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Commissioning dilemma: Your consortium has barred access to new drugs

Your consortium has decided to bar access to a number of new drugs, but you have an interest in these clinical areas and feel the decisions are flawed. Should you accept them? Dr Jo Galvin advises

If it is decided that a new drug(s) should not be available this can create difficulties for general practitioners who are at the interface between the Consortium and the patient.

While it is wise that the doctor seeks advice from their MDO on individual cases it is also important to be aware of the fundamental ethical issues and guidance that should inform how the doctor approaches the situation.

A doctor's first duty is to the patient as outlined in the General Medical Council (GMC) guidance, which states "Make the care of the patient your first concern." However all doctors also have a responsibility to manage resources effectively.

In dealing with such situations it is advisable to consider the following steps:

• Write to the Consortium outlining your concerns about their decision

• Consider doing this collectively if other GPs have similar concerns

• Explain clearly and based on up to date evidence why you have concerns about the decision especially its impact on patient safety

• Ask for a written response to your letter that includes the reasons for their decision and retain a copy for your records

• Ask if there is a procedure for reviewing or appealing the decision.

If the consortium decline to reverse or reconsider their decision and you feel that patient safety is compromised you may wish to consider prescribing the drug, informing the Consortium that you intend to do so and the reasons why. However it would be prudent to discuss this course of action and the potential consequences you may face, with your MDO before doing so.

Dr Jo Galvin is medicolegal adviser at the Medical Protection Society

Dr Jo Galvin