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Wide variations in health services across England

Atlas reveals the extent of variations between areas in the level of services provided

Ingrid Torjesen

Friday, 18 September 2015

The wide variations in health services offered across England are exposed in the third NHS Atlas of Variation in Healthcare published by Public Health England (PHE), NHS England and NHS Right Care today.

The aim of the Atlas is to highlight variations in quality, safety, equity, outcomes, the money spent and the types of service used, to help commissioners, service providers and health professionals deliver the best healthcare.

The NHS Atlas of Variation in Healthcare 2015 identifies where opportunities to address ‘unwarranted’ variation exist.

For example, there is a 2.5 fold variation in the percentage of key antibiotics prescribed in primary care for clinical commissioning groups, ranging from 6.8 to 16.8%. The Antimicrobial Prescribing Quality Measure states usage should be less than 10%.

There is a 1.7 fold variation in the percentage of patients with diabetes who got NICE-recommended annual checks.

GPs can offer an ‘Enhanced Service’ for diagnosis and support for people with dementia, but there is a 2.7-fold variation in claims by GPs for direct enhanced services for dementia.

John Newton, Chief Knowledge Officer at PHE, said: “Variations are not always bad. Some can be explained by local circumstance or patient centred care, but unwarranted variation is very different. While some patients are missing out on the right care, others are being given care they don’t need.

“We hope this collaboration of work between PHE, NHS Right Care and NHS England will encourage commissioners, service providers and clinicians to engage with this tool and ensure resources are being used effectively, and that outcomes improve.”

Professor Sir Bruce Keogh, National Medical Director of NHS England: “This Atlas exposes some inconvenient truths about the extent of clinical practice variation in care for some common conditions. The good news is that - at a time of financial pressure across the health service - hospitals, GPs and mental health providers have substantial opportunities to unleash greater value from their existing NHS budgets.”

Dr Johnny Marshall, policy director of the NHS Confederation, said: “These Atlas reports already provide vital intelligence that our members across the country use to improve care. However, they continue to show marked variations in care and we know that antibiotics, for example, should be used more sparingly.

 “These variations in care need to be better understood at a local level so that our members can identify and adopt the right solutions from other parts of the NHS to improve patient care.

“These solutions need to cover the whole patient experience beginning with the discussions that people have with their GP about the care they need.”

Dr James Kingsland OBE, president of the National Association of Primary Care (a part of the NHS Confederation), said:  “The NHS Atlas of Variation is a great tool for showing what needs more work and what successes we have already achieved - but would benefit from a detailed plan and support package for providers in Primary Care as well as all other sectors.

“Our Vice-President Dr Peter Smith has won awards for his innovative project in reducing antibiotic prescriptions within his practice. While his work is admirable and effective it still remains to be adapted nationally.”

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