PCTs could face significant financial pressures as a result of proposals to make more drugs available to patients at the end of life, the NHS Confederation is warning.

Responding to a consultation on proposals to relax the rules for cost-effectiveness judgements on some drugs for rarer cancers, the confederation said PCTs may be forced to stop funding other popular treatments in order to foot the bill.

The proposals were published by the National Institute for Health and Clinical Excellence to coincide with national clinical director for cancer Mike Richards’ review of co-payments in November.

NICE suggested that for rarer cancers not exceeding 7000 diagnoses in England each year additional rules could be applied to cost effectiveness calculations for drugs, meaning that the institute would be more likely to recommend that they should be funded by the NHS.

At the time, NICE said the number of cases to fall into this category would be small, but the NHS Confederation has estimated that anywhere between 13 and 178 patients per PCT could be affected.

“Even if only small numbers of additional approvals are made under these criteria, depending on the cost of the drugs in question, the financial implications for an individual PCT are not necessarily insignificant,” it says.

“PCTs will be anxious to see some more specific modelling or estimates of the likely financial impact.”

The confederation also warns: “There is a perceived risk that the proposals could lead to less cost-effective medicines being prioritised over those able to provide greater overall benefit.”

The Royal College of Nursing accepted the plans on the basis that they would mean fewer patients would have to choose whether to top up NHS care.

But it warned: “This consultation is being used to endorse the view that certain patients are more deserving than others.”

And it called for a “full and proper debate” on NHS resource allocation and funding.