BCS Accreditation – Elements list
1. Service Planning
Service requirement
1.1 Public Health.
1.2 Local delivery plans.
1.3 National policy (NSF etc).
1.4 Develop and review policies, strategies and plans
for CHD services.
1.5 Review and enhance the strategic position of the
PCT in relation to cardiovascular services.
1.6 Reduce the risk of people experiencing CHD.
1.7 Needs assessment.
1.8 Ensuring equity.
Learning outcomes
Understand how to assess the health needs of local
populations and the interventions that could favourably impact
on them. Be able to provide this data in a form that enables
commissioners to determine the best use of resources.
Know how to collate and present service plans to
commissioners and national bodies in an effective way.
Have an understanding of national targets, standards and audit
points and how national policy can be translated into local
action.
Know how to ensure that local plans are consistent both with
national policy and with local needs.
Work with the PCT in delivering the joint vision for
cardiovascular services.
Understand the factors contributing to risk of CHD, and how to
prevent it. Use this to develop local policy.
Know how to assess the healthcare needs of the local
population in order to develop appropriate cost-effective
policies.
Know how to assess equity and develop plans to improve the
equitable provision of care.
2. Service development and delivery
Service requirement
2.1. Financial planning.
2.2. Expert advice across PCT on developing
cardiac services.
2.3. Service improvement and workforce
development.
2.4. Act as an interface between primary,
secondary and tertiary care.
Learning outcomes
Broadly estimate the cost of existing and planned services.
Make the best use of available resources.
Contribute clinical understanding to the development of
cardiology services.
Understand service improvement methodologies, and how to
tailor the workforce to the tasks necessary to satisfy the
service requirements.
Understand the importance of designing services around the
patient by working across traditional service boundaries.
3. Commissioning
Service requirement
3.1. Work with commissioners, PCT leads and local
secondary care representatives to develop
local CHD services.
3.2. Links to PEC and cardiac network.
Learning outcomes
Work across organisations to develop seamless local services
Work with the PEC and the cardiac network to ensure
consistency of approach.
4. Education
Service requirement
4.1. Educating GPs / PwSIs.
4.2. Mentor staff developing CHD skills.
4.3. Development of training programmes (in-house
/ external).
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Learning outcomes
Know how to assist in the educational development of local
GP’s and other PwSI.
Know how to assist and mentor GP’s and other PwSI towards
their educational goals.
Understand how to design and deliver local educational
programmes.
5. Audit and clinical governance
Service requirement
5.1. Lead the cardiovascular quality assurance
programme in primary care including: Clinical
governance process; Clinical standards.
5.2. Ensure the appropriateness of the various
working environments and monitor and report
on cleanliness.
5.3. Develop audit and IT processes to appraise
services and inform service improvement.
5.4. Physical resources.
Learning outcomes
Understand how to assess the quality of cardiovascular
services, and how to involve other staff in driving up standards.
Understand the design and maintenance issues around the
environments in which cardiovascular services are delivered.
Understand clinical audit and the various audit systems in use
for cardiovascular services. Know how to set up and evaluate
an audit programme.
Know the health and safety requirements relating to the
environments in which cardiovascular services are delivered.
6. Presenting symptoms - breathlessness
Service requirement
6.1. Assessment of the breathless patient.
6.2. Understanding relevant tests (ECG, echo,
BNP, CxR).
6.3. Performing echo for heart failure.
6.4. Performing comprehensive echo.
6.5. Diagnosis.
6.6. Initiation and up-titration of medication.
6.7. Understanding of the role of device therapy.
6.8. Chronic disease management.
6.9. Lifestyle advice risk factor management and
patient self management
6.10.
Any clinician providing enhanced
services to breathless patients.
Learning outcomes
Having a detailed understanding of the pathophysiology and
investigation of conditions causing breathlessness, including
non-cardiac causes.
Knowing the strengths and weaknesses of investigations used
to confirm or refute the diagnosis of heart failure.
Certification from BSE accredited department for screening
echo to exclude systolic LV dysfunction.
BSE accreditation in community echo cardiography.
Be able to assimilate the results of history, examination and
investigations to be able to diagnose the cause of
breathlessness, or to be able to diagnose or rule out heart
failure or other cardiac causes of breathlessness.
Knowledge of the recommended pharmacological agents for
heart failure, their actions, indications, side-effects and use in
combination.
Knowledge of the contribution that device therapy and which
patients might benefit.
Ensuring that all relevant evidence based therapies are offered
and used optimally. Carrying out regular reviews.
Be able to give advice, about lifestyle issues relevant to the
underlying condition, and support the patient in managing their
own condition.
A general understanding of the pathophysiology,
symptomatology, investigation and treatment of heart failure.
7. Presenting symptoms - chest pain
Service requirement
7.1. Assessment of the patient with chest pain.
7.2. Understanding relevant tests (stress ECG,
stress echo, Myocardial Perfusion Imaging,
Coronary angiography).
7.3. Performing stress echo.
7.4. Diagnosis.
7.5. Initiation of medication.
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Learning outcomes
Knowledge of the pathophysiology, clinical characteristics and
investigations for all common causes of chest pain, including
non-cardiac.
