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Report lays out strategy to end “postcode prescribing”

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7241.1027/a (Published 15 April 2000) Cite this as: BMJ 2000;320:1027
  1. Jacqui Wise
  1. London

    Expensive drugs should not be available on the NHS until their clinical effectiveness and cost effectiveness have beenevaluated by the National Institute for Clinical Excellence (NICE), a new report concludes.

    A working party report from the Royal College of Physicians, The Prescribing of Costly Medicines, says that once a newmedicine has fulfilled all the criteria for purchase by the NHS then it should become available everywhere. This should put an end to “postcode prescribing,” whereby expensive treatments such as interferon beta are available in some health authorities and not in others.

    The report calls for a probationary period, during which some new medicines would not be available on the NHS, while the institute evaluates the evidence. In some instances the institute would need to commission research in clinical settings that resembled how the medicine would be used in practice. During this time, promotional activity for the medicine should be limited by voluntary agreement.

    Professor Peter Baylis, chairman of the working party, said that expanding the role of the institute is a major plank of the report, but, he added, “There also needs to be debate at a national level about what the nation can and cannot afford—for example, a national forum with contributions from professionals and the public. In the past there has been rationing, but it has been in a covert way and not explicit.”

    Professor Baylis, who is dean of the faculty of medicine at Newcastle University, said that even with the recent welcome injection of new funds into the NHS more money is still needed in the system to fund expensive drugs and technologies.The United Kingdom spends much less per person on drugs than the United States and many other European countries.

    The report also calls on health authorities and primary care groups to set up area prescribing committees which would advise on the best local use of medicines within the constraints imposed by the institute.

    The Prescribing of Costly Medicines is available from the RCP Publications Department (tel 020 7935 1174, ext 358), price £25.

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