Project Name: Coventry and Warwickshire Integrated Care System Secondary prevention ASCVD pharmacist led service

Project Summary:

The main objective of the CWP is to improve the quality of care for patients treated for Atherosclerotic Cardiovascular Disease (ASCVD) within Coventry and Warwickshire Integrated Care System (ICS) specifically acute coronary syndrome (ACS), with a particular focus on long term risk factor management and the transition of care between secondary and primary care who are at high risk of cardiovascular events or experienced a cardiac event  and who are not achieving lipid levels as specified in national and/or local guidance, in response to the needs of the CW Partner. This will be achieved by implementing and adopting the Accelerated Access Collaborative (AAC) guidelines across the ICS alongside the standardisation of the cardiac rehab services across the integrated Care System (ICS) and through the development of a cardiac rehab services at South Warwickshire University foundation trust (SWFT) and George Eliot Hospital NHS Trust (GEH) that will mirror the established cardiac rehab service at UHCW.

The secondary objective is to reduce the current backlog of patients waiting to be seen (2 months) by the UHCW lipid service by implementing a local secondary care led secondary prevention clinic, focusing on supporting the discharge and onward management of secondary prevention patients, including first dose medicine optimisation, and subsequent transfer to primary care setting.

This will be achieved by the funding for an additional Clinical Pharmacist Band 8A to develop and support a lipid optimisation service offered by the current lipid service and cardiac rehab departments across the ICS.

Project Amendment

The project is to be extended for an additional period of 3 months, starting from December 2024 and ending in March 2025. This extension is necessary for the following reasons:

  1. There was a delay of circa 12 weeks in the pharmacist obtaining an honorary contract for the planned activity at George Eliot Hospital NHS Trust (GEH) and south Warwickshire University foundation trust and as a result, only 9 months of clinical data will have been captured from the activity at GEH and SwFT (as of November 2024)
  2. A full 12 month data set is required for the CWP’s business case, a key milestone and deliverable for this project and its future sustainability.
     

This amendment will mean that at the end of this project a full 12-month data set can be captured, ensuring equitable activity across both South Warwickshire University FT (SWFT) and GEH. An additional 3 months data set will be gathered totaling 15 months from UHCW. The data collected during this extension will support a more robust business case as stated in the CWP (Clinical Workforce Plan).

During the period of delay in issuing the honorary contract, the pharmacist continued to work at full capacity at UHCW. The task of setting up the clinics (including establishing clinical space, gaining approval of clinic protocols) as well as clinical delivery, took longer than anticipated therefore the extended financial contributions remain set at full-time rates. 

Planned Milestones:

MilestoneDescription
1

CW Partner: 

Collection of baseline data, in line with the above Project Outcome
Measures & Data Collection table – COMPLETE

2

CW Partner:

Confirmation of clinical and operational pathway, policy and protocol 
creation, and readiness to begin the clinical activity (CW Partner shall 
ensure that the clinical staff covered by the Novartis Financial 
Contribution are in place, trained and ready to begin clinical activity 
COMPLETE

3

CW Partner: 

Confirmation of recruitment of Clinical Pharmacist Band 8A and 
completion of onboarding COMPLETE

4

CW Partner: 

Collection & submission of 3 months: clinical activity data & 
educational activities

CW Partner & Novartis: 

Project Review meeting to discuss project progress. 
COMPLETE

5Setting up the clinics at SWFT and George Eliot COMPLETE
6

CW Partner: 

Collection & submission of 6 months clinical activity data & 
educational activities

CW Partner & Novartis:

Project Review meeting to discuss project progress. COMPLETE

7

CW Partner: 

Development of business case to continue the service offered by 
this project COMPLETE

8

CW Partner: Collection & submission of 9 months clinical activity 
data & educational activities

CW Partner & Novartis:

Project Review meeting to discuss project progress. COMPLETE

9

CW Partner: Collection & submission of 12 months clinical activity 
data & educational activities

CW Partner & Novartis: Project Review meeting to discuss project 
progress. COMPLETE

10

CW Partner: 

Development of business case with 12 months data to continue the service 
offered by this project COMPLETE

11

CW Partner:
Start outstanding activity and capture 9-12 months data at GEH and SWFT

Incorporate data set from GEH and SWFT into business case

12

CW Partner: 

Analysis of CWP data, submission of Final Project Report, Submission of 
Outcomes Summary 

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 coordinated by secondary care.
  • 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.

