PUTTING PREVENTION FIRST Vascular Checks Dr Bill Kirkup Associate NHS Medical Director

VASCULAR DISEASE STROKE TRANSIENT ISCHAEMIC ATTACK CHRONIC KIDNEY DISEASE HEART ATTACK ANGINA DIABETES

VASCULAR DISEASE CAUSES: Acute illness and death: 170,000 deaths yearly Acute illness and death: 170,000 deaths yearly Long-term illness and disability: 4m people Long-term illness and disability: 4m people Vascular disease is also the major contributor to health inequalities

VASCULAR DAMAGE: THE COMMON THREAD ‘Fixed factors’: ‘Fixed factors’: age age gender gender ethnicity ethnicity ‘Modifiable factors’: ‘Modifiable factors’: smoking smoking physical inactivity physical inactivity obesity obesity blood pressure blood pressure blood fats blood fats

EXCELLENT PROGRESS SO FAR National Service Frameworks National Service Frameworks Coronary Heart Disease Coronary Heart Disease Diabetes Diabetes Kidney Disease Kidney Disease Stroke Strategy Stroke Strategy All highlight need for prevention, but separate approaches Previous gains under threat: aging population rising tide of obesity sedentary lifestyles

WHY A NATIONAL PROGRAMME? The Diabetes, Heart Disease and Stroke Prevention Project: identification of people with diabetes in the general population is best achieved through targeted screening along with other vascular disease The National Screening Committee (NSC) 1 recommended: “the introduction of a vascular risk management programme in which the whole population would be offered a risk assessment that could include, among other risk factors, measurement of blood pressure, cholesterol and glucose” 1 UK NSC Policy Position Chart, November, 2007

VASCULAR CHECKS Measure risk of cardiovascular disease, diabetes and chronic kidney disease Measure risk of cardiovascular disease, diabetes and chronic kidney disease Set out how to reduce risk/maintain low risk Set out how to reduce risk/maintain low risk Offer tailored package of prevention Offer tailored package of prevention A single, universal, integrated check for all aged Evidence confirms that this is both clinically and cost effective

VASCULAR PROGRAMME Population (with no recorded disease) In General Practice Called in Outside General Practice Pharmacy/Local projects Risk Management Spectrum Coronary Heart Disease, Stroke, Chronic Kidney Disease & Diabetes Risk Assessment QuestionsMeasurementsBlood Tests Low Risk Moderate Risk High Risk Disease Identified (Advice) Appropriate feedback and maintenance plan (Advice and assistance) Appropriate personal plan, e.g. referral to: Obesity management Physical activity Smoking cessation (Advice and intervention) As Moderate Risk plus pharmacological interventions Existing clinical pathways

WHAT IS A VASCULAR CHECK? Standard questions Standard questions – age, gender, smoking – family history, ethnicity – medication Measurements Measurements – height, weight – blood pressure Simple blood test Simple blood test – Cholesterol ± glucose ± creatinine Suitable for variety of settings e.g. pharmacies and community facilities

OUTPUT: INDIVIDUAL ASSESSMENT Personal risk measurement Personal risk measurement Individual risk reduction plan Individual risk reduction plan At low risk levels: At low risk levels: – general advice on staying healthy – repeat check 5 years

AT HIGHER LEVELS OF RISK... Advice and assistance Advice and assistance Specific interventions: Specific interventions: – weight reduction class – exercise referral – smoking cessation clinic

AT HIGHEST LEVELS OF RISK... All of the above plus preventive statin medication ± blood pressure control ± intensive diabetes prevention

WE ESTIMATE THAT THIS PROGRAMME WILL: And each year will prevent at least: And each year will prevent at least:  9,500 heart attacks and strokes  2,000 deaths  4,000 people developing diabetes Prevention figures are cautious estimates based only on known effective management applied to those at high risk Offer 3m vascular checks a year Offer 3m vascular checks a year Cost about £250m before savings Cost about £250m before savings

PREVENTIVE MEASURES Physical activity Weight management Smoking cessation IGR intervention Preventive medication PREVENTION 27%8%2%7%19% PERCENT /GP/YR Maximum figures based on 106 invitations annually per GP

POTENTIAL GAINS 1) Sustain gains in life expectancy otherwise at risk 2) Prevent significant illness and premature death 3) Avoid additional NHS acute service use and cost 4) Real opportunity to address inequalities at source

PROGRESS SO FAR Stakeholder engagement  2 stakeholder events held during the summer Reduce your Risk  announced as part of Next Steps Review  campaign to raise public awareness of the risk of vascular disease and to publicise the vascular checks programme  October meeting with third sector organisations to discuss their contribution Technical consultation  assimilating the results which will help to develop and refine our modelling Impact assessment  published in Autumn 2008 Document to prepare PCTs for implementation  will include a Primary Care Service Framework  ready in Autumn 2008 Begin implementation next year

TODAY’S PROGRAMME To share our plans to date and to hear from you about how best to implement and deliver the vascular checks programme To share our plans to date and to hear from you about how best to implement and deliver the vascular checks programme  NHS Primary Care Contracting presenting on Primary Care Service Frameworks  Facilitated discussion to embed understanding and help us think about what it should contain To learn from those of you who are already doing it To learn from those of you who are already doing it  Presentations from a pharmacy and commissioner perspective in delivering vascular checks type programmes To bring the two together in developing support for the next steps To bring the two together in developing support for the next steps  Facilitated discussion to identify what support is needed for successful implementation and delivery