GP No Follow-up Rate - England

This indicator provides an indication of the potential savings to be gained by reducing the number of first outpatient attendances that do not have any follow-up appointments or admissions within a given timeframe. The concept behind this is to not only review the appropriateness of some GP referrals but also to assess whether savings can be made to the health economy by caring for patients in primary care rather than in hospital. You can change region, or view national data.

Potential savings 2008/09

Potential savings that could be gained by reducing the number of first outpatient attendances that do not have any follow-up appointments or admissions.

PCT name Sum of Potential Saving (£)
Norfolk
1,279,513
Eastern and Coastal Kent
963,347
Hampshire
904,854
Devon
865,175
Suffolk
816,582
Oxfordshire
730,036
Cambridgeshire
706,437
Derbyshire County
669,380
Surrey
647,126
Hertfordshire
635,136
West Sussex
619,505
Wiltshire
598,061
Somerset
586,700
Leicestershire County and Rutland
579,580
Cumbria
569,247
Liverpool
564,255
Sheffield
543,321
West Kent
532,488
Cornwall and Isles Of Scilly
529,054
Northamptonshire
524,963
City and Hackney
508,808
Brighton and Hove City
498,236
South Staffordshire
469,902
Lincolnshire
464,089
Leeds
463,540
Wolverhampton City
456,096
Nottinghamshire County
427,760
Plymouth
426,252
North Yorkshire and York
403,231
Wandsworth
399,944
Barnet
387,991
Lambeth
379,778
Bradford and Airedale
378,617
East Sussex Downs and Weald
377,161
Manchester
367,533
Shropshire County
366,547
Mid Essex
365,939
Haringey
364,926
Bromley
364,749
South West Essex
362,602
Berkshire West
353,961
Bath and North East Somerset
342,780
Kirklees
340,276
Southwark
332,729
Gloucestershire
330,192
Luton
325,153
Bedfordshire
321,565
Coventry
321,208
Warwickshire
310,923
Medway
309,163
County Durham
306,197
Nottingham City
303,223
Islington
301,515
Southampton City
298,910
Worcestershire
298,081
South East Essex
297,634
Bolton
287,461
Bristol
277,671
Leicester City
272,994
Croydon
269,405
Portsmouth City
269,402
Birmingham East and North
266,497
Brent
263,025
Heart Of Birmingham
260,523
Bournemouth and Poole
257,654
Enfield
251,442
Waltham Forest
248,605
Central Lancashire
244,201
Buckinghamshire
243,433
Swindon
241,997
Newham
237,017
Central and Eastern Cheshire
234,332
Camden
232,022
Peterborough
226,680
Greenwich
225,687
Ashton, Leigh and Wigan
225,415
Hounslow
222,216
Sandwell
221,411
Northumberland Care Trust
217,927
East Riding Of Yorkshire
217,514
Stoke On Trent
216,204
Berkshire East
212,899
Dorset
208,058
Newcastle
203,820
Wakefield District
202,417
Hull
202,095
Telford and Wrekin
201,806
West Essex
200,051
Herefordshire
199,629
Milton Keynes
196,983
Sutton and Merton
196,768
Lewisham
195,787
Ealing
194,499
Calderdale
192,472
North East Essex
191,337
Westminster
190,761
South Birmingham
190,350
Western Cheshire
186,168
Doncaster
182,897
Salford
181,735
North Lancashire
178,270
South Tyneside
173,063
Richmond and Twickenham
172,001
Havering
170,041
Dudley
169,793
Redbridge
168,903
Hastings and Rother
167,908
North Staffordshire
167,001
Sefton
154,853
Knowsley
149,040
Tower Hamlets
147,862
Tameside and Glossop
147,597
Torbay Care Trust
147,259
Isle Of Wight
145,501
South Gloucestershire
143,008
Rotherham
141,813
Derby City
138,732
East Lancashire
138,270
Stockport
136,930
Walsall
133,501
Kingston
132,128
Hillingdon
131,567
Solihull Care Trust
131,509
Great Yarmouth and Waveney
130,252
Gateshead
125,371
North Somerset
124,167
Sunderland
123,397
Middlesbrough
121,288
Hammersmith and Fulham
118,139
Kensington and Chelsea
115,818
Warrington
111,671
Stockton-On-Tees
111,517
Harrow
109,806
Oldham
109,085
Trafford
108,614
Halton and St Helens
104,424
Barking and Dagenham
102,566
Redcar and Cleveland
96,305
North East Lincolnshire
93,987
Barnsley
92,407
Wirral
81,795
Heywood, Middleton and Rochdale
81,462
Blackpool
75,971
Bury
73,133
North Tyneside
70,956
Hartlepool
69,944
North Lincolnshire
60,063
Blackburn With Darwen
58,112
Bexley Care Trust
47,969
Bassetlaw
33,197
Darlington
27,066
National average: 285,551

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Methodology

Description
Provides an indication of the potential savings to be gained by reducing the number of first outpatient attendances that do not have any follow-up appointments or admissions.
Definition
The percentage of first outpatient attendances where there was not an outpatient follow up attendance to any specialty within 1 year or an admission to any specialty within 6 months. Savings are based on meeting National performance.
Rationale
This indicator reviews the number of outpatient attendances that could be assessed in primary care, rather than in hospital.
Direction
A high rate indicates that the PCT has more first attendances with no follow-ups than the national average. This means that there is greater potential for savings.
Calculation of Potential
Potential savings are calculated by multiplying the number of excess first attendances with no follow-ups (based on a GP practice's observed first attendances with no follow-ups minus expected first attendances with no follow-ups where the GP practice has a higher rate than the national average) by the average PbR tariff for that particular specialty.
Technical definition

The percentage of first outpatient attendances with no follow-ups is calculated as the number of first outpatient attendances that did not have an outpatient follow-up attendance to any specialty within 1 year or an admission to any specialty within 6 months of the original outpatient attendance, divided by the total number of outpatient first attendances. Rates are calculated for each GP practice and outpatient specialty.

The potential savings are based on comparing the observed number of outpatient attendances with no follow-ups to an expected number. The number of expected first attendances with no follow-ups is based National benchmarks which are adjusted for outpatient specialty and year.

The expected number of first attendances with no follow-ups is calculated as the national rate multiplied by the total number of first attendances for each GP practice by specialty. The difference between this expected number and the actual number of first outpatient attendances with no follow-ups gives an excess amount of first outpatient attendances with no follow-up. This excess amount is multiplied by the average PbR tariff to produce a potential saving.

It should be noted that although results are calculated at GP practice and specialty level, for presentation purposes, they have been aggregated into two results tables: one showing the results by PCT and specialty, the other by GP practice only. It is therefore not possible to derive the expected number of outpatient attendances with no follow-ups, the excess amount, and the potential savings directly from the two tables.

In line with HES protocol, single-handed GP Practices have not been identified in the GP practice results table. Cases where the GP practice was unknown, non-applicable (e.g. MoD, prison, dentist), or a single-handed practice have been aggregated under the category 'Null/Unknown/Other'.

Inclusions - Only where the referral source is a General Medical Practitioner for the original first outpatient attendance.

Exclusions - The following specialties were excluded from the analysis of the first outpatient attendance : Paediatric Medical Oncology (260), Medical Oncology (370), Gynaecological Oncology (503), Clinical Oncology (800).

Basis
Primary Care Trust
Data source & Time frame
SUS - 1st Outpatient Appointment in Financial Year 2008/09

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