NICE previously looked at the best approach to primary prevention for diabetes and concluded we should just call in patients who look to be at high risk in our GP registers.
The plan was to use PC 67 information on GP systems to identify patients at high risk and produce registers. That was in the NSF (National Service Framework), which came out in April 2000. All PCTs were supposed to create registers of high-risk patients, but it never happened - a total failure of primary prevention.
And we need this to be in the QOF - we need registers of high-risk patients, who we put on statins, those who we identify as prediabetic - and they need to be followed up. None of that is happening. Sir Roger Boyle, national director for heart disease and stroke, wanted to put this in the QOF six or seven years ago but he could not get it in.
It is a great shame that this was totally ignored by the Department of Health. We have the world’s best database that we could use, but we totally ignore it and just call everybody in, from age 40 to 75 years. So the 43-year-old woman, who we already know had normal blood pressure and weight and does not smoke, because we recorded it last week, is called in – what a waste of time. Her time, our time and taxpayers money.
So the process for who we call in is wrong, and then of those we do, only some come in, and then of those we give, for example, statins for high cardiovascular risk only some will continue taking them. All through that process we are effectively selecting patients and the people who end up being treated at the end of that process will be patients who are middle class, so we are probably making health inequalities worse probably makes health inequalities worse. But we don’t know because no one has done any real work on seeing the impact, although it looks like this may be starting
The irony is that the Government wanted to use the NHS Health Checks programme to reduce health inequalities, but the way the DH is rolling it out is increasing them. Here we are, in a total shambles. It is appalling, that none has got a grasp of this - it feels like the way hypertension was managed back in the 1970s.
Dr John Ashcroft is a GP in Derbyshire