cunliffeanalytics cancer indicator trend analysis stort valley & villages locality summary of...
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cunliffeanalytics
Cancer indicator trend analysisStort Valley & Villages localitySummary of practice level cancer indicators 2010 to 2012
Version 2.1
August 2013
2
Introduction letter TBC
3
Contents
Page
Introduction – purpose of the report 4
Screening indicators 5• Percentage of females aged 50–70 screened for breast cancer in last 36 months• Percentage of females aged 25–64 attending cervical screening within target period• Percentage of persons aged 60–69 screened for bowel cancer in last 30 months
Two week wait indicators 14• Two Week Wait referral ratio• Percentage of Two Week Wait referrals with cancer• Percentage of new cancer cases treated which are Two Week Wait referrals
Emergency admission indicator 23• Rate of emergency admissions with cancer per 100,000 population• Proportion of persons diagnosed with cancer via an emergency admission
Appendices 29• Definitions for indicators and demographics.
4
Introduction
Purpose of the report
The purpose of this report is to provide a three year summary of the key diagnosis and referral indicators for practices across Stort Valley & Villages locality.
Eight key indicators are reviewed at CCG, locality and practice level, highlighting how the activity rates have changed over the last three years, in relation to the current national targets and recommended ranges. The key indicators are:
• Percentage of females aged 50–70 screened for breast cancer in last 36 months• Percentage of females aged 25–64 attending cervical screening within target period• Percentage of persons aged 60–69 screened for bowel cancer in last 30 months• Two Week Wait referral ratio• Percentage of Two Week Wait referrals with cancer• Percentage of new cancer cases treated which are Two Week Wait referrals• Rate of emergency admissions with cancer per 100,000 population• Proportion of persons diagnosed with cancer via an emergency admission
Please note that this report is based on a small number of practices and therefore the locality level percentages shown are sensitive to volatile changes.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit 2010 to 2012Maps contain: Ordnance Survey data © Crown copyright and database right 2012 Royal Mail data © Royal Mail copyright and database right 2012, National Statistics data © Crown copyright and database right 2012.
5
Percentage of females aged 50–70 screened for breast cancer in last 36 months
Aim to be above the national target (70%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be
influential here.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: The number of females aged 50-70 registered to the practice screened adequately in previous 36 months divided by the number of eligible females (aged 50-70) on last day of the review period. (See appendix for full definition)
Indicator source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.
6
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
66%-69% 70%-73% 74%-77% 78%-81%
Num
ber of
pra
ctic
es
% Screened for breast cancer (F50-70)
66%
68%
70%
72%
74%
76%
78%
80%
2010 2011 2012
% S
cree
ned
for br
east
can
cer
( F50
-70)
CCG average remains just below the national average but above the national target of 70% for the last two years. The number of practices within the Stort Valley & Villages locality achieving the national target increased from two practices in 2011 to five in 2012.
Targets achieved for 3 years
Summary statistics
1National target > 70%
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
2010 2011 2012
England mean average 71.8% 72.5% 72.5%
CCG mean average 69.3% 72.5% 71.4%
Locality practice min 72.7% 68.7% 74.2%
Locality practice max 75.2% 70.1% 78.0%
Practices above national target1 5(5) 2(5) 5(5)
Practices above national target (%) 100.0% 40.0% 100.0%
Locality range and CCG mean average
Rate distribution – has the profile changed?
National target
Key
CCG mean average
Locality range
— National target
>70%
Key
2010
2011
2012
Note: Published year shown, 2010 refers to 3 year coverage for 2007/08 to 2009/10, 2011: 2008/09 to 2010/11, 2012: 2009/10 to 2011/12
KeyTargets achieved
3
2
1
0
7
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
South St Parsonage Much Hadham HC Church St Central Surgery
% S
cree
ned
for br
east
can
cer
(F50
-70)
2010 2011 2012 National target
All five practices within the Stort Valley & Villages locality achieved the 70% target in 2012.
Note: Published year shown, 2010 refers to 3 year coverage for 2007/08 to 2009/10, 2011: 2008/09 to 2010/11, 2012: 2009/10 to 2011/12
Key
Year on year increase
Year on year decrease
Above national target
Below national target
National target > 70%
Practice scores 2010 to 2012 Year on year rate At or above targetDifference
over2 years (pp1)
2010 2011 2012 2010 2011 2012
E82074 South St 75.2% q 69.4% p 78.0% ¢ ¢ ¢ p 8.6%
E82654 Parsonage 75.1% q 68.9% p 76.8% ¢ ¢ ¢ p 7.8%
E82021 Much Hadham HC 74.3% q 70.1% p 76.64% ¢ ¢ ¢ p 6.5%
E82067 Church St 72.8% q 68.7% p 76.6% ¢ ¢ ¢ p 7.9%
E82100 Central Surgery 72.7% q 70.0% p 74.2% ¢ ¢ ¢ p 4.1%
Percentage of females aged 25–64 attending cervical screening within target period
Aim to be above the national target (80%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be
influential here.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: The overall cervical screening coverage: the number of women registered at the practice screened adequately in the previous 42 months (if aged 24-49) or 66 months (if aged 50-64) divided by the number of eligible women on last day of review period. (See appendix for full definition)
Indicator source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.
