Optional photo caption Why Innovate? Improving CVD services in tough times. Issues and Answers Conference 10 th November 2017 #IandA2017 Joanne Oliver: oliverjo@bhf.org.uk Morven Dunn: dunnm@bhf.org.uk
Overview BHF Strategy for Research and Innovation Health Services Engagement team Support for Health care Professionals Examples of Innovation in Practice
Our Research Strategy Understand the social, genetic, cellular and molecular causes of cardiovascular disease. Discover better ways of preventing, diagnosing and treating cardiovascular disease. Enhance translation of these research discoveries into better patient care.
In addition to research BHF has piloted and evaluated models of care that can: Avoid unnecessary hospital admissions Improve patient outcomes Save the NHS millions of pounds a year. It s time to think differently about CVD services We also support their implementation.
Innovate to improve services Influencing and enhancing health system leaders across a diverse health & political landscape Keeping CVD as a priority and in the spotlight Health Services Engagement Team
So who are the Health Services Engagement Team?
Head of Health Services Engagement Sally Hughes UK WIDE Programme Manager HSE Professional Lead - North HSE Professional Lead - South Clinical Lead - Implementation Projects Iain Armstrong Home based Lynda Friel Edinburgh Lynne Ruddick GLH Joanne Whitmore Home based HSE Lead Scotland HSE Lead North West (DevoManc/ C&M) HSE Lead North East / Yorkshire & Humber HSE Lead Northern Ireland HSE Lead Wales HSE Lead Midlands HSE Lead London HSE Lead South West HSE Lead South East Richard Forsyth Edinburgh Jennie Barr Manchester Heather McLean Leeds Karen McCammon Belfast Joanne Oliver Cardiff Paul Stern Birmingham Allyson Arnold GLH Heather Beer GLH Helen O Kelly GLH Clinical Development Co-ordinator x 2wte Clinical Development Co-ordinator x 2wte Clinical Development Co-ordinator x 2wte Clinical Development Co-ordinator x 1wte Clinical Development Co-ordinator x 2wte Clinical Development Co-ordinator x 2wte Clinical Development Co-ordinator x 1wte Clinical Development Co-ordinator x 1wte Clinical Development Co-ordinator x 1wte Morven Dunn & Jemima Traill Home Based Debra Russell & Jane Briers Home Based Cathy Maxwell Jo Adams Home Based Craig Moore Home Based Trish Buck & Rhiannon Edwards Home Based Pip Richards (EM) Victoria Meynell (WM) Home Based Kelly Read Home Based Regina Giblin Home Based Sian Martin Home Based
Experience from many different areas Cardiac Care Public Health Charitable sector
And what are we up to? Supporting system leaders Informing utilising BHF Best Practice Evidence Making the case for and activating change
Arrhythmia Care Coordinators 19 pilot sites across England & Wales Single point of contact for coordinating patient care Increased identification of AF through local audit and the use of validated tools Provision of rapid access multidisciplinary clinics Enhanced clinical effectiveness, reduced admissions, patient and carer experience Cost effectiveness demonstrated Within 1 year: 23.5 ACC roles made a net saving of 689,888 across 19 NHS sites.
26 pilot sites across Wales, Scotland and England Heart Failure Specialist Nurses developing and delivering integrated heart failure pathways of care: - Hospital in-reach - Anticipatory care planning - One stop HF clinics - IV diuretics in the community Enhanced outcomes for patients Integrated Heart Failure A 35% reduction in hospital admissions Services Estimated 169,000 saved per 1000 patients across the 26 sites
Cascade Testing for Familial Hypercholesterolaemia FH Specialist FH nurses are coordinating new service models across primary and secondary care This involves cascade testing to identify and treat first-degree relatives of people with FH in England and Scotland following a successful scheme in Wales 1,373 new FH cases detected across 12 sites in England & Scotland The UK could save 380 million from avoided CHD events by diagnosing and treating all relatives of FH index cases
Optional photo caption BHF Alliance Engaging with clinicians Creating Champions Leading Change https://www.bhf.org.uk/alliance
The AF challenge
BHF Funded Integrated Care Awards NHS Lanarkshire NHS Tayside NHS Fife East Cheshire NHS Trust Oxleas NHS Trust NHS Bristol North Somerset CCG ABM University health Board Betsi Cadwaladr UHB NHS Lanarkshire Betsi Cadwaladr UHB ABM University Health Board North Somerset CCG NHS Tayside NHS Fife East Cheshire NHS Trust NHS Bristol Oxleas NHS Trust
NHS Lanarkshire Practice List size: 588,572 GP Practices: 114 Acute Hospitals: 3 CHD prevalence: 4.6% AF register: 1.4%
NHS Lanarkshire AF integrated care project Primary Care Audit and Education Person centred improved AF care Secondary care Nurse led AF Clinic
Primary Care Component Audit GRASP AF audit at baseline, 6months and 12months Education In-practice education sessions run by AF nurse practitioners
Patient identified lists CHA 2 DS 2 VASc score 1. > 1 : currently not on anticoagulant 2. =1 :male only: not on anticoagulant 3. 0 : on either antiplatelet or anticoagulant 4. All those on both antiplatelet AND anticoagulant 5. AF resolved status
Impact 13 strokes saved in one year
Project Legacies : primary care Hearte AF module; based on the project education www.heartelearning.org Primary care guideline Patient self-management tool Primary Care staff survey demonstrated : Increased understanding and awareness of AF in primary care- especially around stroke risk and case finding
Greater Glasgow and Clyde Practice List Size: 1.2million GP practices: 234 Acute Hospitals : CHD prevalence: 4.23% AF register :1.5%
Greater Glasgow and Clyde Make the case for change: Working with the MCN for CHD to influence the implementation of a PC audit for patients with AF. Use best practice portfolio: Sharing of Lanarkshire work and learnings Act as a catalyst for change: with MCN to develop a new protocols for primary care : updated AC availability Educate and empower: Offered BHF CDC time to provide clinical educational support for all primary care staff around AF
Primary care : audit and education GRASP AF audit offered with no cost to all GP practices Education sessions from BHF CDC on AF at practice, cluster, and MCN level, promoted and supported by the MCN and PN support team Community Pharmacy support technicians- trained BY CDC to carry out targeted lists from GRASP AF in individual GP practices
The Glasgow results Out of 174 practices with GRASP AF installed, 101 had targeted lists provided 59 attended BHF provided AF education events. Within GG&C AC prescribing increased from 57.3% to 72.3% Conservative estimate of 40 strokes saved
HSE-team future influencing work Cross party AF inquiry in Scotland Influencing at National level: national advisory committee reviewing AF care focusing on: screening ( silent AF and secondary screening) and anticoagulation- equitable access Planned national AF community of practice: 1. Focused review at time of diagnosis 2. Targeted screening 3. Data collection 4. Patient education
Optional photo caption Thank you Joanne Oliver: oliverjo@bhf.org.uk Morven Dunn: dunnm@bhf.org.uk