Whilst the full content of NICE lipid guidance does make it clear that statin prescribing is only an offer, after lifestyle modification has been advised, we all know that when something becomes a QOF target it very quickly is perceived (rightly or wrongly) as a ‘must do’ unless there is a good reason not to.
The lowering of the prescribing threshold has generated some 4.5 million statin candidates, 4,448,000 of whom would not benefit from treatment over a three-year window, according to NICE figures (though 8,000 deaths, 28,000 MIs and 16,000 CVAs would be prevented).
With chance of gain for an individual patient being so small, it is imperative that patients are not steamrollered into taking statins, which is a real danger when QOF works its magic.
NICE makes a clear statement about patient choice and have produced a decision aid to help us with that, but in the real, time limited, high-pressure world of general practice it is inevitable that the financial drive created by QOF would override this sensible advice.
The QOF consultation document does contain a recommendation to perform a QRISK assessement on new hypertensives and diabetics. This is sensible and should be quite enough.
The decision about what interventions to choose, statins or otherwise, following that assessment, should be left to the doctor and patient to decide between them without financial or tick-box pressure.
Dr Julian Treadwell is vice-chair of the RCGP overdiagnosis working group, and a sessional GP in Somerset