There are widespread concerns with the manner and speed with which NHS England have attempted to push Inclisiran, which is a black triangle injectable drug. As there continues to be a number of questions in relation to this, we have published a briefing for practices.
GPC would like to remind practices that the prescription or administration of Inclisiran is not part of the GMS/PMS contract (the LMC continues to raise this regularly with the ICB around the option of commissioning a LES).
Given workload, liability and still-evolving long-term outcomes evidence, practices should not prescribe/administer inclisiran without an adequately funded locally commissioned service. GPC guidance: Inclisiran (Leqvio®) in General Practice: BMA Briefing
We also reiterate the joint BMA/RCGP statement regarding the lack of current evidence about the benefits of Inclisiran.
The LLR APC website has further details including payment remuneration details – can be found on lipid pathway: Lipid Management for primary and secondary prevention of CVD
We advise practices to consider declining requests to prescribe Inclisiran on the grounds that general practices in LLR are neither contracted nor funded to provide the service and/or the current lack of evidence of effectiveness. If a consultant or other specialist feel that Inclisiran will benefit an individual patient the hospital can arrange to provide and deliver it.
Practices are welcome to use either of the LMC template letters, if you are asked to provide this service and wish to kindly decline as practices are not currently funded or contracted to deliver:
- A template letter to secondary care explaining why the practice is unable to accept prescribing responsibility where appropriate commissioning arrangements are not in place: Inclisiran rejection letter to secondary care
- A patient-facing letter explaining the situation and why the specialist service has been asked to retain prescribing responsibility: Inclisiran rejection letter for patient
We would encourage practices to make use of these resources where requests represent a transfer of unfunded or underfunded workload from secondary care into general practice.
It is important that practices continue to challenge workload transfer that falls outside core contractual requirements or is not supported by appropriate funding. While individual practices may feel pressured to accept such work, doing so can inadvertently reinforce the perception that existing arrangements are acceptable and sustainable. When underfunded work continues to be absorbed by general practice, there is little incentive for commissioners to review pathways, address funding gaps, or develop properly commissioned services.