Government CVD screening plans 'totally unrealistic'
By Nigel Praities
Government plans to offer vascular checks to three million patients a year are based on economic modelling assuming screening and treatment will initially take up just 12 minutes a week of GP time.
The estimates, published last week in a report accompanying the NHS Next State Review, have been branded as ‘totally unrealistic' by GP experts, who said they undermined the economic case for screening.
A separate study, published in the British Journal of General Practice last week, recorded serious holes in GP records, suggesting the screening programme would place a heavier burden on practices than the Government was predicting.
Under the screening plans – detailed in Lord Darzi's review - everyone aged 40 to 74 will be assessed for vascular risk in primary care from next April.
But the report, an economic evaluation of the proposals, insisted screening would not ‘require significant disruption to current provision of services', although it did admit there were major gaps in practice records.
The report estimated vascular checks would cost around £24-34 each. This assumed the checks themselves would take up no GP time, and allocated 12 minutes of GP time a week for subsequent interventions, in the first five years, and 42 minutes a week for the next five years.
It also assumed one hour of healthcare assistant time and over an hour of practice nurse time per week.
But Dr Richard Vautrey, GPC deputy chair, said GP involvement at all stages of the programme was vital and that the Government's model raised serious concerns about the way the scheme was being introduced.
‘Just 12 minutes of GP time is totally unrealistic. There is an assumption that this can be done in a five-minute or 10-minute consultation, but explaining something that it quite a difficult concept to patients about their risk of illness needs to be done properly with the right amount of time, energy and skill,' he said.
Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire, warned the calculations did not include the staff training and the resources needed for long-term management of high-risk patients.
‘I am just not convinced that fire and forget is good enough for primary care. You cannot put people on statins and then just forget about them,' he said.
The BJGP study found practice records would predict that 5.9% of patients aged 50 to 74 would have a 10-year CVD risk of over 20% and so require treatment – whereas if records were complete the figure could be as high as one in three.