At present meeting the quality and outcomes framework (QOF) targets for cardiovascular disease assumes a high priority in primary care. It was therefore encouraging to read that nearly 9,000 cardiovascular events will be prevented in England over the next 5 years as a result of GPs' success in tackling the hypertension indicators in the QOF (News, Guidelines in Practice, May 2006).
What is clear from the QOF achievements is that primary care activity, if incentivised, can deliver improved outcomes in quality care along with the processes to achieve them.
Should practices also be actively implementing all the recommendations of the JBS 2 guidelines at this stage or using it only as a reference document?1
The guidelines make the recommendation that all adults from 40 years of age onwards who are not in a high-risk group should be considered for an opportunistic comprehensive cardiovascular risk assessment in primary care.
The resources required in terms of more practice staff and the increased drugs cost must, however, be taken into account.
The current policy of the UK National Screening Committee,2 which advises the Government on screening, reflects the National Service Framework for Coronary Heart Disease (CHD) which did not recommend screening the whole population for CHD.3
However, a vascular disease control programme is envisaged by Sir Muir Gray, Programme Director of the National Screening Committee, which, it is hoped, will influence QOF payments in 2007/08.4
In April 2006 work began in Scotland on compiling a cardiovascular disease (CVD) risk dataset on all patients between 45 and 64 years of age.This will be carried out in general practice and funded as a directed enhanced service for the forthcoming year.5
Developing this risk dataset and incorporating a risk measurement engine into the information technology system already in use within practices will make the task of CVD risk assessment manageable.6
Preventing CVD is a challenge which primary care will rise to, but it does require a fully coordinated effort as well as ensuring that resources are used in a clearly targeted way.
Dr Alan Begg, GP, Montrose
and member of the SIGN CHD Guideline Development Steering Group
- JBS 2: Joint British Societies' Guidelines on Prevention of Cardiovascular Disease in Clinical Practice.Heart 2005; 91(suppl v); v1-v52.
- Coronary heart disease: national service framework for coronary heart disease - modern standards and service models. London: Department of Health, 2000.
- Scottish Executive. NHS Circular. PCA(M) (2006)4: Cardiovascular Disease (CVD) Dataset. Edinburgh: Scottish Executive, 2006.
- Begg AG,Griffith JM.The electronic health record and the management of cardiovascular disease. Br J Cardiol 2002; 9 (10): 630-33.