Dr Richard Greville looks at a recent survey asking consultants for their view of drugs availability in Wales.
Back in September, I wrote a piece for Click on Wales in support of the Let’s Talk Cancer project, outlining the facts around the use of medicines in Wales. At the time, I highlighted that the ABPI Cymru Wales Oncology Therapy Group had commissioned a survey of Welsh oncologists and haemato-oncologists’ views on access to new cancer treatments in Wales.
This survey, undertaken by The Pollen Shop, was launched at an event held at the National Assembly for Wales on the 24th November. Our members decided to commission this work after regularly hearing anecdotal evidence from individual front-line clinicians. It was felt to be important to better understand if the concerns that they were hearing were more generally held by the wider consultant-base in Wales.
Between November 2014 and January 2015, The Pollen Shop approached the 98 oncology & haemato-oncology consultants identified as working in Wales. As far as we are aware, this remains the most recent and comprehensive poll of senior cancer clinicians working on the front-line in Welsh hospitals asking specifically for their views and experiences regarding medicines. There were 31 completed responses to the survey – equating to 32% of all the consultants approached. The views of the clinicians who responded, seems unequivocal.
The survey contained eleven questions with the aim of assessing clinicians’ perspectives on – and experience of – routine access to oncology medicines, and the effectiveness of the Individual Patient Funding Request (IPFR) process. The survey was purposely anonymised and responses are not attributable to the individual consultants.
What the survey found was that 84% of the clinicians who responded did not think there was equity of access to innovative cancer medicines within Wales. An even higher percentage (94%) of the clinicians surveyed thought there was less access to new cancer therapies in Wales compared to the rest of the UK, whilst 58% of clinicians reported knowing of patients who had been unable to access necessary cancer treatments in Wales, being referred to England.
In response to the questions on the IPFR process, 84% of clinicians responded that they would discuss with their patients a medicine “not normally available”, and which would therefore require an IPFR submission, if it was agreed as the best treatment for them. However, 65% of clinicians appeared to believe that there was a less than 1 in 5 chance of proving their patient was “exceptional” and was therefore unlikely to receive funding to access the medicine.
The survey went on to ask a number of questions around the ease of completing an IPFR submission. Clinicians responded negatively regarding the ease of; demonstrating clinical exceptionality (88%); administrative / time burden (84%); and the perceived chances of approval (84%).
The survey also contained questions about the recruitment and retention of cancer clinicians in Wales and the placement of clinical trials for new cancer medicines. 87% of clinicians held concerns about the future ability of the Welsh NHS to attract and retain the next generation of doctors working in oncology & haemato-oncology, whilst 94% responded that the lack of availability of cancer medicines in Wales, compared to the rest of the UK, was reducing or restricting the current and future placement and running of clinical trials in Wales.
Finally, the survey asked clinicians views on the newest type of medicines, known as stratified, personalised or precision medicines, which are developed for treating only certain patients, with specific genetic profiles. 94% of the clinicians surveyed thought that Wales required a strategic policy to ensure patients have access to molecular diagnostic testing and appropriate stratified medicines.
We know that, since the survey was undertaken, the Welsh Government and NHS Wales have made some changes to improve access and availability of new cancer medicines in Wales. They have reviewed both the way in which medicines for rarer cancers are appraised by the All Wales Medicines Strategy Group (AWMSG) and the IPFR process. We understand that they are also considering the potential funding of some medicines via a new ‘One Wales’ Interim Commissioning process. It remains to be seen if these changes will achieve the desired impact – of improving access to cancer medicines for patients in Wales – in a timely and equitable way.