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Cancer indicator trend analysis NHS Luton CCG Summary of practice level cancer indicators 2010 to 2013 March 2014 Version 1.0 cunliffeanalytics 2 Contents Page Introduction – purpose of the report 4 Screening indicators 5 • • • • Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Percentage of females aged 25–64 attending cervical screening within target period Percentage of persons aged 60–69 screened for bowel cancer within 6 months of invitation 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 • • • 21 31 Rate of emergency admissions with cancer per 100,000 population Rate of persons diagnosed with cancer via an emergency admission per 100,000 population Emergency admission indicator performance vs demographics Appendices • Definitions for indicators and demographics. 43 3 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 Luton CCG. If you have any questions relating to the pack please contact [email protected] Eight key indicators are reviewed at CCG and practice level, highlighting how the activity rates have changed over the last four 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 within 6 months of invitation Percentage of females aged 25–64 attending cervical screening within target period Percentage of persons aged 60–69 screened for bowel cancer within 6 months of invitation 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 Rate of persons diagnosed with cancer via an emergency admission per 100,000 population Please note that this report is based on a small number of practices and therefore the CCG level percentages shown are sensitive to volatile changes. There is no data available for: Whipperley MC (Y02477) for 2010 for any indicator. GP led WIC (Y02463) for 2010 for any indicator. All practices for the ‘rate of persons diagnosed with cancer via an emergency admission per 100,000 population’, 2012. Acknowledgement CCG analysis of GP Cancer Profiles by East of England Strategic Clinical Network based on methodology and best practice recommendations first developed by Mount Vernon Cancer Network. Data source: GP Practice Profiles for cancer, Cancer Commissioning Toolkit 2010 to 2013 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 Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation 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 within 6 months of invitation, divided by the total number of females aged 50-70 invited for screening in the previous 12 months. (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. 5 Luton CCG’s average has remained below the national average for the last four years with just over a third of practices achieving the national target of 70%. CCG range and mean average 2010 2011 2012 2013 England mean average 74.4% 74.7% 74.3% 73.3% CCG/PCT1 mean average 69.3% 72.5% 71.8% 69.3% CCG practice min CCG practice max Practices above national target2 Practices above national target (%) 1 Mean 0.0% 0.0% 25.0% 0.0% 100.0% 80.0% 87.5% 85.2% 10(28) 11(31) 11(31) 11(31) 35.7% 35.5% 35.5% 35.5% % Screened for breast cancer ( F50-70) Summary statistics 100% — 60% 40% 4 Range 2010 Distribution of practice screening rates within the CCG CCG range4 National target >70% average for PCT in 2010 and 2011, CCG for 2012 and 2013. 0% target > 70% CCG/PCT3 mean average 3 Mean 20% average for PCT in 2010 and 2011, CCG for 2012 and 2013. , 2National Key 80% 2011 2012 for practices within the current CCG 2013 Targets achieved for 4 years Key Targets achieved 2013 Indicator value 0%-30% 2012 30%-50% 2011 50%-70% 70%-90% 2010 4 3 2 1 0 90%-100% 0% 20% 40% 60% 80% 100% Proportion of practices Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 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 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 53 Leagrave Rd 2013 2A Malzeard Rd Kingsway HC Hockwell Ring 2012 Gardenia Surgery GP led WIC Leagrave Surgery 2011 Neville Rd Moakes MC Medina MC 90% Whipperley MC Bute House Wenlock St Blenheim MC 49 Ashcroft Rd Lea Vale MC Conway MC Medici Practice Stopsley Village Bell House Petros MC Sundon Park HC 39 Castle St Lister House Larkside Practice Pastures Way Oakley Surgery Sundon MC Barton Hills Kingfisher Practice Woodland Ave % Screened for breast cancer (F50-70) 6 11 out of 31 practices within Luton CCG achieved the 70% target in 2013. 11 practices within the CCG failed to meet the target for the last three years. Three year profile (2011 to 2013) 85% Target 80% 75% 70% 65% 60% 55% 50% 7 Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Practice indicator scores Year on year rate 2011 2012 2010 E81018 E81075 E81632 E81040 E81025 E81076 E81026 E81016 E81013 E81054 E81064 E81005 E81006 E81073 E81063 E81032 E81617 E81028 E81001 E81048 Y02477 E81065 Y02464 E81633 E81010 Y02463 E81041 E81612 Y02332 E81631 E81618 Woodland Ave Kingfisher Practice Barton Hills Sundon MC Oakley Surgery Pastures Way Larkside Practice Lister House 39 Castle St Sundon Park HC Petros MC Bell House Stopsley Village Medici Practice Conway MC Lea Vale MC 49 Ashcroft Rd Blenheim MC Wenlock St Bute House Whipperley MC Medina MC Moakes MC Neville Rd Leagrave Surgery GP led WIC Gardenia Surgery Hockwell Ring Kingsway HC 2A Malzeard Rd 53 Leagrave Rd 66.7% 64.3% 89.5% 78.8% 77.8% 71.0% 90.0% 50.0% 74.7% 73.2% 72.9% 60.7% 50.0% 66.6% 58.3% 67.7% 100.0% 57.9% 64.4% 64.4% 55.6% 42.9% 47.1% 29.4% 38.9% 70.0% 0.0% 33.3% 76.5% 69.2% 78.8% 72.7% 33.3% 33.3% 75.3% 68.0% 57.1% 66.7% 61.5% 74.8% 72.5% 37.0% 60.0% 40.5% 70.0% 62.5% 50.0% 70.6% 63.6% 31.3% 80.0% 66.7% 75.2% 20.0% 75.0% 66.7% 56.3% 0.0% 50.0% Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 55.6% 79.5% 83.3% 76.5% 66.7% 66.7% 69.2% 40.0% 36.4% 87.5% 70.0% 61.5% 82.6% 50.0% 25.0% 44.9% 77.3% 40.0% 71.4% 75.0% 66.7% 60.0% 60.2% 75.0% 70.0% 45.0% 69.2% 45.5% 58.1% 52.2% 50.0% 2013 85.2% 81.8% 79.5% 78.4% 75.8% 75.6% 75.1% 75.0% 73.9% 72.6% 