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CARDIOVASCULAR DISEASE (CVD) PROGRESS REPORT - OCTOBER 2014

1. Purpose

The purpose of this report is to update Wandsworth Clinical Commissioning Group (CCG) Board on progress in developing and implementing services and initiatives which will improve the health outcomes for people with, or at risk of developing cardiovascular disease in Wandsworth. The focus is on the work carried out in the last year and plans for the next two years as outlined in the CCGs Out of Hospital Plan.

2. National and Local Context

Cardiovascular diseases are the main cause of death in the UK causing around 156,800 deaths in England (around a third of all deaths). Around 45% of all deaths from CVD are from coronary heart disease (CHD) and 28% are from stroke.

The main risk factors for cardiovascular disease are:

Increasing age

Male gender

Some ethnicities

Smoking

High blood pressure

Adverse cholesterol profile

Physical inactivity

Obesity

High alcohol consumption

CVD is the most common cause of death (all ages) in Wandsworth accounting for one-third (493) of all deaths in 2010.

The CVD all ages mortality rate (2008-10) is comparatively high in Wandsworth

The CVD mortality rate in 2008-10 for people living in the most deprived areas of Wandsworth is 2.1 times higher than the overall mortality rate for persons who live in the least deprived areas of Wandsworth (SEPHO, 2012, p.16).

There is evidence of improvement. The all age CVD mortality rate in Wandsworth has decreased by a third (33%) since 2005 compared to 22% and 23% for England & Wales and London respectively. More recently, since 2008, the all age mortality rate in Wandsworth has decreased at double the rate (20%) of the decrease for England & Wales (9%) and London (11%). A similar trend is also seen for under 75 years old CVD mortality. These decreases have seen the yearly (as opposed to a 3-year

CVD Mortality Rate (deaths per 100,000 population) England - 167 Other inner London PCTs – 155.1 Wandsworth – 179.7

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average described above) mortality rates in Wandsworth reach a level that is similar or less than the yearly rates for England & Wales and London for 2010.

3. Strategic Context

In March 2013, the Department of Health published the CVD Outcomes Strategy. The strategy identifies ten key actions that will make a difference in improving outcomes for patients with or at risk of developing cardiovascular disease. The strategy also acknowledges the recent changes to NHS, Public Health and Adult Social Care organisational structures and focuses on the need for these organisations to work together as well as engage with local patients, carers, healthcare professionals, voluntary sector organisations and a range of other stakeholders to improve outcomes.

4. Cardiovascular Disease Clinical Reference Group

The CVD Clinical Reference Group (CRG) has reviewed the CVD Outcomes Strategy and has developed a local two year work programme aligned to the national strategy. The CVD CRG will therefore oversee the implementation of the work programme with the aim of improving outcomes for people with, or at risk of developing cardiovascular disease in Wandsworth. The CRG continues to meet every two months and is chaired by Dr Nicola Jones. The group membership includes two GP Clinical Pathway leads, Dr Simon Mills (Battersea) and Dr Lauren Bloch (West Wandsworth), representatives from Commissioning, Public Health, Local Authority and local providers to ensure health and social care representation as well as a lay representative to provide the patient voice. See appendix 2 for a list of CRG members.

5. Current work streams

The CVD CRG work programme for 2014 – 16 is outlined below. A more detailed breakdown on individual progress on initiatives is available in appendix 1. Manage CVD as a single family of diseases In previous years, the primary focus of the CVD CRG has been on improving health outcomes for patients with coronary heart disease, hypertension and stroke. However, as the CVD CRGs remit was extremely broad, separate CRGs were formed to focus on improving health outcomes for patients with diabetes and dementia as well as those individuals who had suffered a stroke.

