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At the heart of general practice since 1960

Study challenges new NICE rules on osteoporosis

In an exclusive interview with

Cato Pedder, the Government's heart tsar praises GPs but says there is much to do

The office of the heart tsar, near Waterloo, is more like a modern bistro than a Government building.

Surrounded by its bright colours and slick glass partitions, the most powerful cardiologist in England appears a little shy at first, introducing himself in a reserved manner.

But get Dr Roger Boyle on to the subject of cardiac care and the caution gives way

to what seems to be genuine enthusiasm.

Perhaps unsurprisingly for the man with overall responsibility for England's cardiac care, Dr Boyle is resolutely upbeat in his assessment of progress, claiming Britain is a world leader in cutting cardiovascular deaths.

'There are lessons to be learned from the British experience,' he insists, gamely ignoring the photographer snapping away inches from his face.

GPs have of course come under criticism from cardiologists recently for their treatment of heart failure, with

Dr Boyle himself signalling tougher scrutiny of standards.

So it is gratifying to hear him issuing a robust defence of GPs' overall role, saying they have done a 'stunning job' introducing more systematic care. 'We have moved from 800,000 people recalled each year for a risk factor review to 1.5 million people, even before the effects of the quality framework have been felt.'

The former general manager of York District Hospital rattles out figures like the experienced political operator he has become ­ cardiovascular deaths are down 27 per cent since 1996, £60 million

has been invested in echocardiography ­ and it might be easy to believe everything was rosy.

But as the discussion moves to the future, it becomes clear that behind his enthusiasm lie real doubts over how quickly progress can be made.

The Joint British Societies recently urged PCOs to work towards a statin prescribing threshold of 15 per cent 10-year CHD risk and set a 22.5 per cent threshold as 'the minimum standard of care'.

Yet Dr Boyle seems curiously reluctant to endorse this, perhaps mindful that he now has to balance the books as well as look after patients.

Indeed, he seems worried PCOs may struggle to meet the NSF's 30 per cent threshold for statins. 'Just to include people at 30 per cent risk would increase the number of people needing treatment by seven million. It would be very costly. Targeting patients at 15 per cent risk would test primary care capacity,' he says.

Dr Boyle's caution on statins jars with his robustness elsewhere. He says an extra £200 million has been factored into the spending review for statins, taking next year's total budget to £2 billion. But with some experts suggesting new guidelines could send the statins bill rocketing by more than £1 billion per year, PCOs are unlikely to be reassured.

And such reservations make one of Dr Boyle's highest priority targets ­ to narrow the wealth divide by improving primary prevention of heart disease in deprived areas ­ look difficult to achieve.

'We need to be working harder on primary prevention interventions to improve coronary health and help people, particularly in areas of most need,' he says.

Dr Boyle admits he is disappointed that one primary prevention intervention, the sale of statins over the counter, 'has not taken off at a greater rate', despite an aggressive advertising drive.

He suggests pharmacists lack the confidence to evaluate risk for OTC simvastatin, although he hopes they will become increasingly involved in CHD and heart failure.

But it is GPs who take centre stage in one of Dr Boyle's more ambitious visions for cardiac care. He wants to see the introduction of what he calls 'mini-treatment centres'.

Here, GPs,

nurses and telecarers will diagnose and monitor patients and adjust treatment, leaving hospitals to deal with acute cases.

'We need GPs trained in echo services and to develop GPs with special interest in cardiology, and we are working hard to make primary care diagnostics part of the pro-cess,' Dr Boyle says.

The heart tsar hopes

this will rectify the failures

in diagnosis revealed in the

recent SHAPE survey, which found that three-quarters of GPs were diagnosing heart failure by signs and symptoms alone.

He will make echocardiography referral a measured waiting time and will also oversee Government inspections of heart failure treatments, to uncover under-treatment.

In the more immediate future, Dr Boyle says the NSF for CHD will be broadened next month to include sudden cardiac death and arrhythmias ­ a change, he notes with a smile, that was planned long before Tony Blair's recent health problems.

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