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What of the future?

All national service frameworks will be completely over-hauled under the Government's plans, with disease prevention becoming the single unifying theme.

The NSFs will be drawn together under a 'comprehensive and integrated prevention framework' and health improvement will become 'mainstream' across the NHS, according to the White Paper on public health.

But GP experts are concerned the 'extension of primary prevention' could include increased prescribing of drugs such as statins, despite a 'total lack of evidence' that such moves are beneficial in primary prevention.

They also warned plans to change the NSFs to address 'geographical variation in preventive action and prescribing rates' would be a 'crude tool'.

Dr Malcolm Kendrick, a GP returner in Macclesfield, Cheshire, who developed an education website for the European Society of Cardiology, warned patients would be put at risk of dangerous side-effects for no proven benefit if statins were used to prevent cardiovascular disease.

'The problem is that everyone talks about cardiovascular mortality, ignoring that dying of anything is not a good idea,' he said.

Dr Simon Griffin, GP member of the Government's national diabetes screening task force and lecturer in public health at Cambridge University, said: 'The health of the public is not dependent on whether their GP prescribes a statin or not. The obese smoker doesn't necessarily come for screening and get prescribed the appropriate drugs.'

But he welcomed the move towards encouraging primary preventive strategies such as better diet and exercise, which could prevent many different diseases.

'Before, the Government put all the emphasis on GPs and nurses to change behaviour and abrogated responsibility themselves. I'm glad that looks to be changing,' he said.

The Government's 'tsars' in each disease area have been asked to make recommendations on revamping the NSFs by March next year, following consultation with experts in the field.

PCTs will then need to consider how far arrangements for delivery of the NSFs meet the new framework.

By Cato Pedder

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