a call to action: ‘beat high blood pressure’ welcome!

A call to action: ‘Beat high blood pressure’

WELCOME!

Welcome and agenda for the dayMorning:

• To gather insight about perceptions of high blood pressure, and how we might best communicate and deliver proposed actions/changes.

• To develop an understanding of how to engage the public in any BP campaigns to improve detection and management

Afternoon:

• To gather insight from representatives of the health care community about perceptions of how high blood pressure is currently managed, and how we might best communicate and deliver proposed actions/changes.

• To develop an report from the day which will identify support future action on this topic

2 Tackling high blood pressure

Housekeeping


Why blood pressure?

Councillor Janet Clowes &Dr Heather Grimabaldeston, Director of Public Health

Cheshire East Council

What is high blood pressure?Hypertension is the medical term for high blood pressure. It means that there

is too much pressure in your blood vessels, which can damage your blood vessels and cause health problems

High blood pressure is a major risk factor for stroke, heart attack, heart failure, chronic kidney disease and dementia

Certain factors can increase your risk of developing high blood pressure, these include:

being overweight or obeseeating too much saltnot eating enough fruit and

vegetablesnot doing enough exercisebeing of African or Caribbean

descent

drinking a lot of alcoholbeing olderhaving a family history of

high blood pressure

CAN BE LOWERED

Why do we need a system wide response?

1. High blood pressure is the second biggest risk factor for premature mortality in the UK.

2. About 30% of adults have hypertension, of which an estimated 5m are undiagnosed.

3. Hypertension is the biggest QOF disease register locally (14.8%).

4. Most outcomes related to hypertension are worse in deprived groups.

Risk factors premature mortality: Global Burden of Disease

Source: The Lancet, UK health performance: findings of the Global Burden of Disease Study 2010

Source: The Lancet, UK health performance: findings of the Global Burden of Disease Study 2010

Variation

Source: Health Survey for England 2011

unwarranted variation

30% difference - most/least deprived

CCGs achieving BP control to 140/90 in treated population ranges from 61-94%

Prevalence

Source: QoF 2012-13, Public Health England - General Practice Profiles, 2011

QOF Performance

Source: QoF 2012-13, Public Health England - General Practice Profiles, 2011

Health checks offered

Cardiovascular Disease – in Cheshire East

Cardiovascular Disease: Coronary heart disease (angina and heart attack), stroke and peripheral artery disease (affecting the blood vessels of arms and legs).

• Cardiovascular disease accounts for approximately a quarter of premature deaths each year in Cheshire East (approximately 250 deaths/year)

• The premature death rate from cardiovascular disease is lower than the national average but higher when compared with local authorities with similar levels of deprivation

premature deaths (heart disease) fallen by 40% ( reductions in smoking and better clinical management); men faster than women

Men and women who live in Crewe have a higher risk of early death from CVD than other people

Cardiovascular Disease key facts – where and who

Cardiovascular Disease in Cheshire East

To reduce the number of deaths in the under 75’s from cardiovascular disease

Improve identification of undiagnosed cases

• There are estimated to be:- 35,000 people with high blood pressure- 20,000 people with kidney disease- 3,300 people with diabetes

(ALL UNDIAGNOSED)

• A Health Check is offered every 5 years to those aged 40-74 who are not diagnosed with heart disease, kidney disease or diabetes

- Approximately 100,000 people are eligible

- The aim of the Health Check is to identify undiagnosed cases of disease

Delivery of a High Standard of Care

• Instigate early management and prevention within the community to prevent premature deaths

• This includes a high standard of active treatment in primary care (e.g. aggressive management of high blood pressure)

• Prompt management of an acute event is also important (e.g. hospital management of a heart attack, mini and full strokes)

In 2011/12 if all cases of high blood pressure (diagnosed and currently undiagnosed) had been optimally managed, it is estimated that 100 heart

attacks and strokes could have been avoided

Improvements can be achieved: England vs Canada

Canada began a systematic initiative to address high blood pressure in the mid-1990s as their treatment and control rates were 13% in early 90’s (now 66%) – with reductions in stroke and MI

Source: Joffres et al, BMJ Open 2013

Priority across Cheshire & Merseyside

Support from

• Directors of Public Health

• Cardiovascular Disease Strategic Clinical Network

• Kidney Clinical Network

• Primary Care Strategic Forum

• NHS England

High blood pressure steering group:

Prevention, Identification, Management

We Need Your Help to make change happen

Tackling high blood pressure: from evidence into action

Ben Lumley, Blood Pressure Programme Lead, PHE

BP System Leadership Board• England’s Blood Pressure System Leadership Board is a cross-sector

group which oversees the programme of work improve the prevention, detection and management of high blood pressure, and reduce health inequalities


NHS England

NHS Improving Quality

The action plan• Tackling high blood pressure: from evidence into action (18 Nov 2014)

• Intended to support partners at all levels to focus upon the work that will make the biggest impact in tackling high blood pressure.

