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Gold, incentives and meh

Wanless backs compulsory data mining of GP records

GPs will be ordered to take part in a massive primary care 'experiment' that will mine confidential patient records for data on health inequalities, if radical Treasury recommendations are accepted by the


The initiative ­ outlined in the latest Wanless report on cost-effectiveness in public health ­ is intended to focus all GP prevention and management of chronic disease firmly on local needs instead of

national targets.

The report ­ Securing Good Health for the Whole Population ­ urges ministers to remove confidentiality barriers to accessing up-to-date patient data and warns that 'considerable damage' could be done to UK health if the obstacles remain in place.

It urges the Government to address this 'threat to public health research' in the Department of Health's White Paper to be published later this year.

The report's author, former banker Derek Wanless, criticises past public health initiatives, warning that policy up until now has focused on a 'National Sickness Service'.

He singles out smoking cessation services for particular criticism, remarking that GPs are paid £15 to record outcomes after just four weeks and that the same quitter

can be recorded up to twice in one year if they return to smoking after the first success.

The report also backs targeted diabetes screening as the most 'promising' means of controlling the disease.

Under key recommendations, patient registers in deprived areas will be harnessed to evaluate PCO investment in IT and to improve GP chronic disease management.

But GP IT experts last week poured scorn on the idea that public health research was threatened by data protection.

Dr Paul Cundy, chair of the GPC IT sub-committee and a GP in Wimbledon, south London, said: 'We say patient confidentiality is paramount. What data do you need that you don't already have access to?'

On smoking cessation, Professor Robert West, co-author of Government guidelines on smoking cessation and professor of psychology at St George's Hospital medical school, warned criticism of the schemes was 'unfair and damaging'. He said: 'Cost per life-year saved is less than £1,000. Even if the clinics were only half as effective they would still be 10 times cheaper for life-year saved as the average lifesaving medical intervention.'

By Cato Pedder

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