Update

Five-minute briefing: How the NHS Long Term Plan will affect cardiovascular care

We explore the NHS’ ambitions for cardiovascular care, stroke and diabetes as part of its Long Term Plan – and the impact this will have on your patients


4 Feb 2019, by Siobhan Chan

Hospital corridor

Cardiovascular disease (CVD) is one of the clinical priorities that NHS England has focused on in its Long Term Plan – and the goals are ambitious.

The plan includes an aspiration to “prevent 150,000 heart attacks, strokes and dementia cases” and NHS England wants to see “more than three million people … benefit from new and improved stroke, respiratory and cardiac services over the next decade”.1

The plan, published in January, will shape the direction of the health service for the next ten years.

We’ve rounded up the key points on heart disease, stroke and diabetes from the NHS Long Term Plan that will affect your work with patients.

Early detection of risk factors

The NHS Long Term Plan says that working with partners such as the voluntary sector, community pharmacy and GP practices, the public will have more opportunities to access tests for high blood pressure and other high-risk conditions.

Read about the BHF’s work on detecting high blood pressure in under-reached populations and our involvement in the cross-party group inquiry into high blood pressure in Scotland.

GP practices have been asked to work as part of primary care networks (PCNs) with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas. These PCNs will work towards better detection of high blood pressure, atrial fibrillation and high cholesterol.

Blood pressure indicators in the Quality and Outcomes Framework, the NHS’ reward and incentive programme for GPs in England, will be tightened from 150/90 mmHg to 140/90, in line with NICE guidance.2

A national CVD prevention audit (CVD Prevent) for primary care, which is being produced in collaboration with the BHF, Public Health England and other partners, will also support continuous clinical improvement, according to NHS England.

Data from CVD Prevent will be published at GP practice and PCN level, giving a sharper picture of the performance in an area.

Detecting heart failure

Around 80% of heart failure cases in England are currently diagnosed in hospital, despite 40% of patients having symptoms that should have triggered an earlier assessment in primary care.3

NHS England wants to see earlier detection of heart failure and heart valve disease, through greater access to echocardiography in primary care.

It also aims to provide more specialised care for people with heart failure by providing faster access to heart failure nurses, and personalised planning for patients in hospital.

Read the 2016 All-Party Parliamentary Group report on heart failure, which was supported by the BHF, to see the recommendations we believe could transform care.

Order our new-look Innovative Services booklet, which showcases the impact that heart failure specialist nurses have on patient care.

Cardiac rehabilitation

The plan says that ‘scaling up and improving marketing of cardiac rehabilitation to be amongst the best in Europe could prevent up to 23,000 premature deaths and 50,000 acute admissions over 10 years’.

Just over half of eligible people currently take up cardiac rehabilitation, according to the National Audit of Cardiac Rehabilitation.4

One of the plan’s ambitions is for 85% of eligible people to access cardiac rehabilitation by 2028, which would be one of the highest uptake rates in Europe.

Genetic testing for inherited high cholesterol

The plan commits to improving access to genetic testing for familial hypercholesterolaemia (FH), to reach a target diagnosis rate of 25% of all estimated cases in the next five years through the NHS genomics programme. NHS England estimates that the diagnosis rate is currently 7%.

The BHF has invested over £1.5m into setting up FH cascade testing services in recent years, building the evidence of what works, identifying the system barriers and levers to adoption, using these to influence policy decisions that have influenced and driven this significant system change. To learn more about our work, see our resources on planning and delivering FH services.

Responding to out-of-hospital cardiac arrest

NHS England will work with partners, including the BHF, to improve survival from out-of-hospital cardiac arrest.

A national network of community first responders and defibrillators could help save up to 4,000 lives each year by 2028, the plan states. CPR is now a part of the school curriculum in England, thanks to BHF’s campaign work.

Innovations such as the BHF’s national defibrillator network and data-mapping of emergency events should mean better tracking of survival rates and the ability to target unwarranted variation.

Self-management of diabetes

People who are newly diagnosed will have access to structured education and digital self-management support tools, including expanding access to HeLP Diabetes, an online self-management tool for those with Type 2 diabetes.

More people will be supported to achieve the recommended diabetes treatment targets and drive down variation between clinical commissioning groups and GP practices to minimise their risk of future complications.

Timely treatment for stroke

NHS England will work with the Royal Colleges to pilot a new programme for hospital consultants to be trained to offer mechanical thrombectomy following a stroke.

The aim is to have a ten-fold increase in the proportion of patients who receive a thrombectomy after a stroke by 2022, so that each year, 1,600 more people will be independent after their stroke.

This is one of the key points the BHF called for in its five-point action plan on CVD, Turning Back the Tide, because only around 5% of people who could benefit from this treatment currently receive it.5

Taking inspiration from other nations

The plan recognises that other countries have made significant progress in making people aware of atrial fibrillation, blood pressure and cholesterol, and that England must replicate these advances using digital technology, as well as working with the voluntary sector, employers, and the public sector.

For example more than 6 million people are living with undiagnosed or uncontrolled high blood pressure in the UK.6 By matching Canada’s levels of early detection and treatment for high blood pressure, an estimated 115,000 heart attacks, strokes and other cardiovascular events in England could be prevented over the next decade.7

To learn about the approaches that other nations have taken, read our report on international case studies, produced with Public Health England.

References

  1. NHS England (2018) NHS Long Term Plan to tackle major killer conditions and save up to half a million lives
  2. NHS England (2018) A five-year framework for GP contract reform to implement The NHS Long Term Plan
  3. Bottle, A et al (2018) Routes to diagnosis of heart failure: observational study using linked data in England. Heart. 104 (7), 600-605. https://doi.org/10.1136/heartjnl-2017-312183
  4. National Audit of Cardiac Rehabilitation Quality and Outcomes Report (2018)  
  5. McMeekan, P et al (2017) Estimating the number of UK stroke patients eligible for endovascular thrombectomy, European Stroke Journal 2017, Vol 2(4) 319-326 https://doi.org/10.1177/2396987317733343
  6. BHF Statistics Factsheet UK (2019) February update will be published soon at bhf.org.uk/statistics
  7. Imperial College Health Partners analysis for the BHF using Sheffield/Public Health England CVD Return on Investment (ROI) tool