• Draws on the best evidence (including new economic analysis) and professional judgment of our group to:• Recommend most pressing issues on blood pressure pathway to address

• demonstrate roles for a wide range of organisations to achieve this

• set out what key partners have already pledged to do in support of our ambition

• Overarching themes:• Tackling inequalities: identifying approaches and targeting to achieve this

• Partnership: need system leadership at all levels across government, health system, voluntary sector and beyond

• Local leaders: change and implementation is influenced and driven by local professionals

www.gov.uk/government/publications/high-blood-pressure-action-plan


Prevention (1 of 2)• High blood pressure is preventable, and risk of

cardiovascular disease is reduced down to a threshold of 115/75mmHg

• Key risk factors include excess weight/salt/alcohol, physical inactivity

• 15% reduction in population salt intake achieved in last decade seen as main contributor to lower population blood pressure (↓3mmHg systolic)

• Over ten years, an estimated 45,000 quality adjusted life years could be saved, and £850m not spent on related health and social care, if England achieved a 5mmHg reduction in the average population systolic blood pressure


Detection

Prevention

Management

What percentage of risk factors associated with someone having their first heart

attack are modifiable?

90% Men

94% Women

Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study


Prevention (2 of 2)Key approaches (plan sets out more fully how different groups contribute):

• reducing salt consumption and improving overall nutrition at population-level

• improving calorie balance to reduce excess body weight at population-level

• personal behaviour change on diet, physical activity, alcohol and smoking, particularly prompted through individuals’ regular contacts with healthcare & other institutions


• Examples of actions identified:• PHE dedicated programmes on diet and obesity, physical activity,

alcohol and healthy places

• Department of Health responsibility deal

• British Heart Foundation 2014-2020 strategic ambition on prevention

• Deliver NHS England Making Every Contact Count action plan

Detection

Prevention

Management

Key approaches (plan sets out more fully how different groups contribute):

• more frequent opportunistic testing in primary care, achieved through using wider staff (nurses, pharmacy etc.), and integrating testing into the management of long term conditions

• improving take-up of the NHS Health Check, a systematic testing and risk assessment offer for 40-74 year olds

• targeting high-risk and deprived groups, particularly through general practice records audit and outreach testing

Detection• Testing advisable at least every five years, more frequent re-

testing for those with high-normal blood pressure. Diagnosis never based on a single test, normally followed by ambulatory (24 hour monitor) or home testing.


Prevention

Detection

Management

Management• NICE recommend lifestyle treatment for all with hypertension –

can achieve dramatic reduction. If drug therapy, 80% require 2+ agents to achieve blood pressure control. NICE treatment target (for adults under 80 years) 140/90mmHg.


Key approaches (plan sets out how different groups contribute):

• local leadership and action planning for system change, to tackle particular areas of local variation, and achieve models of person-centric care

• health professional support (communication, tools & incentives) to bring practice nearer to treatment guidelines

• support adherence to drug therapy and lifestyle change, particularly through self-monitoring of blood pressure and pharmacy medicine support

Prevention

Detection

Management

Resource hub• PHE wants to support local leadership in tackling high blood pressure, and

has gathered resources in one hub to help those planning and delivering high blood pressure services and initiatives


www.gov.uk/high-blood-pressure-plan-and-deliver-effective-services-and-treatment

• Resources include data, guidance, tools, case studies and examples of emerging practice

• The PHE team welcomes feedback and ideas for new resources to include, particularly any local case studies – please email [email protected]

mailto:[email protected]

The future

• Future programme activity will include supporting:

• PHE, working with and reporting to the Blood Pressure System Leadership Board, will continue to pursue this agenda and provide support to local leaders


Clinical leadership, particularly in primary care Local leadership, with local government as the hub for public health

and wider local partner networks Tools, evidence and economics Public and community engagement

What is your role in tackling

high blood pressure?

