Launch of the NHS RightCare CVD Prevention Pathway, Dr Matt Kearney

Dr Matt Kearney, GP and National Clinical Director for Cardiovascular Disease Prevention, NHS England and Public Health England

A core purpose of the NHS Health Check is to prevent cardiovascular disease (CVD), the underlying cause of strokes, heart attacks and some forms of dementia. It aims to achieve this in two ways: firstly, by spotlighting behavioural risk factors, and supporting people in individual behaviour change; and secondly through the detection of high risk undiagnosed conditions such as hypertension, atrial fibrillation, high cholesterol and raised blood sugar. Once detected, the next step is to confirm the diagnosis of these clinical conditions and to provide appropriate preventive treatment in primary care.

This week sees the launch of the NHS RightCare CVD Prevention Pathway, a major new tool that will help CCGs to optimise the detection and management of these conditions. NHS England has invested significant funding to enable every health economy in England to embed the NHS RightCare approach at the heart of their transformation programmes through a two-stage national rollout. This is expected to reach all local health economies by the end of 2016 and will be implemented across the country by a team of RightCare Delivery Partners. NHS RightCare's core objective is to reduce unwarranted variation in order to improve people’s health and outcomes. It aims to achieve this by ensuring that the right person has the right care, in the right place, at the right time, making the best use of available resources. A key element of the approach is development of Optimal Value Pathways, and CVD is the first new pathway to be launched.

The NHS RightCare CVD Prevention Pathway includes six high risk CVD conditions where early detection and optimal management can significantly improve outcomes and which are managed almost entirely in primary care. The pathway is accompanied by metrics that show local performance in diagnosis and treatment, with benchmarking of each CCG against demographically similar CCGs, and benchmarking of the local practices. This allows clinicians and commissioners to identify unwarranted variation and to spotlight opportunity for improvement.

The RightCare package also includes high impact interventions that can be expected to improve detection and management of the high risk conditions, with links to case studies, exemplars and other resources:

1. Ensure systematic collection and analysis of real time audit data from practices using tools such as GRASP, national audits and other local data solutions.
2. Build local primary care leadership to challenge unwarranted variation and drive quality improvement in high risk conditions
3. Maximise NHS Health Check uptake and follow up as a systematic approach to detecting undiagnosed high risk CVD conditions.
4. Commission new models of diagnosis and management of the high risk CVD conditions that support local practices and do not add to their workload: for example, using community pharmacists and other staff and settings, self-monitoring solutions, telehealth and new technologies.

The RightCare CVD Prevention Pathway can be expected to bring significant new support to local NHS Health Check programmes by facilitating a systematic approach to early detection and management of the high risk conditions that contribute so substantially to cardiovascular outcomes.