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Independents' Day

Lack of CVD risk cash to scupper statin ruling

By Emma Wilkinson

Patients are set to miss the benfits of NICE's statins appraisal because only one PCT in 20 is prepared to fund the measurement of cardiovascular risk.

From this week GPs will be expected to prescribe statins to everyone from 20 per cent 10-year risk of cardiovascular disease ­ a move set to cost the NHS £78 million in drug costs alone.

But an investigation by Pulse suggests only a handful of trusts are prepared to pay GPs for assessing patients' cardiovascular risk while many will struggle to cope with spiralling drugs bills.

The majority of PCTs are planning to squeeze the forecast surge in statin prescribing into their annual budget uplift, but many warned they would have to find 'efficiency savings' elsewhere.

Only four of the 90 PCTs that responded to our questions said they had an enhanced service in place to pay GPs for carrying out cardiovascular risk assessments (see case study, right).

The Government's heart tsar, Dr Roger Boyle, admitted to Pulse that there would be no extra funding to help implement the guidance. 'There is no dedicated money for that task. It's going to have to be part of their general activity. A lot of GPs are already doing it so it's not as if we are starting with a blank canvas,' he said.

But GPs believe that without specific funding ­ ideally through the QOF ­ implementation of the appraisal will fall well down PCTs' lists of priorities.

Dr Rubin Minhas, a GP in Gillingham in Kent and CHD lead for Medway PCT, said: 'Few PCTs are pushing ahead with primary prevention as QOF is the key driver.'

Dr Peter Elliott, a GP in east London and prescribing lead for Redbridge PCT, warned: 'People have been busy with other things, like the collapse of the NHS. Money keeps being taken away. Everything is in limbo at the moment ­ GPs have had

no guidance about risk assessment.'

The need for guidance is particularly acute given a series of recent studies criticising the effectiveness of the Framingham risk score. Yet only a third of PCTs have issued specific guidelines to GPs on how to assess eligibility for statins, although another 20 per cent plan to do so.

Dr Terry McCormack, chair of the Primary Care Cardiovascular Society and a GP in Whitby, North Yorkshire, urged GPs to press ahead with primary prevention even without encouragement from their PCTs.

'Practices should start to introduce risk assessment because it is good for patients and somewhere along the line it will be introduced in QOF. If GPs wait they will have a lot of catching up to do.'

Some PCTs, although stopping short of setting up an enhanced service, are planning to push ahead with implementing the appraisal.

Dr Malcolm Ridgway, PEC chair at Blackburn with Darwen PCT, estimated increased statin prescribing would cost the PCT around £400,000.

But he added: 'We already have a CVD scheme over and above the QOF requirements. We've generally been ahead of the game so our statin cost blip has already started and been accounted for.'

Dr John Ashcroft, CHD lead for Erewash PCT, where an enhanced service on primary prevention of cardiovascular disease has been in place for several months, said risk assessment was a lot of work - but worth the effort.

Dr Ashcroft, a GP in Tibshelf, Derbyshire, said: 'PCTs think statins are really expensive ­ but this will be bigger than the QOF in terms of lives saved.'

£2,000 on offer for CVD LES

In Brighton and Hove PCT, the average practice can earn £2,000 for hitting the 17 points on offer under a new local enhanced service for primary prevention of CVD.

For the first year, practices will also earn 20p per patient on their lists aged from 35 to 75 ­ reflecting the extra work in setting up the scheme.

To gain maximum points, GPs must develop and maintain a register of those at risk of CVD, develop and implement a practice protocol for identification, assessment, treatment and follow-up, and complete an audit of patients identified and reviewed.

Caroline Morris, enhanced service programme manager for the PCT, said: 'As part of the NSF we've been monitoring primary prevention and we weren't getting much uptake so the only way we were going to progress was to put some money behind it.'

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