Jonathan Slade

So a very warm welcome to all our listeners for this podcast, which is titled ‘Cracking down on cardiovascular disease.’ I’ll introduce myself – I’m Jonathan Slade. I’m a GP in Stockton-on-Tees and I’m also a medical director at NHS England, North East and Yorkshire region.

So why are we talking about this really important topic?

Well, firstly, we know that in the United Kingdom there are about 7.2 million people diagnosed with cardiovascular disease [also known as CVD], which amounts to about 10% of the population.

If you do the numbers and crunch it down, that amounts to approximately 1 million people living in North East and Yorkshire. So it’s a very substantial number. These are the ones we know about, but of course there’s an undiagnosed burden as well of many, many people.

So for example in United Kingdom there are 4.3 million people who have undiagnosed hypertension and again, if you look at the numbers for North East and Yorkshire, that’s approximately about 640,000 people in our region. But those numbers all assume that there’s an equal distribution of cardiovascular disease across all our communities, which unfortunately, is not the case, because CVD, like all diseases, is very heavily weighted towards people who live with deprivation.

In fact, cardiovascular disease is the number one disease group, demonstrating a difference in health outcomes between the most deprived quintile and the most wealthy quintile and that’s why it appears in Core 20 plus 5 as one of the 5.

Within North East and Yorkshire region, just over a third of our population are actually sitting in the bottom quintile across England. So that obviously increases our burden of CVD. But moreover, in some of our areas, that number is even higher. So in Middlesbrough, for instance, near where I work is just over half of our patients sit in the bottom most deprived quintile.

Well, I’ve heard much about the three strategic shifts that the government is pursuing and one of which rightly so is from illness to prevention. We know that about 80% of non-communicable diseases are in fact preventable and CVD (Cardiovascular disease) is absolutely one of those, and that’s the topics that we’re going to be talking about today.

So with those introductory thoughts in mind, I’ll introduce the panel. So I have great pleasure in being joined by the following.

So Dr Rani Khatib, who is a consultant pharmacist in Leeds, is the national specialty advisor for CVD prevention for NHS England and CVD Clinical Advisor for Health Innovation, Yorkshire and Humber.

We’ve also got Dr Thobi Nkomo, who is a GP in Hedon, and he is the CVD prevention lead for Humber and North Yorkshire ICB.

And finally, we’ve got Dr Dan Clark, who is a GP in Doncaster and he is CVD prevention lead at NHS South Yorkshire Integrated Care Board.

So welcome gentlemen, I think you’ll have, I’m sure, some useful thoughts. So can I start with the first question as a sort of hook for a conversation. So the government has allocated around £198 million towards cardiovascular disease prevention for 25/26 and as you will know as GPs, this is principally the content of QOF for this year – quality and outcomes framework. It’s specifically mentioned in the GP contract – why do you think this is the case? Dan:

Dan Clark

Thanks Jonathan. Yeah. I mean, I think the reason for this is that cardiovascular disease is just so incredibly important. I think it causes 1/4 of all deaths in the UK and that’s just not to be underestimated really about how significant that is.

And I think the other sort of fact that that I carry around a lot is that in England, people are living in the most deprived areas are twice as likely to die from circulatory disease under the age of 75 so its hugely important.

I think the other thing that I think is the reason why it’s come so much to the forefront now is that we’re sort of seeing quite a worrying up-spike in in under 75 mortality from circulatory disease. So by this I mean we had decades upon decades of a slow reduction in people under the age of 75 dying from circulatory diseases.

Where since about 2017, so pre COVID, we’ve actually seen that sort of turn a corner and up-spike and actually we’ve seen that that up-spike is actually more pronounced in our region as well.

Jonathan Slade

Thank you, Dan. Thobi, do you want to come in on this?

Thobi Nkomo

Yes, thank you. Thank you, Dan, for that putting it into context. I share your views around that. I also think it’s worth recognising that there’s significant investment into primary care for us to be able to do a little bit more in prevention and detection of cardiovascular disease is a recognition that that is actually the right place to do it.

Because we’ve got the skills, we’ve got the staffing, we’ve got the multiple disciplinaries that work within primary care that can contribute to the overall management and monitoring of these conditions.

It is also a recognition that for every person that has got cardiovascular condition, more than likely they’ve got another condition, another chronic condition. So it is the management of this complex presentation of an aging population that we want to be focusing on, so primary care lends itself as the right venue for that.

