The article below was just sent to me be a fellow GP, who shares my concerns about the prescribing of statins to everyone with a pulse. In fact it was he (I am being coy about naming him here) who led the protest against the over-prescribing of statins within the Royal College of General Practice (RCGP). He also led the protest within the General Practice Committee (GPC), which is the part of the British Medical Association (BMA) that negotiates on behalf of General Practitioners. Yes, the structures of medical politics are byzantine indeed.
Anyway, for those who believe that doctors are unthinking drones who stare at computer screens and merely follow the guidelines they see there, tonight you may raise a glass of beer, or wine, or even whisky, to them.
Short warning. Before you read this article, which appeared in PULSE magazine (the most widely read medical magazine for UK GPs) I feel I need to quickly flick through the acronyms.
- RCGP = Royal College of General Practitioners
- NICE = the National Institute of Health and Care Excellence (they look at all the evidence in a medical area, then create the guidelines for treatment that doctors are commanded to follow)
- QOF = Quality Outcome Framework. A system of payments designed to incentivise General Practitioners to meet various targets e.g. lower blood pressure, measure weight, put people on statins.
- QRISK = A risk calculator, designed to determine your risk of having a heart attack or stroke in the next five or ten years.
‘The RCGP and the GPC have rejected NICE’s plan to introduce QOF indicators that would see practices rewarded for prescribing statins to patients with a QRISK score above 10%, warning the move threatened the ‘credibility of QOF’.
The move comes as NICE advisors on QOF are due to meet early next week to discuss potential new indicators – including two that would reward practices for prescribing statins to patients newly diagnosed with diabetes or hypertension at a 10% estimated 10-year cardiovascular risk level – which will be up for negotiation for next year’s contract if approved.
The GPC said that it was ‘vital for the credibility of QOF’ that indicators have a robust evidence base, make significant difference to patients and are backed for the profession, adding that these proposals ‘fail on all these counts’.
The RCGP warned that the proposals risked ‘the loss of professional confidence in the healthcare targets they are being asked to meet’.
NICE launched the consultation on proposed new QOF indicators earlier in the year, which included another potential new indicator would pay practices to set up a register of patients with a 10-year risk of 10% or higher, alongside the hypertension and diabetes indicators.
The proposals were made in order to reflect updated NICE lipid modification guidelines, which lowered the 10-year cardiovascular risk threshold at which GPs prescribe interventions, including statin therapy, from 20% to 10%.
This was despite opposition from GP leaders and other leading clinicians concerned about the potential for over-medicalisation of healthy people and diversion of resources away from the sick onto the ‘worried well’.’1
‘Get in!’ as they say. I am, to put it mildly, delighted.