2. Coronary Heart Disease Prevention Hutton Rudby Surgery July 2000 www.bradfordvts.co.uk

3. Aims of This Presentation An overview of where we are now What we have achieved so far Introduction to the NSF How the NSF will affect us What do we have to do new or better

4. Where We Are Now We started to systematically care for patients with CHD in Feb 1997 Created a register of patients with CHD Baseline audit in Feb 1997 Follow-up audits in Sept 1998 and June 2000

5. Who Does What? Wendy Moore. Does initial checks as per ISIS. Explains to patient the importance of seeing the doctor afterwards. Updates records via the ISIS.

6. Who Does What? Barbara Hodgson. Arrange monthly invites to patients. Log invitations on computer.

7. Who Does What? Doctors – various! Complete the checks started by Wendy. Update computer records. Opportunistically maintain register Audit.

8. Register Restricted to patients with a past history of MI and or angina. The reminder “CHD monitoring” is used to identify the patients. Opportunistically updated.

9. Register Monthly batches are invited by letter for a appointment with Wendy and asked to return to see a GP for completion of the check-up. Aims for annual check on all on the register. About seven patients per month.

10. Audits 1997 74 patients on register 50% identifiably taking aspirin 55% had had cholesterol checked – ever Average cholesterol = 6.4mmol 2000 85 patients on register 86% identifiably taking aspirin 97% had had cholesterol checked – ever Average cholesterol = 5.2mmol

11. Audits 1997 Cholesterol - Only 33% checked in last year Average BP 153/86 - 83% checked in last year 2000 Cholesterol - 79% checked in last year. Average BP 119/81 – 91% checked in last year.

12. Introduction to the NSF National Service Framework A set of rules for whole NHS Maybe some stick attached

13. National Service Framework By October 2000 All practices to have teams that meet once a quarter to look at audits and discuss clinical issues.

14. National Service Framework By April 2001 Repeat medication records to be easily retrievable Systematically developed and maintained CHD register in place Use of register to provide structured care

15. National Service Framework By April 2002. Protocols in place for assessment, treatment and follow-up of CHD patients. Protocols in place for the assessment, treatment and follow-up of people with heart failure.

16. National Service Framework By April 2003 Annual audit of CHD care Annual audit of Heart failure care

17. How the NSF Will Affect Us Need too: Create Heart failure register Produce Heart failure protocol Start auditing heart failure Systematically record exercise ECGs & angiography

18. What Do We Have to Do New or Better Systematically care for people with heart failure Automate the audits Discuss these issues regularly at practice meetings