Viewpoint - Reforming NICE will help GP consortia

Dr Rubin Minhas says that value-based drug pricing and a changed role for NICE will thaw relations with GPs.

The government is moving to value-based pricing of prescriptions (Photograph: SPL)
The government is moving to value-based pricing of prescriptions (Photograph: SPL)

The government's announcement in last year's White Paper that it will move to a system of value-based pricing of prescription medicine for England by 2014 is an important development in the relationship between GPs and NICE.

At best, the relationship has been chilly. Neither side has made particular efforts to court the other. But in the spirit of 'you'll miss me when I'm gone' GPs are waking up to the vital role that NICE has played over the past decade.

Collective epiphany
In fact, there seems to have been a collective epiphany among representatives of GP organisations as they belatedly realise how much they owe to NICE. For those like myself who have been undertaking appraisals for NICE during the past 10 years, this is surprising though welcome.

NICE has been under constant attack ever since it was created in 1999. In recent years, the organisation has gained a better understanding of the risks it faces. Through the bitter experience of multiple judicial reviews, it has been able to quantify them too.

But the White Paper proposals to change NICE's role was a surprise to many, including NICE itself. But, after all, times change and by 2014 NICE will no longer be able to ban the use of new medicines in the NHS.

Back in 2007, the Office of Fair Trading recommended that NICE should move toward a system of value-based pricing. Under this NICE would still carry out its new drugs assessments but would stop short of making 'yes', 'no' or qualified 'yes/no' recommendations.

Instead a new body would estimate the price the NHS should pay for new drugs.

This would remove much of the heated argument that surrounds NICE's decisions as the onus would be on drug companies to make medications available at affordable prices.

Nobody yet knows exactly what the new system will look like, but we can be fairly sure that it will only look at new drugs and will not be retrospective.

Dr Rubin Minhas: 'There has been a collective epiphany among GP organisations as they realise how much
they owe to NICE'

Public consultation
One possibility is that after the DoH has examined the response to the public consultation, NICE may retain a role in price setting as well as undertaking the value-based assessment. (This responsibility is unlikely to be delegated to GP consortia as they lack the required skills.)

And another major change could be an end to the quality-adjusted life years threshold as higher prices are set for less cost-effective drugs, which today would be rejected.

This would have some advantage for individual patients.

Access to new drugs would become possible where it previously was not, and undergoing a value-based assessment could encourage more competitive pricing by drug companies.

Against this, GP consortia would be likely to pick up the bill, though this could be a driver of more efficient use of the £10 billion a year NHS drugs budget.

Claims that these reforms will lead to patients protesting outside GP surgeries should be taken with a large pinch of salt as it is likely to be the consortium rather than individual GPs making the funding decisions.

Similarly far-fetched are claims that GPs and consultants would be driven into opposing camps over the issue of which drugs are permitted - closer co-operation between the two is the more likely outcome.

Despite the protests, GPs have many reasons to celebrate these proposals.

Almost uniquely among the arm's-length bodies, NICE's valuable contribution has been recognised and it will be updated to enable it to continue making its valuable contribution. Where NICE has not always been able to find traction among PCTs, the coalition government is sweeping away the NHS's sprawling and inefficient bureaucracy to put doctors and patients centre stage.

Reforms aimed at improving access to drugs for patients are an important part of this equation. Along with details of the forthcoming information revolution, GPs should look forward to further information about transforming NICE with optimism, while patients can expect a more personalised level of care that the NHS in its present form struggles to deliver.

  • Dr Minhas is a GP in Kent and clinical director of the BMJ Evidence Centre

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