Patients will be able to choose where, when and how they receive some of the most common medical tests for the first time under new proposals from the Department of Health.

From April next year, individuals can select where they receive essential medical tests to make it more convenient for them after discussions with their GP.

Health Secretary Andrew Lansley said the plans are designed to make “medical tests work for you, not the system”.

Individuals will be able to choose from locations closer to home or work instead of being told where the nearest available option is. The decision will be made in partnership with their doctor, who will advise which option is most appropriate.

“Our NHS reforms are all about making life easier for patients,” Andrew Lansley commented.

“No two people are the same, and that’s why our plans will offer patients more personalised care, ensuring that ‘no decision about me is made without me.’”

The DH is also proposing a change to the system that GPs and patients use to choose which hospital they visit for treatment.

Choose and Book will include details on waiting times and provide patients and doctors a better sense of how long they may wait for treatment.

The proposal is part of the DH’s model of a shared decision-making process along the patient pathway.

Most high-level medical customers think biopharmaceutical companies should take more commercial risks, according to a new survey.

The New Health Report 2012 from Quintiles also noted that a majority of pharma executives and their customers support more risk sharing in commercial deals.

It also found that 81% of UK patients with long-term conditions would be willing to accept greater clinical risks for the sake of greater benefits.

The report was based on a survey of more than 1350 biopharmaceutical and healthcare management executives and healthcare investors in the US and the UK.

Better metrics are needed to assess both commercial and clinical risks for the sake of wider consensus, the report concluded.

More than half of NHS executives thought the pharma industry was too risk-averse, while 65% of industry executives thought their companies too enough or too many risks.

However, there was widespread agreement between companies and customers on the value of risk-sharing agreements, with 73% of NHS executives and 55% of industry executives convinced they would promote innovation.

More than 70% of biopharma executives and UK payers also believed innovation would benefit from pre-competitive agreements between companies.

John Doyle, Managing Director of Consulting at Quintiles, commented: “Payers’ interest in early involvement in the drug development process, complemented by their experience in balancing risk and benefit, could serve as a wake-up call to the biopharmaceutical industry.”

The Department of Health plans to introduce barcode medicines management systems in care homes by 2014 to reduce the incidence of medication errors.

The policy was developed in response to the finding that over 50% of care home residents suffered a medication error within a three-month period.

The DH’s recent strategy document The Power of Information highlighted existing technologies for electronic checking of medicines and doses.

Following the publication of the strategy, the DH said: “It is our ambition for all care homes to use barcode medication in the future. A number of pilots are now being established to determine how this can best happen.”

The pilots will seek to incentivise the use of barcode medication administration systems such as the Pro-active Care System from Pharmacy Plus, which has been trialled by NHS Bristol.

Research by University of West Of England found that 52% of care home residents experienced a serious medication error, such as receiving another patient’s medication, in any three-month period.

Patients using opioids to relieve pain when receiving palliative care for chronic or incurable illnesses will be given advice on their use as part of a new clinical guideline published by NICE.

The guideline aims to ensure safe and consistent prescribing of opioids as a first line treatment option through clear communication and instructions on their initial and on-going use.

Dr Damien Longson, Chair of the Guideline Development Group for the guideline, said the new measures are “key to ensuring any worries or uncertainties are addressed”.

Evidence found, NICE said, that pain caused by advanced disease remains under-treated, despite a range of opioid options available for use on the NHS.

Patients are also wary, research suggests, about the long-term use of the treatments, their side-effects and the possibility of becoming addicted.

As part of the guideline, clinicians will discuss any worries with patients when prescribing strong opioids and offer access to a frequent review of pain control and side-effects.

When starting treatment, patients should be offered advanced and progressive disease regular oral sustained-release or immediate-release preparations.

Also, oral sustained-release morphine should be offered as a first-line maintenance therapy to patients with advanced and progressive disease who require strong opioids.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said there were currently a number of uncertainties around the use of the drugs which the guideline hopes to erase.

“Many people with chronic or advanced conditions will experience a high level of pain which can only be treated by opioids such as morphine as weaker forms of pain relief will no longer be effective,” he said.