71.1% 68.8% 67.8% 67.6% 65.4% 64.3% 63.6% 62.4% 60.2% 58.3% 56.7% 56.6% 56.5% 56.3% 50.0% 46.5% 44.8% 42.9% 39.5% 33.3% 0.0% At or above target 2010 2011 2012 2013 Difference over 4 years (pp1) 18.5% 17.5% -10.0% -0.4% -2.0% 4.6% -14.9% 25.0% -0.8% -0.6% -1.8% 8.1% 17.8% 1.0% 7.1% -3.4% -36.4% 4.5% -4.2% -6.1% 1.0% 13.4% 2.9% 15.4% 4.0% -30.5% 33.3% -33.3% Key Year on year increase Year on year decrease Above national target Below national target National target > 70% 1 Percentage points 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. Luton CCG’s average has decreased over the last four years, remaining below the national average and national target of 80%. The number of practices within the CCG achieving the 80% target has decreased over the last four years. CCG range and mean average England mean average 1 CCG/PCT mean average CCG practice min CCG practice max Practices above national target 2 Practices above national target (%) 1 Mean 2010 2011 2012 2013 75.4% 75.6% 75.3% 74.0% 73.5% 73.3% 72.5% 70.6% 60.8% 55.4% 54.3% 53.9% 87.8% 88.0% 86.1% 84.5% 6(28) 4(31) 4(31) 3(31) 21.4% 12.9% 12.9% 9.7% % Screened for cervical cancer ( F25-64) Summary statistics 85% Key 80% — 75% 70% 65% 60% 3 Mean 55% 4 Range CCG/PCT3 mean average CCG range4 National target >80% average for PCT in 2010 and 2011, CCG for 2012 and 2013. for practices within the current CCG 50% average for PCT in 2010 and 2011, CCG for 2012 and 2013. , 2National 90% 2010 target > 80% 2011 2012 Distribution of practice screening rates within the CCG Targets achieved for 4 years 2013 Key Targets achieved 2012 Indicator value 50%-60% 2011 60%-70% 70%-80% 2010 2013 4 3 2 1 0 80%-90% 0% 20% 40% 60% 80% 100% Proportion of practices 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, 2013: 2010/11 to 2012/13 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 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 , 2013: 2010/11 to 2012/13 39 Castle St GP led WIC 2013 Lister House Kingsway HC 2012 53 Leagrave Rd Bute House Leagrave Surgery 2011 Medici Practice Lea Vale MC 2A Malzeard Rd 85% Neville Rd Medina MC Blenheim MC Conway MC Gardenia Surgery Hockwell Ring Petros MC Oakley Surgery Barton Hills Woodland Ave Sundon MC Larkside Practice Wenlock St Pastures Way Moakes MC Bell House 49 Ashcroft Rd Whipperley MC Kingfisher Practice Sundon Park HC Stopsley Village % Screened for cervical cancer (F25-64) 10 Three out of 31 practices within Luton CCG achieved the 80% target in 2013. 26 practices within the CCG failed to meet the target for the last three years. Three year profile (2011 to 2013) 90% Target 80% 75% 70% 65% 60% 55% 50% 11 Percentage of females aged 25–64 attending cervical screening within target period Practice indicator scores Year on year rate 2011 2012 2010 E81006 E81054 E81075 Y02477 E81617 E81005 Y02464 E81076 E81001 E81026 E81040 E81018 E81632 E81025 E81064 E81612 E81041 E81063 E81028 E81065 E81633 E81631 E81032 E81073 E81010 E81048 E81618 Y02332 E81016 Y02463 E81013 Stopsley Village Sundon Park HC Kingfisher Practice Whipperley MC 49 Ashcroft Rd Bell House Moakes MC Pastures Way Wenlock St Larkside Practice Sundon MC Woodland Ave Barton Hills Oakley Surgery Petros MC Hockwell Ring Gardenia Surgery Conway MC Blenheim MC Medina MC Neville Rd 2A Malzeard Rd Lea Vale MC Medici Practice Leagrave Surgery Bute House 53 Leagrave Rd Kingsway HC Lister House GP led WIC 39 Castle St 87.8% 84.3% 83.4% 82.7% 80.0% 76.1% 69.4% 77.3% 79.3% 76.4% 74.9% 72.3% 79.5% 74.3% 71.0% 78.8% 67.2% 76.8% 80.3% 74.5% 60.8% 68.8% 73.4% 77.0% 63.3% 64.4% 65.2% 61.0% 88.0% 86.5% 83.6% 74.3% 78.6% 78.9% 77.8% 80.2% 72.9% 76.8% 78.9% 76.7% 74.7% 72.8% 78.2% 76.6% 72.1% 78.5% 67.8% 73.8% 78.0% 76.0% 62.8% 71.2% 72.6% 74.6% 59.4% 68.2% 63.1% 55.4% 58.2% 86.1% 85.9% 81.5% 72.4% 78.9% 80.3% 77.6% 79.4% 72.6% 77.3% 77.0% 76.6% 74.4% 73.5% 76.2% 73.3% 74.6% 76.5% 69.3% 72.8% 75.8% 70.7% 66.3% 71.2% 70.8% 69.7% 60.6% 63.4% 61.6% 58.8% 54.3% 2013 84.5% 84.2% 81.4% 79.3% 78.1% 77.3% 76.8% 76.1% 75.0% 74.9% 74.5% 72.6% 72.5% 71.9% 71.7% 71.5% 71.4% 70.6% 69.9% 69.6% 69.0% 69.0% 67.9% 67.8% 67.8% 67.1% 61.7% 61.2% 57.8% 54.5% 53.9% At or above target 2010 2011 2012 2013 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 , 2013: 2010/11 to 2012/13 Difference over 4 years (pp1) -3.3% Key -0.1% Year on year increase -2.0% Year on year decrease Above national target -4.6% -2.7% 0.0% National target > 80% 5.6% 1 Percentage points -2.4% -4.8% -3.8% -2.4% -0.4% -7.8% -2.8% 0.4% -8.2% 2.7% -7.2% -11.3% -5.5% 7.1% -1.0% -5.6% -9.9% -1.6% -3.2% -7.4% -7.1% Below national target 12 Percentage of persons, 60–69, screened for bowel cancer within 6 months of invitation 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 within 6 months of invitation, divided by the total number of females aged 60-69 invited for screening in the previous 12 months. (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. 13 Over the last four years, Luton CCG’s average has remained below the national target of 60% and below the national average. CCG range and mean average 2010 2011 2012 2013 55.1% 57.5% 55.7% 58.7% CCG/PCT mean average 45.1% 50.1% 46.4% 50.3% CCG practice min 8.3% 12.0% 12.8% 22.0% 58.8% 61.3% 58.9% 63.6% 0(28) 1(31) 0(31) 3(31) 0.0% 3.2% 0.0% 9.7% England mean average 1 CCG practice max Practices above national target 2 Practices above national target (%) 1 Mean % Screened for bowel cancer ( P60-69) Summary statistics average for PCT in 2010 and 2011, CCG for 2012 and 2013. , 2National 70% 60% Key 50% — 40% 30% 20% National target >60% average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range 0% 2010 Distribution of practice screening rates within the CCG CCG range4 3 Mean 10% target > 60% CCG/PCT3 mean average 2011 2012 for practices within the current CCG 2013 Targets achieved for 4 years Key Targets achieved 2013 2012 Indicator value 0%-20% 2011 20%-40% 40%-60% 2010 4 3 2 1 0 60%-80% 0% 20% 40% 60% 80% Proportion of practices Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 100% 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 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 53 Leagrave Rd 2013 Medina MC 2A Malzeard Rd Conway MC 2012 Whipperley MC Kingsway HC Wenlock St 2011 GP led WIC Hockwell Ring Lister House 65% Pastures Way Moakes MC Medici Practice Blenheim MC Bute House Gardenia Surgery Lea Vale MC Oakley Surgery 39 Castle St Petros MC Bell House Sundon Park HC Larkside Practice Woodland Ave Barton Hills Leagrave Surgery Sundon MC Neville Rd 49 Ashcroft Rd Kingfisher Practice Stopsley Village % Screened for bowel cancer (P60-69) 14 Three out of 31 practices within Luton CCG achieved the 60% target in 2013. 