NHS England - Specialised treatments and the Cancer Drugs fund

 

NHS England – Policies


The website for NHS England hosts a wealth of information on what it does. NHS England applies policies to how it decides what to do. These can be found at the following link: http://www.england.nhs.uk/ourwork/d-com/policies/gp/

Identifying Treatments which are Specialised Services

These are listed in a document entitled the “Prescribed Specialised Services Manual”. (page 7 of 31 at http://www.england.nhs.uk/wp-content/uploads/2013/10/comm-intent.pdf):-

“The Prescribed Specialised Services Manual
 
9. The Manual is the technical document that describes the 143 prescribed specialised
services. It sets out which elements of services are commissioned directly by NHS
England and which by CCGs. It provides details of each service to be commissioned
and a rationale as to why a service is commissioned by NHS England and not by CCGs.
 
10. The Manual will be updated to include any changes in commissioning responsibility
agreed by Ministers following receipt of recommendations from the Prescribed
Specialised Services Advisory Group.
 
11. This document will also be updated to take account of any changes in service
description and numbers of providers. All material changes will be highlighted.”

The Current Manual
 
This is a technical document found at http://www.england.nhs.uk/wp-content/uploads/2014/01/pss-manual.pdf
 

Drugs list

The following link is to the current list of drgus which NHS England fund and which are not routinely funded. http://www.england.nhs.uk/wp-content/uploads/2014/03/drugs-list-v8.xlsx

Specialised Treatments

Individual Funding Requests (“IFR”) for Specialised Treatments are dealt with by NHS England who have delegated responsibility for management of them as follows (page 22 of 31 at http://www.england.nhs.uk/wp-content/uploads/2013/10/comm-intent.pdf):-

“Individual Funding Requests
 
93. During 2013/14, the responsibility for Individual Funding Requests (IFR) for
specialised treatments transferred to four regional teams which manage the process
on behalf of the 10 area teams working to a single NHS England “Individual Funding
Requests Policy and Standard Operating Procedure”. The current management
process, the policy and Standard Operating Procedure will be reviewed and revised
for 2014/15, strengthening national consistency. A training programme for panel
members, commissioners and potentially for providers will be available.”

Individual Funding Requests (“IFR”)

The following is a link to the Interim Policy on IFR published by NHS England which applies across the whole of England in specialised services not routinely funded. http://www.england.nhs.uk/wp-content/uploads/2013/04/cp-03.pdf

The following is a link to how NHS England propose to manage IFR. http://www.england.nhs.uk/wp-content/uploads/2013/04/cp-04.pdf

The following is a link to the IFR application form used by NHS England. http://www.england.nhs.uk/wp-content/uploads/2013/09/ifr-from.doc

Area Teams for Specialised services

The 10 area teams are listed here. (page 10 of 31 at http://www.england.nhs.uk/wp-content/uploads/2013/10/comm-intent.pdf):-

“23. The 10 area teams that lead on specialised services contracting across England are:
 
a. Birmingham and Black Country
b. Bristol, North Somerset, Somerset and South Gloucestershire
c. Cheshire, Warrington and Wirral
d. Cumbria, Northumberland, Tyne and Wear
e. East Anglia
f. Leicestershire and Lincolnshire
g. London
h. South Yorkshire and Bassetlaw
i. Surrey and Sussex
j. Wessex “

The Prescribed Specialised Services Manual
 
Specialised services can be commissioned by Clinical Commissioning Groups (“CCG”) but then “move” to be commissioned by NHS England. (page 11 of 31 at http://www.england.nhs.uk/wp-content/uploads/2013/10/comm-intent.pdf):-


“24. In line with the Health and Social Care Act 2012, Ministers take into account four
factors when deciding which elements of specialised services should be prescribed and
therefore directly commissioned by NHS England rather than by CCGs:
 
a. The number of individuals requiring the provision of the service or facility;
b. The cost of providing the service or facility;
c. The number of persons able to provide the service or facility; and
d. The financial implications for CCGs if they were required to arrange for the
provision of the service or facility.
 
25. Ministers take advice from the Prescribed Specialised Services Advisory Group
(PSSAG), a multi-disciplinary committee hosted by the Department of Health.
 
26. The Prescribed Specialised Services Advisory Group will make recommendations to
Ministers who will consult with NHS England on any agreed recommendations. Any
changes in commissioning responsibility will need to be reflected in the Manual, the
Identification Rules and in allocation changes.
 