9
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
70%-74% 75%-79% 80%-84% 85%-89%
Num
ber of
pra
ctic
es
% Attending cervical screening (F25-64)
60%
65%
70%
75%
80%
85%
2010 2011 2012
% A
tten
ding
cer
vica
l sc
reen
ing
( F25
-64)
CCG average remains steady and has been above the national average for the last three years but below the national target of 80%.
Summary statistics
1National target > 80%
2010 2011 2012
England mean average 75.4% 75.6% 75.3%
CCG mean average 78.2% 78.4% 78.2%
Locality practice min 76.7% 76.4% 74.9%
Locality practice max 84.3% 85.7% 84.4%
Practices above national target1 1(5) 2(5) 1(5)
Practices above national target (%) 20.0% 40.0% 20.0%
Locality range and CCG mean average
Rate distribution – has the profile changed?
National target
Key
CCG mean average
Locality range
— National target
>80%
Key
2010
2011
2012
Note: Published year shown, 2010 refers to 3.5 or 5.5 year coverage for 2004/05Q3 to 2009/10, 2011: 2005/06Q3 to 2010/11, 2012: 2006/07Q3 to 2011/12
Targets achieved for 3 years
KeyTargets achieved
3
2
1
0
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
10
55%
60%
65%
70%
75%
80%
85%
90%
Much Hadham HC Central Surgery Parsonage South St Church St
% A
tten
ding
cer
vica
l scr
eeni
ng (F2
5-64
)
2010 2011 2012 National target
One out of five practices within the Stort Valley & Villages locality achieved the 80% target in 2012. Three practices within the locality failed to meet the 80% target for the last three years.
Note: Published year shown, 2010 refers to 3.5 or 5.5 year coverage for 2004/05Q3 to 2009/10, 2011: 2005/06Q3 to 2010/11, 2012: 2006/07Q3 to 2011/12
Practice scores 2010 to 2012 Year on year rate At or above targetDifference
over2 years
(pp1)
2010 2011 2012 2010 2011 2012
E82021 Much Hadham HC 84.3% p 85.7% q 84.4% ¢ ¢ ¢ p -1.3%
E82100 Central Surgery 78.2% p 79.7% q 79.5% ¢ ¢ ¢ p -0.2%
E82654 Parsonage 78.9% p 80.2% q 77.8% ¢ ¢ ¢ q -2.5%
E82074 South St 79.6% q 78.9% q 77.5% ¢ ¢ ¢ q -1.4%
E82067 Church St 76.7% q 76.4% q 74.9% ¢ ¢ ¢ q -1.5%
Key
Year on year increase
Year on year decrease
Above national target
Below national target
National target > 80%
11
Percentage of persons, 60–69, screened for bowel cancer in last 30 months
Aim to be above the national target (60%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be
influential here.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: The number of persons aged 60-69 registered to the practice screened adequately in the previous 30 months divided by the number of eligible persons on last day of the review period. (See appendix for full definition)
Indicator source(s): Bowel Cancer Screening System (BCCS) via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.
12
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
45%-49% 50%-54% 55%-59% 60%-64%
Num
ber of
pra
ctic
es
% Screened for bowel cancer (60-69)
45%
50%
55%
60%
65%
2010 2011 2012
% S
cree
ned
for bo
wel
can
cer
(60-
69)
2010 2011 2012
England mean average 40.2% 51.5% 57.4%
CCG mean average 54.2% 55.1% 58.3%
Locality practice min 49.6% 52.2% 56.3%
Locality practice max 59.2% 58.8% 62.1%
Practices above national target1 0(5) 0(5) 3(5)
Practices above national target (%) 0.0% 0.0% 60.0%
CCG average has increased over the last 3 years, but remains below the national target of 60%. 2012 saw an increase in the proportion 60-69 year olds being screened across the Stort Valley & Villages locality.
Summary statistics
1National target > 60%
Locality range and CCG mean average
Rate distribution – has the profile changed?
National target
Key
CCG mean average
Locality range
— National target
>60%
Key
2010
2011
2012
Note: Published year shown, 2010 refers to 2.5 year coverage for 2007/08Q3 to 2009/10, 2011: 2008/09Q3 to 2010/11, 2012: 2009/10Q3 to 2011/12
Targets achieved for 3 years
KeyTargets achieved
3
2
1
0
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
13
30%
35%
40%
45%
50%
55%
60%
65%
70%
Church St South St Central Surgery Much Hadham HC Parsonage
% S
cree
ned
for bo
wel
canc
er (
60-6
9)
2010 2011 2012 National target
Three out of five practices within the Stort Valley & Villages locality achieved the 60% target in 2012. Two practices within the locality failed to achieved the 60% target during the last three years.
Note: Published year shown, 2010 refers to 2.5 year coverage for 2007/08Q3 to 2009/10, 2011: 2008/09Q3 to 2010/11, 2012: 2009/10Q3 to 2011/12
Practice scores 2010 to 2012 Year on year rate At or above targetDifference
over2 years
(pp1)
2010 2011 2012 2010 2011 2012
E82067 Church St 55.8% p 57.3% p 62.1% ¢ ¢ ¢ p 4.8%
E82074 South St 59.2% q 58.8% p 60.9% ¢ ¢ ¢ p 2.1%
E82100 Central Surgery 54.1% p 55.1% p 60.0% ¢ ¢ ¢ p 4.9%
E82021 Much Hadham HC 57.1% p 58.6% q 57.8% ¢ ¢ ¢ p -0.8%
E82654 Parsonage 49.6% p 52.2% p 56.3% ¢ ¢ ¢ p 4.1%
Key
Year on year increase
Year on year decrease
Above national target
Below national target
National target > 60%
Two Week Wait referral ratio (Indirectly age standardised )
Aim to be referring within 20% of the England average two week wait referral rate. Rates outside this range may indicate over/under use of the two week wait referral route.
