A Primary Care Trust Perspective NHS North Lancashire

A Primary Care Trust Perspective

NHS North Lancashire

Dr Jim GardnerMedical Director & PEC Chair

NHS North Lancashire

Jim.gardner@northlancs.nhs.uk

PCT PerspectivePCT Perspective

• Corporate Objectives• Commission health care• Improve health outcomes• Reduce health inequalities• Achieve financial balance

• ‘Patient Safety First’• Whole-systems thinking• Not experts in VTE

VTE Improvement Cycle

Raise awareness

Measure

Understand

Set standards

Sources of data

• Primary Care– PRIMIS– QoF

• Secondary Care– Regional Data Warehouse (SUS)– CHKS– Hospitals’ own –

pathology/haematology

0

500

1000

1500

2000

2500

3000

1

Primary Care Prevalencefrom PRIMIS searches

Total number of patients diagnosed with either DVT or PE as a % of a total GP population of 298,371 (5 practices data was not included due to discrepancies in the data collection)

Primary Care Patients on Warfarinfrom PRIMIS search

2811

505

383

No of Pts without eitherDVT or PE prescribedWarfarin between01.11.08 - 31.01.09

No of Pts with DVT andWarfarin

No of Pts with PE andWarfarin

Total number of patients prescribed Warfarin (in last 3/12) from the total GP population of 298,371 (5 practices data was not included due to discrepancies in the data collection)

0

200

400

600

800

1000

1200

2005-2006

2006-2007

2007-2008

UHMB

BVH

LCT

Other

Total

Annual Hospital Incidence from SUS data.

Data from Cumbria & Lancashire Commissioning Intelligence Support (CaLCIS)North Lancashire Residents (population 340,000).

Benchmarked Benchmarked Analysis of Venous Analysis of Venous Thromboembolism Thromboembolism

2006-2008 data2006-2008 data

Venous Thromboembolism – primary or secondary position

Venous Thromboembolism – Length of

Stay by type 2008 only

NHS North Lancashire - Population 340,000.

Venous Thromboembolism – mortality rates

2008 only

NHS North Lancashire – Population 340,000

VTE Improvement Cycle

Raise awareness

Measure

Understand

Set standards

Commissioning for Quality

• What is quality?– Safety, efficacy, personalisation, outcome

• ‘Advancing Quality’ – carrots v sticks• Risk Assessment for all hospital

admissions embedded in contracts• Financial support to providers• PCT Project Manger for VTE to monitor

and support– Audits / Root Cause Analyses/ Trajectories

Refining DVT diagnosis in primary care

• >140,000 referrals for ?DVT/year in UK• 80 – 90% do NOT have DVT• Need to refine tests in primary care• Clinical Decision Process including near-

patient-testing• ‘Safely Ruling out Deep Venous Thrombosis in

Primary Care’. Buller et al. Ann intern Med. 2009; 150:229-235

• One PBC consortium implementing.

VTE Mind Map from PCT Perspective

Project Plan

• Understand the data and the issues• Raise awareness• Set standards in contracts• Support improvement initiatives• Measure outcomes• Link VTE to other initiatives• Manage the project through a Lead• Share learning

Questions

• In our PCT area, our two acute hospital trusts have different heparin regimes at discharge. This causes confusion for our community staff.

• In the interests of safety, should we (as a PCT) seek to standardise heparin protocols across our health economy?

• Should we, as an exemplar community, look to standardise heparin protocols across England?