Dr Mel Roche, Public Health Consultant,

Champs Support Team BP/CVD prevention Lead

14th July 2020

C&M High Blood Pressure &

CVD prevention update

Purpose and outline

Update for local PH leads on C&M BP/CVD prevention programme and support action ‘at Place’ during COVID-19.

1. Why talk BP/CVD prevention now?

2. Key National developments

3. Recovery Update: C&M HCP BP programme

4. What’s new?

- Happy Hearts website updates and comms

5. Supporting implementation at Place: Opportunities for PH

1. Why talk BP/CVD prevention now?

A big problem just got bigger:

• CVD patients at higher risk fromCOVID-19 risks higher still in BAME groups

• Many patients are shielding/ reluctant to attend primary/ secondary care

• Some NHS services have been paused/ less available

• CV effects of COVID-19: a new cohort of CVD patients (rehab)

But even during COVID-19 we can make a big difference

• Remains a C&M HCP Prevention priority

• NHS Long Term Plan

• Remote/ digital innovations

• Opportunity to optimise increased health awareness

• Opportunity to reduce CVD inequalities and help address COVID-19 disparities

2. National developments (1/2)NHS LTP Aim: Prevent up to 150,000 heart attacks, strokes and dementia cases by 2029. National Ambitions (ABC) seen as key.

NEW: CVD Prevention DES: CVD prevention direct enhanced primary care network service (DES) specification under development for 2021/22.

Will support delivery on national CVD prevention ambitions for AF/ BP/ cholesterol.

NEW: CVD PREVENT audit: Centralised audit of practice level performance against CVD prevention indicators (including AF/BP/Chol). Revised timeline: Reports available by March 2021 (in time to inform CVD prevention DES). Data to inform work on inequalities.

NHS Health Checks: National pause lifting: RCGP/BMA reduced COVID response status. Restarting will be local decision. PHE support: NHS Health Check restart preparation webinar today! 12:45-13:30

National developments (2/2)Atrial Fibrillation: Qualitative evaluation of AF virtual clinic demonstrator pilots

delayed but expected early 2021.

High Blood Pressure: NEW: Centralised national procurement of system for remote blood pressure monitoring for shielded patients (business case approval pending). To include BP monitors and free access to IT platform until March 2021

High Cholesterol: Genomics hub delay (was planned for 2020), FH strategy to achieve national ambitions through a multifaceted approach coming soon

NEW: Remote CVD Prevention care pathways coming later this month (UCL Partners LTP framework series) will support ABC in primary care

3. Recovery update: C&M BP programme

COMMUNITY BP TESTING & ENGAGEMENT

• BHF BP case-finding pilots in community/ workplaces

• Happy Hearts website

• Wellpoint kiosks

• Community pharmacy

• Fire and Rescue Safe and Well Checks

• Know Your Numbers! week

GENERAL PRACTICE

• Quality improvement support tool (BPQI)

• CPD/ Workforce development

‘Beating the pressure at work’ pilots

Aim: minimum 10,000 new case community BP checks over 2 years.

Pilots paused (nationally/ locally) due to infection control and GP workload implications during COVID-19.

Steering group paused but progress with adapted BP offer (shift from case-finding to HWB & self care) for:

• Kiosks

• Community pharmacies

• Fire and Rescue Safe and Well Checks

Consider if ‘Workplace Champions’ adopt similar approach …

Happy Hearts websiteC&M CVD Prevention website

Significant updates last few months.

• NEW COVID-19 relevant content

• NEW professional resource section

• Focus: AF/BP/Cholesterol

• Health and wellbeing: Supports social prescribing across C&M

Aimed at both patients and professionals

Virtual tool gives cross cutting support and visibility to current BP/CVD prevention objectives, supports key messages

Underpins alternative CVD prevention interventions by BHF pilot partners.

More on this shortly…

Community Pharmacies

BP testing for case finding and medicines optimisation

• Paused (lack of capacity), no date yet to restart face to face BP checks.

Recovery plan - C&M Pharmacy LPNs:

• Healthy Living Pharmacies (HLPs) across C&M to promote Happy hearts website and key messages as part of Healthy Living Pharmacy offer

• Ongoing review of when f2f BP checks feasible

Fire and Rescue Safe and Well Checks• Prior to COVID-19: BP (& AF) case-finding embedded in Safe and Well Checks.

• S&W paused since COVID-19, BP/AF checks not yet feasible

• Recovery plan- both FRSs very supportive of socially-distanced CVD prevention offer that supports social prescribing approach

• Exploring restarting socially-distanced S&W Checks in due course

• Will promote Happy Hearts website & key messages when restart

• Aiming to restart revised S&W Checks in August. Matt Ashton guiding new focus.

• Vulnerable households, elderly

• Keen to support CVD prevention messages and promote Happy Hearts website

• Key messages leaflet/ basic training

Wellpoint Kiosks

8x HCP/BHF-funded kiosks: paused since March 2020

Recovery: Aiming to restart Sept 2020 with infection control package in place.

Opportunity to repurpose more towards supporting BP monitoring/ HWB

Wellpoint extended contract by 5 months (6x until April 2021, 2x until December 2021, +LHCH/St Helens)

Priorities: Infection control measures, user journey refinements, communications, review locations

Know Your Numbers! week

Registration open: BP awareness-raising campaign

7th-13th September 2020.

Theme for 2020: 'YOU are in control’.

A ‘no community testing’ KYN Week, partners encourage home BP monitoring & being healthy at home.

Opportunity to promote Happy Hearts website/resources and BP kiosks.

