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GPs buried under trusts' workload dump

Buy your high-dose statins here for double loyalty card points

Copperfield 

The latest catch-all cliche for primary care, thankfully taking over from ‘GPs are ideally placed to…’ is, ‘Pharmacists are highly trained professionals who are greatly valued by patients’.

And, this week, pharmacists are highly trained professionals who are greatly valued by patients because, according to Government plans, they will soon be able to provide statins OTC, in doses which are high and effective rather than, as at present, homeopathic and pointless.

Cue lots of GP teeth-gnashing about pharmacists not being properly trained for this, about the risks of inadvertent reactions with other drugs, about the lack of NICE recommended LFT monitoring, yada yada. All of which may actually just reflect the tension that resides in most GPs about, on one hand, wanting to reduce our workload, while, on the other, not wanting to appear dispensable.

I like to think I give balanced information about the pros and cons of statins - especially when the topic is as contentious as their value in the primary prevention of cardiovascular disease

But this isn’t just reflex GP protectionism: we do have an important role here. If you don’t believe me, consider the kind of statin-based interactions different professionals might have with patients.

As a GP, I like to think I give balanced information about the pros and cons of statins - especially when the topic is as contentious as their value in the primary prevention of cardiovascular disease - with me providing Numbers Needed to Treat, Numbers Needed to Harm and having no vested interest in the outcome.

Whereas, as a pharmacist - and I admit I’m guessing a bit here, never having been one - I suspect my approach might be less about guiding patients towards an informed choice and more about guiding them towards the checkout with as much high-dose statin as I can cram into their basket/trolley, given that I gave certain pecuniary and target-given pressures to consider.

Yes, community pharmacists may be highly trained professionals who are greatly valued by patients. But I feel that I am ideally placed to point out that they are shopkeepers, too.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield

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Readers' comments (8)

  • Again - brilliant!!

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  • D'you know - if some people want to give themselves unecessary cataracts and diabetes for vanishingly small NNT values in primary prevention, let them. For too long we have tried to be the pastoral role for our patients - informed decision making, of course, but gently guiding some of the more over-enthusiastic towards the "lose a bit of weight and move around more" camp than the "pill for every ill" camp. It appears that is not what is wanted - and the populace is allowed to drink too much, not get enough sleep, not exercise, take drugs which whilst not legal are freely available, eat the wrong things, spend unwisely and generally live an unhealthy life. Why should we stop them taking unnecessary and potentially harmful medications to boot?

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  • Ivan Benett

    Well, I think you make a good point here. Actually several good points, although slightly incompletely.
    1. I think your main point, although I may be wrong, is that pharmacist have a conflict of interest. At least I think they might. Namely, if you are paid to sell something you are more likely to err on the side of wishing to complete the sale.
    2. Which links to the first, that pharmacists may not be sufficiently trained to present the known data in a dispassionate way and allow the patient ( or is it customer) to decide for themselves. They may not be able to discuss risk in such a way as to help them understand that there’s more to it than NNTs and NNHs
    3. Pharmacists may not have the whole picture of the patient, their other diseases, foibles and family idiosyncrasies. Or completely identify and manage their ideas concerns and expectation
    Balanced against all of these risks are the undoubted population benefits as described by NICE guidance for those at risk and the finite capacity of Primary Care to meet the need.
    On balance, for me there is sufficient case that this approach will net benefit the population and therefore some individuals that it is worth piloting. We should quantify risks, benefits and costs. Then we’d be in a stronger position to be confident of rollout. I haven’t seen such an assessment, but there may be one already.

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  • AL "4 TRIES IN ONE GAME" BUNDY

    In some developing countries the pharmacist is effectively the doctor
    you can buy whatever you want
    but then you take the risks yourself as well

    ...
    Copperfield
    have you seen that magazine
    "What doctors don't tell you"
    seen in Sainsburys .. hillarious
    check it out

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  • AL "4 TRIES IN ONE GAME" BUNDY

    https://www.wddty.com/

    Think i might start reading it
    at least then i'll know what i,m not telling patients lol

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  • AL "4 TRIES IN ONE GAME" BUNDY

    A practice based chemist could handle this with access to the patient records.. as per medication reviews
    the usual agenda here is medication cost optimization
    with no pecuniary conflict of interest

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  • Vinci Ho

    There are some ideological dilemma and hence , arguments here :
    (1) Are patients actually customers in 21st century technology driven world ?
    (2) The ‘fascinating’ story about statin , especially in primary prevention, is the way side effects can happen . Remember the evidence that there is actually a nocebo effect ?
    June 27, 2017
    Nocebo Effect May Account for Statin Adverse Events
    Anita Slomski, MA
    JAMA. 2017;317(24):2476. doi:10.1001/jama.2017.7582
    (3) Hence , the patient was more likely to develop side effects if more information about adverse effects was given to them ??
    Then one found oneself in a ‘damned you do ; damned you don’t’ situation. As you guys alluded , the pharmacists would be tempted to run a different philosophy by simply treating a customer to ensure the pack of high dose statin would appear in the checkout basket . Full stop , ‘happy days’ for everyone(less likely to have side effects ??). GPs , please shut up , say less is better , ha ha ha .

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  • why would patients buy an otc statin ? they can get a 2 month supply from the GP.

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