Development of a standardised CVD EMIS assessment template - Over the next two years, the CVD and Stroke CRGs will work together to ensure that patients receive holistic assessment and treatment rather than being required to attend multiple appointments to manage their different conditions. This initiative has already been introduced in Wandsworth through the Planning All Care Together (PACT) contract within primary care. The CVD CRG will build on this work, by working with members of other relevant CRGs and an EMIS specialist to develop a primary care template. This template will enable health care professionals in general practice to systematically review with each patient the factors that impact on CVD risk. This approach, which will include education as well as the practical tools, will support a consistent approach to assessing CVD risk across all Wandsworth GP practices.

Improve prevention and risk management The prevention of cardiovascular disease is part of the remit of Public Health. During 2013/14, Wandsworth Borough Council reviewed their internal organisation structures and responsibility for CVD prevention services sits with a number of departments within the Council.

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NHS Health Check programme - This programme focuses on the early identification and management of CVD risk factors. As the programme is in its 6th year, the focus over the next two years is on improving the quality of the health check whilst maintaining activity levels.

Physical Activity Services - Exercise on referral services, which include the supervised Peripheral Arterial Disease exercise programme which was commissioned during 2013/14, is now under the remit of Sports and Leisure Services. Members of Sports and Leisure Services are now attending the CVD CRG to ensure that any proposed changes to the commissioning of clinically led exercise programmes are reviewed by the CRG.

Smoking Cessation Service – The CCG has taken an active role in promoting smoking cessation services and through the 13/14 quality premium an initiative was launched to increase referral rates to cessation services by GPs and nurses in primary care. This was a successful programme and over 5000 people were referred. The NHS has published a Statement of Support for Tobacco Control, which CCGs are being asked to sign up to. It demonstrates that the CCG is committing to tack the harm smoking causes to health. This statement commits NHS organisations to:

o Actively support local work to reduce smoking prevalence and health inequalities o Develop plans with partners and local communities o Play a role in tackling smoking through appropriate interventions such as “Make

Every Contact Count” o Protect tobacco control work from the commercial and vested interests of the

tobacco industry o Support government action at national level o Participate in local and regional networks for support o Join the Smokefree Action Coalition (SFAC)

Wandsworth CCG is therefore being encouraged to sign up to this NHS Statement of Support.

Improve and enhance case finding in primary care

Chronic Kidney Disease (CKD) - Public Health data shows that the prevalence of CKD in Wandsworth is below the expected level. As a result, the CRG developed a case-finding project to assist in identifying these patients and managing them appropriately. However, there have been technical problems in setting up the searches within EMIS which has resulted in this case-finding project being delayed.

Atrial Fibrillation (AF) - In June 2014, NICE issued a revised clinical guideline on the management of AF. The guideline suggests that CCGs should be focusing on identifying patients who may have AF which is not yet diagnosed, and people who have AF but are not receiving the right treatment. The CVD CRG has developed a project with the CCG pharmacy team to ensure this work happens in practices.

Better identification of very high risk families/individuals

Familial Hypercholesterolemia (FH) - Individuals and families with inherited hypercholesterolemia are at greatly increased risk of cardiovascular disease. There is work going on nationally and in London to develop guidelines and the CRG will therefore adopt the anticipated guidelines for primary care to improve the identification of individuals and families at very high risk of FH.

Better early management and secondary prevention in the community Wandsworth currently commissions a number of diagnostic services which are delivered in primary care. A project manager has been employed to conduct an independent review of the 24 hour

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ambulatory blood pressure monitoring (24 Hour ABPM) and ECG service and provide recommendations on how these services could be improved.

Hypertension - The 24 Hour ABPM service review and patient feedback suggests that although the current service meets NICE clinical guidelines, access may be an issue for some patients who could potentially benefit from this primary care based service. As a result, the CRG will be developing a primary care hypertension service which covers both a 24 Hour ABPM pathway as well as Telehealth to support housebound patients and/or those patients who are not suitable for 24 Hour ABPM.

