Value Based Healthcare King’s Health Partners Our Healthier South East London Pharmacy Systems Leadership | London Regional Event Professor John Moxham | 12 March 2019

Value Based Healthcare is one of the priority themes of King’s Health Partners A value-driven NHS can only be achieved through sharing and use of outcomes that matter to patients, carers and families and clinically-meaningful cost information.

The Vital 5 – addressing the front-end of the complete pathway of care Overall Aim: Improve the population’s health and reduce health inequalities by focusing on the Vital 5 to support prevention, detection, health promotion, management and treatment wherever there is an opportunity to do so. Vital 5 Aim Measured through Blood pressure to reduce stroke and heart attack, and improve well being BP recording Obesity to reduce diabetes, renal dialysis, liver transplants, amputations and other comorbidities, and improve well being BMI from height/weight recording Mental health score to reduce the burden of mental illness, improve physical health, recovery and well being GAD or PHQ-9 score Alcohol intake to reduce liver transplants and malignant disease, to improve well being volume and frequency questionnaire Smoking habits to reduce respiratory and malignant disease, and improve well being Prevention and reducing health inequalities are priorities identified in the NHS Long Term Plan.

Tobacco, dietary risks and high blood pressure are the three leading risk factors contributing to London’s burden of disease The Global Burden of Disease study quantifies and ranks the contribution of various risk factors by cause of death. Greater London, both sexes, all ages, 2017 Source: Institute for Health Metrics and Evaluation, Global Burden of Disease data visualisation, https://vizhub.healthdata.org/gbd-compare/

The treatment of high blood pressure Research undertaken using Lambeth DataNet shows (approximately): Population with hypertension 20% (60k) Patients known to General Practice 50% (30k) Patients whose hypertension is controlled 50% (15k) Conclusion: 75% (45k) patients not identified + treated + controlled. We have done our ‘best’ over many years but the evidence shows we have to do a lot better. Note: Drugs to treat hypertension are available, effective, safe and cheap! (Detailed study by Dr Alice Wu et al is currently under review)

The treatment of high blood pressure What can be done? For those currently diagnosed adopt a locality-based case management approach in General Practice. Learn from and adapt the highly successful treatment of TB – treatment failure is rare. Average of 800 patients per practice. If all patients are seen twice a year – one WTE case worker.

The treatment of high blood pressure For those currently not diagnosed: The universal implementation of the Vital 5 Dashboard will identify more and more people with hypertension . New hypertensive patients would be seen once by the General Practitioner and then referred to the case worker for follow up and support. Eventually, when all patients with hypertension are identified each GP practice would need 2 case workers. The case worker approach, supporting patients by meetings, phone calls, texts, emails, home BP measurements, the Vital 5 Dashboard, could transform the treatment of hypertension. Note: TB nurses reach everyone. If we did the same for hypertension we would have a big impact on health inequalities.

The treatment of high blood pressure The role of pharmacy and pharmacists: Be involved in the Vital 5 ‘movement’. Support patients to achieve better adherence. Work closely with local care networks and neighbourhoods. Add your enthusiasm, skills and leadership to achieve much better control of hypertension in our communities. Find out more: https://www.kingshealthpartners.org/our-work/value-based-care