The success of the Cardiac agenda can be viewed through data audit compliance which is very high, as the causal link between good management and the clarity this provides for commissioner and providers.
Transactional Change creating traction – Heart Failure as exemplar
The establishment of a Heart Failure Day Case Unit at RBFT is a strong case study in how new ways of working can open up improvements in ambulatory care. With the new Unit offering a transactional change to the patient pathway ( and offering a significantly improved patient experience) the SCN is now working with others to help surface other activities with potential benefits. These include:
- Reviewing how earlier referrals for new HF patients can help GPs and others
- Developing diagnostic capability and one-stop clinics for patients;
- Ensuring cardiac rehabilitation services can be optimised to improve patients care
- considering how the Berkshire West House of Care model for long –term conditions might be applied to cardiology conditions. This builds on the existing virtual clinics with community involvement
Joint press release between RBFT and Berkshire West CCGs highlighting methodology and success of the Day case unit
Working with National Audit for Cardiac Rehabilitation and the British Heart Foundation, Thames Valley SCN is seeking to support:
- the monitoring and support of cardiovascular rehabilitation (CR) teams and commissioners in delivering high-quality and effective services, to evidence-based standards, for the benefit of all eligible patients in Thames Valley.
- mapping the extent of provision and highlighting inequalities in delivery against key service indicators at CCG, SCN, Health & Wellbeing Board and Cardiac Network levels for local programmes.
- working to determine the effectiveness of routinely delivered CR services on patient agreed outcomes, cardiovascular disease risk profiles and health and social care utilisation.
- commit to using audit and research data generated through the NACR which will inform:
- NICE clinical guidance and service specification development
- Clinical practice standards from national associations
- NHS healthcare commissioning processes and decision making; and
- the public and cardiac patient groups about how their local services are performing.
Currently Wycombe General Hospital in our local patch are accredited units
The BACPR Certification was launched in June 2015, with 16 sites taking part in the initial pilot, and there are currently 14 Certified Programmes who have successfully gone through the certification process. Currently only Wycombe General hold accreditation in the TVSCN provider region.
Programmes must be entering data in to NACR to be able to apply for the certification and use of this data helps NACR to determine whether programmes meet certain minimum standards.
Details and information on how to achieve BAPCR certification can be accessed at this link
The key actions needed to achieve accreditation are;
- CR teams be entering data into NACR routinely.
- CR teams need to be the minimum standards(not gold standard).
- CR should be inviting inviting priority groups, e.g.MI, MI/PCI, PCI, CABG, HF.
- Patients should be risked assessed prior to being exercised.
- The data shows acceptable wait times.
- The data will show the duration of programme.
- The data will show the percentage of service users completing cardiac rehabilitation
- The mean wait time for each of the priority groups will be available
In addition to quality concerns commissioners and providers should also consider ;
- Local variations in access disparity /variation in care
- Lack of resources in many cases due it not being a consultant lead service.
- Longterm investment reflecting growing demand; and
- Clarity around commissioning arrangements – which services are provided to who and are suitable performance management in place
- Commissioners should ensure that your local cardiac rehabilitation service is registered with, and submitting data to the NACR audit
- To create case for change, the NACR can provide a local data report to determine current programme performance, and how close to meeting the minimum standards your local services are.
The effective identification and management of patients with Familial Hypocholesteraemia (FH) remains one of the NHS CVD “10 high impact interventions” with a significant opportunity to impact effectively on the premature years of life lost in individuals and families.
Estimates suggest around 120,000 patients in the UK have FH (around 1 in 500 patients) and only around 1 in 6 cases are diagnosed in primary care. Patients with the most common form of FH have significantly increased risk of premature coronary heart disease (CHD) if left untreated:
· There is a greater than 50% risk of CHD in men by the age of 50; and
· a greater than 30% risk of CHD in women by the age of 60
Patients and relatives of patients with FH have significantly improved outcomes when the following steps are in place:
· There is a systematic approach to early identification of patients in primary care;
· Identified patients are initiated on high does statin therapy ( where the target LDL is < 50% of baseline);
· There is systematic screening of patients relatives (cascade testing) and patients are subsequently managed in line with NICE guidance (CG71) identified earlier and treated with high dose statin therapy ( where the target LDL is less than 50% of baseline); and
· where all patients with a family history of early CVD receive a lipid profile and thyroid function test
Early TVSCN work in 2014 showed significant variation in FH service provision across Thames Valley and over the last two years service there have been a number of service developments:
- In West Berkshire there is an established service supported by BHF which now extends to cascade service for the children of FH confirmed parents who fall in the Berkshire / RBH catchment: and;
- Commissioners in East Berkshire are working with Royal Brompton & Harefield Hospital to provide access to an established FH service. This offers an “ easy to commission service” with patient identification and cascade testing as part of the offer. Further details are available from Jane Breen via firstname.lastname@example.org
However there remains scope to ensure that services are available to all FH patients across Thames Valley and working collaboratively, commissioners can ensure all FH patients and their families are supported by:
Reviewing existing CCG provision and scope for comprehensive service development. This could be locally or working collaboratively with STP partners
Review the opportunities for comprehensive case finding in primary care and ensure the most recent NICE guidance is fully implemented so that:
- Healthcare professionals should offer all people with FH a referral to a specialist with expertise in FH for confirmation of diagnosis and initiation of cascade testing
- Cascade testing using a combination of DNA testing and LDL-C concentration measurement is recommended to identify affected relatives of those index individuals with a clinical diagnosis of FH. This should include at least the first, second and when possible third – degree biological relatives
- The use of a nation-wide family-based, follow-up system is recommended to enable early comprehensive identification of people affected by FH.
Further information can be accessed online at: