Project Name: ASCVD and Lipid GP-led Primary Care Model of Care – Collaborative Working Project with Urban Health PCN

Project Summary:

The main objective of the Project is to improve the quality of care for patients and support the early identification, review, and medical optimization of patients with Atherosclerotic Cardiovascular Disease (ASCVD) in response to the needs of the PCN.

The service will be GP - led and focus on timely identification of patients with ASCVD including full management reviews and treatment option discussions aiming to achieve: 

  1. Identification of sub-optimally treated patients who are not achieving recommended targets for lipid management
  2. Identification of patients who have previously not tolerated or refused alternative lipid modification therapies
  3. Review treatment options in a consultative way with patients
  4. Counsel and optimize patients where appropriate
  5. On-going ASCVD patients support and annual review to ensure CVD outcomes improve equitably

Planned Milestones:

  1. Collection of baseline data, in line with the measure of success
  2. Collection of 3 months clinical activity data
  3. Collection of 6 months clinical activity data
  4. Collection of 9 months clinical activity data
  5. Analysis of project data, and submission of Final Project Report

Expected Benefits:

Anticipated benefits for patients:

  • Improved access to lipid management care leading to optimal diagnosis and management of ASCVD treatments. 
  • Enhanced experience and counselling around ASCVD with ongoing management of the condition. 
  • Improved access to all NICE approved medicines for ASCVD
  • Easier access to lipid management care closer to home in the PCN setting
  • The additional capacity will provide additional time and support from PCN HCP with their lipid management, focusing on patients who may have previously not attended GP appointment or been lost to follow-up. Thus, levelling health inequalities within the PCN

Anticipated benefits for partner organisation:

  • Increased proportion of ASCVD patients reviewed by primary care 
  • Increased proportion of ASCVD patients receiving expert and timely review closer to home
  • Reduction in ASCVD referral rates to secondary care
  • Increased proportion of patients receiving guideline-directed pharmacotherapy
  • Insight into benefits of primary care pharmacist led lipid management clinics in primary care and demonstration of benefit via development of business case for substantive funding
  • Support aligned to NHS Long Term Plan, CVDPREVENT, and Network Contract DES

Anticipated Benefits for Novartis:

  • Insight on the appropriate use of ASCVD licensed medicines in line with NICE guidelines, including Novartis’s medicine
  • Enhanced reputation
  • Supports Novartis’ vision that no patient should have to wait for an extraordinary life by supporting high quality Collaborative Working with the NHS which addresses the problem of health inequalities

Start Date & Duration: October 2022 – 12 months