28 practices failed to meet the target for the last three years. Three year profile (2011 to 2013) Target 60% 55% 50% 45% 40% 35% 15 Percentage of persons, 60–69, screened for bowel cancer within 6 months of invitation Practice indicator scores Year on year rate 2011 2012 2010 E81006 E81075 E81617 E81633 E81040 E81010 E81632 E81018 E81026 E81054 E81005 E81064 E81013 E81025 E81032 E81041 E81048 E81028 E81073 Y02464 E81076 E81016 E81612 Y02463 E81001 Y02332 Y02477 E81063 E81631 E81065 E81618 Stopsley Village Kingfisher Practice 49 Ashcroft Rd Neville Rd Sundon MC Leagrave Surgery Barton Hills Woodland Ave Larkside Practice Sundon Park HC Bell House Petros MC 39 Castle St Oakley Surgery Lea Vale MC Gardenia Surgery Bute House Blenheim MC Medici Practice Moakes MC Pastures Way Lister House Hockwell Ring GP led WIC Wenlock St Kingsway HC Whipperley MC Conway MC 2A Malzeard Rd Medina MC 53 Leagrave Rd 58.8% 53.5% 51.0% 37.1% 54.4% 50.0% 51.5% 52.4% 46.0% 38.5% 47.3% 44.4% 45.9% 51.7% 47.0% 47.4% 38.0% 28.3% 34.9% 44.8% 39.9% 36.5% 27.2% 27.2% 21.8% 21.3% 20.4% 8.3% 61.3% 56.5% 51.1% 50.0% 59.3% 58.7% 50.9% 58.3% 56.6% 48.7% 50.5% 51.5% 54.2% 51.6% 50.7% 48.6% 45.9% 39.2% 41.1% 48.5% 38.4% 43.9% 42.3% 40.9% 37.1% 30.9% 28.6% 29.5% 13.0% 25.8% 12.0% Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 58.9% 56.3% 57.2% 46.7% 55.3% 51.7% 49.6% 56.1% 43.2% 43.8% 47.8% 45.6% 46.5% 52.5% 44.5% 49.1% 41.0% 36.9% 40.5% 40.0% 43.4% 45.7% 34.3% 28.6% 33.7% 30.1% 37.5% 26.2% 12.8% 25.0% 16.2% 2013 63.6% 60.3% 60.1% 58.7% 58.3% 57.5% 56.7% 56.6% 56.1% 54.1% 53.5% 53.1% 53.1% 50.4% 48.4% 45.4% 43.1% 42.3% 41.9% 41.5% 41.1% 40.7% 39.8% 37.8% 36.9% 34.7% 34.2% 33.3% 28.6% 28.5% 22.0% At or above target 2010 2011 2012 2013 Difference over 4 years (pp1) 4.8% 6.8% 9.1% 21.6% 3.9% 7.5% 5.2% 4.2% 10.1% 15.6% 6.2% 8.7% 7.2% -1.3% 1.4% -2.0% 5.1% 14.0% 7.0% -3.7% 0.8% 3.3% 9.7% 7.5% 11.5% 7.3% 8.1% 13.7% Key Year on year increase Year on year decrease Above national target Below national target National target > 60% 1 Percentage points 16 Screening indicator performance vs demographics • • • Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation Percentage of females aged 25–64 attending cervical screening within target period Percentage of persons aged 60–69 screened for bowel cancer within 6 months of invitation 17 No clear relationship between practices within East and North Hertfordshire CCG achieving the screening targets and local demographics Population aged 65+ Popn aged 65+ (average) 20 15 10 5 0 0 500 2 25% Mean Median 0 1 Mean Median 20% 15% 10% 5% 0% 2 0 1 2 Number of indicators where target was achieved for2+ years Number of indicators where target was achieved for2+ years Number of indicators where target was achieved for2+ years New cancer cases Cancer deaths Cancer prevalence 250 Mean Cancer deaths (average) New cancer cases (average) 600 1 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% Median 400 300 200 100 200 2.0% Mean Median 150 100 50 0 0 0 1 2 Number of indicators where target was achieved for2+ years 0 1 2 Number of indicators where target was achieved for2+ years Cancer prevalence (average) Number of practices 25 Deprivation Deprivation (average) Number of practices 1.5% Mean Median 1.0% 0.5% 0.0% 0 1 2 Number of indicators where target was achieved for2+ years 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): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database. 19 The number of practices within Luton CCG achieving the best practice range (80% to 120%) has varied year on year. CCG range 2010 2011 2012 2013 100.0% 100.0% 100.0% 100.0% n/a n/a n/a n/a CCG practice min 2.3% 3.5% 4.9% 4.1% CCG practice max 148.2% 135.7% 167.6% 141.0% 4(28) 11(31) 8(31) 7(31) 14.3% 35.5% 25.8% 22.6% England mean average 1 CCG/PCT mean average Practices within best practice range 2 Practices within best practice range (%) 1 Mean 2Best 175% TWW Referral ratio (IAS) Summary statistics 150% Key 125% — 100% Best practice range = 80% to 120% 75% 3 Range 50% for practices within the current CCG 25% 0% average for CCG/PCT not available 2010 practice range = 80% to 120% Distribution of practice referral ratios within the CCG CCG range3 2011 2012 2013 Luton CCG practices achieving the best practice range for 4 years Key Targets achieved 2013 2012 Indicator value 0%-40% 2011 40%-80% 80%-120% 2010 4 3 2 1 0 120%-160% 0% 20% 40% 60% 80% Proportion of practices Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 100% 160%-200% 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 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12 , 2013: 2012/13 53 Leagrave Rd Medina MC Wenlock St Gardenia Surgery 2013 GP led WIC Lister House 2012 Lea Vale MC Conway MC 49 Ashcroft Rd 2011 Pastures Way 160% Bute House 180% Hockwell Ring Neville Rd 2A Malzeard Rd Stopsley Village Blenheim MC Woodland Ave Sundon Park HC Bell House Kingfisher Practice Leagrave Surgery 39 Castle St Kingsway HC Whipperley MC Barton Hills Oakley Surgery Petros MC Sundon MC Larkside Practice Medici Practice Moakes MC TWW referral ratio (IAS) 20 Seven out of 31 practices within Luton CCG were within the best practice range of 80% to 120% in 2013. 