Using data to tackle health inequalities
The article we are sharing this week is from the Herefordshire and Worcestershire, Primary Care Analytics Team, looking at using data to tackle health inequalities.
Tackling health inequalities is a core requirement from Primary Care Networks (PCNs). But to do this effectively, accurate and up-to-date data is required.
In Herefordshire and Worcestershire, the Primary Care Analytics Team has been working with the ICS to develop a population health management (PHM) tool that will identify inequalities, lead to better health outcomes for patients and improve their wellbeing.
Prior to this, health leaders only tended to know their own organisations, with no wider picture available in terms of what was going on in the population as a whole. The National Contract Direct Enhanced Service (DES), which sets out core requirements and entitlements for PCNs and provides funding and investment, has a particular specification on inequalities. Yet data analysts did not have sufficient flexibility within the information available to them to report accurately and decisions were made on the basis of data that was 12 months out of date or relied upon 2011 census information.
These factors provided the motivation to use data more cleverly and collaboratively across the 15 PCNs in Herefordshire and Worcestershire. Time was spent with each PCN to understand the inequalities they were trying to address, to show them how they could identify the relevant patient cohorts, and then demonstrate how the data could be harvested.
The PHM tool is interactive and allows users to easily drill down into specific aspects of the 817,000 people who live in the two counties. For example, in the South and West Herefordshire PCN, the Analyst wanted to identify patients who have a high BMI, anxiety or depression and no covid vaccinations. The PHM tool enabled her to identify this cohort of patients who could then be contacted by surgeries with offers of support.
Conor Price, PCN Chief Analyst for Herefordshire and Worcestershire PCNs, believes the PHM tool will continue to grow in value as its usage increases. He says: “What we have seen is that, from a cautious start, practices are now using the tool and identifying where they could make an impact. As they are gaining in confidence, their work on addressing inequalities is growing so they are coming back and asking us to build a search around new areas.”
The creation of a centralised team of analysts ensures shared learning and avoids unnecessary duplication of effort. The PCN team can demonstrate how the tool can be used to understand patients’ needs in a different way.
Conor adds: “What it’s demonstrated more than anything is that PCNs really value the use of data and its ability to identify and address health inequalities.”
To contact the team, please email: hwpcn.analytics@nhs.net.
This article is an abridged version of a more detailed report that contains examples of practical applications of the PHM tool. To read the full article, please visit the Herefordshire General Practice website: https://www.herefordshiregeneralpractice.co.uk/news/using-data-to-address-health-inequalities