DSfC - Newcastle Joint LA / CCG - Comm

One of the key changes under the new Health and Social Care bill is the creation of 42 Integrated Care Systems (ICS) constituted of new legal entities which replace CCGs. As this agreement is coming into existence shortly prior to the expected date of this change, it is understood that it is likely there will need to be a new, closely related agreement put in place well before the end date stated here.

COMMISSIONING

To use pseudonymised data to provide intelligence to support the commissioning of health services. The data (containing both clinical and financial information) is analysed so that health care provision can be planned to support the needs of the population within the CCG and Local Authority area.

The CCGs commission services from a range of providers covering a wide array of services. Each of the data flow categories requested supports the commissioned activity of one or more providers. The Local Authority commissions social care and some other health services and requires access to the same data as the CCG in order to work more collaboratively.

With Integrated Care Systems (ICS) due to be introduced during 2022, the CCG is already working closely with some of its' ICS members, of which includes the Local Authority. Having access to the same data will support this transition.

The CCG and the Council are working jointly on an Outcomes framework. This looks at service provision across the CCG and Local Authority as they commission services from a range of providers covering of health and care functions.

Data will be used to ensure that adequate services are commissioned to meet patient need within the CCG and local authority area, and that these services are designed in such a way as to maximise opportunities for improving efficiency, efficacy, reducing inequalities, and improving outcomes.

Processing for commissioning will be conducted by NHS North of England Commissioning. The data controllers will also process the data.

The following pseudonymised datasets are required to provide intelligence to support commissioning of health services:

• Secondary Uses Service (SUS+)

• Local Provider Flows

• Acute

• Ambulance

• Community

• Demand for Service

• Diagnostic Service

• Emergency Care

• Experience, Quality and Outcomes

• Mental Health

• Other Not Elsewhere Classified

• Population Data

• Primary Care Services

• Public Health Screening

• Mental Health Minimum Data Set (MHMDS)

• Mental Health Learning Disability Data Set (MHLDDS)

• Mental Health Services Data Set (MHSDS)

• Maternity Services Data Set (MSDS)

• Improving Access to Psychological Therapy (IAPT)

• Child and Young People Health Service (CYPHS)

• Community Services Data Set (CSDS)

• Diagnostic Imaging Data Set (DIDS)

• National Cancer Waiting Times Monitoring Data Set (CWT)

• Civil Registries Data (CRD) (Births)

• Civil Registries Data (CRD) (Deaths)

• National Diabetes Audit (NDA)

• Patient Reported Outcome Measures (PROMs)

• e-Referral Service (eRS)

• Personal Demographics Service (PDS)

• Summary Hospital-level Mortality Indicator (SHMI)

• Medicines Dispensed in Primary Care (NHSBSA Data)

• Adult Social Care Data

Processing of the Medicines Dispensed in Primary Care (NHSBSA Data) dataset is only permitted to provide intelligence about the safety and effectiveness of medicines, as specified by the NHS Business Services Authority (NHSBSA) Medicines Data Directions 2019.

The pseudonymised data is required to for the following purposes:

• Population health management:

• Understanding the interdependency of care services

• Targeting care more effectively

• Data Quality and Validation – allowing data quality checks on the submitted data

• Thoroughly investigating the needs of the population, to ensure the right services are available for individuals when and where they need them

• To understand the demand of some of the more expensive services, to better understand and manage those needs

• Monitoring population health and care interactions to understand where people may slip through the net, or where the provision of care may be being duplicated

• Modelling activity across all data sets to understand how services interact with each other, and to understand how changes in one service may affect flows through another

• Service redesign

• Health Needs Assessment – identification of underlying disease prevalence within the local population

• Patient stratification and predictive modelling - to highlight cohorts of patients at risk of requiring hospital admission and other avoidable factors such as risk of falls, computed using algorithms executed against linked de-identified data, and identification of future service delivery models

• Demand Management - to improve the care service for patients by predicting the impact on certain care pathways and support the secondary care system in ensuring enough capacity to manage the demand.

• Support measuring the health, mortality or care needs of the total local population.

• Provide intelligence about the safety and effectiveness of medicines.

• Allow analysis of patient pathways across healthcare and social care.

The pseudonymised data is required to ensure that analysis of health care provision can be completed to support the needs of the health profile of the population within the CCG and local authority area based on the full analysis of multiple pseudonymised datasets.

