Project Name: Collaborative Working Stockton PCN Lipid Optimisation Project

Project Summary:

The main objective of the CWP 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) who are at high risk of cardiovascular events and who are not achieving lipid levels as specified in national and/or local guidance, in response to the needs of the CW Partner. Woodbridge Practice, Stockton-on-Tees, is the Lead Practice for the PCN. 

Planned Milestones:

  • Collection of baseline data, in line with the above Project Outcome Measures & Data Collection table.
  • Confirmation of clinical and operational pathway, policy and protocol creation, and readiness to begin the clinical activity.
  • Confirmation that all Practices within the CW Partner PCN are briefed on project process and protocols.
  • Collection & submission of 3 months clinical activity data.Project Review meeting to discuss project progress.
  • Collection & submission of 6 months clinical activity data.Project Review meeting to discuss project progress.
  • Collection & submission of 9 months clinical activity data.Project Review meeting to discuss project progress.
  • Collection & submission of 12 months clinical activity data. Project Review meeting to discuss project progress.
  • Development of business case to continue the service offered by this project.  
  • Analysis of CWP data, submission of Final Project Report, Submission of Outcomes Summary.

Expected Benefits:

Anticipated benefits for patients:

  • Improved access to lipid management care leading to optimal diagnosis and management of ASCVD treatments.   
  • Enhanced experience around ASCVD with ongoing management of the condition.   
  • Improved 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. 
  • 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, leveling health inequalities within the PCN. 

Anticipated benefits for the 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.
  • 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, 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 and Duration: November 2023; 14 months with 12 months of clinical activity

UK2310307675