You may wish to audit your referrals against NICE cancer referral guidance.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: The number of Two Week Wait referrals where cancer is suspected multiplied by 100,000 divided by the list size of the practice in question.
Indicator source(s): Trent Cancer Registry based on Cancer Waiting Times data for England, 2011/12, held on the DH Cancer Waiting Times Database.
15
0
0.5
1
1.5
2
2.5
3
3.5
40%-59% 120%+ 80%-99% 100%-119%
Num
ber of
pra
ctic
es
Referral ratio (IAS)
40%
60%
80%
100%
120%
140%
2010 2011 2012
Refe
rral
rat
io (
IAS1
)
The proportion of practices within the Stort Valley & Villages locality achieving the best practice range of 80% to 120% has remained steady for the last three years.
Summary statistics
1Best practice range = 80% to 120%, practices with less than 5 referrals excluded.
2010 2011 2012
England mean average 100.0% 100.0% 100.0%
CCG mean average n/a n/a n/a
Locality practice min 60.6% 57.5% 56.9%
Locality practice max 109.3% 90.0% 98.9%
Practices within best practice range1 3(5) 2(5) 3(5)
Practices within best practice range (%) 60.0% 40.0% 60.0%
Locality range and CCG mean average
Referral ratio distribution – has the profile changed?Best practice
range
Key
Locality range
— Best practice range
= 80% to 120%
Key
2010
2011
2012
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Stort Valley & Villages practices achieving the best practice range for 3 years
KeyTargets achieved
3
2
1
0
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
16
20%
40%
60%
80%
100%
120%
140%
160%
Parsonage South St Church St Central Surgery Much Hadham HC
Refe
rral
ratio
(in
dire
ctag
e st
anda
rdised
)
2010 2011 2012 Best practice range
Three out of five practices within the Stort Valley & Villages locality were within the best practice range of 80% to 20% in 2012. One practice failed to achieve the best practice range for the last three years.
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Practice scores 2010 to 2012 Year on year rate Within best practice rangeDifference
over2 years
(pp1)
2010 2011 2012 2010 2011 2012
E82654 Parsonage 69.2% p 74.0% p 98.9% ¢ ¢ ¢ p 24.9%
E82074 South St 83.8% p 90.0% p 97.4% ¢ ¢ ¢ p 7.4%
E82067 Church St 90.3% q 87.9% q 86.0% ¢ ¢ ¢ q -1.9%
E82100 Central Surgery 109.3% q 77.4% q 72.3% ¢ ¢ ¢ q -5.1%
E82021 Much Hadham HC 60.6% q 57.5% q 56.9% ¢ ¢ ¢ q -0.6%
Key
Year on year increase
Year on year decrease
Within best practice range
Outside best practice range
Best practice 80% to 120%
Percentage of Two Week Wait referrals with cancer
Aim to have conversion rate between 8-14%. Rates outside this range may indicate over/under use of the two week wait referral route. You may wish to audit your referrals
against NICE cancer referral guidance. There is no target number for referral as this depends on practice size and demographics.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: The ‘conversion rate’, i.e., the proportion of Two Week Wait referrals that are subsequently diagnosed with cancer: the number of new cancer cases treated in 2011/12 who were referred through the two week wait route divided by the total number of Two Week Wait referrals in 2011/12.
Indicator source(s): Trent Cancer Registry based on Cancer Waiting Times data for England, 2011/12, held on the DH Cancer Waiting Times Database.
18
0
0.5
1
1.5
2
2.5
3
3.5
5%-7% 8%-10% 11%-13% 14%-16%
Num
ber of
pra
ctic
es
% of TWW referrals with cancer
6%
8%
10%
12%
14%
16%
2010 2011 2012
% o
f TW
W re
ferral
s w
ith
canc
er
6%
8%
10%
12%
14%
16%
2010 2011 2012
% o
f TW
W re
ferral
s w
ith
canc
er
The number of practices within the Stort Valley & Villages locality achieving the best practice range of 8% to 14% has remained steady for the last three years.
Summary statistics
1Best practice = 8% to 14%, practices with less than 5 referrals excluded.
2010 2011 2012
England mean average 11.2% 10.9% 10.6%
CCG mean average 10.5% 10.6% 11.6%
Locality practice min 7.5% 6.9% 6.4%
Locality practice max 11.6% 9.6% 15.2%
Practices within best practice range1 1(4) 2(4) 2(4)
Practices within best practice range (%) 25.0% 50.0% 50.0%
Locality range and CCG mean average
Indicator distribution – has the profile changed?
Key
CCG mean average
Locality range
— Best practice = 8% to
14%
Key
2010
2011
2012
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Best practice range
Stort Valley & Villages practices achieving the best practice range over 3 years
KeyTargets achieved
3
2
1
0
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
19
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Much Hadham HC Central Surgery Church St South St Parsonage
% o
f TW
W re
ferral
s w
ith c
ance
r
2010 2011 2012 Best practice range
Two out of four practices within the Stort Valley & Villages locality achieved the best practice range of 8% to 14% within 2012. One practice failed to achieve the best practice range for the last three years.
