Welsh Royal Colleges Launch Choosing Wisely Initiative to Inform Doctors

Welsh royal colleges have launched a ‘Choosing Wisely’ initiative, aimed at providing GPs and other doctors with a list of procedures and treatments that they should avoid in order to help minimise harm from unnecessary healthcare interventions.

The Academy of Medical Royal Colleges (AMRC) in Wales has told GPs to avoid X-rays or scans in patients with lower back pain and prescribing medicines to frail people in their last year of life except for the control of symptoms.

As part of the scheme, each of the medical royal colleges was invited to produce a list of around five treatments or investigations that doctors should avoid conducting.

Unveiling the programme in Wales, the AMRC stated that it intends to “embed a broad cultural change in healthcare where clinicians and patients regularly discuss the value of treatments and make shared decisions”.

Of the final list of treatments and tests to avoid, the Wales programme is asking GPs to avoid:

– X-rays or scans in people with low back pain;
– long-term prescriptions for PPIs;
– prescribing medicines to frail people in their last year of life except for the control of symptoms;
– checking cholesterol levels every year if they are taking a statin, unless they have a history of vascular disease or an inherited lipid disorder.

In addition, the RCGP states that patients should only be considered for treatment with antihypertensive drugs if they have blood pressures of 140-159/90-99 mmHg and other risk factor.

While women should always be offered hormone testing before investigating the possibility of polycystic ovary syndrome.

Dr Paul Myres, programme leader and chair of AMRC Wales, who is also a former GP in Wrexham, commented that the initiative is intended to deliver a healthcare system which is more flexible.

“We’re looking for patients to be a bit more confident in asking what choices are available to them and for clinicians to be more confident about talking about options and not just saying this is what you should do. We’re not expecting every GP to suddenly work on all five and we recognise that certainly in Wales, local groups may choose to focus on certain ones”.

Myres went on to emphasise that the initiative had not been driven by merely financial considerations.

“What we’re very keen to avoid is for CCGs – or here in Wales, the local health boards – to focus on key areas because what we hear very clearly from patients is that this is about saving money. It’s not about saving money it’s about safety and effectiveness and avoiding waste”.

Health expenditure per head in Wales for 2013/14 was the lowest of the four UK nations at £1,992, although England was only slightly higher at £1,994 per head.

Health expenditure per head in Wales has fallen by 6% in real terms since 2009/10.

NHS bed occupancy in Wales has risen steadily over the past few decades, and was recorded at 86.7% for 2014/15.

 

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