It was announced today that NICE will move from a statutory to an advisory role in drug appraisal. Whilst NICE will continue to produce guidelines for doctors on the best treatments for their patients, it will no longer have the power to ban the use of drugs which are considered too expensive. The decision about whether a patient receives a particular treatment will be taken at a local level by GPs.
These changes run in parallel to the move from the PPRS scheme of drug reimbursement, to a value-based pricing model. However the move to value-based pricing does not necessitate this move to more local decision making.
There are benefits as well as severe drawbacks to the move to a local regulation of drug use. This move will allow a greater local management of NHS funds, including the proportional spend on high-end drugs. In addition local decision making will allow a broader and more individual assessment of the value of different medicines, incorporating local societal value as well as patient and economic value.
However the changes may create severe difficulties when implemented. Local decision-making may increase the postcode lottery surrounding which medicines are available. In addition, the need for GPs to make the decision around which drugs should be made available to their patients, may undermine the trust between GP and patient. It may be an extremely difficult decision for a local GP to deny the access to drugs to a patient that they have known and treated for several years, even if they know that the medical and economical arguments are sound.
Whilst we understand the Government’s wish to increase the local influence on healthcare provision this is an issue which needs to be carefully considered so as not to undermine trust, or to further increase the regional disparity between health service provision.