/ Health

Should GPs have the final say on NHS drug funding?

Pile of pills

Latest healthcare proposals could mean that GPs are given more responsibility for funding medicines and treatments. Could this lead to better treatment for patients or make the postcode lottery even worse?

The new leader of the Royal College of GPs, Clare Gerada, hit the headlines recently when she criticised proposed changes to the NHS, saying she fears a system where ‘in Scunthorpe you can get a different service to Scarbourgh’.

She also hit out at plans to reform the National Institute for Health and Clinical Excellence (NICE). This is the body that gives guidance to the NHS on medicines and treatments – it’s rarely out of the news, but what do the changes mean for us?

Part of NICE’s role is to make recommendations about how new drugs and technologies can best be used by the NHS, helping to make tough decisions about what the NHS can and can’t afford.

On the flipside, NICE has been accused of ‘penny-pinching’ and ‘rationing’ expensive drugs that can help life go on for longer – perhaps most infamously with some cancer drugs.

NICE changes to come

In the future, the government wants drug prices to better reflect the benefits they give to doctors and patients through ‘value-based pricing’.

The idea is that NICE will continue to advise on which drugs are effective. But whereas in the past it was local Primary Care Trusts who ultimately decided whether or not to fund the drug, it will be now be down to groups of local GPs to decide.

This means NICE’s role will change, although its guidance will still be important in deciding on value-based pricing. It will also set standards for the way that patients should be treated.

We don’t yet know exactly what this means in practice – but there should be more details by the end of the year. In theory, this system will ensure that the most clinically-effective drugs will also be the most cost-effective – we’ll wait and see if that’s actually the case.

Does this expect too much from GPs?

But will this really work? Can GPs be expected to make all the decisions about budgets? Leading figures among Britain’s GPs have voiced concerns that it could put their relationships with patients at risk.

Gerada certainly agrees with this view, judging by the picture she painted in a recent interview with the Guardian.

‘At worst, the negative impact for GPs could be patients lobbying outside their front door, saying, “You’ve got a nice BMW car but you will not allow me to have this cytotoxic drug that will give me three more months of life.”‘

Do you share her worries? Will these changes mean the ‘postcode lottery’ gets worse, or will they lead to clearer and fairer decisions for patients?

One thing’s for sure – in this age of austerity the price we are willing to pay for drugs is unlikely to become less controversial anytime soon.


I share the worries of others – I wouldn’t really trust my doctor to care enough – I also already doubt his true commitment to patients. The post code lottery will get worse – and it’s bad enough already.

I agree with Richard comments – I wouldn’t trust my GP to care. They are overpaid and underwork and we give them a more oppurtinuty to make money from system.

colin says:
13 December 2010

My present GP practice has enough work caring for local patients, and the partners make no obvious attempts at either democracy or innovation unless one gets some hobby horse or fad. When pressed one might look at treatment options other than the local hospital trust, but that depends on patient pressure to make them spend time on research which they can ill afford.

A previous local practice expelled the entire family when one daughter queried a recommended treatment.

For these two reasons I want a nationally managed NHS to control GP’s & treatment standards with options through Parliament for me to have some influence on long-term priorities.