Using NICE resources to tackle
High Blood Pressure across
Cheshire and Merseyside
Dr Mel Roche, Public Health Consultant, Champs Support Team
Acknowledgements:
Dr Ifeoma Onyia, Public Health Consultant, Halton Council
David Nolan, Senior Analyst, Public Health England NW
Matt Gilmore, Business Intelligence Lead, Wirral CCG,
Jane Harvey, Public Health Consultant, Wirral Council
Dr Bruce Taylor, GP CVD Lead C&M, GP partner in Beacon Practice pilot site
Jenni Barr, British Heart Foundation
Annie Coppel, NICE
20th June
2017
Outline
1. Background: Tackling high BP in Cheshire and
Merseyside
Cross-sector system approach
2. C&M STP (Five Year Forward View)
3. Using NICE resources to turn plans into action
Sub-regional and practice-levels
1. Tackling High Blood Pressure across
C&M
High Blood Pressure prioritised in C&M
(2014)
The CM BP Partnership Board (2015)
C&M BP Strategy: ‘Saving lives:
Reducing the pressure’ (2016)
C&M are… ‘setting the pace’ ...for the rest of the UK. (Professor Jamie Waterall, Chair, National
Blood Pressure System Leadership Board)
The strategy… ‘provides a state of the art, comprehensive approach…. and will serve as a
model for other programmes around the world’ (Prof Norm Campbell, Canada)
Strategic Objectives
2. C&M STP (Five Year Forward View)
Demand management and prevention at scale
The case to include High BP… Close the 3 ‘Gaps’
Health and Wellbeing Gap: Reduce medical complications
e.g. stroke , heart attack, dementia. Improve lifestyle … also reduces other health risks
Care and Quality Gap: Scope to improve (and reduce unwarranted
variation) in care.
In C&M if all GP practices performed as well as the 75th best percentile, over 5 yrs could
prevent 183 strokes, 118 heart attacks, 256 heart failure cases, 96 deaths
Finance and Efficiency Gap: Reduce demand on health and social care
~£500k investment per annum across C&M… net financial benefit of £7m- £8.2m in
5yrs
NHS actions to tackle high BP
1) Empowering patients and communities to live better
NHS as a setting for prevention (link to CQUINs) , Making Every Contact
Count , Awareness-raising campaigns e.g. BP UK's 'Know Your Numbers'
2) Strengthening the role of community pharmacies
BP testing, 24 hour BP monitoring (equipment availability), Medicines
optimisation services, prevention culture
3) Supporting quality in primary care
Support with data and benchmarking, education and training programme,
primary care-led
3. Using NICE Resources to turn plans into
action
• Defining best practice
• Sub-regional level: Monitoring progress against the
strategy
• Practice-level: Supporting quality in primary care
• Wirral Beacon Practice pilots and the practice-level
dashboard
• The C&M BP education and training package
Sub-regional level: Monitoring / evaluating the
strategy
 Cross-system working group established (Jan 2016) to monitor and
evaluate implementation of BP strategy
 PHE North West Centre Chair, analytical support from PHE Local
Knowledge and Intelligence
 Representatives from LA public health teams (analysts and PH
consultants) and CHAMPS. Input from other partners
 Logic-model style indicator dashboard
Strategic Objectives
BP Strategy Dashboard
NICE QS in the BP Strategy Dashboard
Measurable progress against NICE hypertension Quality Standards in
primary care = key medium term ‘healthcare’ outcome
All Hypertensives:
• NM53 (% <80s last recorded BP <140/90) 50-61%
• NM54 (%80+ last recorded BP <150/90) 64-78%
• NM91 (% last recorded BP <150/90) 68-82%
• NM112 (% lifestyle advice) 14-46%
Newly diagnosed hypertensives:
• NM66 (ABPM or HBPM before on QOF register) 0-4%
• NM75 (urinary albumin:creatinine ratio) 6-13%
• NM76 (test for haematuria) 3-16%
• NM77 (12 lead ECG) 6-17%
Practice-level: Using NICE Guidelines and QS to
support quality improvement in Primary Care
2 examples:
• Primary care led: Beacon Practice pilots (practice-level
dashboard)
• Primary care support and education package
Wirral Beacon Practice scheme
what is it?
5 practices trying out a range of measures to
improve their detection & management of
high blood pressure
Supported by local project team & small
budget
Early days
Action plans have included …
Regular practice meetings with focus on
hypertension
In-house educational sessions for practice
teams
Data reviews & development of templates
Practice champions & coordinators
Audits against NICE guidance
Awareness –raising events for patients
Encouragement of self/home-monitoring
Development of ‘Healthy Hub’
The prototype practice-level dashboard
Practice-level dashboard
Fed via data collections from EMIS Clinical Systems
Data extraction utilizes EMIS identification number- allows case
finding element (no strong patient confidential identifiers
extracted)
Preliminary report suite set up for practices enabling data to be
extracted from EMIS Web and flowed into SQL Data Warehouse
using Business Intelligence Developer tools (SSIS, SSRS).
SSRS report is then deployed on to the Wirral CCG Business
Intelligence Portal (for practices that have signed a Data Sharing
Agreement)
Practice-level dashboard: what next?
Locally pilot and refine
Wider roll out (sub-regionally, nationally)
Challenges to overcome:
• Data flow/storage between organisations and reporting platforms
(?Wirral Portal, NHS Digital, DSCRO data management centre)
• Compatibility with non-EMIS systems
• Funding: recent joint application to Health Foundation: Wirral CCG,
NICE, PHE, Champs, Beacon Practices, BHF (await news)
C&M BP Primary care Support and
Education
Aim: Improve BP care and reduce unwarranted
variation
HEE funding
Evidence from Canada and local insight work
What we did
 Collaboration: BHF; CCG and Champs
 Developed a protocol and template based on NICE QS
 Focussed support and education to complement and support their
use
 Piloted with a number of practices
 Links to other approaches such as the Beacon Dashboard and will
enable accurate QS audit
 Exploring CCG Quality premiums to incentivise
Summary
C&M implementing a cross-sector approach to tackle high BP
STP (FYFV) an important lever for change in the NHS
Using NICE resources (Guidelines, Quality Standards) to:
• Monitor progress at the sub-regional level (strategy dashboard)
• Support quality improvement in Primary care at practice-level
• Practice-level dashboard
• Protocols, templates and training support
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