Highly commended - Improving Access and Optimisation of Heart Failure Therapy Through a Pharmacist-Led Service in Primary Care (2025)

Robin Mullen - ASPIRE PCN, Nottingham City GP Alliance (NCGPA)

Project summary

This project addresses local health inequalities by implementing a pharmacist-led heart failure (HF) clinic in a high-prevalence Nottingham primary care setting. Patients previously faced delays exceeding eight weeks to access community HF teams. There was also a lack of structured recall systems for HF compared to diabetes or respiratory care, leading to suboptimal medication optimisation and health inequalities—especially for older, multimorbid, and housebound patients.

To address this, a pharmacist-led heart failure clinic was launched led by a senior PCN pharmacist with a special interest in cardiovascular care. The service aimed to provide equitable access to specialist HF care and guideline-directed medical therapy (GDMT) optimisation for all HF classifications, reduce delays in treatment, and integrate with community HF teams.

The pharmacist delivered comprehensive 30-minute HF reviews through face-to-face, telephone, and home visit consultations. A bespoke HF review template was developed within SystmOne to standardise and support high-quality reviews. Key focuses included the initiation and optimisation of SGLT2 inhibitors, lipid therapy, and polypharmacy management, overcoming barriers to appropriate prescribing in hard-to-reach populations, utilising direct access to MDT input when needed.

Over 18 months, 83 patients received structured reviews, with 90 annual and 65 follow-up appointments. Patients were reviewed on average 40.5 days sooner than if they waited for the community HF service. The practice’s HF prevalence rose from 1.12% to 1.3%, reflecting improved diagnosis and coding. 33 SGLT2is were initiated, and over 100 medication interventions were also recorded.
The practice achieved 100% HF QOF for the first time (up from 59.9% the year prior), resulting in significant QOF income uplift. Staff and patient feedback were 100% positive, citing improved access, care continuity, and communication.

This model demonstrates an innovative, practical solution to addressing HF care inequality, reducing wait times, and maximising prescribing optimisation in primary care. It has high potential for replication across other PCNs and demonstrates the significant impact a PCN Clinical Pharmacist can have in managing and optimising heart failure care within primary care.