Phase Two - tackling cholesterol management in West Yorkshire and Harrogate

Phase two of the West Yorkshire and Harrogate Healthy Hearts project focuses on optimising cholesterol management in patients who are on a low-intensity statin, and initiating treatment in patients with a CVD risk >10 who are currently not on a statin (or those that have had the offer of a statin previously and may now benefit). High cholesterol is one of the most significant risk factors for CVD.

Please note that launch of phase two of the project will be implemented by each local NHS CCG at different times. If you have any questions, please contact your local NHS CCG or email the WYH Healthy Hearts project team WYHHealthyHearts@yhahsn.com

We aim to provide support resources for Primary Care professionals to help minimise workload, whilst at the same time improve the outcomes for patients.  To support practices, we have created several useful resources that we hope will support GPs when carrying out this work. This includes clinical searches, agreed local treatment guidance and information which can be used when communicating with patients.

The local cholesterol treatment guidance document has been created following local engagement, and a review of NICE guideline CG181 as well as other national and international treatment guidance. The guidance has been agreed by the Elective Care and Standardisation of Commissioning Policies Programme Board, the West Yorkshire and Harrogate Pharmacy Leadership Group, the WY&H Area Prescribing Committees and the Joint Committee of CCGs.

The estimated adult population across West Yorkshire and Harrogate with a 10-year CVD risk > 20% is 175,000, and of those 89,250 aren’t treated with a statin. If this project identified and treated 10% -9,000 people would receive treatment and an estimated 225 to 400 CVD events would be prevented over the next 5 years.

Phase Two – supporting resources for Primary Care

Below you will find a list of resources designed to help those working within Primary Care in West Yorkshire and Harrogate who are implementing phase one of the Healthy Hearts project.

• Phase two overview: This document offers a brief summary of what phase two aims to achieve.

• Lipid guidance including (please note we are in the process of revising Treatment Guidance following NICE TA recommendations):

- Clinical searches: to help practices identify patients suitable for statin switches and initiation of a statin.

- Treatment flowchart: detailed information for lipid management for patients with CVD or risks of CVD.

- Supporting clinical information: useful information for GPs who are treating patients with CVD and risks of CVD.

- Statin intolerance: useful advice about statin intolerance and actions to address it.

• Guide on how to import searches and templates.

• Specialist lipid and familial hypercholesterolaemia pathway
• Lipid implementation resource: this implementation resource provides an overview of the project, as well as links to further supporting information, such as clinical searches, system templates linked to patient letters, FH and specialist lipid pathway.
• We have created an example process when communicating with patients about the initiation of statins or change of statins.
• West Yorkshire and Harrogate Lipid and Statin background: it provides detailed information about the rationale and evidence used to develop the local clinical guidance.
• Clinical FAQs: answers to the most common questions about statins and their side effects
• Shared decision making: 8 key points for health professionals to consider in any shared decision making and behaviour change approaches.
• Audit report: a monitoring sheet that practices can use to record their work on cholesterol management.
• Summary of national guidance for lipid management

Phase Two - resources that Primary Care can use for patients

Here you will find patient letters and two frequently asked questions documents to support practices when contacting patients.

• Offer statin QRISK 10%-20% - never had a statin before - patient letter

• Offer statin QRISK 10%-20% - previously had statin - patient letter

• Offer statin QRISK 20% - never had a statin before - patient letter

• Offer statin QRISK 20% - previously had statin - patient letter

• Statin switch (directly included in the next prescription) - primary prevention - patient letter

• Statin switch (directly included in the next prescription) - secondary prevention - patient letter

• Statin switch (further discussion needed before issuing prescription) - patient letter

• New statin medication prescription - frequently asked questions to help answer any questions or concerns patients might have.

• Change of statin medication - frequently asked questions to help address any questions or concerns patients might have. 

• How to guide - templates and patient letters

• Easy Read - never had statin before - patient letter

• Easy Read - previously had a statin - patient letter

• Easy Read - new statin medication prescription - frequently asked questions

• Easy Read - change of statin medication - frequently asked questions

• Moving Medicine: A short, but good quality conversation at the end of a consultation can be very effective in changing people’s levels of physical activity. This toolkit gives you everything you need for a 1 minute, 5 minute and even more minute conversation