Risks facing GPs as NICE loses power on drug scrips

Paul Corrigan on the pressure on GPs to prescribe drugs regardless of cost.

Paul Corrigan: Without the cover of NICE, GPs face high-risk decisions (Photograph: J Heath Lancy)

The coalition government has announced a policy that will impact upon the lives of GP commissioners. Currently NICE decides which drugs are cost effective for the NHS.

Health secretary Andrew Lansley said: 'NICE's role will change. It will focus on advising how best to use treatments and to develop quality standards for the NHS, rather than recommending whether patients should be able to access particular drugs. We want patients to have access to the medicines that their clinicians believe are best for them' (Hansard, 2 November 2010).

GP commissioning will give GPs control of the majority of the funding of NHS services, including medicines budgets, which, currently, is the legal responsibility of PCTs.

Local GP leaders recognise that they can reduce the variability of prescribing but at the moment they make these decisions consequent on NICE making decisions about value for money for the NHS as a whole.

They do this with a formula which judges their cost in relationship to the quality of life years that they provide. The NHS has a great interest in drugs at a price that provides good value outcomes.

Pharma companies
This is also vital for pharmaceutical companies. They need to charge as high a price as possible to recoup their development investment.

In some cases, there is a conflict of interest between the NHS and the company. If NICE does not make these value for money decisions, those GPs in charge of their medicines budget will have to make them.

And this is where two aspects of government policy merge.

GPs are being given the responsibility for managing the NHS commissioning budget including the cost of medicines. It will be their responsibility to ensure that NHS resources are spent within that budget.

GPs are being given the responsibility for the decision about medical and financial cost-effectiveness of drugs. It will be the GP who will suffer the media and personal pressure that is at the moment inflicted on NICE to prescribe drugs regardless of value for money for the NHS.

So without NICE value for money judgments, the choice for GPs is clear. Say yes to high-cost drugs and GPs will bust the budget they have been made responsible for. Or say no to high-cost drugs and be attacked as the organisation responsible for worrying about pharmaceutical value for money.

Without the cover of NICE, GPs taking on the responsibility for commissioning will be doing so at very high risk.

  • Paul Corrigan is a management consultant and former adviser to Tony Blair. More at pauldcorrigan.com

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