16 practices failed to achieve the best practice range for the last three years. Three year profile (2011 to 2013) Best practice range 140% 120% 100% 80% 60% 40% 20% 0% 21 Two Week Wait referral ratio Practice indicator scores Year on year rate 2011 2012 2010 Y02464 E81073 E81026 E81040 E81064 E81025 E81632 Y02477 Y02332 E81013 E81010 E81075 E81005 E81054 E81018 E81028 E81006 E81631 E81633 E81612 E81048 E81076 E81617 E81063 E81032 E81016 Y02463 E81041 E81001 E81065 E81618 Moakes MC Medici Practice Larkside Practice Sundon MC Petros MC Oakley Surgery Barton Hills Whipperley MC Kingsway HC 39 Castle St Leagrave Surgery Kingfisher Practice Bell House Sundon Park HC Woodland Ave Blenheim MC Stopsley Village 2A Malzeard Rd Neville Rd Hockwell Ring Bute House Pastures Way 49 Ashcroft Rd Conway MC Lea Vale MC Lister House GP led WIC Gardenia Surgery Wenlock St Medina MC 53 Leagrave Rd 66.2% 148.2% 62.5% 112.2% 83.3% 81.6% 58.9% 64.3% 79.5% 88.8% 70.8% 70.6% 58.9% 41.0% 70.3% 5.2% 70.0% 38.8% 43.1% 66.3% 24.2% 30.8% 73.8% 51.2% 43.6% 2.6% 2.3% 6.4% 70.3% 110.0% 101.1% 64.7% 96.0% 82.9% 81.6% 63.8% 85.2% 87.7% 94.4% 78.6% 57.8% 114.1% 49.4% 54.7% 72.5% 4.2% 135.7% 18.9% 31.9% 90.9% 23.2% 44.4% 61.6% 40.5% 111.8% 41.3% 11.8% 3.5% 28.3% Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12 , 2013: 2012/13 118.8% 94.8% 99.9% 76.9% 100.2% 72.4% 101.2% 167.6% 74.8% 78.0% 97.4% 107.0% 61.4% 68.6% 73.2% 64.2% 53.5% 19.4% 128.1% 29.4% 61.8% 96.8% 23.9% 31.3% 65.5% 42.6% 34.7% 36.8% 8.5% 10.5% 4.9% 2013 141.0% 137.2% 103.1% 101.3% 98.0% 96.4% 95.8% 90.2% 87.9% 77.4% 75.0% 71.2% 68.4% 66.9% 63.3% 62.5% 62.2% 60.6% 59.1% 59.0% 58.8% 52.0% 51.7% 51.0% 50.2% 43.4% 41.7% 36.2% 28.5% 9.9% 4.1% At or above target 2010 2011 2012 2013 Difference over 4 years (pp1) Key 71.0% -45.1% 38.8% -14.2% 13.1% 14.2% 29.0% 13.1% Best practice range = 80% to -4.5% 120% -17.6% 1 Percentage points -2.4% -3.7% 4.4% 21.5% -8.1% 55.4% -10.9% 20.2% 15.7% -14.3% 27.5% 20.2% -23.6% -7.8% Year on year increase Year on year decrease Within best practice range Outside best practice range -7.4% 25.9% 7.6% -2.3% 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 2012/13 who were referred through the two week wait route divided by the total number of Two Week Wait referrals in 2012/13. Indicator source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database. 23 Luton CCG’s average has remained within the best practice range of 8% to 14% for the last four years. The maximum for the range of values has reduced over the last three years. CCG range and mean average 2010 2011 2012 2013 11.2% 10.9% 10.6% 10.0% CCG/PCT mean average 13.3% 10.3% 12.5% 11.6% CCG practice min 0.0% 0.0% 0.0% 0.0% CCG practice max 100.0% 100.0% 44.4% 37.5% 13(28) 10(31) 9(31) 14(31) 46.4% 32.3% 29.0% 45.2% England mean average 1 Practices within best practice range 2 Practices within best practice range (%) 1 Mean 2Best average for PCT in 2010 and 2011, CCG for 2012 and 2013. , 100% % of TWW referrals with cancer Summary statistics Key 80% — 60% 40% Best practice range = 8% 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range 0% 2010 Distribution of practice referrals within the CCG CCG range4 to 14% 20% practice range = 8% to 14% CCG/PCT3 mean average 2011 2012 for practices within the current CCG 2013 Luton CCG practices achieving the best practice range over 4 years Key Targets achieved 2013 2012 Indicator value 0%-8% 2011 8%-14% 4 3 2 1 0 14%-50% 2010 50%-100% 0% 20% 40% 60% 80% Proportion of practices Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 100% 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 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13. 53 Leagrave Rd Whipperley MC Conway MC Kingsway HC 2013 Pastures Way Sundon Park HC 2012 Larkside Practice Medici Practice Moakes MC 2011 Blenheim MC Kingfisher Practice 45% Oakley Surgery 50% 39 Castle St Three year profile (2011 to 2013) 2A Malzeard Rd Leagrave Surgery Barton Hills GP led WIC 49 Ashcroft Rd Petros MC Neville Rd Bell House Bute House Lea Vale MC Hockwell Ring Woodland Ave Gardenia Surgery Stopsley Village Sundon MC Lister House Medina MC Wenlock St % of TWW referrals with cancer 24 14 of the 31 practices within Luton CCG achieved the best practice range of 8% to 14% in 2013. 10 practices failed to achieve the best practice range for the last three years. 100% Best practice range 40% 35% 30% 25% 20% 15% 10% 5% 0% 25 Percentage of Two Week Wait referrals with cancer Practice indicator scores Year on year rate 2011 2012 2010 E81001 E81065 E81016 E81040 E81006 E81041 E81018 E81612 E81032 E81048 E81005 E81633 E81064 E81617 Y02463 E81632 E81010 E81631 E81013 E81025 E81075 E81028 Y02464 E81073 E81026 E81054 E81076 Y02332 E81063 Y02477 E81618 Wenlock St Medina MC Lister House Sundon MC Stopsley Village Gardenia Surgery Woodland Ave Hockwell Ring Lea Vale MC Bute House Bell House Neville Rd Petros MC 49 Ashcroft Rd GP led WIC Barton Hills Leagrave Surgery 2A Malzeard Rd 39 Castle St Oakley Surgery Kingfisher Practice Blenheim MC Moakes MC Medici Practice Larkside Practice Sundon Park HC Pastures Way Kingsway HC Conway MC Whipperley MC 53 Leagrave Rd 200.0% 0.0% 13.6% 11.7% 13.8% 11.4% 16.2% 8.7% 12.7% 18.2% 13.1% 6.3% 12.2% 47.1% 9.5% 14.9% 0.0% 14.9% 14.5% 20.4% 10.9% 5.6% 13.8% 5.4% 8.3% 14.3% 10.0% 100.0% 40.0% 0.0% 15.4% 14.1% 17.1% 19.4% 11.0% 23.1% 10.2% 16.2% 13.4% 5.6% 9.4% 26.3% 10.5% 9.4% 10.3% 100.0% 5.4% 6.6% 11.8% 2.9% 0.0% 7.0% 7.5% 5.5% 5.3% 12.5% 0.0% 9.1% 0.0% Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13. 