NICE is not always popular, but this is because it makes difficult decisions about what can and cannot be afforded in a cash-limited NHS. It uses the latest evidence to set standards and recommend treatments based on efficacy, cost and safety. This should, in theory, end the postcode lottery and mean such decisions are not left to local managers.
However, time and again PCTs choose to ignore NICE and establish local policies, almost always because of cost. Such local policies often interfere with GPs' abilities to provide their patients with the best quality care. If something is recommended by NICE, it should be available to patients regardless of where they live.
GPs accept that they need to be aware of the costs of their actions. In particular, they understand the importance of prescribing cost-effectively. However, they should not be placed in a position where they are expected to put cost ahead of the best interests of the patient in front of them. They must be allowed to make decisions about prescribing - and any other treatment for that matter - based on the individual patient's needs.
If we are reaching a point where financial restrictions are hampering GPs from following best practice, the government needs to step in. Ministers have been quick to act in the past when PCTs blocked high-profile cancer drugs, and last week health secretary Andrew Lansley took steps to reduce waiting times that have been rising in the wake of budget constraints. We need a similar no-nonsense approach here.
It is right for the NHS to be mindful of the drugs bill, but the DoH must put an end to drugs 'blacklists' if they are not supported by clinical evidence and prevent patients accessing the medicines they need.
