TY - JOUR T1 - Evidence and values in the NHS: choosing treatments and interventions well JF - British Journal of General Practice JO - Br J Gen Pract SP - 4 LP - 5 DO - 10.3399/bjgp19X700313 VL - 69 IS - 678 AU - Margaret McCartney AU - Sam Finnikin Y1 - 2019/01/01 UR - http://bjgp.org/content/69/678/4.abstract N2 - It would be entirely possible to waste the total NHS budget on non-evidence-based interventions, resulting in busier staff without making patients healthier or relieving their suffering. Evidence-based practice is crucial, as is cost-effectiveness. No matter how much money we are prepared to spend on the NHS, it will remain a limited resource. The US is a pertinent example of how more healthcare spending does not necessarily translate into better health care, with ineffective and low-value care leading to overuse, and health inequalities and poor outcomes aggressively persisting despite high spending.1 Sustainable, effective health care needs to critically assess the value of interventions, to ensure that the resources we have are used effectively. Additionally, we should question what value means — and whose ‘values’ are considered. Concurrently, we should also ensure that, when interventions are proven worthwhile, there is the resource to service them. But how do we achieve this while general practice has its local services subject to austerity, budgets activity reckoned through big data, paid for by results, subject to commissioning pressures, and with all the uncertainties that even high-quality evidence-based medicine presents? The overdiagnosis movement can perhaps be seen as a cultural counterpoint, trying to ensure that claims for intervention are fairly expressed, and based on suitably robust and applicable evidence, such that individual patient values are listened to and prioritised, preserving the human relationships that underpin health care.NHS England is consulting on evidence-based interventions and has already issued guidance for GP prescribing. Challenge has been rightly made to general practice to stop doing ineffective or low-value interventions. Indeed, work of little value means less room for better-value health care. But there is a concern that ‘value’ as currently practised may mean monetary cost coming first,2 and may be used to describe the values of … ER -