25.0% 0.0% 17.8% 11.8% 18.9% 14.3% 21.9% 21.7% 13.3% 17.5% 13.5% 5.1% 12.8% 33.3% 44.4% 8.9% 11.9% 0.0% 14.1% 16.7% 7.6% 6.7% 8.0% 9.6% 4.2% 2.8% 10.4% 6.1% 18.5% 7.9% 0.0% 2013 37.5% 37.5% 25.9% 19.5% 18.3% 17.5% 15.3% 14.5% 13.6% 13.2% 13.1% 13.0% 12.2% 11.5% 11.1% 11.0% 10.9% 10.5% 9.9% 8.9% 8.7% 8.6% 7.3% 7.0% 5.5% 4.9% 4.8% 3.1% 1.9% 0.0% 0.0% At or above target 2010 2011 2012 2013 Difference over 4 years (pp1) -162.5% 37.5% 12.3% 7.8% 4.5% 6.1% -0.9% 5.8% 0.9% -5.0% 0.0% 6.7% 0.0% -35.6% 1.5% -4.0% 10.5% -5.0% -5.6% -11.7% -2.3% 1.4% -8.3% -0.5% -3.5% -11.2% -8.1% -100.0% Key Year on year increase Year on year decrease Within best practice range Outside best practice range Best practice range = 8% to 14% 1 Percentage points 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): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England Cancer Waiting Times Database. 27 Luton CCG’s average has remained around the national target of 40%, but below the national average, for the last four years. CCG range and mean average 2010 2011 2012 2013 42.9% 45.3% 46.5% 47.7% CCG/PCT mean average 40.2% 35.3% 41.9% 41.6% CCG practice min 0.0% 0.0% 0.0% 0.0% CCG practice max 67.9% 72.7% 80.0% 85.7% 14(28) 11(31) 16(31) 15(31) Practices above recommended min. (%) 50.0% 35.5% 51.6% 48.4% England mean average 1 Practices above recommended min. 1 Mean 2 % of new cancer cases are TWW referrals Summary statistics 100% — 60% 40% Recommended minimum average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range 2010 Distribution of new cancer cases (as a proportion of TWW) within the CCG CCG range4 3 Mean 0% minimum = 40% CCG/PCT3 mean average = 40% 20% average for PCT in 2010 and 2011, CCG for 2012 and 2013. , 2Recommended Key 80% 2011 2012 for practices within the current CCG 2013 Luton CCG practices achieving the recommended minimum of 40% over 4 years Key Targets achieved 2013 Indicator value 2012 0%-20% 20%-40% 2011 40%-60% 60%-80% 2010 4 3 2 1 0 80%-100% 0% 20% 40% 60% 80% Proportion of practices Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 100% 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 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 53 Leagrave Rd Whipperley MC Conway MC Sundon Park HC Pastures Way 2013 Kingsway HC 49 Ashcroft Rd 2012 Gardenia Surgery Moakes MC Medina MC 2011 Oakley Surgery 39 Castle St 80% Medici Practice Bell House Leagrave Surgery Lea Vale MC GP led WIC Hockwell Ring Larkside Practice Blenheim MC Petros MC Stopsley Village Woodland Ave Kingfisher Practice Lister House Bute House Neville Rd Sundon MC Barton Hills 2A Malzeard Rd Wenlock St % of new cancer cases are TWW referrals 28 15 out of 31 practices within Luton CCG achieved the recommended minimum of 40% in 2013. Five practices failed to achieve 40% for the last three years Three year profile (2011 to 2013) 90% Recommended minimum 70% 60% 50% 40% 30% 20% 10% 0% 29 Percentage of new cancer cases treated which are Two Week Wait referrals Practice indicator scores Year on year rate 2011 2012 2010 E81001 E81631 E81632 E81040 E81633 E81048 E81016 E81075 E81018 E81006 E81064 E81028 E81026 E81612 Y02463 E81032 E81010 E81005 E81073 E81013 E81025 E81065 Y02464 E81041 E81617 Y02332 E81076 E81054 E81063 Y02477 E81618 Wenlock St 2A Malzeard Rd Barton Hills Sundon MC Neville Rd Bute House Lister House Kingfisher Practice Woodland Ave Stopsley Village Petros MC Blenheim MC Larkside Practice Hockwell Ring GP led WIC Lea Vale MC Leagrave Surgery Bell House Medici Practice 39 Castle St Oakley Surgery Medina MC Moakes MC Gardenia Surgery 49 Ashcroft Rd Kingsway HC Pastures Way Sundon Park HC Conway MC Whipperley MC 53 Leagrave Rd 28.6% 0.0% 38.1% 28.1% 50.0% 50.0% 42.9% 67.9% 41.5% 37.5% 50.0% 31.3% 63.3% 15.4% 48.9% 45.2% 34.1% 19.2% 45.5% 45.5% 0.0% 25.8% 36.4% 60.0% 23.1% 25.0% 50.0% 50.0% 50.0% 50.0% 30.0% 40.6% 50.0% 23.1% 35.3% 52.4% 32.4% 44.9% 52.4% 13.3% 32.0% 30.0% 50.0% 35.4% 38.2% 32.5% 40.0% 28.6% 23.8% 0.0% 0.0% 33.3% 62.5% 72.7% 27.3% 23.1% 0.0% 33.3% 0.0% Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 11.1% 0.0% 46.2% 48.3% 40.0% 46.7% 36.4% 40.7% 55.6% 36.8% 58.6% 35.3% 33.3% 35.7% 80.0% 46.4% 43.6% 42.9% 39.0% 43.5% 54.5% 0.0% 50.0% 22.2% 38.1% 30.8% 53.8% 11.1% 38.5% 42.9% 0.0% 2013 85.7% 66.7% 65.4% 60.0% 60.0% 60.0% 53.8% 52.6% 52.1% 51.9% 50.0% 42.9% 42.1% 42.1% 40.0% 39.4% 38.9% 38.8% 36.8% 31.4% 31.3% 30.0% 27.3% 26.9% 24.1% 23.1% 20.0% 14.3% 7.1% 0.0% 0.0% At or above target 2010 2011 2012 2013 Difference over 4 years (pp1) 57.1% 66.7% 27.3% 31.9% 10.0% 10.0% 10.9% -15.3% 10.6% 14.4% 0.0% 11.6% -21.2% 26.7% -9.5% -6.3% 4.7% 17.6% -14.1% -14.2% 30.0% 1.1% -12.3% -36.9% -3.1% -10.7% -42.9% -50.0% Key Year on year increase Year on year decrease Above recommended minimum Below recommended minimum Recommended minimum = 40% 1 Percentage points 30 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 31 Practices within Luton CCG achieving the best practice and recommended ranges for Two Week Waits, tend to have a higher proportion of new cancer cases Population aged 65+ Popn aged 65+ (average) 15 10 5 0 1 2 3 Mean Median 25% Mean 20% Median 15% 10% 5% 0% 0 1 2 3 0 1 2 3 Number of indicators where target was achieved for2+ years Number of indicators where target was achieved for2+ years Number of indicators where target was achieved for2+ years New cancer cases Cancer deaths Cancer prevalence 700 Mean 600 Median 300 Cancer deaths (average) New cancer cases (average) 0 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 500 400 300 200 100 0 250 Mean 2.0% Median 200 150 100 50 0 0 1 2 3 Number of indicators where target was achieved for2+ years 0 1 2 3 Number of indicators where target was achieved for2+ years Cancer prevalence (average) Number of practices 20 Deprivation Deprivation (average) Number of practices Mean Median 1.5% 1.0% 0.5% 0.0% 0 1 2 3 Number of indicators where target was achieved for2+ years 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 2012 to 29th February 2013 was taken from the UKACR “Cancer HES” offload originally sourced from the NHS Information Centre for Health and Social Care HES dataset. The number of practices within Luton CCG below the recommended maximum of 481 increased year