Lime Tree Surgery, Lime Tree Avenue, Worthing, BN14 0DL

Project Name: Lime Tree Surgery ASCVD Primary Care Lipid Management Collaborative Working Project

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 optimisation of patients with atherosclerotic cardiovascular disease (ASCVD) who are at high risk of cardiovascular events and who are not achieving lipid levels as specified in national and/or local guidance, in response to the needs of the CW Partner. 

The CWP will be led by a Pharmacy Technician alongside a multi-disciplinary team; including Clinical Pharmacist / Nurse (Band 7) / General Practitioner / Healthcare Assistant / Nurse Associate, aiming to achieve:

1. Identification of sub-optimally treated ASCVD patients who are at high risk of cardiovascular events and who are not achieving lipid levels as specified in national and/or local guidelines
2. Identification of ASCVD patients who are at higher risk of cardiovascular events and who have previously not tolerated or refused alternative lipid modification therapies  
3. Review of treatment options and decision on next steps in collaboration with ASCVD patients
4. Counsel and optimise ASCVD patients where appropriate  
5. Early identification of at-risk patients who have not had intervention in their health and wellbeing 
6. Identification of ASCVD patients, following risk assessment review, of ASCVD patients who are sub-optimally treated  
7. On-going ASCVD patients support and annual review to ensure CVD outcomes improve equitably

Planned Milestones:

Expected Benefits:

Anticipated Benefits to 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 Surgery HCP with their lipid management, focusing on patients who may have previously not attended GP appointment or been lost to follow-up. Thus, levelling health inequalities within the Surgery. 

Anticipated Benefits to the 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

Anticipated Benefit to 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   
• Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisation

Start Date & Duration: Jun 2023 for 9 Months including 6 months of clinical activity

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Project Name: Lime Tree Surgery ASCVD Primary Care Lipid Management Collaborative Working Project

Partner Organisation(s): Lime Tree Surgery, Lime Tree Avenue, Worthing, BN14 0DL

Completion Date: 19^th January 2024 

Outcome Summary: Primary Care ASCVD Lipid Management Patient Pathway Improvement

Key Project Outcomes Data: 

Our collaboration resulted in 572 lipid patients being reviewed within Limetree Practice, significantly exceeding our initial aspiration of 345.  This equates to approximately 75% of lipid patients originally identified by the Practice.472 patient interventions using NICE approved medicines. 

Existing highly skilled resource within the Practice was successfully upskilled to increase capability and capacity to continue to optimise outcomes for high risk ASCVD patients.

The NHS Stakeholder who led the project has committed to collating multiple case studies of patients whose cholesterol was greatly reduced through receiving the most appropriate treatment. 

Outcomes:

Limetree Practice were able to review and optimise maximum patient numbers by sending personalised letters to patients which included key and relevant information to facilitate patient engagement and education.  The letters included their most recent LDL levels, available options, information around drug therapy and links to websites with cholesterol information. This was followed up by an AccurX text with a link to click if they wished to be contacted. This resulted in a 95% acceptance rate.

A key factor for success was the upskilling of an already competent Pharmacy Technician. A competency framework was put in place prior to the project starting to ensure this role had maximum opportunity to optimise patients. With the exception of prescribing, the Pharmacy Technician was able to manage all aspects of the lipid optimisation, which is more cost effective for the Practice than using a pharmacist role.

There were also multiple streams of work happening in parallel to this project, such as, diabetes team input, remote pharmacist input and QoF team who supported with obtaining up to date blood results, resulting in a more efficient lipid optimisation appointment for the patient.

Milestone Results:

Baseline Start: 705 patients were identified, of which it was agreed that 345 could be seen within the 6 month project at the rate of 1.5 days a week. 

3 Months: 208

6 Months: 572 (165 %)

Attended appointments: 572 (81%)

Initiated / up titrated eligible patients: 472 (67%)

Declined or not appropriate 100

The Manchester Tool was an additional success factor in this project, and it assisted the Practice in identifying eligible patients.  They will continue to use the Manchester tool to keep on top of lipid patient searches.

It is estimated that 75% of lipid patients within the practice have been reviewed and they will be continuing this work to ensure that all existing and newly identified lipid patients will be offered a review appointment.

Pharmacy technician is now mentoring other pharmacy technicians within the PCN to the same competence level, using a train the trainer approach. 

They will also be using Clinical Pharmacist Solutions training modules to support this.

The project has resulted in immediate and ongoing improved   capability within the practice, the impact of which will continue to address healthcare gaps and improve patient outcomes by proactive case finding

The positive long-term impact to the healthcare system capacity downstream as a result of early identification and optimisation of patients with high ASCVD risk factors is significant but not easily quantified at this stage.

Conclusion:

We have presented this project at NHS Confederation Primary Care Conference in order to share best practice and key learns among the primary care community.

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