Download Upper Lea Valley

Cancer indicator trend analysis
Upper Lea Valley locality
Summary of practice level cancer indicators 2010 to 2012
August 2013
Version 2.1
cunliffeanalytics
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
Screening indicator performance vs demographics
Two week wait indicators
•
•
•
•
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
Two week wait indicator performance vs demographics
Emergency admission indicator
•
•
•
16
27
Rate of emergency admissions with cancer per 100,000 population
Proportion of persons diagnosed with cancer via an emergency admission
Emergency admission indicator performance vs demographics
Appendices
• Definitions for indicators and demographics.
35
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 Upper
Lea Valley 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 currently unavailable for Upper Lea Valley:
Haileybury College Surgery (E82620) – no data for 2010/2011/2012
Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit 2010 to 2012
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.
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
CCG average remains just below the national average but above the national target
of 70% for the last two years.
Locality range and CCG mean average
2010
2011
2012
England mean average
71.8%
72.5%
72.5%
CCG mean average
69.3%
72.5%
71.4%
Locality practice min
Locality practice max
Practices above national target
1
Practices above national target (%)
1National
64.6%
70.8%
66.7%
82.2%
80.2%
78.6%
11(15)
15(15)
13(15)
73.3%
100.0%
86.7%
target > 70%
Number of practices
12
10
8
85%
80%
75%
CCG mean average
Locality range
National target >70%
70%
65%
60%
201 1
201 2
Targets
achieved
for 3 years
National target
Key
Key


—
201 0
Rate distribution – has the profile changed?
14
% Screened for breast cancer
( F50-70)
Summary statistics
 2010
 2011
 2012
Key
Targets achieved




6
4
3
2
1
0
2
0
60%-64%
65%-69%
70%-74%
75%-79%
80%-84%
% Screened for breast cancer (F50-70)
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
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
7
13 out of 15 practices within the Upper Lea locality achieved the 70% target in 2012.
All practices exceeded the target for at least two out of the last three years.
% Screened for breast cancer (F50-70)
90%
85%
201 0
201 1
201 2
National target
80%
75%
70%
65%
60%
55%
50%
45%
40%
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
8
Percentage of females aged 50–70 screened for breast cancer in last 36 months
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82038
Puckeridge HC
69.4%

77.0%

78.6%




1.6%
Key
E82006
Limes
75.9%

78.6%

78.5%




-0.1%

Year on year increase
E82090
Park Lane
73.4%

75.1%

76.13%




1.0%
E82011
Orchard
69.1%

79.2%

74.9%




-4.3%


Year on year decrease
Above national target
E82088
Hailey View
75.7%

76.4%

74.4%




-2.1%

Below national target
E82130
MC Buntingford
70.2%

79.3%

74.1%




-5.2%
E82109
Castlegate
82.2%

80.2%

74.1%




-6.1%
E82102
Church Street
70.0%

77.7%

73.2%




-4.6%
E82057
77 Ware Road
75.9%

77.0%

72.4%




-4.6%
E82061
Amwell Street
70.3%

75.5%

72.1%




-3.4%
E82092
Dolphin House
68.8%

77.5%

71.9%




-5.6%
E82024
Wallace House
82.1%

76.7%

71.8%




-4.9%
E82627
Maltings
64.6%

76.9%

71.7%




-5.2%
E82121
Watton Place Clinic
76.3%

73.4%

69.8%




-3.7%
E82007
Hanscombe House
76.2%

70.8%

66.7%




-4.2%
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
National target > 70%
9
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.
CCG average remains steady and has been above the national average for the last three
years but below the national target of 80%. The proportion of practices within the Upper
Lea Valley locality achieving the target reduced from 80% in 2011 to 53% in 2012.
Locality range and CCG mean average
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%
78.1%
76.1%
85.1%
87.3%
86.4%
11(15)
12(15)
8(15)
73.3%
80.0%
53.3%
Locality practice max
Practices above national target
1
Practices above national target (%)
1National
Number of practices
10
8
Key


—
85%
CCG mean average
Locality range
National target >80%
80%
201 0
201 1
201 2
Targets
achieved for
3 years
National target
 2010
 2011
 2012
Key
75%
target > 80%
Rate distribution – has the profile changed?
12
90%
% Attending cervical
screening ( F25-64)
Summary statistics
10
Key
Targets achieved




