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NICE forces guidelines into quality talks

GPs face having to manage seriously ill Alzheimer's patients with almost no options for treatment or referral, after NICE provisionally ruled out the use of the only available drugs.

The decision will put practices under further pressure and restrict the best quality care to private patients, GPs warned.

A NICE draft technology appraisal recommended NHS doctors should not prescribe donepezil, rivastigmine or galantamine to new patients because they were not cost-

effective. But it admitted there was good evidence the drugs provided clinical benefit.

Should it ratify the decision in its final guidance in May it would be the first time NICE had ruled out drugs it had previously recommended. The move will be seen as the clearest example yet of NHS rationing.

Dementia experts condemned the move.

Dr Steve Iliffe, a north London GP and member of the NICE guidelines on dementia care development group, said it would 'set back dementia services by a dec-ade'. He said PCTs would pressure doctors to stop prescribing the drugs and warned that concomitant secondary care services such as memory clinics would be cut.

'Because we are on the frontline we are going to feel that first,' he said.

The Royal College of Psychiatrists said the drugs were not a cure but brought 'substantial benefit' to patients.

Dr Joe Neary, a GP in Portsmouth with a special interest in elderly people, said GPs would 'struggle' with the loss of the treatment or referral option, but 'that is no reason to offer a drug that is no better than placebo'.

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