Workforce Development - The CRG has commissioned a number of training courses to support primary care staff in managing patients with CVD. Over the past 12 months, the following courses have been delivered: Hypertension, AF, heart failure, acute coronary syndrome (ACS) and CKD.

ECG services - The primary care 12-lead ECG service is currently under review and a new 24 Hour ECG primary care based service is under development.

Improve acute care The quality of the services that patients receive in the acute services is of great importance to the CCG as the commissioning organisation. Over the past year, the focus in Wandsworth has been on improving the heart failure pathway.

Acute Services – Wandsworth, Merton and Lambeth CCGs have agreed a combined two year CQUIN (Commissioning for Quality and Innovation) payment to support St George’s NHS Healthcare Trust in improving heart failure services. The first element of the CQUIN will ensure that all patients with heart failure receive the same “bundle of care” i.e. receive the right treatment by the right people. All patients will have a BNP blood test and echocardiogram and receive a review to determine whether psychological support and/or an end of life care plan is required. Patients will also be referred on to the community specialist heart failure service or the heart failure out-patient service as appropriate. The second element of the CQUIN focuses on “cohorting of beds”, i.e. ensuring patients receive the right treatment in the right place. The plan is that all heart failure patients will be treated on the same ward. Initially, this will be achieved by having dedicated beds on an existing cardiology ward. In the long term, the plan is for a dedicated Heart Failure unit within St George’s Hospital. The expected outcomes are a reduction in mortality, length of stay and readmission rates and an improved patient experience.

Community Services - From April 2014, the specialist heart failure nursing service has been incorporated into the new Community Adult Healthcare Service (CAHS) model. The service will work within the specialist nursing function and has received additional investment to recruit two additional heart failure nurses to work in the community. In the long term, it is envisaged that there will be more patients with stable heart failure being managed closer to their home (either by the community specialist nurses or by their GP). This trend is already starting to take effect, with an increased number of patients being referred into the community service.

Primary Care – During 2013/14, Wandsworth GPs reviewed their heart failure registers to determine whether any of their registered patients could benefit from an onward referral into the community heart failure service to improve the management of their heart failure.

Improve care for patients living with CVD Many patients and their carers want to be empowered and supported to live as full a life as possible after diagnosis or an acute event, yet many report that they receive little support or help.

Continuing Cardiac Care – Cardiac rehabilitation is a highly effective intervention which reduces the chance of a second or subsequent cardiac event. The CRG is working with St

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George’s NHS Healthcare Trust to ensure an integrated cardiac rehabilitation service is commissioned across acute and community services. To date, the uptake and completion of the programme has been sub-optimal. By revising the service specification, the service will be able to offer rehabilitation services to a greater number of patients thus meeting the Department of Health’s commissioning guidance.

Improving Access to Psychological Therapies (IAPT) for patients with coronary heart disease (CHD) - A new service has been commissioned for Wandsworth patients with CHD to ensure that they are able to access appropriate psychological support. Local healthcare professionals were highlighting this as an unmet need in Wandsworth, especially amongst patients who have recently been diagnosed with a heart condition as well as amongst patients whose condition may be deteriorating. This service is now receiving referrals from heart failure and cardiac rehabilitation services.

Improve end of life care for patients with CVD The CVD CRG is working closely with the End of Life Care (EOLC) CRG to improve end of life care for patients with CVD in Wandsworth. Achievements to date are that discussions focusing on end of life care are now formally included within the inpatient heart failure bundle of care to ensure that patients have a formal care plan where appropriate.

6. Recommendations Wandsworth CCG Board is asked to:

Note the progress made in the development of cardiovascular disease services and initiatives in the past 12 months;

Note the plans for future developments over the coming two years

Agree to sign-up of the NHS Statement of Support for Tobacco Control

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Appendix 1: Cardiovascular Disease Work Programme

Primary Prevention (Risk Factors and

Lifestyle)

2013/14 report Progress on current year 2014/15 initiatives

Hypertension During 2013/14, 1576 patients received 24 Hour ABPM

within primary care.

