BSW ICB
Lipid Protect Programme

In partnership with Brunel 5 PCN and
ECLIPSE (Equality of Care Led Insights for Patient Safety & Engagement)

Practice Pro-Forma

Project overview:

The BSW Lipid Protect Pathway supports GP practices in improving QOF (Quality and Outcomes Framework) Cholesterol control and lipid management indicator for 2024/25. 

CHOL003 Indicator 
This indicator measures the percentage of patients on QOF registers for Coronary Heart Disease (CHD), Peripheral Arterial Disease (PAD), Stroke/Transient Ischemic Attack (TIA), or Chronic Kidney Disease (CKD) who are prescribed a statin. If statins are declined or clinically unsuitable, alternative lipid-lowering therapies should be considered. 

  • Points Available: 14 

  • Achievement Thresholds: 70%–95% 

QRISK >20%
The second group involved in the BSW Lipid Protect Pathway are those with a QRISK >20% and therefore NICE-indicated for lipid lowering therapy. 

Programme Objectives

  1. Identify and engage eligible patients: Focus on patients with GP-coded cardiovascular disease or CKD not currently on lipid-lowering therapy. 

  2. Facilitate efficient reviews: Enable practices to educate, consent, and review patients for statin initiation or alternative therapies, as clinically appropriate. 

Service Description

This pathway uses Eclipse’s digital patient engagement platform to streamline identification, education, and initiation of eligible patients: 

  1. Patient Identification: Eclipse automatically identifies eligible patient cohorts. 

  2. Digital Engagement: Consented practices will see patients contacted centrally via SMS through the Eclipse PEGASUS platform. Patients will: 

    • Learn about the health benefits of lipid-lowering therapy. 

    • Be guided to a questionnaire to express their preferences and provide consent. 

  3. Follow-Up for Non-Responders: If patients do not respond digitally, the Putting Patients First engagement team will contact them via telephone to complete counselling and the consent process. 

  4. Actionable Patient Lists: Patient responses are stored within Eclipse, with follow-up actions clearly outlined for GP practices to initiate statin therapy or discuss alternatives. 

How Your Practice Benefits

  • Automates patient identification and engagement, saving clinical time. 

  • Enhances QOF achievement by ensuring patients receive appropriate lipid-lowering therapy. 

  • Offers comprehensive patient education and consent support. 

Next Steps 
If your practice would like to participate: 

  • Complete the below pro forma to express interest and provide practice permissions for patient engagement. 

  • You will be notified before any patient engagement begins. A detailed guide will be provided, outlining how to view patient lists and document reviews. 

This pathway is designed to support your practice in achieving QOF cholesterol and lipid management targets while improving patient outcomes.