Services for the prevention of cardiovascular disease

This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg45

7 Further information

Table 9 summarises national drivers relevant to commissioning services for the prevention of cardiovascular disease. Local service redesign may address only one or two of them.

Table 9 National policy and key drivers relevant to the prevention of cardiovascular disease

Document	Author	Year	Significance
Public health outcomes framework 2012–2016	Department of Health	2012	Sets out national level desired outcomes from public health in England, including reduction in health inequalities and mortality from cardiovascular disease.
NHS outcomes framework 2012/13	Department of Health	2011	Includes measures to prevent premature mortality from cardiovascular disease.
Quality and outcomes framework (QOF)	NICE	2011	Rewards general practice for quality care and helps standardise improvements in the delivery of clinical care. Includes indicators for the primary prevention of cardiovascular disease, and a range of modifiable risk factors.
Fair society, healthy lives: the Marmot Review	The Marmot Review	2010	Independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010.
Putting prevention first: NHS Health Check – vascular risk assessment and management: best practice guidance	Department of Health	2009	Provides best practice guidance to support public health in its implementation of the NHS Health Check programme.
Cardio and Vascular Coalition: destination 2020. A plan for cardiac and vascular health. The voluntary sector vision for change	British Heart Foundation	2009	Outlines a strategic approach to cardiac and vascular conditions, with an emphasis on prevention of cardiovascular disease.
The handbook for vascular risk assessment, risk reduction and risk management	University of Leicester and UK National Screening Committee	2008	Handbook draws together best practice guidelines for assessing and managing a range of vascular risks.

Useful sources of information for commissioning may include:

The standard NHS contracts for acute hospital, mental health, community and ambulance services
NHS Evidence: provides free access to clinical and non-clinical information – local, regional, national and international. Includes a QIPP library with case studies and commissioning zone
NHS Improvement for examples of good practice, service development and redesign
The NICE shared learning database offers examples of how commissioners and service providers have used NICE guidance to create innovative and effective local implementation programmes for service improvements
Implementation and audit support tools for NICE guidance
Guidance on risk assessment and stroke prevention for atrial fibrillation (GRASP-AF) is a query and risk stratification tool that enables practices calculate a stroke risk score for each patient with a history of atrial fibrillation and ensure that they are on appropriate oral anticoagulant therapy. It is free to download from the PRIMIS+ Profile Centre.
BACPR standards and core components for cardiovascular disease prevention and rehabilitation (2nd edition).
Skills for Health/National Occupational Standard

Commissioners may wish to alert local overview and scrutiny committees to the following Centre for Public Scrutiny and NICE tools:

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

The Information Centre for Health and Social Care's Health Survey for England is a series of annual surveys designed to measure health and health related behaviours in adults and children.
NHS Evidence is a service that enables access to authoritative clinical and non-clinical evidence and best practice through a web-based portal. It helps people from across the NHS, public health and social care sectors make better decisions.
NHS Information Centre Indicator Portal gathers together a number of health and social care indicators.
NHS Atlas of Variation 2011 covers 71 indicators and 15 Programme Budget categories, including the prescribing of statins.
NHS Comparators provides comparator data for NHS commissioning and provider organisations to enable users to investigate aspects of local activity, costs and outcomes
The Disease management information toolkit is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long-term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options
Disease prevalence models produced by the Association of Public Health Observatories provide primary care trust-level prevalence estimates by topic.