pounds 400m health plan dropped

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The Independent Online
Stephen Dorrell, the Secretary of State for Health, has scrapped a controversial health- promotion programme by GPs on which the Government has spent more than pounds 400m over the past six years.

In a deal with the British Medical Association's family doctors' committee he has agreed that from the autumn GPs will be free to agree their own health-promotion activities locally with health authorities and be paid for them.

Since 1990, in one of the more controversial parts of the contract that Kenneth Clarke imposed on family doctors when Secretary of State for Health, they have been asked to count the numbers of their patients aged 15-74 who smoke and record their blood pressure, alcohol consumption and obesity, together with family histories of heart disease and stroke, and offer advice on better lifestyle.

At the time, academics said there was no evidence that such costly activity would improve health. And the degree of form- filling left GPs complaining that the scheme was bureaucratic, untargeted and involved counting numbers rather than improving patients' health.

The death-knell for the scheme came in 1994 with an evaluation of the British Family Heart Study. It demonstrated that much more intensive interventions by nurses aimed at changing lifestyle were "of little benefit" and concluded that given that the approach the GPs were being asked to follow was less intensive, the benefit was "likely to be even smaller".

After the prescriptive approach of the current programme, Mr Dorrell's new package goes to the other extreme, moving away from the increasingly intensive audit of doctors' activities. It allows GPs to decide with their local health authorities what is likely to be of most benefit, taking account of Health of the Nation targets and locally agreed priorities.

Family doctors will then set out the programmes they intend to follow, but once approved will then merely have to confirm they have carried out the agreed activities to be paid. The pounds 87.5m that the scheme cost last year remains in the system to pay for the new approach. A Department of Health spokesman said the change "recognises the professional skills of GPs in developing health promotion, cuts out paperwork and directs resources to patient care rather than form-filling."

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