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GP practices should reduce stroke rates to free up social care, says NHSE

GP practices should reduce stroke rates to free up social care, says NHSE

GP practices should improve patient blood pressure control to reduce stroke rates and release capacity in social care, NHS England has said.

Speaking at a recent NHS England GP webinar, NHS England national clinical director for cardiovascular disease (CVD) prevention Dr Shahed Ahmad said that the ‘largest gains’ in tackling CVD are going to come from ‘blood pressure control’.

Dr Ahmad told GPs that there are ‘a lot of reasons for taking CVD prevention just as seriously as we’ve taken Covid prevention’, not least the ‘big burning platform’ that is social care.

He said: ‘We know that as a country, stroke is the largest cause of adult disability and we spend £4.5bn a year on social care for people who’ve had a stroke. So if your stroke rate goes up a bit, that’s an enormous social care workforce implication. 

‘Similarly, if you can bring your stroke rate down a bit, then that frees up a huge amount of social care capacity. So one of the reasons for CVD prevention is to release social care capacity.’

He added that there is an ‘incredibly strong evidence base for controlling blood pressure’, as well as controlling cholesterol and controlling atrial fibrillation, to lower rates of CVD.

An accompanying slide said: ‘Hypertension is the leading risk factor for stroke. An increase in incidence could lead to a major increase in social care demand and effect on patient flows out of and through hospitals.’

But Dr Ahmad said that up to two million people did not have their blood pressure controlled in 2021, which could translate to 16,500 extra strokes over the next three years.

He told GPs: ‘Pre pandemic, our ambition was to go from 70% to 80% [blood pressure control]. However, when the 2021 QOF figures came through, our control had fallen to 48.8% – that’s about two million people.’

He added that ‘a lot of this might be a recording issue’ due to QOF income protection in 2021, but said that ‘if it was two million more people who didn’t have their blood pressure controlled, that would translate into 27,000 extra heart attacks and strokes over the next three years and about 16,500 of those would be extra strokes’.

He said: ‘Our maximum interest at the moment is around blood pressure, so we would encourage you to focus on the blood pressure elements [of CVD prevention].’

‘Supporting general practice with often non-general practitioner workforce’ is a key part of NHS England’s ‘four point plan’ to address this shortfall in blood pressure control, Dr Ahmad added.

Other NHS England actions include:

  • Using data to ‘reduce unwarranted variation’
  • Prioritising ‘system leadership’ for CVD prevention such as by funding ICS CVD leadership posts to help local clinicians promote CVD prevention
  • Increasing public communications and education

A document outlining how NHS England is working to restore CVD prevention work, published this month, said: ‘GP teams will be able to access the data they need to be able to spot those at risk of CVD earlier and support them to manage their condition if necessary. 

‘As part of the national CVDPREVENT audit, a data and improvement tool is available which enables GPs and healthcare professionals to understand the performance of their services and identify potential improvement opportunities. This data can be compared against national and local benchmarks, which can be broken down by demographics to highlight inequalities.’

NHS England has also ‘given cardiac networks a significant amount of money, roughly half of which is for prevention’, so that they can liaise with primary care teams with blood pressure as the priority, Dr Ahmad said.

But he added: ‘We’re now seeing blood pressure being measured in pharmacies, at Covid vaccination centres and on outreach buses. 

‘So there’s lots and lots of work going on to find new models of care so GPs and practice teams don’t have to be measuring blood pressure.’

The NHS Long Term Plan identified CVD, which is estimated to kill 136,000 people a year, as the single biggest area where the NHS can save lives over the next 10 years.

It comes as GPs are set to prescribe a new NICE-recommended drug shown to prevent strokes and heart attacks in those with raised blood fat that could benefit hundreds of thousands of patients.


Chris GP 24 June, 2022 4:55 pm

Its almost 5pm, I am no where near finished today, the work is like an avalanche – I haven’t left my desk or had a drink since 8am. I am busy. I can’t physically do any more. F*ck off

Truth Finder 24 June, 2022 5:02 pm

Well said Chris. Well said. Where’s the staff NHSE? Where’s the staff?

The Prime Minister 24 June, 2022 5:33 pm


Cameron Wilson 24 June, 2022 9:41 pm

Spot on PM! Hope you’re taking notes Sajid!! It’s your only hope !!

Patrufini Duffy 24 June, 2022 11:00 pm

A+E discharge letter.
BP 168/98. Sent home. See GP. Thumbs up.

Karen Potterton 25 June, 2022 7:48 am

My medical statistics math is a bit rusty but doesn’t that give an NNT of 222/year to treat to target prevent one vascular incident? (2million/27k/3 years). Is that really good use of primary care time?

Peter McEvedy 25 June, 2022 12:10 pm

I think this has put my blood pressure up!

Alice Hodkinson 25 June, 2022 12:58 pm

So. Let’s blame GPs again. But do consider that the absolute advantages of reducing blood pressure are low, and in the over 80 age group out comes are better with higher BP.
The real source of all those strokes, heart attacks, debility is the lousy public health advice to eat a diet full of starchy (processed) muck to develop insulin resistance and a reliance on medication.
So, NHSE, don’t blame it on me

Jamie Preston 25 June, 2022 2:40 pm

If the overall goal is decreased incidence of hypertension shouldn’t there be a bigger focus on public health? Reducing the modifiable risk factors for hypertension would not only help in hypertension cases but in multiple other diseases.

David OHagan 27 June, 2022 8:41 am

This government is putting everyone’s BP up.

The sooner they go the fewer strokes there will be….
Poverty, ‘hostile environment’, scapegoating, ‘levelling up’- or reinforcing stereotypes,

all of this is on top of large scale corruption and mismanagement

and cheaper than the annual bill for antihypertensives…

David Church 27 June, 2022 1:50 pm

Any benefit gained from GPs reduceing BP-related stroke rate is far outweighed by the effect of Covid increasing stroke rates, which could have been avoided if UK had followed sensible precautions and sustained them just a little bit longer, instead of throwing all our eggs in the Pharmas basket at high cost.

Patrufini Duffy 27 June, 2022 3:32 pm

Too busy reducing IBS and panic attack rates. And fake medicine.

Stephen Alvis 27 June, 2022 9:46 pm

What about the effect of all those people with reduced blood pressure falling over and suffering from trauma resulting in admission and subsequent social care needs. Do NHSE live in the real world.

Nicholas Grundy 27 June, 2022 11:33 pm

NHS England in “GPs to sort problem X” shock.

That’s their solution for everything: we don’t know how to do it, so we’ll make vague assertions in the press about how someone else could.

Nicholas Grundy 27 June, 2022 11:34 pm

You could replace the whole of NHSE with a bot which just churned this sort of garbage out based on this week’s media stories and the country would save a lot of money.

Decorum Est 1 July, 2022 3:35 pm

Maybe as we’re all being impoverished, we might all buy less crap from the supermarket (but then again, isn’t it the cheap stuff fortified with HFCS etc that the poorest will turn to?).