Darzi review: Right of patients to drugs recommended by NICE is strengthened

BMJ 2008; 337 doi: (Published 01 July 2008) Cite this as: BMJ 2008;337:a660
  1. Rebecca Coombes
  1. 1London

    Patients in England will have a new legal right to drugs approved by the National Institute for Health and Clinical Excellence (NICE) if a doctor says they are clinically appropriate.

    The right, outlined in health minister Ara Darzi’s review of the NHS, applies to drugs and treatments recommended by NICE technology appraisals. The findings of technology appraisals, which advise on whether to use a single drug or treatment and in what circumstances, are already mandatory for primary care trusts within three months of being issued.

    But the new right doesn’t extend to treatments recommended by NICE guidelines, a separate tier of advice from technology appraisals. In 2004, for example, NICE issued guidelines recommending that primary care trusts should offer women three attempts at in vitro fertilisation treatment; last month, however, a survey showed that only nine of England’s 151 trusts were doing so ( The enforcement of such guidelines will remain unchanged under Lord Darzi’s plans.

    NICE will, however, speed up assessments of new drugs so that it will issue the majority of its appraisal guidance on or around the time of a drug’s launch. To achieve this, NICE’s budget is expected to triple to £90m (€115m; $180m) over the next four years. An extra £100m a year will fund the cost of primary care trusts implementing technology appraisals across the board.

    Joe Collier, former editor of the Drug and Therapeutics Bulletin, said that speeded-up appraisals could be a major development for doctors: “If it is the case that all drugs will be looked at at the time of launch and advice given, then that will be a great advantage. You won’t have doctors having to make a decision about a drug without NICE’s decision. It gives greater and earlier clarity.”

    He said it would also avoid “NICE blight,” whereby doctors hold off prescribing a new drug until it has been approved by NICE, a process that can take up to two years in some cases.

    Professor Collier added that patients shouldn’t think they will have a legal right to any drug they wanted. “That would be totally inappropriate. The principle is a non-starter. That will be a decision made by doctors, as it always has been.”

    Lord Darzi’s report also says that patients will be given the right to expect local NHS trusts to decide on funding of other drugs in cases where NICE has yet to issue guidance or where it will not be appraising a drug. If the local primary care trust decides not to fund a drug that a patient and his or her GP think would be right for the patient, the trust will have to explain that decision to them.

    Disputes over “postcode prescribing” have occurred when primary care trusts have been reluctant to fund drugs that have a licence but that are yet to be evaluated by NICE.

    Professor Collier thought that if NICE’s appraisals were speeded up at the rate promised by Lord Darzi, in the future there would be very few examples of licensed drugs awaiting NICE’s deliberations. “That will be a thing of the past,” he said.

    Andrew Dillon, chief executive of NICE, said: “We want NICE guidance to be available to patients and NHS staff as (or shortly after) treatments become available for use in the NHS. We welcome the opportunity to work with the Department of Health on measures for speeding up the process.”

    John Appleby, chief economist at the healthcare think tank the King’s Fund, gave the news a cautious welcome. “Moves to speed up [appraisals] are good news for patients. However, NICE needs to be careful not to sacrifice rigour for speed.”

    And he pointed out that the new right might not end postcode prescribing.

    “An even more important source of variation in access to care arises from differences in the clinical decisions of doctors about who, when, and how to treat. Rates of the most common operation in the NHS—cataracts—can vary more than fourfold across England, for example. The Department of Health and the NHS need to put much more effort into understanding why such variations exist and what needs to be done to ensure more equitable access,” said Professor Appleby.


    Cite this as: BMJ 2008;337:a660

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