NHS chief executive Sir David Nicholson has told local health leaders that NHS contracts are to be changed to ensure that local Service drug formularies do not block treatments which are recommended by the National Institute for Health and Clinical Excellence (NICE).
"Formularies have an important role in underpinning safe and effective use of medicines. However, they should not duplicate NICE assessments or challenge an appraisal recommendation. Once on formularies, there should be no further barriers to the use or prescription of technologies or medicines," Sir David writes, in a Dear Colleague letter sent to the chief executives of Strategic Health Authority (SHA) and Primary Care Trust (PCT) clusters and clinical commissioning group (CCG) leaders.
Last November, GP magazine reported that one in four PCTs were blocking the inclusion onto their formularies of 14 drugs recommended in NICE appraisals and a further five supported by NICE guidance because they considered them to be too expensive or not sufficiently effective. The government responded by pledging the introduction of a NICE Compliance Regime for the funding direction attached to NICE technology appraisals, "to ensure rapid and consistent implementation throughout the NHS."
"This will reduce variation and assure patients of their access to the clinically and cost-effective technologies and medicines their doctors believe they need," the government stated in its report, Innovation Health and Wealth: Accelerating Adoption and Diffusion in the NHS, published on December 5, 2011."Our intention was and remains clear - to support patient access to NICE-recommended medicines and technologies," Sir David emphasises, in his letter to local NHS leaders.
While there has been good progress in reducing variation in the adoption of NICE-approved treatments, much more needs to be done, he goes on.
"With that in mind, I want to see all NHS organisations publish information which sets out which NICE technology appraisals are included in their local formularies" - working towards publication by next April 1 "at the very latest," Sir David writes."It will be important that the publications are online, and are clear, simple and transparent, so that patients, the public and stakeholders can easily understand them," he emphasises, adding: "from 1st April 2013, I also intend to make this a standard term and condition in NHS contracts."
Sir David also tells the local NHS leaders that the Chief Pharmaceutical Officer, Keith Ridge, will be writing to NHS chief pharmacists asking them to review local formulary processes.
- Innovation Health and Wealth advises local NHS bodies that their formulary processes should proactively consider the impact of new NICE technology appraisals, and that all recommendations by the Institute should be automatically incorporated into local formularies, where clinically appropriate.
"This process should take place within 90 days to support compliance with the three-month funding direction and the NHS Constitution, ensuring that these medicines are available for clinicians to prescribe, should they choose to, in a way that supports safe and clinically-appropriate practice," the report says.