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Independents' Day

NICE admits 10% statin threshold should have been piloted before QOF recommendation

NICE’s deputy chief executive has said that with ‘hindsight’ it would have ‘been wise’ to pilot the 10% statin threshold before suggesting it went into QOF.

Professor Leng was put on the spot on BBC’s radio show Inside Health by host and media GP Dr Mark Porter, who questioned whether NICE should never have made the - now withdrawn - recommendation on cardiovascular prevention in the first place.

The admission follows closely on NICE’s u-turn on the recommendation that GP practices should be incentivised for statin prescribing at the 10% primary prevention risk threshold in all patients newly diagnosed with diabetes or hypertension.

The NICE QOF menu for the 2015/16 GP contract negotiations includes a revised primary prevention indicator, but critically, does not contain the 10% risk threshold NICE originally said it would put forward.

Dr Porter said: ‘Hindsight’s a wonderful thing but might it not have been better in retrospect to have done this piloting work first rather than raise the hackles of some patients and some doctors?

To which Professor Leng responded: ‘I think that’s a fair point and hindsight is a wonderful thing and perhaps yes that would have been wise.’

But, despite the admission, Professor Leng insisted the plan may be resurrected in future following piloting in real practices.

Professor Leng said: ‘Not straight away because we are piloting it - we’re taking that lower threshold out to some real practices, piloting the impact of that and then we will take it back to our committee and consider whether it should go forward or not.’

Glasgow GP Dr Margaret McCartney, also speaking on the radio show, said that many GPs were ‘very unhappy’ about payments being linked to prescribing statins.

NICE’s decision to withdraw the 10% threshold recommendation from the QOF menu this year was preluded by an outcry from GP professionals - including BMA and RCGP - and even the former chair of the QOF advisory committee saying NICE had ‘lost the plot’ on statins.


Readers' comments (7)

  • It is disgusting that statins are being encouraged in this way. They have so many dangerous side-effects which are reflected by the number of law firms in the States who jspecialise in litigation regarding the health damage done by statins!
    A GP collegue has recently had a number of people who had been on statins for a long time developing pulmonary fibrosis.
    I am one of the above mentioned doctors who is very unhappy about this situation.

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  • Vinci Ho

    NiCE would have been 'nice' if it stays as a body to recommend but in reality , it has been politicised by bureaucrats and the fact CCGs are obliged to provide treatments recommended by NICE ,actually offered the organisation power and authority . As Lord Acton's famous quote, great men almost always become 'bad' guys.
    The truth is we need more Rock n' Roll street professors than these wrongly 'passionate' ,ivory tower academics formulating solutions with a presumption they would save the real world .

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  • Yet the evidence for statins is very strong.
    Remarkably safe you have been able to buy them OTC to reduce CVD risk above 10% for years.
    The USA have had a 10% target in effect for 10years and now have moved to 7.5%, most of Europe similarly have had a 10% risk threshold for years.
    One day people will look back in amazement how we have done so little for so long.
    But the chattering classes have won, they can have there MIs and strokes and repent at leisure.
    Fortunately there is a way out, widespread in the USA, and it's called "calcium scoring".
    Pop your patient in a CT scanner, radiation dose is these days about the same as a mammogram, cost much the same.
    If there's no calcium in their coranary arteries no worry, and if there is, well they take their statins, no problem.

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  • That's a great tip, John. I wonder wether we have access to calcium score checks or we will end up going throught the rigamrole of referral through Consultant. And,,, and this is the bigger issue- whether this screening would be cost effective.

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  • No excrement sherlock?

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  • In our practice of 7500 patients, 1500 have a Qrisk of >10%. The workload involved in abruptly moving to a 10% threshold would be enormous. In the absence of enormous extra funding, it is perhaps achievable if lower thresholds and gradually and progressively introduced over a period of several years.

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  • what a good example of megalomania from so-called scientific brains! to blanket impose any regime without piloting first - O Dear!

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