The committee approved an indicator that pays GPs for every patient on statins who has been newly diagnosed with hypertension or diabetes and has a QRISK2 score above 10% by ‘consensus’, despite vocal opposition from members of the panel and prior warnings from GP leaders.
The proposed indicator will only pay GPs if the patients are ‘currently [being] treated with statins’, despite NICE guidance stating that the treatment need only be ‘offered’ to these patients.
Professor Daniel Keenan, chairman of the Indicator Advisory Committee, said all of these patients ‘should be on statins’ if their risk was 10%.
Statin threshold warning
The evidence that statins could provide a benefit at a risk of 10% was ‘very clear’, he added. ‘Not putting that in suggests we don’t believe the evidence,’ he said, which would not be a 'credible' decision.
GP leaders have previously warned against lowering the risk threshold for prescribing statins from 20% to 10%. But NICE said that the evidence shows prescribing statins at 10% is both cost-effective and beneficial to patient health.
The proposed indicator is intended to provide a strong incentive for GPs to move towards putting all patients with a 10% risk or higher on statins. The committee recommended it have a payment threshold of 40-80%.
QOF experts responsible for trialling the potential indicators said they would look into allowing GPs to file ‘exception reports’ if a patient refused statin treatment despite a recommendation from their GP, which could prevent GPs from being penalised if a patient declines treatment.
Concerns were raised that this could effectively 'mandate' GPs to prescribe statins or feel they must force patients onto the treatment so they do not lose out on funding.
It was one of several indicators added to NICE’s ‘QOF menu’ at the Indicator Advisory Committee’s inaugural meeting. NHS England and the devolved administrations of Northern Ireland, Scotland and Wales will then decide which of these are included in each country’s QOF.
The group also recommended an additional indicator based from this indicator’s proposal, which would reward GPs for providing ‘lifestyle advice’ to patients with a 10% QRISK2 score.
The two proposed indicators in full:
IND 11a: % of patients aged 25-84, with a new diagnosis of hypertension or diabetes who have a recorded cardiovascular risk assessment score of 10% or greater who are currently treated with statins.
IND 11: % of patients aged 25-84, with a new diagnosis of hypertension or diabetes who have a recorded cardiovascular risk assessment score of 10% or greater who are given lifestyle advice.