GPs could be given incentives to prescribe statins under new NICE proposals

Wed, 28 Jan 2015
The National Institute for Health and Care Excellence (NICE) has updated its statin prescription guidelines in the Quality and Outcomes Framework (QOF), in a controversial move.

What are statins?

Statins are cholesterol-lowering drugs that are often used as part of diabetes care. People with diabetes are more likely to have a heart attack or stroke. When used in combination with good blood glucose control, statins can reduce the risk of cardiovascular problems for people with diabetes.

But statins can be controversial. Some people claim that the medication isn't necessary resulting in the over-prescribing of medication to healthy people, taking away time and resources from people who truly need the help.

The new NICE guidelines

Under the old guidelines, statins were prescribed when a patient had a 20 per cent risk of having a cardiovascular event within the next 10 years. If the risk was any lower, statin prescriptions weren't considered necessary.

The new guidelines, however, place this figure at 10 per cent. Moreover, GPs will be rewarded from prescribing statins, which, according to some GP leaders, will lead to a lack of discussion between doctor and patients, and take away the patients choice.

Are statins good for people with diabetes?

For people with diabetes, studies indicate that around 99 per cent of people who take statins for three years do not see anything significant benefit. Some people may be concerned about their risk of heart attack or other cardiovascular event as a result of diabetes, and decide to do everything they can to reduce cholesterol levels. Others may decide the low chance of deriving any benefits from statins isn't worth the risk of side effects.

How have GPs responded to the new guidelines?

Dr. Andrew Green criticised the new guidelines and incentives, saying: "Let me illustrate with an example, one practice simply issues statin prescriptions to anyone with a 10 per cent 10-year risk.

"Another sees those patients, offers lifestyle advice, then goes through with them the chances of statins producing benefit or harm, perhaps using a decision aid; having done that, it respects patients' choices. Which practice will have higher statin prescribing, but which one is offering higher quality care?"

Dr. Martin Brunet, GP, said: "The NICE guidance says that patients should be offered statins if their risk if >10%, not that they should be treated.

"If this indicator is included at all it should be on the basis that the doctor has had an informed discussion about the benefits and harms of statins, rather than whether or not the chooses to take them. This indicator will jeopardise patient choice in its current form."
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