In January, prime minister Gordon Brown promised ECGs, blood tests and ultrasounds in GP surgeries "when patients want and need them", with the aim of focusing on prevention rather than cure for the conditions that put the biggest strain on NHS resources.
While the preventive approach is acknowledged as the right direction for the NHS, Mr Brown was accused by critics of failing to consult properly on how screening should be done. Other detractors commented that large-scale screening programmes lack supporting evidence of their effectiveness.
These criticisms are off target. The reality is that there are examples of highly effective preventive diagnosis and screening programmes that are already being used in GP surgeries. These initiatives are showing how lives and NHS money can be saved in practice, not in theory.
Prevention in action
Broomwell HealthWatch, along with NHS North West and the Greater Manchester and Cheshire and Lancashire and South Cumbria cardiac networks, is involved in a cardiac diagnostic/monitoring service that is running in 150 GP surgeries in 10 primary care trusts across Greater Manchester.
These surgeries are using an advanced telemedical ECG solution that gives patients an accurate result in minutes. It avoids hospitalisation in most cases and reduces patient stress and inconvenience.
A GP or practice nurse records the patient's ECG using a handheld unit. The ECG trace is then transmitted by telephone to a 24-hour monitoring centre, where it is interpreted by highly trained cardiac clinicians, who give the GP or nurse an immediate verbal evaluation on the patient's condition, followed by a written report.
Doctors like the system because it enables them to make a better-informed diagnosis. Patients like it because of the convenience and speed of diagnosis. The NHS benefits because it avoids unnecessary hospital referral. And while this particular service focuses on diagnosing patients who present with symptoms, the same techniques are easily applied to preventive screening.
Evidence base
Evidence from NHS pilots shows that the benefits of this type of testing are strong, giving a clear blueprint for implementing such screening programmes on a wider scale.
A 12-month NHS evaluation of the ECG service in Cumbria and Lancashire demonstrated the potential to save 90,000 accident and emergency visits and 45,000 hospital admissions each year in England. This would result in a minimum saving to the NHS of£46m a year.
Our own data from 10,000 ECG transmissions in the past 20 months shows that 85 per cent of patients tested did not need to be referred to hospital at all. Yet without the test, 57 per cent of the patients would have been referred to hospital (either A&E or outpatient units). If the service were rolled out across all surgeries in England, this would equate to a reduction nationally of more than 400,000 hospital referrals per year, with huge associated cost savings.
So all credit to the prime minister for this initiative. The will and the technology are here; all that is required is to turn the talk into the walk.
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