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At the heart of general practice since 1960

Our statins policy reaps dividends

From Dr David Black,

director of public health,

Derbyshire County PCT

New indicators are being produced quarterly to show how much the NHS could save across a number of areas, including prescribing of low-cost statins (News Analysis,

25 January).

The North Derbyshire Health Community's innovative approach to prescribing low-cost statins

has been a success at both improving the health of the population and making most efficient use of scarce resources.

In addition, our 2003/4 GP prescribing incentive scheme rewarded practices depending on the proportion of all statin items that Simvador 40mg (or a product of comparable price) made up. More than 50 per cent achieved full payment of £2,000.

The policy incorporated the findings of the Heart Protection Study finding that simvastatin 40mg daily reduced the incidence of major vascular events in high-risk individuals including a number of groups of patients not previously studied (for example diabetes, stroke and peripheral vascular disease). Benefits appeared to be irrespective of initial cholesterol levels.

The policy – which would result in more people receiving statins, hence increase expenditure, but was deemed cost-effective – was implemented at practice level from October 2003.

Support included: implementation details circulated to all practices; practice meetings held to discuss implementation process; statin leaflets produced and distributed; support provided to community pharmacies regarding the ordering process for the most cost-effective simvastatin product; template letters and flyers produced to inform patients of medication changes; prescribing support technicians worked in practices on request, to identify patients suitable for change to simvastatin 40mg or initiation of simvastatin 40mg in certain disease groups.

It was felt the introduction of the QOF targets in 2004, rewarding practices for measuring cholesterol and achieving levels below 5mmol/l, could potentially undermine further implementation of our statin policy, penalise those practices that had already implemented the policy and result in unnecessary cholesterol testing (which would drive up unnecessary statin prescribing).

It was therefore decided within North Eastern Derbyshire PCT to have a local arrangement whereby practices are also rewarded for patients in each disease category who are on simvastatin 40mg, regardless of whether a cholesterol level has been taken.

Payments are made to practices depending on the points accrued under QMAS, but in addition the medicines management team worked with individual practices to determine the number of patients who had not had a cholesterol level taken but were being prescribed simvastatin 40mg or on simvastatin 10/20mg together with Read Code 8BL1 (maximum tolerated lipid therapy).

The appropriate additional payment is determined and a separate payment made. This local arrangement works alongside QOF rather than replacing it.

Recent figures show the former North Eastern Derbyshire PCT (now part of Derbyshire County PCT) has the highest proportion of statins prescribed as simvastatin in the country. This has hugely beneficial financial implications, now that simvastatin is off patent compared with other statins.

The policy also has had significant clinical implications for patients as recent figures show the rate of admission for myocardial infarctions has reduced by 25 per cent and there has been a greater reduction in deaths from cardiovascular disease than the national average.

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