite this there is often significant variation between practices in achievement and exception reporting. What questions should we ask in our CCG? 1. For each indicator how wide is the variation in achievement and exception reporting? 2. How many people would benefit if all practices performed as well as the best? 3. How can we support practices who are average and below average to perform as well as the best in: Detection of CKD More systematic delivery of evidence based care What might help Promote participation by all practices in the National CKD Audit Obtain and benchmark practice level data from the National CKD Audit Promote uptake of and follow up from the NHS Health Check to aid detection and management of CKD Local training and education in the detection and management of CKD

Chronic kidney disease (CKD) observed prevalence (2014/15) compared to expected prevalence (2011) by CCG Comparison with CCGs in the SCN NHS Crawley CCG NHS Dartford, Gravesham And Swanley CCG NHS Thanet CCG NHS Ashford CCG 0.88 0.88 0.83 0.80 NHS South Kent Coast CCG 0.79 NHS Eastbourne, Hailsham And Seaford CCG 0.75 NHS Medway CCG 0.75 NHS Canterbury And Coastal CCG 0.72 NHS West Kent CCG 0.71 NHS Swale CCG 0.71 NHS Brighton And Hove CCG 0.70 NHS High Weald Lewes Havens CCG 0.67 NHS Horsham And Mid Sussex CCG 0.67 NHS Coastal West Sussex CCG 0.60 NHS East Surrey CCG 0.57 NHS Surrey Heath CCG 0.57 NHS North West Surrey CCG 0.57 NHS Guildford And Waverley CCG 0.54 NHS Hastings And Rother CCG 0.54 NHS Surrey Downs CCG 0.54 England 0.68 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Ratio 0.75 ratio of observed to expected CKD prevalence in NHS Eastbourne, Hailsham and Seaford CCG compared to 0.68 in England. This suggests that 75% of people with chronic kidney disease have been diagnosed. Note: This slide compares the prevalence of CKD recorded in QOF in 2014/15 to the expected prevalence of CKD produced by the University of Southampton in 2011. A small number of CCGs have a ratio greater than 1. It is unlikely that all people with CKD will be diagnosed in any CCG and therefore a ratio greater than 1 suggests that the figures are underestimating the true CKD prevalence in the area. These ratios should be taken as an indication of the comparative scale of undiagnosed CKD rather than absolute figures. 53 CVD: Primary Care Intelligence Packs

Chronic kidney disease (CKD) observed prevalence (2014/15) compared to expected prevalence (2011) by CCG Comparison with demographically similar CCGs NHS Lincolnshire East CCG 1.00 NHS Fylde & Wyre CCG 0.86 NHS North Derbyshire CCG 0.84 NHS Wyre Forest CCG 0.81 NHS Eastbourne, Hailsham and Seaford CCG 0.75 NHS Great Yarmouth and Waveney CCG 0.75 NHS North Norfolk CCG 0.72 NHS West Norfolk CCG 0.67 NHS South Devon and Torbay CCG 0.64 NHS North Staffordshire CCG 0.60 NHS Isle of Wight CCG 0.54 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Ratio 54 CVD: Primary Care Intelligence Packs

CKD prevalence by GP practice, 2014/15 GP practice CCG Dr S R Dickson And Partners G81004 Stone Cross Surgery G81008 Arlington Road Surgery G81050 Old School Surgery G81099 Seaforth Farm Surgery G81059 Seaford Health Centre G81029 The Lighthouse Medical Practice G81003 Bridgeside Surgery G81012 Grove Road Surgery G81002 Sovereign Practice G81022 Manor Park Medical Centre G81049 The Quintins Medical Centre G81098 Park Practice G81104 Bolton Road Surgery G81027 Green Street Clinic G81032 Crescent Medical Centre G81685 Enys Road Surgery G81056 11.5% 8.0% 8.0% 7.9% 7.7% 7.1% 6.8% 6.4% 5.9% 5.9% 5.8% 5.7% 5.4% 4.9% 4.7% 4.0% 3.9% It is estimated that there are 3,325 people with undiagnosed chronic kidney disease in NHS Eastbourne, Hailsham and Seaford CCG GP practice range of observed CKD: 0.5% to 11.5% Harbour Medical Practice Y00080 3.9% Herstmonceux Surgery G81634 3.6% Seaside Medical Centre G81017 3.4% Eastbourne Station Health Centre Y02816 0.5% 0% 2% 4% 6% 8% 10% 12% 14% Note: CCG estimates for the estimated number of people with CKD are based on applying a proportion from a resident based population estimate to a GP registered population. The characteristics of registered and resident populations may vary in some CCGs, and local interpretation is required. 55 CVD: Primary Care Intelligence Packs

Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmhg or less by CCG, 2014/15 Comparison with CCGs in the SCN Below 140/85 Not below 140/85 Exceptions reported NHS Swale CCG NHS Hastings And Rother CCG NHS North West Surrey CCG NHS Canterbury And Coastal CCG NHS Medway CCG NHS Thanet CCG NHS Eastbourne, Hailsham And Seaford CCG NHS East Surrey CCG NHS South Kent Coast CCG NHS Surrey Heath CCG NHS Crawley CCG NHS Dartford, Gravesham And Swanley CCG NHS West Kent CCG NHS Brighton And Hove CCG NHS Horsham And Mid Sussex CCG NHS Surrey Downs CCG NHS Guildford And Waverley CCG NHS High Weald Lewes Havens CCG NHS Ashford CCG NHS Coastal West Sussex CCG 79.3% 77.9% 77.7% 76.6% 76.3% 74.7% 74.7% 73.9% 73.7% 73.7% 73.5% 73.5% 73.5% 72.3% 72.2% 71.9% 71.6% 71.5% 71.1% 68.6% 9,817 people with CKD (diagnosed*) in NHS Eastbourne, Hailsham and Seaford CCG 7,330 (74.7%) people whose blood pressure is <= 140 /85 1,110 (11.3%) people who are exceptions 1,377 (14%) additional people whose blood pressure is not <= 140 / 85 England 74.4% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CKD002 denominator plus exceptions 56 CVD: Primary Care Intelligence Packs

Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmhg or less by CCG, 2014/15 Comparison with demographically similar CCGs Below 140/85 Not below 140/85 Exceptions reported NHS Isle of Wight CCG 76.0% NHS Lincolnshire East CCG 75.2% NHS Fylde & Wyre CCG 74.9% NHS Eastbourne, Hailsham and Seaford CCG 74.7% NHS North Staffordshire CCG 74.5% NHS Wyre Forest CCG 72.9% NHS North Derbyshire CCG 72.9% NHS West Norfolk CCG 72.5% NHS Great Yarmouth and Waveney CCG 71.8% NHS North Norfolk CCG 71.5% NHS South Devon and Torbay CCG 69.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 57 CVD: Primary Care Intelligence Packs

Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmhg or less by GP practice, 2014/15 Not below 140/85 Exceptions reported Seaford Health Centre G81029 404 Harbour Medical Practice Y00080 Enys Road Surgery G81056 Eastbourne Station Health Centre Y02816 Seaforth Farm Surgery G81059 Sovereign Practice G81022 Grove Road Surgery G81002 Park Practice G81104 Arlington Road Surgery G81050 The Lighthouse Medical Practice G81003 192 100 125 213 218 4 268 99 71 In total, including exceptions, there are 2,487 people whose blood pressure is not <= 140 / 85 GP practice range: 8.2% to 38.0% If all practices were to achieve as well as the average of the best achieving practices, then an additional 716 people would have their blood pressure controlled Bolton Road Surgery G81027 59 Bridgeside Surgery G81012 Herstmonceux Surgery G81634 60 23 Seaside Medical Centre G81017 Manor Park Medical Centre G81049 Old School Surgery G81099 The Quintins Medical Centre G81098 66 61 126 55 Green Street Clinic G81032 Dr S R Dickson And Partners G81004 164 65 Stone Cross Surgery G81008 109 Crescent Medical Centre G81685 5 0% 5% 10% 15% 20% 25% 30% 35% 40% 58 CVD: Primary Care Intelligence Packs

Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with CCGs in the SCN Recorded Not recorded Exceptions reported NHS Hastings And Rother CCG NHS Canterbury And Coastal CCG NHS Swale CCG NHS South Kent Coast CCG NHS Crawley CCG NHS Medway CCG NHS West Kent CCG NHS Thanet CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Guildford And Waverley CCG NHS Surrey Heath CCG NHS North West Surrey CCG NHS Brighton And Hove CCG NHS East Surrey CCG NHS High Weald Lewes Havens CCG NHS Horsham And Mid Sussex CCG NHS Coastal West Sussex CCG NHS Ashford CCG NHS Dartford, Gravesham And Swanley CCG NHS Surrey Downs CCG 80.3% 79.2% 77.1% 76.1% 76.1% 75.7% 75.7% 75.5% 74.9% 74.7% 74.7% 74.6% 73.8% 73.2% 73.0% 71.4% 67.4% 67.0% 66.9% 66.6% 9,817 people with CKD (diagnosed*) in NHS Eastbourne, Hailsham and Seaford CCG 7,349 (74.9%) people who have a record of urine albumin:creatinine ratio test 763 (7.8%) people who are exceptions 1,705 (17.4%) additional people who have no record of urine albumin:creatinine ratio test England 75.4% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CKD004 denominator plus exceptions 59 CVD: Primary Care Intelligence Packs

Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2014/15 Comparison with demographically similar CCGs Recorded Not recorded Exceptions reported NHS Wyre Forest CCG 79.6% NHS North Derbyshire CCG 77.8% NHS West Norfolk CCG 77.7% NHS North Staffordshire CCG 77.6% NHS Fylde & Wyre CCG 76.4% NHS Great Yarmouth and Waveney CCG 75.9% NHS Isle of Wight CCG 74.9% NHS Eastbourne, Hailsham and Seaford CCG 74.9% NHS Lincolnshire East CCG 73.3% NHS North Norfolk CCG 71.3% NHS South Devon and Torbay CCG 68.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 60 CVD: Primary Care Intelligence Packs

Percentage of patients on the CKD register whose notes do not have a record of a urine albumin: creatinine ratio test in the preceding 12 months by GP practice, 2014/15 Not recorded Exceptions reported Harbour Medical Practice Y00080 98 The Lighthouse Medical Practice G81003 Arlington Road Surgery G81050 Sovereign Practice G81022 Seaforth Farm Surgery G81059 Enys Road Surgery G81056 Seaford Health Centre G81029 The Quintins Medical Centre G81098 Grove Road Surgery G81002 Bolton Road Surgery G81027 257 211 246 84 291 78 89 54 343 In total, including exceptions, there are 2,468 people who have no record of urine albumin:creatinine ratio test GP practice range: 13.2% to 49.7% If all practices were to achieve as well as the average of the best achieving practices, then an additional 805 people would have their urine albumin/creatine ratio recorded Crescent Medical Centre G81685 Park Practice G81104 Seaside Medical Centre G81017 100 68 14 Herstmonceux Surgery G81634 Old School Surgery G81099 Eastbourne Station Health Centre Y02816 Manor Park Medical Centre G81049 Stone Cross Surgery G81008 Green Street Clinic G81032 Dr S R Dickson And Partners G81004 Bridgeside Surgery G81012 18 110 2 46 118 57 149 35 0% 10% 20% 30% 40% 50% 60% 61 CVD: Primary Care Intelligence Packs

Heart 62 CVD: Primary Care Intelligence Packs

Management of Heart Disease Premature death and disability in people with CHD can be reduced significantly by systematic evidence based management in primary care Coronary Heart Disease is one of the principal causes of premature death and disability. The key elements of management for an individual who already has had a heart attack or angina are symptom control and secondary prevention of further cardiovascular events and premature mortality. There is robust evidence to support the use of anti-platelet treatment, statins, beta-blockers and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. There is also robust evidence to support good control of blood pressure. Each of these interventions is incentivised in QOF but variation in achievement and exception reporting at practice level shows that there is often considerable potential for improving management and outcomes. Heart failure is a common and an important complication of coronary heart disease and other conditions. Again there is good evidence that appropriate treatment including up-titration of ace inhibitors and beta blockers in heart failure due to LVSD can significantly improve symptom control and quality of life, and improve outcomes for patients. Despite this, around a quarter of people with heart failure are undetected and untreated. And amongst those who are diagnosed, there is significant variation in the quality of care. What questions should we ask in our CCG? 1. For each indicator how wide is the variation in achievement and exception reporting? 2. How many people would benefit if all practices performed as well as the best? 3. How can we support practices who are average and below average to perform as well as the best in: More systematic delivery of evidence based care for people with CHD Improved detection and management of heart failure What might help 1. Roll out of GRASP-Heart Failure audit tool that identifies people with heart failure who are undiagnosed or under treated 2. Education for health professionals to promote evidence based management of CHD and high quality measurement of blood pressure 3. Education and training to support delivery of behaviour change interventions for CVD risk reduction in primary care 4. Ensure access to rapid access diagnostic clinics and specialist support for management of angina and heart failure 5. Ensure access to cardiac rehab for individuals with CHD and heart failure

