Vascular risk assessments costing up to £700 a patient
By Lilian Anekwe
Exclusive: The Government's flagship vascular screening programme is assessing far fewer patients than expected, at an average cost of nearly £70 per patient, a Pulse investigation reveals.
The analysis of data obtained by Pulse under the Freedom of Information act from 25 PCTs has found massive variation in the number and unit cost of vascular checks. It suggests the scheme is being delivered at a much higher cost than Department of Health predictions.
On average, trusts have performed slightly more than 6,000 screens each, at a cost of just over £400,000 – an average cost of £68 each, compared with £30 to see a GP. And some trusts are screening fewer than 100 patients a month, with the cost per assessment at one trust as high as £720 per patient.
Trusts who responded to Pulse had spent a total of £10m on vascular screening, which if representative would extrapolate to £60m across England. By contrast, the DH predicted total ‘transitional costs' of just £9m plus £31m annual costs.
In several areas the cost of the programme diverges hugely from the average, despite it being up and running in some areas for nearly two years.
For example, NHS Hampshire has performed fewer than 2,000 screens – 1,945 by GPs and 46 by pharmacists – at an average cost of £720 per check. Yet vascular screening pilots have been in place since April 2008.
A spokesperson for NHS Hampshire admitted the trust was scrutinising the pilots for clinical and cost-effectiveness, and would look to pull the plug on funding if costs could not be lowered.
‘It is hard to establish which interventions are cost-effective, but an assessment of affordability in relation to outcomes has been made, and this will determine which pilots should continue in 2010/11.'
Other areas began their programmes on the DH's official start date in April 2009, but are struggling to bring down the costs having only performed a tiny number of screens.
NHS Bassetlaw, NHS East Sussex, Downs and Weald, NHS Hastings and Rother and NHS North Tyneside have all performed fewer than 1,000 screens since kicking off their schemes last year.
NHS North Tyneside and NHS Knowsley have both called in academics to evaluate the clinical and cost-effectiveness of their schemes.
Some trusts are performing far better. NHS Blackburn with Darwen's GP-led scheme has performed 12,500 screens in eight months, at an average price of £17.60 each.
NHS Sefton has performed 9,000 screens since October 2009, at an average cost of £26.67, and NHS Newham 23,000 screens at £73.91.
GPC negotiator Dr Dean Marshall said: ‘The GPC position remains that vascular screening was planned and implemented by the Government with little input from us. We always had concerns that it was not the best use of scant NHS resources and none of us is surprised it is being delivered above budget.'
Dr Elizabeth Johnston, a GP in Reading where nearly 5,000 screens have been performed in a year in practices under a LES, said: ‘Overall it's good preventive medicine. But it is quite work-intensive and some practices are struggling to keep up with the workload.'
1. NHS Hampshire – £720
2. NHS Richmond – £647
3. NHS Peterborough – £591
1. NHS Mid Essex – £8
2. NHS Barnsley – £13
3. NHS North East Essex – £14