Experts warn of drug rationing by GPs under new pricing scheme

BMJ 2010; 341 doi: (Published 02 November 2010) Cite this as: BMJ 2010;341:c6240
  1. Zosia Kmietowicz
  1. 1London

Experts have warned that the new GP consortiums in England will be left with the responsibility of rationing which drugs their patients get when a new system of drug pricing is introduced in 2014.

England’s health secretary, Andrew Lansley, has repeatedly stated his preference for switching to a value based pricing scheme because he believes that it will better reflect the benefit of drugs to patients and reduce the drug bill.

He plans to introduce the scheme, in which the government will negotiate the prices that the NHS pays for drugs according to the therapeutic benefits they bring to patients, in the next three years.

The scheme effectively means that the role of the National Institute for Health and Clinical Excellence (NICE) in ruling on whether drugs should be available to patients on the NHS will be redundant. Instead it will be down to the GP consortiums to decide which treatments they will fund.

In a statement Mr Lansley said that by switching to value based pricing “we will move to an NHS where patients will be confident that where their clinicians believe a particular drug is the right and most effective one for them, then the NHS will be able to provide it for them.”

The impact of the policy was debated in the UK national press at the weekend.

Alan Maynard, professor of health economics at the University of York, said that the future for GPs under the new scheme looked “a little anarchistic and uncertain.”

He said, “The government is quite clear that it wants to give clinical autonomy back to the medical profession. If I were a doctor I would be quite wary of that. In the last 10 years technology appraisals from NICE have proved a very useful way of rationing treatment, but in the future it will be down to GP consortia to take on this role.”

A BMA spokesperson said, “Doctors always want their patients to have the best available care; however, this decision will not make access to high cost drugs any easier. Whether it be NICE or GP led consortia making the decisions, the reality is that the only way to find more money for high cost drugs will be to find savings elsewhere, and this will be difficult in the present climate. It is also likely to lead to a postcode lottery in prescribing and treatment.”

The NHS spends about £11bn (€13bn; $18bn) a year on pharmaceuticals, of which £8bn is on branded drugs. However, Professor Maynard said he did not “share Mr Lansley’s optimism” that the new pricing scheme will reduce the national drugs bill.

The current drug pricing system, the pharmaceutical price regulation system (PPRS), has been operating for 50 years. Under the system the government negotiates with the drug industry every five years and allows companies to set drug prices freely but caps their overall profits.

Professor Maynard said that neither this scheme nor the creation of NICE in 1999 have had an effect on the amount of money the NHS spends on drugs.

Andrew Dillon, chief executive of NICE, has insisted that the institute will continue to have an “important and significant” role in deciding what drugs are used in the NHS when value based pricing is introduced, because its technology appraisals would provide the in-depth analysis of the cost effectiveness of new drugs that the government would need to negotiate on price with the drug industry.

He told the BMJ, “We are confident that the government will want to take advantage of NICE’s expertise and experience as it develops value based pricing.

“The UK led the world in the appraisal of new health technologies when it set up NICE in 1999. It can do the same in 2014 with a new approach to managing the entry of effective new treatments into the NHS, in a way which meets the needs and expectations of patients and which uses the health service’s resources effectively.”


Cite this as: BMJ 2010;341:c6240