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What doctors think about NICE


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Results of a research project to explore UK doctors attitudes to NICE and the introduction of new products and treatments to the NHS

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What doctors think about NICE

  1. 1. NICE  and  the  NHS  A  research  report  from  PharmaTimes  &  uk    
  2. 2. Contents    Introduc3on    Methodology  and  Sample    A;tudes  to  NICE  –  Key  findings    Key  conclusions    Appendix   2  
  3. 3. Introduc3on  and  PharmaTimes  have  commissioned  research  from  medeConnect  amongst  GPs  and  specialists  which  had  the  following  objec3ves:    To  evaluate  familiarity  with  aspects  of  NICE      To  assess  opinions  regarding  the  NICE  appraisal  system    To  gauge  awareness  of  recent  and  future  changes  rela3ng  to  the   prescrip3on  of  NICE  approved  medicines    To  understand  the  effect  that  the  publica3on  of  prescribing  uptake  of   NICE  approved  medicines  is  likely  to  have  on  prescribing  paNerns    To  gauge  whether  views  of  the  role  of  NICE  have  changed  over  the  last   few  years    The  research  was  first  presented  by  Dr  Tim  Ringrose,  CEO  of  at  a  mee3ng  of  the  PharmaTimes  Directors’  Club  in  November  2012.  It  offers  an  example  of  the  degree  of  insight  that  can  be  gained  from  the  community.  This  overview  of  the  research  is  now  being  presented  to  all  members.             3  
  4. 4. Methodology  and  Sample    Research  conducted  by  medeConnect    A  5-­‐minute  structured  survey  with  GPs  and  Secondary  Care  Specialists    Sample  =  400  respondents     200  GPs,  200  Specialists  (from  a  range  of  special@es)     Prac@sing  all  over  England  and  Wales    92.5%  of  respondents  have  had  no  involvement  with  NICE  other  than  reading  its   published  guidelines  or  appraisals    Fieldwork  was  conducted  November  2012   4  
  5. 5. A;tudes  to  NICE  -­‐  Key  findings   5  
  6. 6. Overall  a;tudes  to  NICE   46%  of  all  respondents  believe  that  NICE’s  decisions  are  driven  by  arbitrary  measures   of  cost-­‐effec?veness  rather  than  the  best  outcome  for  pa?ents.  Male  aBtudes  even   more  nega?ve  with  almost  50%  believing  this.   24%  of  all  respondents  agreed  with  both  statements,  and  most  respondents  expressed   an  opinion,  with  only  7.5%  answering  “neither”  to  both  ques?ons.     “NICE  offers  essen3al  guidance  regarding   “NICE’s  decisions  are  driven  by  arbitrary   the  most  effec3ve  ways  to  diagnose,  treat   measures  of  cost-­‐effec3veness  rather  than   and  prevent  disease  and  ill  health”   the  best  outcome  for  pa3ents”   59%   53%   39%   38%   31%   27%   28%   25%   23%   22%   10%   11%   10%   8%   9%   7%   2%   0%   0%   1%   Strongly   Disagree   Neither   Agree   Strongly   Strongly   Disagree   Neither   Agree   Strongly   disagree   agree   disagree   agree   GPs   Specialists   GPs   Specialists    Q1.  In  terms  of  your  overall  opinion  of  NICE,  to  what  extent  do  you  agree  or  disagree  with  the  following  statements?  Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   6  
  7. 7. Unfamiliarity  with  NICEs  Medicines  and  Prescribing  Centre   31%  of  all  respondents  are  not  at  all  familiar  with  NICE’s  Medicines  and   Prescribing  Centre.   Only  5.25%  familiar  or  very  familiar  with  the  NICE  Compliance  Regime.   Only  2.75%  familiar  or  very  familiar  with  the  NICE  Innova?on  Scorecard.   Specialists   29%   36%   19%   16%   2%   GPs   33%   29%   24%   13%   2%   Not  at  all  familiar   Vaguely  familiar   Quite  familiar   Familiar   Very  familiar    Q2.  Thinking  in  more  detail  about  NICE,  how  familiar  are  you  with  the  following?  Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   7  
  8. 8. NICE  appraisal  system   37%  of  all  respondents  agree  or  strongly  agree  that  NICE  currently  allows   some  drugs  to  pass  through  its  appraisal  system  that  are  too  costly  for  the   NHS  to  fund.   49%   41%   36%   30%   20%   15%   6%   2%   3%   1%   Strongly  disagree   Disagree   Neither   Agree   Strongly  agree   GPs   Specialists    Q3.  To  what  extent  do  you  agree  or  disagree  with  the  following  statement  re:  the  NICE  appraisal  system?  Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   8  
