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GPs' options for patients with low back pain

The number of patients eligible for statins is set to triple in a move that could cost the NHS up to a billion pounds a year.

Pulse has learned that a NICE appraisal is set to conclude statins are cost-effective at 10-year CHD risk levels 'well below' 15 per cent.

GP CHD experts said the move could make more than 10 per cent of the entire population eligible to receive statins on the NHS with huge implications for GP workload (see box below).

Professor Paul Durrington, a member of the steering committee of the Joint British Societies and professor of medicine at the University of Manchester, told the British Cardiac Society annual conference this week: 'NICE has just had its cost-effectiveness analysis refereed and they're discussing the results. They certainly show statins are cost-effective to well below the 15 per cent risk level.'

A source close to the appraisal process told Pulse NICE was now grappling with the overall cost implications as it decided the best way of phasing in increased statin use.

Current Government recommendations in the CHD NSF recommend statins at 30 per cent 10-year CHD risk but forthcoming Joint British Societies guidelines will advise a threshold of 15 per cent.

A GP adviser to the NICE technology appraisal committee said it was possible the NICE threshold could go even lower. Dr Rubin Minhas, who presented data to the committee in his role as CHD lead for Medway PCT, said: 'The NICE threshold has no relation to the JBS and it could be lower. If you do an analysis and that's what it shows that's what you have to do.'

He added: 'It has been indicated that the Department of Health will be in a position to make the funds available.'

Research published earlier this year found GPs currently use statin prescribing thresholds varying from 6 to 60 per cent 10-year CHD risk.

NICE will publish a consultation document on June 13 and will release its final technology appraisal on statins in November. PCTs would then have three months to fund its recommendations.

Dr Pravin Shah, CHD and diabetes lead for South Stoke PCT and a GP in Stoke-on-Trent, said: 'It will have a tremendous effect on the budget and it will be a big hole.'

Dr Jim Kennedy, RCGP prescribing spokesperson, said: 'There has to be money for the drug costs and it needs to be factored into the pressures of prescribing and workload.'

Dr Nick Plant, PEC chair for South Dudley PCT, said: 'Because simvastatin is now a penny a bucket load it's not going to be as crippling as it would have been, but there is a workload implication.

'Risk assessment will have to be put into the quality framework.'

The committee will have considered new Heart Protection Study data on the effectiveness of simvastatin and the tumbling price of the drug.

GP's plan for enhanced service

Dr John Ashcroft, CHD lead for Erewash PCT, has submitted plans for a local enhanced service on assessing CHD risk to cope with the massive workload implications of forthcoming guidance on statins.

Dr Ashcroft, a GP in Tibshelf, Derbyshire, said there were 'big gaps' in the quality framework, which had failed to provide the money to pay GPs for assessing risk.

Dr Ashcroft said that in his PCT population of 100,000, moving the threshold for statin use from 30 per cent 10-year CHD risk to 15 per cent would increase the number of patients on the drugs from 3,000 to around 11,000.

He said: 'We're talking huge benefits and it's a paradigm shift but it's a huge job and that's why we're looking into an enhanced service.'

By Emma Wilkinson

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