Project Name: Tower Family Healthcare Heart failure with reduced ejection fraction (HFrEF) audit, therapy review, medicines optimisation and functional capacity assessment

Project Summary:

The CWP will fund a  Clinical Pharmacist to review and audit the CW Partner’s databases, to identify sub optimally treated Patients that require a review, medicines optimisation and where required a clinic review. For complex cases, there are existing multidisciplinary team (MDT) meetings with a Consultant Cardiologist, Clinical Pharmacist, and CVD Nurse, to decide on best practice for the patient.  The CWP, led by Clinical Pharmacist (Band 9) will upskill the team of clinical pharmacists to ensure continuity of service when the CWP ends.  Resulting in upskilling of cardiovascular disease (CVD) identification and management in the primary care network (PCN).   

Planned Milestones:

  • Project kick-off meeting
  • Data cleanse patient medical notes from four surgeries
  • Confirm ready to start medicines optimisation clinic/reviews
  • Reviews at month(s) 3, 6, 9 and 12
  • Project write up, outcomes report
  • Project wrap-up meeting

Expected Benefits:

Patients

  • Improved access to diagnosis and treatment
  • Medicine optimisation leading to better outcomes
  • More equitable and consistent care and access to care
  • Enhanced experience for patients and their carers who live with CVD
  • Longer term raised awareness will lead to quicker diagnosis and additional avoided admissions
  • These are vulnerable patients with high mortality and morbidity rates
  • Patients could have more optimised care closer to home and access to specialist in the community

CW Partner

  • Integrated approach to CVD care delivery
  • CW Partner is upskilled to allow for the appropriate assessment and management of CVD patients
  • Increase levels of accurate diagnosis of HF by achieving 0.96% LVSD Prevalence (66% NICOR projection of HF register)
  • Increase the overall quality of care and improve equity of access to primary and specialist care for patients with CVD
  • Improve patient flow and reduce total number of inpatient bed days due to HFImproved 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

Novartis

  • Better understanding of overall customers’ and patients’ needs
  • Improved access to and use of NICE approved medications (including Novartis medicines) in appropriate patients
  • Ethical, professional, and transparent relationship between Novartis and the NHS

Start Date & Duration: September 2023 for 14 months

UK2307208970

Project Name: Tower Family Healthcare Heart failure with reduced ejection fraction (HFrEF) audit, therapy review, medicines optimisation and functional capacity assessment (the “CWP”).

Partner Organisation(s): Tower Family Healthcare, Tottington, 16 Market Street, Tottington, Bury, Lancashire BL8 4AD (the “CW Partner”)

Completion Date: June 2025

Outcome Summary: 

The project identified 1,610 patients through the data cleanse of the patient medical notes and subsequent coding, reviewed 1,486 patients, and performed medicines optimization for 1,345  patients diagnosed with heart failure.

Key Project Outcomes Data:

The CWP has achieved the following measures of success.

  • Reviewed 1,486 patients diagnosed with heart failure.
  • Performed a data cleanse of patient medical notes from four surgeries which realised the following changes in Quality and Outcomes Framework (QOF)
  1. Increase HF prevalence and LVSD QoF register 2%.
  2. Increase no. of six-monthly HF reviews in primary care, 1,486, of which.
    1. HF003 In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an Angiotensin-Converting Enzyme inhibitor (ACE-I) or Angiotensin Receptor Blocker (ARB), 438 patients.
    2. HF006 The percentage of patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, who are currently treated with a beta-blocker licensed for heart failure, 453 patients.
    3. HF007 The percentage of patients with a diagnosis of heart failure on the register, who have had a review in the preceding 12 months, including an assessment of functional capacity and a review of medication to ensure medicines optimisation at maximal tolerated doses, 595 patients.
  3. Increase in the number of patients receiving HF care plan and access to self-care resources 1,610.

Outcomes:

  • All measures of success were achieved as per the project initiation document (PID).
  • The CW Partner submitted a business proposal for future funding of the collaborative working role post project which was not accepted.
  • The lead pharmacist was introduced to the secondary care heart failure team to enable multi disciplinary team (MDT) review of heart failure patients with more complex diseases.

Conclusion: 

The lead pharmacist has acquired an identification tool which is used to search for new heart failure patients, post project.

FA-11523656 | September 2025