  9. 9. The  restric3on  of  NICE  approved  medicines   31%  of  all  respondents  were  unaware  that  it  is  illegal  for  a  CCG,  PCT  or   Hospital  Trust  to  restrict  the  prescribing  of  NICE  approved  medicines  for   financial  or  budgetary  reasons.     GPs   Specialists   6%   5%   Not  sure  if  I  was   26%   Not  sure  if  I  was   37%   aware  of  it  or  not   aware  of  it  or  not   No,  I  was  not  aware   No,  I  was  not  aware   of  that  before  today   of  that  before  today   35%   I  was  par@ally  aware   I  was  par@ally  aware   33%   of  that  before  today   of  that  before  today   Yes,  I  was  fully   Yes,  I  was  fully   aware  of  that  before   aware  of  that  before   today   35%   today   26%  Q4.  Are  you  aware  or  unaware  that  it  is  illegal  for  your  CCG,  PCT  or  Hospital  Trust  to  restrict  your  prescribing  of  NICE  approved  medicines  for  financial  or  budgetary  reasons?  Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   9  
  10. 10. How  became  aware  that  the  restric3on  of  prescribing*  is  illegal     41%   Colleague   20%   28%   Medical  media   34%   10%   Na@onal  newspaper   17%   10%   Online  forum  or  blog   10%   Specialists   13%   Pharma  Company  Rep   5%   GPs   7%   Le`er  from  CCG,  PCT  or  Hospital  Trust   5%   3%   Le`er  from  the  DH   1%   2%   Pharmacist   0%   4%   Other  (combined)   8%   23%   Cannot  remember   22%    *of  NICE  approved  medicines  for  financial  or  budgetary  reasons    Q5.  How  did  you  become  aware  of  this?  Bases:  All  completed  respondents  (who  were  either  fully  or  par@ally  aware  in  Q4a),  116  GPs  and  138  Specialists  
  11. 11. The  restric3on  of  NICE  approved  drugs  for  budgetary  reasons   22%  of  all  respondents  say  that  their  prescribing  of  NICE  approved  drugs  has   been  restricted  for  budgetary  reasons  in  the  last  six  months  either  quite   oXen,  oXen  or  all  the  ?me.  This  figure  rises  to  28%  for  GPs.  However  nearly   62%  of  female  respondents  report  that  this  happens  rarely  or  not  at  all,   compared  to  47%  of  male  respondents.   “Extent  to  which  the  prescribing  of  NICE  approved  drugs  has  been   restricted  for  budgetary  reasons  in  the  last  six  months”   38%   27%   27%   25%   22%   18%   15%   13%   10%   4%   3%   1%   Not  at  all   Very  rarely   Occasionally   Quite  oden   Oden   All  the  @me   GPs   Specialists  Q6.  To  what  extent  have  you  found  that  your  prescribing  of  NICE  approved  drugs  has  been  restricted  for  budgetary  reasons  in  the  last  six  months?  Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   11  
  12. 12. Mee3ng  financial  targets  versus  prescribing  NICE  approved  medicines  12%  of  all  respondents  believe  mee?ng  financial  targets  is  more  important  to  a  varying  degree  –  compared  to  49%  that  believe  prescribing  NICE  approved  medicines  is  rela?vely  more  important.  Specialists  that  agree  that  “NICE  offers  essen?al  guidance  regarding  the  most  effec?ve  ways  to  diagnose,  treat  and  prevent  disease  and  ill  health”  (see  page  6)  are  more  likely  to  agree  that  prescribing  NICE  approved  medicines  is  more  important  compared  to  their  GP  counterparts:  64%  vs.  46%.   Perceived  rela3ve  importance  of  mee3ng  financial  targets   versus  prescribing  NICE  approved  medicines   46%   33%   27%   22%   24%   15%   9%   8%   5%   6%   1%   2%   2%   3%   Much  more   More  important   Slightly  more   Neither  is  more   Slightly  more   More  important   Much  more   important   important   important  than   important   important   the  other   Mee@ng  financial  targets     Prescribing  NICE  approved  medicines     GPs   Specialists   Q7.  Which  would  you  say  was  more  important,  mee@ng  financial  targets  or  prescribing  NICE  approved  medicines?   12   Bases:  All  completed  respondents,  200  GPs  and  200  Specialists  
