Exclusive NICE’s proposals to offer millions more patients statins for primary prevention will leave GPs overwhelmed by increased demand for consultations, the BMA’s official response to the consultation has said.
The BMA rejected outright the proposal to lower the threshold for statin treatment to a 10-year risk of 10%, which it said is not supported by the available evidence and will lead to ‘unsustainable workload implications’ for GPs and ‘reduced access for other conditions’.
The response from the RCGP also warned there was a potential for overtreatment, which it said should be carefully managed through ‘publicity and communication’.
The draft update to NICE lipid modification, published in February, recommended halving the 10-year risk threshold for primary prevention from 20% to 10%, as determined by the QRISK2 risk algorithm, on the back of a large meta-analysis published in The Lancet showing the benefits of lowering lipid levels with statins extended even at risk levels below the 10% cutoff.
But the BMA said NICE had not taken into account the impact on primary care workloads and other patients.
It stated: ‘General practice currently does not have spare capacity, and this situation is likely to get worse due to demographic, medical, social, and workforce changes in coming years.’
‘The appointments required to assess, treat, and monitor patients according to this guidance can only result in fewer appointments being available for other reasons. With studies failing to show improvements in all-cause mortality the implementation of this guidance may well reduce and not increase the health of the nation, by denying primary care appointments for other conditions.’
The draft proposal to lower the risk threshold divided opinion when it was announced, and was met with scepticism by many GPs.
A survey of around 500 GPs conducted by Pulse revealed around 60% did not agree with the recommendation, while over half would not take a statin themselves at the 10% risk – or recommend family or friends do.
The RCGP’s response noted concern regarding the potential for overtreatment, which it said must be carefully managed through ‘publicity and communication’ on how to explain the benefits and harms of treatment in people at lower risk.
The college stated: ‘NICE have reduced the statin intervention threshold understandably in the light of recent meta-analyses which show persisting risk reduction among lower risk patients. This will lead to most of the population > 50 becoming candidates for treatment.’
‘The solution to avoiding overtreatment whilst also making available treatment to those who want it, is a clear presentation of absolute benefits and risk. This needs to be easy for patients, GPs, nurses and the media to understand.’
NICE said it has received 43 responses to the consultation from stakeholders on the proposals, which have also been criticised by public health experts.
Dr John Middleton, vice chair of the Faculty of Public Health, said the Faculty was ‘very concerned’ about the proposals.
Dr Middleton said: ‘The [Faculty of Public Health] is very concerned this draft NICE guidance will lead to the over-medicalisation of a societal issue. This challenge can actually be tackled much more effectively through policies creating healthier environments, which support healthier behaviours.’
‘The evidence clearly supports statin usage for patients with vascular disease, and for individuals at high risk of future events. However, we do not want society to think that statins represent a “get out of jail free” card to offset risky behaviours.’
He added: ‘We need action on all fronts to prevent over-reliance on medications. Policies are potentially much more powerful than pills.’