Due to changes in legislation, CCGs are no longer able to commission local enhanced services from GP practices. As a result, a service review of the 24 Hour ABPM service has been undertaken. The review indicated that the service was initially set up to meet the NICE clinical guideline on the management of primary hypertension in adults; however, there are additional patients that would benefit from accessing this service. As a result, it has been recommended to extend the scope of the service to increase access to this primary care based service.

It has also been noted that there are some patients who are not suitable for 24 hour ABPM and Telehealth offers an alternative to enable the GP to gather data which can then be used to inform the onward care plan. It is proposed that an appropriately trained person at the GP practice issues the kit to the patient with instructions on its use. The data will automatically be sent to the practice and the patient can return the equipment back to the GP practice when they return for care planning. The kit can then be issued to another patient.

The CVD CRG is therefore currently reviewing a proposal to develop a primary care hypertension service that covers both 24 Hour ABPM and Telehealth monitoring. This will enable both clinicians and the patient themselves to choose the most appropriate diagnostic pathway.

Physical Activity

Wandsworth Public Health Department commissioned Exercise on Referral (EoR) & Specialist Exercise on Referral (SEoR) services from DC Leisure for 12 months running until the end of the existing WBC Leisure Facilities Management

Following a Public Health review responsibility for Physical Activity has been transferred to Wandsworth Sport and Leisure Services. Places for People (formerly DC Leisure) have been awarded the new Leisure Facility Management contract which includes provision of EoR and

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Contract. These services will then be included within the service specification for the new Leisure Contract. This commission included changes to the service specification including increasing the target number of referral to 750 for EoR and 100 SEoR.

Responsibility for Physical Activity will be transferred to WBC Leisure and Sport Services on 1st April 2014 following a Public Health Review.

The Refer-All management system was introduced throughout this period with an aim to stop accepting paper referrals as of 1st March 2014. Initially both electronic and paper referrals were accepted with paper referrals phased out between November and March. Referrals increased throughout this period:

EoR SEoR

November 71 11

December 133 25

January 169 30

February 173 60

March 193 18

The NICE clinical guideline for peripheral arterial disease indicates that patients should be offered a supervised exercise programme. This service was commissioned during 2013/14 as part of the specialist exercise on referral scheme. The service was promoted to local GPs as part of

SEoR services and will run through to 2021.

Following the award of the new contract Places for People will be reviewing their delivery structure to improve quality and increase uptake. This will specifically include reviewing the peripheral arterial disease exercise pathway and overall delivery of Specialist Exercise services. It has been noted that the number of patients identified by GP practices does not match the number of patients who accessed the service. It is anticipated that this may be due to issues with the new REFER-ALL online referral system, or a coding issue within EMIS.

EoR and SEoR moved to a solely electronic referral system (Refer-All) on 1st March 2014 and all paper referrals that are received are returned to referrers. Initially high numbers of paper referrals were being received (c. 10-16 per week), however these have reduced considerably (August 2014 <2 per week). Referral numbers have increased considerably since the introduction of Refer-All with an average of 183 referrals received per month since April 2014. There are on-going issues with Refer-All which are being addressed, many GP surgeries find the system hard to use and error-prone. An EMIS template is being designed to help tackle this issue and make referrals easier for GP’s.

An issue has been identified in the physical activity service by the CRG. There is no provision for physical activity services in any language other than English. Many patients who are at high risk of CVD and would benefit from an exercise programme do not have English as their first language. The CRG is raising the issue with the Local Authority.

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the QOF QP pathway development initiative. Between September 2013 and March 2014, over 600 patients were coded on the GP’s EMIS system as being identified as suitable for referral into the exercise programme.

Obesity Weight management services are continuing. Mytime Active is delivering the early years and adult weight management programmes. The Healthy Weight Strategy and action plan is being refreshed along with an Obesity profile report to support the needs assessment. A borough-wide steering group is being established to oversee the implementation of the strategy. Presentations are taking place with Locality Commissioning

Groups to discuss how GPs can increase referrals to obesity

services.

