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NICE in talks to modify proposed 10% risk statins QOF indicator

Exclusive Plans to introduce the 10% risk threshold for cardiovascular primary prevention into the QOF could be watered down, Pulse can reveal, after one of NICE’s top clinical leads hinted that a proposed indicator to reward practices for treating with statins at this risk level could be changed.

Pulse understands NICE is in talks with GP leaders about revising the indicator, which QOF advisors had previously said should reward practices for statin prescribing at the 10% risk threshold in patients newly diagnosed with diabetes or hypertension.

Professor Mark Baker, director of the centre for clinical practice at NICE, told Pulse to ‘watch this space’ regarding the final announcement on the proposed indicator.

The NICE committee on QOF indicator development recently agreed to put forward the indicator, which would reward practices for the ‘percentage of patients aged 25-84, with a new diagnosis of hypertension or diabetes who have a recorded cardiovascular risk assessment score of 10% or greater who are currently treated with statins’.

The move came despite strong objections from both the GPC and RCGP during the official consultation on the plans – and concerns voiced by some GP members of the QOF committee, who warned that the wording of the indicator did not allow for adequate discussion with patients, in particular about trying lifestyle changes before being offered a statin.

Professor Danny Keenan, a consultant cardiothoracic surgeon who chairs the NICE committee overseeing the development of QOF indicators, said NICE ‘had no idea’ why GPs had objected to the proposals and that the indicator would simply represent evidence-based practice.

However, asked by Pulse at a Westminster Health Forum conference on cardiovascular prevention yesterday if the proposed indicator would tip the balance towards treatment and effectively force GPs to prescribe at the 10% threshold, Professor Baker said: ‘Well, it would if that was what we were going to do, but – watch this space.’

The GPC had warned the indicator would simply reward prescribing activity rather than quality care and undermine GPs’ confidence in the QOF.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said he hoped the final result following the negotiations would be more acceptable to GPs.

Dr Green said: ‘There are a number of steps that need to be gone through before suggested changes become QOF indicators and I hope that when changes are introduced they will have the support of the profession.’

A NICE spokesperson said: ‘Only after the QOF indicators, recommended by the Indicator Advisory Committee, have gone through quality assurance and have been approved by the NICE Guidance Executive will the NICE menu for the QOF be finalised and published.

‘The NICE Guidance Executive will consider feedback from stakeholders and the quality assurance process, then take a decision on whether to add the new and amended primary prevention of cardiovascular disease indicators to the QOF menu, remove them from the final menu, or recommend they go through further piloting to determine how well they operate in practice.

‘The indicators are currently going through the quality assurance process. Once the final menu is decided, it will be published in early August 2015.’

Readers' comments (6)

  • surely the indicator should be - discussed cardiovascular risk with patient.

    That discussion could include statins or not - there may or may not need to be a prescription for statins.

    I think that works out fairer and better than measuring prescribing. It should need to be ticked once since the risk reached 10% - not every year.

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  • Just tell the patient about nnt and let them decide if they think they are the 1 in 400 or not (not sure of the stats). Most patients assume they are the 399. Problem solved.

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  • Vinci Ho

    The information of side effects is still important on consulting our patients.There are perhaps some categories of patients in Primary Prevention :
    (1) those who never need to take regular medication but now found to have a CVD risk >10%. They are most likely to ask about the chance of side effects
    (2) Obviously, for diabetics and hypertensives , the chance of accepting another regular medication is better if they are already on anti-hypertensives or anti-diabetic agents. Those who are young , well controlled with no complication and relatively healthy ones will be likely to ask about side effects and exposed to informations from the 'outside world'.
    Ultimately , it is about understanding our patients's ideas , expectations and references. We need to respect these aspects which the academics in NICE very often have neglected ......

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  • Make a polypill sell Otc and monitor if needed

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  • Most younger patients do Google medicine and can get fact on treatment and doctors pay and any other symptom

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  • 922-poly pill copyrighted by Profs Law & Wald.
    Unsurprisingly they would agree with your advice!!

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