The Government spelt out its plans to improve health and tackle health inequality in the White Paper Saving Lives: Our Healthier Nation. In this document the Government commits itself to reducing the death rate from heart disease and related illnesses such as stroke in those under 75 years of age by two-fifths by 2010.
To deliver the Government's objectives there will be major changes in the way the National Health Service delivers its care. Clinical excellence is to become the key focus and driving force in decision making at every level of the NHS.
As part of this quality framework, standards of service for the NHS will be provided by the National Institute for Clinical Excellence (NICE) and by the National Service Frameworks (NSFs).
The NSF for Coronary Heart Disease is an ambitious project which sets out a vision and a mechanism for continuously improving services for the next 10 years and beyond.
When implemented, it will improve the quality of care, and reduce inequalities in health and undesirable variations in the service provided by the NHS.
The NSF establishes 12 standards for the prevention, diagnosis and treatment of coronary heart disease. The standards are intended to remain relevant for 10 years or more.
These standards encompass all aspects of care, including population strategies, the management of acute coronary syndromes and cardiac rehabilitation.
Thus the NSF:
- Sets national standards for care for preventing and treating coronary heart disease
- Recommends service models, enabling the efficient delivery of those standards
- Suggests indicators and clinical audit criteria that can be used to assess the quality of prevention and treatment
- Identifies early priorities
- Establishes milestones and goals that will mark progress with implementation.
- Describes the underpinning programmes and gives examples of practical tools to help implement standards.
Primary care has a contribution to make to all the standards and a major role in half of them. Initially within primary care most resources will be needed to achieve the prevention of cardiovascular events in the highest risk patients, the appropriate management of stable angina and the detection and treatment of heart failure.
To achieve these goals, primary care will have to adopt a structured approach. It is likely that PCGs will have to develop new models of care to enable GPs to achieve their targets. An example of this would be a secondary prevention clinic run by the PCG, to which various practices will refer.
Milestones are provided so that each practice can assess its progress. Additionally, all doctors working within primary care will have to participate in clinical audit and use the results to improve the quality of care.
The NSF offers the patient a coordinated 'pathway of care' which will ensure quality improvement and will make us all accountable for our performance. It provides the opportunity for primary care to demonstrate that it can provide high standards of care to the population it serves.
By embracing the challenges provided by the NSF we have the opportunity both to retain influence and attract the resources that will be required for the ongoing development of primary care.