The chair of the National Institute for Health and Clinical Excellence has floated the idea that it should spend more on ensuring guidance gets implemented than it does on producing the advice.

The chair of the National Institute for Health and Clinical Excellence has floated the idea that it should spend more on ensuring guidance gets implemented than it does on producing the advice.

Speaking at an implementation workshop at the NICE conference in Birmingham, Sir Michael Rawlins acknowledged concerns that the institute was too slow and that GPs were more influenced by drug companies.

GPs at the workshop said they often did not adhere to information produced by NICE because pharmacy companies got there first. 'NICE is too slow and it's not sexy enough. Pharmaceutical companies get there first with glossy pamphlets which look good and are easy to read,' said one.

Another pointed out that NICE guidance competes with other drivers such as the GP contract's quality and outcomes framework, which urged vigorous treatment of hypertension. As a result, increasing numbers of GPs were prescribing the alpha blocker doxazosin although NICE has advised against widespread use of it.

Sir Michael acknowledged the issue, saying: 'Perhaps NICE should spend more on implementation than guidance.'

During the conference, NICE launched two new online databases to support implementation. The first contains more than 30 examples of implementation initiatives from NHS, voluntary and other public sector organisations and shared learning schemes. The second, evaluation and review of NICE implementation evidence (ERNIE), provides guidance-specific reports.

In a plenary session, Liberal Democrat health spokesman Steve Webb backed earlier calls by cancer specialist Professor Karol Sikora for the creation of earmarked funds for drugs approved by NICE.

Professor Sikora, medical director of CancerPartners UK, said a 'NICE slice' was needed to help primary care trusts purchase newly approved drugs: 'When a drug is approved the money must come; PCTs should get a cheque immediately,' he said.

Mr Webb said later: 'Half way through the year NICE approves something the PCT has not budgeted for, and therefore GPs cannot prescribe it. A NICE slice would come out of the DoH budget and take into account what's coming down the line.'

In an earlier session, delegates discussed the impact of last year's decisions about breast cancer drug Herceptin in sparking a national debate about NHS priorities.

Birmingham East and North PCT chief executive Sophia Christie said: 'The most positive thing that came out of the Herceptin debate was that we actually had a debate. It began to expose that just saying that something is life-saving isn't the definitive trump card.'

HSJ and Nursing Times have teamed up with NICE to launch a new service to help managers and nurses implement guidelines. For more information e-mail alexis.nolan@emap.com

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