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, activity based on less than 5 referrals are not shown.
Practice scores 2010 to 2012 Year on year rate Within best practice rangeDifference
over2 years
(pp1)
2010 2011 2012 2010 2011 2012
E82021 Much Hadham HC 11.6% q 9.6% p 15.2% ¢ ¢ ¢ p 5.6%
E82100 Central Surgery 7.5% q 6.9% p 10.6% ¢ ¢ ¢ p 3.7%
E82067 Church St 7.8% p 9.0% q 9.0% ¢ ¢ ¢ p 0.0%
E82074 South St 7.5% q 7.0% q 6.4% ¢ ¢ ¢ q -0.5%
E82654 Parsonage - - - -
Key
Year on year increase
Year on year decrease
Within best practice range
Outside best practice range
Best practice 8% to 14%
Percentage of new cancer cases treated which are Two Week Wait referrals
Aim to be above the line and have more of your cancer cases diagnosed through the two week wait referral route. Consider doing the RCGP cancer diagnosis audit.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: The proportion of new cancer cases treated who were referred through the Two Week Wait route.
Indicator source(s): Trent Cancer Registry based on Cancer Waiting Times data for England, 2011/12, held on the DH Cancer Waiting Times Database.
21
0
0.5
1
1.5
2
2.5
3
3.5
20%-29% 30%-39% 40%-49% 50%-59% 60%-69%
Num
ber
of p
ract
ices
% of new cancer cases are TWW referrals
20%
30%
40%
50%
60%
70%
2010 2011 2012
% o
f new
can
cer
case
s ar
e TW
W
refe
rral
s
CCG average has increased year on year and has achieved the recommended minimum of 40% for the last two years, but remains below the national average.
Summary statistics
1Recommended minimum = 40%, practices with less than 5 referrals excluded.
2010 2011 2012
England mean average 42.9% 45.3% 46.5%
CCG mean average 39.5% 41.9% 43.5%
Locality practice min 29.6% 23.1% 38.0%
Locality practice max 42.9% 41.4% 60.0%
Practices above recommended min.1 1(5) 1(5) 4(5)
Practices above recommended min. (%) 20.0% 20.0% 80.0%
Locality range and CCG mean average
Indicator distribution – has the profile changed?
Key
CCG mean average
Locality range
— Recommended minimum
40%
Key
2010
2011
2012
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Recommended minimum =
40%
Stort Valley & Villages practices achieving the recommended minimum of 40% over 3 years
KeyTargets achieved
3
2
1
0
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
22
0%
10%
20%
30%
40%
50%
60%
70%
80%
Much Hadham HC Church St Parsonage South St Central Surgery
% o
f new
can
cer
case
s ar
e TW
W ref
erra
ls
2010 2011 2012 Recommended minimum
Four out of five practices within the Stort Valley & Villages locality achieved the recommended minimum of 40% in 2012.
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, ratios based on less than 5 referrals are not shown.
Practice scores 2010 to 2012 Year on year rate At or above targetDifference
over2 years
(pp1)
2010 2011 2012 2010 2011 2012
E82021 Much Hadham HC 29.6% p 35.0% p 60.0% ¢ ¢ ¢ p 25.0%
E82067 Church St 34.6% p 38.3% p 46.3% ¢ ¢ ¢ p 8.0%
E82654 Parsonage 42.9% q 23.1% p 40.0% ¢ ¢ ¢ q 16.9%
E82074 South St 33.3% p 39.3% p 40.0% ¢ ¢ ¢ p 0.7%
E82100 Central Surgery 30.8% p 41.4% q 38.0% ¢ ¢ ¢ p -3.4%
Key
Year on year increase
Year on year decrease
Above recommended minimum
Below recommended minimum
Recommended minimum = 40%
Rate of emergency admissions with cancer, per 100,000 population
Aim to minimize the number of cancer patients requiring emergency admissions. Try to proactively manage cases. Consider using the RCGP Significant Event Audit
to reflect on cases.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: The number of persons admitted to hospital as an inpatient or day-case via an emergency admission multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons.
Indicator source(s): Hospital Episode Statistics (HES) data for 1st March 2011 to 29th February 2012 was taken from the UKACR “Cancer HES” offload originally sourced from the NHS Information Centre for Health and Social Care HES dataset.
24
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
300-399 400-499 500-599 1000-1250
Num
ber
of p
ract
ices
Emergency admis. per 100,000 population
300
400
500
600
700
800
2010 2011 2012
Emer
genc
y ad
mis. p
er
100,
000
popu
latio
n
CCG average varies year on year but remains below the recommended maximum of 578 and below the national average. The maximum rate for the Stort Valley & Villages locality has decreased year on year.
Summary statistics
1Recommended maximum = national average (587 in 2012), practices with less than 5 admissions excluded.
2010 2011 2012
England mean average 691 583 587
CCG mean average 519 459 502
Locality practice min 419 397 349
Locality practice max 685 530 463
Practices below recommended max.1 4(5) 5(5) 5(5)
Practices below recommended max. (%) 80.0% 100.0% 100.0%
Locality range and CCG mean average
Rate distribution – has the profile changed?
