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GPs losing enthusiasm for IT modernisation

GPs face a 'postcode lottery' when referring to cardiac rehabilitation clinics because of gross underfunding and pat-chy distribution of services, new research finds.

The Government-backed study found annual funding for clinics would need to jump by £100 million – a 630 per cent increase – to meet national service framework targets.

But the researchers said the 'soft' evidence base for cardiac rehabilitation had seen it excluded from the new GP contract, diverting cash to the growing statins bill. GP experts demanded ring-fenced funding to provide uniform access across the country.

The study, in August's British Journal of Cardiology, analysed hospital discharge records of 266,833 patients with ischaemic heart disease and found 22-33 per cent were referred to a rehabilitation clinic, with 13-20 per cent attending.

The NSF for coronary heart disease states that 85 per cent of people with a primary diagnosis of acute myocardial infarction or coronary revascularisation should be offered rehabilitation.

Costs of clinics varied, depending on staffing levels and design of programmes, but the researchers estimated providing rehabilitation to all eligible patients would cost £115 million, compared to the current expenditure of £12.5-£19 million.

Study leader Dr Robert West, reader in epidemiology at the University of Wales College of Medicine in Cardiff, said: 'Most practising cardiologists think the evidence [for cardiac rehabilitation] is softer than things like secondary prevention using statins and ß-blockers. The fact that it did not go in the new contract means it is now being ignored.

'To some extent there is a postcode lottery. Most areas have some sort of cardiac rehabilitation service but what is provided varies hugely. Some areas have all-singing all-dancing clinics while others have a part-time nurse who squeezes cardiac rehab in between jobs.'

Study co-author Dr Hugh Bethell, director of the Basingstoke and Alton Cardiac Rehabilitation Centre in Hampshire and a GP in the county, said a budget increase of up to 630 per cent would be needed to meet NSF targets and that future funding should be ring-fenced to avoid services 'being dependent on goodwill and vulnerable to fluctuation'.

By Brian Kelly

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