Hot on the heels of the suggestion by Professor Sir Michael Rawlins (Chair of NICE) that patient groups should judicially review trusts which fail to provide patients with access to drugs recommended in NICE Technology Appraisals, Sir David Nicholson has now set trusts and clinical commissioning groups (CCGs) a deadline of April 2013 by which to reveal which NICE Technology Appraisals Guidance drugs are included in their formularies. The NHS Chief Executive has also said that he intends to make the publication obligation a standard term in NHS contracts.

A quarter of primary care trusts (PCT) responding to freedom of information requests from GP Magazine last November (19 of 71) admitted to blacklisting NICE-approved drugs. Yet, with a drugs bill rising to around £13 billion over the last few years and the NHS tasked with embracing the “Nicholson efficiency challenge”, PCTs argue that they are necessarily looking for legitimate costs savings, where equally or more effective drugs in the same class are made available to patients, in place of the NICE recommendations.  

A direction to the NHS from the Secretary of State, however, has long made it clear that trusts are required to make NICE-approved treatments available within three months of publication of a Technology Appraisal. Moreover, the NHS Constitution confers on patients the right to drugs and treatments recommended by NICE for use in the NHS, where the treating clinician believes these are appropriate.  

With Sir Steve Field and the Future Forum pushing for increased public awareness of the NHS Constitution and two more Knights of the Realm wading in to the debate, the pressure is clearly on for commissioners to find other ways of cutting their coat according to their much reduced cloth.