And I think obviously with the advent of the primary care networks, we are recognising that there’s been a lot of growth and innovation with people trying to work together and also people working across the system with other system partners from community pharmacy, optometry and all that to try and create an ecosystem where we share the burden or coordinate the picking up – early picking up of you know the index conditions or the modifiable risks as it were.

So I think it’s the right thing to do and I think it’s just a recognition of that you know the capability of primary care to be able to manage that with that long term outlook and continuity of care. So that’s my thoughts.

Jonathan Slade

Thank you, Thobi. Rani, over to you.

Rani Khatib

Thanks Jonathan. It’s a very good question and probably shows where we seem to believe how tackling CVD lies probably more efficiently because we want CVD management and detection and prevention to happen early on and I think, given the concept that you just explained, the shifts – one of the shifts is to move from sickness to prevention, primary care is well placed to identify and detect those people who are at higher risk of CVD and most of the QOF points that we’ll probably look at in the indicators around CVD. They will be around

Q risking, around detection and finding people who have got hypertension, people who have hypercholesterolemia – all quite prominent risk factors that drive CVD, and therefore if we can detect those early on the earlier, the better, the more that we drive the prevention agenda.

So one of the reasons is because we believe prevention can be better driven in primary care and in the community of course, but primary care in specific as a whole and the other reason is that those people who have been detected to have CVD they need to be maintained and supported to have the risk factors long-term managed and usually they will be under the care of primary care.

So if somebody has suffered from a CVD event then after that – they – we’re going to – for example the QOF targets that we give people is a specific target that we want them to lower cholesterol, or lower blood pressure, etc and that’s because the maintenance of that and the support for patients is there.

So it’s about detecting, optimising and sustaining that optimisation of the risk factors that they’re going to help us deliver on the CVD prevention, whether it is primary prevention or secondary prevention, and that’s probably where the value is seen in terms of delivering both the detection and the sustaining of the optimisation and prevention longer term, these probably are my thoughts around that element.

Jonathan Slade

Thanks Rani.

I’ll quickly explain a CVD event. A cardiovascular disease event – what’s that? So it is an event in your life, a set of symptoms or a diagnosis which represents vascular disease. So in common parlance, a heart attack or an episode of angina or a stroke, or a transient ischemic attack or a peripheral vascular disease presentation. So those are what constitute ‘events’ when we use that language.

Dan, would you like to come back in?

Dan Clark

Yeah. Yes, please. I think also I think this is a sort of the fact that’s included in the in the GP contract is a recognition of the opportunity here. In that NICE state that most cases of cardiovascular disease can be prevented through lifestyle changes or through population-based interventions.

And we actually know from sort of fancy calculations in terms of what we call ‘the size of the prize’ that in South Yorkshire, if we get 80% of our high blood pressure population, so our hypertensives, if we get 80% of those within the target range.

So having a good blood pressure control that we know that in three years of doing that we’ll save 119 heart attacks, 177 strokes and 95 deaths. Powerful numbers, aren’t they?

Jonathan Slade

Thank you they are. Rani?

Rani Khatib

Absolutely. I agree with that Dan. I know we’re focusing on the North East and Yorkshire, but globally, if we look at the risk factors – the top metabolic risk factors that are drivers of CVD burden globally. Hypertension is number one and hypercholesterolemia is number 2.

There are five of them, but these are the first two You know the other ones are relevant to exactly the points that you were mentioning for lifestyle changes for other ones included- BMI and disglycemia and some kidney dysfunction of some sort.

But the top two are hypertension and hypercholesterolemia and that’s why there’s a big emphasis in the GP contract about tackling these two and the benefits seen in optimising these modifiable risk factors.

That’s the other element is that some of the factors, of course, driving CVD are not modifiable, whereas these are modifiable, and this needs to go hand to hand of course, with all the lifestyle changes and modifications that would encourage, but we’re talking about for example 1mmol reduction in LDL cholesterol, giving you a benefit of nearly 25% reduction in CVD events.

And we’re talking about when we’re managing hypertension, and 5mm mercury reduction in systolic blood pressure. You’re going to reduce the risk of major cardiovascular event by 10% and potentially if you want to combine it with heart failures probably goes up to 15%. So these are significant meaningful benefits that you can see from optimising these two risk factors only, which are modifiable of course.