6
4
3
2
1
0
2
0
75%-79%
80%-84%
85%-89%
% Attending cervical screening (F25-64)
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
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
11
8 out of 15 practices within the Upper Lea locality achieved the 80% target in 2012. 3
practices failed to meet the target for the last three years.
% Attending cervical screening (F25-64)
90%
201 0
85%
80%
75%
70%
65%
60%
55%
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
201 1
201 2
National target
12
Percentage of females aged 25–64 attending cervical screening within target period
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82130
MC Buntingford
85.0%

87.3%

86.4%




-0.9%
Key
E82011
Orchard
84.6%

85.5%

83.1%




-2.4%

Year on year increase
E82121
Watton Place Clinic
85.1%

85.0%

82.6%




-2.4%
E82090
Park Lane
80.0%

83.2%

81.4%




-1.8%


Year on year decrease
Above national target
E82006
Limes
81.6%

83.4%

81.3%




-2.1%

Below national target
E82038
Puckeridge HC
79.1%

80.8%

81.3%




0.4%
E82088
Hailey View
80.9%

81.0%

81.1%




0.1%
E82057
77 Ware Road
80.9%

81.3%

80.5%




-0.8%
E82007
Hanscombe House
81.9%

80.9%

79.9%




-1.0%
E82061
Amwell Street
80.9%

81.1%

79.7%




-1.3%
E82024
Wallace House
81.1%

80.7%

79.3%




-1.4%
E82109
Castlegate
77.3%

79.1%

78.9%




-0.2%
E82102
Church Street
82.1%

80.3%

77.5%




-2.8%
E82092
Dolphin House
78.9%

78.1%

76.9%




-1.2%
E82627
Maltings
76.7%

79.6%

76.1%




-3.6%
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
National target > 80%
13
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.
CCG average has increased over the last 3 years, but remains below the national target
of 60%. The number of practices within the Upper Lea Valley achieving the target has
increased in 2012.
Locality range and CCG mean average
2010
2011
2012
England mean average
40.2%
51.5%
57.4%
CCG mean average
54.2%
55.1%
58.3%
Locality practice min
51.0%
49.8%
54.6%
Locality practice max
62.5%
61.7%
65.6%
4(15)
4(15)
10(15)
26.7%
26.7%
66.7%
Practices above national target
1
Practices above national target (%)
1National
target > 60%
Number of practices
8
7
6
70%
65%
60%
CCG mean average
Locality range
National target >60%
55%
50%
45%
201 1
201 2
Targets
achieved for
3 years
National
target
Key
Key


—
201 0
Rate distribution – has the profile changed?
9
% Screened for bowel cancer
(60-69)
Summary statistics
14
 2010
 2011
 2012
Key
Targets achieved




5
4
3
3
2
1
0
2
1
0
45%-49%
50%-54%
55%-59%
60%-64%
65%-69%
% Screened for bowel cancer (60-69)
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
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
15
10 out of 15 practices within the Upper Lea locality achieved the 60% target in 2012. 5
practices failed to meet the target for the last three years.
80%
% Screened for bowelcancer (60-69)
201 0
201 1
201 2
National target
70%
60%
50%
40%
30%
20%
1 0%
0%
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
16
Percentage of persons, 60–69, screened for bowel cancer in last 30 months
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82130
MC Buntingford
62.5%