Processing for commissioning will be conducted by North of England Commissioning Support Unit

PROCESSING CONDITIONS:

Data must only be used for the purposes stipulated within this Data Sharing Agreement. Any additional disclosure / publication will require further approval from NHS Digital.

Data Processors must only act upon specific instructions from the Data Controller.

Data can only be stored at the addresses listed under storage addresses.

All access to data is managed under Role-Based Access Controls. Users can only access data authorised by their role and the tasks that they are required to undertake.

Patient level data will not be linked other than as specifically detailed within this Data Sharing Agreement. Data released will only be shared with those parties listed and will only be used for the purposes laid out in the application/agreement.

NHS Digital reminds all organisations party to this agreement of the need to comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data)

ONWARD SHARING:

There is no requirement for the analytical teams to re-identify patients, but in the development of cohorts of patients considered to be at risk, the data controllers may need the facility to provide identifiable results back to direct healthcare professionals or local authority direct care staff only for the purpose of direct care. Additionally clinicians, made aware of a number of cases that they believe would need intervention may request re-identification for that direct care purpose.

These instances of re-identification will generally be carried out as programmes of work or, rarely, on an individual/small group basis. All re-id requests will be processed and authorised by the DSCRO on a case by case basis. National data opt outs are not applied in these cases as they are for the purposes of direct care which follows the legal basis of implied consent.

The following are typical (generic) examples of instances where a CCG might want to use the re-identification process:

A&E High Attendance usage

The CCG can filter data to show for example the number of A&E attendances in a given period for each patient. The CCG can then flag to the relevant GP of the patient any patients that require intervention. An outcome of this is earlier intervention in the patient(s) care thus potentially reducing future costs and minimising future risk.

Polypharmacy re-IDs

CCG's can request re-ID of a list of patients to be sent to the relevant GP with a high number of medications (ingredient count) and review the medication for these patients. This can help address the risk of polypharmacy which is recognised as an adverse risk factor for patient safety. A by-product of such reviews may be to reduce costs of medication.

The Re-identification process for direct care is as follows:

1. The CCG identifies a patient cohort to be re-identified for the purpose of direct care.

2. The CCG sends a re-id request to the DSCRO. This may be done through the CCG or CSU’s Business Intelligence (BI) Tool, or through a manual form.

3. The DSCRO assesses as to whether the request passes the specified re-identification process checks. Checks include if the requester is authorised to access identifiable data, if the number of patients in the cohort is appropriate, and that the request does not seem inappropriate or outside of expected parameters, including for example around timings and the requestor’s relationship with patients in the data. These checks are carried out either by DSCRO staff using pre-approved information (timing’s, requester’s identity etc) or via an automated system. For automated systems, steps 1 -3 wouldn’t apply in most cases as it would be the direct care professional who identifies the cohort and as long as they are an approved re-id user and have gone through security checks initially, they will be able to re-id without more further checks.

4. If successful/approved, the DSCRO re-identifies the relevant data item(s) for the appropriate patients and returns the identifiable fields to Health or care professional(s) with a legitimate relationship to the patient. The CCG does not see the identifiable record.

5. DSCROs retain an audit trail of all re-id requests

6. National Data opt outs are not applied for the purpose of direct care

SEGREGATION:

Where the Data Processor and/or the Data Controller hold both identifiable and pseudonymised data, the data will be held separately so data cannot be linked.

Where the Data Processor and/or the Data Controller hold identifiable data with opt outs applied and identifiable data with opt outs not applied, the data will be held separately so data cannot be linked.

All access to data is auditable by NHS Digital.

DATA MINIMISATION:

Data Minimisation in relation to the data sets listed within the application are listed below. This also includes the purpose on which they would be applied -

For the purpose of Commissioning:

• Patients who are normally registered and/or resident within the NHS Newcastle Gateshead CCG and Gateshead Metropolitan Borough Council Local Authority region (including historical activity where the patient was previously registered or resident in another commissioner).

and/or

• Patients treated by a provider where NHS Newcastle Gateshead CCG is the host/co-ordinating commissioner and/or has the primary responsibility for the provider services in the local health economy – this is only for commissioning and relates to both national and local flows.

and/or

• Activity identified by the provider and recorded as such within national systems (such as SUS+) as for the attention of NHS Newcastle Gateshead CCG - this is only for commissioning and relates to both national and local flows.

