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PAD screening to be bolted on to vascular checks programmes

By Lilian Anekwe

PCT managers are being told to expand their vascular checks programmes to include screening for peripheral arterial disease (PAD), Pulse can reveal.

NHS documents distributed to PCT commissioners and seen by Pulse advise them to give ‘serious consideration' to bolting PAD screening on to their existing vascular checks programmes.

The primary care service framework for peripheral arterial disease, distributed by Primary Care Commissioning – the Department of Health's policy implementation body – recommends that PCTs ‘may want to give serious consideration to linking services they commission to address PAD to their vascular check programme.'

PAD services should be targeted at symptomatic patients, particularly middle aged and elderly patients, and those with diabetes and cardiovascular disease. And even though the DH concedes that it is not part of the NHS health check programme, it still advises that ‘some PCTs may decide to extend their programme to include PAD.'

The service will include establishing a disease register to identify and record new patients, diagnosing lower limb PAD using ankle brachial pressure index measurements, and risk factor medication.

But GP experts warned bolting on PAD onto existing vascular check programmes was far from realistic for many PCTs.

The framework also sets tough targets for year on year improvements in symptoms. GPs and other providers will need to demonstrate a 40% improvement in achievement of QOF indicators for cholesterol and hypertension, which will then be ramped up to 60% in the second year and 80% in the third year the service is delivered.

Dr Andrew Mimnagh, a GP in Liverpool and a member of the charity Target PAD, told Pulse the fragmented delivery of the health check programme meant many PCTs would be unable to provide additional services for identifying and managing patients with PAD.

‘I would welcome anything that raises the profile of PAD, but I can't see this working,' he said.

‘The chances of upskilling people to use a Doppler ultrasound are close to zero. I don't know any chemist that even has one on the premises. Services will need to be massively scaled up to provide this and the reality is that most PCTs are in debt. The rationale for doing it is there but operationally not all PCTs are even on the starting grid for doing this.'

The PAD primary care service framework: what will it include?

• Establishing a disease register, identifying new patients and putting them on the register
• Diagnosis of lower limb PAD, using measurement of ankle brachial pressure index (ABPI)
• Cardiovascular risk assessment, monitoring and follow up of risk factor modification
• Managing and alleviating current symptoms (e.g. pain, mobility)
• Reducing disease progression and major complications
• Sharing good practice, learning and skills with other providers in the local health community in order to ensure continuity and stability in the local workforce

Source: NHS Primary Care Commissioning

PCTs have been told to expand their vascular checks programmes to include screening for peripheral arterial disease PCTs have been told to expand their vascular checks programmes to include screening for peripheral arterial disease

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