BMC Paston PCN Data pack November 2019 BMC

BMC Paston PCN Data pack November 2019

BMC Paston PCN – summary • • • There almost 40, 000 people registered with BMC Paston PCN, with a higher proportion of people aged 64 and over when compared to the North Alliance, CCG and England. The population is estimated to increase by 7. 2% between 2019 and 2026. BMC Paston PCN has a lower proportion of population from the White British ethnic group compared to the North Alliance, CCG and England averages. Relative deprivation is higher in BMC Paston PCN and each of the constituent practices when compared to the North Alliance, CCG and England. Approximately 21% of children and 22% of older people live in poverty. • Birth rates and the proportion of babies born with a low birth weight are statistically similar to the North Alliance, which in itself has a noticeably high birth rate compared to the CCG • It is estimated that male and female life expectancy in the PCN is statistically similar to the North Alliance average at around 79. 8 years and 83. 0 years respectively. • Recorded obesity in adults is statistically significantly higher than the North Alliance • It is estimated that 22. 2% of adults smoke, which is statistically significantly higher than the North Alliance. • Estimates of people reporting long-term activity-limiting illness and being in Good or Very Good health are statistically worse than the averages for the North Alliance. • On average there around 370 deaths a year in the PCN, with about a third of these in people aged under 75 years • The PCN has statistically significantly high recorded prevalence of hypertension, stroke, COPD and diabetes compared to the North Alliance averages • All-age, all cause mortality is statistically similar to the North Alliance rate but premature all-cause mortality is statistically significantly higher. • BMC Paston PCN has statistically significantly high rates of severe mental illness, dementia and learning disabilities compared to the North Alliance. • BMC Paston PCN has statistically significantly high rates of children’s social care use compared to the North Alliance average. • The overall adult social care use rate in BMC Paston PCN is statistically significantly higher than the North Alliance rate. • BMC Paston PCN has statistically significantly high rates of first outpatient attendances, follow up outpatient attendances and emergency department attendances compared with the North Alliance averages.

BMC Paston PCN Source: Shape Atlas GP registered population, October 2019, NHS Digital.

Demography and key population characteristics

GP registered population BMC Paston PCN has a higher proportion of people aged 65 and over and lower proportions of people aged 16 -64 compared with North Alliance, CCG and England.

Population forecasts The population of BMC Paston PCN is forecast to grow at a lower rate than the CCG as whole. The population is expected to increase by 7. 2% between 2019 and 2026. Source: GP registered population, April 2019, NHS Digital. Population forecasts based on population distribution at ward level (Apr 19), Mid 2015 based population forecasts Cambridgeshire County Council

Population distribution PCN dominant population Source: GP registered population data by Lower Super Output Area, April 19, NHS Digital

Ethnicity BMC Paston PCN has a lower proportion of population from the White British ethnic group and higher proportions from White Other and Asian ethnic origins compared to the North Alliance, CCG and England averages. Source: Census 2011 data applied to GP registered population using Census 2011 ethnic group proportions; England data from NOMIS (patients registered at a GP Practice by LSOA, July 2018, NHS Digital)

Deprivation Index of Multiple Deprivation, 2019, by LSOA Relative deprivation is higher in BMC Paston PCN and each of the constituent practices when compared to the North Alliance, CCG and England. Approximately 21% of children and 22% of older people live in income deprived households in the PCN; higher than the averages for North Alliance, CCG and England. Source: C&P PHI derived from Indices of Multiple Deprivation 2019, MHCLG and GP registered population data for July 2018. Practice data from PHE Fingertips.

Births and Fertility Birth rates by ward Birth rates and low birth weight births in BMC Paston PCN are statistically similar to the averages for the North Alliance. Note: Relates to Cambridgeshire and Peterborough residents only Source: C&P PHI based on NHS Digital Civil Registration Data, 2014 -2016 and patients registered at a GP Practice by LSOA, July 2018, NHS Digital

Self-reported limiting long-term illness and general health status It is estimated that the proportion of people that reported that they had a long-term activity-limiting illness in the 2011 Census was statistically significantly higher than the North Alliance average. It is estimated that the proportion of people that reported that they were in good or very good health in the 2011 Census was statistically significantly lower than the North Alliance average. Source: C&P PHI from Census 2011, NOMIS and patients registered at a GP Practice by LSOA, July 2018, NHS Digital

Life expectancy Male and female life expectancy in BMC Paston PCN is statistically similar to the North Alliance. Source: C&P PHI based, derived from NHS Digital Civil Registration data and GP registered population data 2013 – 2017

