Prevention in primary care: the annual assessment of elderly people

The recent reforms of the NHS have clearly emphasised the potential role of prevention in reducing mortality and morbidity. The specific focus of this paper is the preventive aspects of the new GP contract, and in particular the contractual obligation on GPs to offer an annual assessment to all patients within their practice aged 75 years and over. In reviewing the literature for evidence pertaining to the assessment of elderly people, it is argued that there are a number of unresolved issues which raise certain question marks over the Government's decision to include such assessments in the GP contract. The most fundamental of these issues is whether the costs of such screening are justified by the associated benefits. Other issues relate to the organisation of the assessments. In an attempt to cast some light on these unresolved issues, the results from a recent national survey of GPs in Scotland are presented. The results do not allow a categorical statement to be made on whether or not the assessments are worthwhile per se. However, they do help to clarify the current state of screening elderly people in general practice. In the light of this, directions for future research into the screening of elderly people are suggested.