Ongoing QRISK calculator saga impacting patient safety and GP workload, BMA warns

The BMA has reiterated warnings about the lack of update to QRISK2 calculators on GP software systems after it was completely disabled on EMIS last week.

GPs have long warned of increased workload due to the NICE-recommended QRISK3 calculator not being embedded on their systems and QRISK2 being phased out.

Problems with QRISK updates were first flagged by GPs and reported by Pulse at the start of 2023.

In a newsletter update, the BMA said there has been ‘no response or changes made’ to concerns raised by the Joint GP IT Committee about the issue in January.

While QRISK2 appears to have been enabled again, a long-term solution is needed, GPs have told Pulse.

QRISK3 – which is more accurate in assessing cardiovascular risk – was introduced in 2018 rendering QRISK2 ‘obsolete’, the BMA said in a letter to Dr Amanda Doyle, NHS England director for primary care, in January.

The BMA, RCGP and NHS England are in full support of NICE’s recommendation to use QRISK3, the letter continues, but explains that GP systems have not been upgraded ‘apparently because of concerns about funding and liability’.

It leaves GPs having to input 22 pieces of information about a patient manually into the QRISK website calculator in order to get a risk score, which is unsafe and wastes time.

As a result, data from 2023/24 shows 92% of all risk scores in 2023/24 used QRISK2 (8 million times), while only 8% were done using the QRISK3 website manually, the committee noted.

‘We believe that upgrading our software will measurably improve the health of the population, experience for patients and staff, and make more effective use of NHS resources while also reducing health inequality by more accurate risk assessment,’ the January letter stated.

Now the BMA have confirmed that no effort appears to have been made to address the issue in the intervening months.

‘This past week we were alerted to the disablement of, and lack of update to the QRISK2 calculator on GP software systems.

‘Despite highlighting the importance of embedding accurate and efficient processes within GP IT systems to help identify those patients most at risk, and the need to avoid increasing workload, there has been no response nor changes made to address the concerns.

‘We will be reiterating these concerns and seeking clarification on the matter in further communications this week.’

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said GP colleagues had flagged the recent issues with QRISK2 being disabled with him.

‘Having the calculator embedded directly within GP electronic health record systems like EMIS allows clinicians to generate an accurate risk score instantly, using up-to-date patient data already held in the record.

He added its absence is not a ‘minor inconvenience’ but a ‘significant safety and workload issue.

‘If the calculator is not available in the system, clinicians must resort to manual data entry into external calculators. This is inefficient, adds to workload, and increases the risk of errors when transferring information such as blood pressure.

‘Even small mistakes can lead to inaccurate risk estimates, which in turn may affect clinical decision-making and patient care.’

A spokesperson for Optum, the company that acquired the EMIS system in 2023, said: ‘We are in active discussions with NHS England about its approach regarding QRISK3.’

An NHS England spokesperson, said: ‘We are currently engaging with stakeholders and suppliers to support implementation of the new QRISK3 calculator into clinical systems, following NICE recommendations.’

The commissioner did not provide a timeframe regarding the ongoing work.