Prime Minister backs limited list
Authors: W. Russell
Journal: BMJ (1985)

The time  registering views with ministers on the plan to have a limited list of drugs runs out at the end of the month, so those with views that they wish to put to Mr Norman Fowler, Social Services Secretary, should move smartly. He remains adamant that the principle is not negotiable, but the contents of the list are open to change. On this, he and Mr Kenneth Clarke, the Minister  Health, have the Prime Minister on their side. Mrs Margaret Thatcher, speaking at a Royal College of Nursing dinner last week, threw her weight behind the plan, asserting that in respect of the limited list the two ministers were doing exactly what she would expect any well run company to do: making sure that supplies were acquired at the best possible price. Ministers are perfectly well aware that the  against the scheme will get rougher but have taken some comfort from the clumsy way that the drug companies at least have been running their side of it. They do want to ensure that the list is as foolproof as possible, because if it is not, given the refusal by the medical profession's representatives to discuss its contents, they are well aware that it will be defective and that they could be politically on a hiding to nothing. Mr Fowler has set up a committee of the great and the good to advise Dr Donald Acheson, the Chief Medical Officer. The trouble with that is that the great and the good are not necessarily as acquainted with the problems of those who toil in the vineyards as they might be. But the Secretary of State takes some comfort from the many letters from general practitioners making positive suggestions. More would be welcome. The drug companies'  has been reaching everybody they think might have an interest, and it is not hard to see why it has so annoyed ministers. Mr Fowler dubbed it black propaganda last week. One group of companies have a leaflet out backing their campaign against two tier medicines that urges people to write to their members of parliament, expressing anxiety about what is really happening, and saying that they should do this for the sake of further conquest of disease which can be achieved in areas like pain, mental illness, and the common cold as well as heart disease, cancer, and epilepsy. It shows clearly what Mr Fowler and Mr Clarke mean when they complain about die tactics. Mr Fowler was urged during question time in the Commons by Mr Gary Waller, Conservative MP  Keighley, to set his face resolutely against a system whereby a general practitioner had to consider a patient's means before con? sidering what prescription to write. Mr Waller said that there was considerable support  generic substitution, but the idea of the limited list was quite another matter.  Mr Fowler insisted that they were not seeking to introduce a two tier system as had been suggested by some of the drug industry's misleading advertisements, and that if a branded drug was found  which there was no adequate alternative it would remain available  prescription. And he once again emphasised the consultation being undertaken about the list's contents. In the Lords at question time Lord Kilmarnock, a Social Democrat health spokesman, questioned whether removing the whole of the intermediate range of analgesics met the pledge that drugs would be available to meet the full range of desired thera? peutic activities since it meant that doctors would have nothing to prescribe  conditions between mild pain and exquisite agony. Ministers take some comfort from the fact that the medical pro? fession does not deny that prescribing habits could be improved, and that previous attempts to do so have not worked very well. The suggestion of the local limited list system, which operates  hospitals, being adopted  general practice?it would meet the profession's objections to a List imposed by central regulation? seems a non-starter.