Access to Medications

If a treatment is not recommended by NICE

NICE may not recommend a particular treatment. This is usually because there is not enough reliable evidence that a particular technology is a more effective treatment than others for the same condition.

This means that for the time being it should not be prescribed routinely on the NHS, and your doctor should talk to you about other treatment options available to you.

What can an individual patient do if they are being denied access to a treatment recommended by NICE?

In the first instance, a patient should discuss the recommended treatment with their treating clinician and discover a) whether they are aware of the NICE guidance or b) whether it is a financial decision not to fund the treament.

If it is a clinical decision, then the patient should request to be transferred to the care of a clinician who is willing to provide the treatment.

If the decision is a financial one, then a complaint should be made either to the Trust Chief Executive if this is a Trust funded treatment or to the PCT is they are the funding body.

Patients can bring Judicial Reviews of PCT decisions and legal advice should be sought if this path is to be followed.

What happens whilst the NHS is waiting for NICE guidance to be issued?

Every PCT will have a procedure for treatments awaiting NICE guidance. Enquiries should be made of the PCT and the prescribing doctor for details of the local practice and protocol.

What is the legal status of NICE guidance?

The Nice Guidance - an Interim Guide states:

" Since January 2002, the NHS has been legally obliged to provide funding and resources in England and Wales for medicines and treatments recommended by NICE’s technology appraisal guidance.

This means that when NICE recommends a technology, the NHS must ensure it is available to those people it could help, normally within 3 months of the guidance being issued. So, if your doctors think a recommended technology is right for you, you should be able to have it on the NHS.

If your doctors think a technology that NICE has recommended is right for you but it is not available, your first point of contact for help and support should be your local NHS Patient Advice and Liaison Service (PALS) if you live in England, or your local Community Health Council (CHC) if you live in Wales.

You can find details of your local PALS at www.pals.nhs.uk or your local CHC at www.patienthelp.wales.nhs.uk. Alternatively you can phone NHS Direct on 0845 46 47 or contact your local hospital, clinic, GP surgery or health centre.

However, your doctors may advise you that a treatment that NICE has recommended for most patients is not right for you. For example, you may already be taking a medicine for another health condition that will interact badly with the one that NICE has recommended. If your doctors think a technology that NICE has recommended for most patients is not the right option for you, they should be able to explain why in a way that you can understand. "

For full details please visit the NICE website

Why am I being denied a specific drug?

The ability to prescibe a specific drug should be a matter of clinical judgement, but depends on whether or not the drug is funded either by the Hospital Trust or comes under the list of approved drugs a GP can prescribe which will be dispenseed by an NHS pharmacist.

GPs are encouraged to prescribe from an agreed list of generic drugs rather than named drugs unless there are good clinical reasons why a patient requires a brand name drug rather than a generic one.

A patient may be denied a specific drug for a variety of reasons:

Tthe Primary Care Trust has made a decision not to fund it
The drug is not available in this country because it hasn't passed all the clinical trials yet
The drug has been declared as an unsuitable drug for a specific condition by the National Institute for Clinical Excellence

Each PCT will have a Prescribing and Medicines Management Strategy. Patients should enquire of their local PCT to discover what their prescribing policy is and if the matter has been debated at Trust level.

Patients can also bring Judicial Reviews of PCT decisions and legal advice should be sought if this path is to be followed.