This research report evaluates the attitudes of general practitioners and specialists toward the National Institute for Health and Care Excellence (NICE) regarding its appraisal system and guidelines. Key findings include a significant number of respondents believing NICE's decisions prioritize cost-effectiveness over patient outcomes, along with low familiarity with NICE's medicines and prescribing regulations. The report also highlights the potential influence of publishing prescribing uptake data on prescribing behaviors among healthcare professionals.

1. NICE
and
the
NHS
A
research
report
from
PharmaTimes
&
Doctors.net
uk

2. Contents
 Introduc3on
 Methodology
and
Sample
 A;tudes
to
NICE
–
Key
findings
 Key
conclusions
 Appendix
2

3. Introduc3on
Doctors.net.uk
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
Doctors.net.uk
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
Doctors.net.uk
community.
This
overview
of
the
research
is
now
being
presented
to
all
members.
3

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. A;tudes
to
NICE
-­‐
Key
findings
5

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. Unfamiliarity
with
NICE's
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. 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. 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. 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. 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. 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. 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. 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. 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. Appendix
16

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. 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. NICE
and
the
NHS
A
research
report
from
PharmaTimes
&
Doctors.net
uk
For
further
informa3on,
please
contact:
Dr
Tim
Ringrose,
CEO,
Doctors.net.uk:
Tim.Ringrose@mess.doctors.org.uk
Simon
Grime,
Managing
Director
–
Communica@ons,
Doctors.net.uk:
Simon.Grime@mess.doctors.org.uk
Neil
Reynolds,
Director,
medeConnect,
Neil.Reynolds@medeconnect.net