Current approaches are failing people at risk of heart disease, conference hears

BMJ 2013; 346 doi: (Published 25 April 2013) Cite this as: BMJ 2013;346:f2701
  1. Matthew Limb
  1. 1London

The United Kingdom risks slipping further behind other European countries in tackling cardiovascular disease unless preventive and primary care approaches are radically improved, a conference has heard.

Doctors and charity leaders warned that falling mortality rates over recent years could be reversed without better targeted and coordinated strategies in the community and general practice.

Cardiovascular disease is one of the largest causes of death and disability in the UK. Experts at a seminar held in London on 23 April by the Westminster Health Forum discussed what needed to be done to improve outcomes of the disease, commissioning of services, and patients’ experiences.

Simon Gillespie, chief executive of the British Heart Foundation, said that the NHS had seen important progress in prevention and treatment in recent years. But he said, “Our place in Europe is not as good as it should be. In fact, our overall position has declined compared with other countries.”

He said that the effects of a rising prevalence of obesity and an ageing population meant a big rise within a decade in the number of UK people at risk of developing cardiovascular disease.

Jon Barrick, chief executive of the Stroke Association, said that unless more were done to help patients manage their conditions and to improve health and social care support outside hospitals “gains in falling mortality rates could be lost.”

The seminar showed broad support for the strategy to improve cardiovascular disease outcomes launched by the Department of Health for England in March 2013. This outlined steps to try to reduce premature mortality among people with cardiovascular disease and to enhance people’s quality of life by improving prevention, diagnosis, and treatment, including management in primary care.

But David Haslam, a GP and bariatric physician who chairs the National Obesity Forum, said that the incentives and screening tools used in primary care to identify and supposedly help people at risk of the disease were inadequate. He said that the NHS health check programme, introduced in England in 2009,1 focused on “too narrow” an age group (adults aged 40 to 74 years) and missed many people at risk. He said that obese people needed proper access to drug treatments and exercise referral schemes, but the target on obesity in the Quality and Outcomes Framework, the scheme that rewards good practice in primary care, merely incentivised GPs to “make a list of fat people.”

Haslam told the seminar, “We seem to be scuppered at every stage of what we’re trying to do in general practice.”

Stephen Lawrence, primary care medical adviser at Diabetes UK and the lead on clinical diabetes at the Royal College of General Practitioners, said that prevention in primary care could be improved. Providing lifestyle advice to millions of people with impaired glucose tolerance would be “cheap and easy” and could dramatically reduce the number who developed diabetes, he said.

Barbara Young, chief executive of Diabetes UK and who co-chaired the seminar, asked where responsibility would lie for improving outcomes, listing the acronyms of the new commissioning organisations and their partner bodies.

“Who in the alphabet soup will take a leadership role to make sure the very sensible recommendations in the strategy happen? We need to make sure someone, when the music stops, has a sense of responsibility,” she said.

Mark Smith, director of performance and development for NHS South Commissioning Support Unit, said that clinical commissioning groups should consider new models of contracting for services.

There was no reason why charities such as Diabetes UK shouldn’t be commissioned to provide a whole pathway of diabetes care in a given geographical area, he suggested.

But Young dismissed the idea, saying, “No thanks, it’s not our job.”


Cite this as: BMJ 2013;346:f2701


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