When the initial programme for the National Institute for Clinical Excellence was first announced, we observed that the main emphasis was to be on drug treatments (PJ, August 14, p223): over half of the new technologies to be appraised for their clinical and cost effectiveness were pharmaceuticals of one sort or another. Under the circumstances, we would have expected to see a good level of pharmaceutical representation on the NICE's key technology appraisal committee. This will be the committee which will advise the board of the institute on “the use within the NHS of any new or established health technology in relation to its clinical and cost effectiveness taking into account the interests of the service as a whole”. In the event (see p512) the committee is to have one pharmacist member (Dr Diane Ketley from Leicester Royal infirmary). But while primary care medicine is represented, there is no representation from pharmacy at the primary care level. It remains to be seen whether the committee will feel that that is a gap to be filled; that those at the interface between the patients and the treatments they receive can have a worthwhile input into the decision making process, particularly one that is required to take into account “the interests of the service as a whole”. As things stand, there seems to be a surfeit of academics on the committee. No doubt the appraisal process will evolve and refinements will be made from time to time.
However, the degree of pharmacist involvement in the process is not confined to the appraisal committee. The committee will need to have before it detailed evaluations of the treatments under review. Given pharmacists' abilities to distill and evaluate information of the type that will be required, a fair degree of pharmaceutical input can be expected at this level. There is already considerable pharmacist input into the NICE's work programme through a horizon scanning process that involves the National Prescribing Centre and the Drug Information Pharmacists Group.
Furthermore, the appraisal committee will not be operating in a vacuum. Provisional determinations will be released for consultation and it will be possible to put a pharmaceutical view at this point. The profession will have many opportunities to have an input.