Cancer indicator trend analysis
Stort Valley & Villages 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
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
Emergency admission indicator
•
•
14
23
Rate of emergency admissions with cancer per 100,000 population
Proportion of persons diagnosed with cancer via an emergency admission
Appendices
• Definitions for indicators and demographics.
29
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 Stort
Valley & Villages 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 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.
CCG average remains just below the national average but above the national target of 70% 6
for the last two years. The number of practices within the Stort Valley & Villages locality
achieving the national target increased from two practices in 2011 to five in 2012.
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
72.7%
68.7%
74.2%
Locality practice max
75.2%
70.1%
78.0%
5(5)
2(5)
5(5)
100.0%
40.0%
100.0%
Practices above national target
1
Practices above national target (%)
1National
target > 70%
National target
4.5
80%
76%
74%
 2010
 2011
 2012
3.5
3
CCG mean average
Locality range
National target >70%
72%
70%
68%
66%
201 1
201 2
Targets achieved for 3 years
Key
4
Key


—
78%
201 0
Rate distribution – has the profile changed?
Number of practices
% Screened for breast cancer
( F50-70)
Summary statistics
2.5
Key
Targets achieved




3
2
1
0
2
1 .5
1
0.5
0
66%-69%
70%-73%
74%-77%
78%-81 %
% 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
All five practices within the Stort Valley & Villages locality achieved the 70% target in
2012.
% 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%
South St
Parsonage
Practice scores 2010 to 2012
Much Hadham HC
2010
Year on year rate
2011
2012
Church St
At or above target
2010 2011 2012
Difference over
2 years (pp1)
E82074
South St
75.2%

69.4%

78.0%




8.6%
E82654
Parsonage
75.1%

68.9%

76.8%




7.8%
E82021
Much Hadham HC
74.3%

70.1%

76.64%




E82067
Church St
72.8%

68.7%

76.6%



E82100
Central Surgery
72.7%

70.0%

74.2%



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
Central Surgery
Key

Year on year increase
6.5%


Year on year decrease
Above national target

7.9%

Below national target

4.1%
National target > 70%
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.
9
CCG average remains steady and has been above the national average for the last
three years but below the national target of 80%.
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%
76.4%
74.9%
84.3%
85.7%
84.4%
1(5)
2(5)
1(5)
20.0%
40.0%
20.0%
Locality practice max
Practices above national target
1
Practices above national target (%)
1National
Number of practices
4
3.5
3


—
80%
75%
Locality range
National target >80%
65%
201 1
201 2
Targets
achieved for
3 years
National target
 2010
 2011
 2012
CCG mean average
70%
201 0
Key
Key
60%
target > 80%
Rate distribution – has the profile changed?
4.5
85%
% Attending cervical
screening ( F25-64)
Summary statistics
Key
Targets achieved




2.5
2
1 .5
3
2
1
0
1
0.5
0
70%-74%
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
One out of five practices within the Stort Valley & Villages locality achieved the 80%
target in 2012. Three practices within the locality failed to meet the 80% target for the
last three years.
% Attending cervical screening (F25-64)
90%
201 0
201 1
201 2
National target
85%
80%
75%
70%
65%
60%
55%
Much Hadham HC
Central Surgery
Practice scores 2010 to 2012
Parsonage
2010
Year on year rate
2011
2012
South St
At or above target
2010 2011 2012
Church St
Difference
over
2 years (pp1)
E82021
Much Hadham HC
84.3%

85.7%

84.4%




-1.3%
Key
E82100
Central Surgery
78.2%

79.7%

79.5%




-0.2%

Year on year increase
E82654
Parsonage
78.9%

80.2%

77.8%




-2.5%


Year on year decrease
Above national target
E82074
South St
79.6%

78.9%

77.5%




-1.4%

Below national target
E82067
Church St
76.7%

76.4%

74.9%




-1.5%
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%
10
11
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%. 2012 saw an increase in the proportion 60-69 year olds being screened
across the Stort Valley & Villages locality.
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
49.6%
52.2%
56.3%
59.2%
58.8%
62.1%
0(5)
0(5)
3(5)
0.0%
0.0%
60.0%
Locality practice max
Practices above national target
1
Practices above national target (%)
1National
target > 60%
Number of practices
4
3.5
3
65%
Key
National
target
 2010
 2011
 2012
60%
2
1 .5
CCG mean average
Locality range
National target >60%
55%
50%
45%
201 1
201 2
Targets
achieved for
3 years
Key
Targets achieved