Jonathan Slade

Thank you, Rani. Thobi

Thobi Nkomo

Yeah. Thank you, Rani Just to obviously emphasise the points that Dan and Rani have already mentioned, I think it’s worth recognising that cardiovascular disease in particular, you know coronary heart disease, stroke and heart failure contribute significantly to NHS workload and costs.

So, for instance, if you’re looking at the Humber and North Yorkshire footprint, the annual spend on hospital admissions, you know, driven mainly by strokes and heart failure is about 127 million and if you look at the effects of people that have suffered these acute events from loss of productivity being off sick and all that, you’re adding another 210 million as a cost into the system.

So I think when you’re investing into prevention within primary care, you’re going to get more benefits out of that for spending less.

Because we all know that the numbers needed to treat for these modifiable things are very low, so we get a lot of benefit from hypertension management and lipid management.

So it’s overall going to save a lot of money in the long run for the NHS that can be reinvested elsewhere. So it is an important move in increasing investment.

Jonathan Slade

Thank you, Thobi. So I’m just going to summarise it and then I think we’re going to move on to the next question, if that’s OK. But you know what, what are my thoughts on this having done this for an awful long time?

So firstly, primary and community care is the place to find these people and we have great reach into our communities over and beyond people who turn up at my GP surgery – PCNs particularly allow that as well. So we’ve got access, which is the first thing that we need to have.

The second thing is, as I’ve mentioned in my introduction around deprived communities is we get a win-win here because the disease burden is highest in the most deprived communities. So that’s where we need to reach the most, because that’s where we’ll get the biggest bang for our buck, to coin a phrase.

And thirdly, by the time they turn up to hospital with an event, it’s too late. You know, we need to get there early, which is I think what we’re all talking about. So that’s fantastic.

Thank you so much for your thoughts.

So could we move on to the next question if we may? Because I’m really interested in access and we all know about the inverse care law and what that was originally.

meant to mean and not how we use it, but nonetheless, – it essentially means that the people who need our services most access them the least. That’s how it is interpreted.

So how are we making it easier for people to access the care that they need?

Thobi, thank you, Sir.

Thobi Nkomo

Thank you, Jonathan. I think there’s been a few things that have been, you know, tried or introduced in the recent years that have improved access for cardiovascular care, as it were.

So we know that their national schemes, the community pharmacy scheme, the blood pressure case finding scheme where patients can actually go to their local pharmacist to get their blood pressure checked and actually get a diagnosis. You know from that process.

So that’s increasing the opportunities and also capturing some patients that may not actually be able to get an appointment to a GP or have got work commitments that prevent them from actually accessing a GP in hours.

There have been other innovations and investment in improving access, you know, extended access opening later and opening during the weekends. And I think that also gives more opportunity to those that would be otherwise either working during the week or have got caring commitments.

There’s been some innovations, you know, digital innovations, online consultation platforms that allow that exchange of information between a GP and the patient without actually requiring a face-to-face appointment, which means that we’ve got more of an opportunity to actually diagnose some of these modifiable risk factors and manage them without following a traditional face to face consultation approach, and I think there’s been significant investment in the additional roles.

So we’ve got a lot of practice-based pharmacists who are actually taking over some of the work of managing hypertension, managing lipids and allow there to be space for the GPs to actually manage medical complexity.

So I think those are some of the examples of things that have been done to actually, you know, improve access. And I’m quite sure there’s a lot of investment in adopting newer technologies to see how we can improve on that going forward. Thank you.

Jonathan Slade

Thank you very much Thobi. Rani, would you like to come in?

Rani Khatib

Thank you, Thobi. I think Thobi has covered excellent many excellent points and examples.

He mentioned the community pharmacy element and the blood pressure scheme in community pharmacy has been a success. And we have been modifying that contract with community pharmacists to move more towards not just the random blood pressure checks, but also to have more ambulatory blood pressure to get a better diagnosis.

And we don’t know where that evolves to because we have our eyes globally in some on similar models such as in Canada where the management goes beyond just the diagnosis.

So maybe that’s something that the future brings as well. And also we’ve got the independent prescribing pathfinders at the moment looking at lipids within community pharmacies. That’s another project that is underway by NHS England.

So we do these pilots and we evaluate their impact and so far the idea behind this is not just community pharmacy. We’ve been piloting blood pressure checks in optometry. The idea behind it is every opportunity that we can get patient to have their blood pressure checked. Why not? And that’s the better way to have a wider opportunity for detection and later on management, of course, blood pressure at the latest stage.

