GPs should not be pressured into prescribing against patients' wishes, warns GPC

GP leaders have hit back against claims that uptake of NICE guidance on AF was 'not good enough' over the last year, as national data show a 'slow' rise in the number of patients taking anticoagulants.

Dr Andrew Green: GPs face unfair prescribing pressure

Results from the Sentinel Stroke National Audit Programme (SSNAP) show that, of AF patients admitted to hospital in April to June this year, a total of 45.6% were taking anticoagulation therapy. In July-September last year, this stood at 41.2%.

The report, prepared by the Royal College of Physicians (RCP), warned that there were 'major issues' in primary and secondary care about ensuring effective stroke prevention for patients.

The Stroke Association charity said this small increase was ‘not good enough’, especially considering that NICE issued guidance on treating AF in June 2014, which states all patients diagnosed with AF should be offered an anticoagulant to reduce their stroke risk.

GP prescribing advice

But GP leaders said NICE guidance was not prescriptive, and GPs should not be pressured into prescribing treatments without first discussing them with patients.

Alexis Wieroniey, deputy director for policy and influencing at the Stroke Association, said: ‘After a year of new guidance, over half of the people having strokes caused by AF are not on appropriate anticoagulation treatment when they are admitted to hospital,’ she said.

‘These are avoidable strokes that might have been prevented. It is vital that GPs adhere to NICE guidance in prescribing the appropriate anticoagulant to patients to prevent devastating AF related strokes.’

But Dr Andrew Green, chairman of the GPC’s clinical and prescribing subcommittee, said these figures were not an accurate portrayal of the number of people receiving treatment overall.

He said: ‘The NICE guidance on the use of anticoagulation in AF represented a major step forward and I would share the concerns of the SSNAP audit that change has been slower than ideal and that there is much work still to do. However, the comments from the Stroke Association are devalued by over-simplification and cannot go unchallenged.’

Stroke treatment

The figures in the SSNAP only apply to the small subset of patients who were admitted to hospital, and do not reflect the proportion of patients receving AF treatment in the general population, he added.

‘This population is frailer, older, and has more co-morbidities than others, which will affect the numbers being anticoagulated, and as they have by definition had a stroke they are more likely than others not to be on preventive treatment.

‘There is a further worrying misunderstanding,’ he said. ‘It is not "vital that GPs adhere to NICE guidance in prescribing the appropriate anticoagulant to patients", rather it is vital that we discuss the risks and benefits of this treatment to patients and guide them in their decision making.

‘Whether it is in stroke prevention, breast screening rates, or any one of the "harm reduction" activities we do, the desire to improve treatment figures must never override the right of patients to make choices about their healthcare.’

Photo: JH Lancy

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