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Primrose A and UCLPartners Proactive Care Frameworks: providing tailored CVD support for people with serious mental illness

NIHR ARC Multiple Long-Term Conditions Implementation Programme have awarded funding to a project to evaluate a framework for providing a tailored CVD (Cardio-Vascular Disease) intervention to people with severe mental illness (SMI).

The framework combines two existing programmes: the Primrose A project to address physical health issues in people with serious mental illness, and UCLPartners’ Proactive Care frameworks.

People with severe mental illness experience profound health inequalities, which the NHS long term plan seeks to address. People with serious mental illness die 10-20 years early, particularly from CVD, due to a number of risk factors.

The project will explore the impact of combining the UCLPartners’ Proactive Care and Primrose frameworks on providing sustainable targeted physical health interventions and economic efficiencies at scale within the existing workforce, amplifying health benefits and reducing health inequalities.

The project is a collaboration between the NIHR Applied Research Collaborations (ARCs) for North Thames and Yorkshire and Humber.

It is one of four projects funded as part of the NIHR ARC Multiple Long-Term Conditions Implementation Programme which is being led by ARC East Midlands.

Primrose is a HCA/ nurse-led intervention offering flexible appointments over 6 months, incorporating behaviour change techniques and collaborative work to address cholesterol, smoking, weight and blood pressure in patients with serious mental illness. A cluster trial in 76 English general practices showed a decrease in admissions over 12 months for people who received the intervention, with reduced costs. However, improvements in CVD management were required, particularly on medication management. A HEE-funded updated intervention – Primrose A – is currently being delivered to people with SMI by Camden and Islington NHS Foundation Trust in general practices throughout Camden, with increased focus on medication adherence and recovery work alongside peer support workers. UCLPartner’s Proactive Care frameworks – widely supported both regionally and nationally – can enhance Primrose A by identifying patients on primary care records with SMI to optimise management.

The NIHR ARC Multiple Long-Term conditions project funding will help to evaluate the combination of Primrose A and UCLPartners’ Proactive care frameworks to optimise preventive care for people with SMI and high risk conditions for CVD in primary care and community settings.

The Primrose intervention was developed through focus groups with service users, carers and health professionals, with co-produced content and materials. As part of the new project the team will include a peer coach and will form a new advisory panel with PPI representatives from the North Thames and the Yorkshire and Humber region.

UCLPartners-Primrose SMI Framework Search tools for EMIS and SystmOne

We have built a search tool for EMIS and SystmOne which identifies all patients with severe mental illness (SMI). Using the UCLPartners-Primrose SMI Framework, patients are then stratified into priority groups based on recorded evidence of factors that contribute to cardiovascular disease risk such as high blood pressure and cholesterol.

We also have a range of support materials for practices/PCNs that would like to use the framework. Please contact for more details.