Statins Again

[Outlier]

I have been summoned out of the blue to the GP surgery (good grief!) for a blood cholesterol test. I explained I usually have my Hb1Ac in August, but apparently this is only for cholesterol. I suspect (cynical, moi?) that the criteria for cholesterol reading has been lowered again. Cunningly my last test only gave an average figure not a breakdown of HDL LDL and Triglycerides, which was what I usually have. Anyone else know if this is the new norm, with the purpose of getting more of us on statins?

 

[Keith Saunders]

I'd be interested to know why you think there is a drive to get us on Statins? I spoke about them with my DN and she was more than happy for me not to take them and to review after my next Hb1Ac is done (next month), at which point I will decide.

The only evidence I see is the notional 10% increase in chance of heart issues for those that have diabetes, but if that is being controlled (to a very good level) then I see no reason why either I would want them, or indeed the health service would want me to have them.

 

[MissMuffett]

My GP ‘offers’ statins to me every six months, he knows I’m going to refuse, he even laughs as he’s asking the question. I have a full blood count including hba1c very 3-4 months. I will never take statins.

 

[KennyA]

I have been summoned out of the blue to the GP surgery (good grief!) for a blood cholesterol test. I explained I usually have my Hb1Ac in August, but apparently this is only for cholesterol. I suspect (cynical, moi?) that the criteria for cholesterol reading has been lowered again. Cunningly my last test only gave an average figure not a breakdown of HDL LDL and Triglycerides, which was what I usually have. Anyone else know if this is the new norm, with the purpose of getting more of us on statins?

I got a email from my practice in January out of the blue again recommending statins (I haven't taken it up). I think this was possibly because the Quality and Outcomes Framework indicators were revised again by NHS England in December 2023.

Two new cholesterol indicators have been added (CHOL001 and CHOL002), worth 30 QOF points for those indicators.

There are 635 QOF points available in total. Each QOF point is worth £213.43 to the practice in 2023-24.

Here's the link - screenshot also below.

QOF indicators | Goals and outcome measures | Lipid modification - CVD prevention | CKS | NICE

QOF indicators, Goals and outcome measures, Lipid modification - CVD prevention, CKS

cks.nice.org.uk

This link is also worth a look - the GPs argued strongly for scrapping QOF targets entirely. NHS England is sticking with QOF and imposed the changes.

What changes have been made to QOF in 2023/24? | Practice Business

An overview of the changes that have been made to the Quality and Outcomes Framework for 2023/24.

practicebusiness.co.uk

 

[Rokaab]

I know at my last doctors diabetic yearly checkup my nurse had pretty much already put down that I was declining statins (as my cholesterol is always low) before even asking me if I wanted them - she said that generally that they would be suggested for me given my age (ie over 40) but she figured I just didn't need them.
She's definitely a good nurse - though will be retiring soon

 

[Impy]

I had my annual check recently and my DN asked me if I was going to take the statins (Atorvastatin) which I'd been prescribed (Cholesterol at 5.2). When I said no she removed them from my prescription. Win - win

 

[jaywak]

I have been on 20mg simvastatin for as long as I can remember , when I had my last diabetic review in may my cholesterol was shown as a figure of 6 , I went for a follow up at the clinic in august and mentioned to my consultant that I thought it was a bit high he said that 4 was my good cholesterol and the other 2 were the bad guys , I didn't say anything at the time but am now wondering if I really need to be taking them .

 

[Jasmin2000]

I was also wondering why my GP was so ready to prescribe statins even before testing my HDL/LDL/triglycerides - he only wanted a kidney health check.

Funny thing is, statins were once the big news in cardiovascular health, not only for diabetics, and I asked my former GP if I could have them - I got sent packing with a warning about so-called lifestyle drugs!

Btw the current lifestyle drug is metformin, so some of you are ahead of the game

 

[Rachox]

I have always refused statins to the point where my record is marked ‘statin intolerant’! However when my cholesterol had risen to a level that worried me, I did some homework and asked for an alternative med. called Ezetimibe, a non statin cholesterol tablet. I was happy on it, my GP was happy as my cholesterol came down. However Ezetimibe has now joined the ever growing list of unavailable drugs, so I’m back to taking nothing. Blood test in a couple of months to see what effect this has had on my total cholesterol.

 

[MrsA2]

Am currently reading The Clot Thickens by Dr Malcom Kendrick. Very interesting on cholesterol and statins.

Only on page 47 so can't summarise, but it's proving an eye opener so far

 

[Rachox]

Am currently reading The Clot Thickens by Dr Malcom Kendrick.

