How NICE will support GP consortia

NICE is planning to forge new links with GP consortia, its chief executive Sir Andrew Dillon tells Tom Moberly.

NICE: will continue to assess cost-effectiveness of new drugs (Photograph: JH Lancy)
NICE: will continue to assess cost-effectiveness of new drugs (Photograph: JH Lancy)

GP consortia will not be on their own when they assume control of rationing decisions currently taken by NICE, the institute's chief executive says.

In an exclusive interview with GP, Sir Andrew Dillon says NICE will continue to assess drugs' clinical and cost effectiveness and offer advice for consortia to draw on.

Sir Andrew Dillon: 'We want to make it as easy as possible for people to make the right decision for individual patients about new drugs'

Evidence, not politics
Evidence, not politics, will inform the outcomes framework that will judge GP commissioners' success.

The commissioning outcomes framework will be derived from a rigorous assessment of evidence, he says. 'NICE can start with the evidence base for anything that the health service needs to do,' he says.

NICE already assesses all available evidence to produce its clinical guidelines, quality standards and recommendations for QOF indicators.

'We can use the same evidence base for the work we're going to be asked to do to develop indicators for the commissioning outcomes framework,' Sir Andrew says.

NICE will also produce guidance to support GP consortia as they take responsibility for rationing new drugs, he adds.

From 2014, the DoH and pharmaceutical industry will negotiate prices and GP consortia will decide whether to make drugs available locally.

Exactly how GP consortia cope with rationing decisions will depend on the practical details of DoH plans, he says.

'What we want to do is to make it as easy as possible for people to make the right decision for individual patients about new drugs,' he says.

'To do that, we need to very clearly set out the optimal position of new treatments in clinical practice and we hope to carry on doing that.'

New drug assessments
NICE will continue to produce assessments of the clinical and cost-effectiveness of new drugs and express the outcome of the assessments 'in a way that is very clear about the benefits the new treatment brings in relation to current standard practice', he says.

GPs would be able to go to a piece of work completed by NICE, find out all they need in order to make that judgment, and then use their own clinical expertise to decide, he says.

'I'm not so arrogant to assume that simply everything we do will be picked up and applied without question,' he adds.

'That has never been the case.'

Government plans
Sir Andrew does not see the government's plans to move NICE to an advisory role as an enormous change.

He says that 'by and large' the current situation is already one where all new drugs are available on the NHS and clinicians decide what treatment is best for any given patient.

'NICE's guidance on new drugs has been, and remains, guidance,' he says. 'It doesn't override the responsibility that health professionals have in individual cases to make a judgment that is in the best interests of individual patients.'

NICE will also support consortia through tools to assess the local impact of commissioning and rationing decisions. 'We'll do what's useful for commissioners,' he says.

'To make sure that it is useful, we'll carry on doing what we do at the moment, which is to talk to commissioners before we do anything.'

Sir Andrew says NICE has a 'great opportunity' to work with GPs in a much more extensive way. 'There's a real opportunity for NICE to become a really important, helpful, supportive resource for GPs,' he says.

'That's our intention.

'We'd love to be the go-to place for GPs both in their work as health professionals and the job they have to do as commissioners.'

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