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CCG prescribing postcode lottery revealed in new data

The full extent of the postcode lottery in availability of medicines between CCGs has been laid bare in new data published by the Health and Socail Care Information Centre (HSCIC).

The innovation scorecard - published at health minsiters´insistence so that patients can hold CCGs to account - reveals wide variations in availability of NICE-approved medicines across England.

The data, published in the form of an interactive spread-sheet and accompanying report is described as ‘experimental’ by the HSCIC and covers 76 medicines and six medical technologies covered by 102 NICE technology appraisals.

It provides information on:

- estimates of actual use and expected use of medicines

- volumes of medicines (used primarily in primary care) presented as defined daily dose per 100,000 of CCG population

- use of medical technologies in hospital trusts by the planned CCG of residence of the patient

- volumes of medicines (used primarily in secondary care), presented as milligrams of drug purchased or provided by pharmaceutical companies by NHS trust per 100,000 hospital bed days.

Use of varenicline, for example varies between a low of 31% of what would be expected based on population and a high of 249%. For statins, usage in Camden CCG is 68% per cent of expected use compared with 196% in NHS Knowlesley CCG.

In a statement, the HSCIC said: ‘The information released today cannot be used to accurately consider adherence by individual organisations to NICE recommendations. Variation is to be expected between organisations given the different sizes and needs of populations they serve and differing purchasing arrangements. Many NICE recommendations are also one of a number of options for treatment.’

Dr Charles Alessi, interim chair, NHS Clinical Commissioners said the information would be a useful benchmark for CCGs.

He told Practical Commissioning: ‘Within the constraints of local affordability, and their responsibility to appropriately prioritise care to the requirements of their populations this data provides CCGs with useful information to benchmark their use of NICE recommended medicines and treatments.  The HSCIC themselves recognise that this data is experimental but we welcome the opportunity for CCGs to avail themselves of information such as this to enable them to deliver care to a population which is sensitive to their needs and to the finite resources they have at their disposal.’

The Association of the British Pharmaceutical Industry said many more new medicines need to be included in the scorecard in future if it was to become a useful, long-term tool. Stephen Whitehead, ABPI chief executive said: ‘The variations in the use of medicines across England that this report reveals, must spur us in to action so that in years to come patients can access the same medicines, no matter where they live.

’I believe the Government understands the challenges, but it must act quickly and decisively to drive the adoption and diffusion of the newest and most innovative medicines across England.’

When plans to publish the scorecards were announced last year, the then health minister Paul Burstow said: ‘Patients have a right to drugs and treatments that have been approved by NICE.

’This new regime will be a catalyst for change - we are determined to eradicate variation and drive up standards for everyone.

’NHS organisations must make sure the latest NICE-approved treatments are available in their area, and if they are not, then they will now be responsible for explaining why not.

’Being transparent with data like this is the hallmark of a 21st century NHS. It is a fundamental tool to help healthcare professionals improve patient care.’