Key
CCG mean average
Locality range
— Recommended maximum =
587
Key
2010
2011
2012
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Recommended maximum =
587
Stort Valley & Villages practices achieving recommended maximum rate of 587 over 3 years
KeyTargets achieved
3
2
1
0
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
25
0
100
200
300
400
500
600
700
800
Church St Much Hadham HC South St Central Surgery Parsonage
% o
f new
can
cer
case
s ar
e TW
W ref
erra
ls
2010 2011 2012 Recommended maximum
All five practices in the Stort Valley & Villages locality were below the recommended maximum of 587 in 2012.
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, rates based on less than 5 admissions are not shown.
Practice scores 2010 to 2012 Year on year rate At or below targetDifference
over2 years
(pp1)
2010 2011 2012 2010 2011 2012
E82067 Church St 422 q 397 p 463 ¢ ¢ ¢ p 66
E82021 Much Hadham HC 419 p 488 q 424 ¢ ¢ ¢ p -64
E82074 South St 584 q 442 q 417 ¢ ¢ ¢ q -24
E82100 Central Surgery 572 q 432 q 410 ¢ ¢ ¢ q -23
E82654 Parsonage 685 q 530 q 349 ¢ ¢ ¢ q -181
Key
Year on year increase
Year on year decrease
Below recommended maximum
Above recommended maximum
Recommended range <National average (587 in 2012)
Proportion of persons diagnosed with cancer via an emergency admission
Aim to have as few emergency presentations of cancer and more of the cases detected through managed referral routes. Consider using the RCGP significant Event Audit to reflect
on cases and using Risk Assessment Tools to help guide investigation and referral.
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit
Definition: Proportion of persons diagnosed via an emergency, managed referral or other route.
Indicator source(s): Routes to Diagnosis project database
27
0
0.5
1
1.5
2
2.5
3
3.5
10%-19% 20%-29% 30%-39% 40%-49%
Num
ber
of p
ract
ices
Proportion of persons diagnosed via emergency presentation
0%
10%
20%
30%
40%
50%
2010 2011 2012
Prop
ortio
n of
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CCG average remains around the maximum of the recommended range (0% to 20%).
Summary statistics
1Recommended range = 0% to 20%, practices with less than 5 admissions excluded.
2010 2011 2012
England mean average 23.7% 23.8%
CCG mean average 20.4% 20.9%
Locality practice min 14.3% 10.5%
Locality practice max 36.4% 42.9%
Practices within recommended range1 2(3) 3(5)
Practices within recommended range (%) 66.7% 60.0%
Locality range and CCG mean average
Indicator distribution – has the profile changed?
Key
CCG mean average
Locality range
— Recommended range = 0%
to 20%
Key
2010
2011
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Recommended range - 0% to
20%
Stort Valley & Villages practices achieving recommended range of 0% to 20 % over 2 years
Note: 2012 data not available across all CCGs
KeyTargets achieved
2
1
0
Not shown
(low volumes)
Maps contain: Ordnance Survey data © Crown copyright and database right 2012, Royal Mail data © Royal Mail
copyright and database right 2012, National Statistics data © Crown
copyright and database right 2012
28
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Parsonage South St Much Hadham HC Church St Central Surgery
Pro
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of p
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2010 2011 2012 Recommended range
Two out of three practices in the locality were within the recommended range of 0% to 20% in 2011.
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, rates based on less than 5 admissions are not shown.
Practice scores 2010 to 2012 Year on year rate At or below targetDifference
over2 years
(pp1)
2010 2011 2012 2010 2011 2012
E82654 Parsonage - 42.9% - ¢ -
E82074 South St 19.1% p 21.6% - ¢ ¢ -
E82021 Much Hadham HC - 18.5% - ¢ -
E82067 Church St 22.4% q 16.9% - ¢ ¢ -
E82100 Central Surgery 16.1% q 10.5% - ¢ ¢ -
Key
Year on year increase
Year on year decrease
Within recommended range
Outside recommended range
Recommended range = 0% to 20%
Note: rates based on less than 5 admissions are not shown.
APPENDIXIndicator definitions
30
Percentage of females aged 50–70 screened for breast cancer in last 36 months
Aim to be above the national target (70%). Consider actively encouraging patients to participate in
screening programmes with letters or opportunistic prompts. GPs can be influential here.
Indicator definition• Number: The number of females aged 50 to 70 registered to the practice who were screened adequately in
the previous 36 months.
• Rate or proportion: 3-year screening coverage %: The number of females registered to the practice screened adequately in previous 36 months divided by the number of eligible females on last day of the review period.
• Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2011, and covers the period 2009/10-2011/12.
Binomial confidence intervals are calculated using the Wilson score method1.
• Source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.
• Interpretation: Women are invited for screening for the first time between their 50th and 53rd birthdays and every three years thereafter up to but not including their 71st birthdays. Over this 21 year window a woman who responds to each invitation should be screened 7 times. This indicator measures the fraction of this pool of eligible women who have been screened adequately, at least once, in the three years before April 2011.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
31
Percentage of females aged 25–64 attending cervical screening within target period
Aim to be above the national target (80%). Consider actively encouraging patients to participate in
screening programmes with letters or opportunistic prompts. GPs can be influential here.
