Project overview:

Familial Hypercholesterolaemia (FH) is a known genetic condition that confers a significant increased risk of premature cardiovascular disease and mortality. It is characterised by very high levels of blood cholesterol and impaired lipid metabolism. Treatment with high dose statins and newer lipid lowering therapies significantly reduces that risk and current NHS guidance states these should be made available to all affected by the condition. The NHS provides a genetic screening process for those thought to be affected. Currently, there is no targeted or 'system-wide' approach to the identification, contacting, referral, and subsequent testing of these at-risk individuals within the area. 

The incidence of the condition within a western population is thought to be roughly 1 in every 250 patients - meaning there are approximately 45 affected individuals per practice across Cambridgeshire & Peterborough.

The waiting list for the lipid clinic in Cambridge and Peterborough is currently greater than 12 months, making early treatment with lipid-lowering therapies important for reducing patient risk.

This innovative new scheme, commissioned by the ICB as part of the “Your Healthier Future” initiative, seeks to use a population health approach to accurately identify, engage with and educate patients on the condition and benefits of lipid lowering therapy. This will provide a mechanism to gather patient responses, facilitating increased first line treatment of this important at-risk cohort, whilst also streamlining the referral process for specialist assessment, and hopefully result in a higher yield of genetically confirmed cases.

We are seeking the agreement of all Cambridge and Peterborough practices for their willingness to be involved in this programme.

There are two tiers of support on offer: 

1. Eclipse Detect – Activation of this programme will commence the FH Detect pathway within Eclipse, providing a list of all eligible patients, alongside additional priority groups, which can be further filtered and prioritised by parameters such as levels of deprivation, ethnicity, comorbidities, and risk. Practices can then engage with these patient groups to offer lipid-lowering therapies and referral to the lipid clinic.

2. Eclipse Complete – Activation of this programme will automatically engage with prioritised patients via the PEGASUS platform to inform, educate and invite patients to start lipid lowering therapy and be referred to the lipid clinic via an online questionnaire. If desired, telephone patient engagement to non-responders can be activated to allow a team of motivational interviewers to contact your patients to complete the questionnaire. Once the patients have completed their questionnaires, they will be further segmented within the system into cohorts based on the patient preferences and actions required e.g. “patients consented to statin and lipid clinic referral”. This process aims to streamline clinician activity and reduce the burden on primary care.

The aim of either programme is that practices will both initiate statin therapy for consented and eligible patients, whilst also referring on those who consent for assessment by the lipid clinic. 

REMUNERATION:

This patient support programme is part of the Cambridgeshire & Peterborough Your Healthier Future programme. There will be some additional funding for practices participating in this programme. Practices have three choices:

1. Eclipse Detect - Practices that would like to activate Eclipse Detect to risk stratify and identify patients eligible for a lipid clinic assessment and lipid lowering therapy, will undertake patient engagement through their own practice team. Payment to practice is set at £1,000 if the target* is met.

2. Eclipse Complete - Practices that would like to activate Eclipse Complete will have all patient engagement undertaken for them through a centralised patient support hub. Payment to practice is set at £400.

3. No participation - Practices that would not like to utilise either Eclipse Detect or Complete will not receive any additional financial remuneration for the FH Detect programme.

*Individual practice targets will be based on an average of the proceeding 2 years of practice performance for each of the metrics being targeted in the Your Healthier Future programme. These targets have been approved by the ICB and require an equal effort from all practices within an upper and lower threshold.

EVALUATION: As well as quantitative data, which will be collected via Eclipse, patient reported outcomes and perceptions of the new pathway will be collected through patient questionnaires.

If your practice would like to take part: Please complete the below pro forma, expressing your interest and permissions for patient engagement.

Please note that you will be notified prior to any active patient engagement, and your practice will be issued with a guide on how to view patient lists and document patient reviews.