Tuesday, 29 April 2008

Q & A: Vascular Checks

The following are a series of questions asked further to the recent announcement regarding vascular checks. They can also be downloaded as a PDF file here

Q: When will it be possible to hear more about the fundamental principles lying behind the Department’s modelling?

A: A partial Impact Assessment has already been published on the DH website, which gives some details of how the modelling worked. There will be a technical consultation for the model during 2008. More details about timing for this will be available shortly.

Q: How will information be coordinated between pharmacies and GP practices?

We plan to examine the feasibility of developing a national call and recall type system operating through GP practices, although there have been no final decisions about the exact structures that we would use. If some of the risk assessment is to take place within pharmacies it is essential that we develop a mechanism for linking the results from these assessments into local and/or national systems, so that we can ensure completeness and avoid duplication.

There is already a system for developing national templates for activity by pharmacies and it is likely that we would use this to make sure that vascular risk assessment activity in that sector will be accredited and carried out to the same standards as employed in general practice.

Q: How will you access hard-to-reach groups?

A: We do not want to reinvent the wheel: we will be looking to work that is already going on, much of it pioneered by organisations found within the CVC to inform development of vascular checks. Jan Procter-King has been collecting existing examples of risk assessments from primary care, often developed as locally enhanced services (LES) and Kiran Patel has provided information on the work of West Midlands SHA, which has undertaken a programme of CVD risk assessment. The Healthy Communities Collaboratives, funded by DH, offer another source of information.

At the moment we think the most likely scenario is that PCTs would commission vascular checks and use their greater understanding of local populations through local needs assessments, to develop appropriate access plans. In some areas, GP practices may be the most common location for vascular checks, but in others, pharmacies or community projects may be better suited to the population.

Q: Might you use a risk-assessment card that each individual keeps with them?

This is a possibility. There are also avenues to be explored around web-based “health space”, LifeCheck links, and information services overall. Certainly, providing people with some form of card, whether paper-based or online, could increase a sense of personal responsibility and motivate action to reduce risk.

Q: How do vascular checks fit with the new NICE guideline on CVD risk assessment?

We have been working with colleagues at NICE, and have been aware of the work they are doing around CVD risk assessment. Vascular checks are not a substitute for clinical guidelines; rather they are a framework within which clinical guidelines can sit. Vascular checks as a policy will ensure best practice and knowledge about risk assessment and management is disseminated and available nationwide.

Q: What about implications for life and travel insurance?

This is an area of concern for the Department, and we want to find the right people to talk to in these industries. If anyone in the CVC has appropriate contacts they could put us in touch with, please let us know.

There is a potential for people who have taken up vascular checks to be penalised for doing so, and many insurance policies cost more if you have had a medical check-up recently, particularly if this gives you a risk factor for developing disease.

There is a particular concern over Chronic Kidney Disease, as this is not a clearly defined disease/not disease profile.

Q: How do vascular checks fit in with QOF? Will it be a stand-alone policy?

A: At the moment we think it unlikely that QOF would be the main implementation lever for vascular checks. However, there are already a number of points in QOF associated with CVD and diabetes assessment and management. We work closely with primary care colleagues in the Department and will ensure development of QOF and vascular checks are joined up.

Q: How fixed is the scope of vascular checks – could they be extended to incorporate urine testing for kidney disease?

The elements currently included in vascular checks are all based on the existing evidence base and have been put together on the advice of the relevant National Clinical Directors including the National Clinical Director for Kidney Services. Scope for change to the vascular checks does exist, but it depends on the cost effectiveness and the evidence base available. We will build into the policy an evaluation strategy that will keep abreast of new developments in research to ensure annual changes to the policy are possible where clinically indicated.

Q: What about the potential for research and the ethical questions this raises?

We have not yet extensively considered this point. Current models, for example, that of the West Midlands, invokes the SHA as custodian of the data, enabling research of the database to take place. This certainly needs to be considered during policy development.