on year, leading to a decrease in the CCG average to below the recommended maximum in 2013. CCG range and mean average 2010 2011 2012 2013 691 583 587 481 CCG/PCT mean average 555 464 485 346 CCG practice min 76 77 55 49 CCG practice max 866 977 848 618 Practices below recommended max. 9(28) 17(31) 13(31) 25(31) Practices below recommended max. (%) 32.1% 54.8% 41.9% 80.6% England mean average 1 2 1 Mean Emergency admis. per 100,000 population Summary statistics 1,000 Key 800 — 600 400 CCG range4 Recommended maximum 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range 0 2010 maximum = 481 (National average in 2013) CCG/PCT3 mean average = 481 200 average for PCT in 2010 and 2011, CCG for 2012 and 2013. , 2Recommended 2011 2012 for practices within the current CCG 2013 Distribution of admission rates within the CCG Luton CCG practices achieving recommended maximum rate of 481 over 4 years 2013 Key Targets achieved 2012 Indicator value 0-250 2011 250-500 500-750 2010 4 3 2 1 0 750-1000 0% 20% 33 40% 60% 80% Proportion of practices Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 100% 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 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 Leagrave Surgery Barton Hills Petros MC 49 Ashcroft Rd Sundon Park HC 2013 Sundon MC Kingsway HC 2012 Woodland Ave Oakley Surgery 2011 39 Castle St 900 Stopsley Village 1,000 Gardenia Surgery Bell House Medici Practice Blenheim MC Larkside Practice Wenlock St Kingfisher Practice Bute House Lea Vale MC Hockwell Ring 2A Malzeard Rd Lister House Pastures Way Neville Rd Moakes MC Conway MC GP led WIC Whipperley MC 53 Leagrave Rd Medina MC Emergency admis. per 100,000 population 34 25 out of 31 practices in Luton CCG were below the recommended maximum of 481 in 2013. Four practices failed to achieve the maximum of 481 target for the last three years Three year profile (2011 to 2013) Recommended maximum 800 700 600 500 400 300 200 100 0 35 Rate of emergency admissions with cancer per 100,000 population Practice indicator scores Year on year rate 2011 2012 2010 E81065 E81618 Y02477 Y02463 E81063 Y02464 E81633 E81076 E81016 E81631 E81612 E81032 E81048 E81075 E81001 E81026 E81028 E81073 E81005 E81041 E81006 E81013 E81025 E81018 Y02332 E81040 E81054 E81617 E81064 E81632 E81010 Medina MC 53 Leagrave Rd Whipperley MC GP led WIC Conway MC Moakes MC Neville Rd Pastures Way Lister House 2A Malzeard Rd Hockwell Ring Lea Vale MC Bute House Kingfisher Practice Wenlock St Larkside Practice Blenheim MC Medici Practice Bell House Gardenia Surgery Stopsley Village 39 Castle St Oakley Surgery Woodland Ave Kingsway HC Sundon MC Sundon Park HC 49 Ashcroft Rd Petros MC Barton Hills Leagrave Surgery 334 542 76 302 491 651 376 274 581 434 426 499 521 544 864 643 575 713 491 632 669 407 699 317 652 637 643 866 137 427 977 277 189 139 313 855 295 77 188 403 208 525 343 518 256 467 664 427 772 436 902 537 494 578 391 501 499 739 706 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 104 604 844 236 199 55 592 528 282 150 237 450 278 347 535 734 313 562 626 550 848 604 519 543 374 595 497 555 471 726 632 2013 49 60 153 167 174 195 199 205 221 224 230 235 244 265 266 285 299 303 389 407 417 445 469 470 475 500 503 505 526 575 618 At or above target 2010 2011 2012 2013 Difference over 4 years -285 Key -482 Year on year increase 98 Year on year decrease Below recommended maximum Above recommended -103 maximum -286 -430 -152 Recommended maximum = 481 (national average in 2013) -44 -346 -190 -161 -233 -236 -245 -561 -254 -168 -296 -46 -163 -199 68 -199 186 -147 -111 -68 -248 Rate of persons diagnosed with cancer via an emergency admission, per 100,000 persons 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 NOTE: DEFINITION AND DATA SOURCE CHANGED IN 2013 Definition: Proportion of persons diagnosed via an emergency, managed referral or other route (2010 to 2012) recalculated as a rate per 100,000 persons, Number of persons diagnosed via an emergency route multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons (2013) Indicator source(s): Routes to Diagnosis project database (2010 to 2012), Hospital Episode Statistics (2013) 37 Luton CCG’s average has decreased over the last three years to a level below the recommended maximum of 74 in 2013. It has remained below the national average for the last four years. Note: 2012 data not available for individual practices across all CCGs 2010 2011 2012 2013 89 107 105 74 CCG/PCT mean average 77 81 78 59 CCG practice min 0 0 - 0 CCG practice max 149 167 - 136 13(28) 15(31) - 24(31) 46.4% 48.4% - 77.4% England mean average 1 Practices below recommended max 2 Practices below recommended max (%) 1 Mean CCG range and mean average Emergency presentations per 100,000 population Summary statistics average for PCT in 2010 and 2011, CCG for 2012 and 2013. , 2Recommended maximum = 74 (national average in 2013) 180 160 140 120 100 80 60 40 20 0 Key — CCG/PCT3 mean average CCG range4 Recommended maximum = 74 3 Mean average for PCT in 2010 and 2011, CCG for 2012 and 2013. 