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Cancer tsar sets out plan to end postcode prescribing

Published on 15/06/04 at 05:00pm

The government has promised to eliminate persistent variations in access to cancer drugs across England and Wales, and has unveiled a number of measures to monitor prescribing patterns more closely.

The setting up of NICE in 1999 was intended to introduce a single national standard for the prescribing of new, innovative and expensive drugs, but media reports of some cancer patients being denied potentially life-saving medicines have continued, proving to be a recurrent source of embarrassment for a government committed to improving services.

Government cancer tsar Professor Mike Richards launched an in-depth inquiry into variations of care in October 2003, pinpointing the variations through data supplied by IMS, which also supplies data to the pharmaceutical industry.

The report found that regional variations could not be attributed to differences in casemix or numbers of consultant oncologists and haematologists, but that wider capacity issues - lack of space to prepare and administer the drugs or shortages in pharmacists, nurses or junior doctors had contributed to the problem.

Another major factor was the opinion of local doctors on the cancer drugs. The report noted: "It appears that the use of drugs is heavily dependent on individual doctors' perceived usefulness of the particular drugs, and in some cases, the choice between different drugs that exist."

Variations in the effectiveness of NHS leadership was another reason put forward by members of cancer networks, who said the extent to which the networks, PCTs and trusts were able to plan effectively together for the impact of future guidance on local resources was crucial.

In response to the findings, health minister Lord Warner has sent a letter to relevant NHS professionals setting out a number of measures to bring local health economies into line with each other:

  • Bringing forward the introduction of electronic hospital prescribing by two years to 2006 from 2008-2010 in order to more easily identify which trusts are lagging behind in prescribing.
  • A new NHS agreement with IMS to give the service better data on current prescribing patterns.
  • NICE has already launched its own initiative to disseminate its guidance more effectively and to more people in the NHS
  • NICE will also review how it provides advice on major cost implications and on advising the NHS on how to ensure its guidance is taken up by frontline staff, including working with other NHS bodies such as the Healthcare Commission.

The Commission is the new body in charge of auditing and inspecting all NHS bodies, and will work with Professor Richards on integrating checks on the uptake of NICE guidance into their reviews of acute trusts.

Anna Walker, chief executive of the Commission said assessing NICE uptake was a high priority. "We are currently developing our new ratings and review system within which checking the adherence to NHS guidance will be a top priority."

The new measures may not be universally welcomed, in particular, some PCT budget holders say NICE national recommendation is sometimes not appropriate locally, and that their local knowledge and judgement should be respected.

NHS Alliance chairman Michael Dixon, a practising GP says many clinicians struggle to keep up with NICE proliferating guidance, and find it has often failed to convince them that change was necessary.

"Some people refer to NICE as the organisation that can't say no," he recently told the BBC. "NICE tends to approve a lot of procedures and medications that simply aren't a priority on the frontline.

"The fact that some NICE guidelines are ignored is not necessarily a bad thing."

This view is not shared by many charities, who continue to push for greater access and who have welcomed the new measures."

Pharmaceutical companies have also welcomed the news, including Roche, a company whose own published investigations into variations in prescribing of its treatments, breast cancer drug Herceptin (trastuzumab), Xeloda (capecitabine) and MabThera (rituximab) helped prompt the government to launch its official inquiry.

"Roche welcomes the publication of this important report that strives to improve the quality of cancer patient care in the UK," said John Melville, managing director, Roche UK.

"As a company, Roche is dedicated to working in partnership with the NHS and the wider cancer community to help implement the recommendations made in the report and to continue to deliver innovative solutions such as the capacity-creating oral therapy Xeloda, in order to provide the best quality healthcare for UK cancer patients."

Roche has also produced evidence which it says demonstrates that Xeloda, its oral treatment for breast cancer and colorectal cancer drug is not only more convenient for patients than traditional intravenous chemotherapy, but also frees up NHS staff time andresources.

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