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Proactive Care Frameworks: Implementation lessons learned in Cheshire and Merseyside

Hear from Jane Briers who gives an overview of their achievements, key learning and challenges to date, since implementing the proactive care frameworks in the North West of England as one of the four pilot sites.

Jane Briers, CVD Programme Manager, Innovation Agency, discusses the experiences and learnings from implementing the proactive care frameworks in the North West of England. Listen to her talk below.

Key Learning

• Hypertension management is a crowded space. 
• Align with different system partners and develop joint ambition.
• Pool resources where appropriate. 
• Understand the data. Identify struggling practices.
• Keep focus on control of blood pressure.
• Empathetic approach to capacity issues. Use as an opportunity to innovate.
• Availability and access to practical resources.
• Hands on approach to support and spread good practice. 
• Drop-in clinics particularly successful.
• Capitalise on population health approaches.

Challenges

• Within C&M gaining NHSE ownership has been challenging over BP@home approach.
• Workforce capacity related to pandemic.
• Frequent changes CCG/place leads.
• Practice/PCN recognition that their performance of BP control is sub-optimal.
• Maintaining clarity of messages to primary care. 
• Multitude of different system partners engaged in hypertension space.
• Clinicians keen to engage with risk stratification approach, however less engaged with personalisation agenda.
• Primary care capacity to focus on hypertension, competing priorities.

Proactive care frameworks

Our online support package contains tools and resources to help primary care teams to continue to effectively deliver proactive care for patients with CVD and respiratory conditions.

View the frameworks