Mortality – all causes There have been on average 370 deaths a year in BMC Paston PCN, approximately a third are in people aged under 75 year olds. BMC Paston PCN has a statistically significantly higher premature mortality rate compared with North Alliance. DASR = directly age standardised rate per 100, 000 population Source: C&P PHI, from NHS Digital Civil Registration Data and NHS Digital GP registered population data, 2014 -2018

Selected lifestyle behaviour risk factors

Risk factors Recorded prevalence of obesity is statistically significantly higher in BMC Paston PCN compared to the average for North Alliance. Estimated smoking prevalence is statistically significantly higher in BMC Paston PCN compared to the average for North Alliance. Source: Obesity - C&P PHI derived from NHS Digital QOF data for 2017/18; Estimated smoking - C&P PHI derived from the QOF based smoking prevalence estimate from the Public Health England (PHE) National General Practice Profiles at https: //fingertips. phe. org. uk/profile/general-practice

Prevalence and mortality from principal diseases

Circulatory disease The BMC Paston PCN CHD prevalence rate is statistically similar to North Alliance whereas hypertension and stroke prevalence rates are statistically significantly high compared to North Alliance. Circulatory disease premature mortality rates for the PCN are statistically significantly higher than the North Alliance average. . Note: Prevalence data are not available by age i. e. it is not age weighted so differences may be explained by differing age structures; DASR = Directly age standardised rate per 100, 000 population Source: Prevalence (recorded) - C&P PHI from QOF, NHS Digital, 2017/18; Mortality - C&P PHI, from NHS Digital Civil Registration Data and NHS Digital GP registered population data, 2014 -2018

Respiratory disease PCN asthma prevalence is statistically significantly lower than North Alliance. COPD prevalence is statistically significantly high compared to the North Alliance at PCN level and at Boroughbury Medical Centre. Mortality rates for respiratory diseases, for people of all ages and under 75 years, are similar to the North Alliance rates Note: Prevalence data are not available by age i. e. it is not age weighted so differences may be explained by differing age structures; DASR = Directly age standardised rate per 100, 000 population Source: Prevalence (recorded) - C&P PHI from QOF, NHS Digital, 2017/18; Mortality - C&P PHI, from NHS Digital Civil Registration Data and NHS Digital GP registered population data, 2014 -2018

Long term conditions Diabetes prevalence is statistically significantly higher than the North Alliance at PCN level. Cancer prevalence is statistically similar to the North Alliance average at PCN level with Boroughbury having statistically significantly higher prevalence and Paston significantly lower prevalence than North Alliance. All practices have statistically similar all-age and premature cancer mortality rates to the North Alliance. Note: Prevalence data are not available by age i. e. it is not age weighted so differences may be explained by differing age structures; DASR = Directly age standardised rate per 100, 000 population Source: Prevalence (recorded) - C&P PHI from QOF, NHS Digital, 2017/18; Mortality - C&P PHI, from NHS Digital Civil Registration Data and NHS Digital GP registered population data, 2014 -2018

Mental health, dementia and learning disability BMC Paston PCN prevalence rates of severe mental illness, dementia and learning disability are all statistically significantly high when compared to the North Alliance average. BMC Paston PCN has a statistically significantly low depression prevalence compared to the North Alliance. Note: Prevalence data are not available by age i. e. it is not age weighted so differences may be explained by differing age structures Source: Prevalence (recorded) - C&P PHI from QOF, NHS Digital, 2017/18

Service provision and utilisation

PCN workforce

Who works within the Health and Social Care services for the PCN? Patients receive health care from a range of individuals and organisations 111 staff are employed through BMC Paston PCN’s practices. The majority of which will be directly in contact with patients. ` Data Sources: Local Authority Data extract; PCN Practice data; CPFT data extract

Who works within the Health and Social Care services for the PCN? Patients receive health care from a range of individuals and organisations: There are currently 33, 253 patients under CPFT caseload across the services listed. Caseloads rates for BMC Paston PCN are generally higher compared to the rest of Cambridgeshire and Peterborough. Additional patients will be inpatients in rehab wards and part of the multi-disciplinary team caseload. Boroughbury Medical Surgery has the highest number of caseloads for BMC Paston PCN. Data Sources: Local Authority Data extract; PCN Practice data; CPFT data extract

Social Care Services

Children’s Social Care BMC Paston PCN has statistically significantly high rates of social care involvement cases, early help cases and education, health and care plans compared to the North Alliance average. The North Alliance rates for all Children’s social care cases are estimated to be statistically significantly higher than the CCG averages. Source: Cambridgeshire County Council, BI team. Estimates derived from the LSOA level data, (for those LSOAs in Cambridgeshire or Peterborough only) available as an open data release here: https: //data. cambridgeshireinsight. org. uk/dataset/cambridgeshire-and-peterborough-adult-social-care-long-term-service-users-31 -march-2019 and GP Registered Population April 2019

