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GPs set for incentives to screen for atrial fibrillation

GP practices could soon be offered incentives through QOF to screen elderly people for atrial fibrillation, under new NICE plans unveiled this week.

The proposals will see 30 GP practices piloting yearly pulse checks in elderly people at particularly high risk of stroke, as part of a drive to boost earlier detection of the heart arrhythmia.

The move comes despite opposition from GP leaders, who argue that screening for atrial fibrillation goes against National Screening Committee advice and that it is another example of the tick-box culture.

The plan for a QOF screening indicator has been introduced after concerns that up to 470,000 adults with atrial fibrillation have not been diagnosed and are therefore not receiving appropriate advice to reduce their risk of stroke, NICE said.

The 30 GP practices will test out an indicator that rewards yearly pulse palpation checks in patients over the age of 65 who have conditions such as COPD and diabetes.

The practices will also try out an indicator on yearly reviews of the ‘quality’ of anticoagulation in those patients already diagnosed and receiving treatment for atrial fibrillation, as previously proposed.

This comes after NHS Improvement said that round 8,000 extra strokes could be prevented each year if the condition was better managed – saving the NHS £95 million a year.

NICE said it was not yet known what the exact wording of the indicators would be, but that they could be rolled out in 2017/18, if they ‘are found to improve the identification and management of atrial fibrillation’. 

Dr Andrew Black, a GP in Herefordshire and deputy chair of the indicator advisory committee, said: ‘Improving the identification of atrial fibrillation and ensuring we perform timely reviews of treatment are two very easy steps we can take, which could have a huge benefit to our patients.

‘I am glad these indicators are being piloted and I look forward to reviewing the impact they have had.’

However, both indicators have been met with scepticism amongst GP leaders.

Dr Peter Swinyard, chair of the Family Doctor Association, said it is increasing bureaucracy both should be vetoed even if they are validated through the pilots.

He said: ‘It’s another box to tick , when you get these extra boxes to tick in certain groups – but does that really save lives?

‘We do pick people up – we do already check the pulse – and I’m not sure giving us yet another hurdle to jump is going to help anything at a time when we are so short on appointments and manpower.’

The RCGP’s expert group on overdiagnosis warned the approach ‘is a proposal to screen for atrial fibrillation’ and that ‘NICE should not be promoting a screening activity that has been considered by the National Screening Committee and rejected’.

It also rejected the idea of the anticoagulation review indicator, arguing this ‘will be time consuming’, ‘likely to become a tick-box exercise’ and could cause ‘confusion and irritation’ among patients.

However, the NICE indicators advisory committee dismissed these concerns during a recent meeting, minutes reveal.

The committee said that yearly pulse checks should not have ‘major implications on resources as this process should be done when carrying out other processes such as blood pressure checks’, and that, as the approach only targets an ‘at-risk’ group, ‘it does not constitute screening’.

And it ruled the yearly anticoagulation review ‘would not be captured in a generic indicator on medication review’.

However, it comes as the GPC and NHS England are in talks over the future of QOF.