Commissioning for Value Tool

Bryn ShorneyAnalytical Services

The Commissioning for Value Tool: the beginning of the deep dive……....

• The CfV pack was just the start of the process;- to ask questions, not to answer them- to identify areas to explore in more detail

• Your pack showed a number of indicators where your CCG could improve;- the tool allows you to see how your CCG performs against all the indicators that we used for the packs- the tool allows more in-depth comparisons with the similar CCGs, nationally/regionally, and with any CCG you choose

• The following slides will demonstrate how you can use the tool to build up a picture of how your CCG performs across the pathway for each programme area

The CfV pack identified a number of opportunities for improvement in both spend and quality/outcomes for this CCG.

The table shows all indicators where the CCG value is ‘worse’ than the average of the best five similar CCGs

The interactive tool allows CCGs to view their performance against all of the indicators in the pack compared to the similar ten CCGs, the best five of these similar CCGs for each indicator, and all CCGs nationally/regionally.

Blue dots show CCG value. Yellow diamonds show average of similar ten CCGs. Shaded red area shows worst quartile nationally. => This CCG has most of the blue dots in the shaded red area and values are worse than similar ten CCGs.

Red dot shows where value is statistically significantly worse than the average of the similar ten CCGs.

The blue/green column shows the selected CCG and the orange columns show the similar ten CCGs. The selected CCG has the second highest mortality rate in England for CVD for patients under 75 years (improvement opportunity to save 47 lives a year)

This slide from the pack shows that the opportunity of 47 lives is compared to the best five similar CCGs. The opportunity compared to the average of the similar ten is 33 lives.

The CCG has the third highest level of deprivation compared to the ten similar CCGs

The CCG has the fourth lowest prevalence of Coronary Heart Disease (CHD) compared to the ten similar CCGs

The CCG has the fifth lowest ratio of reported to expected prevalence of CHD compared to the ten similar CCGs. The CCG could be doing more to identify and record patients with CHD (improvement opportunity of 427 patients).

The CCG has the second lowest prevalence of Hypertension compared to the ten similar CCGs

The CCG has the second lowest ratio of reported to expected prevalence of Hypertension compared to the ten similar CCGs so could be doing more to identify and record patients with Hypertension (improvement opportunity of 4,237 patients).

The CCG has the second lowest proportion of patients with CHD whose blood pressure is 150/90 or less compared to the ten similar CCGs (improvement opportunity of 200 patients).

The CCG has the fourth highest rate of Primary Care prescribing expenditure. This relates to a potential savings opportunity of £450k but obviously further work is required to explore this opportunity.

This slide from the pack shows that the £453k opportunity is compared to the best five similar CCGs. As there is no blue bar for Circulation, this shows that the CCG is already spending less than the average of the similar ten CCGs.

The CCG has an average rate of expenditure on elective admissions compared to the ten similar CCGs.

This slide from the pack shows that the £437k opportunity is compared to the best five similar CCGs. As there is no blue bar for Circulation, this shows that the CCG is already spending less than the average of the similar ten CCGs.

The CCG has the second highest rate of expenditure on non-elective admissions compared to the ten similar CCGs.

The CCG has an opportunity of £950k compared to the average of the similar ten CCGs for CVD.

The CCG has the second highest mortality rate for CVD for patients under 75yrs compared to the ten similar CCGs.

Summary

• The CCG could make improvements in • identifying and recording prevalence of CHD and particularly hypertension

• controlling blood pressure and cholesterol for patients with CHD in Primary Care

• The CCG has below average spend on Primary Care prescribing and Elective admissions for CVD compared to similar CCGs (but improvements may be possible)

• The CCG has a high rate of Non-Elective admissions for CVD compared to similar CCGs and there are potentially large savings to be made

• The CCG has high a mortality rate for CVD compared to similar CCGs – potential improvement of 33 lives saved per year compared to the similar ten CCGs and 47 lives saved per year compared to the best five similar CCGs

• By looking in detail across the pathway it appears that improvements in Primary Care could lead to lower spend and save lives

Next Steps

• Next steps (using national and local data);- Explore admissions / prescribing expenditure in more detail

- High spend procedures / drugs- GP Practice level variation

- Assess expenditure in other settings- Learn from best performing CCGs- Assess evidence on best practice pathways, NICE guidance etc- Establish clinical leaders to lead service redesign projects

• Repeat for other disease areas

• Put processes in place to improve estimates of expenditure

Further Information

Commissioning for Value

http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value

Health investment website

http://www.networks.nhs.uk/nhs-networks/health-investment-network

Bryn Shorney, Analytical Services, NHS England

0113 8253669

bryn.shorney@nhs.net

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Find the full series at:www.rightcare.nhs.uk/resourcecentre

The NHS Right Care website offers resources to support CCGs in adopting this approach:

• online videos and ‘how to’ guides• casebooks with learning from previous

pilots• tried and tested process templates to

support taking the approach forward• advice on how to produce “deep dive”

packs locally to support later phases, within the CCG or working with local intelligence services

• access to a practitioner network