As a person responsible for improving the care of patients with diabetes across a locality, it is important to have a good understanding of the current performance of your GP practices. This will help you to identify variation in care so that you can prioritise your QI training and interventions.
Nationally-generated benchmarking data can help you with this task. The links below take you to the data you will need, but there are some limitations:
- Data needs to be interpreted carefully, taking into consideration variations in practice context: for example, demographics of the population and list size turnover. As a local clinical lead, you can use your local knowledge to help make sense of variation.
- Many of the externally-collected data sources are not ‘real-time’ and will not reflect improvements that have already taken place.
- Some of the datasets may be incomplete as practices may have ‘opted out’ of external data collection.
- Not all datasets are applicable across all four nations of the UK.
National Diabetes Audit for England and Wales
The National Diabetes Audit (NDA) continues to provide a comprehensive view of diabetes care in England and Wales and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. Practices have to agree to participate before their data can be extracted.
The Excel spreadsheets showing your CCG/LHB’s performance can be downloaded from the site. Ensure macros are enabled so that you can browse the data.
Practice-level data is available for England, but not for Wales. The spreadsheets in audit report one cover participation, registration and demographics; care process completion; structured education: target achievement. Graphs can show the data by audit year and diabetes type. Practices in Wales can access their data via the Audit + NDA practice support module.
On this site there is a power point presentation, along with slides highlighting the national findings there is also space to allow the incorporation of locally produced slides, which can be used to disseminate the results of the audit locally.
Quality and Outcomes Framework (QOF) Data
This site is independent of the NHS and pulls its data from published QOF performance data across the four nations of the UK. It is possible to ‘drill down’ to practice-level data for England, Scotland and Northern Ireland. QOF data for Wales is available at Health Board level only. The site allows you to compare your locality with others, as well as with national performance. QOF indicators differ across the four nations.
This data can be helpful in deciding your improvement priorities. In diabetes care it gives information on each indicator and prevalence but not on the number achieving all treatment targets. The treatment targets vary slightly between QOF and NDA. QOF has removed all measurements of care processes apart from foot surveillance so these figures can not distinguish whether a target is not being achieved because the process such as blood pressure measurement has not been done or whether the target level has been reached. Smoking in QOF is now bundled with other diseases. The indicators do not deal with type one and type two diabetes separately which may be important in deciding an intervention when patients with type one diabetes may be cared for mainly in secondary care. QOF data for the preceding April-March is usually published by each nation around October; this website then uploads the data in an easy-to-navigate format over the subsequent few weeks.
This site pulls data about diabetes (and other long-term conditions) from a variety of sources. It then benchmarks GP practices within their CCG for performance related to both processes of care and the achievement of treatment targets.
The site is very easy to navigate and takes into consideration the level of deprivation of the patients within a practice and CCG area.
There is a time lag between the collection of data and the publication on the website of 12-24 months.
Practice level data sources
Real-time data about performance in diabetes care is not usually visible to locality clinical leads without visiting their local practices. Practices have a number of ways of gathering this data internally in order to assess performance and decide on improvement priorities.
All GP Electronic Medical Record Systems provide a range of tools to give practices real-time data (usually updated every night) about performance against QOF targets, including diabetes care.
GPs and their teams can also run specific searches related to an area of diabetes care they might be interested in and this can be an important step in the ‘diagnosis’ stage of a QI project. An example might be trying to work out how many patients without a diabetes diagnosis have had a raised HbA1c, but no follow-up provided or planned.
Because of the complexity of some of these searches, the University of Nottingham has developed a range of audit tools that can be linked to the practice’s medical record system to give information about performance in a variety of long-term conditions, including diabetes. The PRIMIS Diabetes care audit tool is currently free for practices to download. It has been developed with pharmaceutical company sponsorship, although PRIMIS retain full editorial control.
Eclipse is another extraction tool used in some areas that can be utilised in benchmarking and audit in LTCs. It is composed of three main elements: Eclipse, Eclipse Live and NHSpatient.org. In addition, there is a specific component for diabetes which links to Eclipse Live and NHSpatient.org: Diabetes Manager. It is a commercial product that has been purchased by some primary care organisations.