Should GPs prescribe statins at NICE’s proposed new threshold? No
Dr Des Spence says the new guidance will overmedicalise patients and be a massive waste of GPs’ time
The new thousand-page NICE guideline is full of intimidating academic research, written largely by specialists, with just two practising GPs involved. The result: many more people treated and at a younger age. The average male patient will now be prescribed a statin at 56. We are told statins are safe and effective – but the number needed to treat is through the roof.
Moreover, there is no ‘give’ left in general practice, no more time available. Where are the new resources to support NICE’s recommendation coming from?
The new 40% reduction target for cholesterol in people with a 10% or greater 10-year risk of developing cardiovascular disease will bring about major changes in clinical practice.1 We doctors are obsessive T-crossing types, and we will treat to target. I calculate an average practice of 5,000 patients will need an extra 20-30 appointments a week – and that’s a conservative estimate.
Add to that all those blood checks with spurious results that need repeating, LFTs, all the appointments to change medication, titrate the drugs and deal with interactions, and all the time spent on the ‘rare’ side-effects such as myalgia, lethargy and dizziness.
Endless phone calls to explain these results will take up even more GP time (and let’s face it, I’m not sure I understand all the lipid results, so that’s another two hours of CPD on top of practice time).
Then there is time spent on insurance forms, medical reports and the new waves of worried well. Why do we let specialists anywhere near primary care guidelines?
Pan-population pill-popping is at best a distraction and at worst a subversion. Modification of other risk factors would be much more effective.
The new guideline will constitute a massive waste of medical time, as well as lead to overmedicalisation of our patients. From a personal perspective, I’ll take my chances without a statin.
Dr Des Spence is a GP in Glasgow
1 Draft for consultation: Lipid modification. London: National Clinical Guideline Centre; 2014:186