27. If NHS England becomes the responsible commissioner, commissioning products such
as service specifications and policies will need to be developed. NHS England will also
consider the funding priority of the service through the Clinical Priorities Advisory Group
and a process for selecting providers. Any highly specialised services that become the
commissioning responsibility of NHS England will be discussed at the Rare Disease
Advisory Group (RDAG).”

Cancer Drugs Fund (“CDF”)
 
This operates as a back up to fund treatments which you Clinical commissioning Group might not usually fund. You have to have been through the IFR process and refused (as quickly as possible) in order to be considered for the CDF. The CDF have drawn up a list of those conditions and treatments which they will consider for funding. The management of the CDF is by NHS England and operated regionally although it is has to be consistently operated across England. (page 22 of 31 at http://www.england.nhs.uk/wp-content/uploads/2013/10/comm-intent.pdf):-

“Cancer Drugs Fund
 
94. The Cancer Drugs Fund will continue during 2014 and will continue to be managed as
part of the prescribed services single operating model. The single national consistent
policy for the management of the Cancer Drugs Fund will continue and be refreshed
as required. This will be operationally managed on a regional footprint by four of the
area teams responsible for prescribed services.
 
95. Trusts must have a process in place to ensure that the Cancer Drugs Fund
application is made as part of the decision-making process i.e. patients should be
registered prior to the commencement of treatment, except in exceptional
circumstances, and in any event within 48 hours of commencing treatment. Failure to
do so may result in withholding of payments.
 
96. Invoices must be submitted within three months of use of the drug. All Cancer Drug
Fund drugs will be funded at cost; no additional charges will be accepted and no gain
sharing will be allowed with drugs funded via the Cancer Drugs Fund. From April
2014 the Cancer Drugs Fund audit will be undertaken from returns to the Systemic
Anti-Cancer Therapy (SACT) database. All trusts will be expected to make complete
submissions to SACT for all chemotherapy.”

Policies on treatments
 

NHS England has policies which apply to its specialised services so if your specialised treatment is not approved in those policies you will need to apply via the IFR route with NHS England. (page 19 of 31 at http://www.england.nhs.uk/wp-content/uploads/2013/10/comm-intent.pdf):-

“Implementing Commissioning Policies
 
74. NHS England commissions according to agreed policies and service specifications,
which identify where treatments, devices and services are routinely commissioned.
Commissioning policies that specify treatment thresholds and criteria act within the
NHS contract as group prior approvals for treatment. In some cases, additional audit
requirements may be required with regard to individual prior approval by
commissioners. Where policies and specifications make clear that treatments, devices
and services are not routinely commissioned or where treatment thresholds and criteria
have not been adhered to interventions will not be funded.”

SIX Principles which NHS England must apply.

There are SIX principles highlighted by NHS England (there may be more – See the discussion on NHS Constitution) which they must apply to their decision making on commissioning and in IFRs. (page 19 of 31 at http://www.england.nhs.uk/wp-content/uploads/2013/10/comm-intent.pdf):-

“50. Six principles, or ‘rights’, of effective commissioning form the foundation of NHS
England’s approach to specialised commissioning and these focus on ensuring patients
receive the most appropriate care in the optimum care setting with the most effective
use of specialised resources. These reinforce and build upon patients’ rights under the
NHS Constitution.
 
51. These principles are summarised below:
 
Right patient In order for patients to receive optimum care, they need to be
assessed and referred appropriately.
 
Right provider Ensuring patients are referred to the most appropriate provider
will support achievement of 18 weeks as well as the most
effective use of resources.
 
Right treatment The national service specification compliance process, together
with the implementation of national clinical policies, will ensure
that only the most effective treatments are commissioned from
compliant providers, supported by outcome based evidence.
 
Right place Patients should receive their treatment in the optimum care
setting. This means that patients should receive care within
designated centres that meet national clinical standards, and that
delayed admission and discharge into and out of specialised
care should be considered a priority for action.
 
Right time This recognises the importance of early referral and prompt
treatment, with a particular emphasis on compliance with
national waiting times and delayed discharges.
 
Right price The development of local and national tariffs that represent best
value for money whilst ensuring appropriate levels of
reimbursement is fundamentally important. “

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