A project in Tower Hamlets in East London that grouped practices into local networks for cardiovascular care saw premature death rates fall almost twice as fast as neighbouring areas, researchers found.
Statin prescribing rates dramatically improved and local QOF performance on cholesterol and BP indicators rose to the highest level in England.
Study authors from the Queen Mary University of London, including three academic GPs, said the initiative could help to address the inverse care law.
The scheme was launched in 2008/9 by the local PCT in Tower Hamlets, a deprived inner-London borough.
At the time, the premature cardiovascular death rate in the area was 60% higher than the England average, and ranked the PCT fourth highest in the country. It also had high hospital admission rates for heart disease and stroke. Despite this, PCT spending on primary care was among the lowest in the country.
In response, the PCT put forward a £10m-a-year fund to promote collaboration between local practices, to boost care for CVD, diabetes, COPD, and childhood immunisation.
Working with the LMC, the PCT allocated 34 local practices to one of eight managed practice networks, each including four or five practices covering a total of up to 50,000 patients.
Every network had a manager, administrative support, and education resources, costing a total of £2m across the eight networks. Practices were incentivised to reach clinical targets for the four conditions to earn a share of the remaining £8m, which previously funded local enhanced services.
Clinical targets for cardiovascular care included reaching BP <140/90mmHg for hypertension, stroke, and CHD; cholesterol <4mmol/l for CHD, stroke, and diabetes; and BP <140/80mmHg for diabetes.
Patients who were ‘off target’ were recalled more frequently using standardised recall searches in all practices. Other targets were added over time, including reviews of recent MI cases and attendance at cardiac rehabilitation.
Deaths fell 43%
Practices were paid if their network’s average achievement exceeded the targets, and pro rata based on attainment and patient numbers. Each network used monthly performance ‘dashboards’ through EMIS to view the performance of other practices in the network.
From 2009 to 2011, practices in Tower Hamlets increased statin prescribing by 17.9%, dwarfing the national increase of 5.5% in England during the same period. Male deaths from CHD fell by 43%, compared to an average fall of 25% in neighbouring PCTs.
In 2012/13, QOF data ranked Tower Hamlets first in England for BP and cholesterol control in CHD and diabetes.
Researchers said the change was ‘unlikely to have been achieved without this method of working’. The local CCG has now expanded the networks to cater for a wider range of services, including integrated complex care, study authors said.
On the success of the network project, they said: ‘The programme is highly popular and perceived as successful by GP practices and commissioners, representing one small step to address the inverse care law.’