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The waiting game

GPs set to screen millions a year for cardiovascular risk

The Government is planning a national screening programme for cardiovascular disease bas-ed in general practice, Pulse can reveal.

The National Screening Committee wants to see screening implemented from April 2007 with funding through the next QOF review.

Under the ambitious proposals, GPs will be required to invite all patients into the surgery on reaching middle-age for tests on cholesterol, blood pressure and blood glucose.

Exact ages are to be decided but the committee is modelling a programme of checks at 40, 50 and 60 ­ under which 1.8 million patients would be assessed each year. Screening would also be conducted opportunistically.

An analysis suggests the scheme ­ titled the Vascular Disease Risk Factor Assessment and Management Programme ­ will identify an extra 116 patients with untreated cardiovascular disease per average three-partner practice.

Sir Muir Gray, director of the National Screening Committee, told Pulse: 'The aim of the vascular risk management programme is to offer everybody a risk assessment. It will be linked to a person's birthday.'

Sir Muir said he was keen to see risk assessment included in the 2007/8 QOF review and wanted to minimise the impact on GP workload. 'We would aim to do it through health care assistants. I'd like it to be resourced through the QOF.'

Dr Umesh Chauhan, a training fellow at the National Primary Care Research and Development Centre working on ways to integrate the programme into general practice, said: 'It's about a different way of working rather than the ad hoc way it's done now.'

Dr Chauhan, a GP in Brierfield, Burnley, added: 'You might have a diabetes nurse, a renal nurse, a heart nurse, etc, and a lot of that could be integrated. You don't really need three people to do the job.'

Professor Mike Kirby, a member of the guideline development group for the new Joint British Societies guidelines, which provide the basis for the screening programme, said significant funding would be required.

'It is reasonable we do risk assessment but we have to remember the sheer numbers and cost. I could set up a clinic but it's also the ongoing costs of follow-up and treatment.'

Dr Rubin Minhas, CHD lead for Medway PCT and a GP in Gillingham, Kent, questioned whether current risk tools were accurate enough for screening.

'Currently risk tools are poor ­ only just better than flipping a coin in low-risk groups. Low-risk patients could end up on high-dose drugs.'

The committee is still to decide on which risk calculator to use, but assessments will include factors such as ethnicity, smoking status and BMI as well as clinical tests.

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