In addition to the dissemination of Cancer Waiting Times Data via the DSCRO, the CCG & Local Authority is able to access reports held within the CWT system in NHS Digital directly. Access within the CCG & Local Authority is limited to those with a need to process the data for the purposes described in this agreement.

A user will be able to access the provider extracts from the portal for any provider where at least 1 patient for whom they are the registered CCG for that individuals GP practice appears in that setting

Although a user may have access to pseudonymised patient information not related to them, users should only process and analyse data for which they have a legitimate relationship (as described within Data Minimisation).

Microsoft Limited provide Cloud Services for NHS North of England Commissioning Support Unit and are therefore listed as a data processor. They supply support to the system, but do not access data. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data

Pulsant and IT Professional Services Ltd do not access data held under this agreement as they only supply the building. Therefore, any access to the data held under this agreement would be considered a breach of the agreement. This includes granting of access to the database[s] containing the data.

COMMISSIONING

The Data Services for Commissioners Regional Office (DSCRO) obtains the following data sets:

1. SUS+

2. Local Provider Flows (received directly from providers)

a. Acute

b. Ambulance

c. Community

d. Demand for Service

e. Diagnostic Service

f. Emergency Care

g. Experience, Quality and Outcomes

h. Mental Health

i. Other Not Elsewhere Classified

j. Population Data

k. Primary Care Services

l. Public Health Screening

3. Mental Health Minimum Data Set (MHMDS)

4. Mental Health Learning Disability Data Set (MHLDDS)

5. Mental Health Services Data Set (MHSDS)

6. Maternity Services Data Set (MSDS)

7. Improving Access to Psychological Therapy (IAPT)

8. Child and Young People Health Service (CYPHS)

9. Community Services Data Set (CSDS)

10. Diagnostic Imaging Data Set (DIDS)

11. National Cancer Waiting Times Monitoring Data Set (CWT)

12. Civil Registries Data (CRD) (Births)

13. Civil Registries Data (CRD) (Deaths)

14. National Diabetes Audit (NDA)

15. Patient Reported Outcome Measures (PROMs)

16. e-Referral Service (eRS)

17. Personal Demographics Service (PDS)

18. Summary Hospital-level Mortality Indicator (SHMI)

19. Medicines Dispensed in Primary Care (NHSBSA Data)

20. Adult Social Care Data

Data quality management and pseudonymisation is completed within the DSCRO and is then disseminated as follows:

Data Processor 1 – North of England Commissioning Support Unit

1. Pseudonymised SUS+, Local Provider data, Mental Health data (MHSDS, MHMDS, MHLDDS), Maternity data (MSDS), Improving Access to Psychological Therapies data (IAPT), Child and Young People’s Health data (CYPHS), Community Services Data Set (CSDS), Diagnostic Imaging data (DIDS), National Cancer Waiting Times Monitoring Data Set (CWT), Civil Registries Data (CRD) (Births and Deaths), National Diabetes Audit (NDA), Patient Reported Outcome Measures (PROMs), e-Referral Service (eRS), Personal Demographics Service (PDS), Summary Hospital-level Mortality Indicator (SHMI), Medicines Dispensed in Primary Care (NHSBSA Data) and Adult Social Care data only is securely transferred from the DSCRO to North of England Commissioning Support Unit.

2. North of England Commissioning Support Unit also receive GP and Social Care Data (see point i - ix)

3. North of England Commissioning Support Unit add derived fields by using existing data, link data and provide analysis to:

a. See patient journeys for pathways or service design, re-design and de-commissioning.

b. Check recorded activity against contracts or invoices and facilitate discussions with providers.

c. Undertake population health management

d. Undertake data quality and validation checks

e. Thoroughly investigate the needs of the population

f. Understand cohorts of residents who are at risk

g. Conduct Health Needs Assessments

4. Allowed linkage is between the data sets contained within point 1 and 2.

5. North of England Commissioning Support Unit then pass the processed, pseudonymised and linked data to the Data Controllers.

6. Aggregation of required data for management use will be completed by North of England Commissioning Support Unit or the Data Controller.

7. Patient level data will not be shared outside of the Data Controller and will only be shared within on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number suppression can be shared as set out within NHS Digital guidance applicable to each data set.

