MCN Aims
The overall aim of the Managed Clinical Network for Coronary Heart Disease is to improve patient care in terms of quality, access and appropriateness. It also acts as the principal advisory group to the NHS in Grampian on the development of a strategy for Coronary Heart Disease including health promotion, primary and secondary prevention, rehabilitation, hospital care, primary care and community care.During the past four months there have been several significant changes and achievements.
Additional Cardiologist
Congratulations are extended to Dr Deepak Garg who has been successful in obtaining a new post as full-time Cardiologist at Dr Gray’s Hospital, Elgin from 1st August 2006.
GP Fellowship in Cardiology
A second year of sessions will commence on 25 October 2006. 14 GPs have been granted places and 3 of these are from Highland as part of the increasing co-operation across the North of Scotland.
Additional Community Based Cardiology Outpatient Clinics
South Aberdeenshire (Stonehaven) – This clinic became fully operational from 20 July 2006.
North Aberdeenshire (Peterhead) – The clinic became operational from 27 September 2006. The MCN would wish to record its thanks to / all Aberdeenshire CHP and Aberdeen Royal Infirmary staff for all their hard work in establishing these clinics.
GPs with Special Interest in Cardiology (GPwSI)
Four GPs have commenced duties with a sessional responsbility for the above in the last few weeks in North Aberdeenshire, Moray and Aberdeen. They are all in the early stages of their induction period and will be featured in much more detail in the next issue of this newsletter.
North of Scotland Regional Delivery Plan for Coronary Heart Disease Services
Regional Clinical Lead
Dr Malcolm Metcalfe was appointed to this role in July 2006. He will be stepping down from his Lead Clinician role in the Grampian Coronary Heart Disease MCN by the end of the year and a new Lead Clinician will be appointed.Regional Delivery Plan
Copies can be obtained from Christine Gray, Secretary, CHD and Stroke MCN Office, 1st Floor, Westholme, Woodend Hospital Site Tel: (01224) 5 56713 or email:Scottish Primary Care Collaborative
The Scottish Primary Care Collaborative has been running since September 2003.The past 3 years have seen some innovative changes to chronic disease management and this has led to more patients being actively managed in primary care settings.
To date, there are 36 practices covering 213,821 patients in the Grampian region involved in the collaborative.
The principles of the programme are:-
To generate early and demonstrable improvements in the care of patients with proven Coronary Heart Disease, demonstrating a reduction in mortality of 10% per year in each participating practice.
To achieve this, development of care pathways for CHD between primary and secondary care and the adoption of best practice guidelines and pro-active secondary prevention, is essential.
Each practice is encouraged to identify and use specific change principles in developing plans for improvements.
They are:-
¨ Know all you patients who have Coronary Heart DiseaseAgree a clear definition of CHD
Develop a CHD register.
Develop systems to maintain a valid register.¨ Be systematic and proactive in managing care.
Measure progress rigorously and frequently.
Establish clear organisational arrangements.
Establish systems for delivering care to patients with CHD.
Use Guidelines, protocols and computer templates to support care delivery. / ¨ Ensure timely and high quality support from secondary care.
Ensure LHCC/CHP/MCN co-ordination at the primary/secondary care interface.
Analyse the patient journey and redesign as necessary.
¨ Involve patients in delivering and developing care.
Deliberate strategy for self- management.
Integrating the patient’s perspective constantly in the design of services.
Ensure written communication is appropriate and understood. Pay special attention to the needs of hard to reach groups.
Some of the changes made by the practices include:-
¨ Validating all CHD registers and recall systems.
¨ Streamlining chronic disease clinics to benefit patient waiting times and staff resources.
¨ Moving work to the most appropriate person.
¨ Making sure that patients with CHD are on appropriate dosage of statins / beta blockers and asprin.
¨ Target those patients who do not comply with set targets for Blood Pressure and ascertain appropriate treatment.
