Reducing risk of recurrent coronary heart disease in Cornwall

Editor—Bradley and Cupples end their editorial on reducing recurrent coronary heart disease by asking whether anyone has a better idea of how to improve performance in this area¹ Earlier they say that adequate resources would be needed to ensure a systematic approach to the secondary prevention of coronary heart disease in primary care and that primary care groups would be well placed to implement this. Such a scheme has begun in the Carrick Primary Care Group in Cornwall.

For the next two years the British Heart Foundation will fund two liaison nurses to ease the discharge of coronary patients from the Royal Cornwall Hospital into the community, as well as the training of a lead nurse from each practice. The primary care group will give extra monies to each of their 13 practices for a scheme that includes creating a register of patients with coronary heart disease, starting a call and recall system, and developing improved links with acute care—that is, structured long term care.

Campbell et al showed that nurse run secondary prevention clinics in primary care can reduce risk factors for the recurrence of coronary events.² The widespread adoption of such clinics will need the same amount of funding as that currently provided for the management of asthma and diabetes.

Carrick Primary Care Group are to be congratulated for doing what the government should have done when it initiated payment for some management of chronic diseases in general practice. All primary care groups should be persuaded to follow this example, if necessary using innovative methods of joint funding.