“However, we understand that patients can be anxious about using these medicines for a number of reasons. Likewise, healthcare professionals may not always be sure about when to prescribe certain types of opioids.”

NICE has recommended Xarelto (rivaroxaban) in final guidance as an option for the prevention of stroke and systemic embolism in people with atrial fibrillation (AF).

The recommendation means patients will get access to the first single tablet, once-daily, oral stroke prevention medicine since the introduction of warfarin in the 1950s

Luis-Felipe Graterol, Medical Director, Bayer HealthCare UK, said the company is “delighted” with NICE’s decision and will now work with local NHS fundraisers to “help evolve services” with Xarelto.

Up to 700,000 people in England and Wales have AF. People with the condition are at a higher risk of developing blood clots and subsequent stroke.

Xarelto is an orally administered drug that helped prevent blood from clotting and has a UK marketing authorisation for the prevention of stroke and system embolism in those with non-valvular AF who have associated risks.

The guidance adds that the decision to swap treatment from warfarin to Xarelto should be discussed between the clinician and patient to highlight any reported risks and benefits.

“We know that some people taking warfarin can find it difficult to maintain their blood clotting at a proper level,” said Professor Carole Longson, NICE Health Technology Evaluation Centre Director. 

“Rivaroxaban, like dabigatran etexilate, which NICE recently approved as an option for this indication, can benefit people with AF. We are therefore pleased to recommend rivaroxaban as another cost-effective option for the prevention of stroke and systemic embolism in people with atrial fibrillation.”

NICE recommended Boehringer Ingelheim’s Pradaxa as a treatment option in final guidance for the same indication back in March.

An integrated approach to the diagnosis and management of ovarian cancer is fundamental to the delivery of high quality care, NICE states in a new quality standard for the disease.

Eight quality statements are included in the standard, including women over 50 reporting one or more symptoms of the disease being offered a CA125 blood test to check protein levels.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said the statements aim to “drive improvements in the diagnosis, care and treatment of this disease”.

There are around 4,400 deaths from ovarian cancer in the UK each year. Around 6,500 new cases are diagnosed annually, with women over the age of 50 at a higher risk.

The diagnosis of the disease is often delayed as its symptoms are similar to those in more common conditions such as irritable bowel syndrome.

The new quality standard states that along with offering women reporting symptoms a CA125 test, they should be given an ultrasound within two weeks of results showing raised CA125 levels.

Those found to have a mass, growth or lump next to their uterus should then be offered an MRI scan to help determine if the lesion is benign or malignant.

“We know that the poor survival rates of ovarian cancer may be linked to late diagnosis, which is often because of a lack of awareness of the early symptoms, which include abdominal bloating or pain and difficulty eating,” said Dr Leng.

“Quality standards help to achieve the goals set out in the NHS Outcomes Framework, as well as informing new Quality and Outcomes Framework indicators.”

NHS diabetes services in England are failing to deliver adequate care and allowing too many patients to develop complications, the National Audit Office (NAO) has said.

The NAO estimates that the NHS spent £3.9bn on diabetes services in 2009–10, but only half of patients received the recommended standards of care.

It recommends only paying GPs for diabetes care if they provide all nine relevant care processes, including a range of tests.

According to the NAO report, the achievement of treatment standards and expected levels of care for diabetes is poor, with no PCT delivering adequate care to all its diabetes patients.

Only half of people with diabetes received the recommended standards of care in 2009–10, though this is an improvement on the 36% achieved in 2006–07.

Fewer than one in five people with diabetes are receiving the recommended tests to measure blood glucose, blood pressure and blood cholesterol.

The NAO states that the variation in the quality of care received by people with diabetes “cannot be explained by need or spending alone and is likely to be influenced by the local organisation and management of health services”.

Amyas Morse, head of the NAO, said: “The expected 23% increase by 2020 in the number of people in England with diabetes will have a major impact on NHS resources unless the efficiency and effectiveness of existing services are substantially improved.”

Among the NAO’s recommendations are:

• GPs should only be paid for diabetes care if they deliver all nine of the recommended care processes, including tests for complications and risk factors.

• The NHS Commissioning Board should “introduce effective systems of governance and accountability” to minimise inequalities in diabetes care.