4 Range 2010 2011 2012 for practices within the current CCG 2013 Distribution of persons diagnosed with cancer (via an emergency admission), within the CCG Luton CCG practices achieving recommended maximum of 74 over three available years 2013 Key Targets achieved 2012 Indicator value 0-50 2011 50-100 3 2 1 0 100-150 2010 150-200 0% 20% 40% 60% 80% Proportion of practices Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 100% 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 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 49 Ashcroft Rd Leagrave Surgery Bell House Moakes MC Stopsley Village Barton Hills Gardenia Surgery Lea Vale MC Sundon Park HC Oakley Surgery Wenlock St Kingsway HC 53 Leagrave Rd Woodland Ave GP led WIC Hockwell Ring Whipperley MC Bute House Petros MC Medici Practice Blenheim MC Larkside Practice 2013 Neville Rd 39 Castle St 2012 Sundon MC Conway MC 2011 Pastures Way Medina MC 160 Lister House Kingfisher Practice 2A Malzeard Rd Emergency presentations per 100,000 population 38 24 out of 31 practices in Luton CCG were below the recommended maximum of 74 in 2013 Three year profile (2011 to 2013) 180 Recommended maximum 140 120 100 80 60 40 20 0 39 Rate of persons diagnosed with cancer via an emergency admission, per 100,000 persons Practice indicator scores Year on year rate 2011 2012 2010 E81631 E81075 E81016 E81065 E81076 E81063 E81040 E81013 E81633 E81026 E81028 E81073 E81064 E81048 Y02477 E81612 Y02463 E81018 E81618 Y02332 E81001 E81025 E81054 E81032 E81041 E81632 E81006 Y02464 E81005 E81010 E81617 2A Malzeard Rd Kingfisher Practice Lister House Medina MC Pastures Way Conway MC Sundon MC 39 Castle St Neville Rd Larkside Practice Blenheim MC Medici Practice Petros MC Bute House Whipperley MC Hockwell Ring GP led WIC Woodland Ave 53 Leagrave Rd Kingsway HC Wenlock St Oakley Surgery Sundon Park HC Lea Vale MC Gardenia Surgery Barton Hills Stopsley Village Moakes MC Bell House Leagrave Surgery 49 Ashcroft Rd 0 77 28 0 47 25 121 95 86 149 65 65 97 40 78 67 120 0 133 22 75 112 96 47 84 96 129 42 0 79 15 39 93 63 55 99 134 76 86 81 115 65 0 76 0 167 61 46 34 68 120 92 102 63 86 69 53 93 83 Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, 2013: 2012/13 2013 0 12 14 16 22 24 27 34 39 45 45 46 47 48 51 53 55 58 60 62 66 67 67 69 75 75 87 97 126 131 136 At or above target 2010 2011 2012 2013 Difference over 4 years 0 -65 -14 16 -25 -1 -94 -61 -47 -104 -20 -19 -50 8 -25 -9 -60 62 -67 45 -8 -43 -21 28 3 30 2 94 Key Year on year increase Year on year decrease Below recommended maximum Above recommended maximum Recommended maximum = 74 (national average in 2013) Emergency admission indicator performance vs demographics • • Rate of emergency admissions with cancer per 100,000 population Rate of persons diagnosed with cancer via an emergency admission Practices within Luton CCG achieving the emergency admission recommended rates tend to have a lower proportion of the population aged 65+, higher levels of deprivation, a lower proportion of new cancer cases, cancer deaths and cancer prevalence. Population aged 65+ Popn aged 65+ (average) 12 10 8 6 4 2 0 0 1 Mean Median 30% Mean 25% Median 20% 15% 10% 5% 0% 0 1 2 0 1 2 Number of indicators where target was achieved for1+ years Number of indicators where target was achieved for1+ years Number of indicators where target was achieved for1+ years New cancer cases Cancer deaths Cancer prevalence Median 400 300 200 100 0 300 Mean 250 Median 200 150 100 50 0 0 1 2 Number of indicators where target was achieved for1+ years 0 1 2 Number of indicators where target was achieved for1+ years Mean 2.0% Cancer prevalence (average) Mean 500 New cancer cases (average) 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 2 Cancer deaths (average) Number of practices 14 Deprivation Deprivation (average) Number of practices Median 1.5% 1.0% 0.5% 0.0% 0 1 2 Number of indicators where target was achieved for1+ years 41 APPENDIX Indicator definitions 43 Percentage of females aged 50–70 screened for breast cancer within 6 months of invitation 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 within 6 months of invitation. • Rate or proportion: 1-year screening uptake %: the number of females registered to the practice aged 50-70 invited for screening in the previous 12 months who were screened within 6 months of invitation divided by the total number of females aged 50-70 invited for screening in the previous 12 months. • Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2013, and covers the period 2010/11-2012/13. 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: This indicator measures the fraction of women invited in a specified period who are screened within 6 months of their invitation date. Due details of local implementation the number of women invited for screening in the previous year may be low (for example if screening is carried out by mobile units which revisit each area once in a screening round). Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 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 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 2013, and covers the period 2007/08Q3-2012/13. 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 4.0, December 2013) 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 Percentage of persons, 60–69, screened for bowel cancer within 6 months of invitation 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 within 6 months of invitation. • Rate or proportion: Screening uptake %: the number of persons aged 60-69 invited for screening in the previous 12 months who were screened adequately following an initial response within 6 months of invitation divided by the total number of persons aged 60-69 invited for screening in the previous 12 months. • Method: Data was taken from the Open Exeter system without further processing. The data extracted represents the situation at April 2013, and covers the period 2010/11Q3-2012/13. 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 people invited who have been screened adequately following an initial response within 6 months of their invitation date. 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 4.0, December 2013) 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 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 2012/13. • 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 NHS England Cancer Waiting Times Database by the Knowledge and Intelligence Team (East Midlands). Each patient was traced to a GP Practice using the Open Exeter Batch Tracing Service. Two Week Wait Referrals were identified for patients with a date first seen on the CWT database in 2012/13. 