Knowing the strengths and weaknesses of tests used to
evaluate the causes of chest pain.
BSE adult certification and further training specifically in stress
echocardiography.
Assess the results of tests to produce a differential diagnosis,
or to rule out myocardial ischaemia
Understanding the indications for treatments for ischaemic
heart disease, and the pharmacology and side-effects of the
various medications.
Service requirement
7.6. Chronic disease management.
7.7. Lifestyle advice, risk factor management.
7.8. Any clinician providing enhanced services to
patients with chest pain.
Learning outcomes
Understanding the indications for invasive investigations for
coronary disease, and the medical management, including all
evidence-based treatments.
Understanding of the value of risk factor management,
including non-pharmacological interventions and rehabilitation.
A general understanding of the pathophysiology,
symptomatology, investigations and treatment of ischaemic
heart disease.
8. Presenting symptoms - palpitation
Service requirement
8.1. Assessment of the patient with palpitations.
8.2. Understanding relevant tests (ECG, Holter,
Reveal, Echo).
8.3. Performing relevant tests.
8.4. Diagnosis.
8.5. Management, inc indications for
anticoagulation and antiarrhythmic drugs and
the role of ablation.
8.6. DC Cardioversion.
8.7. Any clinician providing enhanced services to
patients with palpitations.
Learning outcomes
Understand the causes of palpitations and the value of the
history and examination in assessment.
Knowing the place for and value of the available tests for
palpitations.
Being able to carry out ECG, Holter, long-term ECG recording.
Assimilate the results of tests together with clinical evaluation
to produce a diagnosis.
Know and institute the appropriate management for the
diagnosed cause of palpitations.
Be able to carry out DC cardioversion safely.
A general understanding of the causes and mechanisms of
palpitations as well as the investigations and treatments
available.
9. Presenting symptoms - blackouts and dizzy spells
Service requirement
9.1. Assessment of the patient with blackouts or
dizzy spells.
9.2. Understanding and interpreting the relevant
tests.
9.3. Diagnosis.
9.4. Understanding the indications for permanent
pacemaker implantation.
9.5. Any clinician providing enhanced services to
patients with blackouts and dizzy spells.
Learning outcomes
Understanding the causes of blackouts and dizzy spells
including non-cardiac (eg neurological) causes. Initiating
appropriate tests.
Understanding the strengths and weaknesses of ECG, Holter,
Reveal, Echo and Tilt testing.
Assimilate the results of clinical features and investigations to
arrive at a cause for blackouts, or to rule out a cardiac cause.
Understanding which patients should be referred for
permanent pacemaker implantation, ICD or other device.
A general understanding of the causes and mechanisms of
blackouts and dizzy spells, as well as the investigations and
treatments available.
10. Hypertension
Service requirement
10.1.
Assessment of new cases.
10.2.
Investigation of complex cases.
10.3.
Treatment.
10.4.
Any clinician providing enhanced
services to patients with hypertension.
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Learning outcomes
Understanding of the definition of and means of diagnosing
hypertension.
Understanding when to institute investigations for secondary
hypertension, the tests required and the importance of the
results.
Understanding of the pharmacological and nonpharmacological treatments for hypertension, and their roles in
different situations. Side-effects of drugs. Titration of drugs to
optimal effect.
A general understanding of the definition of hypertension, its
causes and treatment.
11. Palliation
Service requirement
11.1.
Delivery of a service to provide
palliative or supportive care to cardiac patients
with terminal conditions such as heart failure.
Learning outcomes
Understand the medical and psychosocial methods of
palliation and preparation of the patient and carers for death.
12. Primary prevention
Service requirement
12.1.
Risk assessment.
12.2.
Management of risk factors.
Learning outcomes
Know the contributions of risk factors and how to calculate risk
of CHD.
Be able to advise patients about lifestyle modification. Know
when drug therapy is indicated, and the potential side-effects
of medication.
13. Secondary prevention
Service requirement
13.1.
Chronic disease management.
Learning outcomes
Understand the potential for modification of risk factors both by
lifestyle changes and medication.
14. Cardiac rehabilitation
Service requirement
14.1.
Run exercise classes.
14.2.
Assess patients’ suitability for exercise.
14.3.
Provide dietary advice.
14.4.
Provide information about medication.
Learning outcomes
Phase 3 - physiotherapist or exercise specialist. Phase 4
BACR qualification recommended.
Advise patients about appropriate safe exercise programmes
for carrying out either in classes or at home.
Provide patients and carers with broad dietary advice
appropriate to their requirements.
Assist patients with understanding their medication and
encourage compliance.
See: Secondary prevention.
15. Promotion of patient/carer self-management
Service requirement
15.1.
Chronic disease self-management.
Learning outcomes
Be able to educate patients about their condition and instruct
them in making appropriate observations and management
decisions.
16. Managing personal performance
Service requirement
16.1 CPD.
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Learning outcomes
Know how to keep up to date in the chosen field, and
requirements for revalidation.