NPC Archive Item: Atlas of variation: an updated resource to address unwarranted variation in healthcare

NOTE – This is an archive post from the NPC and has not been updated since first publication. Therefore, some hyperlinks may no longer be working.
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25 January 2012

The second issue of the NHS Atlas of Variation in Healthcare has been published by the Department of Health as part of the QIPP (Quality, Innovation, Productivity and Prevention) programme. The aim of the Atlas is to reduce unwarranted variation in healthcare, increase value for money and improve quality of care.

Commissioners should use the Atlas to identify any variations in their local area and take actions to reduce unwarranted variation within their locality, or between their locality and other areas of the country. The maps are not intended to be used as targets or performance tables but rather to highlight variation and support local discussion and decisions, and to help commissioners learn from each other. Commissioners should consider the appropriateness of services and investigate when clinical health outcomes are not reflecting the financial investment that has been made.

What is the Atlas of Variation about?
The NHS Atlas of Variation includes 71 maps which highlight the amount each Primary Care Trust spends on clinical services and link it with the health outcomes patients see. While variation occurs naturally in the NHS and is encouraged where NHS services are tailored to meet local needs, the Atlas aims to support commissioners to expose unwarranted variation and help the NHS provide consistently high quality care for patients. Unwarranted variation has been defined as ‘variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences.’

Examples of variations highlighted in the Atlas include

  • A 25-fold variation in anti-dementia drugs prescribing rates across England.
  • People with type 2 diabetes are twice as likely to receive the highest standard of care in some areas of England in comparison to others.
  • There is an eight-fold variation in the range of patients receiving angioplasty treatment for a severe (STEMI) heart attack – this variation may be due to long travel times to reach patients living in rural areas.

The Atlas is available as an online InstantAtlas or as downloadable PDFs.

What other resources are available to address variation in practice?
A set of 13 prescribing comparators have been published to support the QIPP medicine use and procurement workstream. The comparators cover 10 of the 15 therapeutic areas currently included in the NPC Publication, Key Therapeutic Topics – Medicine Management Options for Local Implementation and should be read in conjunction with that document. For each prescribing comparator a set of charts and data tables have been produced which show national comparisons at PCT level. Local comparisons can be made using the NHS Business Services Authority Prescription Services Prescribing Toolkit.

The aim of the prescribing comparators is to support organisations and prescribers to review the appropriateness of current prescribing, revise prescribing where appropriate and monitor implementation. As with the maps in the Atlas, they are not intended to be used as targets or performance tables but rather highlight variation and support local discussion and decisions regarding QIPP.

More information on QIPP can be found on the Department of Health and NPC websites. The NPC has produced thirteen sets of e-learning resources to support organisations and prescribers in making best use of the QIPP – Key therapeutic topics document. These are accessible via the left-hand menu on the QIPP webpage.

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