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NICE to retain rationing role

The Government has pledged that NICE will keep its rationing role and that the NHS will have a legal responsibility to fund the drugs and treatments it approves.

The U-turn was welcomed by the GPC, who had warned health secretary Andrew Lansley's previous proposal – to strip NICE of its power to make a legally binding recommendation on the drugs it approves, and instead delegate the role to individual GP consortia – would lead to postcode lotteries in care.

In its response to the NHS Future Forum report, published this week, ministers backtracked on previous proposals, and promised to ensure ‘that patients will continue to have the legal right to drugs and treatments that have been recommended by NICE beyond 2014 and the introduction of value-based pricing'.

Value-based pricing will still be introduced in 2014, as a replacement for the current system of appraising drugs and treatments for use in the NHS, the quality-adjusted life year (QALY).

But crucially under the move to a new system of pricing drugs, NICE's role was due to be amended so that it would no longer be able make recommendations on which drugs were cost-effective for use in the NHS, and its role was to be downgraded to purely advisory.

However the Government's response to the NHS Future Forum report pledged to keep the current ‘funding direction' in place – meaning all NHS commissioners will be legally required to fund NICE-approved drugs.

‘Through a funding direction, we currently require NHS commissioners in England to fund drugs and treatments in line with NICE's recommendations. We have committed to maintain this funding direction until January 2014, when we plan to introduce a system of value-based pricing for new drugs,' its response said.

‘A key aim of value-based pricing will be to ensure that NHS patients have consistently good access to effective, clinically appropriate drugs – which the current funding direction is also designed to achieve.'

‘We therefore intend to maintain the effect of the funding direction in the new value-based pricing arrangements to ensure that the NHS in England consistently funds medicines with a value-based price. The NHS will be required to fund drugs already recommended by NICE, as well as drug treatments subject to the value-based pricing regime. This means patients will continue to have the legal right to clinically appropriate, cost-effective drugs and treatments.'

NICE had previously warned demoting it to an advisory role would mean that ‘local judgments about affordability and priorities will prevail', while health economists had also warned that would inevitably lead to inequalities in healthcare.

NICE chairman Sir Michael Rawlins said: ‘GPs wanted our role retained because otherwise each commissioning group and GP would have to decide whether or not to provide any given treatment.'

GP leaders said the climbdown showed one of GPs' major concerns had been heeded. GPC chair Dr Laurence Buckman: ‘On the face of it we are very pleased. It should halt one of our major concerns – that there would be internal medical tourism as patients seek out commissioning groups that are offering drugs that their local one isn't.'


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