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Vascular screening split as PCTs abandon Framingham

By Nigel Praities

Exclusive: A dramatic split is emerging in the Government's vascular screening programme, with a series of PCTs choosing to abandon the Framingham score in favour of the QRISK system developed in UK general practice.

PCTs in several areas and one whole SHA have so far broken ranks and asked GPs to use QRISK for vascular risk assessment, in defiance of NICE guidance recommending a modified version of Framingham.

In at least one case the move to QRISK for the Government's NHS Health Check programme [check] is taking place after primary prevention registers had been drawn up under Framingham, forcing practices to start all over again.

And there is now a real possibility further trusts may be forced to abandon screening schemes set up using Framingham, as evidence emerges of growing support for the QRISK system.

Newham PCT had been using Framingham and QRISK concurrently, but has now decided to plump for QRISK after pilots showed it performed better.

NHS City and Hackney and NHS Tower Hamlets have also decided to use QRISK as their ‘risk engine of choice'.

NHS East of England has decided to use QRISK in all 14 PCTs, in a move that has caused confusion in Luton, where practices had drawn up risk registers using Framingham and must now redo them.

The RCGP last week threw its weight behind use of QRISK, calling on the Department of Health to ensure it was used uniformly across all practices.

The college's chair, Professor Steve Field, told a conference on preventive health in London: 'We support QRISK. It's the risk classification that should be used uniformly across the vascular checks programme and should go into QOF. It's based in the UK, takes into account ethnicity and it's bloody good.'

The Department of Health issued PCTs best practice guidance and funding in April to roll out vascular screening, but left the choice of risk calculator up to individual PCTs.

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Dr Kambiz Boomla, a GP in Tower Hamlets and chair of City and East London LMC, criticised the differing approaches taken by PCTs, saying it would prove confusing for patients: ‘People aren't thinking straight on this one. It is in everybody's interest that the risk recorded is correct. I wouldn't want to be prescribed statins when I didn't need them.'

But Professor Mike Kirby, professor of health and human sciences at the University of Hertfordshire and a GP in Radlett, said the variations in risk score were not so important.

‘The important thing is that people get their risk evaluated, not so much what score is used,' he said.

QRISKtable A series of PCTs have chosen to abandon the Framingham risk score in favour of the QRISK system A series of PCTs have chosen to abandon the Framingham risk score in favour of the QRISK system

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