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Letters to the Editor
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Prescribing
Why do local NHS bodies say the opposite of national bodies?
From Mr C. J. Daly, MRPharmS
There has been much discussion about the implementation of guidance from
the National Institute for Health and Clinical Excellence and the Scottish
Medicines Consortium, with NICE in particular having trouble getting its
recommendations implemented on the ground.1–3
One product that has received positive SMC approval (for use in generalised
anxiety disorder) as well as NICE approval in its guideline on anxiety
(NICE approves selective serotonin reuptake inhibitors licensed for this
indication) is escitalopram. SMC endorsement in particular is interesting
because this body has a reputation as being a “hard hitter” that
quite often refuses prescribing permission outright in Scotland.
It is interesting to note therefore that in many parts of the country (including
my own) escitalopram is one of those products that are on the “less
desirable list” of products, with local advice on prescribing being
different to national advice.
I have been thinking about why local bodies often seem to issue advice
that is different from that of national bodies. Might the reason be that
national bodies are better able, better qualified or better instructed
to take into account total health and social care costs, as opposed to
local bodies, which in some cases still view budgets individually?
If this is the reason maybe things will start to change now that, in England
at least, we have a system that enables GPs to take a holistic view of
all their budgets (practice-based commissioning) as well as a new financial
system that allows disinvestment from hospitals (payment by results).
I would like to hear the views of fellow primary care trust pharmacists
as to why they believe there is such disparity between national and local
guidance as well as how they believe PBC and PBR will affect their advice
on prescribing.
Cathal Daly
Head of Medicines Management
Norfolk Primary Care Trust
Ketteringham, Norwich NR18 9RS
References
1. Wathen B, Dean T. An evaluation of the impact of NICE guidance on
GP prescribing. British Journal of General Practice 2004;54:103–7.
2. Ryan J, Piercy J, James P. Assessment of NICE guidance on two surgical
procedures. Lancet 2004;363:1525–6.
3. Sheldon TA, Cullum N, Dawson D, Lankshear A, Lowson K, Watt I et al.
What’s the evidence that NICE guidance has been implemented? Results
from a national evaluation using time series analysis, audit of patients’ notes,
and interviews. BMJ 2004;329:999. |
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Pharmaceutical Journal