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NICE U-turns on 10% risk statins QOF indicator

NICE has reversed its earlier decision to recommend an indicator that would incentivise GPs to prescribe statins at a 10% primary prevention risk threshold.

Its ‘QOF menu’ that will be put forward for negotiation this year does include a revised primary prevention indicator, but crucially, it does not contain the 10% risk threshold it originally said it would put forward.

Pulse revealed earlier this month that NICE were considering withdrawing its proposal for the 10% indicator after the GPC and RCGP both come out strongly against it, with even the former chair of the QOF advisory committee saying NICE had ‘lost the plot’ on statins.

Instead, NICE has recommended some slight modifications to the current indicator that rewards practices for treating patients with a 20% risk threshold, widening it to more patients and specifying that QRISK must be used.

A 10% statins indicator will be piloted with a view to introducing it at a later stage, NICE said.

QOF advisors had previously recommended that GP practices should be incentivised for statin prescribing at the 10% risk threshold in all patients newly diagnosed with diabetes or hypertension.

What is the new indicator?

In those patients with a new diagnosis of hypertension or type 2 diabetes aged 25-84 years, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, diabetes, stroke and/or TIA), who have a recorded CVD risk assessment score (using the QRISK2 assessment tool) of>20% in the preceding 12 months: the percentage who are currently treated with statins (unless there is a contraindication)

Source: NICE

But 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’.

However, despite this, the chair of the QOF advisory – Professor Danny Keenan, a cardiothoracic surgeon - pushed the measure through, and later claimed that he had ‘no idea’ why GPs were so against the move.

But Pulse revealed this month that NICE was in talks with GP leaders about removing the threshold.

NICE said that it had ‘carefully considered’ the indicators before putting them forward, but that it would be piloting and testing further indicators on lifestyle modification, informed decision making, statins prescribing for people that have a 10% or greater 10-year CVD risk and the ‘establishment of a register that would allow the identification of people with a 10% or greater risk 10-year CVD risk’.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: ‘NICE is undertaking additional work to ensure that we have a suite of indicators that support the intent of the underpinning NICE guidance for lipid modification.

‘The additional work will involve testing and piloting a number of indicators, including general practice indicators that support lifestyle modification for people that have a 10% or greater 10-year CVD risk alongside indicators that measure the prescribing of statins for those with a new diagnosis of hypertension or type 2 diabetes.’

Related images

  • mixed statins assortment packaging  PPL

Readers' comments (19)

  • hoo-rah!

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  • was it the cost implications or common sense?

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  • Peter Swinyard

    For as long as tertiary care ivory tower specialists try to subvert the QOF, we will have more of this nonsense.

    Resignation time, Prof Keenan - and let the GPs who actually do know how to treat and look after patients set the standards. We can read clinical trials too, you know.

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  • Samuel Lewis

    a triumph of unreason.
    Peter Swinyard says GPs can read trials too..

    so which RCT trials shows Statins work cost-effectively down to 10-year risk thresholds at least as low as 10% ?

    Answer - ALL OF THEM

    Statins for all | The BMJ
    www.bmj.com/content/348/bmj.g1899/rr/689666

    GPs have baulked at their imagined workload, side-effects. and potentially large numbers involved..
    But the evidence of benefit is much clearer than most of their hypertensive, diabetic, and GI prescribed

    hey-ho.. lets hope the NICE pilot trials can change their mindset.

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  • Statins are cheap and actually save the NHS money while reducing heart attacks by over 50% with long term treatment.

    Instead we continue to prescribe more dangerous and less effective drugs ( anti-hypertensives) to patients with far less risk.

    The USA have been treating to 10% risk for 10years, and European guidance is the same.

    We will be using them to 10% risk because that's where the evidence is.

    What is really strange is that the 2 most important studies that have driven this change across the world were done in this country, on UK patients, paid for by UK taxpayers.

    The HPS and WOSOP ... And yes they both showed that this level of treatment would save money and lifes.

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  • I'm quite happy to discuss them and prescribe them
    ......if that is what the patient wants
    .....but making it part of QOF distorts the position and also more particularly if not backed by the resources -which means more time and therefore more GPs and nurses - it is not sustainable within the current NHS

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  • Alice Hodkinson

    Chronic disease management is virtually all done based on population based statistics and minuscule benefit for individuals! It keeps more of us living longer so we can die of dementia or rare cancers instead.
    Arguably!

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  • I love the process:

    1. GPs aren't consulted.

    2. 'Experts' advise what should be done.

    3. GPs say 'Well that won't work'.

    4. 'Experts' advise 'Well don't do that then'.

    How much have we spent on the expert advice?? If step 1 was 'consult GPs' we might have half a chance of developing a satisfactory process.

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  • Need to make the flipping mind up. How much has this fiasco cost?

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  • Samuel Lewis

    dear anonymous ( 7.44am)

    you say "I'm quite happy to discuss them and prescribe them ......if that is what the patient wants
    .....but making it part of QOF distorts the position and also more particularly if not backed by the resources -which means more time and therefore more GPs and nurses - it is not sustainable within the current NHS"

    that is exactly what the ditched NICE proposal was saying -

    discuss risk and offer statin (in hypertensives >10% risk), and claim some 'payment' (resources) for doing so..

    hardworking GPs have shot yourselves in both feet..

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