  

ANTICIPATED BENEFITS FOR THE ORGANISATION(S)

  • Increased proportion of ASCVD patients reviewed. 
  • 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 

ANTICIPATED BENEFITS FOR NOVARTIS

  • Insight on the use of ASCVD licensed medicines in line with NICE guidelines, including Novartis’s medicine , where appropriate.
  • 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    
  • Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisation

 

Start Date & Duration: October 2023 for 13 months

Amended Contract extended for 3 months from December 2024 to March 2025

FA-11326363 | November 2024

Project Name: Coventry and Warwickshire Integrated Care System (ICS) Secondary prevention ASCVD pharmacist led service 

Organisation(s): University Hospitals Coventry and Warwickshire NHS Trust

Completion Date: 31st March 2025

Outcome Summary:

This project implemented a pharmacist-led strategy to optimise lipid management and review patients within the cardiac rehabilitation footprint. The aims were to improve lipid management in high-risk patients (i.e. those who had recently been discharged with a diagnosis of acute coronary syndromes (ACS), increase patient engagement with cardiac rehabilitation and create an over-arching guideline for use across primary and secondary care for lipid management.

Through collaboration between Novartis and other stakeholders (ICB and three acute Trusts), the project was implemented across four cardiac rehabilitation centers over the duration of the project. 

Key Project Outcomes Data:

The service achieved the following outcomes:

  • At baseline, only two cardiac rehab provider sites (University Hospitals Coventry (UHCW) and Rugby St. Cross provided repeat blood forms to recheck lipid profile whilst in the cardiac rehab program. Pathways were established at George Eliot Hospitals (GEH) and South Warwickshire University NHS Foundation Trust (SWFT) to mirror this practice, to reduce inequity of access to healthcare.
  • Patient reach: 1461 patients (of which 26 passed away) were referred to the cardiac rehabilitation program following an ACS event. Of this, 1074 (74%) took up the exercise program in some capacity.

Lipid Optimisation 

  • 521 pharmacist appointments were carried out over a 12-month period. 
    • 362 patients (69%) had a review of their lipids or lipid lowering therapy 
    • 292 patients had adjustment in their lipid lowering therapy.
    • 19 patients (5%) declined further pharmacological intervention. 
       
  • 130 patients (of the 292) had a repeat blood test following an adjustment in their lipid lowering therapy
    • 106 patients (81%) of the 130 patients who had a repeat blood test, were to target (i.e. LDL-C ≤1.8mmol/L or non-HDL-C ≤2.5mmol/L) on a second blood test. 
    • Patient-reviews are ongoing and repeat lipid profiles obtained in community for the next two months in order to obtain a full data set and complete picture of what proportion of patients were to target following intervention. 
       
  • On average, a 0.4mmol/L reduction in LDL-C in those patients who were seen in the pharmacist clinic for lipid optimisation. 
  • Improved access to cardiac rehabilitation; 150 patients who did not undertake the exercise program took up a pharmacist appointment. 
  • 46 patients had other medications optimised, not linked to lipid lowering therapy, demonstrating that there is scope to upscale this project to provide a broader secondary prevention optimisation clinic. 

Outcomes:

For patients:

  • There was increased engagement from patients with the cardiac rehabilitation programme, offering individualized risk factor optimisation. 
  • Positive feedback from patients through qualitative feedback questionnaires. 34 patients returned a questionnaire, with 100% agreement on this being a useful addition to the cardiac rehabilitation service. 

For healthcare professionals and organizations:

  • Increased engagement from healthcare professionals in both primary and secondary care, with multiple education sessions led, reaching over 500 people. 
  • Creation of overarching guidelines for management of lipids, published on GP Gateway and APC website. 
  • Upskilling of pharmacist to work in an MDT outpatient environment to manage high risk patients. 

For population health:

  • A focus on prevention reduced re-admission, with an estimated 2.6% reduction in readmissions across the system (modelling based on ICB data). However, the true impact of reductions in re-admissions would need to be reviewed over a three-to-five-year time frame. 
  • At a baseline, 66% of patients were having repeat blood tests at UHCW following their MI to recheck cholesterol. No patients at the other two sites were having repeat cholesterol profiles whilst undertaking CR. During the pilot project, this increased to 69% having a repeat lipid profile within 6-12 weeks post MI across the system.

Conclusion:

This project made a positive impact on lipid management and as well as increasing access to the cardiac rehabilitation program following an ACS event at a system level for patients. It is an example of how system working and integrated care with a multi-functioning MDT can help improve patient outcomes.

A greater patient population was optimized on their lipid lowering therapy, in line with local and ESC guidance.

The collaborative approach between Coventry and Warwickshire ICB and Novartis has allowed practice to engage patients, reduce cardiovascular risks and allow timelier up-titration of appropriate therapies. This approach has shaped how cardiac rehabilitation teams across the ICB manage patients risk factors, in particular lipid optimisation, which aligns with the ICBs and NHSEs wider plan to improve CVD prevention.

A business case has been written for discussion with the ICB for continued funding of these posts. Internal discussions at both UHCW and GEH are underway to obtain funding for substantive posts to review and optimise medical therapy for patients recently diagnosed with an ACS event.

In the interim, a further 12 months funding has been agreed for pharmacist clinics to continue at UHCW and Rugby St. Cross, with an emphasis on ASCVD risk reduction. 

FA-11463510 | June 2025