The Healthy Weight, Healthy Lives strategy and action plan has been refreshed and is due to be ratified by the Health and Wellbeing Board in October. This includes many initiatives aimed at preventing and treating obesity. Obesity care pathways for professionals and members of the public are being developed, it is anticipated that they will be available online. Due to a restructure of the Public Health department, the 4 contracts for weight management services now sit with the Education and Social Services Department. In 2014/15 the service for children and young people (5-18 y/o) is being re-commissioned in conjunction with the School Nursing Service, and the Tier 2 Adult Weight Management Service is being retendered in conjunction with the CCG funded Tier 3/4 Adult Weight Management Service.

NHS Health Checks In 2013/14, 24% of the eligible Wandsworth population were offered an NHS Health Check and 75% of those who were invited took up the offer and received a health check. This is above the National target of inviting 20% and ensuring 66% take up of the offer, this is below performance in 2012/13 when 28% of those eligible were invited and 80% took up the offer. A key influence on this was an update by Public Health England to the numbers of people eligible in each Borough; for Wandsworth this increased our potential target population by 7,128 individuals.

Work continues in 2014/15 to ensure good coverage and uptake of this service. This includes marketing of the programme and provision through five local pharmacies, ‘Solutions4Health’, an outreach provider, who continue to provide the checks alongside GPs. The GP registered list provides a natural means of identifying eligible and screened patients and the clinical system is a rich source of data on inputs and outcomes. Wandsworth’s focus is on ensuring those at highest risk are actively targeted through good engagement of GP practices in deprived wards and using the outreach provider to increase uptake among communities who may not find GP services accessible. This is well evidenced through the targeted service provided by Solutions 4 Health, which achieved 79% uptake among target groups in 2013/14, including BME, residents of deprived wards

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and people not registered with a GP.

CVD Prevention Guidelines from the National Institute for Health and Care Excellence (NICE) on the Prevention of Cardiovascular Disease (CVD) were issued in June 2010. A baseline audit of compliance was undertaken and an action plan was developed to address the gaps outlined in the audit.

Gaps were identified around obesity in the younger population and fast food outlets. This has been addressed in the Obesity Strategy. Related public health initiatives include obesity prevention and treatment for children and young people and the Wandsworth Heartbeat Awards whereby local takeaways and other food outlets can apply for a Bronze, Silver or Gold award, showing that they are adopting healthier cooking methods and menus.

Secondary Prevention 2013/14 report Progress on current year 2014/15 initiatives

Cardiac Rehabilitation and Acute Coronary Syndrome (ACS) Pathway

The CCG secured recurrent investment to increase capacity within the cardiac rehabilitation service to ensure the implementation of an integrated pathway which meets national guidelines as well as incorporated service improvement developments carried out as part of the ACS Integrated Care Pathway project.

Work was also undertaken to develop EMIS searches to support primary care in the identification of appropriate patients for cardiac rehabilitation services. These searches were launched as part of the Quality Outcomes Framework (QOF) Quality and Productivity (QP) development initiative, however, this pathway was not chosen by GPs as part of the QOF initiative.

The Continuing Cardiac Care service specification has been amended to align with the Department of Health’s commissioning guidance for Cardiac Rehabilitation services. The CCG is awaiting confirmation from St George’s NHS Healthcare Trust as to whether the revised specification has been approved. As soon as confirmation is received, the additional investment will be released to support recruitment of additional staff members.

Ischaemic Heart Disease 2013/14 Report Progress on 2014/15 Initiatives

Heart Failure Non-recurrent investment was secured to recruit an additional specialist heart failure nurse for the community team. However, the service was unable to recruit into the

Heart Failure CQUIN

The CCG has developed a Heart Failure which includes the following

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short-term specialist role, therefore used some of the allocated investment to recruit an agency administrative assistant to support the team. Lessons learnt was the allocation of non-recurrent investment results in short fixed term contracts being advertised. This is not an attractive option for specialist clinical staff as these staff members are generally seeking long-term permanent contracts.