Just downloaded the sample onto my Kindle app, ready to read tomorrow

 

[DEBBIESCOTT]

I have always refused statins to the point where my record is marked ‘statin intolerant’! However when my cholesterol had risen to a level that worried me, I did some homework and asked for an alternative med. called Ezetimibe, a non statin cholesterol tablet. I was happy on it, my GP was happy as my cholesterol came down. However Ezetimibe has now joined the ever growing list of unavailable drugs, so I’m back to taking nothing. Blood test in a couple of months to see what effect this has had on my total cholesterol.

Still available here, consultant just prescribed it

 

[LivingLightly]

I have always refused statins to the point where my record is marked ‘statin intolerant’! However when my cholesterol had risen to a level that worried me, I did some homework and asked for an alternative med. called Ezetimibe, a non statin cholesterol tablet. I was happy on it, my GP was happy as my cholesterol came down. However Ezetimibe has now joined the ever growing list of unavailable drugs, so I’m back to taking nothing. Blood test in a couple of months to see what effect this has had on my total cholesterol.

Our practice nurse is strident about recommending statins; my husband, who is not diabetic, takes them. In the past, I've tried two different brands, but experienced unacceptable side effects, so both were discontinued. I declined the offer of a third brand.

At my last diabetes review in October 2023, my lipid panel was in good order. That said, I have a strong family history of coronary heart disease. Today, I was offered this alternative medication called Ezetimibe, but warned it may be temporarily unavailable.

 

[Rachox]

Still available here, consultant just prescribed it

That’s interesting, i’ll request it with my next lot of repeats and see what happens.

 

[AndBreathe]

I received this text recently.

"Your last blood test showed your cholesterol was high. Would you like another blood test to monitor your cholesterol with a view to start medication such as a statin or increase your medication if already on cholesterol medication? :

I could have been open to another test to see where it currently sits, but not one with the outcome decided before I even choose.

 

[DEBBIESCOTT]

That’s interesting, i’ll request it with my next lot of repeats and see what happens.

I’ve not taken any yet as been ill since Christmas & on 4th course of antibiotics, read the side effects & didn’t want to start them until better, daughters a pharmacist I’ll ask her if they’re still available

 

[AndBreathe]

That’s interesting, i’ll request it with my next lot of repeats and see what happens.

Rachox, I don't have my finger on it at the moment, but there is some new guidance on Ezetimibe. You might be able to find it on MIMS online if youhave full access.

Ezetimibe | Prescribing information | Hypercholesterolaemia - familial | CKS | NICE

Ezetimibe, Prescribing information, Hypercholesterolaemia - familial, CKS

cks.nice.org.uk

 

[AndBreathe]

I got a email from my practice in January out of the blue again recommending statins (I haven't taken it up). I think this was possibly because the Quality and Outcomes Framework indicators were revised again by NHS England in December 2023.

Two new cholesterol indicators have been added (CHOL001 and CHOL002), worth 30 QOF points for those indicators.

There are 635 QOF points available in total. Each QOF point is worth £213.43 to the practice in 2023-24.

Here's the link - screenshot also below.

QOF indicators | Goals and outcome measures | Lipid modification - CVD prevention | CKS | NICE

QOF indicators, Goals and outcome measures, Lipid modification - CVD prevention, CKS

cks.nice.org.uk

This link is also worth a look - the GPs argued strongly for scrapping QOF targets entirely. NHS England is sticking with QOF and imposed the changes.

What changes have been made to QOF in 2023/24? | Practice Business

An overview of the changes that have been made to the Quality and Outcomes Framework for 2023/24.

practicebusiness.co.uk

@KennyA - Searchmeister (Yes, I am creeping), I don't suppose you have found a comprehensive list of all the QOF elements?

 

[KennyA]

@KennyA - Searchmeister (Yes, I am creeping), I don't suppose you have found a comprehensive list of all the QOF elements?

I have had one, let me see if I can remember where the up to date version is.

 

[KennyA]

NHS England » Quality and outcomes framework guidance for 2023/24

www.england.nhs.uk

Here we go - this is the second version, updated in January 2024 (published 30 January and updated 31 January makes it look like they missed an error somewhere).

[edited to note that there are many interesting things hidden on the NHS England website, but they can be hard to find unless you know exactly what you're looking for]

Unfortunately it's definitely not an "at a glance" document. All the indicators are in the early sections. If you want to see the internal workings, follow the link through to the Statement of Financial Entitlements Directions (SFE), which give the legal power to make payments to GPs for doing particular things (and not doing other things). An earlier version, now twenty years old, has my fingerprints on it.

The GP representatives are increasingly fed up with QOF (it was first introduced in the new GP contract in 2003) and in the 23/24 negotiations wanted to scrap it entirely. This was not accepted and NHS England imposed the arrangements (rather than agreeing them).

GPs are anti-QOF because the QOF is all about earning points by practices doing things. The GP view is that target chasing gets in the way of good patient care. Many patients have noticed this too.