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Gold, incentives and meh

GMC to weed out frivolous complaints

New NICE proposals to extend the use of statins will only be implemented successfully if GPs are paid for the extra work, researchers warn.

Their study of GP adherence to the previous national service framework guidance on statins found workload pressures were a major barrier to initiating the drugs.

GPs said the institute's new draft appraisal on statins would make 11 per cent of the entire adult population eligible for the drugs, sparking fears of a huge surge in workload.

Study leader Dr James Hickling, a GP in north London, said: 'It would be appropriate for primary prevention to be included as a QOF target to provide adequate remuneration for the increased workload and to ensure it is treated as a priority.'

The Primary Care Cardiovascular Society and Heart UK have both requested quality points for cardiovascular risk assessment and primary prevention in submissions to the quality framework review.

The new study, published in July's British Journal of General Practice, interviewed GPs from eight practices about their initiation of statins. It found confusion over guidelines was another serious barrier to use of the drugs.

'In our study, it came across very clearly that GPs were very frustrated by everyone saying different things. It tends to encourage GPs not to change at all,' said Dr Hickling, research fellow at the Royal Free and University College Medical School.

GPs face a new guidance clash, with NICE recommending statins at 20 per cent 10-year CHD risk, but the Joint British Societies due to advise a threshold equivalent to 15 per cent risk of CHD.

Dr John Pittard, a GP in Staines, Middlesex, said it was 'irritating' the expert groups hadn't co-ordinated their advice. 'It devalues both groups and we end up not having any confidence in either. People adopt guidelines which are simple and coherent,' he said.

But Dr Rubin Minhas, a GP in Gillingham, Kent, who gave evidence to the NICE appraisal committee on statins, said the workload implications would have been far worse had NICE fallen in line with the JBS. 'The JBS threshold of 15 per cent would result in GPs being overwhelmed,' he said.

By Emma Wilkinson

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