Optimising Care of Long-Term Conditions (starting with Cardiovascular Disease)

The ambition for NW London is that by 2029, we will have prevented 25% of heart attacks and strokes in our local population, whilst actively addressing health inequalities in cardiovascular disease.

We will achieve this by creating a culture of care focussed on the prevention, detection and treatment optimisation of CVD risk factors, prioritising interventions for those who are most adversely affected by health inequalities in this disease area.

Prioritising prevention

We will take a coordinated, system level approach to tackling the environmental, psychological and social determinants of CVD, and focus on targeting the most at-risk population groups.

Closing the detection gap

We will reduce unwarranted variation in the detection of the disease by integrating services to ensure that case finding and detection are not completed in isolation.

Optimising treatment

We will increase the number of NW London residents being treated to target and increase appropriate monitoring for the five priority cardiac workstreams across the sector. 

Strengthening the system and engaging communities

Through all our activities we will strengthen our local system’s ability to collaborate and create change, enable staff to deliver quality care and ensure our work reaches the communities most in need of proactive intervention. For example, our clinical partners serve the NWL community through our CVD Champions Programme. Learn more about the programme here.

Innovation opportunity areas

It is our mission to improve these outcomes for our NW London population, so everyone gets a better chance at living a healthier life for longer.

To begin to develop this new culture of care, we are building innovation networks: communities of momentum and movement that bring together energy within the system with the appropriate skills, support and sponsorship for effective delivery and sustainable change.

These networks will build on the brilliant partnerships that exist in cardiovascular care already and be used to facilitate the testing innovations across a variety of real-world settings – our ‘implementation sites’.

Want to learn more about how you can become part of our innovation networks? Email clare.thomson@imperialcollegehealthpartners.com.

Interested in finding out more about our CVD mission?

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Why is this important? 

We’ve spoken to NHS staff, patients and carers to better understand why optimising care for CVD in NW London is so vital… 


Having only ever worked in a hospital pharmacy, I learnt a lot about primary care which was hugely beneficial and will certainly influence my working practices going forward. Having contacts in primary care and good working relationships can only benefit everyone going forward and in particular the patients

Trust Pharmacist/Nurse

Collaborative working, for example via MDTs, integration between physical and mental health – we need a whole person approach. This is critical to cracking prevention.

I’d love us to have the same CVD care and outcomes wherever in this patch that you live. I’d love us to have access to the same treatments at the same time. I’d really love us to be at the forefront of research and innovation.

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