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'No need to involve RCGP'

GPs face increased scrutiny of prescribing and referral rates and pressure to make lifestyle advice a central part of practice, under plans released by Government inspectors.

The Healthcare Commission is to clamp down on GP care for heart disease after expressing disappointment at the slow rate of progress in heart failure, primary prevention and cardiac rehabilitation.

GPs warned that the move, predicted by Pulse in January, would mean more time spent ticking boxes and further increases in workload. They questioned whether improvements were possible without significant extra resources.

The commission plans to monitor GPs' prescribing rates for heart failure and to set targets for the percentage of patients assessed for cardiovascular risk and offered advice on diet and exercise. It wants to monitor referrals for cardiac rehabilitation amid growing concern over lack of access for some groups, particularly women.

The commission said it had not yet decided how to enforce targets. It suggested new indicators for heart failure, lifestyle advice and cardiac rehabilitation could be included in the next draft of the quality framework.

Dr Rob Barnett, GPC member and Liverpool LMC secretary, said: 'A lot of practices are struggling to maintain essential services as well as everything else that has been bolted on. This is not going to happen unless additional resources come our way.'

Dr Fiona Underhill, a GP in Essex, said: 'These are things we do all the time anyway. The frustration is having to tick boxes all the time to prove it. They should trust us more. Patients would prefer to have our time.'

But cardiovascular experts welcomed the initiative.

Dr Stewart Findlay, member of the Primary Care Cardiovascular Society and a GP in Bishop Auckland, County Durham, said: 'If we are going to deliver on cardiac care we need indicators in the quality framework to make it happen.'

The commission's review of heart care since the launch of the national service framework on CHD found overall standards had improved, but progress had been 'too slow' in some areas.

In January the SHAPE study found UK GPs were the worst in Europe for using betablockers and ACE inhibitors in heart failure.

By Cato Pedder

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