From the outset, Easington PCT supported a nurse-led approach to improving care for patients with established CHD and nurses from the collaborative practices were given authority to lead the work. Continuous liaison with other clinicians involved in delivering care was a prerequisite. Led by a specialist nurse in CHD, the nurse team:

• Developed a PCT-wide strategy for structured care for patients with established CHD
• Developed a partnership approach to provide comprehensive care across all settings
• Supported the PCT-wide development of specialist CHD nurse-led clinics
• Produced valid CHD registers
• Developed templates for gathering information and protocols for ensuring consistently managed care
• Implemented a system of audit and a strategy to meet training needs
• Liaised with GPs to ensure their agreement to developments
• Liaised routinely with coronary rehabilitation nurses at local acute trusts
• Collected monthly data on CHD based on the collaborative measures
• Measured patient satisfaction with the changes.