The National Refractory Angina Centre (NRAC, pronounced en-rak) is based in Liverpool and provides the UK’s most advanced patient centred angina care. Since NRAC was established in 1996 it has won the NHS’s most prestigious awards and accolades for delivering excellent, safe and modern care.

In October 2008, the Undersecretary of State for Health said, The ongoing development of the NRAC as a national and international centre of excellence for the treatment and management of refractory angina… means that we have not only the best possible service to which people in this country can be referred for that condition, but a blueprint for the development of other such services elsewhere.”

Some years ago NRAC personnel set up a redesign service called Virtual Angina to set up NRAC-like services across the NHS. Patients in Derbyshire can access the Wheatbridge patient centred angina clinic and North Wirral patients can access the Wirral Health Alliance patient centred angina clinic. Link to patient centred angina clinics.

We know that most patients and their families have misunderstandings about angina and its treatment. The key differences between patient centred angina clinics and traditional cardiac clinics are that we have time to find out how the angina affects you and your family and we explain things in language you can understand so you can take a more active role in your care. Patients are always surprised that new patient clinics usually take 90 minutes or longer. Patients invariably say they learned more about their condition in that 90 minutes than in all the time before.

Next is a series of ‘classes’ where you and your close relative(s) will learn even more about the condition and how to get the best out of life. Many patients are initially sceptical about how classes could help them but every one of over 450 patients and carers who have completed the programme says how much they enjoyed it and say they wish they had come sooner. At the end of the classes most patients report that they feel better in themselves, are more able to control the symptoms and are doing more. The majority are able to reduce the number of tablets they take. Increasingly patients choose to come to NRAC clinics to find out if there is an alternative to heart operations. In most cases there is.

Research shows that patients who attend NRAC have a better quality of life, feel less anxious, experience less pain and have fewer emergency admissions (1, 2).

Everyone who visits NRAC clinics remarks on how much they enjoyed it and since 2003 we have routinely asked patients and carers to rate the experience. The average satisfaction rating from over 7,800 visits is over 99%. NRAC is the current holder of the prestigious Sunday Times Business management award for leading service excellence.

In November 2009, NRAC became the only NHS service to receive the maximum 5 star rating from the prestigious UK Customer Experience Accreditation Panel.


1. Moore RK et al. Health related quality of life of patients with refractory angina before and one year after enrolment onto a refractory angina program. European Journal of Pain. 2005;9:305-10

2. Moore RKG et al. A Brief Cognitive-Behavioral Intervention Reduces Hospital Admissions in Refractory Angina Patients. J Pain Symptom Manage. 2007 Mar;33(3):310-316

Here is an eight minute slidecast

What patients say about the service.

”Your skill and compassion has made a huge difference to my life and that of my family”

“The whole experience, I found not only of great benefit but also educational. The fear factor about angina has greatly diminished. I feel I am now back in control of my life”

“I attended NRAC and was blown away by the compassion, understanding and time that was afforded me. For the first time since the attack I came away thinking I may have some quality of life ahead. Myths were torn apart and I actually came away with a positive understanding of my condition. I realise how misinformed I actually was and armed with the knowledge I now have, coupled with the strength of having the support from NRAC, my life feels like it is seriously changing. It is staggering how much incorrect information is out there. A friend told me after my heart attack that my condition was 95% mental – now I realise how much he was right”

“Your always professional manner, which is combined with a ‘down to earth’ approach, makes the complex nature of D’s illness easier to understand and live with”

“Basically it is all FANTASTIC! I have not been using the GTN since I saw you. Your teaching was enlightening and much needed”

“Before B started on the programme he had to stop doing home visits as he had lost his confidence. He rarely went out on his own, but with your help he has regained the confidence he lost 10 years ago as a fit man. All the family thank you as we have benefited too”

”In my time dealing with various doctors…. this was the first time that I was actually treated as an equal partner”

“I am much more confident about my condition and how to manage it and the medication I need. As a result I am less anxious and many of the minor episodes of angina no longer develop into major ones”

“I felt like I was getting somewhere at last”

“I have attended your clinic since Sep 04 since then I can only say the improvement in my angina pain management has been nothing less than miraculous”

“I was sceptical at first but I am so glad I stuck with it. Thanks to the whole team!”

“If only this was available 14 years ago”

In future patients and healthcare professionals will be able to attend an on-line Virtual Angina education programme to help them become more effective partners in health care.