2.5
Key


—
201 0
Rate distribution – has the profile changed?
4.5
% Screened for bowel cancer
(60-69)
Summary statistics
12
3
2
1
0
1
0.5
0
45%-49%
50%-54%
55%-59%
60%-64%
% 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
Three out of five practices within the Stort Valley & Villages locality achieved the 60%
target in 2012. Two practices within the locality failed to achieved the 60% target
during the last three years.
70%
% Screened for bowelcancer (60-69)
65%
201 0
201 1
201 2
National target
60%
55%
50%
45%
40%
35%
30%
Church St
South St
Practice scores 2010 to 2012
Central Surgery
2010
Year on year rate
2011
2012
Much Hadham HC
At or above target
2010 2011 2012
Difference
over
2 years (pp1)
E82067
Church St
55.8%

57.3%

62.1%




4.8%
E82074
South St
59.2%

58.8%

60.9%




2.1%
E82100
Central Surgery
54.1%

55.1%

60.0%




E82021
Much Hadham HC
57.1%

58.6%

57.8%



E82654
Parsonage
49.6%

52.2%

56.3%



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
Parsonage
Key

Year on year increase
4.9%


Year on year decrease
Above national target

-0.8%

Below national target

4.1%
National target > 60%
13
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.
15
The proportion of practices within the Stort Valley & Villages locality achieving the
best practice range of 80% to 120% has remained steady for the last three years.
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
60.6%
57.5%
56.9%
Locality practice max
109.3%
90.0%
98.9%
3(5)
2(5)
3(5)
60.0%
40.0%
60.0%
England mean average
Practices within best practice range
1
Practices within best practice range (%)
1Best
Number of practices
3
2.5
2
Best practice range
Key
Key
 Locality range
— Best practice range =
1 20%
80% to 120%
1 00%
80%
60%
40%
practice range = 80% to 120%, practices with less than 5 referrals excluded.
Referral ratio distribution – has the profile changed?
3.5
1 40%
Referral ratio (IAS 1 )
Summary statistics
201 0
201 1
201 2
Stort Valley & Villages practices achieving the best practice
range for 3 years
Key
Targets achieved
 2010
 2011
 2012




1 .5
3
2
1
0
1
0.5
0
40%-59%
1 20%+
80%-99%
Referral ratio (IAS)
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
1 00%-1 1 9%
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
Three out of five practices within the Stort Valley & Villages locality were within the
best practice range of 80% to 20% in 2012. One practice failed to achieve the best
practice range for the last three years.
1 60%
201 0
201 1
201 2
Best practice range
Referral ratio (indirectage standardised)
1 40%
1 20%
1 00%
80%
60%
40%
20%
Parsonage
South St
Practice scores 2010 to 2012
Church St
2010
Year on year rate
2011
2012
Central Surgery
Within best practice range
2010 2011 2012
Difference
over
2 years (pp1)
E82654
Parsonage
69.2%

74.0%

98.9%




24.9%
E82074
South St
83.8%

90.0%

97.4%




7.4%
E82067
Church St
90.3%

87.9%

86.0%




E82100
Central Surgery
109.3%

77.4%

72.3%



E82021
Much Hadham HC
60.6%

57.5%

56.9%



Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
Much Hadham HC
Key

Year on year increase
-1.9%


Year on year decrease
Within best practice range

-5.1%

Outside best practice range

-0.6%
Best practice 80% to 120%
16
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.
18
The number of practices within the Stort Valley & Villages locality achieving the best
practice range of 8% to 14% has remained steady for the last three years.
Locality range and CCG mean average
2010
2011
2012
England mean average
11.2%
10.9%
10.6%
CCG mean average
10.5%
10.6%
11.6%
Locality practice min
7.5%
6.9%
6.4%
Locality practice max
11.6%
9.6%
15.2%
1(4)
2(4)
2(4)
25.0%
50.0%
50.0%
Practices within best practice range
1
Practices within best practice range (%)
1Best
3.5
Best practice range
3
2.5
Key


