The Guild of Healthcare Pharmacists day conference took place in Oxford on November 26
Not allowing valid drugs or procedures, such as Viagra, Relenza and infertility treatment, to be prescribed on the NHS prevented poor people from having access to them. So said Dr EVAN HARRIS MP (Liberal Democrat spokesman for health). The reason for this was, he said, that unlike more well-to-do patients, the poor were unable to afford private prescriptions for such interventions. The same principle applied to making drugs available over-the-counter because poorer people might not even be able to afford these products. If rationing had to exist, it should be explicit and the government should take responsibility for it rather than blaming doctors . He defined rationing as the shortfall between the needs of patients and the delivery of services by the NHS and outlined a number of ways that it could be minimised. These included increasing service delivery or decreasing patient expectations.
Service provision could be increased by encouraging patients to use private rather than NHS providers, by excluding treatment of some conditions from the NHS, by increasing funding, or by increasing rational prescribing. Also, rationing should be made more consistent, for example, multiple sclerosis sufferers were in the "bizarre" situation whereby they could be given Viagra for impotence but were often denied b-interferon for treatment of their disease. The general public had to be made aware that increased taxation might be required in order to fund the NHS.
Funding of health care continued to be a problem in the UK. Demands on the NHS had increased as the wealth of the country and public expectations had grown. The funding problem was exacerbated by increasing drug costs, faster market penetration of new products and an ageing population.
With regard to new products, licensing ensured their efficacy but not necessarily for "real life" situations. Some drugs might be less effective in ordinary patients or only certain sub-groups might benefit from them and it was not always possible to ascertain this from trials. If "real life" evidence became mandatory before any general prescribing could take place, innovation would be stifled and this could not be good for patients and the NHS in the long-term. Bodies such as the National Institute for Clinical Excellence (NICE) would help provide unbiased evidence but their guidelines should put efficacy before cost. However, the NICE was now required to assess products in terms of affordability as well as clinical efficacy and might be forced to ban products on the grounds of NHS underfunding. This could cause companies to stop marketing their products, or even from conducting trials, in the UK and that was undesirable.
Rationalising prescribing of existing products and implementing mandatory generic substitution, unless there were good clinical reasons for using a proprietary product, would take the pressure off new products and allow clinical experience to be gained before a decision was made on their routine use in the NHS.
Other topics discussed:
No confidence vote rebuke
New journal and website
Vaccine storage and prescription legibility
Testing competence to practise