A primary care audit was developed as part of the QOF QP service development initiative. This will be used to support primary care in the identification of heart failure and onward refer into the specialist heart failure service. The initiative was launched in October 2014, but due to issues in recruiting additional staff, the number of patient referrals increased but the service was not able to meet demand.

Inpatients: Bundle of care and Patient cohorting; Community Heart

Failure: Admission avoidance and Post-admission referrals

Community Adult Health Services (CAHS) From April 2014, the Specialist Heart Failure Nursing service became part of the Community Adult Health Services (CAHS) service model. Learning lessons from 2013/14, a business case was submitted for recurrent investment to support the recruitment of additional heart failure nurses to the service. Integrated Care Pathway St George’s NHS Healthcare Trust commissioned GE Healthcare to review the congestive heart failure integrated care pathway. Achievements: Positive results from patient experience survey; heart failure daily checklist developed; consistent patient information packs developed across the sector and translated into two languages; engagement with palliative care; referral pathways between the emergency department and cardiology are much improved. Issues: Lack of psychological support, further capacity required in

cardiac rehabilitation, additional self-management/patient and public

involvement required.

Arrhythmia An interim project manager was appointed to develop an options appraisal which was presented to the CVD CRG. The CRG was asked for their view on the approach to be used in selecting GP pilot sites as well as the commissioning of the 24 Hour ECG reporting service.

Work has been undertaken to develop service specifications for both the diagnostic and reporting service. However, the project is currently on hold, as the CCG is awaiting a quote from the Commissioning Support Unit to deliver a server that would link the two elements of the service. Without the server cost, the CCG is unable to determine the savings that are predicted from delivering the service in primary care.

Stroke and TIA A Clinical Reference Group for Life After Stroke was established in December 2014 from a sub group of the CVD CRG.

The newly established Clinical Reference Group for Life After Stroke is now separate from the CVD CRG although regular reports are provided to the group. The group are working on establishing an effective work

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plan for delivering quality stroke services in Wandsworth. In 2014 a new Stroke Information Advice and Support service and a Six Month Stroke Review Service has been implemented and future plans are in place to develop community stroke support services.

Chronic Kidney Disease

(CKD)

NHS Kidney Care contacted Wandsworth CCG to highlight that according to QOF reports Wandsworth had the 2nd widest gap pan London between locally observed/reported CKD and the age standardised prevalence estimate.

The Battersea CVD Locality Lead worked with an EMIS specialist to develop searches for use within primary care. Practices would use these searches to identify patients with undiagnosed CKD and ensure that these patients were offered appropriate information, education and lifestyle advice to manage their condition as well as being prescribed appropriate medication.

However, during the pilot stages, it was noted that there was an issue with the EMIS search that needed to be resolved nationally. As a result, the audit was delayed. Work in underway on a national pilot which should ultimately resolve the data issues and allow the project to proceed in Wandsworth

A development request was submitted to the EMIS national team requesting that CKD Finder is re-instated into EMIS. All Wandsworth GP practices were asked to support this CCG development request, as it was considered by the GP Clinical Leads that by using this tool, it would enable the audit to be carried out.

However, despite this request being supported by numerous GP practices, CKD Finder has not been reinstated. The viability of this initiative will therefore be reviewed by the CVD CRG.

PCI

Enabling/ Cross-Cutting Projects

2013/14 Report Progress on 2014/15 Initiatives

Patient and Public Involvement

Patient Questionnaires Patients were surveyed to understand current experience of diagnostic services available in Wandsworth. Although

Patient Questionnaire Patients were asked to complete a short questionnaire and talk about their experience of the anticoagulation service at St George’s Hospital.

