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NICE plans crackdown as GPs ignore its guidance

A NICE demand to link GP quality pay and PCT star ratings to compliance with its guidance has been condemned by GPs as a nail in the coffin of independent practice.

Reports released by NICE last week showed that, despite success in some areas, its guidance had had 'little discernible impact on medicines in primary care' with any changes in practice only 'transient'.

Of drugs used in primary care, Cox-2 inhibitors for arthritis and nicotine replacement therapy for smoking

cessation were singled out

by NICE as being under-used.

Now, in a bid to improve compliance, NICE wants its guidance 'used as the basis for quality-related incentive payments' – including the quality and outcomes framework.

And it said the Healthcare Commission in England and Health Inspectorate Wales would factor the extent of compliance into their PCT league table rankings, acting as a 'crucially important stimulus to implementation'.

NICE also warned it had set aside cash to fund a database collating evidence on compliance with guidance.

It also planned to make

this data available to the public.

But GPs are worried that patient care will suffer if they are forced to implement guidance based on 'rationing' rather than using their clinical judgment.

Bristol GP Dr Tim Mitchell said the idea was 'very worrying' and would impact 'terribly' on patient care. 'Lots of people don't agree with NICE guidance,' he said. 'I can only see the problems being magnified. It will mark the end of independent practice.'

Dr Peter Stott, a GP in Tadworth, Surrey, said: 'The implementation of the quality and outcomes framework and freedom of information will allow you to star-rate individual practices.

'If that is going to be based on the implementation of NICE guidance it will have a huge impact on primary care.'

NICE chief executive Andrew Dillon told Pulse: 'We would like NICE guidance where relevant in clinical areas to be used as a reference.'

NICE has promised 'more active consultation with NHS staff' in drawing up guidance.

By Cato Pedder

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