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 approximation1. • Source(s): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England 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 4.0, December 2013) 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 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 2012/13 who were referred through the two week wait route divided by the total number of Two Week Wait referrals in 2012/13. • Method: Patient level Cancer Waiting Times data (including patient identifiers) was downloaded from the NHS England Cancer Waiting Times Database by the Knowledge and Intelligence Team (East Midlands). 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 2012/13, 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 2012/13 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 2012/13 who were diagnosed with cancer will have started treatment in 2012/13 but a small number will have started treatment in 2012/13 and a small number of patients who started treatment in 2012/13 will have been first seen in 2011/12. 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): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England 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 4.0, December 2013) 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 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 2012/13 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 2012/13 on the cancer waiting times system. • Method: Patient level Cancer Waiting Times data (including patient identifiers) was downloaded from the NHS England Cancer Waiting Times Database by the Knowledge and Intelligence Team (East Midlands). 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): Knowledge and Intelligence Team (East Midlands) based on Cancer Waiting Times data for England, 2012/13, held on the NHS England 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 4.0, December 2013) 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 49 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 2012 to 28th February 2013 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 4.0, December 2013) 50 Rate of persons diagnosed with cancer via an emergency admission (2010 to 2012) 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 multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons • 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 51 Rate of persons diagnosed with cancer via an emergency admission (2013) 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 a first admission with a cancer code in the patient's HES record which is an emergency. • Rate or proportion: Number of persons diagnosed via an emergency route multiplied by 100,000 divided by the number of persons in the practice list, expressed as a rate per 100,000 persons. • Method: Each person with a inpatient HES record containing a cancer diagnostic code (ICD-10 C00-C97 excl C44) in one of the first three diagnostic fields is identified. This cohort is deduplicated by matching to previous years HES records and cancer registration records. Any duplicates are removed 15 and the remaining patients can be considered the remainder are an estimate of the members of the cohort of patients diagnosed with a new cancer in the period of interest. The numbers by practice are counted by allocating the patients to a practice according the practice as recorded by inpatient HES. The emergency status of the diagnostic episode is taken from the ADMETH field. • Source(s): Hospital Episode Statistics, The Health and Social Care Information Centre. Copyright © [2013], re-used with the permission of the Health and Social Care Information Centre. All rights reserved. • Interpretation: Emergency presentation is linked to lower short term survival in newly diagnosed patients. However is strongly affected by case-mix: more emergency presentations can be expected in older practice populations and the mix of tumour types is also highly significant (for example, lung cancers have a higher fraction of emergency presentations while breast cancers have a low fraction of emergency presentations). More emergency presentations can therefore be expected in practices with an older or more deprived population. Note: 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. The “Rapid” Routes to Diagnosis emergency data remain experimental, and are a proxy indicator. They are used to provide more timely data, but are not as rigorous as the figures found in Routes to Diagnosis. As such the figures may differ from other published sources and care should be taken in their interpretation. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) APPENDIX Demographic definitions 53 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 2012. 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 2012/13 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 2012 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 4.0, December 2013) 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 54 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 4.0, December 2013) 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 55 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 2011. • 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 2011 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 2011. 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 2011. 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 2012/13 taken from the Cancer Waiting Times database. Source: NCAT General Practice Profiles for cancer: meta-data for profile indicators (Version 4.0, December 2013) 56 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 4.0, December 2013) 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 57 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 2012/13 data2. • Interpretation: The prevalence data is taken from QOF data for 12/13, 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 4.0, December 2013) 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