Project Name: Enfield Healthcare Co-operative Limited - Lipid Clinic CWP

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 optimisation of patients with atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia (FH) in response to the needs of the CW Partner. 

The CWP will be led by a Medical Lead General Practitioner (GP) alongside a multi-disciplinary team; including, Cardiovascular Disease (CVD) Lead GP, Clinical Pharmacist, Nurse (Band 8), GP, Healthcare Assistant (HCA), aiming to achieve:

  • Identification of sub-optimally treated ASCVD and FH patients who are at the highest risk of cardiovascular events and who are not achieving lipid levels as specified in national and/or local guidelines
  • Identification of ASCVD and FH patients who have previously not tolerated or refused alternative lipid modification therapies 
  • Review of treatment options and decision on next steps in collaboration with ASCVD and FH patients
  • Counsel and optimise ASCVD and FH patients where appropriate 
  • Early identification of at-risk patients who have not had intervention in their health and wellbeing
  • Identification of ASCVD and FH patients, following risk assessment review, of ASCVD and FH patients who are sub-optimally treated 
  • On-going ASCVD and FH patients support and annual review to ensure CVD outcomes improve equitably

Planned Milestones:

  1. Collection of baseline data, in line with the above Project Outcome Measures & Data Collection table
  2. Confirmation of clinical and operational pathway, policy and protocol creation, and readiness to begin the clinical activity. CW Partner shall ensure that the recruitment of 2 x 0.8 WTE Clinical Pharmacist covered by the Novartis Financial Contribution are in place, trained and ready to begin clinical activity
  3. Collection & submission of 3 months clinical activity data.
  4. Collection & submission of 6 months clinical activity data.
  5. Collection & submission of 9 months clinical activity data.
  6. Collection & submission of 12 months clinical activity data
  7. Development of business case
  8. 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 and FH treatments
  • Enhanced experience around ASCVD and FH 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, levelling health inequalities within the PCN

Anticipated benefits for partner organisation:

  • Increased proportion of ASCVD and FH patients reviewed by primary care  
  • Increased proportion of ASCVD and FH patients receiving expert and timely review closer to home 
  • Reduction in ASCVD and FH 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 organisation which addresses the problem of health inequalities   
  • Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisation 

Start Date & Duration: December 2022 – 18 months

UK | December 2022 | 552735