Insights about public knowledge and attitudes to high blood pressure

Ben Lumley, Blood Pressure Programme Lead, PHE

35% expect symptoms from hypertension


Public informed about disease risks


Spontaneous knowledge of issues caused by high blood pressure

Confidence in knowledge of issues caused by high blood pressure

60-70% see hypertension as inevitable


Blood pressure not only affects elderly


70-80% understand immediate risk


Hypertension thought as ‘easy to treat’


56

43

14

14

9

7

56

41

12

15

8

6

63

56

26

7

19

11

Asda Mobile

Total

Convenience/curiosity motivate testing


BASE: All respondents; Total (362) Mobile testing point (236) Asda (126)Q6:And what made you decide to have your blood pressure checked today? (Top seven codes shown only)

I was interested to know what my blood pressure is

It was convenient

It’s an important thing to monitor

I was concerned I might have high blood pressure

I thought I would be able to get some advice about

my health

It was free

%

What made you decide to have your blood pressure checked today?

Views in diagnosed population


A large number of participants used the presence or absence of

symptoms to indicate whether their blood pressure was raised

Most participants understood that hypertension caused serious complications such as stroke

Hypertension was seen by some participants as a temporary or

curable condition that would not require long-term treatment

Deliberately choosing to avoid or reduce treatment was a theme recurring in many of the studies

NICE. Clinical management of primary hypertension in adults. Clinical Guidance 127 (Full version), 2011Marshall I, Wolfe C, McKevitt C. Lay perspectives on hypertension and drug adherence: systematic review of qualitative research. BMJ. 2012Benson J, Britten N. Patients' views about taking antihypertensive drugs: questionnaire study. BMJ. 2003; 326(7402):1314-1315

Four in every five people said they had reservations about taking

anti-hypertensives

After diagnosis – for some nothing had changed, others viewed

themselves as unhealthy or even focused on their mortality

Differences between groupsSocio-economic group

• Lower socio-economic groups (C2DE) less knowledgeable about health consequences of high blood pressure, and less positive about outcomes from treating high blood pressure if diagnosed early. (PHE surveys)

• Economic hardship and linked stress thought to worsen condition (Marshall)

Geographic and ethnic groups (Marshall et al.)

• Principal themes in attitudes were “remarkably similar”, despite recommendations for culturally-appropriate education in many studies

• Traditional diet raised as an exacerbating fact for hypertension by all groups

Segmentation (in context of testing initiative) (PHE research)

• “Not for me” (largest group) firm miss-assumptions, low levels of concern

• “Why not” likely to take a test simply because it is being offered

• “On my mind” (minority) more actively worried about their health


Take-away pointsA caveat, studies almost universally small sample-sizes and typically based on older populations.

Two themes that are not yet consistently understood and could represent engaging ‘news’ for many people:


High blood pressure

normally has no symptoms

High blood pressure can be

avoided in many cases

Clinical Leadership

Dr Kieran Murphy, Medical Director, NHS England Cheshire & Merseyside

Reducing premature mortality


Inequalities


Healthier Lives Atlas

Stand up!Now sit down if…

Cheshire and Merseyside: Blood pressure/hypertension

Caoimhe McKerr, Knowledge and Intelligence Team (NW)Ben Lumley, Blood Pressure Programme Lead

Local data and data tools:Using PHE Healthier Lives data

44 BP event - 9 March 2015

Risk and prevention Detection

Care High risk groups

LA CCG GP

healthierlives.phe.org.uk/topic/hypertension

“ … make England’s data about many aspects of hypertension

prevalence, diagnosis and management available to everyone”

Detection• Recorded hypertension

prevalence

• Estimated hypertension prevalence

• % of estimated hypertension detected

• % of patients aged 40+ who have a record of blood pressure in last five years


Prevention

• Deprivation

• % aged 65+ years

• Prevalence of adult healthy eating

• Prevalence of obesity in adults


Care / High Risk Groups

• GP record of blood pressure reading in previous 9 months in people with hypertension

• Blood pressure control – e.g. maintaining ≤140/90 mmHg, with additional info for diabetes, CHD, stroke, CKD co-morbidities

• Processes for newly diagnosed - GP lifestyle advice, statins for high CVD risk

• GP physical activity assessment in people with hypertension


How does this look locally?


Hypertension diagnosis


Hypertension control


Statins for high CVD risk


Next steps• What is the bigger picture?

