CCG Blanket (non-)Prescribing Policies

[helvella]

Those who have had funding of a treatment refused on the basis of a medicine being on a red list or some such thing may care to consider the underlined section below. Obviously the most likely thyroid medicine to fall into this is Liothyronine.

“You have the right to expect local

decisions on funding of other drugs and

treatments to be made rationally following a

proper consideration of the evidence. If the

local NHS decides not to fund a drug or

treatment you and your doctor feel would

be right for you, they will explain that

decision to you.”

(Section 3a of the NHS Constitution)

What this right means for patients

The availability of some healthcare services is determined nationally – for example, under the National Institute for Health and Care Excellence’s (NICE) technology appraisal or highly

specialised technology recommendations, where all CCGs, NHS England or local authorities

have to fund the recommended drugs and treatments. There are also some services that are

commissioned directly by NHS England, which will therefore take a national decision on their

funding.

However, in most cases, decision-making on whether to fund a service or treatment is left

to the local CCG or local authority. This is to enable CCGs and local authorities to commission services that best fit the needs of their local population.

For such decision-making, it is important that the process is rational, transparent and fair.

This right ensures that there is such a process.

If a CCG, a local authority or NHS England has decided that a treatment will not normally be

funded, it needs to be able to consider whether to fund that treatment for an individual patient on an exceptional basis.

Source of the right

From 1 April 2013,19 Part 7 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 placed a requirement on CCGs and NHS England to have arrangements in place for making decisions and adopting policies on whether a particular drug or other treatment is made available for the people for whom they are responsible. NHS England and CCGs will also have to publish information on those arrangements, and publish reasons for any funding policy or make such reasons available on request.

Administrative law requires that the decisions of NHS bodies and local authorities are rational, procedurally fair and within their powers.

In addition, decisions by the courts have made it clear that, although an NHS commissioner (which since 1 April 2013 includes a local authority commissioning public health services) can have a policy not to fund a particular treatment (unless recommended in a NICE technology appraisal recommendation or highly specialised technology recommendation), it cannot have a blanket policy; i.e. it must consider exceptional individual cases where funding should be provided.

Page 49 et seq.

gov.uk/government/uploads/s...

[shaws Administrator]

Thanks Helvella for posting.

[Clutter]

Thanks for posting Helvella.

CCGs are ignoring the advice and imposing blanket bans on prescribing Liothyronine and withdrawing prescriptions after years of successful therapy. I hope the information will help members challenge those decisions but I fear the BTA "Levothyroxine is the preferred therapy" is being used to get CCGs off the hook.

[helvella Administrator Thyroid UK in reply to Clutter]

Very much agreed.

Don't want to put the burden of complaining onto any individual but, overall, it does seem to be what is required.

[Clutter in reply to helvella]

Helvella, it is an awful burden for someone feeling so unwell to have to fight bureacracy for a therapy which might resolve their illness

[helvella Administrator Thyroid UK in reply to Clutter]

If you are ill and then improve markedly, you might feel that you can stomach the complaints processes. If you are still feeling unwell, for months and years, the person may well not have the stamina.

I suspect that the subjects of complaints do not represent the actuality. Often it seems that people pursue complaints when that is the only way to get long-term support for the patient. That is, when the family has not got the money to keep going and looking after the wronged patient. it probably needs that sort of impetus to go through with it, sadly.

[Afaghieh]

Well it took me two years to be put on t3 by my Endo. I had such a bad cramps, I thought I had motor neuron disease.