Indicator definition• Number: The number of women registered at the practice screened adequately in the previous 42 months (if
aged 24-49) or 66 months (if aged 50-64)
• Rate or proportion: The overall cervical screening coverage: the number of women registered at the practice screened adequately in the previous 42 months (if aged 24-49) or 66 months (if aged 50-64) divided by the number of eligible women on last day of review period.
• Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2011, and covers the period 2006/07Q3-2011/12.
Binomial confidence intervals are calculated using the Wilson score method1.
• Source(s): Data was extracted from the NHAIS via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.
• Interpretation: Women aged 25-49 are invited for routine screening every 3 years and women aged 50-64 are invited for routine screening every 5 years. This indicator gives a combined coverage for the full age range so that it counts women aged 25-49 screened within a period of 3.5 years and women aged 50-64 within a period of 5.5 years prior to the report date and combines the counts to give the final measure.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
32
Percentage of persons, 60–69, screened for bowel cancer in last 30 months
Aim to be above the national target (60%). Consider actively encouraging patients to participate in screening programmes with letters or opportunistic prompts. GPs can be
influential here.
Indicator definition• Number: The number of persons aged 60 to 69 registered to the practice who were screened adequately in
the previous 30 months.
• Rate or proportion: 2.5-year screening coverage %: The number of persons registered to the practice screened adequately in the previous 30 months divided by the number of eligible persons on last day of the review period.
• Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2011, and covers the period 2009/10Q3-2011/12.
Binomial confidence intervals are calculated using the Wilson score method1.
• Source(s): Data was extracted from the Bowel Cancer Screening System (BCCS) via the Open Exeter system. Data was collected by the NHS Cancer Screening Programme.
• Interpretation: This indicator measures the fraction of this pool of eligible people who have been screened adequately in the previous 2.5 years. Caution should be used in interpreting the data as not all CCGs had full implementation of the programme in the recorded period.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
33
Two Week Wait referral ratio (indirectly age standardised)
Aim to be referring within 20% of the England average two week wait referral rate. Rates outside this range may indicate over/under use of the two week wait referral route.
You may wish to audit your referrals against NICE cancer referral guidance.
Indicator definition• Number: The number of Two Week Wait (GP urgent) referrals where cancer is suspected for patients
registered at the practice in question in 2011/12.
• Rate or proportion: The crude rate of referral: the number of Two Week Wait referrals where cancer is suspected multiplied by 100,000 divided by the list size of the practice in question.
• Method: Patient level Cancer Waiting Times (CWT) data (including patient identifiers) was downloaded from the DH Cancer Waiting Times Database by the Trent Cancer Registry. Each patient was traced to a GP Practice using the Open Exeter Batch Tracing Service. Two Week Wait Referrals were identified for patients with a date first seen on the CWT database in 2011/12. All records with a ‘Referral Priority Type’ of 3 (Two Week Wait) were counted, excluding patients referred for non-cancer breast symptoms.
Poisson confidence intervals are calculated using Byar’s approximation1.
• Source(s): Trent Cancer Registry based on Cancer Waiting Times data for England, 2011/12, held on the DH Cancer Waiting Times Database.
• Interpretation: The number of Two Week Wait referrals with a suspicion of cancer, whether or not cancer was subsequently diagnosed. This indicator may be expected to be higher in practices with an unusually high proportion of persons of 65+ years of age, due to the higher incidence of cancer at these ages.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
34
Percentage of Two Week Wait referrals with cancer
Aim to have conversion rate between 8-14%. Rates outside this range may indicate over/under use of the two week wait referral route. You may wish to audit your referrals against NICE cancer referral guidance.
There is no target number for referral as this depends on practice size and demographics.
Indicator definition• Number: The number of Two Week Wait referrals treated for cancer for patients registered at the practice in question.
• Rate or proportion: The ‘conversion rate’, i.e., the proportion of Two Week Wait referrals that are subsequently diagnosed with cancer: the number of new cancer cases treated in 2011/12 who were referred through the two week wait route divided by the total number of Two Week Wait referrals in 2011/12.
• Method: Patient level Cancer Waiting Times data (including patient identifiers) was downloaded from the DH Cancer Waiting Times Database by the Trent Cancer Registry. Each patient was traced to a GP Practice using the Open Exeter Batch Tracing Service. Patients on the CWT database who had received a cancer diagnosis were identified as those patients receiving a first treatment in 2011/12, i.e. with ‘Cancer Treatment Event Type’ of 01 (First definitive treatment for a new primary cancer) or 07 (First treatment for metastatic disease following an unknown primary).
It was not possible to directly identify which referrals were subsequently diagnosed with cancer. Therefore, the proportion of referrals diagnosed with cancer was calculated by dividing the number of patients receiving a first treatment in 2011/12 who were referred through the two week wait route by the number of two week wait referrals. Most of the Two Week Wait referrals first seen in 2011/12 who were diagnosed with cancer will have started treatment in 2011/12 but a small number will have started treatment in 2011/12 and a small number of patients who started treatment in 2011/12 will have been first seen in 2010/11. For a very small number of practices, this may result in a ‘conversion rate’ of more than 100% being calculated.
Binomial confidence intervals are calculated using the Wilson score method1.
• Source(s): Trent Cancer Registry based on Cancer Waiting Times data for England, 2011/12, held on the DH Cancer Waiting Times Database.
