What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

·         Hypertension is the biggest medical risk factor for heart attack and stroke among other conditions and is a huge driver of health inequalities.

·         Lewisham is the lowest performing borough in South-East London of blood pressure that is controlled according to NICE thresholds amongst diagnosed patients.

·         Of the estimated 38,576 people with hypertension, 33,264 have at least one other long-term condition.

·         Local data shows the majority of patients who have uncontrolled high blood pressure are of Black ethnicity.

·         This project brings together all system partners from ICB, acute trust, social care and the VCSE to tackle the challenge and takes a data led approach.

·         Stakeholder engagement and previous insight work with local VCSE groups has identified the significant impact working together with community groups as an equal partner can have.

·         This project is truly collaborative and aims to provide greater involvement to solution development and delivery with the communities most affected.

What does your project aim to achieve?

Objectives:

1.       Work in partnership with local VCSE organisation to co-design an approach to improve Lewisham hypertension control rates

2.       Engage with local residents and deliver solutions based on feedback

3.       Empower and educate the local community to support self-management

·         Hypertension is a driver of health inequalities, adversely affecting our Black population in Lewisham.

·         We will work alongside VCSE, grass roots organisations and existing networks to shape and develop the approach to VCSE involvement, particularly working with Black-led VCSE groups.

·         We intend to create an equitable partnership between clinicians, system experts and Black VCS addressing health inequalities in relation to high blood pressure.

·         Take a targeted approach to working in areas of the highest need and develop approaches to reaching groups least likely to engage with primary care.

·         Upskilling of community neighbourhood teams in Lewisham beyond general practice to include a wider range of disciplines for staff and community groups.

How will the project be delivered?

This project will be delivered as part of a wider hypertension improvement programme, providing appropriate infrastructure at Lewisham place and associated robust governance. We have already engaged and are actively working with system partners including Lewisham and Greenwich NHS Trust (LGT), Clinical Effectiveness South-East London (CESEL); Voluntary and Community Sector organisations, Public Health, Primary Care including pharmacy, the Health Innovation Network and beyond. This project will allow us to mobilise our efforts and work with a dedicated VCSE group to focus on a specific cohort who are most at risk. Involving all key stakeholders has led to the development of a well-considered approach. Our population health team are providing expert guidance on measuring impact using multi-source data, and we have established our baseline. The project team will maintain oversight of project spend and develop a robust evaluation framework to identify financial savings and to maintain oversight of project spend.

How is your project going to share learning?

·         Our well established improvement function at LGT will showcase learning at events and through channels including social media.

·         We will promote learning through The Health Innovation Network and wider AHSN’s.

·         Through Clinical Effectiveness South-East London (CESEL) who have strong connections across quality improvement networks.

·         With the Q community.

·         Through NHS South-East London Integrated Care Board Cardiovascular Programme.

·         Through London Cardiac Networks.

·         Through the British Heart Foundation local health engagement teams.

·         Across the VCSE sector in Lewisham and beyond.