• What is the overall picture for the area or practice? Are just one or two, or several, indicators ‘red’?

• How do they compare with areas with similar deprivation and demography?

• Is there a problem with one or two, or most, of the practices in the area?

• What is the role of other factors such as deprivation, obesity and determinants of health?

• Download data for further analyses


Supplementary data sourcesPublic Health Outcomes Framework

The outcomes in this framework reflect a focus not only on how long people live, but on how well they live at all stages of life

http://www.phoutcomes.info/

Cardiovascular disease profiles

These profiles allow you to download a cardiovascular disease (CVD) health profile for each clinical commissioning group and strategic clinical network in England, with the interactive version allowing comparisons.

http://www.yhpho.org.uk/ncvinc

Longer Lives

Longer Lives highlights premature mortality across every local authority in England, giving people important information to help them improve their community’s health.

http://healthierlives.phe.org.uk/topic/mortality


http://www.phoutcomes.info/



http://healthierlives.phe.org.uk/topic/mortality

Acknowledgements• Knowledge and Intelligence Team (North West)

• Catherine Lagord, NHS Health Checks, PHE

Contact and further support

[email protected]; 0151 231 4528

[email protected]





Table work

Questions:• Do people know and care what their blood pressure is?

• If no- why?

• If yes- why?


Insights from local populations: Halton and Knowsley

Dr Ifeoma Onyia, Halton Borough Council

Dr Sarah McNulty, Knowsley Borough Council

Objectives

Evaluate local residents attitudes to getting their BP checked and how we can encourage them to do so.

Current behaviour and barriers

Evaluation of messages and existing campaigns

What should a call to action look like?

HALTON

Who did we ask?

408 face to face interviews across Widnes and Runcorn

All lived within Halton

Age range 30 – 70 year olds

Equal M/F ratio

All registered with a GP in Halton

40% employed; 25% retired; 1%Education; Unemployed/carer/ disabled/ homemaker

What they said about themselves

Half described themselves as overweight

One in three in fair, poor or very poor health

Over one in three disabled

When was last BP check?

Why did they have a BP check?

Part of a check-up

Recommended by GP/nurse

Unwell

Underlying health problems

In hospital

Every time see GP

Checked regularly

Where was last BP check?

Links with NHS Health Checks

72% had heard of NHS HealthChecks

37% could recall an invite

Of those invited 82% attended

Younger females and working less likely

Most expected BP would be checked

Some expected checks on eyes/ feet/ cancer

Inertia largest barrier to going for check

Understanding of BP factors

SymptomsLight-headedness (40%)

Hot/flushes

Headaches

Blurred vision

None ( 5%)

CausesStress (40%)

Unhealthy lifestyle (20%)

Overweight

Not eating enough Fruit and Veg

Excess Alcohol

Hereditary

Other illness

Salt

Understanding of Impacts

Heart attack @ 76%

Stroke @ 58%

Next danger @ 4%

( kidney/ diabetes/ nosebleeds/ blindness etc)

How concerned were people?

KNOWSLEY

Focus groups

Healthy foundations segment

Town Age range Participants

Unconfident fatalists Huyton Mixed 9 (5 women and 4 men)

Health conscious realists

Kirkby ≤ 40 7 (5 women and 2 men)

Live for today Prescot 41 - 70 9 (5 women and 4 men)

Attitudes

General concern but low understanding about definition, signs symptoms and treatment.

Better awareness amongst those with long term conditions eg diabetes or on the pill.

Perception that a diagnosis of high blood pressure is a life sentence.

Importance of having checks

Prevention

‘It can save your life’ (Health Conscious Realist and Live for Today)

‘They can prevent you from becoming more ill if you do have high blood pressure’ (Health Conscious Realist)

Want more info on how to get checked and how often.

Barriers to having checks

Poor access to GP prevents regular checks.

Inertia

‘I’m OK; I’m not at that age right now’ (Unconfident fatalist)

Lack of information

‘People are not aware of how serious high blood pressure is’ (Unconfident fatalist)

Who should do BP measurements?

GPs should offer them to everyone regardless of what they go to the surgery for

Pharmacies

Walk-in centre

Don’t really mind as long as evidence that person doing the check had been trained

Mixed views on home testing.

Messaging territoryHeadlines that resonated with all groups

‘After cancer, high BP is the second biggest cause of early death and disability for people aged under 75’

‘Around 12.5 million people in the UK have high BP. Of these, around 5 million are not aware of it’

Simple messages, tips and information, shock factors, happy with cartoons.

