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Professor David Haslam: ‘We are not in cloud cuckoo land’



There has been a lot of debate around NICE’s proposals to halve the primary prevention threshold for statin treatment. Will you reverse your final decision if the feedback is not supportive? 

NICE genuinely takes on board all consultation responses and the views that are fed back to us will back final decisions. We have to strike a balance and look at what the question was that we were asked to consider. With the particular issue of lipids it is about looking at the cost-effectiveness and whether the risks and benefits have changed. 

Do you look at the implications for practice workload when drawing up guidelines? For example, when recommending to halve the primary prevention threshold? 

The committee certainly looks at the impact. In terms of the specific GP workload, to be honest with you, I simply don’t know [for the lipid modification guideline]. But this is not cloud cuckoo land – completely separated from the real world of the busy doctor. Otherwise, why would we want to do the job?

But cost-effectiveness does not necessarily mean it is practical. Is that part of NICE’s remit? 

If we look at the QOF, NICE’s role is very clear; to look at what the academic evidence is for any given activity, to look at other metrics that are measurable and whether it is worth doing. What we have done in the past is produce a nebula of things that the GPC and NHS Employers can negotiate in terms of the impact on general practice. What we are producing is the evidence base for the negotiators to work their way through.