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Independents' Day

Enough of the tricks on BP

Two months ago, NICE and the British Hypertension Society finally ended years of wrangling with a new guideline on treating hypertension, giving GPs the choice of using either calcium channel blockers or diuretics as main

first-line agents.

The move was a popular one with GPs – but not with PCTs, which baulked at the potential costs. So much so that a new Pulse investigation reveals more than half of trusts are over-riding the guidance and insisting GPs use diuretics first-line.

Underhand tactics

Such decisions question the whole point of NICE, which was supposed to put an end to this kind of postcode lottery. The institute did, after all, judge calcium channel blockers and diuretics to be equally cost-effective – with any short-term savings from diuretics soaked up in the long run by increased rates of diabetes.

But long-term cost-effectiveness is one thing, upfront costs are quite another. In these cash-strapped times, it was inevitable that some PCTs would insist on the cheapest immediate option.

Less understandable are the underhand tactics that many are using. Pulse found that local protocols often gave the strong impression they were following NICE guidance, when in fact they were diverging sharply from it. And of the overriding desire to control costs, there was barely a whisper.

Asking GPs to be complicit in cutting costs is one thing. Tricking them into it is another entirely.

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