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GPs risk litigation for ignoring Government advice on NSAIDs

GPs have been warned they risk litigation if they continue to prescribe standard non-steroidal anti-inflammatory drugs to high-risk patients.

The Primary Care Rheum-atology Society claimed a considerable number of GPs continued to prescribe regular NSAIDs to high-risk patients with osteoarthritis despite Government guidance recommending Cox-2 selective inhibitors.

The National Institute for Clinical Excellence ruled in 2001 that Cox-2s should be prescribed for high-risk patients, including patients aged over 65, instead of standard NSAIDs for osteoarthritis.

But NICE estimated the guidance would cost the NHS £25 million a year.

Dr Graham Davenport, chair of the society and a GP in Nantwich, Cheshire, warned GPs could end up in court if a patient suffered an adverse event related to standard NSAID prescribing, such as a GI bleed or even death.

Dr Davenport, a member of Cheshire LMC, said GPs tended to prescribe standard NSAIDs because of pressure from PCTs to stay within their drug budgets.

But he said: 'GPs would find it very difficult to justify prescribing standard non-steroidals if a patient died. You could be in very big trouble and end up in court.'

Dr Davenport was recently criticised by his local PCT for having too many patients on Cox-2s instead of standard NSAIDs, which had strained his practice's drug budget.

But the PCT backed off

after he referred to the NICE guidance.

He said: 'PCTs are now fully aware of NICE guidance and they realise that Cox-2s will result in less GI complications. It is unfortunate for GPs that primary care will bear the brunt of the cost.'

The Primary Care Rheum-atology Society said osteo-arthritis accounted for about 40 consultations per GP per week and was present in about 80 per cent of the over-70s.

Dr Andrei Calin, consultant rheumatologist at The Royal National Hospital for Rheu-matic Diseases in Bath, estimated wider use of Cox-2s would halve the death rate linked to adverse effects of standard NSAIDs and any increase in cost would be offset by savings in secondary care.

'Cox-2 inhibitors are perhaps twice as expensive, but virtually every study confirms that by taking these, half as many patients suffer a massive GI bleed, perforate their bowel, require emergency transport to hospital, are admitted and half as much will be transfused.

'Given some 2,500-3,000 patients die each year from using conventional NSAIDs, twice as many lives could be saved.

'We anticipate the death rate to reduce to perhaps 1,000-1,500 per annum.'

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