61.7%

65.6%




4.0%
Key
E82090
Park Lane
60.1%

59.3%

65.2%




5.9%

Year on year increase
E82057
77 Ware Road
60.4%

60.5%

63.6%




3.1%
E82088
Hailey View
58.3%

59.2%

62.6%




3.3%


Year on year decrease
Above national target
E82011
Orchard
59.3%

60.0%

62.6%




2.5%

Below national target
E82102
Church Street
60.6%

60.7%

61.7%




1.0%
E82061
Amwell Street
57.3%

58.1%

61.1%




3.0%
E82007
Hanscombe House
56.6%

57.3%

60.9%




3.6%
E82006
Limes
58.0%

58.0%

60.5%




2.6%
E82092
Dolphin House
57.6%

57.4%

60.2%




2.8%
E82109
Castlegate
57.4%

57.3%

58.5%




1.2%
E82121
Watton Place Clinic
51.7%

54.6%

58.2%




3.6%
E82038
Puckeridge HC
53.3%

53.6%

57.3%




3.7%
E82024
Wallace House
55.0%

54.7%

56.6%




1.9%
E82627
Maltings
51.0%

49.8%

54.6%




4.8%
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
National target > 60%
17
Screening indicator performance vs demographics
•
•
•
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
18
Practices within the Upper Lea locality failing to meet the screening targets tend to have a
lower proportion of the population aged 65+.
3.0
4
3
3
2.0
1 .0
0.0
20%
2 to 2.5
1 2%
1 0%
5%
2.5 to 3
600
Cancer deaths
1 00
0.5 to 1 .5 1 .5 to 2
2 to 2.5
2.5 to 3
Average targets achieved per practice
over 3 years
0.5 to 1 .5 1 .5 to 2
2.5%
Mean
Median
300
200
1 00
2 to 2.5
2.5 to 3
Average targets achieved per practice
over 3 years
Cancer deaths
0
0
4%
2.5 to 3
400
200
6%
0%
2 to 2.5
500
400
300
8%
Average targets achieved per practice
over 3 years
Mean
Median
500
1 0%
2%
0.5 to 1 .5 1 .5 to 2
New cancer cases
Mean
Median
1 4%
1 5%
Average targets achieved per practice
over 3 years
New cancer cases
Mean
Median
0%
0.5 to 1 .5 1 .5 to 2
600
Deprivation
1 6%
Cancer prevalence
4.0
5
Population aged 65+
Number of practices
5.0
Population aged 65+
25%
Deprivation
Number of practices
6.0
2.0%
Cancer prevalence
Mean
Median
1 .5%
1 .0%
0.5%
0.0%
0.5 to 1 .5 1 .5 to 2
2 to 2.5
2.5 to 3
Average targets achieved per practice
over 3 years
0.5 to 1 .5 1 .5 to 2
2 to 2.5
2.5 to 3
Average targets achieved per practice
over 3 years
19
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.
There is little change in the number of practices within the Upper Lea Valley locality
achieving the best practice range over the three years, however the minimum and
maximum for the indicator scores have decreased.
Locality range and CCG mean average
2010
2011
2012
100.0%
100.0%
100.0%
CCG mean average
n/a
n/a
n/a
Locality practice min
26.4%
27.9%
11.7%
Locality practice max
168.1%
152.1%
95.9%
5(15)
5(15)
4(15)
33.3%
33.3%
26.7%
England mean average
Practices within best practice range
1
Practices within best practice range (%)
1Best
Number of practices
10
8
Best
practice
range
Key
 2010
 2011
 2012
Key
 Locality range
— Best practice range =
1 50%
80% to 120%
1 00%
50%
0%
practice range = 80% to 120%, practices with less than 5 referrals excluded.
Referral rate distribution – has the profile changed?
12
200%
Referral ratio (IAS 1 )
Summary statistics
20
201 0
201 1
201 2
Upper Lea practices
achieving the best
practice range for 3
years
Key
Targets achieved




6
4
3
2
1
0
2
0
0%-39%
40%-79%
80%-1 1 9%
Referral ratio (IAS)
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
1 20%+
1 60%-1 99%
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
4 out of 15 practices within the Upper Lea locality were within the best practice range
of 80% to 120% in 2012. 8 practices failed to achieve the best practice range for the
last three years.
1 80%
201 0
Referral ratio (indirectage standardised)
1 60%
1 40%
1 20%
1 00%
80%
60%
40%
20%
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
201 1
201 2
Best practice range
21
22
Two Week Wait referral ratio
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82088
Hailey View
109.3%
 116.4%

95.9%




-20.5%
Key
E82092
Dolphin House
107.9%
 103.2%

87.7%




-15.5%

Year on year increase
E82130
MC Buntingford
168.1%
 110.7%

82.4%




-28.3%
E82007
Hanscombe House
84.9%

83.9%

80.1%




-3.9%


Year on year decrease
Within best practice range
E82057
77 Ware Road
117.7%  105.3%