That kind of goes to focus on the wider use of primary care and the wider use of our healthcare professional colleagues across the hall of the Community and primary care context.

Thobi mentioned about the digital element, that’s really important. The NHS App has been evolving and improving. And we are trying to even make it better. The idea behind it is to empower people so that they are more aware of their numbers.

So do people know what their blood pressure is? Do they know what their blood pressure target is? Do they know what their cholesterol is? Do they know what their cholesterol target is?

Think the ambition is that every person should know their numbers, not just the blood pressure numbers, but they should know the cholesterol. They should know their glycaemia.

These are the risk factors that are driving CVD, which are modifiable as mentioned.

So these are some of the three points I want to highlight – the digital element, the wider use of healthcare systems that we have in primary care and contribution of healthcare colleagues as well.

Jonathan Slade

Thank you, Rani. Dan.

Dan Clark

Yeah, I think a lot of the points that I was going to make have been covered by my colleagues, which is great to hear that we’re sort of thinking along the same lines.

I think I suppose the point that I’d like to make is that we’re offering more appointments than ever in primary care, which is really helping people access the care they need.

And you know, it’s specifically mentioned in this year’s GP contract that we have to provide an equitable service for those accessing online, via the phone and walking in as well.

So all of those options are available to patients and I think the other point I would make is that actually we’re not just there in our extended access out-of-hours roles to provide emergency or routine follow up. We’re also there for prevention as well. So actually those.

People who are working sort of during the week 9:00 to 5:00 you know, there is the opportunity to go to primary care in order to seek out advice about prevention as well.

Jonathan Slade

Yeah, I think you’re all right in referencing appointment numbers and improved access, which you know we’re definitely doing. I think it’s incredible when you think that general practice primary care offers a million appointments a day approximately.

We hear a lot about A&E departments under pressure, they offer 24,000,000 appointments per annum. So in general practice, we see more in a month than they see in an entire year.

So, you know, let’s just get some sense of scale here. But also it gives us the power to make a difference, which is really what we’re trying to talk about here and do better with.

So should we move on to the next question and I’m really interested in both your regional assessment and ideas about initiatives as much as I am a national one, which I think probably comes from Rani, but just describe a little bit about initiatives in your region.

In your particular regions that are really making a difference because this conversation we’re having isn’t a new conversation And yes, we’ve made great inroads into smoking, for instance, which is the biggest risk factor for cardiovascular disease.

But that said, within our communities, there’s a huge disparity in the smoking prevalence, going back to my health inequity issue. But I’m really interested in what initiatives – special initiatives you’re doing in your areas. So if we could come to Dan and Thobi and then Rani, I’m interested around the national picture and what you feel is working at a national level.

Dan, shall I pick on you? Thank you.

Dan Clark

I mean, I think I’m going to start a bit nationally actually I think.

I actually think one of the sort of greatest initiatives is that sort of occurred recently is GP Connect and this is the functionality that allows community pharmacies to directly access primary care records. And all of a sudden that’s opened up this sort of huge opportunity where we can almost essentially tap into this unused resource that that sort of community pharmacists now rather naively, we might have considered them just dispensers where we might get our medications, but then all of a sudden they’re becoming a sort of real great asset to primary care. So I think that would probably one of my examples.

I think you know, if I was to think sort of more locally about what’s been happening in South Yorkshire.

I think one of our greatest success stories and this really sort of was a focus on those in the most deprived areas. We identified those in the most deprived areas who’d already had cardiovascular disease and incentivised our colleagues to target their cholesterol more strongly than they perhaps would do. And that sort of allowed us to increase target levels by nearly 6%.

So we had six more percent of patients treated to target than we did before and that was focusing specifically on those in those sort of low deprivation areas. So the most deprived.

Jonathan Slade

Thank you, Dan. Can I just press you on a particular point? Because I mentioned at the beginning about undiagnosed hypertension. But some naysayers will say, well, the ones we even know about, we don’t treat to target in many cases. So what are we doing about that?

So just currently around 2/3 of people with diagnosed hypertension are treated to NICE target. We’re hoping or our ambition is that we’ll get to the 80% by the end of 2029 – but have you any thoughts around that? How we could do better with the people we know about?

Dan Clark

I mean, I think it comes back a lot to what we’ve we’ve already discussed really. So one is about improving access to healthcare in terms , you know, being able to sort of get in at primary care and not feel like you’re burdening your GP with your blood pressure that you know we have the community pharmacy where you can go and get it checked.

