Statin targets threaten QOF credibility, says GPC

Proposed QOF targets that promote statin use at lower cardiac risk levels threaten the quality framework's credibility and risk stripping patients of choice, the GPC has said.

Dr Andrew Green: statin targets threaten QOF credibility (Photo: JH Lancy)
Dr Andrew Green: statin targets threaten QOF credibility (Photo: JH Lancy)

Indicators proposed by NICE echo its controversial guidance that recommends treating patients with statins if they are at 10% risk of developing cardiac disease in the next 10 years.

The guidance drew criticism from top GPs when it was approved in July last year.

GPC clinical and prescribing subcommittee chairman Dr Andrew Green said: ‘A QOF indicator for this will not measure the quality of care offered by practices to their patients, merely their willingness to resort to pharmacological rather than behavioural intervention, which is hardly a measure of good care.

‘It is vital for the credibility of QOF that it remains focused on indicators that make a significant difference to individual patients, where the evidence base for benefit is strong and the profession as a whole backs their inclusion. The proposal to include a measure of statin use at the 10% risk threshold fails on all these counts.’

Disempowering patients

Patient choice is key when it comes to preventing cardiac disease and the new QOF indicators would mean patients would no longer be able to discuss all possible treatment options with their GP, including lifestyle changes, said Dr Green.

‘Attempts to evaluate this nuanced discussion by bean-counting crude prescription numbers is not only medically unjustifiable but returns us to an interventionist doctor-knows-best model of care, which disempowers patients and undermines informed patient choice,’ he said.

NICE has previously said that there is ‘no credible argument’ against the effectiveness of statins, and that its guidance ‘encourages GPs to fully explore with their patients the ways in which people can reduce their risk of cardiovascular disease’.

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