Enfield South West PCN

Enfield South West PCN

Improving blood pressure control at scale across Enfield South West PCN

Enfield South West PCN tasked Suvera to fully manage their hypertensive population. Part of North Central London ICB and with an overall list of 50,000 patients, Suvera significantly improved blood pressure control across practices.

Supporting risk stratification 

At the outset of the partnership, The Suvera team worked closely with the PCN to establish goals for the service. One of the key aims was to help all practices achieve normotensive ranges for HYP 003/007 QOF indicators with a target of 77%. 

Suvera analysts risk stratified populations and engaged patients across the PCN footprint. Individuals were enrolled in Suvera’s virtual clinic, and given support for condition and medication review, alongside care plan development. Patients could submit key health readings in the Suvera app, and were monitored in real-time by the Suvera care team.

83% QOF

target achievement on average across all practices

Suvera were easy to engage with, understanding our needs and ways of working. The induction process was well organised and easy to follow, and they are extremely responsive to any queries or issues. We are now extending our work with them to cover type 2 diabetic patients and patients with raised cholesterol in high-risk groups/QOF cohorts.

Dr Arjuna Yogaskaran

Surpassing targets

The service helped to proactively manage hypertension patients, enabling prevention and early intervention at scale. While for practices, the clinic has helped to streamline care coordination, patient outreach and provided additional chronic care capacity to the system. 

As a result, Suvera delivered an average 83% target achievement across all practices, surpassing the target of 77%. More importantly, Suvera achieved significant progression across all practices within the PCN as shown below. 

Leaving no practice behind

HYP003 (QOF Target 77%) – Patients aged 79 years or under with BP 140/90 or less HYP007 (QOF Target 80%) – Patients aged 80 years or over with BP 150/90 or less

Leaving no practice behind

HYP003 (QOF Target 77%) – Patients aged 79 years or under with BP 140/90 or less HYP007 (QOF Target 80%) – Patients aged 80 years or over with BP 150/90 or less

Want to know more?

To find out how we can support your population, contact us: partnerships@suvera.co.uk

See what we can deliver for your practice, PCN or ICB here.