East Lancashire cholesterol drug row: GPs explain inclisiran access concerns

The Lancashire and Cumbria Consortium of Local Medical Committees (LMCs) has responded to the Burnley Express report about retired Burnley vascular surgeon Robert Hughes (81) who said he had struggled to access inclisiran despite believing the treatment could reduce his risk of a major cardiovascular event.

The consortium said it “fully agrees” that patients who meet the clinical criteria should have access to inclisiran – but said the issue centres on who is responsible for commissioning and funding the service involved in providing it through general practice.

It said there had been “some misunderstanding” over the £15 difference between the £45 purchase price of the medicine and the £60 reimbursement received by GP practices.

According to the LMCs, the £15 is not a payment to practices for administering the injection, but forms part of the medicine reimbursement arrangements.

The consortium said providing inclisiran also involved identifying eligible patients, prescribing, shared decision-making, arranging six-monthly recalls, administering the injection, maintaining records and taking ongoing clinical responsibility for treatment.

The LMCs said Lancashire and South Cumbria Integrated Care Board had originally recognised this as additional work when it proposed funding inclisiran through a Complex Injection Local Enhanced Service.

That arrangement was subsequently withdrawn following the introduction of national reimbursement arrangements.

However, the consortium said the work required from GP practices had remained.

“The work did not disappear,” it said. “The prescribing responsibility, six-monthly recalls, administration and ongoing clinical governance remain.”

The LMCs said changing how the medicine itself is reimbursed did not automatically make the additional work part of core general practice services.

It also described inclisiran as an example of what it sees as a wider problem for GPs, with practices increasingly expected to take on work when there are gaps elsewhere in NHS pathways.

The consortium said this could include monitoring, prescribing, investigations or administering treatments which originate elsewhere in the NHS.

It said general practice “cannot be the default provider for every gap in NHS commissioning”. However, the LMCs stressed that it was not opposed to inclisiran and did not want eligible patients to be denied treatment.

It said patients who believe they may be suitable should continue to discuss the treatment with their GP.

The consortium said patients should not be caught in the middle of a dispute over NHS commissioning.

“If the ICB expects general practice to deliver inclisiran, then the service should be properly commissioned and funded,” it said.

“If another NHS provider is responsible for delivering the service, then patients should have access to that pathway.”

The comments come after NHS Lancashire and South Cumbria ICB previously told the Express that inclisiran is commissioned across Lancashire and South Cumbria and that patients should be assessed against the same national clinical criteria regardless of where they live.

The ICB said the pace at which cardiovascular prevention programmes are implemented can vary because of factors including local population health needs, investment decisions, workforce availability and provider readiness.

Mr Hughes has argued that greater awareness is needed among patients who could potentially benefit from the treatment and that they should be able to discuss it with their GP.