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Independents' Day

GPs to screen millions for pre-diabetes from 2009

By Nigel Praities

GPs will be screening for pre-diabetes from next year after the Government flung open the remit of its vascular screening programme and ushered in a new era of mass disease prevention.

Half of all patients over 40 are set to be on some kind of cardiovascular medication under the greatest preventive initiative in the history of the NHS.

A Department of Health impact assessment reveals the programme of five-yearly vascular checks – for everyone aged 40 to 74 – will require the equivalent of an extra 1,000 GPs, practice nurses and healthcare assistants by 2012.

The full programme is estimated to cost £332m a year – £82m more than had been forecast – although the DH insists it will be hugely cost-effective in the long term.

NHS Employers said it expected the Government to spend up to £100m a year to back the initiative – this week quoting the figure in its evidence to the pay review body to justify ruling out any substantial rise in GP pay.

But it is the move to offer screening for pre-diabetes and chronic kidney disease – set out in implementation guidelines to PCTs – that will cause most controversy.

Once at-risk patients are identified through a vascular check, practices will carry out oral glucose tolerance tests in those with high blood glucose, and creatinine tests in those with high blood pressure.

The programme is to be phased in over a four-year period, with the DH planning to publish the precise blood glucose thresholds for IGT testing next year.

But its assessment shows that for obese men and women aged between 50 and 54, 37% and 32% respectively would have impaired glucose tolerance, on top of 21% and 8% respectively with diabetes. Even among non-obese patients of the same age, a fifth would have impaired glucose tolerance.

Some 41% of men aged 50-54, and 32% of women of the same age, would be eligible for antihypertensive treatment.

Pulse can reveal several PCTs have already drawn up plans to spearhead screening, to launch over the next few months.

Knowsley PCT will pay GPs to identify patients at high risk from practice records and screen them for CKD and pre-diabetes.

An outside provider will also be brought in to carry out proactive vascular checks, in settings such as supermarkets, bingo halls and community centres.

Heart of Birmingham PCT and Berkshire West PCT are planning similar schemes, and Wirral PCT has already launched a LES to encourage GPs to set up high-risk registers and screen all patients aged 55 to 75 years for CVD risk and pre-diabetes.

Dr Matt Kearney, a GP in Runcorn, Cheshire, and a public health practitioner at Knowsley PCT, said he anticipated almost all practices in the area would sign up. ‘I think GPs have seen the opportunity to make a real difference to patient outcomes,' he said.

But some GPs have significant concerns about the plans. Dr Michael Burke, a GP in Wirral, said his practice would sign up to the programme but that it was ‘a big job'.

‘The medicalisation of people who think they are otherwise well is a concern,' he said.

A new era of disease prevention

• Some 15 million people aged 40 to 74 will be invited for
a vascular check every five years when the programme is fully implemented

• The total cost of the programme is £332m per year, a rise of £82m on previous estimates and a cost per QALY of £3,505

• PCTs will be encouraged to commission checks from the providers that ‘best meet the needs of their population'

• The numbers of GPs needed has the ‘potential to put upward pressure on costs', with about 800 extra GPs needed to oversee the programme in full swing

• Providers of lifestyle interventions face rising workloads, with an extra 7.5 million patients receiving a brief intervention on physical exercise, 3.7 million people referred to a weight management service and 1.9 million people referred to smoking cessation services over the first 20 years

Millions of patients will be diagnosed with impaired glucose tolerance under vascular screening plans Millions of patients will be diagnosed with impaired glucose tolerance under vascular screening plans

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