¨ Provide clinics for patients on CHD register who cannot attend during normal working hours.
¨ Provide lifestyle information and improve communication with patients.
¨ Improve patient pathway between primary and secondary care. Review referral systems and keep patients informed of progress with appointments.
¨ Improvement and development of protocols, templates and ensure correct read codes applied.
¨ Promote self help and patient education to reduce unnecessary visits to surgery.
The practices have to choose a second chronic disease as a third topic during the second year of the programme. Several are concentrating on Hypertension, COPD. Asthma and Obesity.
By using the simple PDSA ( Plan, Do, Study, Act ) methodology which is transferable to all areas, they can continue to make small but sustainable changes and improvement to chronic disease management and be pro-active in care rather than reactive. Concentrating on secondary prevention is imperative if significant improvements to mortality rates from CHD are to be achieved.
A very successful and enjoyable joint SPCC/ MCN Seminar was held in Huntly Castle Hotel on Wednesday 6th September 06 and further events are being considered across Grampian.
Christine Atkinson
SPCC Project Manager – ElginCHP
(01343) 567843
Peterhead gets Second Cardiac Exercise Class
An increasing demand in the Buchan area, for cardiac rehabilitation exercise classes after working hours, has prompted Grampian Cardiac Rehabilitation Association to arrange a new class to meet the need.
The new class commenced on 5th September 2006, at the Rescue Hall and will run from 7pm to 8pm. The timing of the class is deliberately set to suit those heart disease sufferers who are back at work but is open to anyone who has or has had heart problems of one sort or another and has recovered.
This very specialised style of exercise is specifically designed to stimulate and improve a persons breathing and heart functions to help them enjoy a normal and rewarding life. / Evidence suggests that participation in this type of exercise two or three times a week may assist in extending life expectancy by up to 25%.
The programme is generally a mix of aerobic exercise to music and circuit based routines using simple exercise aids.
Ann Walker, vice-chairperson of the executive committee of GCRA, exercises every week at the existing Peterhead class since suffering a heart attack six years ago and is responsible for organising the venue.
The GCRA classes are the only ones recommended and fully accredited by NHS Grampian for anyone recovering from a heart incident as they most certainly improve fitness and health. They are also great fun and do help reduce the risk of having a second heart attack. You also enjoy the personal satisfaction of making a contribution to your own health.
The class will be led by local woman Susie Crane who is a fully qualified and B.A.C.R. accredited cardiac exercise instructor. Anyone requiring more information should call Susie on (01779) 471830. Entry to the class is open to anyone who has recovered from a cardiac incident and is in a stable condition. If they are currently visiting their health centre or/and taking regular exercise they may be able to be admitted directly to the class depending on their level of fitness. For others it may be necessary to contact their local GP or Health Visitor for a referral interview.
Heart Failure Service
A series of five 2-day Education sessions have been funded by the MCN as follows:
Dates and Venues
31 Oct & 1st November 2006
Goals Soccer Centre, Bridge of Dee
14th & 15th November 2006
Edwards Café Bar, Inverurie
28th & 29th November 2006
Elgin
10th & 11th January 2007
The David Anderson Building, Foresterhill
30th & 31 January 2007
The Waterfront Hotel, Macduff
Lunch and Refreshments will be provided.
This is open to Practice Nurses (one place per GP practice) and Community Nursing staff.
Both days must be attended consecutively.
It is expected all those attending will have good background knowledge of the heart and cardiovascular system and are involved in the care of patients with heart failure.
The course will take the form of formal lectures but also group work and case studies.
There will be sessions on:
· diagnosis
· pathophysiology
· drug therapies
· non-pharmacological management
· advanced treatments
The purpose of this training programme is to raise awareness of Chronic Heart Failure and how to manage it effectively in the community.
