Ischaemic Heart Disease Care

The most recent patient survey has shown that patients want to be able to see the clinician sooner (i.e less than 2 weeks) and on time (i.e not have to wait an hour for a scheduled appointment) and feel that all their concerns have been met. It has been independently confirmed that the practice already offers more appointments than the average to its patients. 

Being prepared for the consultation greatly helps as does recognising the length of the appointment slot and helping the clinician to stay within the time limit.  

The term Ischaemic Heart Disease denotes anybody that suffers with angina or has had a heart attack (myocardial infarction) or has had angioplasty or even coronary artery bypass surgery. It is sometimes also referred to as Coronary Heart Disease. Even if you do not suffer any symptoms now, if you have had any of the above then you suffer with Ischaemic Heart Disease and should find this term in your GP-held record. 

Here are some links for heart disease that you may wish to see: 

• NHS Choices
• British Heart Foundation: Heart health
• Cardiac Risk in the Young
• Watch talk about heart disease and why understanding your heart disease can help you get better care

This condition is primarily managed by the nurses unless you are suffering with symptoms. They can check your blood pressure readings, order tests and review them, check any problems you may be encountering and do a medication review for you. They can also advise on things you may wish to consider and discuss things that you may have learned during your journey of discovery. The health care assistants can check your height and weight and do any blood tests you may need as well as check your urine sample. Doctors can see patients whose symptoms are not getting under control or if you are having difficulties due to possible side effects. There is a blood pressure machine in the waiting room for you to check your blood pressure whenever you come to the practice. 

You need to know what your target blood pressure and target cholesterol (less than 5 mmol /l) and LDL (less than 3 mmol/l) should be and what other risk factors you have that need to be managed eg whether you smoke or not or if you are obese or whether you suffer with diabetes or raised cholesterol. You also need to know what is expected of you in the course of a year even if your blood pressure and symptoms are well-controlled. Finally you can monitor your own blood pressure, weight and smoking status and blood tests and urine test as a way of seeing how you are doing. This information should be in your GP-held record for you to see. 

The typical patient with ischaemic heart disease which is well controlled needs the following: 

• Fasting blood tests and urinalysis once a year with the healthcare assistant– checking their kidney function (Sodium, Potassium, Urea, Creatinine and eGFR), Liver function tests, lipid profile (Cholesterol, HDL, LDL, triglycerides) , diabetes status (glucose) and urinalysis (dip stick urine checking for protein and blood) 
• Blood Pressure reading at least twice a year 6 months apart. You can do this on your own! This is the minimum needed but you are encouraged to do this more often by using the practice blood pressure machine in the waiting room or buying a blood pressure machine yourself so that you can monitor it at home / work yourself. The local pharmacies all sell reasonably priced blood pressure machines and can give you more details about them. 
• Medication Review twice a year usually with the nurse unless you are told otherwise

As this is a new way of working, it is worth discussing this with the nurse to see how this can be done the first time you decide to take control. 

• Get access to your GP-held record. Without knowing what is in your records and what you need to do, it will be very hard to know what to do when and with who. This is an essential first step for anybody with any condition or who wants the best from the practice. 
• Ideally we want you to book in with the healthcare assistant for fasting blood tests and urine test if you have not had them done for 12 months or prior to your next medication review. At the same time, ask to book in with the nurse a week later. The nurse will check your records and book you in for you. (This is because the nurse needs to check who is the most appropriate person to do the medication review dependent on what else you may also suffer with). 
• Remember to ask for a yellow topped urine bottle from the receptionist which you can bring with you when you have your blood tests. You can do this when you turn up to the surgery and are waiting for the healthcare assistant or bring it with you. 
• Bring your blood pressure readings with you to show to the nurse or doctor if you have been checking them at home. 
• Record your blood pressure twice a day for a week and then take an average of your readings. Write your readings down and bring them with you when you see the nurse / doctor. 
• You can download a form here for you to use.
• Look at the web page – pre-consultation care – and go through it prior to your review with the clinician. This can help us to understand your needs better and what you want out of the consultation. If there are no specific issues AND all the tests are normal and you are well-controlled, it may even be possible to conduct the medication review over the telephone. This must be with the agreement of the clinician and if you are happy with this. We think many people may benefit from this but we do not want to prevent anybody from coming to the surgery of they so wish.. Understanding your needs is key to a successful outcome of the medication review. See the above mentioned websites to help you to understand what your needs are. Initially you may need the clinician to help you understand how to look at the websites and what they mean for you.

The Quality Outcomes Framework was set up so that practices can look at how successful they are in delivering services to their practice population and also give an opportunity to see how we compare with others around the country. This data is readily available from here (http://qof.hscic.gov.uk/search/index.asp) our postcode is SK14 1JY. Overall we got 1000 points out of a maximum of 1000 last year indicating that we are a very high performing practice across the board which is reassuring for you and us. But you can help us do even better because there are still things  that are missing. Perhaps you could look at your own record and check if we have done everything for you that we should and ask why not if you find a discrepancy. It’s in your interests to get the best treatment and that’s why we want you to check you are getting it!

This is very important. In your journey of discovery about your health, you may come across odd things that do not make sense about the way the practice runs and you may have a better suggestion. Or you may come across something new that we have not considered that helps you even more. Tell us about it next time you see a clinician or preferably write it down and hand it in or send it as a comment to the Patient Participation Group (PPG) so that they can bring it up with the practice the next time we meet up. Even better, why don’t you join the PPG and become an active member. We are always on the look out for new members and new ideas. 

Instead of having to come to the surgery 5 times a year to check your blood pressure (x2), check blood tests and urine test (x1) and get your results of the blood tests and have a medication review (x2 if you are lucky – x4 if this is not done at the same time), you may find that you only need to come once for the blood tests and urine test and the other things could be done over the telephone as long as everything is normal. That frees up 4 appointments that others could use! This means more appointments available for patients that are more focused for your needs within the time allocated.

By working together and understanding each other’s needs better, we can help you to get the best out of the practice and the wider NHS.