NEW guidelines for saving NHS money by prescribing older, cheaper heart drugs will mean less effective care for some patients, specialists claim.

Primary care trusts have been told that at least 60 per cent of prescriptions for life-saving statin drugs should be for simvastatin and pravastatin, which are out of patent and much cheaper than newer, more potent statins.

The policy emerged quietly last week as part of a report from the NHS Institute for Innovation and Improvement that claimed productivity and efficiency savings could be worth £700 million a year.

While the report makes no mention of any new target, an accompanying document says that generic statins should represent a minimum of 60 per cent of all prescriptions. “Greater savings will be achieved for larger shifts,” it says.

While primary care trusts cannot force GPs to prescribe particular drugs, they can exert considerable pressure.

Pfizer, the drug company that makes Lipitor, the statin likely to lose market share as a result of any enforced change, says that the policy risks reversing recent advances in the management of heart disease.

Olivier Brandicourt, Pfizer’s managing director, said: “Not only does this represent bad medicine and a further assault on clinicians’ freedom to prescribe the most appropriate medicine for their patients, but it could also slow progress towards the Government’s own goal of significantly reducing deaths caused by coronary disease by 2010.” He is backed by heart specialists.

John Betteridge, Professor of Endocrinology and Metabolism at University College London, said: “It is crucial that the quest for savings on prescribing costs for statins should not lead to less effective care for individual patients at high risk of cardiovascular events. I fear that this may be the case.”

Professor Paul Durrington, of the Cardiovascular Research Group at the University of Manchester, said: “This is essentially robbing Peter to pay Paul.

“Substantial numbers of patients with above-average cholesterol levels will fail to hit the Department of Health’s own targets with generic statins and these are also the targets GPs are contracted to achieve.

“Failing to achieve these targets will translate into more expensive hospitalisation and surgical intervention.”

A recent paper in the British Medical Journal suggested that, at the right dose, all statins were of more or less equal potency, and that £2 billion could be saved over five years if the NHS prescribed only simvastatin. But Pfizer cites trials in which Lipitor produced greater reductions in cholesterol levels than simvastatin. Dr Berkely Phillips, medical adviser to the company, said: “The most important thing is that we are moving to new, lower targets for cholesterol.

“The current target is 5 mmol/litre of total cholesterol but the Joint British Societies — the British Cardiac Society, the British Hypertension Society, Diabetes UK, Heart UK, the Primary Care Cardiovascular Society and the Stroke Association — have recommended that the target should be 4 mmol/litre.

“On 40 mg of simvastatin, a normal dose, only 33 per cent of people would reach this target. Lipitor [atorvastatin] is more potent.”

The Department of Health denied that there was any new target. A spokesman said: “This is guidance for trusts showing the potential savings that could be achieved if their GPs prescribe lower cost statins.”

He added: “There is no government ‘cholesterol target’. However, under the new GP contract, doctors are rewarded for controlling the cholesterol level of patients with coronary heart disease. We are not aware of any evidence that shows the prescription of low-cost statins — in line with guidance from the National Institute for Health and Clinical Excellence — will reduce the effectiveness of this measure.”

• A report from the Royal College of Physicians shows big improvements in the care of heart attack patients in the NHS. In England, 83 per cent of patients were given clot-busting drugs within 30 minutes of arrival at hospital, compared with 44 per cent in 2001. These greatly improve the chances of survival.

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