The National Institute for Health and Clinical Excellence has launched a database pulling together its recommendations on referring patients from primary to secondary care to improve outcomes and cut costs.

The database will provide GPs with a one-stop-shop of guidance highlighting when patients could benefit from secondary care or specialist services, which, aside from securing better value for money and clinical outcomes, should help to improve the patient experience and reduce local and regional inequalities in care, the Institute said.

Inappropriate referral to secondary care represents a significant and unnecessary cost to the NHS, and the database is one of a number of initiatives designed to help the health service deliver the QIPP (Quality, Improvement, Productivity and Prevention) agenda during a time of financial constraint.

Professor Peter Littlejohns, NICE Clinical and Public Health Director said the new ‘referral advice’ recommendations database “is a valuable resource for those providing and commissioning care on when patients should be referred on from primary care”, which should help to ensure that patients receive treatment that is proven to be both clinically and cost effective.

Final guidance for clopidogrel/dipyridamol

Meanwhile, the cost watchdog has endorsed the wider use of clopidogrel as well as Boehringer Ingelheim’s modified-release dipyridamol for the prevention of occlusive vascular events.

The Institute has OK’d funding for the wider use of clopidogrel (using the least costly preparation) in National Health Service patients who have had a stroke or who have peripheral arterial disease, and those who have cardiovascular disease in more than one area, to help prevent a subsequent heart attack or stroke. However, the drug is only recommended for patients who have had a heart attack if they are unable to take aspirin.

A combination of modified-release dipyridamole - sold as Persantin Retard and Asasantin Retard by Boehringer - and aspirin is backed as an option for patients who have had a transient ischaemic attack, but should only be used when patients have had an ischaemic stroke where clopidogrel is contraindicated or not tolerated. The drug can also be used alone as an option following ischaemic stroke where aspirin and clopidogrel cannot be taken, the Institute said.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE, noted that heart attacks and strokes are some of the biggest killers and causes of disability the country, and that the new guidelines have “the potential to have a significant impact on the treatment of many thousands of patients in England and Wales”.