GPs to be ‘monitored’ by ICBs on meeting priorities for cardiovascular disease prevention
GP practices will be monitored by ICBs on ‘immediate’ priorities to improve prevention and care for patients with cardiovascular disease, the Government has announced.
The Department of Health and Social Care has launched a new framework for cardiovascular disease prevention and care, which will be used to ‘drive better prevention, earlier diagnosis, faster treatment’ and ‘more consistent care’.
The framework established 12 ‘immediate priorities’ (see box) over the next three years, setting out initiatives ICBs should deliver to cut mortality and reduce inequalities.
The Government expects that the plan will reduce pressure on services, with fewer consultations and hospital admissions resulting from acute events like heart attacks and strokes, ‘avoiding over 942,000 primary care consultations and over 926,000 secondary care attendances and admissions’ over the next decade.
It said that SGLT2 inhibitors and GLP-1 agonists will play ‘an increasingly important role in reducing the risk of major cardiovascular events’, with opportunities for ‘improved pathways for the uptake of new CVD medicines’.
The document said that the delivery of the framework will be led within neighbourhoods, though the precise configuration of services within neighbourhoods ‘may differ from one area to another’.
For example, in some areas case-finding initiatives may sit with GP practices, in others be undertaken by providers spanning multiple neighbourhoods.
Similarly, delivery of care processes will ‘often sit within GP practices’, but in some areas, specialist community services (for example, for diabetes or heart failure) will be established spanning multiple practices.
The 12 priorities
Finding the missing millions
1. Proactively and systematically identify people who smoke and offer evidence based smoking cessation and tobacco dependency services for all smokers in your local population.
2. Systematically identify and group individuals with established or emerging CVKM risk factors by risk level, using a holistic assessment of atrial fibrillation, albuminuria, blood pressure, cholesterol, diabetes, excess weight (overweight or obesity) and reduced kidney function (eGFR) (ABCDE) approach. Ensure timely linkage into appropriate prevention and treatment pathways.
Driving treatment to target
3. Improve uptake of sodium-glucose cotransporter 2 inhibitors (SGLT2i) for eligible people with heart failure, chronic kidney disease and type 2 diabetes. Consider scope to secure financial savings by switching patients to lower cost therapies.
4. Ensure people with hypertension are treated to evidence-based targets.
5. Optimise lipid management for people at risk of CVD.
6. Deliver all 9 diabetes care processes (blood glucose, cholesterol and kidney function, blood pressure, urine ACR, feet examination, weight and eyes, smoking cessation). This will help to prevent complications and identify deterioration early.
7. Ensure people living with CVD have their cholesterol and blood pressure optimally managed to evidence-based targets. Use proactive monitoring and escalation where control is not achieved.
8. Rapidly increase uptake of 4 pillar therapy for eligible people with heart failure with reduced ejection fraction (HFrEF) with early initiation and timely optimisation.
Ensuring timely, equitable, high-quality acute care
9. Increase access to specialist and organised stroke care.
10. Standardise use of multiple therapies for intracerebral haemorrhage (ICH).
11. Ensure timely access is available to primary percutaneous coronary intervention (pPCI) for STEMI.
Living with CVD and expanding access to rehabilitation
12. Focus on strengthening and scaling cardiovascular rehabilitation to maximise its contribution to reducing premature CVD mortality, improving outcomes and tackling inequalities.
Source: DHSC
The document added that ICBs and local government are ‘accountable for outcomes in their population’ and that later this year a delivery plan containing further detail to support the implementation will be published.
It said: ‘ICBs should actively manage performance across providers, neighbourhoods and practices, monitor variation in outcomes and access, and take action where delivery is below expectation.’
ICBs should:
- identify areas of highest variation
- identify provider organisations with unacceptably low levels of performance against the main indicators for the 12 priorities
- prioritise targeted action in underserved populations
- monitor and report progress in closing gaps
It added: ‘We will ask ICBs needing improvement in the 12 priorities to set out plans to deliver improvements over the forthcoming 3-year period, against which a measurable level of ambition will need to be set.
‘The expectation is that ICBs will have a stronger focus on supporting improvements in providers that show an unacceptable level of performance against the indicators for the 12 priorities.’
Where performance is ‘below expectation’, ICBs could be required to:
- develop remedial plans
- actively work with and support improvement in the poorest performing practices and providers
- set clear delivery trajectories
- demonstrate measurable progress over defined timeframes
The framework added that ‘persistent underperformance’ against these priorities may result in ‘increased oversight’.
It said: ‘This may include enhanced commissioner intervention and could inform the intelligence used by the Care Quality Commission (CQC) and other national bodies to identify where further scrutiny or regulatory action may be required.’
In relation to the second priority on the list, the document said that the NHS Health Check is ‘a proximal, pragmatic metric’ to measure implementation of this priority. However, the NHS Health Check does not
measure albuminuria, or eGFR currently, nor does it include measurements for foot (ankle brachial index) and heart failure (NT-pro BNP testing).
‘Therefore, there is a clear need to test new models to enhance current services and expand
case-finding opportunities in line with our roadmap – with aligned metrics and ambitions – over the coming years,’ it added.
It comes after a major Pulse investigation found that cash-strapped local authorities around the country are limiting the number of checks that can be carried out by GP practices annually, affecting both practices and patients.
The Government has also launched ‘prevention accelerators’ with the first being established in Greater London, Greater Manchester, Liverpool City Region, South Yorkshire and the West Midlands, whose initial focus will be on preventing cardiovascular disease.
Health secretary James Murray said: ‘Too many people are dying early from heart attacks and strokes that we know are preventable.
‘This is not good enough and that’s why we are setting clear priorities to help people stay healthier for longer, identify and diagnose serious disease much earlier, and deliver better treatment when it is needed.’
Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.
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READERS' COMMENTS [2]
Please note, only GPs are permitted to add comments to articles
So what’s it to be? Spend out time bailing out urgent care and prioritising same day access or better long term condition management? – (which actually save ives and improves quality of life and is cheaper in the long run!). GP capacity is not changing – where would you like us to work? This does sound very much like the beatings will continnue until morale improves…
Is it contractual ? No
Is it an enhanced service? No
Till they can find funding for it, not the responsibility of general practice.