High blood pressure quality improvement in Cheshire and Merseyside
Findings suggest a locally developed support package for general practice nursing teams is an effective way to improve practice-level blood pressure care and control
Summary
The Cheshire and Merseyside (C&M) Blood Pressure Quality Improvement (BPQI) package is an effective and well-received way to improve practice-level blood pressure (BP) care and control, and meets a national need for BP quality improvement solutions in general practice.
Background
Unwarranted variation in high BP care and control is a local and national priority. Currently general practices and primary care commissioners are largely unaware of their performance against the National Institute for Health and Care Excellence (NICE) hypertension guidelines, and workload pressures make quality improvement initiatives challenging.
If BP treatment is optimised for known patients across C&M, it is estimated that over 3 years outcomes would improve (460 fewer heart attacks and 680 fewer strokes) whilst saving around £13 million.
Quality improvement in general practice BP care is one of a number of prevention priorities under the C&M Health and Care Partnership (HCP, or STP). Under the C&M HCP, partners from a range of sectors and organisations have co-developed a nursing-focused support package, the BPQI package, for general practice to improve high BP care and control and reduce the burden of cardiovascular disease.
What was involved?
The BPQI package was co-developed by British Heart Foundation (BHF) Clinical Development Coordinators collaborating with Sefton clinical commissioning groups (CCGs) and practice staff. It built on primary care insights from a NICE-led workshop and local developments in Wirral, Sefton and Liverpool CCGs.
Public health consultant leadership was secured for around a year with a Health Education England bid and 10 practices across C&M volunteered to become early adopters of the package.
The BPQI package offers general practice nursing-focused high BP quality improvement through:
- EMIS-embedded dashboard and audit tool (NICE standards-aligned)
- EMIS-embedded consultation templates (for new and existing patients)
- practice protocols
- printable patient information leaflet
- training support
The C&M General Practice Nursing Collaborative (GPNC) helped secure NHS England (NHSE) funding for dashboard refinements and insight with early adopting practices:
- the dashboard enabled comparison of practice-level performance at baseline with performance at 14 weeks (average)
- semi-structured interviews and an email survey were used to collect views of practice nurses, health care assistants, practice managers and GPs from 3 practices
What worked well?
The C&M BPQI package shows great potential as an effective and acceptable tool to support and improve practice-level BP care.
The dashboard showed that practice-level performance against indicators for care and control improved between approximately 3% and 15% at 14 weeks.
Semi-structured interview and email survey responses from practice nurses, health care assistants, practice managers and GPs from 3 practices was positive, with nurses describing the package as intuitive, time-saving, and effective.
Next steps
C&M NHSE and GPNC are working with development partners to scale-up use of the package through a phased sub-regional roll out.
Two C&M events for commissioners and primary care teams, respectively, are being planned which will support the roll out. Public Health England North West together with NHS RightCare, the Strategic Clinical Network, BHF, the Champs Public Health Collaborative and NICE, will make the case for BP quality improvement in general practice through use of data, and incentivise and support BP quality improvement action planning (including through adoption of the BPQI package).
Progress with BPQI is being shared with the national CVD PREVENT team, to feed into national solutions around CVD prevention quality improvement in general practice.
The BPQI package is featured on the NICE Shared Learning Database and is currently going through the process of seeking NICE endorsement.
Explore how to embed learning from the project into nursing workforce development.
Future inclusion of other CVD risk factors, such as cholesterol and atrial fibrillation, could enable a more patient-focused solution and improve sustainability and impact. The model developed could be adopted for a range of long term conditions.
Further information
Dr Melanie Roche (BP Lead, Public Health Consultant Champs Support Team, Wirral Council).