The Cardiac Networks Co-ordinating Group: Signing Off
In mid-October the Cardiac Networks Co-ordinating Group (CNCG) will come to an end after a decade in which CNCG has brought together the Cardiac Networks, the Welsh Government, the wider NHS, and major charities in the effort of improving cardiac services across Wales.
The term CNCG became synonymous with the activities of the CNCG team: Mrs Fiona Peel who set the wheels in motion for the creation of CNCG and the Cardiac Networks, and who was the Chair from the beginning in March 2002 until September 2010; Dr Phil Thomas who provided clinical leadership to CNCG in addition to his role as the Lead Cardiac Clinician for Wales and his early role as the Lead Clinician for the Mid and South West Wales Cardiac Network; Mrs Nicola Miller who has kept the office running smoothly since November 2007; and Dr Elizabeth Gould who has been the Programme Co-ordinator from March 2002. Writing this from the inside of that team, it has been a joy to work together and to have felt we were making a positive contribution to cardiac services in Wales.
A new way of working
CNCG with the Cardiac Networks has been instrumental in many of the improvements in services for cardiac patients throughout Wales over the past decade. Having set up the original Cardiac Networks, organisational and professional barriers were broken down, best practice shared and the whole seamless patient journey considered in ways which were unthinkable ten years ago. An organisational model was created that enabled all individuals who contributed to cardiac care in Wales to have a voice, providing a more cohesive, collaborative approach to the delivery of cardiac services.
Advising on capital funding
In the early years CNCG and the Networks provided advice to specialist commissioners and were integral to capital developments such as the cardiac catheter laboratories, coronary care units, and diagnostic equipment bids; CNCG worked closely with colleagues to make possible the all Wales procurement of this equipment. The training of paramedics to deliver pre-hospital thrombolysis in Mid and South West Wales in 2002 was funded from this early investment.
Focusing on the workforce and service re-design
CNCG set up the only all Wales speciality-specific workforce group and the focus on cardiac physiologists led to the establishment of a new course in Wales for the training of post-graduates as cardiac physiologists. We championed a competence-based approach to workforce redesign; and the outputs from our efforts were used by Skills for Health as case studies of good practice.
Working with Patient Groups
We built a strong and productive relationship with the British Heart Foundation, and Wales has seen very generous investment from them in the past decade. We pioneered a new approach to the BHF bidding process by which the Cardiac Networks co-ordinated bids for BHF funded nurse and physiologist posts, and CNCG submitted the successful Wales wide bid for familial hypercholesterolaemia (FH) cascade testing. The FH initiative, which then received additional funding from the Welsh Government, is the only service of its kind in the UK and now has an international profile. We developed very positive relations with other patient groups such as the Arrhythmia Alliance and the Atrial Fibrillation Association.
Supporting Continuing Professional Development
Over the years CNCG hosted a range of national events with speakers from across the UK with topics including: Workforce Redesign, FH, Heart Failure, Sudden Cardiac Death, Primary PCI, and Cardiac Health Inequities. Sometimes these events were held were in partnership with the pharmaceutical industry through the Wales Industry Group (WIG); the Terms of Engagement we agreed with WIG were seen as an exemplar of good practice. More recently CNCG has supported a Peer Learning Programme as an innovative, cost-effective and time-efficient way of helping heart failure specialists and palliative care specialists deepen their knowledge about each others’ specialism and at the same time develop effective working relations between cardiac and palliative care teams.
Participation in National Cardiac Clinical Audits
CNCG has always pushed for participation in a range of national cardiac clinical audits, believing them to be fundamental to high quality services. When CNCG came into being very few hospitals in Wales were participating in MINAP, the Myocardial Ischaemia National Audit Project; now it is 100%. CNCG supported the All Wales Cardiac Rehabilitation Group by managing the BHF funding to participate in the National Audit of Cardiac Rehabilitation (NACR); as a result Wales became the only UK country to have 100% compliance with NACR. With funding from the Welsh Government, a Wales angiography dataset has been agreed and data collated which will help inform good practice and reduce complications from this common intervention. CNCG has worked with the Central Cardiac Audit Database team each year to ensure that the national audit reports reflect accurately the data from Wales.
Helping to reduce waiting times
Cardiology services were in the vanguard of Referral to Treatment (RTT) times, and CNCG played a key role in designing the guidance, and encouraging clinicians to believe that such reduced waiting times were possible. Cardiology RTT, unlike most specialities, includes the tertiary element of referral making it particularly challenging.
Supporting the AWMSG
Working together with the Welsh Medicines Partnership and the All Wales Medicines Strategy Group, CNCG helped to establish a New Cardiovascular Drugs Group. This group provides the AWMSG with expert advice both on horizon scanning and implementation of new cardiovascular drugs.
Developing a new National Service Framework and Quality Requirements
We provided a multi-disciplinary forum for working groups to develop the new Cardiac Disease NSF, and introduced for the first time accompanying Cardiac Quality Requirements, against which the service could assess its provision and standard of cardiac care. The Cardiac Disease NSF introduced new chapters on Arrhythmias, Cardiac Rehabilitation, and Adult Congenital Heart Disease, raising the profile of all these services.
In recognition of the importance of research to implementing the NSF, CNCG encouraged the development of a cardiovascular research network to mirror the clinical model and the Cardiovascular Research Group-Cymru is now funded and is up and running with clinical representation from the Cardiac Networks.
Supporting the identification of those at risk
CNCG has recently helped to pilot a cardiovascular risk assessment tool in general practice. The pilot confirmed the need for a structured and systematic programme of CVD risk identification and this work will be fed into Public Health Wales.
Advising the Welsh Government
CNCG has been the first port-of-call for the Welsh Government for advice on policy, Ministerial briefings and AM questions. CNCG advice has in turn depended on the infrastructure of advice and support created through the Cardiac Networks and through the wealth of other relationships that have been developed over the years.
There can be little argument that CNCG found itself without the necessary organisational legitimacy since the major reorganisation of NHS Wales and the restructuring of the Cardiac Networks which followed. As a consequence of these changes it has simply not been possible for CNCG to drive change in the way it once did and in a way CNCG has come to a natural end. Hopefully the enthusiasm and energy which gave life to CNCG will carry on through the Cardiac Networks, and the spirit of respect and collaboration that CNCG tried to foster will continue and grow.
Dr Elizabeth Gould