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CCG refuseniks

Clinical leaders across three sustainability and transformation partnership patches are defying public health guidelines and refusing to commission flu antivirals on grounds of cost effectiveness, HSJ revealed on Thursday.

The Northern Clinical Commissioning Group Forum, covering the North East and North Cumbria, wrote to NHS England earlier this month to say it would not pay for antiviral drugs for influenza.

The decision follows a letter from NHS England telling CCGs it was “urgent” they commission appropriate assessment, prescription and supply of antiviral drugs.

Antivirals, such as Tamiflu, are prescription medications that may help prevent flu complications or shorten the severity and duration of flu once someone has it.

In the letter to David Geddes, head of primary care commissioning at NHS England, South Tyneside CCG chief executive David Hambleton said the evidence for antivirals was “very weak”; cited a Cochrane review, which he said found “very little benefit” from using antivirals; and said it was not “cost effective” to commission them.

The decision defies both Public Health England and National Institute for Health and Clinical Excellence guidelines, which recommend the use of antivirals during winter months.

Although NHS England has not publicly set a red line over antivirals, it is clear in letters from Dr Geddes that it was keen for CCGs to commission them.

But judging from its initial response, NHS England does not look like it is going to heavily sanction the 12 northern CCGs or demand they reverse their decision.

What is not clear is if this will set a precedent for commissioners nationwide, who may follow suit if they believe spending on antivirals may now represent a quick and easy saving.

Splitting headache

The commissioner/provider split is still alive and well, judging by manoeuvres going on in response to the winter crisis.

The deferral of all elective care until the end of January, ordered by national leaders at the start of the month, was always going to leave a large dent in trusts’ financial plans

Some providers might have had to do it anyway, but others will have been hoping to max out their electives as much as possible to generate more income.

NHS Providers, which represents trust leaders, has written to NHS Improvement to point out the “significant” financial impact of the pressures and the deferral policy – and proposed a one off adjustment to funding flows to get CCGs to share the burden.

Naturally, this provoked a prickly response from commissioners, whose representatives said they are all for CCGs and trusts working together “within” their local systems, but any intervention that “appears to potentially pitch one part of the system against the other” would not be helpful.

Julie Wood, chief executive of NHS Clinical Commissioners, added: “Many health systems have gone beyond the old world of using ‘robbing Peter to pay Paul’ and vice versa tactics, and anything that takes us back towards that risks us not focusing on the right conversations and outcomes we all want and need for our patients.”