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At the heart of general practice since 1960

It's not for everyone, says GP

PCTs have been accused of 'undermining the national quality framework' after offering GPs quality money without requiring them to hit

cholesterol targets.

GPs in three PCTs are being allowed to exception report patients who are not brought to target by simvastatin without having to try more expensive drugs.

In patients whose initial cholesterol is below 6.2mmol/L, GPs can collect quality money without even having to remeasure cholesterol levels.

North Eastern Derbyshire PCT, which with Chesterfield and High Peak and Dales PCTs is employing the policy, denied it was ignoring targets in the quality framework.

PCT chief executive Dr Martin McShane insisted the policy was 'in the spirit' of the framework and was based on the strong evidence for using simvastatin. He added: 'The quality framework indicates that there is justification with local practice to look at exception reporting.'

But GP prescribing experts expressed disbelief and outrage that the GMS contract standard cholesterol level of 5mmol/L was being ignored.

Dr Chaand Nagpaul, member of the GPC prescribing sub-committee and a GP in Harrow, Middlesex, said he could not believe trusts had implemented the policy.

'If what they say is correct it undermines the whole basis of national standards of the framework. This is not in the spirit of exception reporting.'

RCGP prescribing lead Dr Jim Kennedy said: 'Everyone on secondary prevention should be going for a cholesterol level of less than five ­ the only thing that should limit you is side-effects or intolerance to drugs.'

PCT scheme for

secondary

prevention

Prescribe simvastatin 40mg daily regardless of initial cholesterol level

If initial cholesterol level is less than 6.2mmol/L no need to recheck ­ this can be exception reported

If initial level is more than 6.2, recheck after three months; if cholesterol is over 5.0, check compliance and exception report if patient is non-compliant

If after increasing simvastatin dose there is no improvement and no benefit of further increases in dosage, then exception report

By Nerys Hairon

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