Screening in general practice and primary care

General practice and its associated primary care services are the final com mon pathway for the delivery of most screening programmes. The absence of n ationally agreed priorities, guidelines and identifiable resources has mean t that screening in primary care remains somewhat arbitrary, practice varie s widely and programmes remain largely unevaluated. Discussion of screening has focused largely on test characteristics and performance with less atte ntion being given to issues of policy formation, priority setting, implemen tation and quality assurance. Without these elements, quality and test perf ormance deteriorate, recruitment and follow-up are incomplete and a poorly discriminating test of doubtful utility is applied inequitably and ineffici ently. For general practice there are two major concerns. The first is to improve delivery of programmes of proven efficacy, such as breast or cervical scree ning, that already have a national framework. The second is to develop and provide a national structure for preventive programmes for cardiovascular a nd smoking-related disease. For cardiovascular disease, the issue is no lon ger whether to screen and advise whole populations for multiple risk factor s, but how best to implement this programme. In this chapter, the case for screening for cardiovascular disease is reviewed and potential strategies f or improving delivery of screening in general practice and primary care dis cussed.