Vascular screening of over 40s will save 2000 lives a year, says health department

BMJ 2008; 336 doi: (Published 03 April 2008) Cite this as: BMJ 2008;336:737
  1. Zosia Kmietowicz
  1. 1London

    Everyone in England aged between 40 and 74 is to be offered a health check every five years to screen for the risk of heart disease, diabetes, kidney disease, and stroke, the Department of Health announced this week.

    The health checks are the latest in a series of reforms designed to fulfil the prime minister’s promise of a more personalised NHS.

    Alan Johnson, the secretary of state for health, said that detailed modelling by the department had shown that universal vascular screening will be clinically and cost effective. Vascular disease affects four million people in England and kills 170 000 people every year, he said.

    “The case for a national programme of vascular checks is compelling. We could prevent 9500 heart attacks and strokes every year and save 2000 lives. It would also reduce the health inequalities that blight the lives of the country’s most deprived families,” said Mr Johnson.

    National service frameworks on coronary heart disease, renal services, and diabetes had led to a 40% reduction in the number of deaths from cardiovascular disease in people aged under 75 since 1996, he added. But screening would extend the benefits. It would prevent at least 4000 people a year from developing diabetes and could detect 25 000 cases of diabetes or kidney disease earlier, when they could be better managed.

    Bill Kirkup, associate chief medical officer for England, said that vascular disease was the largest single cause of death and premature death in England. At least half the health inequalities between rich and poor people were due to vascular disease, he said.

    Although 21% of middle aged people already had the checks that would be offered in the new screening programme, through opportunistic checks offered by GPs, the programme would pick up those people who don’t access health services so readily, said Dr Kirkup.

    The programme, which will cost £250m (€320m; $500m) a year, will be funded with new money and rolled out from the next financial year (2009-10). Checks will take place in GPs’ surgeries, pharmacies, and community settings.

    To screen England’s middle aged population every five years will mean three million checks a year or seven checks a week for the average general practice, said Dr Kirkup.

    A preliminary meeting with stakeholders on how to organise the programme had received unanimous support from those attending, among whom were representatives of the Royal College of General Practitioners, the British Heart Foundation, Diabetes UK, and the Stroke Association, said Mr Johnson. Although he was invited, Laurence Buckman, chairman of the BMA’s General Practitioners Committee, was unable to attend.

    Vascular checks were not “high tech,” said Mr Johnson. They will involve standard questions and measurements, such as age, sex, weight, height, blood pressure, and postcode (an indication of deprivation), and a blood lipid test. People at low risk of vascular disease will be given advice on how to stay healthy, while others may be invited to join a weight management programme or a smoking cessation service. If necessary, those at highest risk will be given treatment to control their cholesterol concentration, blood pressure, or diabetes.

    However, Dr Buckman expressed concern that the programme would make it more difficult for sick patients to see their GP.

    “While we would like to welcome this, as prevention is undoubtedly better than cure, we have serious concerns about the pressure this will put on an already overstretched general practice,” he said. “Over a third of the population fall into this age range, which for an average practice means 2000 patients. It could work out at 40 extra appointments a week [on the basis of an annual vascular check]—and that’s if they only need one appointment.

    “If the process means they need two or three appointments, to ultimately be told they are fit and healthy, then you’re looking at doubling or tripling that number. Whether it is nurses, GPs, healthcare assistants, or pharmacists who do these checks, there is not currently the workforce, the time in the day, or even the space in our surgeries to carry out this number of consultations. At the moment all our appointments are booked up with patients who are in immediate need of medical care.”

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