QIPP versus NICE – the war goes on

 QIPP is trumping NICE as the driver of local prescribing decisions, with price ranked above value, the parliamentary Health Select Committee has been told.

Witnesses representing healthcare providers, patients and the pharmaceutical industry told the MPs that local commissioners are still restricting patient access to NICE-recommended treatments.

The ‘grey area’ between two conflicting agendas, cost-cutting and innovation, was highlighted as a cause of confusion among decision-makers.

Laura Weir, chairwoman of the patient coalition group Patients Involved in NICE, noted that despite patients’ legal right to receive drugs approved by NICE, the implementation of guidance was often blocked or delayed at local level.

“Currently there is no scrutiny or monitoring of NICE approved medicines, and there’s no one body that is responsible,” she said, arguing that the Care Quality Commission (perhaps together with Monitor) could help the NHS Commissioning Board to monitor that aspect of CCG work.

Stephen Whitehead (pictured), ABPI Chief Executive, pointed to the conflict of priorities: “Although often there will be medicines that go on the formulary, there is often not the freedom of the healthcare professional to prescribe the most appropriate medicine for that patient.

“This has been explicitly recognised by government through the publication of Innovation, Health and Wealth, which says the uptake of NICE medicines is a problem in the UK.”

Linda Patterson, Clinical Vice President of the Royal College of Physicians, highlighted the key issue: “There is an issue about implementation, which is partly about practice and the clinical decision maker implementing the guidance or not.

“On wider implementation, that is a debate about how we encourage good practice to be implemented across the country without variation. At the moment, there is a rather grey area as to who is responsible.”