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PCTs set for clash with GPs over stroke target

GPs will ignore a key national service framework deadline intended to prevent strokes because they won't get paid for the work under the quality and outcomes framework, experts are warning.

They say PCTs will have to offer GPs local cash incentives to hit the older people's NSF target for all atrial fibrillation patients to be identified and treated with an anticoagulant or antiplatelet agent by April 2004.

The Department of Health said it expected PCTs to monitor GP progress towards the deadline but made clear there would be no new money. A spokesman said: 'Meeting NSF targets is a priority for PCTs and they will have to use already allocated resources.'

The NSF says GPs must document a reason in any case where they fail to ensure a patient with atrial fibrillation is treated with warfarin or, if this is inappropriate, with aspirin or another antiplatelet agent. Atrial fibrillation increases the risk of stroke by up to seven times.

The quality framework will only pay GPs for offering anticoagulation or antiplatelet therapy to patients with a history of non-haemorrhagic stroke or TIA. Four points are available for ensuring 90 per cent of patients are treated.

Professor David Fitzmaurice, professor of primary care research at the University of Birmingham and chair of the Primary Care Anticoagulation Society, said warfarin prescribing was seen as 'troublesome' by GPs. He added: 'There is no incentive to either identify patients with AF or use thromboprophylaxis in those patients we know about. This is unlikely to change without cash incentives.'

He said the new contract would worsen the problem because many practices currently offering anticoagulation treatment and monitoring were earning more now than they would for providing it as a

national enhanced service.

Dr Mark Davis, a GP in Leeds and member of the external reference team for the CHD national service framework, said PCTs ­ under heavy pressure to meet NSF deadlines ­ may have to offer financial or managerial support to practices to hit the target.

He added: 'It is clear that effective management of atrial fibrillation in a primary care environment is crucial to the reduction of both the incidence and impact of stroke.'

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