Statin the bleeding obvious
I have a question, and I’d like someone clever out there to answer it.
To explain: one of my HCAs came to see me the other day. Big panic. She was doing something wrong, she said, with the NHS Health Checks.
No matter that the individual’s health she was checking seemed faultless, blameless and therefore potentially endless, the QRISK was coming in at >10%. And this was happening repeatedly. Was she, she speculated, forgetting to subtract the patient’s inside-leg measurement, or something?
The back story is that we have, for a long time, resisted providing NHS Health Checks on the basis of all the well-aired arguments, which could be summarised by saying that these checks are a politically-driven, non-evidence based heap of dung. However, when an activity, even a bonkers one, becomes the norm, there comes a time when a principled stand starts to looks like laziness or neglect. Plus we needed to earn some more cash.
So here we are, with a confused HCA and frightened patients. Of course, there’s actually nothing wrong with the way the HCA is performing the health checks. She’s simply forgetting that the single most important parameter is the one we’re all powerless to influence: age.
Why invite men over 59 or women over 65? Just send them a pack of Atorva on their birthday
As I have mentioned before, no matter how perfect your parameters, once you hit 59 (male) or 65 (female), your risk score is inevitable above 10%. Which means that, according to NICE, we should be offering statins - and NICE’s mealy-mouthed qualifier about trying lifestyle interventions first counts for nothing in this group, unless those interventions includes a device to reverse ageing that they’ve forgotten to mention.
So here’s the question. As the end game of any NHS Health Check is the calculation of the QRISK score and therefore a take-home prize of statin eligibility, what is the point of inviting any male over 59 or female over 65, given that the outcome is a given? Why not just send them a pack of atorva on the appropriate birthday, with a repeat prescription slip for those who like the taste?
While I’m waiting for someone to enlighten me, I can console myself with the fact that a green paper was produced last month on ‘Prevention in the 2020s’. Everything about it is ‘Bold’, not least the adjective ‘Bold’, which has clearly replaced ‘Robust’ as the politician’s go-to word for when they’re trying to convey that they mean business. It appears countless times in the document, almost always followed by the word ‘action’.
And the ‘Bold action’ with NHS Health Checks will apparently make them more ‘intelligent’. Which sounds good until you realise that means maximising uptake (so much for informed consent), increasing the range of checks offered (so much for evidence) and considering a ‘retirement MOT’ (so much for feeling carefree when I hang up my stethoscope).
I sent in my above questions to the consultation. And I pointed out that my personal future vision for NHS screening and prevention would be one that delinks scientific medicine from political propaganda. Now, that would be bold.
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