North of England Commissioning Support Unit have individual data processing agreements in place with GPs, Local Authorities and the CCGs, to pseudonymise data. Acting on their behalf, North of England Commissioning Support Unit pseudonymises the data as follows:

i. Identifiable GP and Social Care data is submitted to North of England Commissioning Support Unit.

ii. The data lands in a ring-fenced area.

iii. North of England Commissioning Support Unit has access to a pseudonymisation tool. North of England Commissioning Support Unit requests an organisation specific pseudonymisation key from the DSCRO. The key can only be used once. The key is specific to the individual request and the organisation it is being requested for.

iv. The data is then pseudonymised using the organisation specific pseudonymisation tool and DSCRO issued key. The identifiable data is then deleted from the ring-fenced area.

v. To enable linkage to data listed in point 1, North of England Commissioning Support Unit make a request to the DSCRO.

vi. The DSCRO then send a mapping table to North of England Commissioning Support Unit.

vii. A black box uses the mapping table to overwrite the organisation specific pseudonym with the DSCRO pseudonym to enable linkage to NHS Digital released products (under this agreement).

viii. The mapping table if then deleted.

ix. In addition, for social care data only: Social Care organisations have access to the pseudonymisation tool and can request an organisation specific pseudonymisation key from the DSCRO. The key can only be used once and is specific to that date. The organisation then submits the pseudonymised social care data to North of England Commissioning Support Unit. The data then follows from point v.

For the purposes of the Outcomes framework processing will be as follows

1. NECS will provide processed, pseudonymised and linked commissioning datasets, primary care and local authority data contained within point 1 (Data processor – North of England Commissioning Support Unit) to Newcastle Gateshead CCG and Gateshead Council who will undertake joint analysis to:

-See patient journeys for pathways or service design, re-design and de-commissioning.

-Undertake population health management

-Undertake data quality and validation checks

-Thoroughly investigate the needs of the population

-Understand cohorts of residents who are at risk

-Conduct Health Needs Assessments

2. Allowed linkage is between the data sets contained within point 1 as above. This linkage will be carried out in a shared cloud environment that both Newcastle Gateshead CCG and Gateshead council have access to. For clarity, this Cloud Environment is North of England CSU’s Microsoft Azure Cloud platform.

3. Gateshead Council will only analyse data where they have a legitimate relationship

4. The outputs of the analysis will be visible to both the CCG and Council

5. Patient level data will not be shared outside of the CCG and Council and will only be shared within the CCG and Council on a need to know basis, as per the purposes stipulated within the Data Sharing Agreement. External aggregated reports only with small number.

Suppression can be shared with other providers of health and care in the locality.

COMMISSIONING

1. Commissioner reporting:

a. Summary by provider view - plan & actuals year to date (YTD).

b. Summary by Patient Outcome Data (POD) view - plan & actuals YTD.

c. Summary by provider view - activity & finance variance by POD.

d. Planned care by provider view - activity & finance plan & actuals YTD.

e. Planned care by POD view - activity plan & actuals YTD.

f. Provider reporting.

g. Statutory returns.

h. Statutory returns - monthly activity return.

i. Statutory returns - quarterly activity return.

j. Delayed discharges.

k. Quality & performance referral to treatment reporting.

2. Readmissions analysis.

3. Production of aggregate reports for CCG Business Intelligence.

4. Production of project / programme level dashboards.

5. Monitoring of acute / community / mental health quality matrix.

6. Clinical coding reviews / audits.

7. Budget reporting down to individual GP Practice level.

8. GP Practice level dashboard reports.

9. Comparators of CCG performance with similar CCGs as set out by a specific range of care quality and performance measures detailed activity and cost reports

10. Data Quality and Validation measures allowing data quality checks on the submitted data

11. Contract Management and Modelling

12. Patient Stratification, such as:

o Patients at highest risk of admission

o High cost activity uses (top 15%)

o Frail and elderly

o Patients that are currently in hospital

o Patients with most referrals to secondary care

o Patients with most emergency activity

o Patients with most expensive prescriptions

o Patients recently moving from one care setting to another

i. Discharged from hospital

ii. Discharged from community

13. Validation for payment approval, ability to validate that claims are not being made after an individual has died, like Oxygen services.

14. Validation of programs implemented to improve patient pathway e.g. High users unable to validate if the process to help patients find the best support are working or did the patient die.

