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GPs are increasingly flouting the Government's 'out-of-date' guidance on statins after being left in 'no-man's land' by the decision to move simvastatin over the counter.
The drug is available in pharmacies to patients over 55 with a 10-year risk of coronary heart disease of 10 to 15 per cent, but GPs are only advised to prescribe statins to patients at 30 per cent risk or higher, leaving around seven million patients caught in the middle.
The Joint British Societies are shortly expected to intensify pressure on the Department of Health to close the gap after meeting last week to finalise recommendations for a prescribing threshold equivalent to 15 per cent CHD risk.
Pulse has learned that PCT prescribing leads are increasingly ignoring the four-year-old national service framework – which recommends the 30 per cent threshold – and advising that GPs prescribe at much lower levels.
But the department said it continued to advise the use of statins in patients at a 30 per cent risk or higher except where other risk factors such as diabetes were present. It has referred the matter to NICE, which is not expected to report back until 2006.
Dr Chaand Nagpaul, a member of the GPC prescribing sub-committee, called the department's position 'grossly iniquitous' and said: 'There is currently an inexplicable incongruity in Government policy – it is promoting over-the-counter statins yet it is denying access for patients to get them from their GPs.'
Dr John Ashcroft, vice-chair of the PEC of Erewash PCT, said the Government had failed in its duty to review the NSF annually and that each year of delay would cost 20,000 lives.
And Dr Rubin Minhas, CHD lead for Medway PCT and a GP in Rochester, added: 'It leaves you in no-man's land. Primary prevention is not included in the new GMS contract.
'The department should look at its primary prevention strategy and seriously consider implementing one.'
PCT prescribing leads approached by Pulse confirmed they were recommending statin use below the current threshold. They said the Wanless report had made the economic case for statin use from 15 per cent risk.
By Rob Finch