Registration/ further info:

• register for the Week as Pressure Partners

• campaign plan

• Zoom meeting Monday 20th July 11-12am

General practice: BPQI packageBPQI: Quality Improvement support for BP care in general practice

• Includes: Consultation templates, practice dashboard, protocol, patient information prescription (NICE guidelines)

• Embeds EMIS/System One, nursing focus

• Rolled out Knowsley/ East Cheshire CCGs, further rollout paused to 2019 NICE guideline updates & then COVID-19

T&F group recovery plan:

• Early adopter stocktake

• Refine to align with CVDPREVENT audit/ CVD prevention PCN DES

• Testing and rollout in partnership with IA/NHSE ( & AFQI later on)

• Opportunity to reduce inequalities highlighted by CVDPREVENT

• Primary Care Leads meetings (GPFV/ Transforming Primary Care)

General practice High BP CPDCCG PLT sessions developed in partnership with Education for Health

• Case-study based scenarios on areas of variation/ uncertainty in BP care

• Introduction to BPQI

Session delivered Cheshire East CCG, then COVID-19- paused.

Recovery plan:

• New delivery approach/ provider moving forwards, virtual delivery model

• Content: Highlight national developments, key QI messages & support BPQI rollout support

• Dovetail into CVD CPD series being planned for primary care (HCP)

• Primary Care Leads meetings (GPFV/ Transforming Primary Care)

4. What’s new during COVID-19?

New group: C&M HCP CVD Prevention Sub-Group [COVID-19]

Governance – HCP CVD Programme Board

Objectives:

1. Promote Health and wellbeing measures to minimise population CVD risk

2. Empower self-management of CVD risk factors at home

3. Support remote CVD risk management in primary care

4. Raise awareness to seek medical review for acute CVD symptoms

5. Address CVD inequalities that COVID-19 may exacerbate

Cross-cutting enablers

• Happy Hearts website: New COVID section and Professional resources

• Communications: Comms toolkit, digital assets, CVD stakeholder comms plan

• Equipment to support remote care – seeking resource for additional tech (kiosks/ BP machines)

• Local and national networks

Happy Hearts Website

Happy Hearts Benefits

Patients/carers

• resources from wide range of reputable sources

• Supports health and wellbeing

• Empowers patients with AF, high BP and high cholesterol

• Support for self-care, e.g. how to measure BP at home

• News and key messages

• Translated resources

• Easy read information, videos

Health professionals

• Easier access to latest CVD prevention resources

• National/local updates and guidance

• Resources to support patient care and social prescribing (links to local HWB & COVID services)

• Evidence & data

• Register for updates

• Support for key workers/clinician wellbeing

• Workforce learning and professional development.

Happy Hearts communications

Facebook campaign

Communications toolkit

Happy Hearts Facebook campaign

Public facing (3 months, LHCH Facebook account)

Promotes key CVD prevention messages, 3 themes

Directs patients and carers to the HH website

All C&M local authorities, focused on most deprived areas

Being happy and healthy during COVID-19

‘Reduce the risk of heart attack and stroke by looking after your physical and mental health’.

1. Eat and drink well

2. Make time for yourself

3. Get active

Looking after your conditions (AF/BP/cholesterol)

‘Atrial fibrillation, high blood pressure and high cholesterol increase the risk of heart attack and stroke. Simple actions can reduce the risk, even during the coronavirus pandemic’.

1. Know your blood pressure

2. Take prescribed medications

3. Get checked annually

Seeking medical help

‘Seek urgent medical help if symptoms of stroke or heart attack occur, even during the coronavirus pandemic’.

1. Act FAST

2. Dial 999

3. Keep your appointments

Communications toolkit

Toolkit document

Template news story

Digital and web assets:

• Facebook

• Instagram

• Twitter,

• Web bannersAvailable on request Sophiepemberton@wirral.gov.uk

Happy Hearts: Addressing inequalities and promoting a systems working

Helping to reducing inequalities

e.g.

Translated resources

Easy-read resources

Different formats, e.g. videos

Supports local social prescribing

Facebook campaign focuses on deprived communities

C&M System Approach

A relatively ‘quick win’

Bringing visibility to CVD prevention messages, work and resources

Gaining engagement and support from:

• Community Pharmacies (HLP offer)

• Fire and Rescue Safe & Well Checks

• CCGs (Warr/Halton, Primary care leads meeting)

• NHS Trust (StHK)

• GP practices

• more..

5. Supporting implementation at Place

Suggested PH actions to support

• Communications toolkit and digital assets: Use to promote Happy Hearts website and key messages locally, embed in work with vulnerable and at risk groups

• Happy Hearts website: New content suggestions welcome

• Know Your Numbers! week 7th-13th Sept: register, save date

• Workplace champions: Promote Happy Hearts/ key messages?

• Wellpoint Kiosks: Preparing for restarting from 1st Sept. Consider locations to support BP monitoring / workplace testing.

• General practice/ CCGs: raise profile CVD prevention: national developments (DES, CVDPREVENT audit) and local QI tools

• NHS Health Checks: PHE restart support (webinar today!)

Summary • Strong case to prioritise CVD prevention throughout COVID-19

• Big part of addressing inequalities (deprivation, BAME groups)

• National drive on CVD prevention (CVD PREVENT, DES, NHS LTP)

• C&M HCP CVD Prevention subgroup well aligned to national approach

• Recovery of paused C&M BP/CVD work underway

• New work: C&M Happy Hearts website is cross-cutting enabler for BP/ CVD prevention work (HWB, self care ‘ABC’, remote care, key messages, inequalities)

• Many opportunities for PH teams to support CVD prevention locally and to reduce inequalities at Place

Thank you

melanieroche@wirral.gov.uk