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At the heart of general practice since 1960

GPwSI policy 'could waste NHS money'

NICE is to crack down on drugs that do not offer value for money in an effort to bring the spiralling drugs bill under control.

Chief executive Andrew Dillon says NICE guidance has been associated with increased costs and is calling for a 'more balanced agenda', with an increased focus on

areas of potential savings.

NICE is consulting with PCTs and NHS advisers to identify potential candidates for exclusion from normal practice ahead of the next wave of appraisals, due to be announced this spring.

But prescribing experts struggled to identify many

areas where changes could be made and warned the moves could lead to 'bullying'.

Mr Dillon told Pulse: 'We would like a more balanced agenda. We have not had many cases where there was a prima facia case for disinvestment.'

He said he wanted to know where money was being 'wasted' so NICE could 'tease out that outdated practice'.

Professor Alan Maynard, professor of health economics at the University of York and an adviser during the inception of NICE, said it had had a severe 'inflationary impact' on the NHS because it had concentrated on reviewing new and expensive drugs. He said: 'I have argued for several years that it should be self-financing new drugs by taking others out ­ one in, one out.'

Professor Maynard admitted NICE would face a challenge in getting clinicians to change practices they felt were beneficial to patients. But he added: 'If GPs want to ignore the evidence base they will be wasting resources and treating patients badly.'

Dr Peter Fellows, GPC prescribing sub-committee chair, said GPs must retain prescribing independence and added: 'Education is what matters, not bullying. As a former member of the drugs blacklist committee I know just how difficult it is to decide whether something has therapeutic value.'

GPs said many older drugs were effective but had only a limited evidence base. 'NICE is going to have a problem if it looks at older drugs,' said Dr Thomas Poyner, a GP in Stockton-on-Tees. 'Who is going to fund research to prove they're cost-effective?'

Areas experts

believe could come

under scrutiny

from NICE

Asthma

·Antihistamines

·Sodium cromoglycate in children

·Nebulisers for reliever medication

Cancer

·Food supplement drinks such as Ensure

Diabetes

·Some sulphonylureas

Hypertension

·The less cost-effective ?-blockers and ACE inhibitors

By Cato Pedder

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