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Commissioning board to police GPs on vascular screening uptake

By Lilian Anekwe

Exclusive: GP consortia will be held to account by the NHS Commissioning Board for any dip in uptake levels for the Department of Health's flagship vascular checks programme, says the heart tsar.

Professor Roger Boyle, the DH heart disease tsar, said the NHS Commissioning Board will be drafted in to publish uptake levels around the country to root out poor performers in the Department of Health's flagship vascular checks programme.

In an interview with Pulse, Professor Boyle said the programme had the 'full backing' of health secretary Andrew Lansley, who signalled last year he would launch a full review of the evidence base around the NHS Health Check programme if elected.

NHS managers in some areas have struggled to boost uptake levels and Pulse also revealed last month that a senior DH official had admitted for the first time that its flagship vascular screening programme was rushed forward because of a 'political imperative'.

But Professor Boyle said he has since received assurances from ministers the programme would continue in its 'current configuration' for now.

He said: 'The reports of a premature demise of this programme were misplaced because it is alive and well and has the full support of ministers.'

'We've had extensive discussions with ministers about its format and the intentions of the programme and they are fully behind the current configuration.'

'That is not to say it will not change in the future as the evidence base changes but at the moment we'd like to keep things simple and everybody understands the content of the current plan, we just need to get it fully rolled out.'

The DH has set the NHS the target to screen two million more people by next April, and Professor Boyle said both he and the DH are 'very anxious that the rollout of the programme should continue at a rapid pace, despite all the changes that have been happening in the NHS.'

In order to maintain the pressure on GPs after 2013, Professor Boyle said the NHS Commissioning Board would be asked to monitor uptake in primary care and publish national league tables comparing uptake in different areas.

'We have now got a dataset agreed and we will be able to extract that from primary care records almost automatically. We will be able to check where the gaps are and understand where people are having difficulty in delivering it and we will have plenty of levers by which we will be able to ensure that the programme is successful in the longer run.'

'It will be a matter for the NHS Commissioning Board to look at the guidance and make public the difference in uptake across the country.'

And Professor Boyle said there were still areas where there were more work to be done, including implementing the forthcoming JBS3 guidance from the Joint British Societies, which he is helping to draft.

'It's really important that GPs understand the variation in cardiovascular disease rates and morbidity and tackle the burden of disease head on. That's part of the accountability process of being in charge of commissioning.'

'If I'm critical of public health in the past it's because I don't think we've had sufficient engagement with primary care to indicate just what the power of simple interventions that could happen at practice level could make to the population's health and the individual's level of risk.'

'What we need to do is to find better ways of explaining risk to people. That's where this concept of lifetime risk is going to be figuring large in the revised guidance as a means of communicating to people.'

'We see this guidance as a means to helping GPs have the conversation with individuals, whether they are making up their minds about referring to a smoking cessation clinic or to an exercise programme of whether to offer dietary advice or whether to take tablets which would be important if they were in very high-risk categories. The tool helps explain what the benefits would be from those interventions.'

He also identified improving the diagnosis of patients with blood pressure and increasing the number of patients with atrial fibrillation treated with warfarin, as areas where GPs still need to improve – and suggested this could be done through the QOF.

'I think there is plenty more that could be done to make sure the QOF is updated and that it stretches primary care to work harder.'

Professor Roger Boyle