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CVD indicators mark start of screening programme

By Lilian Anekwe

New indicators for the primary prevention of cardiovascular disease are the first steps towards including a population-wide screening programme in the QOF, Pulse can reveal.

From April 2009, GPs will be asked to invite in all newly diagnosed hypertensive patients, who have not been diagnosed with other cardiovascular conditions, for a face-to-face cardiovascular risk assessment.

A second new indicator will reward practices for offering lifestyle advice to patients identified as at risk by the assessment – which can be conducted using either the Framingham or QRISK tool.

Expert QOF advisors said the two new indicators were just the start and they intended to use the framework to roll out more CVD primary prevention measures.

Dr James Hodgkinson, a research fellow at the University of Birmingham and a co-author of the QOF evidence report, said: ‘Full screening would have been very difficult to put into QOF because it would have been difficult to show the GP-specific outcomes, particular where you have a number of different providers.

‘These two indicators are an incremental approach to a population-wide primary prevention programme. It's quite possible that it could broaden out to all hypertensive patients – these are the first tentative steps.'

Dr Mike Kirby, professor of health and human sciences at the University of Hertfordshire and a member of the QOF consensus panel, said the indicators would relate to between 10 and 12% of an average GP's practice list.

He added: ‘The idea is that patients with hypertension often have other risk factors and this is to prompt GPs to think more about global risk and not think about conditions individually.

‘I think there will be more and more primary prevention measures for CVD in the QOF but we need to take things one step at a time.'

He added: 'I think most GPs will accept these new indicators are part of being a good GP and this is paying them for doing work they have been doing unpaid for a long time.'

However, Dr John Ashcroft, CHD lead for Erewash PCT and a GP in Ilkeston, Derbyshire, said the new indicators ‘didn't go anywhere near far enough'.

He said QOF points should have been introduced for screening smokers and criticised the Government for lack of action in taking forward its CVD screening plans.

‘They obviously don't have anything like the money that they need to do it properly, so instead they have chosen to just rearrange the deck chairs,' he said.

‘The Government promised £250m for a population-wide cardiovascular screening programme. It's not in the QOF – so where has the money gone?'

The Department of Health insisted it was not scaling back its £250m-a-year screening plans.

A spokesperson said: ‘The money to pay for the 13 points comes from the QOF through recycling. This is part of the GP contract and completely separate from the vascular checks money.'

BOX: New indicators for primary prevention of cardiovascular disease

PP 1: % of patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) who have had a face-to-face cardiovascular risk assessment within three months of the initial diagnosis using an agreed risk assessment treatment tool. (8 points; thresholds 40 – 70%).

PP 2: % of people diagnosed with hypertension after 1 April 2009 given lifestyle advice in the last 15 months for increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet. (5 points; thresholds 40 – 70%)

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