However people are put off byAge 75

1:4 or 1:3. They prefer the big numbers.

• Give local stats

Knowsley messaging idea

‘x people in Knowsley have high blood pressure and don’t know it. Are you one of them? Get checked’

Campaign deliveryMaterials discussed

Liked cartoons and

red balloon.

Liked NHS identity.

Recommendations for visuals

Image-based

Shock

List service providers

Communication channels

Ambient media in areas of high footfall – town centre posters, pharmacies, fliers

Bus sides/internals

Social media inappropriate for health matters

Coffee break – please return by 11:45

Table work

Questions:• What can we do to empower people to know and care about what their

blood pressure is?

• And what steps will you take to make this happen?

• Feedback at 12:15


Next steps for this work• What will you do next?

• What’s your pledge? How are you going to contribute to this agenda?

• Report from the day

• Steering group – planning and coordinating

• Wider system ownership and action


Lunch, learning and networking• DATA STATION: Check your local data on blood pressure

• BP CHECKS: Do you know your blood pressure?

• BHF: Resources available from British Heart Foundation

• PLEDGE / DIFFICULT QUESTIONS / LIGHTBULB MOMENTS

• Please return by 13:30 for the afternoon session


A call to action: ‘Beat high blood pressure’

Purpose of the afternoon• To gather insight from representatives of the health care community about

perceptions of how high blood pressure is currently managed, and how we might best communicate and deliver proposed actions/changes.

• To develop an report from the day which will identify support future action on this topic


Quick housekeeping reminder


Impact on health and care system


12%

£2 billion

£850m45,000

30%

High blood pressure very frequently accompanies other conditions - relevant to most clinicians

regardless of speciality.


Barnet K et al, Lancet 2012

Links across systemThree key strands:

• Prevention

• Detection

• Management

Overarching themes:

• Tackling inequalities: the most deprived communities are more likely to have high blood pressure – great opportunity to reduce variation in outcomes

• Partnership: need system leadership at all levels across government, health system, voluntary sector and beyond

• Local leaders: change and implementation is influenced and driven by local professionals


Hypertension clinical guidelines

Dr Matt KearneyGP RuncornNational Clinical Advisor NHS England and Public Health England

We have clear evidence based guidance

93 Hypertension clinical guidelines

Diagnosing hypertension

• CBPM ≥ 140/90 check up to twice more

• Offer ABPM and ensure correct cuff

• Daytime average of 135/85 mm Hg = HTN

• If ABPM not tolerated use HBPM

• ABPM for 24 hrs, 2 measures/hr during day and at least 1 at night. Average BP needs 14 daytime measurements

• HBPM – 2 readings, twice a day for 4-7 days, discard day one and take average of remaining measures

• CVD risk assessment core to diagnosis


Thresholds for diagnosis

• Stage 1: 140/90mm Hg (135/85 ABPM or HBPM)

• Stage 2: 160/100mm Hg (150/95 ABPM or HBPM)

(Studies show ABPM and HBPM give values on average 10/5 lower than in the office)


Drug treatment

• Stage 2 Hypertension

• Patients under 80 with Stage 1 and:• Target organ damage• CVD• Renal Disease• Diabetes• 10 yr CV Risk 20% or more


Summary of anti-hypertensive drug treatment


Step 4

CAStep 1

Step 2

Step 3

Aged over 55 years or black person of African or Caribbean family origin of any age

Aged under55 years

A + C + D

Resistant hypertension

A + C + D + consider further diuretic, or alpha- or

beta-blocker

Consider seeking expert advice

A + C

KeyA – ACE inhibitor or low-cost angiotensin II receptor blocker (ARB)C – Calcium-channel blocker (CCB) D – Thiazide-like diuretic

We have clear evidence based guidance


But…

Implementing guidelines in real world primary care brings challenges


It’s not just about knowledge transfer

• Consultations structure

• Time pressures

• Multimorbidity

• Polypharmacy

• Patient knowledge, expectations, activation, adherence

• (Lack of) follow up systems

Multi-morbidity is the norm


Most people with hypertension have other conditions

Tackling high blood pressure

Implementing guidelines in real world primary care brings challenges


But there are new opportunities

• Wider primary care staff

• Other settings

• New models of care

• Automation

Improving detection of high blood pressure


1. More BP testing in practices

• More opportunistic testing by clinicians

• More routine testing in people being seen for other long term conditions

• More waiting room testing eg automated systems

2. NHS Health Check – improving uptake and clinical follow up

3. More systematic audit of practice records to regularly detect people at high risk of undiagnosed hypertension – eg high last reading not followed up, other risk factors but no recent BP

