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CV screening pilot funding rejected

By Nigel Praities

The Government is to push ahead with GP cardiovascular screening without first building an evidence base after controversially refusing to fund a pilot designed to thoroughly road test its plans.

Academics branded as ‘madness' the Department of Health's decision to turn down a funding application for a trial aiming to find out whether the workload from screening was feasible for GPs.

Plans for nationwide cardiovascular screening have been heavily criticised for lacking an evidence base and for risking swamping GPs with workload.

Under the pilot proposals, submitted by leading GP academic Professor Mike Kirby, GPs would have identified high-risk individuals and referred them to a nurse-led treatment centre, along the lines of proposals from the National Screening Committee.

Nurses, supported by health assistants, would have attempted to take the pressure off GPs by providing lifestyle modification and appropriate prescribing.

Professor Kirby, head of health and human sciences at the University of Hertfordshire and a GP in Radlett, told Pulse: ‘It's madness. People are prepared to do it but not to pay for the evidence that it works. It would have contributed a lot to the debate over screening plans.'

Dr John Pittard, a member of the Primary Care Cardiovascular Society and a GP in Staines, Middlesex, said the refusal of funding was typical of ‘political health policy'.

‘There is lots of rhetoric and not too much trialling. Occasionally if the Government wants to stall on something it will have a pilot. If it wants political kudos then it won't,' he said.

The Department of Health is currently modelling different approaches to cardiovascular screening but has been criticised by its own advisors for the lack of evidence for the plans. If funding for the pilot had been granted, preliminary results would have been available in a year with a view to potentially including screening in the QOF in 2009 or 2010.

Dr Surendra Kumar, a GP in Widnes, Cheshire, and member of the National Screening Committee, said he would have welcomed the project as the committee needed all the evidence possible to form plans for vascular screening.

‘Any research in this area is welcome and it is very sad the government decided not to fund this,' he said.

Last week, a pilot in the West Midlands of just one element of screening found practices had struggled to cope with the workload.

Rocky Road to CVD screening

Dec 2005 – Successful Caerphilly pilot of a self-assessment scheme run in general practice

March 2006 – Pulse reveals the Government is planning a national screening programme based in general practice

November 2006 – West Midlands pilot of ‘e-nudge' software indicates GPs can screen electronic patient records automatically

June 2007 – NICE throws plans into doubt by not advocating any population-based programme in draft lipid modification guidance

Jan 2008 – Department of Health advisor says evidence for screening is ‘not clear cut'

March 2008 – Nurse-led record-based pilot in Sandwell shows ‘huge pressure' on practices

March 2008 – Funding for University of Hertfordshire pilot rejected

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