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Gold, incentives and meh

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)

  • A textbook socialist, he believes that centralised government committee knows best, knows better than any individual at the coalface. You are simply a worker drone for the socialist state diktats.

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  • Doctors are progressively being micro-managed into paralysis.

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  • i genuinely have absolutely no hope that even if they were elected that this marvelous (and clearly not at all living in cloud cukoo land, honest guv) gentleman would be any better that the current marvelous (and not at all living in cloud cukoo land, honest guv) gentleman occupying the health secretary job.

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  • To be fair, on the face of it this does not seem to be a move towards obliging clinicians to prescribe every NICE-recommended treatment.

    Rather, it seems to be a move towards obliging commissioners to ensure availability of every NICE-approved treatment.

    So some of the outrage in the responses here may be misplaced.

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  • I think some of the problem with the TFT issue is that the GPs are so overloaded with firefighting, that an appointment is needed for the GP to have protected time to consider the issue.

    I quite agree that it could all be done on the phone, but the logistics need time. Writing a form takes time, phoning a patient takes time. We need more GPs,looking after fewer problems.

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  • Peter Swinyard

    It may be a side issue - but my hypothyroid colleague needs either to have a serious private word with his GP about their obstructionist system in the practice or change doctors.
    If he/she as a doctor cannot get that practice's system to work for him what chance do the other punters have?
    The doctor-centred practice has no place in the 21st century. We are, like it or not, a consumer industry and should aim for a patient-centred practice - it is much less like hard work to provide an accessible service than to put up barriers

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  • The concept of evidence based medicine and guideline informed clinical practice is too complex a concept for the politicians brain. Guideline directed care as proposed here would be nothing short of catastrophic

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  • I was once proud of nice. It gave us reasonably up to date, evidence based cost effective guidance which can be used as a good base to which I worked from. Now it's become unrealistic, detached from reality and bit even sure about the evidence based approach. Look at the new diabetes guideline for example!

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  • i don't think micro-management will be an incentive for youngdoctors to choose general practice. also if you believe you can manage patients by protocols and guidelines why bother with GPs. Just hire nurse practitioners and medical assistants and get them to follow protocols. very soon you will see why GPs were needed. Let the social experiment begin - it will be fun watching it implode.

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  • Get rid of Drs and use a book with rules in it.
    Really ...we just need to be rid of Drs with their various opinions and individual non standard approaches. What we need are rules...set by groups of 'smart people ' in advance. What the hell do we need Drs for? Get rid of the lot of them! ...we might miss not having someone to blame when things don't go the way the rules say they must...but we'll all be better off in the long run without these incompetent idiots who can't follow rules and moan about what our elected leaders decide is best. More rules...less Drs
    Drs suck

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