Area prescribing committees < Influencers contents | Print this page Area prescribing committees Area prescribing committees (APCs) in England were first proposed in 1994. The proposals included a mechanism for the ‘managed entry’ of new drugs into the NHS by the old health authorities, and in many ways presaged the arrival of NICE. The National Prescribing Centre has produced a useful booklet on APCs — Area prescribing committees: maintaining effectiveness in the modern NHS. Many APCs still appear to be finding their feet in the PCT-based structure of the NHS in England and getting hold of a comprehensive database of APC members has proved to be difficult. Nevertheless APCs are still very important for NHS influencers. As far as primary care formularies are concerned, a literature search by Bandolier (April 2002) found no evidence either way in terms of such formularies either reducing costs or improving health outcomes. Indeed what little Bandolier could find in their article ‘Do formularies work?’ suggested the opposite. NHS influencers could consider using this as a counter argument for the setting up of practice formularies, where they are being considered. However, ‘cash releasing efficiency savings’ are still the name of the game and in a health service factsheet put out by the Association of Chartered Certified Accountants (ACCA), prescribing is mentioned as a key pressure point. NHS finance directors should seek to increase further levels of generic prescribing, agree and extend formulary arrangements in primary care and implement prescribing incentive schemes, the factsheet suggests. PCTs appear to be picking up medicines management in a number of areas, with ‘traffic light’ systems set up by them to ensure hospital consultants are not shifting costs and the responsibilities of complex medical areas onto GPs. Certainly, PCTs are increasingly encouraging consultants to consider the cost of the drugs they prescribe and to remind them that unified budgets are now in place. Joint prescribing committees, medicines management committees, therapeutic committees and area prescribing committees are all being dusted down. For NHS influencers this will be particularly important for new (expensive) drugs. Primary care in the future Sir Denis Pereira Gray, chair of the Nuffield Trust, has looked at the broad trends likely to shape the future of health and healthcare over the next 20 years. The Nuffield Trust identified the following broad principles: Patient empowerment This about the changing role of patients and the knock-on effects of the role of healthcare professionals. ‘Instead of being the suppliers of information, they will become interpreters’. Also patients will be expected to be offered individualised options for their health needs (patient choice). Research studies have shown that patients, users and carers want to share in decisions about the treatment and care that is appropriate to them and that this results in improved outcomes. But as one would predict, GPs apparently are worried that providing more healthcare choices will increase their workload. As a GP wrote in Pulse, ‘so the minister says the NHS must be driven by what patients want? Okay, if patients want to see me when they want about anything they want, I want £15,000/£40,000 for an assistant nurse/doctor.’ Shift to primary care Worldwide trends point to more local services, supported by new, miniaturised technology both for diagnosis and treatment: ‘Among the new technologies, better drugs stand out. There will be many more new entities, facilitated by research stemming from the human genome and advanced computer techniques… Drugs will be targeted more efficiently and treatments individualised; two individuals with the same disease, of the same severity, may soon be treated differently… What will these treatment treat? Three trends stand out. First the rising numbers of patients with chronic disease, such as asthma, dementia, depression, diabetes, hyperlipidaemia and hypertension, which demands long-term care and advice over years. These six diseases will increasingly dominate the health scene. Second, the ageing population will place new emphasis on care of the elderly… Third the rise of diseases like depression, which is already the commonest disease in some general practices.’ Sir Denis also suggested that the proportion of healthcare expenditure in primary care will rise from about a quarter to a third. Note that GPs are becoming more distanced from their patients, compromising continuity of care, a YouGov opinion poll has suggested. (See Wellard’s NHS news, August 2004.) They found patients felt changes in GPs' work, like opting out of 24-hour duties, have lowered standards of care with many patients uneasy about the changes that have come about under the new GP contract. The poll of 2,424 patients was carried out for the Daily Telegraph. Patients in group practices were far unhappier with standards of care than those with their own GP, particularly those living in cities like London, Birmingham and Glasgow. And a York University survey of some 100 consultations found that patients preferred to talk to nurses. Nurses were open to discuss anything with patients and patients felt on a level with nurses. In contrast patients were still in awe of doctors and failed to tell them very much at all! Patients see doctors as people to listen to and gain guidance from rather than have a conversation with. The NHS Alliance has said that figures produced by the Department on GP numbers continue to be misleading since most are part-timers. They also say that consultant numbers (full-time) on the other hand have grown by 4,000. The Alliance further says that more and more care is being shifted out of hospitals and all of this focus on the acute sector is rather short-sighted. ‘In fact, hospital death rates are more closely related to the number of GPs in the area than to the number of doctors in the hospital. Failing to recruit GPs means that people will die unnecessarily because they do not get the treatment they need early enough’, says NHS Alliance chairman Dr Michael Dixon.
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