NHS Eastbourne, Hailsham And Seaford CCG NHS Hastings And Rother CCG NHS Coastal West Sussex CCG NHS Thanet CCG NHS Swale CCG NHS High Weald Lewes Havens CCG NHS Horsham And Mid Sussex CCG NHS Medway CCG NHS South Kent Coast CCG NHS Canterbury And Coastal CCG NHS West Kent CCG NHS East Surrey CCG NHS Ashford CCG NHS Crawley CCG NHS Guildford And Waverley CCG NHS Brighton And Hove CCG NHS Dartford, Gravesham And Swanley CCG NHS North West Surrey CCG NHS Surrey Downs CCG NHS Surrey Heath CCG 1.00% 1.00% 0.85% 0.81% 0.76% 0.72% 0.70% 0.69% 0.64% 0.63% 0.61% 0.60% 0.59% 0.58% 0.53% 0.52% 0.52% 0.50% 0.50% 0.49% Heart failure prevalence by CCG Comparison with CCGs in the SCN Prevalence of 1% in NHS Eastbourne, Hailsham and Seaford CCG compared to 0.72% in England England 0.72% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 64 CVD: Primary Care Intelligence Packs

Heart failure prevalence by CCG Comparison with demographically similar CCGs NHS Fylde & Wyre CCG 1.43% NHS Wyre Forest CCG 1.08% NHS North Norfolk CCG 1.06% NHS Lincolnshire East CCG 1.03% NHS North Derbyshire CCG 1.03% NHS Eastbourne, Hailsham and Seaford CCG 1.00% NHS Great Yarmouth and Waveney CCG 0.93% NHS West Norfolk CCG 0.92% NHS Isle of Wight CCG 0.91% NHS North Staffordshire CCG 0.78% NHS South Devon and Torbay CCG 0.78% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 65 CVD: Primary Care Intelligence Packs

Heart failure prevalence by GP practice GP practice CCG The Lighthouse Medical Practice G81003 The Quintins Medical Centre G81098 Arlington Road Surgery G81050 Seaforth Farm Surgery G81059 Crescent Medical Centre G81685 Old School Surgery G81099 Seaford Health Centre G81029 Dr S R Dickson And Partners G81004 Stone Cross Surgery G81008 Grove Road Surgery G81002 Herstmonceux Surgery G81634 Bridgeside Surgery G81012 Bolton Road Surgery G81027 Sovereign Practice G81022 Enys Road Surgery G81056 Park Practice G81104 Seaside Medical Centre G81017 Green Street Clinic G81032 Manor Park Medical Centre G81049 Harbour Medical Practice Y00080 Eastbourne Station Health Centre Y02816 1.5% 1.4% 1.2% 1.2% 1.1% 1.1% 1.1% 1.1% 1.1% 1.0% 1.0% 0.9% 0.9% 0.8% 0.8% 0.8% 0.7% 0.7% 0.7% 0.6% 0.2% 1,906 people with diagnosed heart failure in NHS Eastbourne, Hailsham and Seaford CCG GP practice range: 0.2% to 1.5% 0.0% 0.2% 0.4% 0.6% 0.8% 1.0% 1.2% 1.4% 1.6% 66 CVD: Primary Care Intelligence Packs

Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with CCGs in the SCN Treatment No treatment Exceptions reported NHS Medway CCG NHS Guildford And Waverley CCG NHS Dartford, Gravesham And Swanley CCG NHS West Kent CCG NHS Horsham And Mid Sussex CCG NHS High Weald Lewes Havens CCG NHS South Kent Coast CCG NHS Surrey Heath CCG NHS North West Surrey CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Thanet CCG NHS Hastings And Rother CCG NHS Swale CCG NHS East Surrey CCG NHS Surrey Downs CCG NHS Crawley CCG NHS Canterbury And Coastal CCG NHS Brighton And Hove CCG NHS Ashford CCG NHS Coastal West Sussex CCG 89.7% 89.0% 88.2% 88.1% 87.7% 87.4% 87.4% 87.3% 86.9% 85.8% 85.8% 85.4% 84.7% 84.4% 84.3% 84.2% 83.6% 82.9% 82.7% 79.6% 843 people with heart failure* with LVSD in NHS Eastbourne, Hailsham and Seaford CCG 723 (85.8%) people treated with ACE- I or ARB 118 (14%) people who are exceptions 2 (0.2%) additional people who are not treated with ACE-I or ARB England 86.0% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF003 denominator plus exceptions 67 CVD: Primary Care Intelligence Packs

Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported NHS North Staffordshire CCG 89.1% NHS Lincolnshire East CCG 88.9% NHS Wyre Forest CCG 88.2% NHS Fylde & Wyre CCG 88.0% NHS Isle of Wight CCG 87.4% NHS Eastbourne, Hailsham and Seaford CCG 85.8% NHS Great Yarmouth and Waveney CCG 85.1% NHS North Derbyshire CCG 84.1% NHS West Norfolk CCG 84.0% NHS North Norfolk CCG 82.4% NHS South Devon and Torbay CCG 81.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 68 CVD: Primary Care Intelligence Packs

Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB by GP practice No treatment Exceptions reported Eastbourne Station Health Centre Y02816 1 Arlington Road Surgery G81050 Old School Surgery G81099 Dr S R Dickson And Partners G81004 Herstmonceux Surgery G81634 Seaforth Farm Surgery G81059 Bridgeside Surgery G81012 Manor Park Medical Centre G81049 Grove Road Surgery G81002 9 2 2 3 11 2 12 18 In total, including exceptions, there are 120 people who are not treated with ACE-I or ARB GP practice range: 0.0% to 25.0% If all practices were to achieve as well as the average of the best achieving practices, then an additional 46 people would be treated Harbour Medical Practice Y00080 1 Green Street Clinic G81032 6 Sovereign Practice G81022 The Quintins Medical Centre G81098 Seaford Health Centre G81029 7 8 10 Stone Cross Surgery G81008 10 The Lighthouse Medical Practice G81003 12 Seaside Medical Centre G81017 Crescent Medical Centre G81685 3 1 Enys Road Surgery G81056 1 Park Practice G81104 1 Bolton Road Surgery G81027 0% 5% 10% 15% 20% 25% 30% 69 CVD: Primary Care Intelligence Packs

Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with CCGs in the SCN Treatment No treatment Exceptions reported NHS North West Surrey CCG NHS Surrey Heath CCG NHS Swale CCG NHS Dartford, Gravesham And Swanley CCG NHS Crawley CCG NHS Medway CCG NHS Thanet CCG NHS Ashford CCG NHS West Kent CCG NHS South Kent Coast CCG NHS Horsham And Mid Sussex CCG NHS Guildford And Waverley CCG NHS Canterbury And Coastal CCG NHS Brighton And Hove CCG NHS East Surrey CCG NHS Hastings And Rother CCG NHS Coastal West Sussex CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Surrey Downs CCG NHS High Weald Lewes Havens CCG 84.8% 82.0% 81.4% 80.4% 79.5% 78.6% 76.6% 76.4% 76.3% 75.9% 75.8% 75.8% 75.4% 74.9% 74.6% 74.4% 72.9% 70.7% 67.5% 66.1% 721 people with heart failure* with LVSD treated with ACE-I/ARB in NHS Eastbourne, Hailsham and Seaford CCG 510 (70.7%) people treated with ACE- I/ARB and BB 141 (19.6%) people who are exceptions 70 (9.7%) additional people who are not treated with ACE-I/ARB and BB England 76.3% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator HF004 denominator plus exceptions 70 CVD: Primary Care Intelligence Packs

Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with demographically similar CCGs Treatment No treatment Exceptions reported NHS Fylde & Wyre CCG 84.1% NHS North Staffordshire CCG 80.7% NHS Lincolnshire East CCG 75.5% NHS North Derbyshire CCG 75.2% NHS Great Yarmouth and Waveney CCG 73.5% NHS West Norfolk CCG 71.7% NHS Wyre Forest CCG 71.0% NHS Eastbourne, Hailsham and Seaford CCG 70.7% NHS Isle of Wight CCG 69.2% NHS North Norfolk CCG 61.8% NHS South Devon and Torbay CCG 60.2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 71 CVD: Primary Care Intelligence Packs

Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB and BB by GP practice No treatment Exceptions reported Eastbourne Station Health Centre Y02816 2 Manor Park Medical Centre G81049 Enys Road Surgery G81056 Park Practice G81104 Arlington Road Surgery G81050 Herstmonceux Surgery G81634 Old School Surgery G81099 The Quintins Medical Centre G81098 Grove Road Surgery G81002 7 21 3 4 19 16 7 6 In total, including exceptions, there are 211 people who are not treated with ACE-I or ARB GP practice range: 0.0% to 66.7% If all practices were to achieve as well as the average of the best achieving practices, then an additional 79 people would be treated Bolton Road Surgery G81027 2 Seaforth Farm Surgery G81059 16 The Lighthouse Medical Practice G81003 33 Stone Cross Surgery G81008 Dr S R Dickson And Partners G81004 20 11 Sovereign Practice G81022 Seaford Health Centre G81029 Green Street Clinic G81032 11 16 9 Seaside Medical Centre G81017 7 Bridgeside Surgery G81012 1 Crescent Medical Centre G81685 Harbour Medical Practice Y00080 0% 10% 20% 30% 40% 50% 60% 70% 72 CVD: Primary Care Intelligence Packs

Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmhg or less by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported NHS Hastings And Rother CCG NHS Canterbury And Coastal CCG NHS West Kent CCG NHS Horsham And Mid Sussex CCG NHS North West Surrey CCG NHS Dartford, Gravesham And Swanley CCG NHS Crawley CCG NHS Thanet CCG NHS East Surrey CCG NHS Surrey Heath CCG NHS Ashford CCG NHS South Kent Coast CCG NHS Medway CCG NHS Guildford And Waverley CCG NHS Swale CCG NHS Eastbourne, Hailsham And Seaford CCG NHS High Weald Lewes Havens CCG NHS Brighton And Hove CCG NHS Surrey Downs CCG NHS Coastal West Sussex CCG 90.5% 90.0% 88.8% 88.8% 88.7% 88.7% 88.6% 88.2% 88.2% 88.0% 88.0% 87.9% 87.4% 87.3% 87.1% 86.9% 86.8% 86.2% 85.6% 85.2% 8,087 people with coronary heart disease* in NHS Eastbourne, Hailsham and Seaford CCG 7,029 (86.9%) people whose blood pressure <= 150 / 90 497 (6.1%) people who are exceptions 561 (6.9%) additional people whose blood pressure is not <= 150 / 90 England 88.4% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD002 denominator plus exceptions 73 CVD: Primary Care Intelligence Packs

Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmhg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported NHS Isle of Wight CCG 89.2% NHS Fylde & Wyre CCG 88.9% NHS North Derbyshire CCG 88.9% NHS Wyre Forest CCG 88.8% NHS Lincolnshire East CCG 88.2% NHS North Norfolk CCG 87.8% NHS West Norfolk CCG 87.7% NHS North Staffordshire CCG 87.7% NHS Eastbourne, Hailsham and Seaford CCG 86.9% NHS Great Yarmouth and Waveney CCG 86.8% NHS South Devon and Torbay CCG 85.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 74 CVD: Primary Care Intelligence Packs

Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmhg or less by GP practice Not below 150/90 Exceptions reported Sovereign Practice G81022 130 Park Practice G81104 Seaford Health Centre G81029 The Lighthouse Medical Practice G81003 Eastbourne Station Health Centre Y02816 Harbour Medical Practice Y00080 Seaforth Farm Surgery G81059 Grove Road Surgery G81002 Bolton Road Surgery G81027 Enys Road Surgery G81056 34 71 164 114 5 28 102 52 31 In total, including exceptions, there are 1,058 people whose blood pressure is not <= 150 / 90 GP practice range: 6.5% to 22.0% If all practices were to achieve as well as the average of the best achieving practices, then an additional 387 people would be treated Arlington Road Surgery G81050 Bridgeside Surgery G81012 Manor Park Medical Centre G81049 29 25 59 Old School Surgery G81099 46 Crescent Medical Centre G81685 7 Seaside Medical Centre G81017 28 Dr S R Dickson And Partners G81004 Stone Cross Surgery G81008 The Quintins Medical Centre G81098 Herstmonceux Surgery G81634 Green Street Clinic G81032 45 37 19 8 24 0% 5% 10% 15% 20% 25% 75 CVD: Primary Care Intelligence Packs

Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported NHS West Kent CCG NHS Dartford, Gravesham And Swanley CCG NHS Surrey Heath CCG NHS Hastings And Rother CCG NHS Ashford CCG NHS North West Surrey CCG NHS Canterbury And Coastal CCG NHS Eastbourne, Hailsham And Seaford CCG NHS South Kent Coast CCG NHS Medway CCG NHS Thanet CCG NHS East Surrey CCG NHS Crawley CCG NHS Horsham And Mid Sussex CCG NHS High Weald Lewes Havens CCG NHS Guildford And Waverley CCG NHS Surrey Downs CCG NHS Coastal West Sussex CCG NHS Brighton And Hove CCG NHS Swale CCG 93.3% 93.1% 92.9% 92.6% 92.6% 92.5% 92.4% 92.4% 92.3% 92.3% 92.1% 91.7% 91.4% 91.4% 91.2% 91.1% 90.3% 89.9% 89.7% 87.1% 8,087 people with coronary heart disease* in NHS Eastbourne, Hailsham and Seaford CCG 7,470 (92.4%) people who are taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant 354 (4.4%) people who are exceptions 263 (3.3%) additional people who are not taking aspirin, an alternative antiplatelet therapy, or an anti-coagulant England 91.7% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD005 denominator plus exceptions 76 CVD: Primary Care Intelligence Packs

Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported NHS Wyre Forest CCG 92.4% NHS Eastbourne, Hailsham and Seaford CCG 92.4% NHS North Derbyshire CCG 92.2% NHS North Staffordshire CCG 92.0% NHS Isle of Wight CCG 91.8% NHS North Norfolk CCG 91.6% NHS Fylde & Wyre CCG 91.5% NHS Great Yarmouth and Waveney CCG 91.1% NHS West Norfolk CCG 90.9% NHS Lincolnshire East CCG 90.2% NHS South Devon and Torbay CCG 88.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 77 CVD: Primary Care Intelligence Packs

Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice No treatment Exceptions reported Enys Road Surgery G81056 40 Sovereign Practice G81022 Bolton Road Surgery G81027 The Quintins Medical Centre G81098 Grove Road Surgery G81002 Harbour Medical Practice Y00080 Arlington Road Surgery G81050 Park Practice G81104 Herstmonceux Surgery G81634 Seaforth Farm Surgery G81059 35 10 53 29 34 17 48 24 69 In total, including exceptions, there are 617 people are not taking aspirin, an alternative anti-platelet therapy, or an anti-coagulant GP practice range: 2.7% to 15.8% If all practices were to achieve as well as the average of the best achieving practices, then an additional 187 people would be treated Green Street Clinic G81032 29 Stone Cross Surgery G81008 Manor Park Medical Centre G81049 Seaford Health Centre G81029 67 38 20 Bridgeside Surgery G81012 14 Seaside Medical Centre G81017 20 Crescent Medical Centre G81685 Dr S R Dickson And Partners G81004 4 32 Eastbourne Station Health Centre Y02816 Old School Surgery G81099 The Lighthouse Medical Practice G81003 18 1 15 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 78 CVD: Primary Care Intelligence Packs

The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported NHS Medway CCG NHS Surrey Heath CCG NHS Swale CCG NHS North West Surrey CCG NHS Crawley CCG NHS Eastbourne, Hailsham And Seaford CCG NHS Horsham And Mid Sussex CCG NHS West Kent CCG NHS Guildford And Waverley CCG NHS Canterbury And Coastal CCG NHS Hastings And Rother CCG NHS High Weald Lewes Havens CCG NHS South Kent Coast CCG NHS Surrey Downs CCG NHS East Surrey CCG NHS Brighton And Hove CCG NHS Thanet CCG NHS Ashford CCG NHS Coastal West Sussex CCG NHS Dartford, Gravesham And Swanley CCG 75.3% 75.2% 75.0% 71.2% 69.0% 66.9% 66.9% 66.8% 66.3% 66.0% 65.9% 65.5% 64.2% 64.0% 63.6% 63.4% 62.4% 59.7% 56.7% 43.5% 590 people with a history of myocardial infarction* in NHS Eastbourne, Hailsham and Seaford CCG 395 (66.9%) people who are taking an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, betablocker and statin <= 150 / 90 185 (31.4%) people who are exceptions 10 (1.7%) additional people who are not taking an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin England 69.1% 0% 20% 40% 60% 80% 100% *Using the QOF clinical indicator CHD006 denominator plus exceptions 79 CVD: Primary Care Intelligence Packs

The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported NHS Fylde & Wyre CCG 72.4% NHS Lincolnshire East CCG 71.9% NHS Isle of Wight CCG 70.3% NHS North Staffordshire CCG 69.5% NHS Great Yarmouth and Waveney CCG 68.8% NHS Wyre Forest CCG 67.4% NHS North Derbyshire CCG 67.1% NHS Eastbourne, Hailsham and Seaford CCG 66.9% NHS West Norfolk CCG 63.2% NHS North Norfolk CCG 62.0% NHS South Devon and Torbay CCG 57.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 80 CVD: Primary Care Intelligence Packs

The percentage of patients with a history of MI not currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by GP practice No treatment Exceptions reported Seaford Health Centre G81029 30 Manor Park Medical Centre G81049 Arlington Road Surgery G81050 Green Street Clinic G81032 Enys Road Surgery G81056 Eastbourne Station Health Centre Y02816 Sovereign Practice G81022 Bolton Road Surgery G81027 Park Practice G81104 Herstmonceux Surgery G81634 Grove Road Surgery G81002 8 12 4 10 3 3 27 6 11 14 In total, including exceptions, there are 195 people who are not taking an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin GP practice range: 0.0% to 47.6% If all practices were to achieve as well as the average of the best achieving practices, then an additional 60 people would be treated The Lighthouse Medical Practice G81003 18 Seaforth Farm Surgery G81059 8 The Quintins Medical Centre G81098 7 Bridgeside Surgery G81012 Harbour Medical Practice Y00080 9 3 Old School Surgery G81099 7 Dr S R Dickson And Partners G81004 5 Seaside Medical Centre G81017 5 Stone Cross Surgery G81008 5 Crescent Medical Centre G81685 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 81 CVD: Primary Care Intelligence Packs

