Partnering with the CCG’s and Heatlh Boards

 “I have worked with OPC on several projects, most recently to deliver a CCG wide initiative to improve respiratory care in a CCG comprising of 19 practices. 16 practices took part and the resulting work and clinical improvement which took place after the initial review has resulted in a reduction in admissions in most of the participating practices.”


NHS Norfolk Clinical Respiratory Lead, Dr Daryl Freeman

Optimum Patient Care is currently celebrating 14 years as a non-profit social enterprise working with primary care practitioners to produce high quality patient profiles that can make a difference.

As well as working with the individual GP practices we can offer extensive support to CCG’s, this can include:

  • Quality improvement evaluation, reporting and recommendations
  • Improved achievement of health targets e.g. QOF
  • Potential cost savings from reduction in appropriate treatments and unscheduled care
  • Support with implementing bespoke initiatives to GP practices
  • Access to primary care data relevant to your CCG

As part of our ongoing effort to support CCG’s we also offer a standard and bespoke CCG report containing de-identified practice data from participating practices. These reports can include:

  • Analysis of practice level data collected from participating practices
  • Expert recommendations on chosen disease area(s)
  • Specified key focuses by the CCG or health board
  • Patient reported outcomes if patient questionnaires have been implemented across the locality or for selected practices

To find out more about the CCG standard & bespoke level reports visit the “Review Services” section.

Optimum Patient Care (OPC) was commissioned by NHS North Norfolk CCG to support the COPD Impact initiative involving GP data extraction, risk profiling, COPD therapy review and reporting system for COPD patients for general practices in the North Norfolk area.

16 general practices participated in the initiative which was completed in 2016. OPC supported the CCG to collect service agreements for participating practices. Data extraction was undertaken at all practices for report production. OPC Tools and the OPC tailored practice reports were generated and provided to all participating practices to support the practices with general management of patients with COPD as well as asthma. Tutorials and support on how to access and use OPC Tools along with tailored practice reports were also provided.

OPC Tools was also used to support identification of two targeted COPD patient groups in conjunction with mentored COPD clinics and pulmonary rehabilitation provided by the CCG. Practices were also supported to print out patient lists for these specific patient groups:

  • Patients at increased risk of COPD exacerbations or hospitalisations (high risk COPD patients) who could benefit from intervention to prevent exacerbations and hospitalisations
  • Patients on inhaled corticosteroids (ICS) who could benefit from either reducing their ICS dose or stopping their ICS treatment.

The COPD Impact initiative was a successful project with improvement in skills for clinical staff via the mentored clinics and reduction in hospital admissions in most of the participating practices.

Following on from this, OPC continues to work in partnership with NHS North Norfolk CCG supporting its practices with asthma and COPD care among other initiatives to improve patient outcomes.