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Alcohol and obesity checks to pile pressure on GPs

By Nigel Praities

The Government's vascular screening programme is to be hugely expanded to cover a series of public health checks, including those for obesity and alcohol misuse, Pulse has learned.

The Department of Health has rebranded the scheme as the NHS Health Check and urged PCTs to consider bolting on a range of new initiatives, such as interventions for weight management, smoking cessation and dangerous drinking.

A DH guidance document circulated to PCTs recommends that they adopt a ‘systematic approach' to screening as part of the drive to check everyone from 40 to 74 for risk factors for heart disease, stroke, diabetes and kidney disease.

Under the health checks programme, GPs and other professionals involved in screening will be expected to record BMI, smoking status, daily number of units of alcohol and duration and frequency of physical activity.

Everyone who has a health check is then expected to be given tailored lifestyle advice, regardless of their risk score, and to be referred for specialist help if needed.

‘Everyone having the check should be provided with individually tailored advice that will help motivate them and support necessary lifestyle changes to mange their risk,' the guidelines recommend.

‘The individual should be followed up at appropriate interval over a three to six month period,' the guidance adds.

The move is in line with Prime Minister Gordon Brown's aim, expressed last year, for the NHS to focus on disease prevention.

It follows Pulse's revelation that the BMA and Department of Health were in talks about how to include public health outcome targets in the QOF.

But while GPs have been broadly supportive of the focus on prevention, some have questioned whether the resources and specialist services exist to allow the new healthy living drive to work.

Dr Andrew Mimnagh, a GP in Merseyside and chair of Sefton LMC, said his local vascular screening scheme had already stagnated because of cost constraints and questioned whether the extra activity could be supported.

‘You can't fault the general strategic direction, it is just the practicalities. How can this be paid for and what budget will it come from?' he said.

Dr David Haslam, chair of the National Obesity Forum and a GP in Watton-on-Stone, Hertfordshire, said: ‘I'm a screenaholic. If a patient breathes I'll screen them, but if they are on a GP's doorstep it's often because it's a specialist case already.

‘It's all very well saying general practice should be a wellness not an illness service but if they're not going to pay us any more we're not going to be able to help, he said.

Bolt-on schemes for vascular screening

1. Alcohol use: provide brief advice during discussions over lifestyle, particularly in overweight patients. Those wanting to stop drinking who are experiencing difficulty should be referred to specialist services.

2. Weight management: reinforce the benefits of healthy eating and being physically active. Where weight status is key risk factor, advice or onward referral should be provided.

3. Physical activity: agree goals and consider exercise referral for those with physical activity levels below recommended levels. Follow-up at appropriate intervals over a three to six month period.

4. Stop smoking: advise patient of health benefits and offer the support of a NHS Stop Smoking Service to anyone who wants to quit.

Source: NHS Health Check: Vascular Risk Assessment and Management Best Practice Guideline, April 2009

alcohol abuse screening part of the expanded health checks plans alcohol abuse screening part of the expanded health checks plans

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