—
1 4%
1 2%
CCG mean average
Locality range
Best practice = 8% to 14%
1 0%
8%
6%
practice = 8% to 14%, practices with less than 5 referrals excluded.
Indicator distribution – has the profile changed?
Number of practices
1 6%
% of TWW referrals with
cancer
Summary statistics
201 0
201 1
201 2
Stort Valley & Villages practices achieving the best practice
range over 3 years
Key
 2010
 2011
 2012
2
1 .5
Key
Targets achieved




3
2
1
0
1
0.5
0
5%-7%
8%-1 0%
1 1 %-1 3%
% of TWW referrals with cancer
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
1 4%-1 6%
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
Two out of four practices within the Stort Valley & Villages locality achieved the best
practice range of 8% to 14% within 2012. One practice failed to achieve the best
practice range for the last three years.
20%
201 0
% of TWW referrals with cancer
1 8%
201 1
201 2
Best practice range
1 6%
1 4%
1 2%
1 0%
8%
6%
4%
2%
0%
Much Hadham HC
Central Surgery
Practice scores 2010 to 2012
Church St
2010
Year on year rate
2011
2012
South St
Within best practice range
2010 2011 2012
Parsonage
Difference
over
2 years (pp1)
E82021
Much Hadham HC
11.6%

9.6%

15.2%




5.6%
E82100
Central Surgery
7.5%

6.9%

10.6%




3.7%
E82067
Church St
7.8%

9.0%

9.0%




E82074
South St
7.5%

7.0%

6.4%




E82654
Parsonage
-
-
-
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, activity based on less than 5 referrals are not shown.
Key

Year on year increase
0.0%


Year on year decrease
Within best practice range
-0.5%

Outside best practice range
-
Best practice 8% to 14%
19
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.
21
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
29.6%
23.1%
38.0%
Locality practice max
42.9%
41.4%
60.0%
1(5)
1(5)
4(5)
20.0%
20.0%
80.0%
Practices above recommended min.
1
Practices above recommended min. (%)
1Recommended
minimum = 40%, practices with less than 5 referrals excluded.
Indicator distribution – has the profile changed?
Recommended
minimum = 40%
3.5
2.5
70%
Key


—
60%
50%
CCG mean average
Locality range
Recommended minimum 40%
40%
30%
20%
201 0
201 1
201 2
Stort Valley & Villages practices achieving the
recommended minimum of 40% over 3 years
Key
 2010
 2011
 2012
3
Number of practices
% of new cancer cases are TWW
referrals
Summary statistics
2
1 .5
Key
Targets achieved




3
2
1
0
1
0.5
0
20%-29%
30%-39%
40%-49%
50%-59%
% of new cancer cases are TWW referrals
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12
60%-69%
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
22
Four out of five practices within the Stort Valley & Villages locality achieved the
recommended minimum of 40% in 2012.
80%
% of new cancer cases are TWW referrals
70%
201 0
201 1
201 2
Recommended minimum
60%
50%
40%
30%
20%
1 0%
0%
Much Hadham HC
Church St
Practice scores 2010 to 2012
Parsonage
2010
Year on year rate
2011
2012
South St
At or above target
2010 2011 2012
Difference
over
2 years (pp1)
E82021
Much Hadham HC
29.6%

35.0%

60.0%




25.0%
E82067
Church St
34.6%

38.3%

46.3%




8.0%
E82654
Parsonage
42.9%

23.1%

40.0%




E82074
South St
33.3%

39.3%

40.0%



E82100
Central Surgery
30.8%

41.4%

38.0%



Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, ratios based on less than 5 referrals are not shown.
Central Surgery
Key