• Interpretation: The number of Two Week Wait referrals with a suspicion of cancer, in which cancer was subsequently diagnosed.
The proportion is the ‘conversion rate’ for the practice. This varies by cancer type and so will depend on the case-mix of cancers diagnosed in persons registered at the practice. Either an unusually high or an unusually low conversion rate may merit further investigation.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
35
Percentage of new cancer cases treated which are Two Week Wait referrals
Aim to be above the line and have more of your cancer cases diagnosed through the two week wait referral route. Consider doing the RCGP cancer diagnosis audit.
Indicator definition• Number: The number of patients registered at the practice who have a date of first treatment in 2011/12 on
the cancer waiting times system.
• Rate or proportion: The proportion of new cancer cases treated who were referred through the Two Week Wait route. This is calculated as the number of persons referred as a Two Week Wait referral who were subsequently diagnosed with cancer divided by the total number of patients registered at the practice who have a date of first treatment in 2011/12 on the cancer waiting times system.
• Method: Patient level Cancer Waiting Times data (including patient identifiers) was downloaded from the DH Cancer Waiting Times Database by the Trent Cancer Registry. Each patient was traced to a GP Practice using the Open Exeter Batch Tracing Service.
Binomial confidence intervals are calculated using the Wilson score method1.
• Source(s): Trent Cancer Registry based on Cancer Waiting Times data for England, 2011/12, held on the DH Cancer Waiting Times Database.
• Interpretation: This indicator shows the proportion of cancers that were first diagnosed following a two week wait referral. This varies by cancer type and so will depend on the case-mix of cancers diagnosed in persons registered at the practice.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
36
Rate of emergency admissions with cancer, per 100,000 population
Aim to minimize the number of cancer patients requiring emergency admissions. Try to proactively manage cases. Consider using the RCGP Significant Event Audit to reflect on
cases.
Indicator definition• Number: The number of persons admitted to hospital as an inpatient or day-case via an emergency
admission, with a diagnostic code that includes cancer.
• Rate or proportion: The number of persons admitted to hospital as an inpatient or day-case via an emergency admission multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons.
• Method: All emergency admissions with an invasive, in-situ, uncertain or unknown behaviour, or benign brain cancer (ICD-10 C00-C97, D00-D09, D33, and D37-48) present in any of the first three diagnostic fields were extracted from the inpatient HES database.
• Source(s): Hospital Episode Statistics (HES) data for 1st March 2011 to 29th February 2012 was taken from the UKACR “Cancer HES” offload originally sourced from the NHS Information Centre for Health and Social Care HES dataset.
• Interpretation: The number and crude rate per 100,000 persons of emergency in-patient or day-case admissions, sourced from HES data, with a diagnosis that includes cancer. These may occur at any stage of the cancer pathway and will include persons diagnosed with cancer in prior years. This indicator may be expected to be higher in practices with an unusually high fraction of persons of 65+ years of age, due to the higher incidence of cancer at these ages.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)
37
Aim to have as few emergency presentations of cancer and more of the cases detected through managed
referral routes. Consider using the RCGP significant Event Audit to reflect on cases and using
Risk Assessment Tools to help guide investigation and referral.
Indicator definition• Number: Number of persons diagnosed via an emergency route, as defined by the Routes to Diagnosis project methodology1
• Rate or proportion: Number of persons diagnosed via an emergency route divided by the number of persons with any categorised route to diagnosis.
• Method: The data for the pool of patients diagnosed with cancer (ICD-10 C00-C97 excluding C44) in 2008 cancer registry records was examined. These were linked at a patient level to the Routes to Diagnosis
In brief, the Routes to Diagnosis project method was that data sources of Screening, Inpatient HES, Outpatient HES, and Cancer Waiting Times were used to trace the history of each patient diagnosed with cancer in the year 2008. Patient histories in the datasets above prior to diagnosis were used to categorise the route that the patient took to arrive at the point of diagnosis.
Eight main routes were defined in the Routes to Diagnosis project, these are aggregated into three broad routes in these Practice Profiles – Emergency Presentation, Managed Presentation, and Other Presentation. Emergency presentations are those initiated by an emergency event of some type, Managed Presentations consist of those following a routine or Two week Wait referral from a GP, Other Presentations are those via screening, death certificate only, Inpatient Elective, Other outpatients, and Unknown. See the Routes to Diagnosis Project for further information1.
Binomial confidence intervals are calculated using the Wilson score method2.
• Source(s): Routes to Diagnosis project database.
• Interpretation: The number of persons who present as an emergency. The rate is the estimated fraction of all presentations that are emergencies, though patients who were diagnosed with multiple independent cancers in the same year were excluded.
Aggregated data may give slightly different totals for England than previously published as it applies only to those patients who can be traced to a practice database.
Proportion of persons diagnosed with cancer via an emergency admission
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1Routes to Diagnosis methodology, available online at: http://www.ncin.org.uk/publications/routes_to_diagnosis.aspx2APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
APPENDIXDemographic definitions
39
Practice Population aged 65+
Indicator definition• Number: The number of persons registered at the practice aged 65+.
• Rate or proportion: The percentage of persons registered at the practice aged 65+, defined by the number of persons registered at the practice divided by the list size of the practice.
