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Practices blocked from using CV risk tool on IT system following errors

Exclusive Practices using the SystmOne IT system have had their QRISK2 tool disabled, after inaccurate risk scores meant potentially thousands of patients could have missed out on interventions for cardiovascular disease, as revealed by Pulse this week.

GPs trying to use the tool in the last few days have received an error message (pictured) from TPP saying the tool had been ‘disabled until further notice’ and have been directed to using an online version.

Pulse has confirmed that this was at the direction of the Medicines and Healthcare products Regulatory Agency (MHRA), who issued an alert to practices over the problems with QRISK2.

Pulse can also reveal the medicines watchdog is urgently investigating whether any other tools in SystmOne are similarly affected, and will also investigate whether the tool should have remained active so long after problems were first identified.

QRISK message

GP leaders said they would ‘welcome a clear explanation’ about what had caused the problems, as uncertainty over the extent of problems was causing system-wide ‘anxiety’.

Earlier this week Pulse revealed how GPs were alerted to the size of the error on 29 April, and were provided with a list of patients who may have had their risk underestimated and not been prescribed statins as a result, or who were on the drug unnecessarily.

Though the original update only covered patients given a QRISK2 score since October 2015, TPP has said that some of the problems have been present since 2009.

GP leaders told Pulse ‘pop up’ alerts had been warning of potential inaccuracy with the tool for some months beforehand, but it is only in the last 48 hours that TPP have pulled the defective tool.

The alert from TPP states: ‘TPP have disabled this tool until further notice. If there is a requirement to use this algorithm, please consider using QRISK2 at

‘As per previous messages, TPP have identified issues with the QRISK2 Calculator in SystmOne, some of which have been present since 2009…TPP apologise for any inconvenience cause.’

A spokesperson for the MHRA told Pulse: ‘We are working closely with TPP and they have been directed by us to disable this particular tool until the matter has been satisfactorily resolved.

They added: ’As far as we are aware this issue only affects the interaction between the calculator and SystmOne however this is being urgently investigated.’

Chair of the GPC’s IT subcommittee Dr Paul Cundy told Pulse: ‘I would welcome a clear explanation from TPP, as to what exactly the problem is. Because at the moment uncertainty is creating great anxiety. For instance, is this a systemwide bug that might apply to other clinical tools in SystmOne?’

TPP declined to comment on the disabling of the QRISK2 tool, but said on Wednesday: ‘TPP is dealing with the Clinical Safety Incident involving the QRISK2 Calculator in SystmOne. The tool is intended to support GPs in assessing patients at risk of developing cardiovascular disease and in developing treatment plans. The QRISK2 Calculator is presented within SystmOne as an advisory tool.

 ‘We are actively working to ensure the issues identified are addressed and to ensure that clinicians are informed of any patients that may have been affected as soon as possible.’

Readers' comments (4)

  • It gets worse and worse! Is the problem with QRisk2 or the interface or both? Given that the ACC/AHA algorithm has also been called into question with defined over-prediction of risk it is time for a serious reappraisal not only of the predictor formulae but also of the need for them. The evidence that intervention on the cholesterol-lowering front is necessary, not least if in fact the actual risk is less than 5% (as the latest American study implies) is now so flawed as to be unacceptable. And to consider using statin alternatives at a cost of £4000 annually is crazy.

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  • Are TPP going to pay for the costs of checking every patient's risk, write to them and compensate patients for an unnecessary staton ill effects, prescription charges and the NHS for the statin costs? This is huge.

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  • Peter Swinyard

    my Qrisk tool on TPP seems to be still active.....

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  • My EMISWeb seems to be working fine. Shame I didn't agree to the PCT pressure to switch.

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