NICE to be wanted
The sexy NICE headlines tend to be when a drug has been blocked or access is restricted.
Indeed, how your company’s medicine is positioned within specific guidance could influence your view of NICE. I believe, however, that this organisation has a very positive impact across our health services. It raises standards, achieves consistency and ensures evidence underpins what we do.
NICE looks at drugs where availability varies; this could be due to different local prescribing, funding policies or indecision over value. NICE standardises access to healthcare and this has to be good. Variation only leads to poor care.
It also does much more that influences our daily practice; providing confidence-boosting guidance on managing specific conditions, improving health, providing social care, services and interventions that flow into communities.
NICE Technology Appraisals (TA) go further, and when NICE recommends a treatment as an option, the NHS must make sure it is available within three months. Therefore, if a patient has a condition and their doctor thinks the therapy is right, it should be ready for use, thereby standardising care across the country.
Despite the wealth of guidance, an ‘industry’ has existed in local NHS organisations across the country where teams of people, usually led by pharmacists, review the evidence and come up with local guidance themselves, even when NICE has published in the area. This is largely driven by budget constraints and a real or perceived need for localism. There has to be a more efficient way.
NHS England has also been concerned that new medicines, not evaluated by the TA programme, are instead being assessed multiple times across the NHS. This has resulted in the establishment of four Regional Medicines Optimisation Committees, who evaluate new medicines which are not on the TA programme, and share recommendations across the four regions.
This will enable pharmacists and CCG colleagues to focus on the implementation of recommendations to achieve greater consistency in local medicines and prescribing practice. My hope is that this work complements the recommendations made by NICE and does not duplicate their activity. Coordination is key.
Aside from the known-about guidance, we’re increasingly seeing the impact of NICE Quality Standards in a number of disease areas, ranging from standards in acute coronary syndromes to varicose veins. These set out the priority areas for improvement in health and social care; essential reading for commissioners and providers who want to give the best care to patients.
What is clear is that NICE guidance and standards can be a solid foundation for encouraging behaviour change and improving evidence-based practice within a range of healthcare settings.
When I work in practice or when developing pharmacy services, I want to be confident that I am doing the best for patients and that care is underpinned by research and evidence. I will always turn to NICE.
Thank you to Dr Mahendra G Patel, NICE Principal Enterprise Fellow in Pharmacy Practice, for his help in compiling this piece. Deborah Evans is Managing Director of Pharmacy Complete, a specialist consultancy and training company enabling a healthier future for pharmacy. Go to pharmacycomplete.org
The function of RMOCs has been co-developed by NHS England and NHS Clinical Commissioners on behalf of CCGs, in partnership with NHS hospital representatives, NICE and representative bodies of the branded and generic pharmaceutical industry.
RMOCs bring together decision makers and clinicians across the four regions of England to share best practice, understand the evidence base, coordinate action in order to reduce variation, improve outcomes and maximise value from medicines.