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positive feedback was received about these services, patients did indicate that they would prefer to have tests completed at their GP practice. The reasons behind this choice, is that parking is a problem at St George’s Hospital and it is anticipated that there would be shorter waiting times at the GP practice. Community Engagement Event A community engagement event was held in September 2013 in conjunction with Lifetimes (a local community and voluntary sector umbrella company). The purpose of the event was to inform local residents, patients and carers about the prevention of cardiovascular disease, to promote local services and to understand experiences of using the services as well as barriers to accessing these services.

The event highlighted that there is some awareness of cardiovascular disease risk factors but not all were aware of how prevalence differs across the borough. Some of the ideas generated were that local community groups would be interested in becoming “health champions” to deliver healthy lifestyle messages within their communities. It was also felt that there should be more information provided and communicated in differing formats. It was strongly felt that healthy lifestyle messages should start at school.

Patient Representative The CVD CRG continues to include a patient representative on its membership. This is to ensure that the patient viewpoint is considered whilst making commissioning decisions.

Patient feedback at the dosing clinics indicates a general dissatisfaction with the system in terms of waits for hospital transport, overcrowding of clinics and out of date systems with regard to the yellow dosing books. However, it was noted that the staff are very well thought of and always friendly. This information will be used to inform the anticoagulation redesign which is planned this financial year, in light of the changes to the NICE clinical guidelines on the management of atrial fibrillation.

Primary Care Healthcare Professional Training

British Heart Foundation The CCG were offered the opportunity to commission training courses for primary care staff, which would be fully

Chronic Kidney Disease (CKD) Two training courses focusing on management of patients with CKD were delivered in June 2014. These courses were commissioned to

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funded by the British Heart Foundation. Training courses have focused on hypertension, atrial fibrillation, heart failure and acute coronary syndrome.

link directly to the primary care initiative focusing on the identification of patients who are at risk of developing CKD.

Quality and Outcomes Framework

Medicine Management Primary Care Prescribing Guidelines are developed to support GPs and are reviewed periodically or when NICE guidance is updated.

Clinical Guidelines

IT

New Technologies

Related Workstreams 2013/14 Report Progress on 2014/15 Initiatives

Diabetes

Smoking CVD is the leading cause of death in all ages in Wandsworth, accounting for one-third (32%) of all deaths in 2010. As a result, the CCG chose addressing cardiovascular mortality as one of the local Quality Premium targets. The target would be measured through an increase in referrals into the stop smoking service (4800 referrals by 31st March 2014).

By 31st March 2014, 5476 patients had been referred to the Stop Smoking Service, therefore exceeding the target. As a result, the CCG is set to exceed the target and receive a financial incentive of approximately £230,000 from NHS England to re-invest in patient care.

The final data was presented to the CVD CRG in May 2014. The CRG reviewed the data in more detail comparing the number of referrals against the number of patients who set a quit date and subsequently stopped smoking.

23% of patients referred (measured by EMIS) set a quit date

53% of patients who set a quit date went on to stop smoking

12% of patients referred (measured by EMIS) stopped smoking

Alcohol

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Appendix 2 – CVD CRG Membership

The core membership is as follows:

Organisation Role

Wandsworth Clinical Commissioning Group (CCG)

GP Clinical Lead (Chair)

GP Locality Leads (Deputy Chair)

Commissioning

Medicine Management

Wandsworth Borough Council Public Health

Parks and Leisure Service

St George’s NHS Healthcare Trust (including Community Services Wandsworth)

Secondary Care Consultants o Cardiologist o Heart Failure o Stroke o Prevention

Community Services Wandsworth o Heart Failure Specialist Nurses o Cardiac Rehabilitation team

N/A Patient representative

Other members may be co-opted as necessary.

Where there are conflicts of interest, members of the Cardiovascular Disease Clinical Reference

Group must declare an interest where appropriate.