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Independents' Day

GP leaders unite to reject NICE proposal to put 10% statin threshold in the QOF

Exclusive The RCGP and the GPC have rejected NICE’s plan to introduce QOF indicators that would see practices rewarded for prescribing statins to patients with a QRISK score above 10%, warning the move threatened the ‘credibility of QOF’.

The move comes as NICE advisors on QOF are due to meet early next week to discuss potential new indicators - including two that would reward practices for prescribing statins to patients newly diagnosed with diabetes or hypertension at a 10% estimated 10-year cardiovascular risk level - which will be up for negotiation for next year’s contract if approved.

The GPC said that it was ‘vital for the credibility of QOF’ that indicators have a robust evidence base, make significant difference to patients and are backed for the profession, adding that these proposals ‘fail on all these counts’.

The RCGP warned that the proposals risked ‘the loss of professional confidence in the healthcare targets they are being asked to meet’.

NICE launched the consultation on proposed new QOF indicators earlier in the year, which included another potential new indicator would pay practices to set up a register of patients with a 10-year risk of 10% or higher, alongside the hypertension and diabetes indicators.

The proposals were made in order to reflect updated NICE lipid modification guidelines, which lowered the 10-year cardiovascular risk threshold at which GPs prescribe interventions, including statin therapy, from 20% to 10%.

This was despite opposition from GP leaders and other leading clinicians concerned about the potential for over-medicalisation of healthy people and diversion of resources away from the sick onto the ‘worried well’.

Both the GPC and the RCGP have sent robustly worded objections to enforcing statin use at the lowered threshold through QOF.

In its response to the consultation, the GPC said the plans lacked evidence, were not backed by the profession and risked undermining the credibility of QOF.

The GPC said: ‘It is vital for the credibility of QOF that it remains focussed on indicators that make a significant difference to individual patients, where the evidence base for benefit is strong, and the profession as a whole backs their inclusions; the proposal to include a measure of statin use at the 10% risk threshold fails on all these counts.’

The response also warned the indicators would reward ‘willingness to resort to pharmacological rather than behavioural intervention’, and that they were ‘medically unjustifiable’ and would ‘disempower patients and undermine informed patient choice’.

Similarly the RCGP’s official consultation response cited concerns the move would result in ‘medicalisation of five million healthy adults’ and warned it risked ‘the loss of professional confidence in the healthcare targets they are being asked to meet’ – pointing to Pulse’s finding that most GPs themselves would not opt to take a statin at this level of risk.

The response added that indicators would ‘not encourage pursuit of lifestyle modication and in fact promote over-medicalisation of risk rather than disease’.

A NICE spokesperson said: ‘NICE opened a consultation on potential new indicators for the 2016/17 QOF menu in January 2015. On 1 June and 2 June the NICE Indicators Advisory Committee will be reviewing all comments received from stakeholders. NICE will be in a position to comment on stakeholder responses after the committee has come to a final decision, at that meeting.’

Readers' comments (8)

  • Nice waste of time all round. True.

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  • At last a whiff of common sense.

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  • 10% risk and statin means add it in cornflakes for all over 50

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  • Vinci Ho

    I just 'love' the word Statinisation. If you spell it slightly wrongly , reminds of our dearly old friend Joseph S.

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  • It is clearly important that organisations charged with decision making that will potentially affect hundreds of thousands of people can be relied upon to make judgements on the basis of firm evidence alone. We should have confidence in the process and ultimately accept that we at the grassroots do not have access to all the facts that have been examined.
    So I am really looking forward to going to Qatar in 2022.
    Not sure about this statins business though....

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  • QoF decision makers need to read the evidence which shws that most people, even with serious longterm conditions, don't take thir medication as prescribed. Opening the mdicine cupboard at patient's houses means ducking out o the way to avoid the pills as they cascade down. we medicalise and overtreat, broccoli not statins!

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  • Difficult one as presumably the sooner you start statins the sooner you reduce progression of atherosclerosis. I give patients the option citing current NICE guidelines , alternatives [ nothing so effective] and potential adverse effects. On balance most opt for the statins after a 6 month trial of lifestyle improvement has made little impact on their lipid levels.

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  • Samuel Lewis

    dear sessional locum 6:17

    "10% risk and statin means add it in cornflakes for all over 50"

    no it doesn't. it means almost all men over 55.

    using Qrisk it means all women over 65.

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