Commissioning guides
Published 01 May 2012

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

5 Service specification for services for the prevention of cardiovascular disease

Commissioners may wish to consider commissioning services in a number of different ways and mixed models of provision are likely to be appropriate. Commissioners may wish to take action to stimulate the local market if there are identified shortages of providers at any point in the pathway and should note that any qualified providers may include health, local authority or other statutory partners, or private or third sector organisations.

Table 8 includes considerations for commissioners when developing a contract specification for cardiovascular disease prevention services. Contract considerations will differ depending on whether the contract is for population-wide, community-based or individual approaches.

Table 8 Considerations for contract specification

Heading

Section

To be described in service specification

Purpose

Policy context

National policy drivers (see section 7).

Evidence base (for example, NICE guidance and quality standards and NHS evidence).

Local strategic context

Local commissioning drivers (for example, reducing health inequalities, QIPP, CQUIN).

Invest to save.

Results of joint strategic needs assessment (JSNA).

Aims and objectives of service

The expected outcomes of the services, including a reduction in under-75 mortality from cardiovascular disease and other non-communicable disease (see section 1.1).

Service scope

Define service user groups

Demographic profile of the local population (age, gender, ethnicity, socioeconomic status).

Local recorded and expected prevalence of people with cardiovascular disease (stroke, TIA, peripheral arterial disease, myocardial infarction, angina and chronic heart failure).

Local recorded and expected prevalence of people with cardiovascular disease risk factors (smoking, poor diet, high blood cholesterol, hypertension, physical activity, overweight/obesity, diabetes, psychosocial stress and excess alcohol consumption).

Local recorded and expected prevalence of people younger than 75 with low, moderate and high risk of cardiovascular disease.

Estimated prevalence of comorbidities (for example, hypertension, stroke, heart failure, depression).

Evidence of inequalities in outcomes between specific groups.

Number of wholly attributable and partially attributable cardiovascular disease-related hospital admissions, bed days and readmissions.

Number of people currently being treated in community-based lifestyle and behaviour change services.

Number of people who see their GP and have a recorded incidence of cardiovascular disease, cardiovascular disease risk, smoking, obesity, hypertension, atrial fibrillation, chronic kidney disease or diabetes (via relevant QOF data).

Population groups that will be targeted.

Exclusion criteria

Define exclusion criteria in accordance with NICE guidance, relevant policy such as local implementation of NHS Health Check, and other locally determined criteria.

Geographical population

Proportion of people living in urban and/or rural areas.

Areas of higher-than-average need (for example, areas of deprivation, areas with a high population of older people, areas with a high South Asian, African or African-Caribbean population).

Population coverage required or geographical boundaries.

Service description/care package

Mapping existing services and assets for the prevention of cardiovascular disease, including:

population-wide and community-based initiatives designed to create healthier environments supporting the prevention and reduction of cardiovascular disease.

NHS Health Check.

Opportunities for opportunistic identification.

Lifestyle and behaviour change interventions..

Commissioning of core service components.

Interface with other local services including those for drugs and alcohol, smoking cessation, diet and nutrition, physical activity, weight management, and existing services across all sectors for the management and secondary prevention of cardiovascular disease, diabetes and chronic kidney disease.

Service delivery

Location

Service location and accessibility requirements.

Integration with other services for people at risk of cardiovascular disease.

Home-based, locality-based and centrally based services.

Opportunities for personalisation.

Days/hours

Expected hours of operation, including days, evenings and weekends.

Expected number of people for cardiovascular disease risk assessments, opportunistic identification and lifestyle and behaviour change services, taking into account potential increased flow through the system over defined periods.

Depending on local demography, consider:

  • commissioning interpreting services in areas with a large black or minority ethnic population

  • flexible drop-in style services, which may appeal to younger people and people who work long hours.

Referral processes

Referral criteria and processes for people with low, medium and high risk of cardiovascular disease, and existing diabetes or chronic kidney disease.

Management of 'unable to attends' and 'did not attends' for cardiovascular disease risk assessments or lifestyle and behaviour change interventions.

Response times

Needs-based and outcomes-based.

Setting specific times, particularly for access to lifestyle and behaviour change interventions.

Care pathways

Agreed clinical protocols or guidelines to support decision making in the patient pathway.

Pathways for people with complex needs and comorbidities.

Care coordination, for example using health mentors and health trainers.

Discharge processes

Process for discharge from services for people at risk of cardiovascular disease, including ongoing monitoring and communication with other teams (particularly general practice).

Staffing

Profile of existing health and social care workforce.

Staffing levels to be funded: minimum band or levels of experience and competency and expected skill mix.

Skill mix and competencies of staff for specific areas of care.

Information sharing

Define information sharing, confidentiality and audit requirements, including IT support and infrastructure.

Raising awareness of services for people at risk of cardiovascular disease (do patients and health and social care professionals know how to access services?).

Quality assurance and clinical governance

Patient and public involvement

Processes to understand patient experience of cardiovascular disease prevention services in order to develop and monitor services. See also Patient experience online network.

Expectations of how patient opinion, preference and experience will be used to inform service delivery (for example, focus groups, representation on working groups, and surveys).

Monitoring of complaints and compliments and how they are used to inform service.

Quality indicators

NICE quality standards define high-quality care.

QOF rewards GPs for how well they care for patients.

Patient satisfaction surveys and access to treatment.

Performance monitoring

Local need and demand for cardiovascular disease prevention services, including smoking cessation, weight management, diet and nutrition, physical activity.

Impact of service on cardiovascular disease incidence and associated admissions to accident and emergency department, inpatient hospital care and length of stay in hospital.

Measurement of referrals, starters and completers for lifestyle and behaviour change interventions (to be determined locally using best evidence if national guidance not available).

Equality

Measures to ensure equality of access to services, taking into account the risks of unintentional discrimination against groups who are often under-represented, such as people who do not speak English as a first language.

Consider equity of access for people living in residential and nursing homes, those who are housebound, and people in prisons.

Staff training and competency

Training and competencies on recruitment and for ongoing development.

Processes for monitoring clinical practice and competency, including professional registration and clinical supervision arrangements.

Skill mix and competencies required across the care pathway, including competencies in cardiovascular disease risk assessments, clinical tests, behaviour change, prescribing. See Skills for Health for examples.

Staff development – appraisal and personal development plans, and mandatory training.

Audit

Specify expectations for audit, which may include assessment, intervention, prescribing practices and successful treatment outcomes.

Staff and patient safety

Procedures for risk assessment.

Formal procedures for incident reporting and monitoring.

Address any safeguarding concerns and promote the welfare of children and vulnerable adults.

Activity plan

Long-term impact of cardiovascular disease prevention programme on incidence and trends of cardiovascular disease in the population.

Planned service development setting out any productivity improvements.

Cost

Value for money

Likely cost of new or additional services.

Anticipated set-up costs.

How will pricing be set?

Potential for better value for money.

Are patients receiving most appropriate services for reducing cardiovascular disease risk?

Cost of facilities (for example, venue hire).

Cost of staff travel to services and patients' homes.

QIPP.

See the Commissioning and benchmarking tool for further information.