Screening by GPs faces axe

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The Independent Online
The Government is prepared to consider abolishing an pounds 85m-a-year health promotion package undertaken by family doctors which academics say is largely a waste of taxpayers' money.

The scheme involves GPs counting their patients aged 15-74 who smoke, recording their blood pressure, alcohol consumption and obesity; their family history of heart disease and stroke, and offering them advice on a better lifestyle.

The scheme - which pays family doctors thousands of pounds a year if they hit all their targets - has been one of the more controversial parts of the contract the Government imposed on GPs in 1990. GPs say it is bureaucratic, untargeted and involves counting numbers rather than genuinely intervening to improve health.

Stephen Dorrell, Secretary of State for Health, has told GPs' leaders at the British Medical Association that he recognises "the dissatisfaction" within the profession over the programme, adding: "I am therefore willing to consider its abolition."

An evaluation in 1994 of the British Family Heart Study, which uses intensive interventions by nurses to try to persuade individuals to change their lifestyle, concluded it was "of little benefit". The gains from the less- intensive programme most GPs offer were therefore "likely to be even smaller", the study concluded.

A cut in heart disease and stroke is one of the Government's Health of the Nation targets, but the study said focusing on those who have heart disease or are known to be at high risk was likely to give better results.

Dr Ian Bogle, chairman of the BMA's family doctors' committee, welcomed Mr Dorrell's move yesterday, but stressed that neither Mr Dorrell nor GPs wanted to put an end to health promotion in general practice. "It's just that we want to get rid of this particular programme and the way it is constructed."

The change is likely to come as part of a new contract which Mr Dorrell has indicated will be on offer if he and GPs' leaders can agree on changes that will shift more of the work traditionally done in hospitals into general practice.