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Labour to 'toughen rules' on following NICE guidelines as part of 'wide-ranging review'

Exclusive Labour will implement a ‘wide-ranging’ review of NICE guidance, including a potential requirement for commissioners to report and explain any departures from NICE guidance.

A spokesperson for shadow health secretary Andy Burnham told Pulse that the party is considering ‘tougher rules’ on implementing NICE guidance.

Mr Burnham has previously hinted he wants NICE guidance to have ‘more clout’, arguing that ‘if [NICE] says something is worth doing, then it should be done everywhere’.

GP leaders have said that tougher rules would mean that NICE would have to consider costs ‘much more carefully’ if they were to work.

The move follows ongoing concerns around commissioners restricting access to NICE-recommended treatments in order to keep within budgets, while there has been increasing criticism from GPs that NICE guidelines are becoming detached from general practice.

A spokesperson for Mr Burnham told Pulse: ‘We are committed to setting up a wide-ranging review of NICE which will look at reforming the NICE technology appraisal process and setting tougher rules on implementing NICE guidance.’

‘Specifically the review will look at whether there should be a more robust approach to implementation of NICE guidance and appraisals, and if should there be a requirement on commissioners to report and explain any departure from NICE guidelines.’

However, GP leaders warned NICE would have to consider the cost implications of its guidelines for use in general practice if there was any mandatory requirement to follow NICE advice, and retain enough flexibility for GPs to use their own judgement where needed.

It follows a series of draft recommendations from NICE that have been criticised by GPs, with guidelines on diabetes called a ‘laughing stock’, proposals for antibiotic prescribing reports branded ‘pointless’ and announcements around asthma guidelines labelled potentially ‘dangerous’.

NICE has also come under fire from GP leaders over recent guidelines on lipid modification partly because of the significant workload burden recommendations to expand statin use will place on GPs, while Pulse revealed two-thirds of GPs were tending not to follow the new lipid guidelines recommending statin use at the lower, 10-year risk threshold of 10% because of doubts about the drugs’ safety in lower risk patients.

Dr Richard Vautrey, GPC deputy chair, said: ‘We have had concerns about postcode access to services and that is unacceptable. Having said that it is very difficult for many parts of the country to afford everything NICE recommends, so NICE would have to look at much more carefully [at the costs] when they make recommendations.

‘They would have to have a much better feel for whether something was fully fundable and that would include the impact on general practice, because one of the concerns we had have had consistently is [that] much of the NICE guidance does not take into account the workload pressures on general practice.’   

Dr Vautrey added that GPs have to be given the freedom to exercise their professional judgement in individual cases rather than stick to guidelines.

He said: ‘The chair of NICE has often said that NICE produce guidelines not tramlines, and we have to allow clinicians to use their professional judgement to step outside guidelines when it is appropriate and in the best interest of patients.’

Commissioning leads agreed NICE would have to take the wider financial implications of its recommendations into account if guidelines were to become more rigid.

Dr Steve Kell, co-chair of NHS Clinical Commissioners, said: ‘NICE guidance plays an important role in quality improvement for CCGs. However it is important that NICE take account of financial pressures in the wider system, and move beyond advising in isolation on disease specific areas.   

‘Mandatory NICE Guidance would have a significant cost implication for the NHS and politicians considering this must first ensure the additional funding for this was available.  It would certainly not be covered by any spending commitments made so far.’

A NICE spokesperson said: ‘Public sector organisations do not comment on party manifestos’.

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  • Andy Burnham - online

Readers' comments (26)

  • NICE guidelines......the clue is in the word "guideline" you fool.
    Humans are not robots and do not always respond like homogenous machines.
    Does Burnham knock on the door of the cockpit while flying on holiday to give his advice to the Pilot?
    While this man does not seem a "thug" like Hunt, he really should leave matters that he does not understand to those who do.

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  • And of course NICE never get it wrong and patients only have one illness at a time. Micromanagment is destroying UK General Practice. Even in my mid 50s I am thinking Canada is a better option.

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  • "unconscious incompetence" is when Politicians don't understand that they don't understand.....

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  • Bankers or terrorists get transient and intermittent media attacks but GPs have been getting sustained and obsessional attacks from the media (especially THE DAILY NUTTER) for years and to be honest we have all finally had enough of it.

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  • We forget the effect this constant micromanagement and dictatorial inflexibility has on patients.
    I happen to be hypothyroid. Have been for 20 years, really no big deal!
    Had a blood test in December...TSH a bit high. Receptionists refused to give me result as " doctor needs to speak to you" needless to say it took 10 phone calls and two letters for me to get the result and agree to repeat test in 6-8 weeks.
    Now received a demand to attend for a medication review. Phoned to explain I needed repeat blood test first, told I could not do this without a form and had to see doctor to get the form. Explained this is crazy and a waste of her time. Eventually made blood test for 3 weeks time ( first available) Tried to book appt with doctor the following week but can't as too far in advance! Told I can phone for the results after a week.
    So, I can make an appointment with the doctor to get a form, but not to discuss the results.
    Rules rules rules rules...... Totally without any logic or flexibility for the patient. ( I happen to have been a fellow GP trainer in the adjacent practice)
    Result... In 2 months, 11 phone calls, 3 letters, several text messages and no resolution to the issue.
    Surely these stupid rules are making work for everyone including the patient.

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  • Samuel Lewis

    rules ? whose rules ? NICE is simply trying to identify cost-effective guidance.

    I commiserate with the anonymous hypothyroid doc above, but NICE never promulgated these 'defensive' rules - his GP did !

    QOF wants an annual TFT and medication review..

    so why doesn't the practice setup up phone clinics ?

    I find ringing patients direct with abnormalities, and agreeing to up the thyroxine there and then earns my QOF milk and saves a shedload of 'churning it into butter'. If there's no answer, the a message 'Tell patient result, and collect increased script'. a requirement to see the doctor is a sign of his misplaced anxiety, and counterproductive effort to reduce his workload pressure..

    GPs do need to get a grip - they actually DO have control of their practice.

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  • love's labour lost......just when you thought they may have more sense!

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  • Re Samuel
    Thank you for your commiserations!
    Actually, this is not bout QOF but NICE guidelines. There is some overlap between the two but they are different.
    The issue is that practices create rules to prevent patients slipping through the net. For QoF the carrot is payment, for what is proposed above it will be peer review and public shaming. Personally I think the above insistence that doctors apply NICE guidance and therefore pressurise patients to abide by the rules without flexibility is more dangerous than QoF. AT&T he end of the day a practice can choose to forego a small QoF payment, but public shaming is altogether a different matter.

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  • He'd have to change the name as this would no longer be guidance. NICE is too slow and cumbersome to respond adequately to new information that might put patients at risk were clinicians forced to adhere to current edicts.

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  • Do labour actually expect to winthis election.What a bunch of non entities(I would include alll parties in that at the moment.This countries going down the pan rapidly.Panic(sadly I wont be able to leave)

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