Year on year increase
16.9%


Year on year decrease
Above recommended minimum

0.7%

Below recommended minimum

-3.4%
Recommended minimum = 40%
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.
CCG average varies year on year but remains below the recommended maximum of
578 and below the national average. The maximum rate for the Stort Valley & Villages
locality has decreased year on year.
Locality range and CCG mean average
2010
2011
2012
England mean average
691
583
587
CCG mean average
519
459
502
Locality practice min
419
397
349
Locality practice max
685
530
463
4(5)
5(5)
5(5)
80.0%
100.0%
100.0%
1
Practices below recommended max.
Practices below recommended max. (%)
maximum = national average (587 in 2012), practices with less
than 5 admissions excluded.
Key
 2010
 2011
 2012
4
3.5
Number of practices
700
600
CCG mean average
Locality range
Recommended maximum = 587
500
400
201 0
201 1
201 2
Stort Valley & Villages practices achieving recommended
maximum rate of 587 over 3 years
Recommended
maximum = 587
4.5


—
300
1Recommended
Rate distribution – has the profile changed?
Key
800
Emergency admis. per
1 00,000 population
Summary statistics
24
3
2.5
2
Key
Targets achieved




3
2
1
0
1 .5
1
0.5
0
300-399
400-499
500-599
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
25
All five practices in the Stort Valley & Villages locality were below the recommended
maximum of 587 in 2012.
800
% of new cancer cases are TWW referrals
700
201 0
201 1
201 2
Recommended maximum
600
500
400
300
200
1 00
0
Church St
Much Hadham HC
South St
Practice scores 2010 to 2012
2010
Year on year rate
2011
2012
Central Surgery
At or below target
2010 2011 2012
Difference
over
2 years (pp1)
E82067
Church St
422

397

463




66
E82021
Much Hadham HC
419

488

424




-64
E82074
South St
584

442

417




-24
E82100
Central Surgery
572

432

410




-23
E82654
Parsonage
685

530

349




-181
Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, rates based on less than 5 admissions are not shown.
Parsonage
Key

Year on year increase


Year on year decrease
Below recommended maximum

Above recommended maximum
Recommended range <National
average (587 in 2012)
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
27
CCG average remains around the maximum of the recommended range (0% to 20%).
Note: 2012 data not available across all CCGs
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
14.3%
10.5%
Locality practice max
36.4%
42.9%
2(3)
3(5)
66.7%
60.0%
Practices within recommended range
1
Practices within recommended range (%)
1Recommended
2012
Recommended
range - 0% to 20%
Number of practices
3
2.5
Key
50%
Key


—
40%
30%
CCG mean average
Locality range
Recommended range = 0% to 20%
20%
1 0%
0%
range = 0% to 20%, practices with less than 5 admissions excluded.
Indicator distribution – has the profile changed?
3.5
Proportion of persons
diagnosed via emergency
presentation
Summary statistics
201 0
201 1
201 2
Stort Valley & Villages practices achieving recommended
range of 0% to 20 % over 2 years
Key
Targets achieved
 2010
 2011




2
1 .5
2
1
0
Not shown
(low volumes)
1
0.5
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
28
Proportion of persons diagnosed via emergency presentation
Two out of three practices in the locality were within the recommended range of 0% to 20%
in 2011.
50%
45%
201 0
201 1
201 2
Recommended range
40%
35%
30%
25%
20%
1 5%
1 0%
5%
0%
Parsonage
South St
Practice scores 2010 to 2012
Much Hadham HC
Church St
2010
Year on year rate
2011
2012
At or below target
2010 2011 2012
-
42.9%
-

-
21.6%
-

-
18.5%
-

-
E82654
Parsonage
E82074
South St
E82021
Much Hadham HC
E82067
Church St
22.4%

16.9%
-


E82100
Central Surgery
16.1%

10.5%
-


19.1%

-

Note: Published year shown, 2010 refers to 2009/10, 2011: 2010/11, 2012: 2011/12, rates based on less than 5 admissions are not shown.
Difference
over
2 years (pp1)
Central Surgery
Key

Year on year increase


Year on year decrease
Within recommended range
-

Outside recommended range
-
Recommended range = 0% to 20%
Note: rates based on less than 5
admissions are not shown.
APPENDIX
Indicator definitions
30
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
31
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
32
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
33
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 approximation1.
•
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
34
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
35
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
36
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)
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.
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
39
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
40
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
41
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)
42
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
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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