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GPs go forth

GPs told to avoid raft of interventions by royal colleges

Welsh royal colleges have launched their ‘Choosing Wisely’ initiative, giving GPs and other doctors a list of procedures and treatments they should avoid in order to help minimise harm from unnecessary healthcare interventions.

The Academy of Medical Royal Colleges (AMRC) in Wales has told GPs to avoid X-rays or scans in patients with lower back pain and prescribing medicines to frail people in their last year of life except for the control of symptoms. 

The initiative was announced by the UK AMRC last year. As part of the scheme, each of the medical royal colleges was invited to come up with a list of around five treatments or investigations that doctors should avoid doing.

Unveiling the programme in Wales, the AMRC said it wants to ‘embed a broad cultural change in healthcare where clinicians and patients regularly discuss the value of treatments and make shared decisions’.

The programme also encourages GPs to get patients to ask questions about their care – and provide them with a leaflet suggesting the four key questions: ‘What are my options?’; ‘What are the benefits and harms?’; ‘Do I really need this?’; and ‘What can I do to help myself?’.

Of the final list of treatments and tests to avoid, the Wales programme is asking GPs to avoid:

  • X-rays or scans in people with low back pain;
  • long-term prescriptions for PPIs;
  • prescribing medicines to frail people in their last year of life except for the control of symptoms;
  • checking cholesterol levels every year if they are taking a statin, unless they have a history of vascular disease or an inherited lipid disorder.

It also calls for GPs to make sure healthy people are properly involved in choosing to start taking a preventive medication for heart disease or osteoporosis.

In addition, the RCGP says patients should only be considered for treatment with antihypertensive drugs if they have blood pressures of 140-159/90-99 mmHg and other risk factors, and women should always be offered hormone testing before investigating the possibility of polycystic ovary syndrome.

Dr Paul Myres, programme leader and chair of AMRC Wales, who is also a former GP in Wrexham, told Pulse the campaign was about ‘rebalancing the conversations that GPs have with their patients’.

Dr Myres said: ‘We’re looking for patients to be a bit more confident in asking what choices are available to them and for clinicians to be more confident about talking about options and not just saying this is what you should do.’

Of the RCGP recommendations, Dr Myres said that the call to only treat hypertension at above 140/90 mmHg and in patients with other risk factors related to a hangover from earlier guidelines with lower target blood pressures, which meant some patients and GPs still pursue treatment at lower blood pressure levels than this, when lifestyle changes would be more appropriate.

He said the overall message was in line ‘with the overdiagnosis movement, that more is not necessarily better and to look for alternatives’.

But he stressed that although there could be advantages for the NHS in terms of reduced waste and lost opportunity costs, the programme was ‘not about saving money’.

Dr Myres said: ‘We’re not expecting every GP to suddenly work on all five and we recognise that certainly in Wales, local groups may choose to focus on certain ones. What we’re very keen to avoid is for CCGs – or here in Wales, the local health boards – to focus on key areas because what we hear very clearly from patients is that this is about saving money.

‘It’s not about saving money it’s about safety and effectiveness and avoiding waste.’

Readers' comments (10)

  • Lawyers rubbing their hands together
    1) ageist
    2) family members will object if the patient doesn't

    call of the lawyers, take away the risk of and need to answer vexatious complaints when this is done and support GPs when people are not happy about it. Then there is small chance this will happen. Otherwise, everyone continue as normal, x-raying backs and over treating bp, putting in pacemakers at the end of life and if palliative, offering statins to over 90' can't have it both way. Protect doctors against the over regulation and "patient and their relatives" are alway right and can complaint to all and sundry , otherwise take you "guidelines" and put them somewhere else.

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  • The Royal Colleges are irrelevance,what is more important is to practice defensively so that our fair to the medical professions society cannot take your livelihood off you and ruin your career.

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  • GP Partners 5:09pm & 5:37pm - I agree entirely - GPs are being asked to practice 'population based medicine' whilst being subjected to individual-whim litigation, complaint and press comment.

    Doctors have families to provide for and have little choice but safeguard their own professional future by practising very defensively.

    It would of course help immensely if the current minister stopped continuously shelling his own troops.

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  • Yet another request for one more 'Big Push' from the armchair generals long gone from the trenches.

    If you don't see patients at least 4 sessions a week, and now mainly pontificate from the comfort of a committee or academic post, your opinion is worthless to me. Move on. Next.

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  • I don't unerstand why we still monitor cholesterol levels in diabetics or CHD. They are usually already on max statin dose...

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  • Is there a last year of life test or should we avoid doing that one as well?

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  • Listening doesn't cost but use your own judgement at every step. If things go wrong, these same 'wise' people won't be there to support you.

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  • Hello Mrs Smith. Good to see you again. Now, according to Mystic Meg and my crystal ball, you are in the last year of your life. Should we chat about stopping your medications?

    Of course I'm sure you'll die pretty soon.You are welcome to come and sue me if you suffer a heart attack in 5 years time.

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  • Is any of this utter B**cks actually new anyway or have they just packaged it in a shiny new "initiative"?

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  • Will any of these ROYAL COLLEGES FEED MY KIDS AND PAY MY MORTGAGE AND ASSURE ME OF MY CURRENT LIFE STYLE, If I loose my licence to practice or get sued by one the patients who comes to any harm by not having x ray or stopping medication or not having test.
    If they can give it in writing then yes I will certainly follow their advice otherwise they can go .......

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