Regional AHSNs are working to lower these CVD risk factors through our Blood Pressure Optimisation (BPO) programme, supporting primary care in three ways:
1. Implement UCLPartners’ Proactive Care Frameworks
Proactive Care Frameworks support primary care staff within Primary Care Networks (PCNs) to optimise clinical care and self-management for people with high blood pressure and other CVD risk factors such as high cholesterol. The Frameworks offer:
- Risk stratification to prioritise which patients to see first
- Use of the wider workforce to support remote care and self-care
- Supporting patients to maximise the benefits of remote monitoring and virtual consultations where appropriate
These initiatives support GP practices to meet the Quality and Outcomes Framework (QOF) and other quality improvement targets.
2. Develop case finding initiatives
AHSNs are supporting PCNs to identify patients with previously undiagnosed high blood pressure through case finding interventions.
3. Focus on tackling health inequalities
AHSNs are supporting Integrated Care Systems (ICSs) to reduce health inequalities by targeting support to the most deprived populations and other local priority groups for CVD, as outlined in NHS England’s Core20PLUS5 guidance.