Transforming primary care pathways to optimise treatment for familial hypercholesterolemia and cholesterol
A new and improved Lipid Service in Somerset is improving patient access to lipid lowering treatment by increasing its capacity to manage and treat patients, and increasing knowledge and confidence in primary care by providing clear clinical guidance, resources and education.
In Somerset 23,000 people are living with coronary heart disease, and there are around 14,000 stroke survivors in the Somerset area (Somerset Intelligence, 2021) (BHF, 2023).
Heart and circulatory diseases kill more the 1 in 4 people in the Somerset Area (BHF 2023). Somerset detection and treatment of hyperlipidaemias, including familial hypercholesterolemia (FH), in primary care is low, putting a significant proportion of the population at increased risk of cardiovascular disease (CVD).
In 2021, there was a limited provision of lipid clinics and specialists within the region, with one consultant-led clinic a month in secondary care. There was a growing waiting list and lengthy waiting times from referral to appointment for patients (waiting time above 79 weeks for some patients and a 92nd percentile waiting time of 77 weeks for those referred in 2021) due to limited service provision and capacity.
To address these challenges, Health Innovation South West, in partnership with the regional teams and leads, developed a phased approach to design, deliver, deploy and evaluate an innovative lipid service in Somerset and Devon, with the ambition to spread more widely across the peninsula.
Health Innovation South West secured funding through the Collaborative Lipids Fund (CLF) to deliver a project focused on improving and building a service model in Somerset, implementing best practice and developing cross-organisational working in both Somerset and Devon since April 2023.
The team consisted of the South West Genomic Medicine Service Alliance (SWGMSA), Somerset CCG (now Somerset Integrated Care System), The Somerset Training Hub, Yeovil District Hospital (YDH), Public Health Somerset and lipid service colleagues from University Hospitals Bristol (UHB).
In September 2021, The Health Innovation South West led the formation of a multi-organisational steering group headed by the Lipid service lead to, to reduce the high lipid service waiting lists in the county. During the period September 2021 to March 2024, the work of this group has focused on:
- Securing funding for the lipid service design and delivery
- Building and solidify the foundations for a sustainable service, including defining and recruiting into key roles
- Delivering primary care education in lipid management to improve detection and treatment of hyperlipidaemia, including the development of key resources for Health Care Professionals (HCPs) and people with or at risk of CVD
- Building evaluation and learning into the programme and conducting an early evaluation of the programme; embedding evaluation tools and processes into the programme for ongoing learning to support the sustainability of the programme
- Helping to develop a primary/secondary care integrated and regional lipid pathway by working alongside the lead clinician and primary care and the commissioners
- Developing pharmacist and GP led lipid clinics, with oversight from the lead clinician
- Creating a service re-design toolkit to share with a wider audience to support NHS organisations to plan, set up, run and evaluate a lipid service re-design.
Patient impact
- An increase from one to four lipid clinics being delivered per month.
- 323 patients have had a consultation, with a significant number receiving treatment for their CVD condition. and patient feedback is positive.
- Reduction in the average and median waiting time from referral to treatment has also been seen between 2021 and 2023.
Clinical impact
- 608 attendees have participated in 20 education sessions in lipid management.
- 45% of GP practices in Somerset have access to the resources developed during the redesign of the service.
- More than 67 healthcare organisations across the region have benefited from these sessions and the resources.
- The newly redesigned Somerset service scored 76 out of 100 on the NHS Sustainability Model, which predicts how sustainable an improvement project is likely to be. The higher the score, the more likely it is that the initiative will become an established way of working, replacing older structures and processes, and potentially allowing for continued improvement over time.
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A really positive input. It's been really satisfying...I feel like I have a positive contribution. It certainly led to more satisfaction, and understanding of my own role and how I fit in primary care.
Lipid practitioner
