Targets are fine in principle, but unrealistic

Primary care p 269

The United Kingdom's national service framework for cardiovascular disease1 is one year old. It describes an ambitious list of standards, milestones, and performance indicators against which the NHS will be held to account. It requires primary care to identify and institute preventive strategies not only for people with established ischaemic heart disease but also for those with a 30% 10 year cardiovascular risk. In this issue Hippisley-Cox and Pringle report a study of 18 computerised general practices to estimate the workload involved in meeting these expectations (p 269).2 Is it matched by the benefits gained?

Clearly, the increased workload for primary care is huge. In the absence of additional resources, how should this extra work be prioritised alongside everything else required of primary care? Apparently there will be more doctors and nurses,1 but given a global shortage where will they come from in the time frame of this framework? Without extra staffing the opportunity costs will be high, so which existing activities should stop?

Most general practitioners accept the desirability of working towards systematic evidence based management of patients with established ischaemic heart disease. Hippisley-Cox …