To express your interest in attending, please contact
Gloria Barrie, Secretary extension 54930, direct dial: 01224 554930
/ NHS Grampian ‘Healthy Helpings’ Weight Management Programme
Obesity is an increasingly important challenge to health, a system wide NHS Grampian priority and a priority of local Joint Health Improvement Plans. Increasing body weight is seen across all ages and all social groups. Obesity and overweight are recognised as independent risk factors for CHD and also as major risk factors for high blood pressure, raised blood cholesterol, diabetes and impaired glucose tolerance.
The Healthy Helpings weight management programme was originally piloted in 1996 and implemented on a GP/self referred basis. Following a strategic review of NHS Grampian weight management and obesity services in 2003 the need was identified to review the programme, as a part of wider activity to integrate weight management services.
Healthy Helpings is core funded through Public Health and is being reviewed and redeveloped in partnership with Community Dietetics. The redesigned programme will combine a theoretical approach to learning with the need to take account of participants’ readiness to change, enabling them to identify and find informed solutions to overcoming the barriers they face to achieving a healthier weight.
The programme comprises 8 weekly 1-hour sessions and is designed to offer a generic approach to weight management useable in a variety of settings by trained facilitators.
The aim of the HH pilot programme will be:
To provide an 8-week course that will support individuals with a BMI over 25 with no co-morbidities to achieve and maintain a healthier weight, in a group setting.
Specifically the objectives of HH pilot will be:
· To increase knowledge around healthy eating and physical activity
· To provide an holistic approach to lifestyle change with an emphasis on active learning
· To support participants to make lifestyle changes by the setting of realistic and achievable goals
· To evaluate the effectiveness of the pilot programme to inform future programme development as part of an integrated approach to weight management in Grampian
A range of methods will be used to evaluate the effectiveness of the HH pilot programme which will be measured against the following outcomes:
· Increased knowledge of healthy eating messages
· Increased knowledge and take up of a more active lifestyle
· Weight loss
· Increased self efficacy
· Attendance at sessions
Healthy Helpings will be piloted in 2 stages. Initially in 2 settings (Primary Care and Community) in early 2007 followed by a wider pilot in a broader range of settings. It is anticipated that participants will be both self and GP referred and the course will be marketed in the location in which it is planned to take place. Trained facilitators will deliver the sessions using a client centred, empathetic approach to delivery. Following successful piloting it is anticipated that the Healthy Helpings Programme will be rolled out with the support of CHPs later in 2007.
We are in the process of identifying potential Primary Care pilot sites for the programme and would welcome interest in and support for the programme through CHD MCN networks.
Please contact Caroline Comerford, Nutrition Co-ordinator, Public Health Unit 01224 558601 for more information. /
MCN Cardiac Symposium
A very successful and well-attended Event was held on 20th September 2006. The Event allowed over 60 GPs to discuss a range of conditions with Secondary Care Consultants and how they can be managed within primary care. A report of the Event, including copies of presentations is available from Christine Gray.Website
The Managed Clinical Network for Coronary Heart Disease has established a website athttp://www.nhsgchdmcn.scot.nhs.uk
Minutes, agendas, newsletters, forthcoming events, local and national policies, protocols and guidelines are all available on this website. Links to other websites will include the Grampian Intranet and the GP Portal.
Contact Details
If you require more information about the CHD MCN or have anything that you would like to share, please contact:CHD and Stroke MCN Office
1st Floor
Westholme
Woodend Hospital Site
Eday Road
Aberdeen
AB15 6LS Tel: (01224) 5 56713
Dr Malcolm Metcalfe, Lead Clinician (Tel. No. above)
Dr Jim Black, Lead GP (Tel. No. above)
Mr Sandy Reid, Network Manager,
CHD/Stroke MCN Tel: (01224) 5 56713
Mrs Christine Gray, Secretary
(Tel. above no.)
Mrs Karen Secombes, Heart Failure Co-ordinator
Tel: (01224) 553605
Mrs Brenda Anderson, Cardiac Rehabilitation
Project Manager
Tel: (01224) 5 53946
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