Pennine GP Alliance Limited on behalf of, Central Halifax Primary Care Network (PCN)

Project Name: Central Halifax PCN Lipid and Cardiovascular Disease (CVD) Audit and Medicines Optimisation Collaborative Working

Project Summary:

The CWP is structured such that a multi-disciplinary health professional team will provide tailored care for patients, aligned with the Primary Care Network (PCN) Contract Direct Enhanced Service (DES) and the Locally defined Cardiovascular plans.

The main objective of the CWP is to improve the quality of care for patients and support the early identification, review, and medical optimization of patients with Heart Failure reduced Ejection Fraction (HFrEF), Left Ventricular Systolic Dysfunction (LVSD), or atherosclerotic cardiovascular disease (ASCVD) in response to the needs of the CW Partner. Pennine GP Alliance Limited, is the legal entity for the PCN. Novartis will contract with Pennine GP Alliance Limited as they are the legal entity contracting on behalf of the PCN.

The CWP will be led by a Clinical Pharmacist (Band 8d), alongside a multi-disciplinary team; including an Advanced Practitioner (Band 8d), and a Technician (Band 7), aiming to achieve:

• Early identification of at-risk patients who have not had intervention in their health and wellbeing
• Review of treatment options and decision on next steps in collaboration with HFrEF, LVSD, and ASCVD patients
• Counsel and optimize HFrEF, LVSD, and ASCVD patients where appropriate 
• Identification of HFrEF, LVSD, and ASCVD patients, following risk assessment review, of HFrEF, LVSD, and ASCVD patients who are sub-optimally treated 
• Identification of ASCVD patients who have previously not tolerated or refused alternative lipid modification therapies
• On-going HFrEF, LVSD, and ASCVD patient’s support and annual review to ensure CVD outcomes improve equitably

Planned Milestones:

Expected Benefits:

Anticipated benefits for patients:

• Improved access to lipid management care leading to optimal diagnosis and management of ASCVD treatments
• Enhanced experience around ASCVD with ongoing management of the condition  
• Improved access to appropriate medication for suitable patients to preserve health and prevent long-term events 
• Easier access to lipid management care closer to home in the Primary Care setting
• The additional capacity will provide additional time and support from PCN HCP with their lipid management, focusing on patients who may have previously not attended GP appointment or been lost to follow-up. Thus, leveling health inequalities within the PCN
• PCN Improved access to diagnosis and treatment for HF patients
• More equitable and consistent care and access to care for HF patients; and 
• Enhanced experience for patients and their carers who live with HF  

Anticipated benefits for organisation:

• Increased proportion of ASCVD patients reviewed by primary care  
• Increased proportion of ASCVD patients receiving expert and timely review closer to home 
• Reduction in ASCVD referral rates to secondary care 
• Increased proportion of patients receiving guideline-directed pharmacotherapy 
• Insight into benefits of primary care pharmacist led lipid management clinics in primary care  
• Support aligned to NHS Long Term Plan, CVDPREVENT, and Network Contract DES
• Increase the overall quality of care and improve equity of access to specialist care for patients with HF;
• Improve patient flow and increase levels of accurate diagnosis on non-cardiology wards; 
• Potential less unscheduled re-admissions through faster escalation to current treatments recommended by ESC-HF guidelines, and 
• Insight into benefits of increased in-patient long-term therapy initiation/optimisation, which may inform ongoing redesign and workforce planning 

Anticipated benefits for Novartis:

• Insight on the appropriate use of ASCVD licensed medicines in line with NICE guidelines, including Novartis’s medicine 
• Enhanced reputation, and supporting Novartis’ vision that no patient should have to wait for an extraordinary life, by supporting high quality Collaborative Working with healthcare organisations which addresses the problem of health inequalities
• Further opportunities for the appropriate use of heart failure licensed medicines, including Novartis’ medicine, given the current low uptake of contemporary and evidence-based therapies   
• Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisation  

Start Date & Duration: December 2022 for 14 months.

UK | December 2022 | 577813

Project Name: Central Halifax PCN Lipid and Cardiovascular Disease (CVD) Audit and Medicines Optimisation Collaborative Working

Partner Organisation(s): Pennine GP Alliance Limited on behalf of, Central Halifax Primary Care Network (PCN)

Completion Date: 29th January 2024

Outcome Summary:

Lipid Optimisation. The pharmacist clinics successfully supported the GP practices within the PCN to achieve their CHOL001 and CHOL002 targets.

Heart Failure. The project did enable many patients to receive a more holistic review of their therapy than they would have done through usual care and did lead to both improved drug optimisation and patient understanding of their condition and treatment goals as well as better symptomatic control.

Outcomes:

Lipid Optimisation

Regarding the pharmacist-led lipid optimisation clinics - these targeted both Post-ACS and ASCVD patients. The average reduction in LDL-C and non-HDL-C at 6 months was around 15% from baseline. Additionally, the pharmacist clinics successfully supported the GP practices within the PCN to achieve their CHOL0011 and CHOL0022 targets. Patients on the HF Register increased from 454 at baseline to 520 at project end. An increase in the register of ASCVD patients in the CW Partner’s system, from 94 at baseline to 529 at project end.

Whilst most ASCVD patients were optimised to LDL-C below 1.8mmol/L, we found it difficult to get the majority of Post-ACS patients to a target of 1.4mmol/L (a target agreed with the local cardiology department). Further review and assessment of the more challenging post -ACS cohort where target LDL-C levels (<1.4mmol/l LDL-C) are to be considered for future initiatives. This may be part of the work stream that we look to take forward locally within the pharmacist-led cardiovascular disease clinics (see below).

Heart Failure

The pharmacist-led heart failure clinics proved more complex to deliver than anticipated. The complexity arose primarily as Calderdale is already served well with a secondary care pharmacist-led heart failure optimisation clinic as well as the local heart failure nurse service. This meant that a lot of the drug optimisation needs in this patient cohort had already been achieved. Nonetheless, the project did enable many patients to receive a comprehensive review of their therapy than they would have done through usual care and did lead to both improved drug optimisation and patient understanding of their condition and treatment goals as well as better symptomatic control.

Conclusion:

Future Service Development

The project has successfully laid the basis for pharmacist-led management of lipids and heart failure patients in primary care. As a consequence, Central Halifax PCN will be looking to build upon this work by continuing with a pharmacist-led cardiovascular disease clinic which will encompass:

1. Hypertension management

2. Lipid optimisation

3. Annual heart failure QOF reviews

References:

1. CHOL001 - Percentage of patients on the QOF Coronary Heart Disease, Peripheral Arterial Disease, Stroke/TIA or Chronic Kidney Disease Register who are currently prescribed a statin, or where a statin is declined or clinically unsuitable, another lipid-lowering therapy
2. CHOL002 – Percentage of patients on the QOF Coronary Heart Disease, Peripheral Arterial Disease, or Stroke/TIA Register, who have a recording of non-HDL cholesterol in the preceding 12 months that is lower than 2.5 mmol/L, or where non-HDL cholesterol is not recorded a recording of LDL cholesterol in the preceding 12 months that is lower than 1.8 mmol/L

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