Update on Stroke Prevention LCS
We have recently reviewed the LCS and had hoped that we would be able to issue a new specification that would enhance the work that you have already been undertaking. However we are still awaiting confirmation of the new budgets for 2017/18 and so cannot finalise the scope of the new specification at this time.
For this reason we will roll forward the activity element of the current specification for another quarter (2017/18 Q1), or until we have confirmation that the new specification can be issued.
We will keep you updated should the circumstances change.
The Stroke Prevention Case Finding service has been developed to address the public health issue that we face in Haringey. This page has information relevant to this service. It includes:
2. Training for GP staff
3. Updated READ code
4. Updated NICE Guidelines
5. Searches and templates for EMIS and VISION Practices
6. Other relevant documents (see downloads box)
Please find attached the specification for the ‘Stroke management: Case finding primary care led service’. This service has been developed to address the public health issue that we face in Haringey; according to the 2013/14 QOF figures, Haringey has one of the highest levels of premature mortality from stroke in England, and is currently ranked as the 146th worst rate of premature stroke mortality out of 149 areas compared by Public Health England.
QOF data (2013/14) demonstrates that there is a significant under diagnosis of both hypertension and Atrial Fibrillation which are key risk factors for stroke:
Haringey has 30,289 people on GP registers with diagnosed hypertension. The total number of people with hypertension in Haringey (diagnosed and undiagnosed) is estimated at 62,323, (which includes an estimated 32,034 people who are undiagnosed). This gives Haringey an estimated diagnosis rate for hypertension of 49%, which is the 197th lowest of 211 CCGs.
There are 1,935 people on GP registers with AF in Haringey. This is estimated as 46% of the total number of people with AF in Haringey. There are an estimated 2271 people in Haringey with undiagnosed AF. The estimated diagnosis rate of AF of 46% in Haringey, compares to a national average of 65%, and is the 3rd worst of all London CCGs.
In response to these health outcomes, Haringey CCG put in a bid for funding to aid the identification of patients who are more at risk of having a stroke, and the bid was successful. The available funding will be used to bring additional resources in to general practice and so with the support of two clinical leads, the attached specification for stroke prevention has been developed.
2. Training for GP practice staff
It is recognised that HCAs will undertake a significant amount of screening work, particularly those who are providing flu clinics. Training is currently being commissioned and will be made available for any member of primary care staff who requires training for the following:
Understanding the theory that underpins AF
Identification and diagnostic assessment of AF including the importance of pulse checks.
Applying current guidelines appropriately in managing patients with AF.
Managing AF safely in line with the quality and outcomes framework aimed at prevention of stroke.
3. READ code in updated specification document
READ codes updated in specification document, in downloads box.
4. NICE Guidance
Click here for link to NICE Guidelines ‘Hypertension in adults: diagnosis and management’
5. Searches and Templates
A number of tools have been created for practices including searches and templates for practices to complete and live popups that inform the health professional to check BP or pulse (pulse check for when they are giving flu jabs).
These searches are available through search and report for EMIS practices. Practices can enable access to these searches from their clinical system by activating EMIS enterprise. EMIS enterprise permits searches created by the CCG to be utilised by practices to perform the LIS. It also permits the CCG to reimburse practices quicker through better reporting of the selected searches. EMIS enterprise is for searches only and contains only pseudo-anonymised data containing no patient identifiable data.
See Vision - 'Group input for AF and HTN' document in Downloads box
6. Other relative documents (in the Downloads box) include:
The monitoring audit form that will need to be submitted in January and April – 'Audit report'
Suggestions for prioritising patients on your list – 'Cohorts of patients for hypertension screening'
Guidance for patients about blood pressure monitoring types - 'Ambulatory blood pressure monitoring'
Please feel free to contact your Primary Care facilitator or Kate Thomson (email@example.com) if you have any queries about this service.