The influential Kings Fund think-tank has come out in favour of allowing patients to top up their NHS care, describing the current system as “untenable”. The statement has been issued in response to cancer czar Professor Mike Richards’ review of the consequences of additional private drugs for NHS care, due to report in October.

Under current rules, if a patient obtains a privately prescribed drug that the local NHS primary care trust (PCT) will not fund and NICE does not recommend for NHS use, they can be asked to pay for all care they receive on the NHS. The Sunday Times has highlighted a number of high-profile cases over the past six months.

Untenable
Their paper describes the current status quo option as the “solidarity” position, and summarises the proposal to permit top-ups of NHS care as “individualist”. It als, rightly, points out that top-up charges already exist in dentistry and prescriptions.

It warns that “the existing high level of public support for the NHS may be underined if it does not offer services people feel ought to be available because of their potential benefits or because they feel that through taxes and natinal insurance they have already paid for them.”

If the “individualist” approach should prevail, the paper warns of a number of caveat issues:
calculating the costs of the additional care involved in delivering the top-up
defining the precise circumstances in which top-ups apply (to avoid the ‘slippery slope’
defining the level of top-up – is it the difference between what the PCT and NICE would fund and the manufacturer price and full costs of associated care?
ensuring individuals understand their financial liability – if a drug extends life unexpectedly long, medium- and long-term private funding may become unsustainable

Wider system improvements
the paper also suggests a variety of changes that are needed to the decision-making processes of NICE and of PCTs, and also warns of issues around patient information to guide consent.

It also concludes that this presents an opportunity to review the way new medicines (and other treatments) come into use, pointing out that clinical trial data is at variance with the realities of clinical practice.