De veloping Public Health Information for PCG/PCTs Association of Public Health Observatories 2001

Prefac e

T he London Health Observatory is pleased to present this report - the first of its kind to be published on behalf of the Association of Public Health Observatories. We publish this report at a time when Primary Care Trusts (PCTs) are to become the heart of the devolved engine of the NHS - not only for healthcare but also for improving health and reducing inequalities.

There is a paucity of validated population-based information available at PCT level, and no clear agreement on methods for estimating health indicators at PCT level. Without this, PCTs and emerging Local Strategic Partnerships will have no simple way of monitoring or comparing progress in their population’s health over time. It is vital that PCTs and academics have ‘one stop’ access to such data that is collected by agreed methods.

This report paves the way for collecting such a dataset as part of what could be made routinely available in the now widely used Public Health Common Dataset. Our report is accessible on the website of the Association of Public Health Observatories (www.pho.org.uk). We are also sending copies to every Primary Care Group/Trust and Health Authority in England. We hope this helps embed public health issues firmly on the PCT map.

There is much more work to be done on assessing the role of GP list-based populations in developing population based indicators, but we should waste no more time in giving primary care access to the basic information needed to monitor health and access to healthcare for their resident populations. The Public Health Observatories have indicated their willingness to help develop the methodologies discussed in this report further. We hope this report will be widely used.

Dr Bobbie Jacobson,
Director, London Health Observatory
On behalf of the A ssociation of Public Health Observatories
June 2001
 

S ummary

Efforts to improve health and reduce inequality are dependent on good quality and relevant information to inform decision making. As organisational forms change, so our information systems must adapt and ensure that relevant information is available on the health of the local population. This is especially true as Primary Care Groups (PCGs) and Trusts (PCTs) grow to be a major force in improving health and managing and commissioning services within the NHS

Over the past ten years, the Public Health Common Data Set (latterly the Compendium of Clinical and Health Indicators) has provided health authorities with a common currency for evaluating and comparing information about health, and the determinants of health. We now need such tools for the new entities of PCGs and PCTs.

There has been work on PCG/T level health indicators at various levels and in varying organisations. However, this work has tended to be fragmented and has used a variety of different methods to overcome the peculiarities of how PCG/T populations are defined and the accessibility of common information on health and the determinants of health.

This work was initiated by the Association of Public Health Observatories as recognition of the fact that different groups up and down the country were doing analysis of public health information at the PCG/T level. However, there appeared to be a problem in that the methods that had been used were not always sufficiently clear. Through contacts in the Public Health Observatories (PHOs) a workshop was convened in November 2000 with groups from around the country. At that workshop it was agreed to produce a report outlining the methods that could be applied. A small group agreed to write this report with the explicit aims of:

• Clarifying the different approaches to developing information for PCG/Ts

• Identifying key resources available at present

• Outlining the role that PHOs could play

This report is intended to be a resource for those people interested in either developing their own PCG/T level information or interpreting and understanding existing sources.

Methods We identified six distinct approaches to developing PCG/T level health information depending on the purpose of the analysis and the type of information available. Five of these methods have been used in practice and, depending on the circumstances, can be considered a legitimate approach. Appendix 1 provides detailed descriptions of how to apply these, and the potential and the problems with each method.

The table below gives a simple summary. We should stress that the application of some of these methods in practice can be quite complex and require relatively detailed data sets (eg at small-area level). The choice of method will also affect the results obtained.

List-based or resident-based?

The most important initial question is the choice between a list-based view of the PCG/T or a resident-based one. The list (GP-relevant population) describes the population registered with the practices in that PCG/T. Such a population can be quite diffuse and may cross traditional administrative boundaries. The resident-relevant population relates to people living within defined geographic areas that are the responsibility of the PCG/T. The transition from PCG to PCT will mean that this view of the relevant population will become increasingly important.

For questions over the management of primary care resources, a list view is probably the most appropriate. For issues of public health, where a defined population is needed (and one that relates to other organisation such as local authorities) then the resident-based view is to be preferred.

Developing local capacity for analysis at PCG/T level

Public Health Observatories have an important role to play in disseminating information and facilitating local analysis. One of our key concerns was to help local analysts in their work during a period when the situation is changing rapidly. We would also stress that there are advantages (both in terms of efficiency and comparability) for such work to be undertaken centrally. The most important advice for anyone is to check that the information they are looking for is not already available from the national sources. In particular we stress the importance of checking:

• Department of Health sources

• PCG/T database developed by the University of Manchester;

• Compendium of Clinical Indicators (Public Health Common Data Set);

• Regional Observatories and NHS Regional Offices.

Recommendations

We recommend that:

• Work on updating some of the basic tools for mapping PCG/T populations continues and the results are made easily accessible to workers in the NHS and other sectors. In particular it is important that academic groups with an interest in this area are allowed access to tools and information

• The Department of Health should move towards all indicators in the Compendium (PHCDS) being estimated for the latest PCG/T areas on a GP- and resident-relevant population basis

• Key organisations such as the Department of Health and ONS need to have named contact points that act as information sources on work that is underway

• PHOs will have a role in disseminating how PCGs and PCTs can get access to information and the methods that can be used. In addition they need to be alert to work that is being undertaken within their regions that may be relevant. We would suggest that over the next year the PHOs actively collate contacts and experience in such work and review the position in January 2002 to update this report;

• PHOs/DH should undertake further work on developing the methodology for list-based indicators at practice/GP level, eg mortality rates, hospitalisation rates;

• Department of Health and ONS need to agree on the process for disseminating the work they have done. In particular these should enable open access from academic bodies and non-NHS groups relevant to public health.