75.3%




-30.0%

Outside best practice range
E82024
Wallace House
78.7%

64.8%

72.4%




7.6%
E82038
Puckeridge HC
63.7%

74.0%

70.2%




-3.8%
E82011
Orchard
121.7%
 152.1%

69.0%




-83.1%
E82090
Park Lane
80.4%

64.4%

68.6%




4.1%
E82006
Limes
73.0%

73.3%

54.9%




-18.4%
E82102
Church Street
74.2%

66.1%

52.8%




-13.3%
E82109
Castlegate
52.2%

43.6%

48.7%




5.1%
E82061
Amwell Street
77.4%

78.9%

46.8%




-32.1%
E82627
Maltings
42.4%

51.1%

44.4%




-6.7%
E82121
Watton Place Clinic
26.4%

27.9%

11.7%




-16.2%
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Best practice range =80% to 120%
23
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.
CCG average has remained within the best practice range of 8% to 14% for the last
three years. The proportion of practices within the Upper Lea Valley locality achieving
the best practice range varies year on year.
Summary statistics
Locality range and CCG mean average
2011
2012
35%
England mean average
11.2%
10.9%
10.6%
30%
CCG mean average
10.5%
10.6%
11.6%
Locality practice min
5.6%
5.4%
6.4%
Locality practice max
30.0%
20.8%
18.2%
9(14)
6(14)
9(12)
64.3%
42.9%
75.0%
Practices within best practice range
1
Practices within best practice range (%)
1Best
10
Key
9
 2010
 2011
 2012
8
7
6
4
Best
practice
range
3
2
1


—
25%
20%
CCG mean average
Locality range
Best practice = 8% to 14%
1 5%
1 0%
5%
201 0
201 1
201 2
Upper Lea
practices achieving
the best practice
range over 3 years
Key
Targets achieved





5
Key
0%
practice = 8% to 14%, practices with less than 5 referrals excluded.
Indicator distribution – has the profile changed?
Number of practices
% of TWW referrals with
cancer
2010
24
3
2
1
0
Not shown
(low volumes)
0
0%-7%
8%-1 3%
1 4%-1 9%
20%-25%
% of TWW referrals with cancer
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
20%+
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
9 of the 12 practices within the Upper Lea locality achieved the best practice range
of 8% to 14% within 2012. 2 practices failed to achieve the best practice range for
the last three years1
1 Excluding practices with low volumes or data is unavailable for all three years
35%
% of TWW referrals with cancer
201 0
201 1
201 2
30%
25%
20%
1 5%
1 0%
5%
0%
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Best practice range
25
26
Percentage of Two Week Wait referrals with cancer
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82109
Castlegate
22.2%

17.3%

15.9%




-1.4%
Key
E82038
Puckeridge HC
15.3%

13.8%

15.7%




1.9%

Year on year increase
E82007
Hanscombe House
14.1%

5.4%

13.6%




8.2%
E82006
Limes
17.8%

20.0%

12.6%




-7.4%


Year on year decrease
Within best practice range
E82061
Amwell Street
8.8%

11.7%

12.5%




0.8%

Outside best practice range
E82024
Wallace House
11.9%

16.6%

12.3%




-4.3%
E82092
Dolphin House
10.3%

12.2%

10.8%




-1.4%
E82057
77 Ware Road
8.3%

15.2%

10.1%




-5.0%
E82130
MC Buntingford
8.0%

8.1%

8.8%




0.7%
E82090
Park Lane
10.2%

16.0%

8.4%




-7.6%
E82102
Church Street
9.5%

8.3%

8.3%




0.0%
E82088
Hailey View
9.1%

5.9%

6.4%




0.6%
E82011
Orchard
13.2%

8.1%
-


-
E82627
Maltings
-
-
-


-
E82121
Watton Place Clinic
20.8%
-


-
30.0%

Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Best practice 8% to 14%
27
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.
28
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.
Locality range and CCG mean average
2010
2011
2012
England mean average
42.9%
45.3%
46.5%
CCG mean average
39.5%
41.9%
43.5%
Locality practice min
20.0%
20.8%
15.4%
Locality practice max
60.9%
66.7%
100.0%
11(15)
9(15)
12(14)
73.3%
60.0%
85.7%
Practices above recommended min.
1
Practices above recommended min. (%)
1Recommended
minimum = 40%, practices with less than 5 referrals excluded.
Rate distribution – has the profile changed?
12
Number of practices
10
8
% of new cancer cases are TWW
referrals
Summary statistics
Recommended
minimum = 40%
Key
 2010
 2011
 2012
1 20%
Key


—
1 00%
80%
60%
CCG mean average
Locality range
Recommended minimum = 40%
40%
20%
0%
201 0
201 1
201 2
Targets
achieved
for 3 years
Key
Targets achieved





6
4
2
3
2
1
0
Not shown
(low volumes)
0
0%-1 9%
20%-39%
40%-59%
% of new cancer cases are TWW referrals
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
60%-79%
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
29
12 out of 14 practices within the locality achieved the recommended minimum of 40%
in 2012. Two practices failed to achieve 40% for the last three years1.
1 Excluding practices with low volumes or data is unavailable for all three years
90%
% of new cancer cases are TWW referrals
80%
201 0
201 1
201 2
Recommended minimum
70%
60%
50%
40%
30%
20%
1 0%
0%
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
30
Percentage of new cancer cases treated which are Two Week Wait referrals
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82130
MC Buntingford
46.4%

