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GPs criticised for patchy progress on CHD targets

CHI reports on CHD care and access to GPs

Government inspectors have criticised GPs for their slow and patchy progress towards targets in the national service framework for coronary heart disease.

But PCTs must share the blame because of their failure to provide enough funding and staff to help GPs, according to emerging findings from the Commission for Health Improvement's national audit of CHD care.

CHI found that CHD registers ­ the key framework milestone for GPs ­ were up and running in most practices. But it made clear GPs needed to do more work to make the registers accurate.

Treatment of patients already on the registers was branded 'variable'.

CHI also highlighted poor progress in identifying patients at-risk of CHD for primary prevention, another NSF milestone. Some of the PCTs inspected said at-risk patients were unlikely to be added to registers before 2010.

Prescribing of statins had improved in most areas but more work was needed to improve consistency between practices.

A postcode lottery in heart failure diagnostic services was flagged up, with some practices having direct access to echocardiography and others in the same area having to wait up to six months.

CHI is auditing CHD care in 26 areas of England. The emerging findings come from its first six reports, published last week. They cover Hambleton and Richmondshire, West Suffolk, Croydon, Plymouth, East Kent and Central Nottinghamshire.

East Kent, where GPs already receive incentives to

improve the management of chronic conditions, was

singled out as a 'leader' in setting up accurate CHD registers that include at-risk patients.

By Brian Kelly

CHI's verdict on GP care

What the audit found in Croydon PCT

Practice CHD registers ­ 70 per cent accurate but no register of at-risk patients before 2010.

Appropriate use of register ­ two-thirds of practices offer structured care including regular clinics. However, in some cases only half of patients on registers received an annual review.

Statin prescribing ­ big variations between practices. Proportion of patients with a history of MI who were taking statins varied from 60 to 80 per cent.

Heart failure ­ no common standards or dedicated funding for identifying patients. Waiting times for echocardiography are 70 days and increasing. Rapid-access echo only available to some practices.

Source: Commission for Health Improvement

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