Post by kickingfrog on May 3, 2011 12:53:59 GMT
Do primary care trusts really deny patients the medicines they need?
Wed, 27/04/2011 - 13:35
Royal Pharmaceutical Society of Great Britain
PJ Online Library
By Duncan Petty and Sue Carter
According to some recent articles in the media, including Pulse and The Daily Telegraph of 13 April 2011, primary care trusts are alleged to be “banning”, “blacklisting” and “preventing” GPs from prescribing drugs.
In these articles a number of concepts about rational use of medicines have been muddled and confused in the pursuit of another NHS scandal. ....
NHS managers, pharmaceutical advisers and clinicians need to balance a number of issues, outlined in the NHS Constitution, when making decisions about the use of NHS resources.
On the one hand “NHS services must reflect the needs and preferences of patients, their families and their carers” (principle 4) while also recognising that “the NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources” (principle 6).
This means that although some clinicians and patients may want a treatment, that “want” is not necessarily the same as a “need”, and the local NHS is not obliged to make it available, the exception being drugs specifically approved by technology appraisal guidance (TAG) from the National Institute for Health and Clinical Excellence.
It is important that a clinically led, transparent and rational process is followed when making funding and commissioning decisions that also follows a proper consideration of the evidence.
PCTs follow a framework for local decision making outlined by the National Prescribing Centre, and the reasons for local decisions must be made available to the public.
However, in primary care, decisions about what to prescribe for an individual ultimately rest with GPs,
whose national contract requires them to
prescribe whatever they believe a patient clinically needs, within available resources.
The Pulse article “GPs banned from using NICE-approved drugs” claims that half of PCTs have brought in “blacklists” of drugs that will not be funded by the NHS.
The idea that PCTs can “ban” or “blacklist” drugs from being prescribed on the NHS is nonsense. PCTs do not have this power.
Only the Secretary State for Health has the power formally to blacklist a licensed product (part XVIIIA of the Drug Tariff), ...
The concept that PCTs are banning the prescribing of NICE-approved drugs may have resulted from a misunderstanding of the difference between technology appraisal guidance and a clinical guideline.
If NICE has approved a drug through TAG, PCTs must provide funds for it to be prescribed as per that TAG, but not necessarily for uses of that drug which that TAG does not cover.
If a drug has only been recommended under a NICE clinical guideline then PCTs are not legally obliged to provide funding for the recommended drugs.
Never is it more important to distinguish between the words “guidance” and “guideline”.
Many PCTs will be making recommendations to GPs to rationalise prescribing in line with the national Quality, Innovation, Productivity and Prevention (QIPP) agenda.
....
Safeguard
It is incumbent on PCTs, new GP consortia and everyone in the NHS to safeguard taxpayers’ money by finding ways to improve safety, effectiveness and productivity without compromising patient care.
....
But the QIPP recommendations are not mandatory: it is for local PCTs and clinicians to decide which apply locally.
....
...the key point to make here is that the right of the GP to prescribe what the patient clinically needs is paramount.
www.pjonline.com/news/do_primary_care_trusts_really_deny_patients_the_medicines_they_need
Wed, 27/04/2011 - 13:35
Royal Pharmaceutical Society of Great Britain
PJ Online Library
By Duncan Petty and Sue Carter
According to some recent articles in the media, including Pulse and The Daily Telegraph of 13 April 2011, primary care trusts are alleged to be “banning”, “blacklisting” and “preventing” GPs from prescribing drugs.
In these articles a number of concepts about rational use of medicines have been muddled and confused in the pursuit of another NHS scandal. ....
NHS managers, pharmaceutical advisers and clinicians need to balance a number of issues, outlined in the NHS Constitution, when making decisions about the use of NHS resources.
On the one hand “NHS services must reflect the needs and preferences of patients, their families and their carers” (principle 4) while also recognising that “the NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources” (principle 6).
This means that although some clinicians and patients may want a treatment, that “want” is not necessarily the same as a “need”, and the local NHS is not obliged to make it available, the exception being drugs specifically approved by technology appraisal guidance (TAG) from the National Institute for Health and Clinical Excellence.
It is important that a clinically led, transparent and rational process is followed when making funding and commissioning decisions that also follows a proper consideration of the evidence.
PCTs follow a framework for local decision making outlined by the National Prescribing Centre, and the reasons for local decisions must be made available to the public.
However, in primary care, decisions about what to prescribe for an individual ultimately rest with GPs,
whose national contract requires them to
prescribe whatever they believe a patient clinically needs, within available resources.
The Pulse article “GPs banned from using NICE-approved drugs” claims that half of PCTs have brought in “blacklists” of drugs that will not be funded by the NHS.
The idea that PCTs can “ban” or “blacklist” drugs from being prescribed on the NHS is nonsense. PCTs do not have this power.
Only the Secretary State for Health has the power formally to blacklist a licensed product (part XVIIIA of the Drug Tariff), ...
The concept that PCTs are banning the prescribing of NICE-approved drugs may have resulted from a misunderstanding of the difference between technology appraisal guidance and a clinical guideline.
If NICE has approved a drug through TAG, PCTs must provide funds for it to be prescribed as per that TAG, but not necessarily for uses of that drug which that TAG does not cover.
If a drug has only been recommended under a NICE clinical guideline then PCTs are not legally obliged to provide funding for the recommended drugs.
Never is it more important to distinguish between the words “guidance” and “guideline”.
Many PCTs will be making recommendations to GPs to rationalise prescribing in line with the national Quality, Innovation, Productivity and Prevention (QIPP) agenda.
....
Safeguard
It is incumbent on PCTs, new GP consortia and everyone in the NHS to safeguard taxpayers’ money by finding ways to improve safety, effectiveness and productivity without compromising patient care.
....
But the QIPP recommendations are not mandatory: it is for local PCTs and clinicians to decide which apply locally.
....
...the key point to make here is that the right of the GP to prescribe what the patient clinically needs is paramount.
www.pjonline.com/news/do_primary_care_trusts_really_deny_patients_the_medicines_they_need