Shared learning database
Type and Title of Submission
Delivering Primary Prevention in Primary CareDescription:
NICE Clinical and Public Health guidance make recommendations for primary prevention in primary care. This submission describes how in Knowsley we have engaged GPs to develop a practical framework for embedding primary prevention in the GP/nurse consultation.Category:
GeneralDoes the submission relate to the general implementation of all NICE guidance?
YesDoes the submission relate to the implementation of a specific piece of NICE guidance?
NoFull title of NICE guidance:
-Category(s) that most closely reflects the nature of the submission:
engagement strategy and framework for delivery
Description of submission
To embed primary prevention in primary care in order to implement NICE guidance on obesity, lipid modification, physical activity, smoking cessation, and identifying and supporting people most at risk of dying prematurely.Objectives
1. Develop a process to engage GPs in primary prevention. 2. Develop a practical framework for delivering primary prevention in the GP/nurse consultation.Context
Knowsley is a spearhead PCT in the north west of England. Cardiovascular disease (CVD) kills a third of the population and is highly preventable through lifestyle modification. Large numbers of people at high risk of CVD are unaware of their risk and unsupported in reducing that risk. Improving case-finding for those at high risk together with intensive support for lifestyle modification is likely to reduce deaths from CVD and when focused on disadvantaged populations has the potential to reduce health inequalities. Although every health care encounter offers a health promotion opportunity, there is a limited tradition of primary prevention in primary care. Partly this is because many in primary care see treatment rather than prevention as the core business, and partly because GPs and nurses lack the basic tools for delivering primary prevention in their short consultations.Methods
1. Initial discussions were held with the three local practice based commissioning (PBC) consortia about the impact of primary prevention and the impact of variation in clinical practice. In response to this, nominated GPs and nurses from each PBC group came together to form a CVD Community of Practice. With credibility as a group of clinical champions the Community of Practice has examined the evidence and developed a long-term condition local enhanced service (LES) to incentivise both primary prevention and improved clinical management. 2. The CVD element of the LES funds practices to case-find patients with high CVD risk and to conduct annual preventive reviews on these patients. The review includes ensuring treatment with aspirin and a statin, screening for diabetes and chronic kidney disease, and support for lifestyle modification. To help GPs and nurses deliver this support in their short consultations, a smoking cessation LES, a physical activity brief intervention (modelled on NICE guidance) and a primary prevention pathway have also been developed. The prevention pathway assists the practitioner in referring to the appropriate preventive services. The physical activity brief intervention and the primary prevention pathway are both attached. The long term condition LES also incentivises case-finding for Hypertension, Diabetes and COPD as well as improved management in these conditions. The LES is funded through PBC savings.Results and evaluation
The long term condition LES is launching in October 2008 and its implementation will be evaluated. As evidence of success in the process of engagement, the Community of Practice has proved an effective vehicle for involving clinicians in discussions about prevention and quality. GPs and nurses in the Community of Practice are regarded by their peers as clinical champions and there is widespread acceptance of the proposed framework for change in relation both to primary prevention and clinical quality. Most practices have indicated their intention to sign up to the long term condition LES.Key learning points
Major challenges to the delivery of primary prevention in primary care include the limited tradition of prevention amongst GPs and the lack of prevention toolkits. The Community of Practice model has proved to be successful in engaging clinicians to consider primary prevention as part of a suite of interventions to improve patient outcomes. The combination of local enhanced service, brief interventions and prevention pathway provides a practical framework for embedding primary prevention into routine consultations. Dr Matt Kearney GP Public Health Practitioner Dr Diana Forrest Director of Public Health Knowsley PCT/MBC
View the supporting material
|Name:||Dr Matt Kearney|
|Job Title:||GP Public Health Practitioner|
|Address:||Nutgrove Villa, Westmorland Road|
|Phone:||07773 374 206|
NICE handles personal information provided to the Institute in accordance with the Data Protection Act 1998. Find further details in our data protection policy.
This page was last updated: 30 September 2008