The National Clinical Director for Cardiovascular Disease Prevention describes a major resource to support early detection and secondary prevention in primary care:
The second edition of the CVD Primary Care Intelligence Packs has just been launched by the National Cardiovascular Intelligence Network (NCVIN).
This is a major resource that will help CCGs and practices drive improved outcomes in cardiovascular disease – by identifying key gaps and opportunities in primary care.
CVD prevention is important because it is responsible for a quarter of all premature deaths in England and because it has such an impact on the lives of millions of people. High quality primary care is central to achieving good outcomes in CVD because primary care is where most prevention, diagnosis and treatment in the NHS is delivered.
Detecting and managing high risk conditions such as high blood pressure, atrial fibrillation, diabetes and chronic kidney disease (CKD) is a major element of our work as GPs and nurses because these conditions put our patients at significant risk of early death and disability.
For example, half of all heart attacks and strokes are linked to high blood pressure, people with diabetes or CKD have around twice the risk of a heart attack and stroke, and individuals who suffer from atrial fibrillation are five times more likely to have a stroke. On the other hand, these catastrophic events are highly preventable through early detection and effective management of the underlying risk factors. This is therefore a core element of our contribution to prevention in primary care.
The CVD Primary Care Intelligence Packs – there is one for every CCG in England – show how well we are doing and where the opportunities for improvement lie in each of these high risk conditions. The Packs have been developed by the NCVIN with support from 30 GPs, nurses and pharmacists in the Primary Care CVD Leadership Forum.
For each of the high risk conditions the packs use QOF and other data to show detection and management rates, comparing the CCG with demographically similar CCGs, and comparing neighbouring practices with each other. But the packs are not just about dry data. They are designed to tell a story that will have will have meaning for primary care clinicians – because it has been written by primary care clinicians.
The story focuses on variation in care and outcomes. It recognises that some variation may have legitimate explanations such as population differences, but also that much variation cannot be explained in that way. For each indicator in the Intelligence Pack, the magnitude of variation between CCGs and between practices is identified, and calculations are made to show how many more individuals with high risk conditions in the CCG would be detected and effectively managed if all practices performed as well as the top 25%. Some of these numbers are surprisingly high and show just how great an opportunity most CCGs have to improve outcomes in CVD by focusing on primary care.
The Intelligence Packs also acknowledge that most improvement is not about individual clinician performance. In the very busy world of front line general practice, we will only reduce unwarranted variation in care and outcomes by supporting clinicians to do things differently and by taking a systematic approach across a CCG or other footprint. The Intelligence Packs are helpful because they use data to stimulate questions that clinicians and commissioners will want to ask of their local system.
For example – how much variation is there in detection and management of the high risk conditions? How many people does this affect? What impact does this have on outcomes such as stroke and heart attack? Do our practices take part in national audits and do they use local audit tools to identify late diagnosis and under-treatment? Do we share and analyse local performance data? What are better performing practices doing that is different from the others and what can we do to ensure good practice is quickly shared? How can we organise care differently to plug the gaps while not increasing GP workload – for example through use of wider teams and community pharmacies, self-testing and self-monitoring approaches, new technologies, sharing of protocols and pathways, training and education, etc?
Prevention of course is about much more than clinical care, and a focus on population level interventions is essential if we are to slow the relentless rise in preventable illness such as CVD. But the NHS also has a key role to play, not least in relation to early detection and secondary prevention of high risk conditions.
The CVD Intelligence Packs offer us a great tool to help identify the opportunities for improvement in this core aspect of primary care.
Matt Kearney is NHS England’s National Clinical Director for Cardiovascular Disease Prevention and a GP in Runcorn.
He has been working for both NHS England and Public Health England since 2013, supporting programmes to improve primary and secondary prevention of cardiovascular disease and diabetes.
In particular, he has focused on building primary care leadership to champion earlier detection and improved management of conditions such as hypertension, atrial fibrillation, type 2 diabetes and raised cholesterol, and in exploring ways in which the third sector, local authorities and other partners can help the NHS to get serious about prevention.
Previously Matt worked as clinical and public health advisor to the Department of Health respiratory programme, and was a member of the NICE Public Health Interventions Advisory Committee from 2005 to 2013.