Some data on outcomes for people with cardiovascular disease 82 CVD: Primary Care Intelligence Packs

Age standardised rate (per 100,000) Hospital admissions for myocardial infarction for all ages 2002/03 2014/15 NHS Eastbourne, Hailsham and Seaford CCG England 1000 900 800 700 In NHS Eastbourne, Hailsham and Seaford CCG, the hospital admission rate for myocardial infarction in 2014/15 was 524.1 (1,186) compared to 539.7 for England 600 500 400 300 200 100 0 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Source: Hospital Episode Statistics (HES), 2002/03-2014/15, Copyright 2016, Re used with the permission of The Health and Social Care Information Centre. All rights reserved 83 CVD: Primary Care Intelligence Packs

Age standardised rate (per 100,000) Hospital admissions for stroke for all ages 2002/03 2014/15 NHS Eastbourne, Hailsham and Seaford CCG England 200 180 160 140 In NHS Eastbourne, Hailsham and Seaford CCG, the hospital admission rate for stroke in 2014/15 was 118.8 (307) compared to 171.9 for England 120 100 80 60 40 20 0 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Source: Hospital Episode Statistics (HES), 2002/03-2014/15, Copyright 2016, Re used with the permission of The Health and Social Care Information Centre. All rights reserved 84 CVD: Primary Care Intelligence Packs

Additional risk of complications for people with diabetes, three year follow up, 2012/13 NHS Eastbourne, Hailsham and Seaford CCG England Angina Heart Attack Heart failure 113.9% 136.8% 56.4% 108.6% 137.6% 150.0% The risk of a stroke was 48% higher and the risk of a heart attack was 56.4% higher compared to people without diabetes. The risk of a major amputation was 360.2% higher. Stroke 48.0% 81.3% Major amputation 360.2% 445.8% Minor amputation 550.0% 753.5% RRT 344.6% 293.0% 0.0% 100.0% 200.0% 300.0% 400.0% 500.0% 600.0% 700.0% 800.0% Note: This slide uses data from the National Diabetes Audit (NDA) 85 CVD: Primary Care Intelligence Packs

Age standardised rate (per 1000,000) Deaths from myocardial infarction, under 75s NHS Eastbourne, Hailsham and Seaford CCG England 90 80 70 60 In NHS Eastbourne, Hailsham and Seaford CCG, the early mortality rate for myocardial infarction in 2012-14 was 28, compared to 41.5 for England 50 40 30 20 10 0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 Source: Office for National Statistics (ONS) mortality data 2002-2014 86 CVD: Primary Care Intelligence Packs

Age standardised rate (per 100,000) Deaths from stroke, under 75s NHS Eastbourne, Hailsham and Seaford CCG England 30 25 In NHS Eastbourne, Hailsham and Seaford CCG, the early mortality rate for stroke in 2012-14 was 13.2, compared to 13.8 for England 20 15 10 5 0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 Source: Office for National Statistics (ONS) mortality data 2002-2014 87 CVD: Primary Care Intelligence Packs

Appendix Data sources Quality and Outcomes Framework (QOF), 2014/15, Copyright 2016, re-used with the permission of the Health and Social Care Information Centre. All rights reserved Active people survey, Sport England, 2012, and 2012-2014 East of England Public Health Observatory modelled estimates 2011 CKD Prevalence model, G.Aitken, University of Southampton NHS Stop smoking services Copyright 2014, Health and Social Care Information Centre NHS Health checks, 2014/15 Norberg J, Bäckström S, Jansson J-H, Johansson L. Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clin Epidemiol 2013 ; 5 475 81. National Diabetes Audit, 2012/13 and 2013/14, Copyright 2016, re-used with the permission of the Health and Social Care Information Centre. All rights reserved Hospital Episode Statistics (HES), 2002/03-2014/15, Copyright 2016, Re used with the permission of The Health and Social Care Information Centre. All rights reserved Office for National Statistics (ONS) mortality data 2002 2014, Copyright 2016, Re-used with the permission of the Office for National Statistics. All rights reserved 88 CVD: Primary Care Intelligence Packs

About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Public Health England Wellington House 133-155 Waterloo Road London SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/publichealthengland Crown copyright 2016 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Published March 2016 89 CVD: Primary Care Intelligence Packs