The National Institute for Clinical Excellence has defended its handling of the fast-track appraisal of Relenza, despite concern about the way news that the anti-flu drug had been turned down for NHS prescription this winter emerged.

Communications director Anne-Toni Rodgers said: 'This was the first rapid assessment and from our point of view it has gone well.'

But Relenza manufacturer Glaxo Wellcome criticised the 'very short' timescales involved and said leaks about the outcome 'did not instill confidence in the process'.

NHS Confederation policy director Nigel Edwards also expressed concern that NICE could be undermined by press speculation about the outcome of its first assessment. 'The process by which we heard about this by leak, without the background evidence, is not a satisfactory way of handling a difficult issue, ' he said.

A rapid assessment committee set up by NICE recommended last week that Relenza should not be prescribed on the NHS this winter. Glaxo Wellcome appealed to NICE's full board on Friday, which made a final recommendation to health secretary Frank Dobson on Monday.

As news of the decision broke, NICE was unable to comment on the unfolding situation, as staff were 'working on a press release or in a meeting about Relenza'.

Ms Rodgers was still refusing to 'confirm anything to do with the process' this week on the grounds that 'if we get sued it will be on questions of process', while saying 'I hate being in this position' and describing speculation in the press as 'not entirely helpful'.

The row broke as health minister John Denham disclosed that NICE will also be responsible for issuing protocols for GP referrals to specialists.

Announcing the move as part of the government's waiting list initiative, Mr Denham said the guidelines would cover everything from back pain to cancer 'as part of our overall aim to provide better access to treatment and minimise on unnecessary or incorrect referrals'.

Dr Peter Schutte, Medical Defence Union deputy head of advisory services, said he would welcome referral guidelines 'with open arms' because 'having helpful guidelines is an enormous step in the right direction'.

And National Association of Primary Care vice-chair Dr Greg Wilcox said: 'Anything that makes our job easier and clearer is to be welcomed.'

But London local medical committees secretary Dr Tony Stanton was sceptical. 'I can't imagine this is being introduced to facilitate referral, ' he said. 'Are they trying to ration it?' NHS Primary Care Group Alliance chair Dr Michael Dixon said: 'If it creates greater equity of access, it's a good thing. But it must leave flexibility for local situations and individual patients.'

NICE's apparent decision not to approve Relenza for immediate prescription on the NHS was condemned by the Patients Association, which said it was 'short sighted' when flu cost money in lost productivity.

But British Medical Association GP prescribing committee chair Dr George Rae said he hoped the government would now alleviate GP concerns about the drug's impact on workload and budgets.

King's Fund chief executive Rabbi Julia Neuberger said NICE had 'thrown down the gauntlet' to health secretary Frank Dobson. 'Priority setting in the NHS is a political matter, not merely a scientific one, ' she said.