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QOF chair: We have no idea why GPs oppose the 10% statins indicator

The new chair of the NICE advisory panel on QOF has said he has ‘no idea’ why GP leaders have opposed the introduction of an indicator promoting statin use in patients at a 10% 10-year risk of cardiovascular disease.

Professor Danny Keenan, the cardiothoracic surgeon who took over chairing the QOF advisory panel earlier this year, told Pulse the RCGP and GPC were disregarding the evidence base for NICE guidelines, which he said had clearly shown statin use at the 10% threshold would benefit patients.

It came after the panel yesterday gave the green light for the 10% threshold to be included in QOF, despite opposition from some on the panel itself.

Professor Keenan said that the evidence has been ‘debated extensively’.

He told Pulse: ‘We are implementing evidence into indicators, which are there in order to improve practice. It’s inconceivable that a committee developing indicators could disregard evidence.

‘It’s not like the evidence is iffy or hasn’t been debated - it has been debated extensively and agreed, you can’t come in and go against it.’

Asked why he thought the profession was still so concerned if the evidence was clear-cut, Professor Keenan said he had ‘no idea why they had a problem’.

Professor Keenan said: ‘We have no idea. I don’t really know why – evidence is evidence, I don’t know why they have a problem accepting the guidance has moved from 20% to 10%.’

He added: ‘Today [GPs] are rewarded at the 20% risk threshold for statin use and tomorrow – or whenever it is implemented they will be rewarded at the 10%.’

The NICE QOF advisory panel yesterday gave the go-ahead for the new indicator, which will reward practices for ‘the percentage of patients aged 25-84, with a new diagnosis of hypertension or diabetes who have a recorded cardiovascular risk assessment score of 10% or greater, who are currently treated with statins’.

The RCGP and GPC lodged official objections to the indicator during consultation – arguing it would over-medicalise the population and risked undermining the credibility of QOF amongst the profession.

However, Professor Keenan insisted that NICE had listened to the RCGP and GPC concerns over the proposed indicator, by putting forward a separate indicator which will incentivise lifestyle advice in these patient groups.

He said: ‘I thought we got a good solution, we obviously listened to the committee and the result of the consultation which was to add in lifestyle advice, which came across clearly and went in the indicator.’

Professor Keenan also rejected criticisms – voiced during the QOF advisory group meeting – that the indicator did not reflect guidance by using the wording ‘treated with’ rather than ‘offered’ a statin.

He said: ‘We went over the guideline – the use of the words - and it is actually quite prescriptive. If you read the guideline it is unequivocal that you should give the treatment.’

In the run-up to the panel’s meeting this week, the former chair said ‘NICE had lost the plot’, while GP leaders expressed concern at the panel being headed by a non-GP.

Readers' comments (40)

  • Why? Because I as a GP have seen an incident of rhabdomyolysis while participating in an international clinical trial and no stupid indicator is going to make me unnecessarily prescribe statins.

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  • One reason is workload. The lowering of the threshold to 10% will medicalize a lot more patients.

    As the statin will have to be prescribed, it will involve discussions with the patient, blood tests, extra consultations if they develop side effects. These are all consultations that we are short of.

    Soon the actually ill people will not be seen because we are doing the infinite workload of prescribing statins for infinitesimal benefit.

    What does society want ? A service for the ill or for the worried well.

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  • Oh, dear. Professor Keenan is suffering from a touch of tunnel vision, isn't he? I suppose that makes him an ideal chair of the NICE advisory panel on QOF.

    I'm not at all averse to offering an evidence-based intervention to the currently well patients on my practice list and am happy to take the studies showing the benefits of statins on trust. However, two things ...

    1. I became a doctor - and a GP - because I wanted to make sick people better, and I'm getting increasingly fed up with how much of my job now involves being a prescribing technician responsible for acting on other people's decisions. And it's all the same to me whether it's statins for Professor Keenan, a specific phosphate preparation requested by the local nephrologist, or endless prescriptions for moisturisers and nutritional products at the behest of care home managers. It's a waste of an expensive education and it pisses me off no end.

    2. I want to be able to respect my patients' right to make a decision, informed or otherwise, to decline statin treatment without the spectre of seeing my pay docked as a result. And I want to be able to choose, if I see fit, to decline statin treatment myself in the future without the spectre of knowing that my decision could affect my own GP's income.

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  • Once again a tertiary specialist surgeon feels entirely qualified to tell lowly GPs how to do their job. Remember Lord Darzi and WICs and what a waste of NHS resources that was?
    He is basically saying just shut up, accept NICEs evidence at face value and be good little boys and girls and prescribe what we tell you.
    I'm sorry the evidence is very debatable, see BMJ editorials. He also assumes that our time is free and we can see all these millions of patients without any effect on our existing core workload. Every new bit of work has an opportunity cost, ie we have to give up something more valuable and more evidence based.
    If public health experts want to medicalise healthy people, can they arrange this themselves or just make all statins otc.

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  • 'Now chaps, we've been sat in this room for two weeks now on £650 a day. We have to come up with something. Come on now'.
    'How about we reduce that 20% target to say 10%'.
    'Hmmm, that's bloody genius......custard cream?'

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  • I feel sorry for NICE and the other quangos ... I mean what are they going to do when primary care goes private like the dental industry - they are all going to have to get new jobs :)

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  • Lorna, you are spot on!
    Totally sick of this nonsense. If the population want this they should be allowed to buy it over the counter.

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  • we need to take the narrative - we studied long years worked many nights changed with a changing profession and enough is enough ,I was asked by the hospital to prescribe a 91 year old, lovely lady with dementia warfarin ...WTF are we doing ? one wonders at times

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  • He has no idea as he is not a GP and will not he doing the work. Coomon sense for a hallowed advisor.

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  • Medicine is so much better than it was 16y ago before NICE arrived on the scene. Despite this 100% of patients still die. We should allow people to manage some of their own risks in life, all humans should be afforded this basic human right. To twist GPs arms into prescribing they don't want to, is not just paternalism, it's unethical.

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