There is still no clarification on if and when the QRISK3 cardiovascular risk score will be embedded in GP systems, despite more guidance from NICE recommending its use, Pulse has learned.
Until it is resolved, it could mean those with EMIS IT systems having to manually input information for some patients into the online version of the risk calculator, NICE has admitted.
In a primary care bulletin this week, NHS England said when assessing risk for patients taking corticosteroids or atypical antipsychotics or people with systemic lupus erythematosus, migraine, severe mental illness or erectile dysfunction, GPs should use QRISK3 moving to the online version if needed.
Updated cardiovascular disease risk assessment and reduction guidance from NICE recommends GPs use the QRISK3 tool to calculate 10-year cardiovascular disease risk for people aged between 25 and 84 years and in patients with type 2 diabetes.
It follows draft guidance on statins published in January lowering the risk threshold at which the cholesterol-lowering drugs can be considered.
At the time NICE noted that QRISK3 performs best in a UK population with GPs expected to move to using the newer score routinely as it takes into account key factors such as severe mental illness.
‘Use of QRISK3 should, therefore, result in more people within these groups being appropriately considered for risk reduction approaches including statin treatment,’ the committee concluded.
In the latest recommendations on cardiovascular disease, NICE added: ‘Until electronic clinical systems in which QRISK2 is embedded are updated with QRISK3, it may be necessary to use QRISK2.’
GPs had previously raised concerns when the embedded version of QRISK2 was going to be removed from EMIS systems completely over issues with read codes.
Currently QRISK2 remains embedded but NHS England confirmed there was no update on if and when this would change.
A spokesperson for EMIS said: ‘We are in discussion with NHS England pertaining to their desired approach to implement NICE recommended cardiovascular risk tools into EMIS systems.’
Professor Carolyn Chew-Graham, a GP and professor of general practice research at Keele University confirmed that QRISK2 is still embedded in EMIS IT systems for now.
‘Clinicians do not have time to go out of EMIS to add data to QRISK3 template within a primary care consultation.’
She added that the draft guidance on statins which potentially expands their use to many more patients also requires time for shared decision making, which there is also little capacity for.
‘This could be key role for the practice pharmacist,’ she said.