GPs losing out to pharmacists in vascular screening lottery
By Nigel Praities
Exclusive: Pharmacists will be paid nearly three times as much as GPs on average to participate in the national vascular screening programme, Pulse can reveal.
Our investigation uncovers huge variation in trusts' plans for vascular checks, with some practices to be paid thousands of pounds for taking part while others get nothing.
The GPC condemned the rollout of the screening programme as ‘crazy' and accused the Department of Health of trying to drive a wedge between GPs and pharmacists.
In some areas, practices are being frozen out from the £332m-a-year programme, with pharmacists and nurses mopping up all the funding.
Detailed plans obtained via the Freedom of Information Act from 44 PCTs reveal trusts are rushing ahead with screening, with more than half to have schemes in place by the start of the national rollout in April.
But trusts are employing a wide variety of methods, with some using searches of practice records, some birthday-based population screening and others opportunistic approaches at workplaces and local centres.
GPs are involved in 88% of schemes, but will have a leading role in just 61%, while a third will use pharmacists. Practices will receive an average of £10 per patient screened, compared with £26 for pharmacies.
But this figure masks extraordinary variation, with Hull PCT paying £25 per check and follow-up, but Wirral PCT just £1 per check, plus an initial £750.
South West Essex PCT is not paying GPs anything for conducting checks, although it does have a LES for follow-up.
A DH spokesperson insisted: ‘Our framework encourages PCTs to commission vascular checks however it is most effective locally. We anticipate this will vary from place to place.'
But Dr Richard Vautrey, deputy chair of the GPC, angrily condemned the erratic way screening was being rolled out, and said it was ‘crazy' some trusts were excluding GPs.
‘The way the Government has done this beggars belief. There is a disparate variety of schemes, rather than a sensible, consistent approach. It's crazy that any PCT would not give GPs a key role.'
In North Somerset, the PCT has sparked anger after asking GPs to surrender practice lists to community pharmacies, which will provide the checks for £25 a patient.
Dr Tom Frewin, a local GP and LMC member in Avon, said: ‘Why are they doing this? If they don't have the right experience or equipment it is just doubling everyone's work.'
Dr Tom Marshall, a member of the NICE lipid modification guideline development group and clinical lecturer at the University of Birmingham, warned the wide variation in schemes would make the programme extremely difficult to evaluate: ‘It is absolutely critical we evaluate the results, otherwise we will not really know what works.'
NICE could throw the programme into yet more chaos with documents released under the Freedom of Information Act revealing it could be ready to ditch the Framingham score, on which the schemes are based. Its officials have urged Government heart tsar Professor Roger Boyle to intervene to speed up publication of its evaluation of the alternative QRISK score.
Philip Alderson, NICE associate director, wrote: ‘If this was in the public domain it would give us sufficient reason to trigger an update.'Framingham: its future is as uncertain as the role of GPs in screening Framingham: its future is as uncertain as the role of GPs in screening