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A helping hand for PBC data

Emma Wilkinson takes a look at what tools the Information Centre can offer commissioners

Emma Wilkinson takes a look at what tools the Information Centre can offer commissioners

Whether you are identifying commissioning priorities or redesigning a service, getting the right bit of data from the enormous mountain of information collated by the NHS can seem incredibly daunting.

The NHS Information Centre is the depository of a great deal of this information and, say staff, there is much work going on to improve the quality, timeliness and accessibility of data available to commissioners.

Clicking on ‘commissioning' on the NHS Information Centre website takes users to a portal which splits into monitoring and evaluation, strategic planning and procuring services.

The theory is that this signposts users to a range of data products and tools which can support all aspects of the commissioning cycle.

Sandra Hills, Information Centre director of commissioning, says they have been working over the past year to make the data they have, which includes population size and demographics, public health information and QOF details, more easily useable.

‘We have started to build in a degree of simplicity,' she says.

She hopes visitors to the website would be surprised at how much easier they have made the data mining process and admits that 12 months ago people would have found it hard to find what they needed.


For those new to data trawling, the amount of information available will almost certainly seem overwhelming and working out how the bits of data fit together nevermind interpretation is not always straightforward.

With this in mind, it would be wise to have a focus.

A good place to start, says Hills, is the hospital episode statistics.

Commissioners can use this acute activity information to find out what is being spent in different areas and whether that money is having the expected impact.

She also advises taking a look at factors such as life expectancy, mortality rates and cancer statistics to build up a picture of local needs.

‘GPs can become trapped into thinking they really know their patch but my tip is to stand back and assess a number of different things,' Hills says.

NHS Comparators

The next logical step would be to use NHS Comparators - a tool developed by the Information Centre in partnership with Connecting for Health.

It pulls together a variety of data sources - including referral rates to secondary care, 18-week wait targets, emergency admissions and prescribing – and enables users (who need an nww connection and a password) to compare that with other practices, PCTs and against the national average.

‘It gives an insight into the practices in your cluster – what's going on, who's doing what the average is, who's the leader and who's lagging at the back,' says Hills.

NHS Comparators, which is becoming increasingly popular with 6,000 users in primary care, does not provide the answer but can start commissioners asking the right questions (see example below).

Checking out anomalies

It is important to bear in mind that an apparent anomaly may be easily explained.

But for example, if through NHS comparators, a PBC cluster identified that referrals into secondary care for dermatology are higher than average across all but two practices, it could start to identify reasons.

First checking with sources such as the Compendium of Clinical and Health Indicators to see if there were demographic trends that could explain the activity, such as higher than average deaths from melanoma.

Then hospital episode statistics could provide an insight into what types of dermatological conditions are being referred.

A final step would be for the cluster to sample high and low referring practices, and discuss the reasons with the GPs involved.

They might find it is due to GP confidence in dealing with dermatological problems and appointing a GP with a special interest in dermatology to triage cases on behalf of the PBC cluster would be a more efficient use of resources.

‘If you end up finding an idea for service improvement that works, it will boost everyone's confidence to move on to the next, perhaps more ambitious redesign,' says Hills.

Procurement tools

Once a PBC group have identified a service that may be better delivered in the community, where quality can be improved or where savings can be made, there are procurement tools available through the second section of the commissioning portal.

How data is then used to monitor and evaluate the uptake, quality and cost of a service will depend on what has been commissioned but the key is to get the plan in place from the outset, says Hills.

‘The PCT needs to establish what they are going to monitor and measure and what can be done with the processes that already exist.

‘So for example, with anticoagulation you could look at activity and also quality of service - you would undertake a number of patient surveys to look at experience so you can check it is doing what was intended - but you can tailor that to the service you're commissioning,' she says.

In the pipeline

The information available to commissioners is far from perfect and the Information Centre admits there are gaps.

Complaints about it being out of date or inaccurate are commonplace but there is work going on to improve certain pieces of the puzzle.

This includes a project to drill down data to finer detail where possible.

And enable new access to workforce data for insights into factors such as skill mix within the local health system.

Hospital episode statistics, which many commissioners complain are so out of date as to be useless, will be moving to a monthly rather than quarterly basis.

Mental health information can now be provided on a PCT or provider basis and there are moves to make this available on a practice basis.

"We're also looking at how we can provide data for PBC clusters but there are resource implications to that so we're looking at the feasibility and cost," Hills adds.

Changing services – a real life example

For Dr Ian Greaves, a GP in Staffordshire, a look at NHS Comparators revealed a higher than average rate of hospital admission for patients with asthma.

So his practice developed a strategic partnership with their local acute trust

Since January 2008, junior doctors and registrars have been based at the practice between 6.30pm and 10.30pm every evening, including weekends and bank holidays.

They see urgent cases, including asthmatics, and will also see hospital outpatient follow-ups.

"We felt the high number of admissions could be avoided if urgent care services were better," he says.

"So we agreed with the trust to bring those services here to the practice.

"Any new patient we refer will be seen by the doctors that evening – so we can therefore easily meet the 18-week target."

It also streamlined the practice's aim to deliver a more community driven service, and discussions are now in progress for a workforce capacity of nurses.

"The NHS Comparators site enabled us to map and plan how we could change from a hospital based to a community-based service," says Dr Greaves.

Some of the data products available

Neighbour Statistics Service for detail on deprivation gaps

National clinical audits support programme to help clinicians review and improve performance

Health Survey for England for annual information on health and lifestyle

Digital mapping data for health inequalities and epidemiological analysis

The Quality and Outcomes Framework database for GP practice comparisons

Health poverty index

Hospital episode statistics for acute activity in England

The Compendium of Clinical and Health Indicators for calculating how your area is doing on public health measures

National child measurement programme

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