Partnerships against heart disease

The government has made much of encouraging the NHS to work in partnership with other organisations to improve choice and care standards.

However, there is one sector with which the NHS has been wary of working closely. Some people remain to be convinced that the pharmaceutical industry could be a genuine stakeholder in the delivery of improved care to patients.

For some time, Nottingham City primary care trust had wanted to develop and implement a primary care-based cardiovascular disease primary prevention programme.

There is a well-established link between deprivation, CVD and lower life expectancy, and Nottingham is the seventh most deprived local authority area in England and the most deprived in the NHS East Midlands region.

Nottingham has a poor profile for contributory lifestyle factors, including high levels of smoking, low levels of physical activity and poor diet and nutrition. All this contributes to CVD being the main cause of death in the city and accounting for 36 per cent of all deaths in 2004.

With little financial incentive (via the quality and outcomes framework) and potentially significantly increased workloads for GPs to undertake such a programme, the PCT knew it would have to provide significant resources to the practices to encourage participation.

In 2006, the pharmaceutical industry, led by the Association of the British Pharmaceutical Industry, developed the NHS outreach programme, which sought to show that groups of pharmaceutical companies could work in genuine partnership with NHS organisations on projects that would lead directly to improved patient outcomes and help NHS organisations achieve their strategic objectives.

Setting up three pilot areas, in the East Midlands, North West and the South West, the association engaged specialist regional facilitators to work with PCTs on identifying joint-working opportunities and then making them happen.

Interrogating databases

Through the outreach programme, Nottingham City PCT worked with six pharmaceutical companies to develop and implement a primary care-based CVD risk identification project. This aims to reduce levels of CVD risk by managing people who have more than a 20 per cent risk of developing the disease. Thirteen practices in the most deprived areas of the city have been recruited and each has taken on a specialist clinical healthcare assistant, funded and trained by the collaborative.

Using specialist software, the assistants will interrogate GP databases and calculate risk scores for all patients. The most at-risk people will be invited to have a detailed health check.

The patient and the assistant will develop jointly agreed lifestyle improvements goals. Where necessary they will be signposted to other support services, such as Nottingham's smoking cessation service, New Leaf. If their clinical tests reveal concerns regarding hypertension, diabetes or raised cholesterol, the patient will be referred to the GP or practice nurse.

This may sound similar to many screening programmes in development around the country. But what makes this project so different is the collaboration between the PCT and the pharmaceutical industry. The PCT and the six participating pharmaceutical companies, brokered by the outreach programme, have worked in partnership on every aspect of the project.

Sponsored by public health director Chris Packham, a steering committee was established in January 2007, equally representing the PCT and the pharmaceutical industry and jointly chaired. Small working sub-groups of the committee were responsible for developing the specific elements of the project, including the service-level agreement and recruitment of practices, the development of a detailed job specification and position profile for the specialist clinical assistants and a detailed monitoring and evaluation process supported by a sophisticated software tool.

The programme was named the Happy Hearts Project, which gave it a life of its own and for the purposes of all discussions and meetings around the project, the traditional boundaries between PCT and industry were forgotten.

Skills boost

The pharmaceutical industry has significant commercial skills. By bringing in expertise in marketing and communications, the project has been given a high-profile brand and identity both within Nottingham and with the key stakeholders taking part, which has increased buy-in to the project.

Decisions about treatment guidelines were made by the PCT before any pharmaceutical companies were approached, so any links with prescribing were removed from the start. And many companies that supported the project do not have products on the PCT vascular guideline formulary.

For them, this was an opportunity to work in a different way with their customers and by working side by side, to gain a better understanding of how their customers worked and the challenges they faced.

Both sides recognised the other's different but complementary skills and expertise and learned much from each other. Most importantly, the patients of Nottingham will benefit from being part of this unique partnership.

For successful collaborative working between the NHS and the pharmaceutical industry, both parties should aim to ensure:

• favourable organisational structure and organisational buy-in to the collaboration;

• mutual respect, understanding and trust;

• appropriate group membership;

• clear roles and responsibilities/accountabilities;

• shared vision;

• clear aims and objectives and expected project outcomes;

• open and honest communication on a regular basis;

• sufficient funds, staff, materials and time;

• skilled leadership/facilitation.