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PCTs defend closer working with NICE

Primary care trusts and the National Institute for Health and Clinical Excellence have defended a £300,000 a year contract designed to help PCTs influence NICE appraisals.

The three-year contract means the agency Commissioning Support Appraisals Service will effectively represent all 152 PCTs in future NICE appraisals.

A lot of money is spent on appeals which could be saved if we were there [as part of the approval process] in the first place

The new service was criticised in the Daily Mail last week, as a “sinister bid to reduce funding for life-saving drugs”. But NICE centre for health technology evaluation director Carole Longson said a dedicated agent representing PCT perspectives could have the opposite effect.

She said low PCT engagement in NICE appraisals had been “the issue” for some time and improvements in that could help PCTs “understand the process overall” and make it “easier to at least make the case for implementation”.

She said arguing the case had been “difficult when we haven’t got NHS stakeholders. We do ask for them but they can’t come forward”.

For each of its technology appraisals NICE asks two randomly selected PCTs to represent the commissioning view.

But Ms Longson said PCT stakeholders often had not engaged well in the process.

“That voice really hasn’t been heard,” she said.

The lead commissioner for the new service is Birmingham East and North PCT. Chief operating officer Andrew Donald said PCTs had struggled to engage because of a lack of capacity and expertise. Having one central body would overcome that, he said.

He defended the £300,000 a year cost of the contract, which he claimed was the biggest collaborative procurement in the UK.

“A lot of money is spent on appeals which could be saved if we were there [as part of the approval process] in the first place. If you worked out the cost of appeals if we don’t engage, it will pale into insignificance,” he said.

He agreed increased engagement from PCTs would enhance the “credibility” of NICE guidance, which could lead to greater compliance. He denied PCTs were trying to “lobby” to cut costs.

But he said PCTs should be providing NICE with information about the “consequence on other things” that approvals for certain high cost drugs and technologies could have.

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