What next for NICE? It will no longer have the power to dictate to the NHS what it can and can’t afford, but is to be reduced to the level of producing guidance only, as doctors take back control of prescribing. Is it a visionary move towards a clinically led service? Or an act of monumental stupidity?
Ever since the Conservative’s manifesto pledge of a cancer drugs fund to pay for treatments that doctors and patients wanted, but that NICE didn’t think were cost effective, the writing has been on the wall. My first inkling that all was not well was the ‘postponement’ of the annual NICE conference. This is my highlight of the NHS calendar, as I’ve chaired it for the last 4 years and got to ask lots of powerful people very impertinent questions. My favourite moment was asking Andrew Lansley to repeat after me: ‘There is, and has to be, rationing in the NHS.’ How we all laughed.
This year, at the National Association of Primary Care conference, Mr Lansley fixed me in his sights and told the story of having to admit to rationing at the NICE conference. He’s now cut NICE back and is making GPs explicitly responsible for all the rationing, which is all my fault for giving him the idea in the first place. Sorry! The point is whether GP consortia, having consulted their local clinically led cancer panel, want to take up the challenge of deciding which drugs and procedures they can afford to purchase for their patients. In many ways, deciding which drugs to fund is a logical extension of commissioning services, and NICE will still be producing its excellent guidance to support GPs. But the buck will well and truly stop with the consortia now. NICE provided a convenient fire-wall for politicians to see off the press pack when a new drug was turned down.
From 1 October, £50 million has been put aside in the cancer fund to take us through to March 2011, with £200 million a year available thereafter.1 What Lansley has done is give doctors back the right to try out a new drug on an individual patient, either before NICE has reached its judgment or after it has decided the drug doesn’t give enough bang for its buck. This is fine up to a point— individuals don’t always respond the way a meta-analysis says they should—but it takes much of the logic and fairness out of the rationing process. And what happens when Mrs Miggins at number 32 gets her cancer drug, but Mrs Smith at 31 doesn’t because the cancer fund runs out? That’s right! You open the curtains to find a Daily Mail reporter on your lawn.
NICE is not perfect. Its measurements and benchmarks are limited and crude, but far better than anything else we have. But it was the best hope we had of making sense of the drugs budget and standing up to the might of big pharma in a way previously not seen. NICE already recommends 75% of cancer drugs;2 pausing for thought over the remaining 25% that offer a few months at a huge cost is no bad thing.
So, it’s over to GP consortia. As well as taking over from SHAs and PCTs; cutting management costs by 45%; saving £20 billion through Quality, Innovation, Productivity, and Prevention; and learning how to procure and commission; we now have to understand value-based pricing and decide which health technology assessments to implement and which to ignore. That’s quite a big reading list. Oh, and don’t forget the patients!
Dr Phil’s books and comedy DVDs can be ordered at: www.drphilhammond.com
- Department of Health website. Cancer drugs fund will provide £200 million a year. www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_120941 (accessed 3 November 2010).
- NICE website. NICE to publish final guidance on topotecan for the treatment of small-cell lung cancer and preliminary recommendations for bevacizumab for metastatic colorectal cancer. Available at: www.nice.org.uk/newsroom/pressreleases/press_releases.jsp?domedia=1&mid=270F36EE-19B9-E0B5-D4ACAB95EAF9B93C. G
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