EZ Analytics Release Notes (June 2023)

The EZ Analytics PCN DES app has been refreshed to reflect the updated national guidance for this financial year. While the original Investment and Impact Fund indicators have been scaled down, the expectations around the remainder of the DES remain high. The updated app now brings these requirements together and covers the following areas:

IIF Indicators:

·        Influenza vaccinations (noting that payment is now limited to at risk 18–64-year-olds and 2,3 year olds) – IIF indicator

·        LD health checks (noting that ethnicity recording is now mandatory for each LD patient) – IIF indicator

·        Colorectal cancer referrals and FIT (unchanged from 2022/23) – IIF indicator

Social Prescribing:

·        Number of social prescribing referrals by practice this FY

·        Breakdown of social prescribing referrals by ethnicity

Cardiovascular prevention:

Hypertension:

·        Hypertension and BP check this FY

·        Overall hypertension control across all age ranges this FY

·        Hypertension and BP on target aged <80 years this FY

·        Hypertension and BP on target aged 80 years or more this FY

·        Patients with no hypertension diagnosis aged >40 with BP recorded last 5 years

·        Patients with no hypertension diagnosis, BMI > 30 and BP recorded this FY

·        Hypertension and last systolic BP <100mmHg on antihypertensive medication (to consider deprescribing)

Cholesterol:

·        Established cardiovascular disease and on lipid lowering therapy

·        Patients aged 25-84 with Qrisk 20% or more on lipid lowering therapy (All non CVD patients)

·        Diabetes or CKD, Qrisk 10% or more and on lipid lowering therapy

·        Diabetes or CKD, Qrisk 20% or more and on lipid lowering therapy

·        Possible familial hypercholesterolaemia register and referrals for assessment

Chronic Kidney Disease:

·        CKD and on lipid lowering therapy

·        CKD and eGFR/creatinine recorded this FY

·        CKD and hypertension with BP <140/80 this FY

·        CKD, hypertension and proteinuria on ACE/ARB  

Atrial Fibrillation:

·        Patients aged 65 or more with pulse rhythm check in last 2 years

·        AF with CHA2DS2-VASc score of 2 or more and anticoagulated this FY

Other:

·        BNP testing rates in patients aged 50 or over in last 2 years

·        Smoking status and smoking cessation advice in LTC patients this FY

Early cancer diagnosis:

·        Overall 2WW referral rates by practice last 12 months

·        Breakdown of overall referral rates by ethnicity compared to overall practice demographic

·        Breakdown of most common fast track cancer referrals by specialty

·        Breakdown of each individual referral type by ethnicity compared to overall practice demographic

·        Public Health England (PHE) historical cancer services data across all national practices 

Inclusion Health: 

·        Inclusion health register as a % of list size

·        Inclusion health register breakdown by vulnerability

The register includes groups experiencing some of the worst health inequalities include Gypsies,  Roma, Travellers, homelessness, refugees, sex workers and those with learning disabilities. *Note that not all of these groups are consistently coded on practice clinical systems. 

Tackling Neighbourhood Inequalities:

·        SMI complete 6 core physical health checks this FY

·        Breakdown of performance for each of the core components

·        COPD and Influenza vaccine uptake this FY

·        COPD and Pneumococcal vaccine uptake ever

·        BAME women coded as currently pregnant