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At the heart of general practice since 1960

In with the new... and out with general practice?

New, as everyone knows, is always good. This is especially true of drugs, which are best when they are absolutely brand new, and ideally not even licensed.

By Richard Hoey

New, as everyone knows, is always good. This is especially true of drugs, which are best when they are absolutely brand new, and ideally not even licensed.



That at least appears be Lord Darzi's driving philosophy as he reshapes NICE, with a series of recommendations all focusing on faster identification and review of new products, with the aim of getting many more of them into mainstream use in the NHS.

It's hard to argue with quickness and newness, especially when allied to compassion, in the form of recent proposals for NICE to change the way it assesses products for terminally ill patients, again in order to approve more for NHS use.

But now the really tricky part: even though all this appears to come with an inevitable price tag, the Government has refused point blank to say where the money will come from.

The NHS Confederation is among those bodies that are worried about this. Its response to the proposals on end-of-life treatments warned the costs could be ‘significant' for PCTs and that more cost-effective treatments that have not been approved by NICE may end up missing out.

It is talking about standard treatments that may have been around for a long time and that NICE is never going to get round to looking at. In other words, it is talking about primary care.

The same will be true, only more so, if NICE focuses ever more of its limited resources on evaluating specialist new drugs that may only benefit small numbers of patients.

There is no easy answer to this. GPs would be the first to argue that their patients should have access to the best treatments available, but also the first to realise that a sensible approach to rationing is essential whenever resources are limited.

GPs treat cardiovascular disease and rheumatoid arthritis and asthma and diabetes and a host of other illnesses besides, and it is patently obvious that not every single one can get the very best all at the same time.

But that rounded view is precisely what NICE lacks. An analysis of the institute by GP Dr Simon Bradley, which Pulse will be publishing soon, found a miserly general practice representation. Just one member of NICE's board of 14 is a current GP.

Until NICE properly listens to the views of GPs, there will be concern that in its rush to approve shiny new medicines, boring old general practice will be left behind.

By Richard Hoey, Pulse deputy editor

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