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Community Pharmacies to deliver Vascular Risk Checks
A national programme to identify vulnerability to vascular diseases will prevent up to 9,500 heart attacks and strokes every year and save 2,000 lives, Health Secretary Alan Johnson announced today.
Collectively, vascular diseases - heart disease, stroke, diabetes and kidney disease - affect the lives of more than four million people and kill 170,000 every year. They also account for more than half the mortality gap between rich and poor.
Initial results from modelling work carried out by the Department shows that a vascular check programme would prevent 4,000 people a year from developing diabetes. It could also detect at least 25,000 cases of diabetes or kidney disease earlier, allowing cases to be better managed and improving outcomes.
Alan Johnson said:
"As we look to the future of the NHS in its 60th anniversary year, our vision is to create a modern service that meets the unique challenges of today's society.
"The case for a national programme of vascular checks is compelling. We could prevent 9,500 heart attacks and strokes every year and save 2,000 lives. It would also reduce the health inequalities that blight the lives of the country's most deprived families.
"The NHS is becoming more personal and responsive to individual needs; becoming as good at prevention and keeping people healthy as it is at providing care and cures; and able to offer the information and support people need to make healthy choices.
"This is an NHS that is properly equipped to face the challenges of the next 60 years."
We are today setting out our evidence for a national vascular check programme in 'Putting Prevention First'. Everyone between the ages of 40 and 74 will be entitled to the checks.
The checks would be based on straightforward questions and measurements such as age, sex, family history, height, weight and blood pressure. They would also include a simple blood test to measure cholesterol.
Everyone would receive a personal assessment report, setting out not only the person's level of risk, but exactly what they could do to reduce it. For those at low risk, this might be no more than general advice on how best to stay healthy. Others may be assisted to join a weight management programme or a stop smoking service. Those at the highest risk might also require preventative medication with statins or blood pressure treatment.
Associate Chief Medical Officer Bill Kirkup said:
"We aim to make vascular checks to be available in a variety of convenient places. These could include GP surgeries, pharmacies or other community settings. This programme can make a major contribution to preventing early death and disability, and it is vital that it reaches as many people as possible.
"We are also determined to tackle the inequalities in health, and vascular diseases are the main cause. All too often, people with the worst health have the poorest access to GPs. We want a system that will encourage them to take part, and help to reduce the health gap between rich and poor."
We intend to begin implementation in 2009/10. We will now work with our key partners across the NHS, the medical profession and the voluntary sectors in drawing up a national system that works for them and patients.
Our initial modelling suggests that the annual costs will be in the region of £250 million per year. This includes the cost of the checks themselves as well as the NHS care likely to result from the checks once the proposals are fully implemented across the NHS. However, these figures depend on the details of implementation and levels of demand. We will refine these costings as we continue to design an implementation system with our partners.
We have put aside resources from the health budget and we are committed to providing this funding to the NHS to support this critical shift towards prevention.
Anne Mackie, Director of the UK National Screening Committee, said:
"The UK National Screening Committee welcomes the priority that the government has placed on implementing its recommendations in England. We will now work with stakeholders and the public to develop robust implementation plans. We will particularly focus on how we can make this accessible to the whole population and reduce inequalities in vascular health."
Commenting on the Department of Health's announcement on the new national vascular risk screening programme, Sue Sharpe, CEO, PSNC said:
"We are very pleased that the government is committed to developing community pharmacy's role in tackling vascular disease.
Pharmacies can play an important role in reducing the impact of vascular disease, by looking at risk factors, and advising on the measures that can be taken to reduce the risk of development of the condition.
We can use the network of pharmacies and their easy accessibility to provide this support to people in locations and at times that are convenient to them."
PSNC identified vascular risk screening as a target service for community pharmacy provision two years ago and has been lobbying the Department of Health and other key influencers to ensure inclusion of pharmacy within government plans.
A draft Enhanced service specification has been developed and was submitted to the Department of Health for consideration last year. PSNC will be continuing discussions with policy leads at DH on how the community pharmacy service should be developed.
The DH proposals
All people between 40 and 74 will be invited to undertake screening on a 5 yearly basis. The approach will be standardised and will be based on a stepped approach that will include collation of some or all of the following parameters:
Age, Sex, Ethnicity, Smoking habit, Family history of premature CHD, Family history of Diabetes, BMI, Waist circumference, Blood glucose level, Blood pressure, Cholesterol level and current medication.
A pre-questionnaire is likely to be used to collect a lot of the above information and finger prick samples could be used for near patient cholesterol/blood glucose assessment. Point of care testing (POCT) means there is no delay in making the assessment and hence no loss of patients to follow up. A quick and convenient test means community pharmacy has more opportunity to capture the groups of patients who are infrequent users of GPs.
The DH proposals are contained in a short document which is available here.
Background to the screening programme
The NHS National Screening Committee (NSC) has for a long while held the view that population screening for diabetes is not an effective intervention, but some targeted screening of at risk populations may prove beneficial in certain circumstances.
The Diabetes, Heart Disease and Stroke (DHDS) Pilot Prevention Project, funded by the Department of Health, assessed the feasibility of screening for Type 2 diabetes in primary care ran from 1st October 2003 to 30th September 2005.
A significant idea to emerge during the course of the DHDS Pilot Prevention Project was the concept of thinking in terms of ‘the vascular syndrome', as opposed to individual diseases such as coronary artery disease or diabetes. People who happen to be diagnosed as having diabetes almost always have vascular disease and the prevalence of diabetes in people with, for example, coronary artery disease is significantly higher than in the general population.
Another important theme was to move away from tackling risk factors, either singly or in combination, rather to focus on people at risk. Therefore, diabetes can be viewed as another risk factor for vascular disease, as well as a condition in its own right. Also, controlling the risk factors for vascular disease is seen as being as important as the management of blood glucose levels in people with diabetes. This finding was included in the proposal for a Vascular Disease Risk Factor Assessment and Management Programme - submitted to the NSC meeting on 29th November 2005.
As a result of the DHDS prevention project, the NSC recommended to the four Chief Medical Officers, the introduction of a Vascular Risk Management Programme, in which the whole population (over 40 years) would be offered risk assessment that could include measurement of risk factors such as blood pressure, cholesterol and glucose.
A number of different options were considered by the NSC; these include:
1. self-assessment of risk through the NHS Health Check Programme;
2. record-based assessment to identify people at highest risk who are not receiving comprehensive risk advice and management. This would involve interrogation of GP records, basing assessments on data already held on individuals; and
3. primary care population-based risk assessment which would use the primary care populations to offer those who are not at highest risk, as identified by record-based assessment, the opportunity of risk assessment.
These developments clearly provide an opportunity for community pharmacy to play a role in vascular risk assessment, specifically by providing a venue for option 3 - the population-based risk assessment. This would involve a service that assessed vascular risk in the 40+ target population, who are not in regular contact with their GP, hence will not have been assessed by the record-based approach.
Two weeks ago comprehensive guidance on vascular risk assessment was published by the National Screening Committee (The handbook for vascular risk assessment, risk reduction and risk management, University of Leicester).
Posted 1 April 2008