And we’re also, I think it’s also being included within the GP contract isn’t it? So it’s been given a lot more emphasis in this year’s contract in terms of getting people to target. Those would be my sort of instant thoughts. I don’t know if my colleagues have any sort of other thoughts on that one.

Jonathan Slade

Well, I’ll bring Thobi in to answer the sort of broader question then. Maybe he could just think about that.

I mean, I’m going to give my tuppence worth and I think and this is a risky observation, but I think nurses are particularly good because they stick to the numbers rather better than doctors who find doctorly reasons to be a bit more relaxed around 140/90 for example.

So protocolising it and using people who aren’t doctors is a really good way to improve treatment to target. Dan, you coming back at me on that?

Dan Clark

Yeah, I am. Because I totally agree with you and I’d actually take it a step further to say that actually I think this is one of the advantages of having PCN staff. So that’s primary care network staff within the primary care team. So the likes of pharmacists and those sort of professionals to help with this because as you say, that they’re much better at following up.

Jonathan Slade

There you are. Thank you. I’m glad we’re aligned on that, Thobi can I come to you? Just about the question around initiatives that you’re aware of that actually make a difference in your area?

Thobi Nkomo

Thank you, Jonathan. So maybe if I start and answer the last question, because in my PCN we’ve actually come up with a hypertension management service that’s strictly run by the pharmacist or the clinical pharmacist in in charge of titration and follow-ups and all that. And we find that it works really well because they make the prescribing decisions and stick to the numbers like what Jonathan has said – so I think that’s an interesting point.

I mean to the broader question, I think looking at our hypertension figures in our Humber and North Yorkshire, ICB, we had about 310,000 patients diagnosed with hypertension at the end of March 2024. And we’ve done a few things both in the community and within the practices and we’ve actually increased that number by about 13.5000.

So we’ve got 323,251 at the end of last QOF year and this has been a combination of things. I mean obviously offering more opportunities for blood pressure checks, so making every contact count, whether it’s in the community, even if it’s not in a healthcare setting, so local council libraries, leisure centres and actually coordinating with local authority, which seems to be responsible for doing the NHS health checks to just conscientise people that the health checks are available so this has increased the opportunity to pick up more cases, but also we found that there’s an issue with the quality of the data that is within our clinical systems in terms of the correct coding of patients.

So we came up with locally developed toolkits that I meant to help PCNs do a bit of data stocktaking -data audit – you know what we call case finders within the clinical systems. So you will find that there’s a lot of people that actually have hypertension because they’ve achieved that diagnosis because of things that have been done in the past but are not coded appropriately.

So what that means is that they don’t come for their reviews because they don’t show up in a recall. So we did that with most of the PCNs that are within the footprint and we’ve got all those toolkits published within the ICB’s website. So it can be a continuous quality improvement project that can keep running.

With regards to treatment target and how we can be trying to achieve that more, more efficiently we are currently exploring, you know, coming up with a unified treatment protocol that might be a little bit more aggressive than what we would get with NICE because the evidence out there shows that you’re more likely to have your blood pressure controlled with two medications than with one.

So we are exploring how that can be feasible. So that’s something to look out for in the future, but it’s just been a question of increasing the opportunities of blood pressure checking and also getting the PCNs to work very well within the neighbourhood care teams and also doing the coding exercises within the clinical systems for the patients that are already there. Thank you.

Jonathan Slade

Thank you, Thobi. Can I just ask you a further question? It’s just around cholesterol. So the three prongs of CVD prevention are around diagnosing atrial fibrillation, are about diagnosing and managing hypertension and about diagnosing and managing hypercholesterolemia. Those are the three prongs.

What works in your area around the cholesterol question? Because I think that’s a little bit more troublesome, perhaps even than the hypertension one.

Thobi Nkomo

Yeah. So. Cholesterol is kind of difficult, especially when you’re looking at primary prevention. It’s a little bit easier when you’re talking about secondary prevention because people have already had the CVD event that you’ve described before, so they’re a bit more conscientised and invested in taking medications. But we have recognised that there is no proper system to actually find these patients that have had a cardiovascular risk assessment that qualifies them to be considered for statins because it doesn’t really appear anywhere, but they come in through the chronic disease review recalls. And sometimes that conversation may be lost in the things that need to be covered during the consultation.