15. Clinical - understand reasons why patients are dying, what additional support services can be put in to support.

16. Understanding where patient are dying e.g. are patients dying at hospitals due to hospices closing due to Local authorities withdrawing support, or is there a problem at a particular trust.

17. Removal of patients from Risk Stratification reports.

18. Re births provide a one stop shop of information, Births are recorded in multiple sources covering hospital and home births, a chance to overlook activity.

19. Manage demand, by understanding the quantity of assessments required CCGs are able to improve the care service for patients by predicting the impact on certain care pathways and ensure the secondary care system has enough capacity to manage the demand.

20. Monitor the timing of key actions relating to referral letters. CCG’s are unable to see the contents of the referral letters.

21. Identify low priority procedures which could be directed to community-based alternatives and as such commission these services and deflect referrals for low priority procedures resulting in a reduction in hospital referrals.

22. Allow Commissioners to better protect or improve the public health of the total local patient population

23. Allow Commissioners to plan, evaluate and monitor health and social care policies, services, or interventions for the total local patient population

24. Allow Commissioners to compare their providers (trusts) mortality outcomes to the national baseline.

25. Investigate mortality outcomes for trusts.

26. Identify medication prescribing trends and their effectiveness.

27. Linking prescribing habits to entry points into the health and social care system

28. Identify, quantify and understand cohorts of patient’s high numbers of different medications (polypharmacy)

29. Monitoring, at a population level, particular cohorts of service users and designing analytical models which support more effective interventions in health and adult social care

30. Monitoring service and integrated care outcomes across a pathway or care setting involving adult social care

Gateshead Council

The council will utilise the pseudonymised data to provide analysis to support with:

- Conduct Health Needs Assessments

- Thoroughly investigate the needs of the population to provide a joint understanding

- Support with Population Health Management

- Understand the performance of jointly commissioned services and production of related reporting

- Systems outcome framework to measure the performance across health and social care system

The outputs listed will support both the CCG and the local authorities to fulfil their statutory duties. This joint application will allow collaboration where these statutory duties overlap

COMMISSIONING

1. Supporting Quality Innovation Productivity and Prevention (QIPP) to review demand management, integrated care and pathways.

a. Analysis to support full business cases.

b. Develop business models.

c. Monitor In year projects.

2. Supporting Joint Strategic Needs Assessment (JSNA) for specific disease types.

3. Health economic modelling using:

a. Analysis on provider performance against 18 weeks wait targets.

b. Learning from and predicting likely patient pathways for certain conditions, in order to influence early interventions and other treatments for patients.

c. Analysis of outcome measures for differential treatments, accounting for the full patient pathway.

d. Analysis to understand emergency care and linking A&E and Emergency Urgent Care Flows (EUCC).

4. Commissioning cycle support for grouping and re-costing previous activity.

5. Enables monitoring of:

a. CCG outcome indicators.

b. Financial and Non-financial validation of activity.

c. Successful delivery of integrated care within the CCG.

d. Checking frequent or multiple attendances to improve early intervention and avoid admissions.

e. Case management.

f. Care service planning.

g. Commissioning and performance management.

h. List size verification by GP practices.

i. Understanding the care of patients in nursing homes.

6. Feedback to NHS service providers on data quality at an aggregate and individual record level – only on data initially provided by the service providers.

7. Improved planning by better understanding patient flows through the healthcare system, thus allowing commissioners to design appropriate pathways to improve patient flow and allowing commissioners to identify priorities and identify plans to address these.

8. Improved quality of services through reduced emergency readmissions, especially avoidable emergency admissions. This is achieved through mapping of frequent users of emergency services and early intervention of appropriate care.

9. Improved access to services by identifying which services may be in demand but have poor access, and from this identify areas where improvement is required.

10. Potentially reduced premature mortality by more targeted intervention in primary care, which supports the commissioner to meets its requirement to reduce premature mortality in line with the CCG Outcome Framework.

11. Better understanding of the health of and the variations in health outcomes within the population to help understand local population characteristics.

12. Better understanding of contract requirements, contract execution, and required services for management of existing contracts, and to assist with identification and planning of future contracts

13. Insights into patient outcomes, and identification of the possible efficacy of outcomes-based contracting opportunities.

