GPs raise workload and safety concerns over loss of QRISK calculator from IT system

GPs are warning that the removal of the QRISK calculator from a leading IT system at the end of March will lead to increased workload and may also mean fewer patients have their cardiovascular risk assessed.

Currently users of EMIS IT systems receive an error message warning that the QRISK2 calculator that automates the calculation of cardiovascular risk scores will not be available from 31 March.

GPs will instead be advised to use the online version of the risk tool provided by ClinRisk which requires manual input of the relevant data.

It comes as GP practices are expected to move to routinely using QRISK3, an updated version of the risk score that takes into account other factors including migraine and severe mental illness.

In recent updated draft guidance on statins, NICE said QRISK3 performed best in assessing cardiovascular risk in a UK population.

‘Until systems are updated with QRISK3 it may be necessary to use QRISK2’, NICE said except in those who use corticosteroids, atypical antipsychotics or have a diagnosis of systemic lupus erythematosus, migraine, severe mental illness, or erectile dysfunction.’

GPs have yet been given little information on when to expect a version of QRISK3 as an embedded risk calculator only that it would be updated ‘in due course’.

Software supplier EMIS confirmed to Pulse that they are working to offer the QRISK2 calculator beyond April but would not provide any information about a QRISK3 update.

A spokesperson said: ‘The existing QRISK2 tool, provided by ClinRisk, uses the older read code structure, whereas EMIS Web has moved to the national SNOMED-CT clinical coding standard.

‘This creates a potential clinical risk when using the existing QRISK2 scores, eg, newer SNOMED-CT codes will not be included in risk calculations.’

But EMIS said they recognised that integrated risk scores ‘are valued by our customers for their positive benefit to clinical care’ and said they were ‘committed to continuing to provide this service and we are in active discussion with NHS England and the authors of the tool to understand the quantum of those risks and the potential remediations’.

They added: ‘We are hopeful that we will be able to announce a solution shortly that will enable continuity of the service from April 2023.’

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said he had raised this issue at various levels in the NHS.

At the moment, he explained, it was very easy to generate a QRISK score but removing the calculator from GP systems would increase GP workload.

‘[It] would make calculating the QRISK score much more laborious as the data would have to entered manually on an external website.

‘This would take much longer to complete than the current automated method using the inbuilt calculator. There would also be greater risk of mistakes as some data entry errors will be inevitable.

‘As well as increasing workload for primary care teams, it may also affect primary CVD prevention as fewer patients may end up having their QRISK2 score calculated.

He added: ‘We do need clarity from NHS England and the system suppliers about what they are doing to address this problem.’

Dr Hussain Gandhi, a GP in Nottingham, said the issue was causing a lot of worry.

Having to input data separately would create a lot of extra work for GPs which he estimates could be about 30 seconds per patient based on a similar issue with osteoporosis risk calculators.

‘It doesn’t sound like much, but factor that by the volume of QRISK we are asked to do, then it becomes unmanageable and the main issue is practices may not do it.’

It is thought the issue does not impact SystemOne but TPP did not respond to Pulse when asked for more details.