Project Name: Gateshead Secondary Prevention ASCVD MDT Clinic

Project Summary:

The CWP is structured such that a Band 8A Clinical Pharmacist and Health Care Assistant (HCA) are supported by a multi-disciplinary health professional team, will provide tailored care for patients aiming towards early identification, review, and medical  optimisation of patients with atherosclerotic cardiovascular disease (ASCVD), previous cerebrovascular accident (CVA or TIA) and/or peripheral vascular disease (PVD) for 12 months clinical activity out of an 18 months project.

All patients referred into the service will be discussed at a consultant-led MDT, with appropriate patients receiving specialist clinic review thereafter. Currently there is a 12-week waiting list time with and additional 4-6 week wait for implementation of lipid optimisation.

There is also the opportunity for the Band 8A clinical pharmacist to liaise with the PCN pharmacists in the area to create a “lipid-optimisation network” aiming to offer advice and support for lipid-related queries, supported by the MDT.

Aims are:

  1. Identification of patients with ASCVD/PVD/CVA who are not achieving secondary prevention lipid targets as specified in national guidelines
  2. Identification of ASCVD/PVD/CVA patients who have previously not tolerated lipid modification therapies and therefore have not reached secondary prevention lipid targets
  3. Review and medicines optimisation for ASCVD/PVD/CVA patients who have associated cardiovascular risk factors including diabetes and hypertension
  4. Review of treatment options and decisions on next steps in collaboration with patients
  5. Medicines optimisation post-MI including titration of secondary prevention medication (e.g., beta-blockers, ACE-inhibitors), including heart failure medication where applicable
  6. Counsel and support patients with regards to starting and continuing secondary prevention medication
  7. Onward referral of patients to specialist lipid clinic who meet criteria for assessment of familial hypercholesterolaemia or other inherited lipid disorders; or to diabetes clinic for specialist input where needed

Planned Milestones:

  • Kick off meeting and Collection of baseline data
  • Confirmation of clinical and operational pathway, policy and protocol creation, and readiness to begin the clinical activity
  • Confirmation of recruitment of Band 8A clinical pharmacist
  • The clinical staff are trained and ready to begin clinical activity.   
  • Collection & submission of 3 months clinical activity data.
  • Collection & submission of 6 months clinical activity data.
  • Collection & submission of 9 months clinical activity data.
  • Collection & submission of 12 months clinical activity data.
  • Development of business case and submission to the Trust board
  • Analysis of CWP data, submission of Final Project Report, Submission of Outcomes Summary 

Expected Benefits:


  • Improved access to specialist lipid management, diabetes and cardiology care leading to optimal secondary prevention of future ASCVD/CVA/PVD
  • Improved access to appropriate NICE-approved medication for suitable patients to preserve health and prevent long-term events  
  • Access to specialist secondary prevention services based in local hospital


  • Increased proportion of ASCVD/CVA/PVD patients being referred to and receiving care in dedicated specialist secondary prevention MDT and clinic.
  • Increased proportion of patients receiving guideline-directed pharmacotherapy  
  • Provide patient tailored support and education to promote adherence with treatment and optimisation of non-HDL levels and other risk factors for ASCVD/CVA/PVD (diabetes, hypertension etc)
  • Align and collaborate with regional services i.e., Newcastle ASCVD Service to optimise patient management
  • Reduce health inequalities within Gateshead as patients will have a local specialist secondary prevention service to access and will not need to travel out of area for this


  • 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: June 2023 for 18 months