NICE sets out plan to limit impact of PAD ahead of new target

NICE has urged GPs to take a more rigorous approach to managing peripheral arterial disease (PAD), ahead of new QOF targets starting in April.

Dr Knapton: variation in amputation rates is unacceptable (Photograph: S Barber)
Dr Knapton: variation in amputation rates is unacceptable (Photograph: S Barber)

Experts backed the changes but warned they would drive up GP workload.

The institute said changes in PAD management were vital to end ‘considerable uncertainty and variations in practice’.

From 1 April, the QOF will require GPs to hold a register of PAD patients, record BP and cholesterol annually, and prescribe aspirin or alternative antiplatelet drugs. Up to nine QOF points are available, worth £1,200 on average.

Draft NICE guidance suggests further changes to imp­rove care for the 20% of people aged over 60 years with PAD and limit lower limb amputation.

Patients with suspected PAD should be assessed using structured questioning, examination and measurement of ankle brachial pressure index, the institute said.

Patients with intermittent claudication should be offer­ed supervised exercise programmes, while those with critical limb ischaemia should be reviewed by a vascular multidisciplinary team.

GPs have until 24 April to comment on the proposals.

Cambridgeshire GP and British Heart Foundation associate medical director Dr Mike Knapton backed the advice but said GP workload would rise.

‘It is helpful to have an appraisal of the evidence. The variation in amputation rates across the country is unacceptable,’ he said.

North Yorkshire GP Dr Terry McCormack, council member at the Primary Care Cardiovascular Society, said: 'I feel that PAD has been treated as a 'Cinderella' service for a long time. I feel this advice and the QOF changes are a good thing for PAD patients.'

Stephen Robinson

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