• Method: Data is taken from the Attribution Dataset, extracted April 2011. The number of persons aged 65+ is the sum across the population in the 65-69, 70-74, 75-79, 80-84, and 85+ age-bands. The fraction of the practice population aged 65+ is calculated by dividing the number aged 65+ by the list size of the practice sourced from the 2011/12 QOF data.
Binomial confidence intervals are calculated using the Wilson score method1.
• Interpretation: The percentage of the population over the age of 65 may be expected to have a significant effect on the burden of cancer in the practice population. The percentage of the population is taken as at April 2011 and will not reflect changes since then.
• Source(s): Data sourced from the Attribution Dataset provided by the South East Public Health Observatory.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012) 1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
40
Socio-economic deprivation
Indicator definition• Number: The estimated quintile of deprivation of the practice.
• Rate or proportion: The estimated income domain score for the practice, which is the percentage of the practice list that is income deprived1.
• Method: Index of Multiple Deprivation (IMD) scores for each deprivation domain have been estimated for each practice by the English Public Health Observatories using the Index of Multiple Deprivation (IMD) 2010 by Lower Super Output Area (LSOA)2. Briefly, the overall socio-economic deprivation of the practice is estimated by averaging the socio-economic deprivation of each person on the practice list based on their LSOA of residence. Practices were ranked nationally by Income Domain score and allocated into equal population quintiles (1 being coded as the most affluent quintile, and 5 as the most deprived quintile).
Binomial confidence intervals are calculated using the Wilson score method3.
• Interpretation: Several common cancers have a known dependence on the socio-economic status of the population. A more deprived population may be expected to have a higher incidence rate of lung cancer but lower incidence rates of prostate and breast cancer.
• Source(s): Data provide by the English Public Health Observatories.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012) 1The English Indices of Deprivation 2010. Communities and Local Government. Available online at: http://www.communities.gov.uk/publications/corporate/statistics/indices20102GP practice IMD 2007 – Calculation Notes, South East Public Health Observatory, 2010. 3APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
41
New cancer cases
Indicator definition• Number: The number of persons diagnosed with any invasive cancer excluding non-melanoma skin cancer
(ICD-10 C00-C97, excluding C44) in 2010
• Rate or proportion: The crude incidence rate per 100,000 persons: the number of new cases diagnosed multiplied by 100,000 divided by the practice list size.
• Method: All invasive cancers diagnosed in 2010 registered by cancer registries and present in the 2010 Office of National Statistics analysis dataset were included. These patients were matched to a GP surgery by tracing them by NHS number to find their current and previous practice. Persons were allocated to their practice at their time of diagnosis. If this was not possible (for example, due to the patient having moved practice more than once in the time between diagnosis and trace) they were not included. The resultant total number of cancer diagnoses across England is 93% of the Office of National Statistics total number of cases for the country.
• Source(s): Office of National Statistics 2010. Each patient was traced to a GP Practice using the NHS Personal Demographics Service.
• Interpretation: This indicator gives the number of new cases and incidence rate of invasive cancer (excluding non-melanoma skin cancer) in the practice population, as estimated from cancer registry data for calendar year 2010. Cancer registry data includes persons diagnosed solely through their death certificate or who died shortly after an emergency presentation in secondary care, so may be larger than number of persons known to the practice. However, as 7% of cases could not be traced to a specific practice and are not included numbers at an individual practice may be undercounted by approximately this much. Numbers of cases may also fluctuate year to year meaning that caution should be used in comparing this indicator to other indicators such as the number of new cancer cases treated in 2011/12 taken from the Cancer Waiting Times database.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)
42
Cancer deaths
Indicator definition• Number: The number of deaths with an underlying cause of death which is any invasive cancer (ICD-10 C00-
C97) in 2011/12.
• Rate or proportion: The crude mortality rate per 100,000 persons: the number of deaths due to invasive cancer multiplied by 100,000 divided by the practice list size.
• Method: Records of all deaths in England occurring in 2011/12 were downloaded from the Primary Care Mortality Database. These were filtered on the Underlying Cause of Death by ICD-10 code to exclude all deaths not due to invasive cancer (ICD-10 C00-C97)) and aggregated to GP Practices using the built-in practice codes.
Binomial confidence intervals are calculated using the Wilson score method1.
• Source(s): The Primary Care Mortality Database, which is a collaborative project between the Office of National Statistics and the Information Centre.
• Interpretation: This indicator gives the number of cancer deaths and crude mortality rate in the practice. Numbers of cases may fluctuate year to year meaning that caution should be used in comparing this indicator to other indicators such as the number of new cancer cases in 2010.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
43
Prevalent cancer cases
Indicator definition• Number: The number of persons registered on the practice cancer register.
• Rate or proportion: The proportion of persons on the practice cancer register: the number of persons on the practice cancer register divided by the practice list size.
• Method: Data is taken from the QOF dataset without further processing.
Binomial confidence intervals are calculated using the Wilson score method1.
• Source(s): Data sourced from the cancer prevalence field of the QOF 2011/12 data2.
• Interpretation: The prevalence data is taken from QOF data for 11/12, and originally sourced from each practice’s cancer register. Recording methodology varies by practice and may underestimate the true cancer prevalence.
Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 3.0, December 2012)1APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457 22011/12 QOF data. Available online at: http://www.ic.nhs.uk/webfiles/publications/002_Audits/QOF_2011-12/Practice_Tables/QOF1112_Pracs_Prevalence.xls