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Closing the gap: tools to tackle variation in cardiovascular disease

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Unique ID: FRAM431 Caption: A doctor measures talks to a patient while taking his blood pressure and heart rate using electronic monitoring equipment in hospital. Assessment. Medical equipment. Restrictions: NHS Photo Library - for use in NHS, local authority Social Care services and Department of Health material only Copyright: ©Crown Copyright

Healthcare around the country can vary in many ways – from the quality of care, to equity of outcomes and the type of services that are invested in and used.

In some cases variation is inevitable. It can relate to differing levels of illness and patient choice. However, variation caused by varying professional opinions and disparate organisational performance is both unwarranted and unfair, and must be addressed.

At PHE we are working with our colleagues and partners locally to tackle this type of variation and work towards consistent quality of care across the country, and maximum value for local populations and for every patient.

Along with NHS England and NHS Right Care, we work to support clinical commissioning groups and local authorities to identify gaps in care, and highlight opportunities to be more efficient, to gain greater value from constrained budgets and to improve health outcomes for patients.

The first step is to determine where we are doing well, and where there is room for improvement, and there are many different tools available to help local areas and CCGs to do this, such as the NHS Atlas of Variation in Healthcare.

But knowing which tool to use when, and for what purpose, can be challenging. In this blog I want to provide an overview of some of these tools, with a particular focus on cardiovascular disease.

Tackling variation in cardiovascular disease

 The facts:

  • Cardiovascular disease is responsible for a quarter of all premature deaths in England.
  • Risk factors include high blood pressure, atrial fibrillation, diabetes and chronic kidney disease.
  • Half of all heart attacks and strokes are linked to high blood pressure.
  • People with diabetes have around twice the risk of heart attacks and strokes.

Addressing cardiovascular disease is therefore dependent on primary care, where most prevention, as well as the detection and management of these high risk conditions take place.

At PHE, our role is to support GPs and nurses to improve outcomes in cardiovascular disease by helping clinicians and commissioners build up a picture of need in their local areas, and find new ways to address gaps in prevention, treatment and care, without increasing primary care workload.

 A range of resources

The CVD Primary Care Intelligence Packs are the most recent resource, produced by PHE’s National Cardiovascular Intelligence Network (NCVIN). These comprise a set of slides for every CCG in England, and demonstrate the level of variation compared with demographically similar CCGs and across practices for key CVD risk factors and areas such as hypertension, diabetes and kidney care.

The slides highlight opportunities to drive up the quality of care and outcomes for people with cardiovascular disease and support two basic steps of the NHS Right Care model: Where to Look and What to Change.

NCVIN also produce CVD Profiles, which present data across the whole CVD care pathway for each CCG. The data is packaged into a summary profile across six chapters: CVD overview; CVD risk factors; diabetes, heart, stroke and renal. They support the NHS Right Care approach of Where to Look – or where to prioritise your activity.

NHS Right Care has also produced CVD focus packs, and the NCVIN CVD Profiles will be reviewed in 2016/17 with a view to aligning these two resources. We will be conducting user feedback over the next couple of months to agree next steps on this.

Primary care has a key role

We have been pleased to receive positive feedback on the CVD Primary Intelligence Care Packs from a number of clinicians and directors of public health.

The benchmarked data comes with a helpful narrative to help clinicians and commissioners understand the variation in diagnosis and treatment, and highlight key questions generated by the data. The packs are a great tool to help local areas identify opportunities for improvement in this vital aspect of primary care.

Newly-appointed National Clinical Director for Cardiovascular Disease Prevention Matt Kearney welcomed the early prevention opportunities presented by the new packs in his blog posted in April. He highlights that primary care is central to improving outcomes in CVD as the place where most prevention, diagnosis and treatment is delivered.

However, as he also points out, primary care professionals are dealing with heavy workloads and financial strains. Consistently high-quality care can only be achieved by taking a systematic approach across wider footprints to support change at local level. The new CVD Primary Intelligence Care Packs are intended to help CCGs to do just that.

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