And we’ve been looking at ways at how we can actually manage that, including how we can manage patient perception around statins and how we can build on a system that actually doesn’t use too much resource. There’s been an exploration of actually using group consults.

So actually inviting patients using our AccuRX, which is a texting system, into a group consultation where they can sit in a meeting room and they can have a conversation with a pharmacist or a nurse just to explain around statins and lipids and all that.

So what that does, it obviously reduces the number of individual appointments that you need, but also it plants that idea, even if those patients don’t make a decision during that time, they are more likely to agree to try statins at a subsequent appointment.

So those are some of the initiatives. We’ve actually produced quite a bit of material in terms of videos and you know just some graphical information that patients can, you know, look at ’cause we understand that everyone learns in different ways, so it’s just about varying that message for the patient to see how they can actually, you know, realise that goal of, you know, reducing their risk.

Jonathan Slade

Thank you, Thobi. Excellent. So, Rani, I wondered if you could come in and give us a bit of a national overview on the substance under discussion – you know what really makes a difference, I guess.

Rani Khatib

Yeah. Thank you so much, Jonathan. Thanks for Thobi and Dan for their contributions. I think I’ll give you a bit of an idea of what we at CVD Prevent prevention team in NHS England – we’re seeing on the national level. First of all, one of our big initiatives that we’re supporting is CVD Prevent, which is the database that gets updated quarterly with all the data on what’s happening.

And primary care in terms of the indicators that you’ve mentioned, whether it is at fibrillation, whether it is cholesterol or hypertension and the idea behind this database, which is updated quarterly, is to keep track of how we’re doing.

Yes, it is affected by coding and it’s affected if readings were taken in the last 12 months.

But there is an intention behind that so that people are reviewed every 12 months and there is some data around them. But the database is actually quite useful supporting ICB regions, ICBs and down to PCNs and practices, and that actually drives more identification of any gaps in areas that need improving, but also celebrating success so that people can learn from where things are working and how people are doing it and what we’re finding from the

CVD Prevent data is that it gives us really good insight into meeting targets, definitely and how we’re doing it regionally, but also it reveals health inequalities.

So we know, for example, based on CVD Prevent that patient with CVD in the most deprived areas are more likely to be treated with lipid-lowering therapies, but less likely to have their cholesterol managed to target.

That is something that’s quite intriguing and is like we need to investigate -why is that? We’re finding that when we did a bit of an analysis into the differences between the sexes and the genders is that found that it’s highlighting significant inequalities between sex across all age groups – like women with CVD are consistently less likely to be treated with lipid lowering therapy, for example.

So why? Why is that? So these things are being flagged down to a practice level if needed in order to tackle health inequalities.

So CVD Prevent is – and it’s evolving. And what we’re doing, we have more indicators that we tried to add so they can benefit and you can see how it’s tracking success. We’re also looking at the challenges of being first. Same with hypertension, same with lipids and we’re doing really well for AF. We reached our targets.

We at the moment we are at 92% detected prevalence and about one in 10 patients with AF still not detected. But in terms of anticoagulation, we’re hitting over 90% anticoagulation, which is brilliant in reducing the risk of stroke.

So CVD Prevent is a big thing nationally to support the work we’re doing around CVD. The other things that we’ve been doing with different initiatives that I’ve mentioned early on is working with different sectors within primary care in order to improve detection of blood pressure, of hypertension, where it’s community pharmacy, where there’s optometry and also in terms of the new Pathfinder that we started recently around lipids as well.

We do have a lot of interest in adherence as well, so we are at the moment looking into and that goes back to the point that you made around, you know, we start people in therapy. How do we make sure that they actually sustain the benefit and that actually it continues as and as we do, whether it’s cholesterol or hypertension management.

It needs to be sustained to drive the benefits that we hope and anticipate to get from it in terms of CVD protection and that reduction in CVD events.

So adherence is quite important and we’re exploring ways of best practices and innovations out there that we can support our people up there and our clinicians in in doing something around that. There’s also work around the NHS App, that we try to enhance the working with the team within NHS App in order to digitise more of a kind of know your numbers.

So we’re really keen in ensuring that there are facilities and ways of actually getting people to know the numbers better to get uploaded better. There is also a shift in thinking towards CVRM (cardiovascular, renal, metabolic) because these risk factors- hypertension, cholesterol, they are also behind and drivers of other cardiometabolic conditions that also tend to happen with cardiovascular disease and to drive them.

