Exclusive: NICE was wrong to back controversial QOF statin indicator, say GPs

Two thirds of GPs say NICE was wrong to a recommend a QOF indicator that would incentivise them to prescribe statins to millions more lower-risk patients, a GPOnline survey shows.

Statins: lower QOF threshold sparking concern (Photo: iStock)
Statins: lower QOF threshold sparking concern (Photo: iStock)

The indicator approved by NICE, which will now be considered for inclusion in the QOF in talks between GPC and government negotiators, would reward GPs for every patient taking statins who has been newly diagnosed with hypertension or diabetes and has a 10-year cardiovascular risk of 10% or higher.

One GP warned that the indicator would ‘distort patient care in order to maintain funding of the practice’, while many raised concerns about needlessly over-medicalising the population.

GPs leaders have previously argued against lowering the threshold for statin prescription from 20% to 10%, and later warned that the indicator could ‘threaten QOF credibility’.

When pressed at the meeting by GPOnline, chairman of the NICE Indicator Advisory Committee Dr Daniel Keenan said he could not understand why so many GPs were against the ‘evidence-based’ indicator.

QOF credibility

‘It would be crazy to use indicators for performance and not base it on the current evidence, because then your whole credibility would be gone,’ he said.

‘The truth is I am not sure why there is so much [opposition from GPs]. Patients today are being treated at the 20% level all over the place, there's virtually no change.

‘If the risk algorithm shows they have a 10% risk then they should be given a statin, that’s the evidence and that’s the guidance.’

But only 20% of GPs surveyed agreed with the controversial decision, while 13% said they were not sure whether the indicator should have been recommended.

One GP who responded to the survey said they were ‘perfectly happy to be incentivised because something is good practice’.

'Medicalisation of middle-age'

The majority of GPs disagreed with the decision. One GP said it would be ‘reasonable to advise but should not be compulsory to prescribe’.

Another said: ‘I feel GPs should be able to decide with their patients what is best based on evidence. This will increase workload for no reason other than payment.’

One respondent said: ‘This is the medicalisation of middle-age and the wrong way to go about prevention. Lifestyle change in a big way such as the Active Cities initiative is a more cost-effective way and more holistic of reducing cardiovascular disease risk.

‘I would not take statins for primary prevention unless I had familial hypercholesterolemia and find it difficult to recommend a medication to patients that I personally would not take.’

A total of seven indicators were recommended by NICE during the meeting last week. These form its ‘QOF menu’, which negotiators will consider for inclusion in the 2016/17 contract.

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