Cardiovascular Disease Directed Enhanced Service: views and experiences of General Practices

2. Reasons for participating

This chapter looks at the interview findings about why practices decided to participate in the CVD DES.

Reasons for signing up to the CVD DES (interview findings)

At interview, General Practices were asked the main reasons why their practice had signed up to participate in the CVD DES. Four main – and often connected – themes emerged, namely the:

• availability of funding
• focus on prevention
• age and health profile of the patients on their list
• opportunity to try and engage with patients with whom they have had no recent contact

While most interviewees noted that the availability of funding had been key, it was sometimes described as a central consideration.

“In general practice, there’s very little goes on unless people are having additional payments for it… there’s no putting icing sugar on top of that… that was the major driver… if there was no financial adjustment to undertake this, it would never have happened in the practice.” Other Health Professional, medium-sized practice in an urban area with a relatively high proportion of people living in deprived areas

Others referred to the financial pressures practices have been dealing with, along with the need to balance the books, with any additional resources coming into the practice seen as both welcome and as an enabling factor; in this case, the funding was seen as supporting practices to carry out work they saw as valuable, with the focus on preventative health care as of particular value.

The focus on, or as some practices articulated it the refocusing on, preventative healthcare was universally welcomed, albeit there were occasional questions about the specific focus of the CVD DES (discussed further in Chapter 9).

“I think it was us seeing the first opportunity for preventative medicine in a long time, really… because there seems to be a lot of firefighting and dealing with disease once it’s progressed. We’ve seen [it] as an opportunity to try and have earlier intervention and do some preventative health care, which we were really interested in.” GP, large practice serving a predominantly urban population with a relatively low proportion of people living in deprived areas

In terms of the general principal of preventative action, there were references to having been supportive of, or involved in, the delivery of the Keep Well and THRIVE approaches^[3] or to running their own Well People clinics for the over 40s. However, there were also reflections that the recent and current pressures on General Practice services, along with the current funding arrangements, have left little room for practices to be proactive and focus on delivering preventative healthcare.

Those that were seeking actively to keep some focus on preventative work – for example by adding on additional checks when already taking a blood test – suggested that the CVD DES not only offered welcome recompense for this (currently unfunded) work but also gave an added structure and focus to this strand of their activity.

Frequently linked to being supportive of an increased focus on prevention were observations about the profile of patients on the practices’ lists, including references to both the age profile (usually in terms of an ageing population profile) and to the prevalence of chronic health conditions of the kind linked to CVD. Practices with a higher proportion of patients living in an SIMD 1 or 2 area were more likely to make the connection between CVD rates and socio-economic deprivation, and to support explicitly the focus on deprivation more generally and on patients with whom they have had no recent contact in particular.

“I think we all collectively agreed that it was a really good service to offer the patients in the town. We have a higher level of deprivation… we’re one of the highest in Scotland, if I remember correctly. We thought it might give us a chance to pick up on some of the ‘missingness’ that everybody's talking about and pre-empt all those MIs [Myocardial infarctions] and strokes and diabetes that are going to come in 5 and 10 and 20-years’ time.” Practice Manager, large practice in a small town with a relatively high proportion of people living in deprived areas

This focus was seen as not only beneficial to individual patients and communities, but also as a rational ‘invest to save’ approach that could potentially have an impact on the requirement for more resource-intensive interventions at a later stage. However, it was also noted that the scale of any impact would be linked to the scale of the CVD DES and, by extension, the amount of funding put into it (discussed further in Chapter 9).

In addition to the more frequently given reasons outlined above, other reasons given for participating in the CVD DES included:

• a health board-run practice being required to do so by their health board
• as an opportunity for a particular member of staff, who was often relatively new to the practice, to take a central or lead role in delivery: this included a GP registrar leading the CVD project as part of their training
• the relative flexibility in the delivery approach, including an expectation of being able to deliver the programme with limited GP involvement

Summary findings

From interviews:

• The main reasons given by practices for signing up to the CVD DES were the availability of funding, the focus on prevention, the age and health profile of the patients on their list and having an opportunity to try and engage with patients with whom they have had no recent contact.
• The focus on preventative work was particularly welcomed; this was connected to experience that the pressure on General Practice services, along with current funding arrangements, have left little room for practices to be proactive and focus on delivering preventative healthcare.