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Prescribing Support Unit ‘Shadow Information Centre’
Dave Roberts Unit Manager
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Prescribing Support Unit
Founded in 1996 Hosted by
Leeds Health Authority West Yorkshire Strategic Health Authority
Six full time staff Policy and Analytical Unit for the DH Liaison role with the NHS Close ties with
Prescription Pricing Authority (PPA) National Prescribing Centre (NPC)
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Prescribing Agenda Resource Allocation Forecasting the drugs bill Policy issues Quality assessment Teaching/Training
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Health and Social Care Information Centre
January 2005
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Current Issues Too great a demand on the ‘front line’ No national focus for information & knowledge management in clinical
AND social care Does existing information really focus on what matters? A ‘vision’ for information
• Sir Ian Kennedy - Bristol Royal Infirmary Inquiry report • Sheila Leatherman - The Quest for Quality in the NHS • NHS Confederation The Response
Creation of the Health and Social Care Information Centre
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Arm’s Length Body Review
Reduction in numbers of ALBs from 38 to 20
Reductions in Posts by 25% by 2007-08 Savings in expenditure of 10% by 2007-08 ALBs will be expected to relocate away
from South & East (Lyons Review)
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Arm’s Length Body Review Reports - Reconfiguring the Department of Health’s Arm’s Length
Bodies and NHS Improvement Plan Creation of the Information Centre as a Special Health Authority Consisting of:
‘Information’ elements of the NHS Information Authority (NHS IA)
Statistics & information policy functions of the Department of Health (DH)
Prescribing Support Unit IC to operate in shadow form until 31 March 2005 Chairman and board appointments will be made as soon as possible 1 April 2005 – organisation established Headquarters in Leeds
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What is the Information Centre? Purpose:
“to improve the quality and use of information and knowledge for the benefit of patients and service users”
A joined-up system for health and social care information Provides national leadership and focus for data and
information Is driven by wishes & requirements of those in the
system Works with all parts of the Health and Social Care System
and NPfIT
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Scope for the Information Centre
Service Users
Clinicians
Managers
Healthcare Commission
SHA
Social Care Commission (CSCI)
NPSA
Social care
Professionals
Public
Registries
Central Users
Local Organisations
Local Individuals
Politicians Policy teams
Public Health Government
NHS Trusts
Local Authorities
Families
Carers
Royal Colleges
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Key areas of work
Regulation and co-ordination of information requirements Mandating data collections and setting standards Co-ordinating data collection across regulators/inspectors/others
Provision of information and knowledge management services i.e. collection, development, dissemination, standards, analysis, strategic information management
Acting as an agent to improve the scope, quality and use of information for the benefit of patients and service users and their care
National focus for education, training and development for information management
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Benefits Reduced bureaucracy and waste Easy, timely access to data sources, information and
knowledge Improved accuracy, scope, quality and use of
information and knowledge for the good of patient care • Patient-focused • Integrated information • Service improvements can be evidence based
Increased support and development of health informatics staff
Add value to the investment in technology led by NPfIT
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PSU ‘Service’
Datasets
Prescribing Cost Analysis database National PPA electronic systems IMS Hospital Pharmacy database Quality, Prevalence and Indicator database New primary care user/data requirements
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Quality and Outcomes Framework
GMS contract
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Rewards for Quality
£1.3bn for the UK for quality in GMS and PMS Non-discretionary In addition to the global sum Payment for what many already do Work converts to points; points to payment 1050 maximum points
Modified by prevalence Modified by list size
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Quality Points Available
Clinical indicators: 550 Patient experience: 100 Organisational indicators: 184 Additional services: 36 Other: 180 Total: 1050
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Totals
Clinical Indicators
CHD including LVD etc 121
Stroke or transient ischaemic attack 31
Cancer 12
Hypothyroidism 8
Diabetes 99
Hypertension 105
Mental Health 41
Asthma 72
COPD 45
Epilepsy 16
Clinical Maximum 550
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Quality points – Secondary prevention of CHD
register 6 patients with newly diagnosed angina who are referred 7 patients with record of smoking 7 patients who have been offered smoking cessation advice 4 patients with record of BP 7 patients with BP < 150/90 19 patients with record of cholesterol 7 patients with total cholesterol < 5 16 patients on anti-platelet therapy or anti-coagulant 7 patients on beta blocker 7 patients on ACE inhibitor 7 patients with influenza immunisation 7
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Quality Management and Analysis System
QMAS is national IT solution to support QOF payments to practices
Extraction of practice indicator data to national QMAS database
Computation of practice scores Application of list size and prevalence
adjustment factors Feedback for practices, PCTs and SHAs Informs practice payment systems (NHAIS)
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Other achievement data – web interface
QMAS – Inputs and Outputs
QMAS Central Server
PCT Payment
Agency
NHAIS
Confirm Achievement
Automated
“Manual”
Achievement data from clinical system
GP Practice
BACS Payment
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Potential Secondary Users
DH branches (eg NSFs, finance) NHS Bank (QOF risk management) Healthcare Commission Public health organisations NICE Academic researchers
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Potential Secondary Uses of QMAS Data (1)
Support surveillance and screening by Healthcare Commission.
