Postcode prescribing is alive and well in Scotland

July 11, 2002

Drug availability in Scotland continues to depend on local health board decisions, despite one of the intentions of the National Institute for Clinical Excellence (NICE) being to ensure that NHS patients have equitable access, argue doctors from Lothian in this week's BMJ.

For example, Imatinib (for the treatment of chronic leukaemia) is available to patients in Fife, yet Lothian Health Board's drug evaluation panel has rejected it, write David Cameron and Michael Dixon of the Western General Hospital in Edinburgh.

Irinotecan (licensed for the treatment of colorectal cancer) was approved by NICE and the Health Technology Board for Scotland, but has also been rejected in Lothian. Patients in the west of Scotland can receive it, and in Aberdeen, doctors are allowed to prescribe it but without any additional funding, so that expenditure on Irinotecan competes with that on other drugs, add the authors.

The current system seems no more equitable than previously; extra layers of central committees exist, and drug availability continues to depend on local health board decisions, say the authors.

"We would advocate a streamlined approach, with centralised decision making bodies, such as NICE and the Scottish Health Consortium. Any decisions in favour of a new drug should result in automatic top-sliced funding going direct to the departments dispensing the drugs, so that clinicians do not have to apply locally for approval and funding," they conclude.


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