Prevention is at the heart of the NHS Long Term Plan. In addition to substantial commitments to tackle obesity, alcohol and smoking, the Plan includes a major ambition to prevent 150,000 strokes and heart attacks over the next ten years by improving the treatment of the high-risk conditions – hypertension (high blood pressure), high cholesterol and atrial fibrillation (AF).
Individuals with these common conditions are more at risk of developing cardiovascular disease (CVD) which includes heart attack, heart failure and stroke, and many cases of dementia. Despite the impact of treatment on outcomes, large numbers of people are undiagnosed or under treated, partly because these conditions often have no symptoms to alert the patient and clinician to, and partly because treatment decisions are complex.
To help tackle this, and to support the Long Term Plan ambition, NHS England and NHS Improvement will commission a national primary care audit – CVDPREVENT.
What is CVDPREVENT?
CVDPREVENT is a national primary care audit that will automatically extract routinely held GP data covering diagnosis and management of six high risk conditions that cause stroke, heart attack and dementia: atrial fibrillation (AF), high blood pressure, high cholesterol, diabetes, non-diabetic hyperglycaemia and chronic kidney disease.
CVDPREVENT will provide a foundation for professionally led quality improvement in individual GP practices across Primary Care Networks (PCNs). It will support primary care in understanding how many patients with the high-risk conditions are potentially undiagnosed, under treated or over treated.
The audit will provide data to highlight gaps, identify inequalities and monitor improvement and impact on inequalities, as well as enabling and guiding opportunities for improvement. It will generate quarterly, anonymised data at national, regional, PCN and CCG practice level, across a broad range of metrics. Locally based QI audit tools based on the CVDPREVENT business rule set will enable practices and primary care networks to systematically identify individuals whose clinical risk factors are sub-optimally managed so that they can be offered treatment that will minimise their risk of life changing heart attack or stroke.
When will CVDPREVENT be available?
A first data extraction using NHS Digital’s GP Extraction Services (GPES) is planned for summer 2020 with initial analysis being undertaken in 2020/2021.
The CVDPREVENT Implementation Steering Group
A number of partner organisations are involved in the work, including RCGP, NHS Digital, NICE, Public Health England, NHS England and NHS Improvement, British Heart Foundation, Royal Pharmaceutical Society, Primary Care Cardiovascular Society and GP representatives.
Working with PRIMIS, and funded by the British Heart Foundation, the group has developed a draft business rule set for condition specific metrics. The final business rule set will be published by NHS Digital.
PRIMIS has also conducted a feasibility report which concluded that the audit is feasible and that the optimal route for extraction of the audit dataset would be via the NHS Digital GP Extraction Service (GPES).
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CVDprevent frequently asked questions
Who will deliver the audit?
NHS England and NHS Improvement funding has been secured via the NHS Long Term Plan initially for three years (Year 1 2020/21), they have agreed a partnership model as follows:
- NHS Digital will be directed by NHS England under section 254 of the Health and Social Care Act 2012 to establish and operate a system for the collection and analysis of the information specified for this service. The Direction is progressing through the appropriate channels to gain agreement and is provisional until accepted by NHS Digital.
- NCVIN-PHE will be commissioned to deliver the analytical work package.
- The Healthcare Quality Improvement Partnership (HQIP) will seek a national audit “preferred” provider through a tender process who will provide the strategic oversight and clinical leadership.
What data will be extracted?
Data extraction will be limited to routinely recorded primary care data and will require no additional data input from GPs.
The General Practice Extraction Service (GPES) will extract data according to the agreed CVDprevent business rule set which will be published via NHS Digital, on their website. The business rule set has been developed with a wide range of national and clinical partners to ensure that only the necessary data is extracted for three clearly defined cohorts: those with one or more of the high-risk conditions for CVD, those with pre-existing CVD and those with clinical records that flag the possibility of an undiagnosed high-risk condition.
How often will the extract occur?
The extracts will occur on a quarterly basis.
What data will PHE receive, will they be able to identify individuals?