34.5%

69.2%




34.7%
Key
E82007
Hanscombe House
56.3%

27.6%

60.0%




32.4%

Year on year increase
E82092
Dolphin House
40.0%

49.0%

58.8%




9.8%
E82011
Orchard
52.8%

53.1%

57.1%




4.0%


Year on year decrease
Above recommended minimum
E82038
Puckeridge HC
46.4%

42.1%

54.3%




12.2%

Below recommended minimum
E82109
Castlegate
42.9%

34.6%

52.6%




18.0%
E82088
Hailey View
60.9%

34.4%

50.0%




15.6%
E82024
Wallace House
43.5%

48.1%

50.0%




1.9%
E82057
77 Ware Road
57.1%

53.6%

47.1%




-6.5%
E82090
Park Lane
45.7%

54.8%

45.2%




-9.6%
E82061
Amwell Street
32.5%

44.4%

45.2%




0.7%
E82006
Limes
42.6%

58.0%

40.5%




-17.5%
E82102
Church Street
31.3%

31.0%

22.9%




-8.2%
E82121
Watton Place Clinic
27.3%

20.8%

15.4%




-5.4%
E82627
Maltings
20.0%

66.7%
-



Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
-
Recommended minimum = 40%
31
Two week wait indicator performance vs demographics
•
•
•
Two Week Wait referral ratio (Indirectly age standardised )
Percentage of Two Week Wait referrals with cancer
Percentage of new cancer cases treated which are Two Week Wait referrals
32
Practices within the Upper Lea locality failing to meet two week wait best practice
ranges/ recommended minimum tend to have more new cancer cases
Excludes practices with low volumes
7
Population aged 65+
3
2
1
20%
Mean
Median
1 5%
1 0%
5%
0%
0
0 to 1
1 to 2
0 to 1
2 to 3
New cancer cases
Cancer deaths
400
300
200
1 00
0
0 to 1
1 to 2
2 to 3
Average targets achieved per practice over
3 years
500
450
400
350
300
250
200
1 50
1 00
50
0
Mean
Median
0 to 1
2 to 3
1 to 2
2 to 3
Average targets achieved per practice
over 3 years
Cancer deaths
Mean
Median
500
1 to 2
1 8%
1 6%
1 4%
1 2%
1 0%
8%
6%
4%
2%
0%
Average targets achieved per practice
over 3 years
Average targets achieved per practice
over 3 years
New cancer cases
Deprivation
Cancer prevalence
2.5%
Mean
Median
Cancer prevalence
Number of practices
5
5
3
25%
6
6
4
Population aged 65+
Deprivation
Number of practices
2.0%
Mean
Median
1 .5%
1 .0%
0.5%
0.0%
0 to 1
1 to 2
2 to 3
Average targets achieved per practice
over 3 years
0 to 1
1 to 2
2 to 3
Average targets achieved per practice
over 3 years
33
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.
34
CCG average varies year on year but remains below the recommended maximum of
587 and below the national average.
Locality range and CCG mean average
2010
2011
2012
England mean average
691
583
587
CCG mean average
519
459
502
Locality practice min
213
259
227
Locality practice max
598
821
647
Practices below recommended max.
14(15)
12(15)
13(15)
Practices below recommended max (%)
93.3%
80.0%
86.7%
1
900
Emergency admis. per
1 00,000 population
Summary statistics
Number of practices
10
8
Key
 2010
 2011
 2012
Recommended
maximum = 587
700
600
CCG mean average
Locality range
Recommended range < 587
500
400
300
1 00
maximum = national average (587 in 2012), practices with less
than 5 admissions excluded.
12


—
800
200
1Recommended
Indicator distribution – has the profile changed?
Key
201 0
201 1
201 2
Upper Lea practices
achieving
recommended
maximum rate of 587
over 3 years
Key
Targets achieved
6




4
2
3
2
1
0
0
200-399
400-599
600-799
1 000-1 250
Emergency admis. per 1 00,000 population
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
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
35
12 out of 14 practices in the Upper Lea locality were below the recommended
maximum of 587 in 2012.
900
% of new cancer cases are TWW referrals
800
201 0
201 1
201 2
Recommended maximum
700
600
500
400
300
200
1 00
0
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
36
Rate of emergency admissions with cancer per 100,000 population
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82007
Hanscombe House
230