4. More testing by pharmacies – eg on request and routine in MURs, NMS etc

5. More self-testing

Improving management of high blood pressure


1. Systematic primary care audit

• Detecting people with inadequately controlled hypertension

• More frequent routine and opportunistic testing in people with hypertension

2. Integrating BP testing into management long term conditions

3. Improved implementation of NICE guidance

4. Support adherence

• Shared decision making and patient activation

5. Expand community pharmacist role

• Monitoring BP in people with hypertension

• Supporting adherence to medication and lifestyle

5. Expand self-monitoring and telehealth options

It’s quite easy to measure blood pressure inaccurately


World Hypertension League Video

https://www.youtube.com/watch?v=egBmUw0Y0IE




Thank [email protected]

106

Hypertension and NHS Health Checks

Jamie Waterall, Head of NHS Health Checks and Blood Programme

Hypertension Project Brookvale Practice 2015

June Rhodes and Dawn Heggarty

Santa checking in for his NHS “Elf” Check

Waiting Patiently!!!

Santa passed his “Elf” check with flying colours!!

• For all patients over the age of 18 years to have had a blood pressure recording documented within the preceding 3-years.

• For all patients with an initial reading >140/85 to have follow up reviews and appropriate management as defined in the Hypertension guidelines.

• For patients newly diagnosed with hypertension who are under the age of 40 years, to be referred to secondary care for full investigations

• For all patients diagnosed with hypertension to be monitored on a 6-monthly basis and their blood pressure to be maintained under 140/85.

• For all patients to receive education on the risks of uncontrolled hypertension on cardiovascular disease.

• All patients should receive advice and support on lifestyle changes to promote health, to include diet, exercise and alcohol management and smoking cessation.

The Vision

• We have an 8,150 practice population

• We have 1,333 Patients diagnosed with hypertension

• We have 111 Hypertensive patients who are above target

• We have 128 Patients over 45 years that have not had a Blood pressure recorded in the last 5-years

• We have 508 Patients aged 18-44 who have not had a blood pressure recorded in the last 5 years.

• We have 314 Patients who have a raised blood pressure reading but no diagnosis of hypertension in the last 3-years.

• How do we engage these people who have not had a blood pressure check or who have been found to have a raised blood pressure reading but not come back for a recheck.

• How do we educate this population and inform them of their potential risk of cardiovascular disease.

The Challenge

• The practice IT team would concentrate on calling for the hypertensive patients who have not attended for review and encourage them to come in.

• The practice nurse and health care assistant would contact the patients with uncontrolled hypertension and book them in for review.

• A Saturday morning clinic was set up for the 7th February to target those 128 patients over the age of 45 with no blood pressure reading in the last 5 years. These patients could also be booked in with the practice nurse or health care assistant any day of the working week for a health check. Letters were sent to all of the patients that could not be contacted by phone 18 patients attended and had a full health check and 9 patients dna’d.

• Patients aged 18-44 years, who have not had a blood pressure recorded in the last 5 years (508) will be sent letters to inform them of the importance of having a blood pressure taken and will be asked to book an appointment with the practice nurse or health care assistant.

The Plan

• Those patients who have not responded or made an appointment after their invite letters will be informed that the nurses will be calling to their homes week beginning 23rd March to record their blood pressure and weight.

• Brookvale practice will then audit the results and provide feedback to the Halton CCG

• If successful we hope to roll the program out to the other practices in Halton from June 2015.

The Plan continued

Thank you

Click icon to add picture

SWOT Analysis

SWOB of effective BP identification and management

Strengths

Weaknesses

Opportunities

Barriers

• Move stations – 10 minutes at first then 5 minutes to add to others

• Complete all four stations


Coffee break – please return by 15:00

Action planning

What steps can we take to make a change?

• Work on tables to produce action plans

• What can you do to make a difference?


Panel Q&A

Thank you • Next steps for this work


a call to action: ‘beat high blood pressure’ welcome!

Documents

high blood pressure

blood vessels of arms

premature deaths heart

biggest qof disease

health survey

global burden of disease

health checks

uk health performance