NICE to propose adding controversial 10% statin threshold to QOF

NICE advisors will meet on Monday to discuss whether new QOF indicators to incentivise putting patients with a 10% risk of cardiovascular disease on statins should be considered for next year's contract.

A total of 12 potential indicators will be up for discussion in the inaugural meeting of NICE’s Indicator Advisory Committee, which replaced its QOF advisory committee earlier this year.

NICE lowered the threshold for prescribing statins in controversial guidance released last July, which recommended treatment for patients with a risk of cardiovascular disease in the next decade of 10% or greater, as determined by the QRISK2 assessment tool. The threshold was previously 20%.

The GPC previously warned that lowering the threshold threatened to 'distort' care by directing time and resources away from patients who needed it most.

During Monday’s meeting, the committee will discuss whether GPs should be rewarded through the QOF for prescribing statins to patients who have a 10% risk and have been newly diagnosed with hypertension or diabetes.

Another indicator up for discussion would see GPs paid for ‘establishing and maintaining’ a register of all patients with a 10-year risk of cardiovascular disease of 10% or more.

The decision on whether to include the potential new indicators will hinge upon evidence provided from GP practices where the indicators have been trialled, as well as taking into account expert opinions.

Those that make the cut will be formally recommended as part of NICE’s QOF menu, which will then be included in discussions for inclusion in the next GP contract.

Potential Indicators

The full list of potential indicators to be discussed at the meeting is as follows:

  • The percentage of patients aged between 25 and 84 years with schizophrenia, bipolar affective disorder and other psychoses who have had a CVD risk assessment performed in the preceding 12 months
  • The percentage of patients with coronary heart disease, stroke or transient ischemic attack, diabetes, hypertension, peripheral arterial disease, heart failure, chronic obstructive pulmonary disease, asthma, osteoarthritis and/ or rheumatoid arthritis who have had a body mass index (BMI) recorded in the preceding 12 months
  • The percentage of patients with coronary heart disease, stroke or transient ischemic attack, diabetes and/or chronic obstructive pulmonary disease who had a flu vaccination between the preceding 1 August and 31 March.
  • The practice can produce a register of patients who are either resident in a care home or who are housebound.
  • The percentage of patients recorded as being resident in a care home or housebound who have had a medication review recorded in the preceding 12 months.
  • The percentage of patients with a new diagnosis of depression in the preceding QOF year whose notes record an offer of referral for psychological treatment within 3 months of the diagnosis.
  • The percentage of patients with a new diagnosis of anxiety in the preceding QOF year whose notes record an offer of referral for psychological treatment within 3 months of the diagnosis.
  • The percentage of patients aged between 25 and 84 years, with a new diagnosis of hypertension recorded between the preceding 1 April and 31 March who have had a face-to-face cardiovascular risk assessment using the QRISK2 risk assessment tool within 3 months of the date of the hypertension diagnosis.
  • The percentage of patients aged between 25 and 84 years, with a new diagnosis of hypertension or diabetes recorded between the preceding 1 April and 31 March who have had a face-to-face cardiovascular risk assessment using the QRISK2 risk assessment tool within 3 months of the date of the diagnosis.
  • The percentage of patients aged between 25 and 84 years, with a new diagnosis of hypertension recorded between the preceding 1 April and 31 March who have a recorded cardiovascular risk assessment score of 10% or greater who are currently treated with statins.
  • The percentage of patients aged between 25 and 84 years, with a new diagnosis of hypertension or diabetes recorded between the preceding 1 April and 31 March who have a recorded cardiovascular risk assessment score of 10% or greater who are currently treated with statins.
  • The contractor establishes and maintains a register of patients with a 10-year risk of CVD of 10% or more.

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