what doctors think about nice
DESCRIPTION
Results of a research project to explore UK doctors attitudes to NICE and the introduction of new products and treatments to the NHSTRANSCRIPT
NICE and the NHS A research report from PharmaTimes & Doctors.net uk
Contents
Introduc3on Methodology and Sample
A;tudes to NICE – Key findings
Key conclusions Appendix
2
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
Introduc3on
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
Methodology and Sample
A;tudes to NICE -‐ Key findings
5
6
2%
10%
25%
53%
11%
0%
8%
23%
59%
10%
Strongly disagree
Disagree Neither Agree Strongly agree
“NICE offers essen3al guidance regarding the most effec3ve ways to diagnose, treat
and prevent disease and ill health”
GPs Specialists
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.
0%
22%
31%
39%
9%
1%
27% 28%
38%
7%
Strongly disagree
Disagree Neither Agree Strongly agree
“NICE’s decisions are driven by arbitrary measures of cost-‐effec3veness rather than
the best outcome for pa3ents”
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
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.
33%
29%
29%
36%
24%
19%
13%
16%
2%
2%
GPs
Specialists
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
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.
2%
15%
49%
30%
6% 1%
20%
41% 36%
3%
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
35%
35%
26%
5%
Specialists
Not sure if I was aware of it or not
No, I was not aware of that before today
I was par@ally aware of that before today
Yes, I was fully aware of that before today
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.
26%
33%
37%
6%
GPs
Not sure if I was aware of it or not
No, I was not aware of that before today
I was par@ally aware of that before today
Yes, I was fully aware of that before today
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
How became aware that the restric3on of prescribing* is illegal
22%
8%
0%
1%
5%
5%
10%
17%
34%
20%
23%
4%
2%
3%
7%
13%
10%
10%
28%
41%
Cannot remember
Other (combined)
Pharmacist
Le`er from the DH
Le`er from CCG, PCT or Hospital Trust
Pharma Company Rep
Online forum or blog
Na@onal newspaper
Medical media
Colleague
Specialists
GPs
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
*of NICE approved medicines for financial or budgetary reasons
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.
27% 22%
25%
15% 10%
3%
38%
18%
27%
13%
4% 1%
Not at all Very rarely Occasionally Quite oden Oden All the @me
“Extent to which the prescribing of NICE approved drugs has been restricted for budgetary reasons in the last six months”
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
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%.
1% 5%
9%
46%
22%
15%
3% 2% 2% 6%
33%
24% 27%
8%
Much more important
More important Slightly more important
Neither is more important than
the other
Slightly more important
More important Much more important
Perceived rela3ve importance of mee3ng financial targets versus prescribing NICE approved medicines
GPs Specialists Prescribing NICE approved medicines Mee@ng financial targets
Q7. Which would you say was more important, mee@ng financial targets or prescribing NICE approved medicines? Bases: All completed respondents, 200 GPs and 200 Specialists
12
13
0% 3%
38%
54%
6% 1% 3%
31%
52%
14%
Will be significantly
lower
Will be slightly lower
Levels will not change
Will be slightly higher
Will be significantly
higher
“Effect on prescribing paNerns of colleagues in primary care”
GPs Specialists
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.
1% 2%
30%
49%
19%
0% 2%
39%
50%
10%
Will be significantly
lower
Will be slightly lower
Levels will not change
Will be slightly higher
Will be significantly
higher
“Effect on prescribing paNerns of colleagues in secondary care”
GPs Specialists
Q10a. To what extent do you think the publica@on of the prescribing uptake of NICE approved medicines will have an effect on the prescribing pa`erns of your colleagues? Bases: All completed respondents, 200 GPs and 200 Specialists
Q9. And are you aware or unaware that all local NHS organisa@ons will have to publish their prescribing uptake of NICE approved medicines? Bases: All completed respondents, 200 GPs and 200 Specialists
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.
0% 3%
46% 47%
5% 0% 2%
53%
41%
5%
My prescribing will be significantly lower
My prescribing will be slightly lower
My prescribing levels will not change
My prescribing will be slightly higher
My prescribing will be significantly higher
Predicted effect of the publica3on of the prescribing uptake of NICE approved medicines on prescribing
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
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
Appendix
16
17
45%
39%
15%
2%
Specialists
Other (combined)
A private prac@ce
A ter@ary centre
A DGH
A teaching hospital
Loca3on and type or prac3ce
6%
23%
37%
35%
GPs
Urban area
Suburban
Semi-‐rural
Rural area
18
3% 4%
40% 52%
32%
33%
20%
10% 6% 2%
GPs Specialists
Age range
61 or over
51-‐60
41-‐50
31-‐40
30 or under
Gender and age
65% 66%
36% 34%
GPs Specialists
Gender
Female
Male
NICE and the NHS A research report from PharmaTimes & Doctors.net uk
For further informa3on, please contact: Dr Tim Ringrose, CEO, Doctors.net.uk: [email protected] Simon Grime, Managing Director – Communica@ons, Doctors.net.uk: [email protected] Neil Reynolds, Director, medeConnect, [email protected]