So we’re trying to think holistically and these risk factors are common between a lot of these conditions that we’re managing. We’ve been running national campaigns, educational campaigns, whether it is summit.

So we’ve done actually a successful summit in North East and Yorkshire. It’s called the lipid summit and was focused on myth busting around lipids and issues that clinicians might come across. We’re trying to do it in different regions as well, and we’ve been doing lunch and learn events where we actually inviting people who innovated in the CVD prevention territory to come present to us. And yesterday we had our first lunch and learn event and we’re hoping to run another one in September, and the idea behind it, we invite anybody who had initiatives or an invention or innovation that actually supports the CVD prevention to come and showcase what they’ve done. And yesterday what I’ve listened to was brilliant.

Two kind of primary care based, one integrated secondary primary care project around lipid optimisation and optimisation of the CVD risk factors. It’s brilliant work. So these are some of the work that we are doing which is of relevance and I have to agree with Thobi and Dan that most of what is being presented seems to be proper multi-disciplinary team working and we’ve heard yesterday from a team down South where they have CVD hubs in primary care- it’s mainly pharmacy and nurse-led CVD hubs, and they’re covering multiple PCNs.

And they’re quite intriguing because they had really good results and huge shifts in improving their CVD prevent database figures after those interventions. So we’re hearing more about these excellent collaborations and better use of the skill sets of our healthcare colleagues. So I hope that gives you a bit of a flavour of the different things going on.

Jonathan Slade

Rani, that was a wonderful, comprehensive answer. Thank you ever so much. And there’s a lot of exciting work that you’re involved with, which I think will bring great benefit for our citizens and our patients.

So, how are we involving the most important people in this whole conversation in this – namely our citizens, our patients?

Rani Khatib

Thank you, Jonathan. It’s a very important point. I think all this work that we’re doing, it needs to be done in partnership with people or with patients, when they are patients, and we need to hear their experiences and their voice should be ensured and they should be listened to.

So the whole shared decision making, the whole hearing the voice of people and patients in our services, in the delivery of the work that we do is quite vital. Hearing the feedback, their experiences in order to enhance what we do and ensure that it is more efficacious, more tailored and personalised to their needs.

So every committee that we’re forming we’re consciously making sure that there is a patient representative in the committee.

Patients are kind of partners with us in this mission and everything that we’re doing is with them. Patient voice is important.

Jonathan Slade

Thank you, Rani. So, we’ve come to the end of the podcast, so I’m just going to just pick out a few highlights in a minute.

So AF, what does that stand for? – Atrial fibrillation. It is a common condition where the heart beats in an irregular fashion, and unfortunately it can increase your risk of strokes by forming blood clots in the heart, which can then go and block a blood vessel in the brain.

About a quarter of all strokes are caused by atrial fibrillation, but unfortunately the harm that these particular type of strokes cause is much, much more significant than the more common type of strokes. So in other words, death and disability thereafter is substantially worse, and it is preventable. So if you have blood thinners anticoagulants, we can stop people from having strokes with this particular condition.

So yes, to summarise – well, where do I start? Well, firstly, I think we’re agreeing around data being really important and the focus on population health is never more so in this particular disease area, and I think we’ve heard a lot about data and using data well and also interoperability, which is around data sharing between different sources. And I think that’s something that’s going to have to sit behind our work in this area.

We’ve heard, unfortunately, that the progress over the last two decades in cardiovascular disease prevalence has stalled somewhat. In fact, it’s up-ticked, and that is a great concern and is something that we need to work hard on. And we’ve also discussed at length actually the influence of deprivation on cardiovascular disease and how important it is that we go into deprived communities.

Finally, we’ve heard around the fact that this is a teams sport. This is not just about GPs, this is about the community team and all that brings both health and non-health and I think if we harness the energies that we have in the community, then we have a huge opportunity to reduce unavoidable death and illness, which is essentially what underpins CVD. I remember when COVID was along – 150,000 deaths from COVID – we hit that mark.

And people were saying, well, we have that every year from CVD and that’s preventable. Why aren’t we having the same conversations? And it is an absolutely valid analysis and comparison. And I think when people say, well, you know we’ve done that, I said what have we?

So I’d like to thank our panel members for their contributions. Absolutely tremendous. Keep up the good work and look forward to coming across you in the future. Thank you so much.