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Vascular screening descends into farce

The start of the Government’s much-trumpeted vascular checks programme is just months away. A series of PCTs have already introduced schemes of their own, as they gear up for the April launch of the national rollout. And still, as we learn this week, nobody has any idea how screening will be done.

The start of the Government's much-trumpeted vascular checks programme is just months away. A series of PCTs have already introduced schemes of their own, as they gear up for the April launch of the national rollout. And still, as we learn this week, nobody has any idea how screening will be done.



The news that NICE is to go back to the drawing board on its ruling over which cardiovascular risk score GPs should be using has plunged the plans into chaos.

The vascular checks programme has been dogged with controversy right from the outset. When Prime Minister Gordon Brown pledged he would introduce a vascular screening programme last year, the announcement came out of the blue, and took the National Screening Committee completely by surprise. Much panic ensued behind the scenes, not least in trying to work out how vascular checks would fit with the programme of Life Checks the Government had already committed to.

But it has been the wrangling over risk scoring that has left the programme so hamstrung. To recap, NICE originally came down in favour of UK-based QRISK rather than the increasingly criticised Framingham score. An unpublished study raising doubts about QRISK was then submitted to the institute, which changed its mind and plumped for Framingham after all. It was this move that prompted a series of PCTs to begin their own vascular screening schemes, all using Framingham.

But as we reveal this week, there has now been a further twist. A second study was submitted to the Department of Health, apparently discrediting the previous one, and ministers have forwarded this to NICE with firm instructions to think again.

Jumping the gun

If it all sounds rather like a farce, that's because it is. It is bad enough that proposals for vascular checks were rushed through without the full involvement, or indeed agreement, of the Government's own screening experts. But it is simply extraordinary that trusts have been encouraged to jump the gun on the national launch date before details of how screening should work are settled. It is even possible

GPs whose trusts have introduced screening schemes already may have to re-screen patients with QRISK should the case for Framingham be rejected.

Of course, change always causes disruption, but that is no case against switching to a new system should it be better for patients. The question is over timescale, and whether it is wise to press ahead with plans for vascular checks while serious issues remain over how to implement them. If QRISK is to be introduced in place of Framingham, there will need to be a period of adjustment. The Government should put the brakes on vascular checks until the debate is settled.

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