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NICE admits 10% statin threshold should have been piloted before QOF recommendation

NICE’s deputy chief executive has said that with ‘hindsight’ it would have ‘been wise’ to pilot the 10% statin threshold before suggesting it went into QOF.

Professor Leng was put on the spot on BBC’s radio show Inside Health by host and media GP Dr Mark Porter, who questioned whether NICE should never have made the – now withdrawn – recommendation on cardiovascular prevention in the first place.

The admission follows closely on NICE’s u-turn on the recommendation that GP practices should be incentivised for statin prescribing at the 10% primary prevention risk threshold in all patients newly diagnosed with diabetes or hypertension.

The NICE QOF menu for the 2015/16 GP contract negotiations includes a revised primary prevention indicator, but critically, does not contain the 10% risk threshold NICE originally said it would put forward.

Dr Porter said: ‘Hindsight’s a wonderful thing but might it not have been better in retrospect to have done this piloting work first rather than raise the hackles of some patients and some doctors?

To which Professor Leng responded: ‘I think that’s a fair point and hindsight is a wonderful thing and perhaps yes that would have been wise.’

But, despite the admission, Professor Leng insisted the plan may be resurrected in future following piloting in real practices.

Professor Leng said: ‘Not straight away because we are piloting it – we’re taking that lower threshold out to some real practices, piloting the impact of that and then we will take it back to our committee and consider whether it should go forward or not.’

Glasgow GP Dr Margaret McCartney, also speaking on the radio show, said that many GPs were ‘very unhappy’ about payments being linked to prescribing statins.

NICE’s decision to withdraw the 10% threshold recommendation from the QOF menu this year was preluded by an outcry from GP professionals – including BMA and RCGP – and even the former chair of the QOF advisory committee saying NICE had ‘lost the plot’ on statins.