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How I helped improve heart disease care and reduce admissions

Dr Raj Thakkar recognised that management of patients with heart failure at his practice could be improved. The innovative system he developed has helped to improve their care and reduced hospital admissions, and is now being adopted across the whole CCG. The work led to Dr Thakkar being shortlisted for ‘GP of the Year’ at the prestigious General Practice Awards.

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Profile: Dr Raj Thakkar

What’s your role? GP partner in Wooburn Green, Buckinghamshire; Clinical Commissioning Director, Chiltern and Aylesbury Vale CCGs; Thames Valley Primary Care Cardiac Lead for HF and AF; Oxford Academic Health Science Network

How long have you been a GP? 14 years

How would you describe your practice?

A semi-rural practice with 7,200 patients who represent a mixed demographic

What gets you up in the morning?

My alarm clock, and the drive to improve patient outcomes across the system

What problems was the practice facing?

As with other practices in our area, we have a high proportion of older patients with long-term conditions, including heart disease. There is also significant undiagnosed disease and wide variations in the quality of care. There were no early warning systems in place, leading to ever greater numbers of patients developing decompensated heart disease and ultimately, increased pressure on the healthcare system.

What did you do?

I developed an innovative, patient-centred, heart failure management system that draws together the best medical evidence available. The model uses a multi-pronged approach to treat and manage heart failure patients with left ventricular systolic dysfunction. The computer-based approach focuses on holistic care and regular recall systems.

The most important aspect of the process was to ensure patients and clinicians bought into up-titration of cardiac drugs, and it was embedded as ‘business as usual’. Patients were encouraged to adopt a healthier lifestyle and asked to weigh themselves regularly, seeking help early if they deteriorated.

Finally, we embraced patient education and enablement, alongside comprehensive care plans including recognising frailty and patients in their last year of life.

What were the challenges?

A crucial part of developing and embedding the model of care was to sell the need for change and the movement of care upstream – so, identifying more cases and diagnosing earlier, better preventive measures and optimising care – among all stakeholders. There has historically been a lack of understanding among patients about the risks of their own disease, so patient buy-in was important. Getting patients on board with new ways of managing their disease and to recognise the importance of positive lifestyle changes was a challenge at times.

Leadership and championing the cause has been an important part of this service from the beginning, in order to innovate and embed a new care template in the clinical systems, and to ensure primary care is enabled to deliver this work through quality schemes at CCG level.

What improvements did you see?

Because patients are empowered and involved in their own health needs, we have managed to get our admission rates down to around 7% and maintained this over the past several years, despite the increasing incidence of heart failure. This is consistently much lower than in other practices, where admission rates were as high as 40%.

Keeping patients out of hospital has improved their quality of life and freed up capacity across the wider health system in our area. Patients consistently thank us for taking an interest in their care.

We have now also scaled up the model of care and rolled it out across the CCG – implementing the new system across the county, and other heart failure initiatives achieved £625,000 worth of savings last year.

What colleagues say

Neil Flint, Head of Commissioning for Planned Care, NHS Chiltern CCG and NHS Aylesbury Vale CCG: ‘Dr Thakkar has been a great motivational and inspirational leader to work with, and his work on cardiac improvement for Buckinghamshire has been exceptional. He has galvanised the collaboration of primary care, secondary care and community care.

‘Piloting new initiatives in his own practice and then facilitating the roll out across the rest of the county has seen our heart failure-related admissions reduce and the management of patients in the community increase.

‘His leadership and active involvement in commissioning, delivering care and challenging system partners has led to two consecutive years of delivering millions of pounds of savings to Buckinghamshire while remaining focused on improving care.’



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