Support new resource allocation methodologies Support monitoring by public health
organisations and integration of epidemiology in service planning and delivery
Facilitation of the Research and Development arm of the new Information Centre at the DH
Resource allocation, forecasting and monitoring for primary care drugs bill
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Potential Secondary Uses of QMAS Data (2)
Analysis of disease prevalence Monitoring of the gross investment guarantee DH and NHS Bank monitoring and risk
management of primary care finance DH implementation of QOF, eg analysis of
exception reporting DH monitoring of NSFs Medicines management and clinical governance
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Introduction to QPID
Quality, Prevalence and Indicator Database
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Why QPID?
To make QMAS data available to a wider set of potential users in DH and NHS
To enable access to QMAS data without affecting scope of QMAS project
To provide analytical support around flexible access to QMAS data – no requirement for QMAS developers to deliver additional reporting tools
National analysis (eg prevalence)
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Who is Developing QPID?
Prescribing Support Unit (PSU) on behalf of DH and in collaboration with NPfIT
PSU will be part of new Health and Social Care Information Centre (IC), and is based in Leeds
QPID project team drawn from PSU staff PSU will host the QPID database Web: www.psu.co.uk
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Project Structure
Project Board (representation from IC, DH Policy, NPfIT, NHS)
Project Team Project Management User Issues Technical Issues Analytical Issues
Gateway Committee
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QPID Project Stages
Stage 1 (to April 2005): establish QPID database and develop analytical and user processes
Stage 2 (from April 2005): implement analysis service for QPID users
Note the need to prioritise delivery to users in early post-implementation phase
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Accessing QPID Data
Users inform QPID team of high level requirements, and proposed use of data or information from QPID
User request considered by QPID Gateway Committee
Approved requests lead to detailed user specifications
QPID team and user sign agreement on provision and use of data before delivery
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Access Criteria
Publication strategy will take account of freedom of information legislation
Criteria for release of data: PCT-level data available to all? Practice data only to be released as anonymised data
(relevant PCTs can be identified)? Protection for small numbers for some conditions at
practice level. Other criteria?
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Conditions for Release of Data
Conditions of release to be drafted and agreed with users.
To be informed by good practice, such as conditions around release of HES data, eg: Users must not pass raw data on to third
parties. Agreement on internal use or publication.
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Charging for Users?
Charging policy to be determined ahead of analysis service launch in April 2005
Some information to be published free of charge by IC Project to determine level of requests that can be met
free of charge Project to determine charging for substantive pieces of
work Charging to cover marginal analysis costs, not data
collection
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Contact
Potential users of QPID data should contact Dave Roberts at PSU to discuss potential high level requirements
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SMOKING STATUS AMONGST THE POPULATION AGED 15 TO 75 YEARS
Detailed Descriptor: Smoking status among people aged 15 to 75 years, as
recorded in GP records Units: Line 1: Number of people aged 15 to 75 years on a
GP register, recorded as being a smoker in the last 15 months.
Line 2: Number of people aged 15 to 75 years on a GP register, with a smoking status recorded in the last 15 months.
Line 3: Total number of people aged 15 to 75 years on a GP register.
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BROADER STRATEGY ON OBESITY: Obesity status amongst the GP Registered
Population aged 15 to 75 Years Detailed Descriptor: Obesity status among people aged 15 to 75 years, as recorded in
GP records Units: Expressed as:
Line 1: Total number of people aged 15 to 75 years on GP register, recorded as having a BMI of 30 or greater in the last 15 months.
Line 2: Total number of people aged 15 to 75 years on GP register, with a BMI recorded in the last 15 months.
Line 3: Total number of people aged 15 to 75 years on GP register.
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Other Data
Hospital Episode Statistics IMS Hospital Pharmacy data Consolidated databases
QResearch (EMIS practices IMS Mediplus (In Practice
systems) GPRD (Torex) THIN (Torex)
Other data from GP systems GP workload Public Health (smoking and
obesity) Diabetes (Diabetes-E and
NCASP)
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The future
National data spine Secondary User
Service