Postcode prescribing down to poor financial management, says report
pharmafile | September 13, 2005 | News story | |Â Â Â
Postcode prescribing will only be eradicated if PCTs and NHS Trusts improve their financial management, according to a new report.
The report by the Audit Commission and NICE identified a number of weaknesses in financial planning at grassroots level which is handicapping the implementation of guidance on new treatments.
Its conclusion that implementation of NICE guidance is less comprehensive and less timely than desired confirms complaints from charities and patients that postcode prescribing still persists in the UK.
The weaknesses identified in the report include insufficient communications between finance and clinical staff; the omission of NICE guidance costs in financial plans; and uncertainty about the implications of new reforms, like Payment by Results, for the funding of NICE guidance locally.
Audit Commission chairman James Strachan said: "There will always be competing priorities for funding, but surprisingly, our report shows that it is not actually cost which is the root of the problem. What would make all the difference, and is readily achievable, is improved financial planning and better communications between finance and clinical staff."
The Audit Commission warned that postcode prescribing and inefficient implementation of NICE guidance would continue unless improved planning, budgeting, and monitoring processes are introduced by local trusts.
But most of the trusts surveyed disagreed with the Audit Commission's conclusions and stressed that cost was the major barrier to implementing NICE guidance.
The research for the report involved questionnaire responses from 71 NHS bodies and visits to 16 sites for in-depth interviews.
Over 80% of trusts said funds available to implement guidance on individual appraisals were insufficient, citing particularly the high cost of implementing guidance for rheumatoid arthritis treatments.
Among the site visits, only a quarter could verify that NICE appraisals were implemented within three months, the time given for local trusts to find funding for individual drugs recommended by NICE.
One trust said it had taken them nearly three years to achieve full implementation because of high costs associated with guidance.
Charities, patients and the pharmaceutical industry have long-campaigned for an end to postcode prescribing, with areas of concern including access to new cancer and rheumatoid arthritis treatments.
Commenting on the Audit Commission's report, NICE deputy chief executive Andrea Sutcliffe, said: "We welcome this report and the recommendations made by the Audit Commission to improve financial management in the implementation of NICE clinical guidance. The report demonstrates that good financial planning, joint clinical involvement and clear leadership will support the successful implementation of NICE clinical guidance."
The NHS Confederation, which represents trust managers, said the difficulty in implementing NICE guidance was part of a wider problem of a rising drugs bill.
"Extra investment in the NHS is growing by an average of 7.4% a year in real terms but drug costs are rising even faster," said Dr Gill Morgan, chief executive of the confederation.
Dr Morgan said this was why most NHS trusts reported there wasn't enough funding available to fully implement NICE guidance.
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