398

647




249
Key
E82130
MC Buntingford
598

565

629




64

Year on year increase
E82057
77 Ware Road
213

337

567




230
E82090
Park Lane
452

338

553




216


Year on year decrease
Below recommended maximum
E82121
Watton Place Clinic
499

431

518




87

Above recommended maximum
E82038
Puckeridge HC
461

630

469




-160
E82627
Maltings
432

334

432




97
E82006
Limes
392

612

412




-200
E82024
Wallace House
547

421

379




-42
E82092
Dolphin House
414

503

362




-141
E82061
Amwell Street
488

468

331




-137
E82088
Hailey View
453

428

319




-108
E82109
Castlegate
399

259

288




30
E82102
Church Street
362

415

275




-141
E82011
Orchard
448

821

227




-595
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Recommended maximum =National
average (587 in 2012)
37
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
CCG average remains just outside the recommended range of 0% to 20%, the
proportion of practices in the Upper Lea Valley locality within the recommended range
increased in 2011.
38
Note: 2012 data not available
Locality range and CCG mean average
2010
2011
England mean average
23.7%
23.8%
CCG mean average
20.4%
20.9%
Locality practice min
3.1%
3.3%
29.6%
41.7%
4(7)
6(10)
57.1%
60.0%
Locality practice max
Practices below recommended range
1
Practices below recommended range (%)
1Recommended
2012
Recommended
range < 20
Key
 2010
 2011
Number of practices
5
4
50%
Key


—
40%
30%
CCG mean average
Locality range
Recommended range =0%
to 20%
20%
1 0%
0%
range < 20%, practices with less than 5 admissions excluded.
Indicator distribution – has the profile changed?
6
Proportion of persons
diagnosed via emergency
presentation
Summary statistics
201 0
201 1
201 2
Upper Lea practices
achieving
recommended range
of 0% to 20 %
over 2 years
Key
Targets achieved
3




2
1
2
1
0
Not shown
(low volumes)
0
1 0%-1 9%
20%-29%
30%-39%
40%-49%
Proportion of persons diagnosed via emergency presentation
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
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
39
Proportion of persons diagnosed via emergency presentation
6 out of 10 practices in the locality were within the recommended range of 20% in 2011.
50%
45%
201 0
201 1
201 2
Recommended range
40%
35%
30%
25%
20%
1 5%
1 0%
5%
0%
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
40
Proportion of persons diagnosed with cancer via an emergency admission
Practice indicator scores
2010
Year on year rate
2011
2012
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82627
Maltings
-
41.7%
-

-
Key
E82092
Dolphin House
-
23.6%
-

-

Year on year increase
E82121
Watton Place Clinic
-
22.7%
-

-
E82038
Puckeridge HC
-
21.6%
-

-


Year on year decrease
Within recommended range
E82109
Castlegate
-
20.0%
-

-

Outside recommended range
E82024
Wallace House
18.8%

19.2%
-


-
E82102
Church Street
29.6%

19.1%
-


-
E82006
Limes
26.1%

15.4%
-


-
E82090
Park Lane
19.6%

14.6%
-


-
E82061
Amwell Street
19.6%

12.9%
-


-
E82011
Orchard
-
-
-
-
E82130
MC Buntingford
-
-
-
-
E82088
Hailey View
21.7%
-
-
E82057
77 Ware Road
-
-
-
E82007
Hanscombe House
14.6%
-
-
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12

-

-
Recommended range < 20%
Note: rates based on less than 5
admissions are not shown.
APPENDIX
Indicator definitions
42
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 method 1.
•
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
43
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 method 1.
•
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
44
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 method 1.
•
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
45
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 Ser vice.
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 approximation 1.
•
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
46
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
47
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 method 1.
•
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
48
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 C00C97, 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)
49
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.
Indicator definition
•
Number: Number of persons diagnosed via an emergency route, as defined by the Routes to Diagnosis project methodology 1
•
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 method 2.
•
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.
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.aspx
2APHO Technical Briefing 3: Commonly used public health statistics and their confidence intervals. Available online at: www.apho.org.uk/resource/view.aspx?RID=48457
APPENDIX
Demographic definitions
51
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 method 1.
•
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
52
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/indices2010
2GP 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
53
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)
54
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 method 1.
•
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
55
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 method 1.
•
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