Disease Management Proposals For UK NHS

The discussion paper circulated by UK Secretary for State for Health Stephen Dorrell, concerning proposals to involve the drug industry more closely in the running of the National Health Service through the development of disease management packages (Marketletter May 27), says any such agreements should meet certain basic criteria.

These are that, in all cases, NHS parties should satisfy themselves and be able to show: - the agreement is appropriate to a publicly-funded service; - compatibility with national arrangements for prescribing and dispensing of medicines; - the agreement represents good value for money; and - that potential conflicts of interest have been identified and resolved.

Ethical Issues A framework of requirements is provided relating to issues of confidentiality, patients, legal matters, transparency and accountability, financing and ethics. The latter says the agreement should not, nor appear to, undermine or conflict with the ethical requirements of any health care professionals involved, including doctors' duty to provide whatever treatment they consider necessary. Under the NHS, clinicians have a responsibility to prescribe whatever they judge to be clinically beneficial to the patient, and the general principle of the General Medical Council's guidance is that it is unethical for a doctor to put himself in a position that his care of a patient is or could be suspected of being influenced by personal gain. Doctors are expected to consider the ethical dimension of any decision, and if necessary to defend their decision to the GMC.