1. Chronic Disease Management Why is this an important issue? High numbers of patients affected Effective interventions may be available Concern that there is variation in standards of care across the country In response to this the Government/DoH has set up some National Service Frameworks

2. National Service Frameworks What are National Service Frameworks? DoH documents/plans but with expert input Part of modernisation of NHS Provide standards & service models Aim to disseminate good practice

3. National Service Frameworks Aim to ensure nationwide access to consistent, good standards of care Evidence-based E.g. CHD, Elderly, Mental Health More to come

4. National Service Framework for Coronary Heart Disease 10 year programme published by the government in 2000 Sets out 12 national standards for prevention and treatment of CHD

5. National Service Framework for Coronary Heart Disease Recommends service delivery models Gives milestones to mark progress Lays down audit requirements

6. The 12 standards 1 & 2: Reducing heart disease in the population, reducing smoking 3 & 4: Preventing CHD in high-risk groups 5,6 & 7: Heart attacks and other acute coronary symptoms

7. The 12 standards 8: Stable angina 9 & 10: Revascularisation 11: Heart failure 12: Cardiac rehabilitation

8. NSF requirements for primary care All relevant but perhaps especially - Standards 1 & 2: Reducing heart disease in the population, reducing smoking Standards 3 & 4: Preventing CHD in high risk patients Standard 11: Management of heart failure

9. What is required to make it happen? A systematic approach to preventive cardiac care Clinical protocols for dealing with established heart disease A robust system for identification, management & recall of patients

10. Ensuring quality Structure and process elements of any system easier to monitor than outcome Outcome may be years in the future Will morbidity/mortality be improved?