The data extracted by NHS Digital will include full identifiers to support data linkage. The dataset shared with PHE will be pseudonymised, record level data with all patient identifiers removed in line with the Information Commissioner’s Office (ICO) Anonymisation Code of Practice. Individuals will not be identifiable. Data on demographics, ethnicity and gender etc. will allow the assessment of the impact of quality improvement on health inequalities, particular important as CVD contributes to the disparity in health outcomes between rich and poor, accounting for 25% of the total gap in life expectancy. The use of pseudonymisation will allow future linkage of CVDPREVENT to other datasets including Hospital Episode (HES) statistics to give a more complete picture of cardiovascular disease and its progression. Any data linkage will be governed by strict information governance procedures. All requests for linked data will need to be reviewed by the Independent Group for Review of Data Requests (IGARD) and if approved will be updated in the relevant PHE Data Sharing Agreement via the Data Access Request Service (DARS).
When will CVDPREVENT publish regular reports?
Subject to information governance procedures and the data extraction timetable it is anticipated that audit reporting will begin in early 2021.
What will the outputs of the analysis include?
The detail of the analysis and reporting will be agreed by NHS England’s national audit preferred provider and PHE working with an expert reference group but the likely focus will be to understand the variation of detection and management of CVD high risk conditions across different geographical areas; highlight populations whose high-risk conditions are sub-optimally managed, either through non-diagnosis, under treatment or over treatment and assess the impact of the wider CVD prevention quality improvement activity within the NHS Long Term Plan. The analysis and reporting will support systematic quality improvement to reduce health inequalities and improve outcomes for individuals and populations.
Who will be able to have access to any part of the data extract?
NHS Digital will be responsible for assessing and fulfilling the applications for access to any part of the data extract. These applications will only be successful if they pass the appropriate ethical, legal and Information Governance requirements to ensure that data is only shared where it is secure, lawful and appropriate to do so. NHS Digital will do this through the Data Access Request Service (DARS) with advice on requests for data from this collection from the Independent Group Advising on the Release of Data (IGARD) where appropriate.
All data approved for release through DARS and IGARD are subject to robust data sharing agreements between NHS Digital and the Controller requesting the data. More detail on the DARS process, standards and the data sharing agreements used are available here.
More information on NHS Digital’s Directions and Data Provision Notices is available on their website.
FAQs for colleagues working in primary care:
When will data collection start?
The first extraction is scheduled for Autumn 2020 and will include data up to the end of March 2020.
Will there be a burden to general practice?
The data will be extracted without any additional burden to practices. The core principles of CVDPREVENT are that the audit should support professionally led quality improvement, should not impose a data burden on general practice and should facilitate practices to work together across networks.
How does CVDPREVENT align to the wider CVD prevention activity proposed within the new GP contract?
NHS England and NHS Improvement has been working with wider partners to develop a QOF Quality Improvement domain. There will also be a CVD prevention specification as part of the PCN DES for implementation in 2021/22. It is envisaged that CVDPREVENT will provide the necessary measurement and audit mechanisms to support practices and PCNs drive the planned quality improvement activity such as determining local need and directing resources.
Will general practices need to do anything to facilitate the data extraction for CVDPREVENT? Do practices need to opt in?
Yes, practices will be required to opt in or “participate” in order to be included in the extract. This is an established process that practices are familiar with and it is not considered burdensome. An offer of participation will be sent to practices in the CQRS system after a Data Provision Notice (DPN) is published. In line with the DPN, practices will be required to log in to Calculating Quality Reporting Service (CQRS) in order to take a positive action and either accept or reject the offer of participation. A practice can change their participation status if required, so if they initially reject the offer but later decide to participate, the offer can be reissued. There is no new data recording burden on general practice as a result of this extract.
Will CVDPREVENT provide practices with identifiable data for case finding and other quality improvement initiatives?
CVDPREVENT will provide aggregate level reporting at different geographies eg. practices; PCNs; STPs/ICS. Existing and new patient level case finder tools will continue to support local quality improvement activity and local systems will be encouraged to adopt the CVDPREVENT business rule set once it is published – provisionally August 2020. Discussions have also commenced with GPIT Futures to see if there’s potential to mandate the CVDPREVENT business rule set and case finder functionality within existing GPIT systems through template development. This work has been placed on pause temporarily in light of COVID-19 but further updates will be provided as this work progresses.
How will CVDPREVENT affect the patients concerned?
There will be no impact on patients from sharing the data, as no one can be identified from the information shown in our reports.
The National Data Opt-Out does not apply to the submission of data to NHS Digital for this collection as a Data Provision Notice, that will be published, imposes a legal requirement on the participating General Practices once they agree to participate. However, all requests to NHS Digital for dissemination of the submitted data will be handled in accordance with the National Data Opt-Out Policy by the Data Access Request Service (DARS).