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Under the Innovation for Healthcare Inequalities Programme we have piloted a community lipid management hub in Bexley to help tackle cardiovascular disease in south London. In this blog we hear from the team who supported the pilot as they explore the changes the pilot has made since its launch. 

The Innovation for Healthcare Inequalities Programme (InHIP) aims to reduce healthcare inequalities by improving access to proven healthcare innovations for the under-served populations in the Core20PLUS5 strategy. Data from national primary care audit ‘CVDPREVENT’ showed Bexley patients as having comparatively poor access to lipid lowering therapies, with particular inequalities in certain ethnic, gender and age groups; increasing the likelihood of cardiovascular events, like heart attack or stroke, in these populations.

One of south London’s InHIP projects is piloting a pharmacist-led community lipid management hub, for cardiovascular disease prevention, in Clocktower Primary Care Network (PCN), Bexley, which launched in July 2023. In this blog, we hear from Abi (Bexley GP Federation’s Chief Operating Officer), Dee (Clinical Services Coordinator), Aneal (Specialist Pharmacist in the lipids clinic), Rachel (Senior Cardiovascular Disease Pharmacist) and Margaret (HIN Project Manager) as they discuss how the new service is making positive changes to the way cardiovascular care is delivered in south London.

Margaret

The clinic has seen 70 patients in its first six months, with 80 more expected through the pilot. Due to the high-risk profile of this patient group, an estimated 8+ cardiovascular events could be prevented through the pilot period alone.

Aneal

Having 30-minute patient consultations in the Bexley Community Lipids Hub has transformed the way care is delivered, in a way which is not always possible in general primary care settings. There’s more time to discuss the patient’s symptoms and medication in detail and they can be closely monitored. We’re often told by patients that the specialist pharmacist is the first clinician who’s discussed test results in depth with them and made sense of the numbers. In a general practice consultation this might not always happen due to the amount of time clinicians have with patients.

Success stories: 

Abi & Dee

Clocktower PCN actively invested in the new Additional Roles Reimbursement Scheme (ARRS) and upskilled staff such as pharmacists, to become specialised in a number of areas including lipid management optimisation and cardiovascular disease (CVD) risk reduction. We saw the Bexley Community Lipids Hub, known locally as ‘Protect Your Heart’, as a good opportunity for these staff to utilise their extended skills and knowledge in a new way.

The aim of the Bexley Community Lipids Hub was to improve access for high cardiovascular risk patients to interventions to reduce their risk of a heart attack or stroke through shared decision making. This project was co-produced by Bexley Health Neighbourhood Care, the GP Federation, Clocktower PCN and the Health Innovation Network South London, with support from the local medicines management team. Through a collaborative working approach, we have piloted a service reviewed by all partners involved that has allowed us to deliver the agreed outcomes and share learning for future sustainable models of care to protect patients in SEL from CVD.

Aneal

During consultations we discuss options with patients to optimise lipid management treatment plans. Using the Vital 5* approach it is also possible to create a list of suggestions on other patient-specific areas of focus or co-morbidities for the patient to discuss with their GP, social prescriber or community support groups. We can detail this intervention in the patient’s notes and send text messages to their GP for information to support the ongoing improvement of the patient’s treatment. Collaborative working between the pharmacists running the service, the patient and other healthcare professionals can really enhance the care a patient receives, and hopefully services similar to this can be adopted in other south London areas.

Aneal

The care provided under the clinic is flexible and is tailored to each person. There have been instances where patients on the clinic list have refused an appointment because they are housebound or are caring for others. We can follow up with these patients via a telephone appointment instead and liaise with district nursing services to provide any further care that is needed. We offer individualised care and it’s fantastic seeing the difference this makes for patients.

Abi & Dee

For the lipid hub, we have provided enhanced administrative time, compared to other services, recognising the person-centred care that is required for this patient group. The team contact all patients by phone call to book them into the clinic and will also administer calls to check people have had their blood tests or arrange follow up appointments. People using the service are often elderly and require more time on the phone, or in other cases, won’t have a mobile phone and therefore will need letters sent to them. Delivering more holistic care does demand more of your time but it is incredibly rewarding seeing positive outcomes being achieved in people’s health.

We have received fantastic feedback and engagement from people attending the service. In a survey we found out that 32 out of 34 respondents would recommend the clinic. Patients fed back that they felt listened to, reassured and that explanations of next steps were clear.

Abi & Dee

As this is one of the first clinics of its kind it is inevitable that we’ll experience some issues whilst delivering the service. However, by our service experiencing it first it means that the issues can be addressed before clinics are adopted in other south London areas and care can be delivered faster to people who require this enhanced service.

Margaret

The learning gained through this project has informed the set up and delivery of two further community hubs, one in Lewisham and one in Greenwich. This has assisted a more rapid implementation, especially as clinical pathways, governance issues and the patient intervention and engagement have already been trialled in Bexley.

Aneal

This clinic was set up with the focus primarily of tackling health inequalities in cardiovascular care and it is important for any health care professional involved in facilitating a new service to be clear on what the set objectives are. In this service we need to make sure the pharmacists are recognised for their expertise and support them with sharing any lessons they have learnt with GPs and wider practice staff. For example if a GP has told the patient their cholesterol is fine but it’s not for this particular patient then not being afraid to go back and discuss it further and encourage the patient to take action.

Rachel

This community hub has been a great example of how primary care healthcare professionals, specialists working in secondary care, management and administrative support can work together to make every contact count for our local populations. Patients have had the time to discuss and reflect on many aspects of their health and can leave the service feeling more empowered to take holistic actions to improve their cardiovascular risk and overall wellbeing. Six patients have been referred to secondary care lipid specialists for potential Familial Hypercholesterolemia, while their CVD risk and lipid management is optimised by interventions made via the hub.

The insights gathered from this service, along with its outcomes, are being shared throughout south London and beyond at a national level. Specifically, the advantages of incorporating the Vital 5* approach in all patient assessments are being promoted to mitigate adverse health effects and enhance wellbeing and motivation through collaborative decision making processes.

*Vital 5 - the 5 leading causes of poor health in our local communities: high blood pressure, obesity, smoking, alcohol and common mental health conditions.  The clinic also checked for pre-diabetes and uncontrolled diabetes as an additional risk factor for CVD supporting the population health needs for diabetes awareness and management.