Editorial: Preventing cardiovascular disease in primary care BMJ Volume 323, pp 246-247
Primary care teams in England face a huge and unrealistic increase in workload in order to meet the goals of the national service framework for coronary heart disease, finds a study in this week's BMJ.
Researchers at Nottingham University used computerised records from 18 general practices to identify two groups of patients aged 35-74: those with established coronary heart disease or stroke and those at high risk of developing coronary heart disease.
Based on the list of standards described in the framework, the team estimated that in the average practice of 10,000 patients, over 900 items will need recording and over 2,000 disease control measures will be needed, with profound implications for primary care, say the authors. Furthermore, study limitations mean that these estimates are conservative, they add.
In an accompanying editorial, two leading experts in general practice ask: "In the absence of additional resources, how should this extra work be prioritised alongside everything else required of primary care?" They discuss the challenges involved in identifying and delivering effective preventative strategies given a global shortage of doctors and nurses, and question whether the workload involved in meeting these expectations is matched by the benefits gained.
With more national service frameworks promised, those seeking accountability from the health service should acknowledge the current workload, morale, and opportunity costs of their targets and timeframes, conclude the authors.