There can be few allegations that NHS commissioning managers dread as much as “the postcode lottery” – the charge that patients in some areas are being denied drugs and treatments available in others. Although this concern was one of the reasons behind the establishment of NICE, over the years the backlog of drugs licensed, but still awaiting NICE’s attention, has increased. Secretary of State for Health, Alan Johnson, has declared that “we can speed up the NICE process” and that is indeed one of the Darzi report’s conclusions.
But there will always be new, unapproved treatments – and patients and clinicians keen to use them – however short the approval time. The thinking behind the newly established Primary Care Commissioning Network is that it will pool PCTs’ expertise to assist them in reaching difficult decisions on prioritising drugs and treatments, in advance of the publication of NICE guidance. After all, HSC 1999/176 has long made it clear that it is not acceptable to cite a lack of NICE guidance as a reason for not providing treatment. If challenged, a PCT must be able to demonstrate that it has taken all the relevant cost and clinical-effectiveness data rigorously into account.
It is anticipated that individual PCTs will put forward areas of expertise where they would be happy to assess new drugs and treatments. Once the evaluations have taken place, the consequent recommendations will be disseminated to all PCTs. Whether or not this leads to greater consistency nationwide remains to be seen, however, as there is no obligation on PCTs to accept the recommendations. Having seen NICE, a large and robust organisation, on the receiving end of high-octane fury for some of its decisions, it will be a bold PCT that will be prepared to break away from a widely publicised recommendation.