Abstract
When a politician trots out a list of world leading innovations from the UK, you probably won’t hear the phrase ‘cost effectiveness and rationing in healthcare’. Yet the UK can certainly claim it has the credentials for that accolade. This reputation was in large part earned through two decades of work from the National Institute for Health and Care Excellence (NICE), which is an innovator, leader and global role model in health technology assessment.
But if you imagine that clinicians are waiting for NICE edicts before adopting more cost effective practices, you’d be wrong. A new research paper shows that GPs start switching to generic statins once a patent lapses. 1 Importantly, this is before NICE has even made a recommendation. However, although many clinicians are ahead of the curve, enough continue prescribing more expensive branded drugs, in this case to the tune of over £2bn. The action is clear: that good clinician-led generic switching needs to be implemented more widely, or NICE needs to act faster.
Just as good practice can flourish below the radar, so can bad policy. This month we learn how the government's undesirable ‘hostile environment’ created to deter illegal immigrants has damaging health consequences and might now be labelled as abuse. 2 Another article describes how competency reviews of clinicians would work better if they operated in a ‘no blame’ environment. 3 This is especially desirable given chronic workforce shortages and financial pressures.
As this month's research paper shows, clinicians are taking responsibility to reduce health service costs – an important competency. In a health service that is struggling to contain the demand created by worsening inequalities and a damaging pandemic, it's perhaps too easy to overlook the world class efforts of health professionals.