Adult Social Care The overall adult social care use rate in BMC Paston PCN is statistically significantly higher than the North Alliance rate. The overall adult social care use rate in North Alliance is statistically significantly higher compared with the CCG average. Source: Cambridgeshire County Council, BI team. Estimates derived from the LSOA level data, (for those LSOAs in Cambridgeshire or Peterborough only) available as an open data release here: https: //data. cambridgeshireinsight. org. uk/dataset/cambridgeshire-and-peterborough-adult-social-care-long-term-service-users-31 -march-2019 and GP Registered Population April 2019

Secondary Care Services

Secondary Care Services Boroughbury Medical Centre first outpatient attendance and follow up outpatient attendance rates are statistically significantly higher than the PCN rates. BMC Paston PCN has statistically significantly high rates of first outpatient attendances, follow up outpatient attendances and emergency department attendances compared with the North Alliance averages. The rates for emergency admission and emergency admission for ACS conditions are statistically similar to the North Alliance average. North Alliance has statistically significantly high rates of secondary care services compared with the CCG average Ophthalmology and Trauma & Orthopaedics account for the most outpatient attendances. This was the case for both 17/18 and 18/19. Together they make up 24% of the activity for 18/19. Audiology and Ophthalmology are the most common specialties. This is reflected where 22% of first outpatient attendances are hearing and sight related. The most common elective admissions are for General Surgery and Gastroenterology related conditions. 77% of the Gastroenterology admissions were to PSHFT during 18/19. Note: DASR = Directly age standardised rate per 1, 000 population, reference population used is the ONS National Standard Population. Source: C&P PHI, from HED Tool, 2018/19, Cambridgeshire and Peterborough “Practice Benchmarker”

Disease Specific Emergency Hospital Admission Rates The PCN emergency hospital admission rates shown are statistically similar to the North Alliance average For BMC Paston PCN there were 3, 941 emergency admissions during 2018/19. The majority of emergency admissions were for Paediatric Medicine, Geriatric Medicine, and General Medicine. Paediatric Medicine and Geriatric Medicine made up 30% of emergency admissions during 18/19. While these specialties grew by 18% year on year, the nearest 4 specialities in terms of admissions either showed little growth or a year on year decline. The rate of emergency admissions for Endocrinology almost doubled during 18/19. BMC Paston PCN had the second highest rate for Nephrology related emergency admissions across Cambridgeshire and Peterborough. Referrals from “Health Care Provider: same or other” increased by 62% where the majority of the other referral types showed no significant year on year increase. Note: DASR = Directly age standardised rate per 1, 000 population, reference population used is the ONS National Standard Population. Source: C&P PHI, from HED Tool, 2018/19, Cambridgeshire and Peterborough “All Trusts 18/19”

Potentially Avoidable Hospital Admissions Having a higher proportion of people aged 65 and a high prevalence of smokers has helped make COPD the most common ambulatory care sensitive condition Selected Ambulatory Care Sensitive Conditions NEL admissions in 2018/19 by age Although there was a 6% increase for ACSC admissions across Cambridgeshire and Peterborough, admissions for BMC Paston PCN remained the same. Those aged over 65 account for the majority of the 5 most common potentially preventable (ACSC) related admissions during 18/19. COPD and Pyelonephritis and kidney/urinary tract infections were most common for the older age bands. The number of emergency ACS conditions for BMC Paston PCN has remained flat and not grown year on year. COPD and Cellulitis are more common for the younger age bracket. Data Source: Cambridgeshire and Peterborough “Practice Benchmarker”

Glossary of key methods and terms To assess statistical significance, 95% confidence intervals are calculated which provide a measure of uncertainty around the calculated value which arises due to random variation. If the confidence interval for a value excludes the value for the relevant benchmark, the difference between the local value and the benchmark is said to be ‘statistically significant’. The following hierarchy of benchmarks has been used in this profile: practice to PCN; PCN to Alliance; Alliance to CCG and CCG to England. The most commonly used RAG-rating in this profile: Exceptions to this are life expectancy which is RAG rated like this: And self-reported limiting long-term illness and general health status which is RAG rated like this: DASR = directly age standardised rate per 100, 000 population C&P PHI = Cambridgeshire and Peterborough Public Health Intelligence QOF = Quality Outcomes Framework. Prevalence data are not available by age i. e. it is not age weighted so differences may be explained by differing age structures.

Produced by: Cambridgeshire and Peterborough Public Health Intelligence Team Contact: PHI-team@Cambridgeshire. gov. uk Date updated: 29 th November 2019