In June 2009 the Pharmaceutical Services Negotiating Committee (PSNC), working collaboratively with the Department of Health’s Vascular Team and the Medicines, Pharmacy and Industry Division, developed a national enhanced service specification for the NHS Health Check – Vascular risk assessment and management service (EN15).
Vascular disease is the largest single cause of long-term ill health and disability in England, it affects the lives of over 4 million people and results in 170,000 deaths a year.1 Putting Prevention First Vascular Checks: risk assessment and management (DH 2008) states that evidence shows that it is possible to identify the risk factors of vascular disease (including coronary heart disease, stroke, diabetes, and kidney disease), enabling early intervention to reduce risk which can prevent, delay, and, in some circumstances reverse the onset of vascular disease.
In late 2005, the UK National Screening Committee recommended screening certain subgroups of the population who are at high risk of type-2 diabetes as part of an integrated programme to detect and manage cardiovascular risk factors. The Department of Health (DH) took the initiative to examine how a comprehensive vascular risk assessment and management programme could work, including assessment and modelling of clinical and cost effectiveness.
In April 2008 the DH released the publication putting prevention first, which announced the development of a Vascular Risk Assessment (VRA) and management service across England for people aged 40 to 74 years. Two days after that announcement, the DH published the white paper, Pharmacy in England – Building on strengths, delivering the future, highlighting the role of community pharmacy in the provision of VRA. Since then, more details of the programme have been documented in two further DH publications: next steps guidance for Primary Care Trusts (November 2008) and best practice guidance (April 2009).
The national enhanced service specification outlines the significant opportunity for community pharmacy to play a major role in preventing ill health by tackling health inequalities in the target group, (people 40 to 74 years of age who have not had a previous diagnosis of vascular disease), in order to improve awareness of vascular risk and how to minimise or manage that risk.
What does this mean to Medicines Management
The PSNC website points out that all Primary Care Trusts (PCTs) must ‘show some evidence of participation’ with the NHS health check programme during 2009. The new service specification provides a starting point for the development of local service specifications by Local Pharmaceutical Committees and PCTs to commission NHS health checks from community pharmacy.
PCTs may initially choose to target specific groups of the population as the first people to be offered the NHS Health Check. As stated in the national enhanced service specification, people living in deprived circumstances have poorer health than the rest of the population, and this is strongly reflected in vascular disease where people in lower socio-economic groups tend to suffer earlier and more severe disease. Other people at risk include those with modifiable risk factors such as smoking, physical inactivity/sedentary lifestyle, high blood pressure, raised cholesterol levels and obesity.
1. Department of Health (2008). Putting Prevention First Vascular Checks: risk assessment and management