Editorial: NICE guidance essential for decommissioning

This month an Audit Commission report concluded that NICE should help commissioners identify treatments of low clinical value from which funding can be withdrawn.

This week GP reveals exclusively that between 2008/9 and 2010/11 patient funding requests submitted to PCTs increased by a fifth.

In a sign perhaps of the savings that need to be made within the NHS and a rising pressure on PCT funding, successful applications have also fallen by a fifth over the same period.

Individual patient funding requests can be made by GPs or consultants on behalf of patients to apply for funding for treatments PCTs will not routinely cover. PCTs produce lists of treatments and patient groups for which clinicians need to apply for funding in this way.

PCTs are allowed to decide not to fund particular therapies unless a particular treatment has been recommended by a NICE technology appraisal. But the NHS Constitution means that this cannot be a blanket ban and that PCTs have to consider individual cases.

Highlighted in our focus on page 22 are some of the contentious clinical areas which are the subject of such appeals, including bariatric surgery, fertility and wet age-related macular degeneration treatments.

The Royal National Institute of Blind People says patients face problems when no NICE guidance has been developed for an area, such as for the treatment of cataracts.

NICE maintains that it has raised the prominence of its 'recommendations that direct the NHS away from less effective practice'.

Hertfordshire GP Professor David Haslam, chairman of the National Obesity Forum, is correct to point out that GP consortia will have their work cut out if they are to improve on the uncomfortable decisions PCTs are increasingly having to make.

As the Audit Commission report claims, getting it right could save up to £500 million a year, freeing up funding for more clinically effective treatments.

Evidence-backed NICE guidance will therefore be essential for consortia taking on both decommissioning and rationing work from PCTs.

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