Intended for healthcare professionals


NICE will retain drug approval role in government U turn

BMJ 2011; 342 doi: (Published 20 June 2011) Cite this as: BMJ 2011;342:d3862
  1. Ingrid Torjesen
  1. 1London

GPs in commissioning groups in England will not have to make decisions on whether individual drugs are cost effective and whether they should be available on the NHS, after an apparent U turn by the government on its plans to downgrade the role of the National Institute for Health and Clinical Excellence (NICE) in recommending drugs.

Under the health secretary’s original plans, laid down in the draft Health and Social Care Bill, NICE would still have appraised new products but would no longer make a recommendation as to whether they should be funded by the NHS. Instead the government planned to introduce value based pricing in 2014 and negotiate the price that the NHS pays for drugs on the basis of the evidence on their therapeutic benefits.

Individual GP commissioning consortiums (or clinical commissioning groups as they are now to be called) would have then had to decide whether drugs were sufficiently cost effective to be used and should be funded locally. GPs would have, in effect, then been responsible for rationing treatments, rather than NICE, a prospect that many were unhappy with.

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

Although the role of NICE has been reconsidered, value based pricing will still go ahead. The government’s response to the NHS Future Forum listening exercise, published last week (BMJ 2011; 342:d3777, doi:10.1136/bmj.d3777), states that it will uphold all patient rights in the NHS Constitution, including “the right to drugs and treatments recommended by NICE, which we will retain after the introduction of value-based pricing for new drugs from January 2014.”

The Department of Health for England was unable to provide specific details of how a drug will be evaluated, approved, and priced for the NHS after 2014, saying that final details are still being worked out.

It is also unclear whether NICE will be renamed the National Institute for Health and Care Excellence and re-established as a non-departmental public body rather than a special health authority, as proposed in the draft bill.

Andrew Dillon, NICE’s chief executive, said, “We are pleased to see that NICE will continue to play a key role in helping to ensure that patients receive the best possible care on the NHS.

“We look forward to engaging with clinical commissioning groups and to supporting their work through the use of our guidelines, quality standards, and commissioning guides.”

Laurence Buckman, chairman of the BMA’s General Practitioners Committee, said that central decision making on whether a drug should be available on the NHS was much better than allowing clinical commissioning groups to each make their own decision.

He added, “It means that you will get consistent prescribing across England, and that is important. It means that you will stop the concept that we have been very worried about of internal health tourism, where people travel between consortia in order to get one that will give them what they want.

“This way—and may I say this is my interpretation—all consortia will have to make available medications that NICE recommends, and that must be a good thing.”


Cite this as: BMJ 2011;342:d3862

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