14. Providing greater understanding of the underlying courses and look to commission improved supportive networks, this would be ongoing work which would be continually assessed.

15. Insight to understand the numerous factors that play a role in the outcome for both datasets. The linkage will allow the reporting both prior to, during and after the activity, to provide greater assurance on predictive outcomes and delivery of best practice.

16. Provision of indicators of health problems, and patterns of risk within the commissioning region.

17. Support of benchmarking for evaluating progress in future years.

18. Allow reporting to drive changes and improve the quality of commissioned services and health outcomes for people.

19. Assists commissioners to make better decisions to support patients and drive changes in health care

20. Allows comparisons of providers performance to assist improvement in services – increase the quality

21. Allow analysis of health care provision to be completed to support the needs of the health profile of the population within the CCG area based on the full analysis of multiple pseudonymised datasets.

22. To evaluate the impact of new services and innovations (e.g. if commissioners implement a new service or type of procedure with a provider, they can evaluate whether it improves outcomes for patients compared to the previous one).

23. Monitoring of entire population, as opposed to only those that engage with services

24. Enable Commissioners to be able to see early indications of potential practice resilience issues in that an early warning marker can often be a trend of patients re-registering themselves at a neighbouring practice.

25. Monitor the quality and safety of the delivery of healthcare services.

26. Allow focused commissioning support based on factual data rather than assumed and projected sources

27. Understand admissions linked to overprescribing.

28. Add value to the population health management workstream by adding prescribing data into linked dataset for segmentation and stratification.

29. Developing, through evaluation of person-level data, more effective prevention strategies and interventions across a pathway or care setting involving adult social care

30. Designing and implementing new payment models across health and adult social care

31. Understanding current and future population needs and resource utilisation for local strategic planning and commissioning purposes including for health, social care and public health needs.

Gateshead Council

This projects will provide a number of benefits for the CCG and Local Authority :

- Provide an ability to re-design services across health & social care to provide an opportunity if deemed suitable to jointly plan, commission and deliver services which will lead to improved outcomes for the population of the area

- Enable the CCG and Local Authority to enhance their joint outcomes framework that will establish an integrated approach to service management and delivery

- Support the move to a person rather than sector centred approach to service development

This will not only provide direct benefits to individuals and families within Newcastle Gateshead CCG, but also the wider strategic outcomes for the CCG and other providers in the system.

The CCG has recently published their annual report for 2020/21 - https://newcastlegatesheadccg.nhs.uk/wp-content/uploads/sites/12/2021/06/NG-Annual-Report-Accounts-2021-2022-NS.pdf

A summary of this can be found at https://newcastlegatesheadccg.nhs.uk/wp-content/uploads/sites/12/2021/09/Newcastle-Gateshead-CCG-annual-report-summary-2020-21.pdf

The annual report highlights the achievements made during the year, of which some would only have been achieved by using the data from NHS Digital.

Page 5 of the annual report and accounts states;

The CCG has continued to play an active part in the North East and North Cumbria Integrated Care System (ICS), building on the existing local leadership of clinical commissioning groups as the ICS moves towards statutory body status.

The Department of Health and Social Care's white paper 'Integration and Innovation: working together to improve health and social care for all' points the way towards greater regional integration at ICS level as well as a strong focus on 'place-based' working in local areas, alongside key partners like local authorities. We are already very well placed to deliver strong 'place-based' working in both Newcastle and Gateshead, working with partners through the Collaborative Newcastle and Gateshead Cares partnerships.

- NECS worked with the CCG to produce analysis to support the integration agenda using NHS Digital flows such as SUS.

We have established dedicated local teams for Newcastle and Gateshead, which will provide a strong basis for future joint working as the new commissioning landscape takes shape.

Both teams have already developed a range of local achievements along with their local partners, ranging from more efficient hospital discharge systems to better services for children with Special Educational Needs and Disabilities (SEND).

- NHS Digital flows were used to support discharge and SEND work alongside other datasets

Practices have continued to work towards a reduction in opioid, gabapentinoid and antibiotic prescribing, with Newcastle Gateshead the first CCG in the region to bring antibiotic prescribing below the national target.

Our practices have continued to develop the care and support planning approach to long term conditions, while new initiatives are working to diagnose lung cancer earlier and support people who are at risk of type 2 diabetes.

Further information about other achievements and future priorities can be found within the report.