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GPs who prescribe drugs that have not been deemed cost-effective by NICE will be 'held accountable', a health minister has warned.

Clinical governance procedures will be used to ensure GPs who depart from NICE advice are forced to justify their decisions, John Hutton told Parliament.

GPs reacted with anger and medical defence bodies branded it 'heavy handed'.

Mr Hutton said GPs must take 'due account of NICE's advice and the strength of evidence which lies behind it'. He added: 'They may depart from the advice if the circumstances of the individual patient justify doing so. But they will be held accountable.'

Dr Brian Crichton, a GP in Solihull and honorary lecturer in therapeutics and pharmacology at the University of Warwick, said GPs should ignore Mr Hutton's 'sabre-rattling' and make their own decisions. Much NICE guidance was out of date and 'out of kilter with good prescribing'.

GPC prescribing chair Dr Peter Fellows said: 'We're not obliged to follow NICE. The Government would like to think NICE guidance is accepted as the last word, but it isn't always as well regarded as they may think.'

But Dr Fellows, a GP in Lydney, Gloucestershire, warned that the very existence of NICE limited GPs' clinical freedom, and any conscious decision to defy NICE advice could 'rebound medicolegally'.

Dr Gerard Panting, head of policy at the Medical Protection Society, said Mr Hutton's comments were 'very heavy'.

He added: ' The annual appraisal and clinical governance agenda implies much more monitoring of how GPs operate. An awful lot of people do feel their hands are being tied.'

The department could give no further detail of how it planned to detect GPs prescribing outside NICE recommendations. But earlier this year NICE said it had asked the Healthcare Commission and Health Inspectorate Wales to force better GP compliance via PCO league table rankings.

A recent study in the BMJ suggested many GPs could fall foul of Mr Hutton's directive. It found 88 per cent of scripts for orlistat did not meet NICE requirements.

By Rob Finch

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