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Independents' Day

Pharmacist to dispense high-dose statins without GP prescription under NHS plans

The NHS is looking at removing the need for GPs to prescribe statins and to allow high street pharmacies to give high dose statins over the counter instead.

In a new review confirmed today, NHS chief executive Simon Stevens announced the NHS will consider how high dose statins could be made available on the high street as part of the long-term plan to cut heart disease and stroke.

NHS England claims there to be estimates that two-thirds of people who are most at risk of heart attacks and strokes do not take statins but would benefit from them.

Currently, low dose statins are available over the counter, but the NHS has said making more powerful versions 'safely available' without a GP prescription could prevent 'thousands' more deaths.

The review will be conducted by NHS England and NHS Improvement and the findings will be presented to manufacturers and medicine watchdog the Medicines and Healthcare products Regulatory Agency (MHRA).

Mr Stevens said at today's Expo healthcare and innovation conference in Manchester: 'Pharmacists are highly trained health professionals who are greatly valued by patients. Since the NHS will be funding local chemists to undertake health checks, it makes sense to consider whether there are a broader range of medicines that patients could access conveniently and locally on the high street.

'So the NHS will now work with the MHRA and industry to see how we can best make this happen.

'After lung cancer scanning trucks in supermarket carparks and high street heart checks, this is another step towards making care and treatment more accessible, convenient and effective.'

However, RCGP chair Professor Helen Stokes-Lampard said there are 'concerns' about making the drugs more easily accessible.

She said: 'GPs are also mindful of the risks of overdiagnosis and over-treatment – a concern we expressed in response to recent NICE guidelines that lowered the threshold for eligibility of statins – and we also have concerns about making these drugs more easily accessible, without a prescription.

'Statins, like any medication, have associated risks, and GPs will only prescribe them if we think it is in the best interests of individual patients, based on their individual circumstances – and after a frank conversation about the potential risks and benefits.

'Nevertheless, it is encouraging that NHS England is conducting this review before implementing a new initiative, and the College looks forward to feeding into it. Prevention is important, but it is essential that any NHS intervention to promote it is evidence-based, and in the best interests of patients.'

But chief pharmaceutical officer Dr Keith Ridge added that 'hundreds of thousands' of people could benefit if there was more committed research to allow high dose statins to be made available on the high street.

He said: 'Used appropriately, statins are effective and can save lives.

'Hundreds of thousands of people could benefit if the industry committed more research and investment in bringing high-dose statins to the high street, and the NHS is going to be driving forward these efforts, as we save thousands of lives from deadly heart attacks and strokes as part of our long-term plan.'

The review follows more powers being handed to pharmacists as from October, they will be allowed to conduct high street heart checks for high blood pressure.

More to follow...

Readers' comments (19)

  • Maybe it would be better to check whether statins make that much difference to total mortality and the cost of this in terms of drugs, tests and health care professionals time, before they roll this out.

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  • 'Give high dose statins'?? I think you mean given a licence to flog for a very healthy profit ...

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  • 1. Would the pharmacists arrange follow up bloods?

    2. Would the pharmacist see the patient if side effects develop?

    3. Is there any patient demand for bypassing the GP in this way? I can see the appeal with obtaining viagra over the counter but statins?!

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  • @ Kath Morrison, we already know the benefits of statins in terms of reducing mortality.

    They obviously make a bigger difference to higher risk patients or in secondary prevention.

    The benefit for lower risk patients is small but from a population point of view it is still beneficial.

    Monitoring is needed in terms of LFTs, the risk however in terms of liver adverse effects is very small.

    My worry with this scheme is whether Community Pharmacists will actually do this work. We’re endlessly told Community Pharmacists will start taking some of the workload from General Practice however I find out workload is just forever increasing. I’m sure Community Pharmacists are already busy to take this on.

    My other worry with this is whether we’ll find out if the patient is taking a statin, particularly important if we’re prescribing something like a macrolide where there is a significant interaction.

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  • Dear All,
    "NHS England claims there to be estimates that two-thirds of people who are most at risk of heart attacks and strokes do not take statins but would benefit from them."

    Yes of course, they could pick them up on their way to McDonalds.

    What exactly is the evidence for life prolongation for statins given for primary prevention?

    Paul C

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  • Do you really think the prols will PAY for a drug they will not get immediate benefit for and pay to take them for the long term.We live in an entitled society where folk think they have paid their way.Little do they know the economic of the situation.Pay for a kentucky ,pay for lager or pay for ciggies or Sky TV/mobile phone vs pay for statin.I know which I would pay for first and the bottom of the pile come the statin.Viagra pay to combat the effects of all the others' statin they are on to a loser methinks.

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  • Dear All
    On a more serious note is this not a proposal for a national screening program? Therefore should it not be within the mandate of the recently announced national screening program review?
    Paul C

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  • Statins used to be like Ramipril.
    Now they're like amlodipine. They used to require LFTs at baseline, 3 months and 12 months.

    Happily my CCG now supports a "fire and forget" approach. So we still do the baseline LFTs, but none thereafter unless symptomatic.

    This simplifies an "offer of station therapy" greatly. If the patient is ambivalent, I do the script, point them to some further reading, put on repeat and forget about it. Either they keep requesting, or they don't.

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  • What is the point of us any more?

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  • Keep your hair on everybody!

    OTC statins, like all other OTC medications, will be set at a price that still encourages people to get a prescription!

    How long will it be until CCGs put statins on the list of things patients shouldn't bothering their GPs for!?!

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