  13. 13. The  publica3on  of  the  prescribing  uptake  of  NICE  approved  medicines  and  its  effect  on  the  prescribing  paNerns  of  colleagues  Nearly  80%  of  all  respondents  not  aware  that  all  local  NHS  organisa?ons  will  have  to  publish.     “Effect  on  prescribing  paNerns  of   “Effect  on  prescribing  paNerns  of   colleagues  in  primary  care”   colleagues  in  secondary  care”   54%   52%   50%   49%   38%   39%   31%   30%   19%   14%   10%   6%   3%   3%   2%   2%   0%   1%   1%   0%   Will  be   Will  be   Levels  will   Will  be   Will  be   Will  be   Will  be   Levels  will   Will  be   Will  be   significantly   slightly   not  change   slightly   significantly   significantly   slightly   not  change   slightly   significantly   lower   lower   higher   higher   lower   lower   higher   higher   GPs   Specialists   GPs   Specialists   Q10a.  To  what  extent  do  you  think  the  publica@on  of  the  prescribing  uptake  of  NICE   Q9.  And  are  you  aware  or  unaware  that  all  local  NHS  organisa@ons  will   approved  medicines  will  have  an  effect  on  the  prescribing  pa`erns  of  your  colleagues?   have  to  publish  their  prescribing  uptake  of  NICE  approved  medicines?   Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   13  
  14. 14. The  publica3on  of  the  prescribing  uptake  of  NICE  approved   medicines   48%  of  all  respondents  say  their  own  prescribing  levels  will  be  slightly  or   significantly  higher.     Predicted  effect  of  the  publica3on  of  the  prescribing   uptake  of  NICE  approved  medicines  on  prescribing   53%   46%   47%   41%   3%   5%   5%   0%   0%   2%   My  prescribing  will                   My  prescribing  will                   My  prescribing  levels           My  prescribing  will                   My  prescribing  will                   be  significantly  lower   be  slightly  lower   will  not  change   be  slightly  higher   be  significantly  higher   GPs   Specialists  Q10b.  And  to  what  extent  do  you  think  the  publica@on  of  the  prescribing  uptake  of  NICE  approved  medicines  will  have  an  effect  on  your  prescribing  of  them?  Bases:  All  completed  respondents,  200  GPs  and  200  Specialists   14  
  15. 15. Key  findings    The  majority  of  doctors  agree  that  “NICE  offers  essen?al  guidance  regarding  the   most  effec?ve  ways  to  diagnose,  treat  and  prevent  disease  and  ill  health”  BUT   nearly  50%  of  doctors  feel  that  “NICE’s  decisions  are  driven  by  arbitrary  measures   of  cost-­‐effec?veness  rather  than  the  best  outcome  for  pa?ents”    Despite  this,  over  a  third  of  doctors  (37%)  are  concerned  that  NICE  currently   allows  some  drugs  to  pass  through  its  appraisal  system  that  are  too  costly  for  the   NHS  to  fund.    Close  to  a  third  (31%)  of  doctors  were  unaware  that  it  is  illegal  for  a  CCG,  PCT  or   Hospital  Trust  to  restrict  the  prescribing  of  NICE  approved  medicines  for  financial   or  budgetary  reasons,  but  most  doctors  do  not  report  that  they  have  ogen  been   prevented  from  prescribing  NICE  approved  medicines.    Doctors  awareness  of  important  ini3a3ves  and  services  offered  by  NICE  is  very   low  –  doctors  are  more  likely  to  have  heard  about  them  from  colleagues  than   from  their  PCT/Trust.    The  publica3on  of  the  prescribing  uptake  of  NICE  approved  medicines  is  likely  to   have  a  significant  impact  on  the  prescribing  behaviour  of  doctors.   15  
  16. 16. Appendix   16  
  17. 17. Loca3on  and  type  or  prac3ce   GPs   Specialists   2%   15%   35%   Urban  area   Other  (combined)   39%   A  private  prac@ce   Suburban   A  ter@ary  centre   37%   Semi-­‐rural   A  DGH   A  teaching   Rural  area   45%   hospital   23%   6%   17  
  18. 18. Gender  and  age   Gender   Age  range   6%   2%   10%   34%   20%   36%   61  or  over   33%   51-­‐60   Female   32%   41-­‐50   Male   31-­‐40   65%   66%   52%   40%   30  or  under   3%   4%   GPs   Specialists   GPs   Specialists   18  
  19. 19. NICE  and  the  NHS   A  research  report  from  PharmaTimes  &  uk    For  further  informa3on,  please  contact:    Dr  Tim  Ringrose,  CEO,  Simon  Grime,  Managing  Director  –  Communica@ons,  Neil  Reynolds,  Director,  medeConnect,