Cardiovascular disease outcomes can be improved by using managed networks in general practice, shows a recent UK study.
A total of 34 inner-city general practices in Tower Hamlets, London were included in the three-year observational study. All 34 practices were allocated to eight geographical managed networks of four to five practices, each serving 30,000-50,000 patients. Each network had a network manager, administrative support, and an educational budget to deliver attainment targets in four care packages, of which CVD comprised one. The CVD care package consisted of four components: hypertension, stroke/transient ischaemic attack, CHD, and the NHS health check. Each component had network targets agreed by local GP representatives, and financial incentives were distributed on the basis of achieving these network targets, compared to previous schemes based on individual practice achievement. Targets included blood pressure below 140/90mmHg for hypertension, stroke and CHD, cholesterol below 4mmol/l for CHD, stroke and diabetes, and blood pressure below 140/80mmHg for diabetes.
Over the three-year study period, Tower Hamlets increased total statin prescribing by 17.9% compared with 5.5% in England. Blood pressure control (below 150/90mmHg) for CHD, stroke and hypertension improved significantly faster from 2009 to 2012 in Tower Hamlets than in England, London or local PCTs. Blood pressure control for hypertension improved 5.9% in Tower Hamlets, compared to 1.7% and 1.9% in London and England, respectively. For stroke, blood pressure control improved 4.9% in Tower Hamlets, compared to 0.8% in London and 1.1% in England. In 2012/13, Tower Hamlets ranked top in the national QOF for blood pressure and cholesterol control in CHD and diabetes, top five for stroke and top in London for all these measures. Male mortality from CHD was fourth highest in England in 2008 and was reduced more than any other PCT in the next three years, dropping 43% compared with an average fall of 25% for the top 10 PCTs in 2008, ranked by mortality.
The researchers noted that this is ‘the first example of general practice managed networks applied specifically to unselected geographical groups of general practices in an entire local primary healthcare economy, contracted to deliver specific care packages and improve service provision’, and that the programme is ‘highly popular and perceived as successful by GP practices and commissioners, representing one small step to address the inverse care law’.