GPs are refusing to give life-saving cholesterol injections because they ‘don’t get paid enough’, claims a leading British scientist

By Liam On Sep 12, 2024

One of Britain’s most renowned health experts has accused GPs of withholding from patients a life-saving drug that could cut levels of deadly ‘bad’ cholesterol by more than 50 per cent.

Top scientist Professor Sir John Bell, former president of the Academy of Medical Sciences, has claimed that GPs are refusing to give the inclisiran injection — which could save 30,000 lives — because they are “not paid enough” to cope with the extra workload it would bring.

Responding to this week’s damning report into the NHS’s failings by Lord Darzi, Prof Bell told BBC Radio 4’s Today: ‘The NHS was very excited and said they were going to give 700,000 people a dose of this (cholesterol vaccine) in the first year.

‘It reached the GPs and they said: “Too bad, we can’t do this.”

“They weren’t paid enough for the injection they were going to give and they blocked the injection.”

The twice-yearly jab, called inclisiran, was approved for use by the NHS in 2021 for patients with persistently high cholesterol levels who have already had a heart attack

Professor Bell added that GPs claimed they did not have enough time to administer the injections.

“I think the medical profession is stuck in a certain way of living and practicing medicine. They’re very conservative and it’s very hard to get them to work somewhere else.”

The twice-yearly jab, called inclisiran, was approved for use by the NHS in 2021 in patients with persistently high cholesterol levels who have already had a heart attack.

According to NHS England, the drug could prevent 55,000 heart attacks and strokes and save 30,000 lives within a decade, at a cost of just £45 per dose.

Research shows that it is a useful alternative to statins. Only a third of people prescribed this drug forget to take it.

But the British Medical Association and the Royal College of General Practitioners said last year that administering the shot would require “additional resources”.

Professor Sir John Bell, who was a member of the Covid Vaccine Taskforce, today claimed that GPs were refusing to give the life-saving drug because they are not paid enough

It comes after Keir Starmer warned the NHS must be ‘reformed or perish’ after a damning report found billions of pounds of extra investment has failed to improve performance.

In a series of interviews ahead of the Prime Minister’s speech this morning, Health Secretary Wes Streeting said the NHS was “without a shadow of a doubt” wasting money and could “go bust” unless fundamental changes were made.

He also criticised the BMA, which is both a regulator and an industry organisation, for ‘sabre-rattling’.

How does Inclisiran work?

Inclisiran is one of a number of new therapies called small interfering RNA (siRNA) drugs.

These treatments essentially modify the genetic code in cells, changing the way the body functions. Genes send commands to cells to produce molecules that are crucial to the body’s functioning, and these commands are transmitted within cells by what is known as messenger RNA (mRNA).

However, sometimes they can create unwanted molecules that lead to disease.

In patients with very high cholesterol levels, the liver produces too much of a protein called PCSK9. These proteins inhibit the liver’s ability to break down “bad” LDL cholesterol, which has been linked to higher rates of heart attacks and strokes.

Inclisiran works by binding to mRNA strands that create the PCSK9 protein, disrupting the way they work. This means that much less of these proteins are made and the liver clears more LDL, removing it from the bloodstream.

Cardiologists are convinced that this will protect patients against heart attacks and strokes.

Inclisiran is not the only groundbreaking siRNA drug. This year, a US study found that the siRNA zilebesiran can ‘switch off’ high blood pressure.

“This technology will be used in medicine to treat everything,” said Professor Derek Connolly, a cardiologist at Sandwell and West Birmingham Hospitals NHS Trust.

“These drugs are convenient, effective and appear to have few side effects. This is undoubtedly the future.”

Professor Bell raised concerns about the BMA, saying it is a “major barrier” to reform.

He did not say the NHS is underfunded, but that the service needs to make better use of the money it already has.

He brought up the situation using inclisiran as an example.

Professor Bell said: ‘The great thing is that you can get an injection and your cholesterol will drop by 50 percent for a year.

‘You don’t have to remember to take the statin tablets.’

He explained that the NHS was given a discount on the drug.

‘There was a deal made with the company that made it, called the Medicines Company, that the NHS would get it because the NHS has done a lot of trials and we can get it for a bargain, the cheapest ever,’ he added.

However, patients are unable to get the injections due to lack of cooperation from their GPs, he said.

Inclisiran, also known as Leqvio, is a drug that lowers LDL cholesterol (the “bad” cholesterol). This cholesterol damages the artery walls, leading to the buildup of plaque that can block blood flow and cause a heart attack or stroke.

In contrast, “good” cholesterol, known as HDL, helps remove other forms of cholesterol from your bloodstream. Higher levels of HDL are associated with a lower risk of heart disease.

Inclisiran is known as a small interfering RNA, or siRNA, which works at the genetic level to inhibit the production of PCSK9, a protein involved in regulating LDL. Reducing PCSK9 helps the liver remove more LDL from the blood.

And the need for the drug is clear. Statins — daily pills that lower LDL levels by 30 to 50 percent — have been the gold standard treatment for high cholesterol for decades.

The tablets are offered to anyone who has a greater than ten percent risk of having a heart attack or stroke in the next ten years. More than eight million Britons take the pills.

But research shows that about half of those who take them don’t achieve healthy cholesterol levels. Some stop taking the medication, while others find they can’t take a high enough dose, often due to side effects such as muscle pain.

This medicine is intended to be taken together with statins or other cholesterol-lowering medicines, to ensure that cholesterol levels are sufficiently lowered.

In a bid to increase its use, The Medicines Company, which makes inclisiran and is part of Novartis, earlier this year cut the cost of the injection from around £2,500 to £45.

Inclisiran was approved for high-risk patients in 2021 by the medicines regulator, the National Institute of Health and Care Excellence (NICE), after trials showed it dramatically reduced LDL levels and there were no safety concerns.

According to NICE, there is a clear need for more cholesterol-lowering drugs to reduce the number of heart attacks and strokes the NHS experiences, each accounting for around 100,000 hospital admissions each year in the UK.

But the RCGP and BMA almost immediately issued a joint statement in December last year questioning the decision.

The study data showed that it was not clear to what extent inclisiran reduced the number of heart attacks and strokes.

There were also concerns about ‘as yet unknown long-term side effects’ and the ‘possible additional capacity or resources’ for GPs if they were to prescribe the drug.