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GPs to review 260,000 patients as full scale of CV risk calculator error revealed

Exclusive As many as 260,000 patients may have received inaccurate cardiovascular disease scores and will need to be actively reviewed by GPs through scheduling appointments, blood tests and reviewing records, NHS England has told Pulse.

In an exclusive briefing, NHS England told Pulse that up to 100 patients will need to be reviewed in an average practice using the SystmOne IT system – of which there are approximately 2,600 in the UK - to see whether they should be put on or taken off statins.

It has told practices in a letter that they should prioritise patients who should be on statins but who have missed out because of the bug.

It follows Pulse’s reports of a bug with the QRISK2 cardiovascular risk calculator in SystmOne IT software, which led to practices being blocked from using it.

NHS England, which has been coordinating the response from the organisations involved, said that they will audit the workload implications for practices.

A letter to practices has said that ’for some patients, practices will wish to call patients in for reassessment,’

But GP leaders warned that the workload implications may be bigger than this as GPs will need to consult with the majority of patients face to face or on the phone, and the GPC is demanding compensation for practices.

The bug is in the process of being corrected, and practices using SystmOne will be able to access the QRISK2 tool this week, NHS England has said.

Issues have been identified back to 2009, so some affected patients may have been seen multiple times since, and many may not need further action.

A letter to practices said: ’Many patients will not require a face-to-face review and, for some, a phone call will be sufficient. For some patients, practices will wish to call patients in for reassessment and to discuss their newly calculated cardiovascular risk profile.’

But Dr Grant Ingrams, deputy chair of the GPC IT subcommittee, told Pulse that, while re-running QRISK2 should be a quick task, the number of patients GPs will need to consult could be be quite high, ‘and that’s going to take a lot more time’.

He said: ’If it has affected the original decision, then you’re going to have to have a consultation with the patient, because it’s not really something you can write out and say “because of a computer bug we put you on this drug, which we should have done” or the other way round.’

Dr Richard Vautrey, deputy chair of GPC, said: ’Both practices and patients will feel rightly let down by the system provider and practices will expect the additional workload involved in reviewing these patients to be compensated for.

’We’re insisting that NHS England make sure the system provider does this for practices.’

An NHS England spokesperson said: ’TPP, the provider of a calculator used by GPs to estimate cardiovascular risk, has identified issues with their software. This has led to some patients being given an incorrect risk score but these issues have been resolved and the risk to the overall patient population is low.

‘A number of stakeholders, including NHS England, are supporting TPP to identify patients affected and address the workload impact on GP practices.’

Pulse was the first to reveal the issues with the QRISK2 cardiovascular tool in SystmOne after GPs were sent lists of around 20 patients each who had received incorrect risk scores and needed a review.

The Medicines and Healthcare products Regulatory Agency (MHRA) announced it had launched an urgent investigation of the tool, which had been adapted by SystmOne.

The 2014 NICE guidance - which introduced the 10% risk prescribing threshold - has said the QRISK2 calculator should be used exclusively for assessing patients up to age 84.

A spokesperson for TPP told Pulse: ’Regarding the mapping errors TPP identified with the QRISK2 Calculator, TPP has worked with HSCIC and MHRA to create new code mappings for the QRISK2 calculator within SystmOne. The tool has now been externally validated for use.

’After careful analysis with clinical experts from NHS England, we can confirm that approximately 100 patient records per practice may need to be looked at by a staff member. TPP has produced reports and additional resources in SystmOne which allow most patients in the identified cohort to be reviewed quickly without direct consultation. Early indications suggest that clinical workload to resolve this issue is small.

’The QRISK2 Calculator is a third-party, advisory tool in SystmOne, developed by ClinRisk. All four responsible bodies (NHS England, MHRA, HSCIC and TPP) are working together to support GPs during this time.

Readers' comments (11)

  • IT companies take out insurance against this type of thing. So it should be a simple insurance claim. As to who makes the initial claim, I am not sure. An insurance loss adjustor should help.

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  • So how much are System One offering GPs to be pay for this extra work?

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  • oh come on, these low risk patients don't want the statins and their doctors dont want to prescribe them. Just do a new calculation the next time the patient comes in. There is no immediate need to recall ANYONE. We're all busy enough without this c***

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  • That's not the case as I know many who believe nice guides and have issued statins to those over 10% risk.
    If you don't use nice you are ok

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  • An NHS England spokesperson said: 'the risk to the overall patient population is low'. I presume that 'overall population' to include everyone who has never been mangled by the S1 calculator - under 40s, patients in non-S1 practices, patients at my local vets ...

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  • www.NNT.com has a paper analysing the 'benefits' of 5 years statin therapy in 60,000 patients in this risk group (Arch Int Medicine 2010)
    •None were helped (life saved)
    •1 in 104 were helped (preventing heart attack)
    •1 in 154 were helped (preventing stroke)
    ?Harms in NNH
    •1 in 100 were harmed (develop diabetes*)
    •1 in 10 were harmed (muscle damage)

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  • www.thennt.com

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  • anonymous 8.50
    absolutely, well said
    the primary purpose of a statin is to change the label on the death certificate,
    the primary purpose of NICE etc is to misrepresent
    The advice is to offer a patient with a 10% risk a statin
    There is then a stunning silence, as to what they are claiming this reduces the risk to;
    The clear aim is to mislead the public, that it reduces the risk to 0%
    This is the message they hope the public will mistakenly take on board,there is no attempt to give a more realistic message

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  • Why don't HSCIC just do the work?

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  • Please tell me that the BMA will be organising legal action against System Dumb to reclaim the costs of this exercise.

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