The lack of a mandate for clinical commissioning groups (CCGs) to fund treatments yet to be appraised by NICE and duplication of local decision making will worsen inequality in drug access, according to Paul McManus, pharmacist and clinical advisor to the NHS Yorkshire.
GP leaders warned present inequality in access under PCTs could worsen unless CCGs work together on funding decisions.
CCGs will design local formularies and make specific drug funding decisions from April 2013, subject to passage of the Health Bill through parliament. This will include access to newer agents, such as those incentivised through the government's cancer drugs fund, on which NICE has yet to publish a verdict or has not recommended as cost effective.
Speaking at a seminar on the future of NICE in London last month, Mr McManus said handing decision making to CCGs, coupled to plans for value-based pricing of drugs, could lead to increasing duplication of local decision making.
He said: 'Increasingly, we’ve seen local health economies fill the gap left where NICE hasn’t carried out an appraisal or is in the process of an appraisal, with local organisations working together on local decision making processes and setting up regional groups, for example.'
He continued: 'I’m concerned that the proposals for value-based pricing that we’ve seen so far, and bearing in mind that there’s more information to come, will lead to a need for more local decision-making and greater inconsistency in access.'
Mr McManus said he was in favour of developing existing processes for evaluating drug cost-effectiveness by NICE, rather than negotiating prices based on value.
Commissioning GPs should be given greater input into the NICE process, he added.
Commenting on the problems around drug access variations, GPC deputy chairman Dr Richard Vautrey said: 'This is already the case for PCTs and leads to variation between PCTs and duplication in decision making.
'However, with more CCGs than PCTs this process is likely to increase risk of variation and duplication unless CCGs can develop good ways of working together.'
NICE recently announced it will publish a best-practice guide to developing local formularies for PCTs and CCGs later in the year.
It followed a DH innovation report that said local formularies often excluded certain technology appraisals or challenged their conclusions, creating a barrier to use of clinically and cost-effective drugs.
An NHS panel recently ruled that cataract surgery, knee replacement and other 'low clinical value' treatments must only be restricted on the basis of strict evidence-based criteria. It said blanket bans should be abandoned.
Last year, GP revealed that most PCTs now have lists restricting 'non-urgent' or 'low clinical value' treatments, such as knee replacement and cataract and bariatric surgery.