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Type and Title of Submission


Title:

A Commissioning Toolkit for use of Natriuretic Peptide assessment for suspected heart failure in Primary Care

Description:

Using local experience of implementing BNP in East Sussex, this provides a summary of helpful tips, planning guidance, quality standards, how much to commission and how to monitor compliance. It is supported by a simple care pathway and education package that can be used with GPs.

Category:

2010-11 Shared Learning examples

Does the submission relate to the general implementation of all NICE guidance?

No

Does the submission relate to the implementation of a specific piece of NICE guidance?

Yes

Full title of NICE guidance:

CG108 - Management of chronic heart failure in adults in primary and secondary care

Category(s) that most closely reflects the nature of the submission:

Is the submission industry-sponsored in any way?

No


Description of submission


Aim

To spread learning of best practice across the South East Coast on the implementation of BNP for primary care to improve quality of care for patients with suspected heart failure.

Objectives

To improve the quality of care for patients with suspected heart failure. To increase the use of BNP by General Practice in South East Coast. To encourage commissioners to learn from an exemplar site and make their jobs easier by providing a simple toolkit for them to follow. To educate GPs in the use of BNP To promulgate the new pathway for suspected heart failure. To reduce wastage and costs.

Context

The use of BNP across South East Coast was variable based on the initial assessment. Even where it was available, it had not been commissioned to a standard that allowed the benefits to be enjoyed, for example waiting time for results were 2 weeks by which time the GP had referred for echo and outpatient appointment leading to inefficiencies of unecessary echocardiograms and cardiology costs. GPs held mixed views of the benefit of use of BNP. The cut off levels cited in NICE guidance use evidence from untreated patients, in this population, it would be reasonable that patients will already be under some treatment for related conditions and therefore local cut off levels were agreed with cardiologists and pathologists.

Methods

In the exemplar site, commissioners and budget holders had to be convinced that this was a contribution to QIPP as the contract for the BNP had to be signed up front. Agreeing 'cut off' levels was challenging as the evidence used related to untreated patients which would be unlikely in this population. It was finally agreed to use lower cut off levels to avoid 'missing' patients. The Enhancing Quality Programme is funded across the region and supported the roll out of learning gained in the exemplar site. Communicating with GPs and embedding the change into everyday practice is a continual process requiring constant feedback when the pathway has not been followed.

Results and evaluation

The results to date in the exemplar site are demonstrating that about 50% of echos and referrals can be avoided by using BNP properly amounting to about 15,000 per month in just one population around an acute hospital. The anticipated volumes are proving to be accurate but as GPs accept the new pathway that may increase.

Key learning points

Communicate regularly and through every means possible to GPs. Use simple messages and a clinical champion to get the message across. Convince the finance team using the business case that it will deliver financial efficiencies if GPs adopt the pathway. Start the discussion with cardiologists and pathologists early about the cut off levels to be adopted. Talk to our clinical lead on Richard.blakey@nhs.net.

View the supporting material

Contact Details

Name:Kay Mackay
Job Title:Director Enhancing Quality
Organisation:Enhancing Quality
Address:Wentworth House (Crawley Hospital), West Green Drive
Town:Crawley
County:West Sussex
Postcode:RH11 7DH
Phone:01293 600300 ex1751
Email:kay.mackay@westsussexpct.nhs.uk

 

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This page was last updated: 10 February 2011

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.