Chris Lancelot - PCT campaign on statins will leave GPs nursing a headache

Spring is coming! Put your head outside and listen to the faint sound of drumming. No, it's not woodpeckers but 40,000 GPs banging their heads repeatedly against the nearest brick wall.

Switching patients from one drug to another and then back again will cause a big headache in primary care
Switching patients from one drug to another and then back again will cause a big headache in primary care

Because with the spring comes May, and in May atorvastatin comes off patent. Its cost should fall dramatically: several PCTs are already planning mass campaigns to switch patients from simvastatin to atorvastatin.

Except that we've all just completed a project to do it the other way round. GPs are going to look like right proper Charlies when we approach those same patients and ask them to change back again.

Even worse, many GPs made the original swap to simvastatin under protest, and under threat - legal and financial - from their PCT. This might be defensible if all statins were equivalent, but many doctors believe that atorvastatin is more potent, has fewer side-effects, and a better resulting lipid profile.

Nevertheless, we did as we were told, venepuncturing the patients until they were stabilised on the new medication. (Bearing in mind this procedure was for the benefit of the PCT rather than the patient, this was arguably an assault.)

Understanding patients
The patients have been understanding - though what if there had been a problem? Could I really stand up in court and say that in my professional opinion I was giving the patient the best treatment? No, I couldn't.

Nor could my defence be 'I was told to swap by the PCT', because the PCT would claim that any decision to change was 'always a matter for clinical judgment, and therefore the responsibility of the GP', even though that same PCT was quite prepared to name, shame and fine practices which didn't hit their arbitrary targets.

How much practice time has been wasted on this exercise? Time taken to call in the patients, explain the changes, take the blood, titrate the new statin, take the blood again ... and time is money (though unfortunately, not considered as a valid expense against prescription savings, which it should be).

This whole operation has been poor quality medicine, thoroughly intrusive and totally counterproductive. And now we are being asked to do it all again, in reverse.

Unlike woodpeckers, I've got a headache.

  • Read more of comment from Chris Lancelot including his views on GP burnout and stress

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