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  • Includes England and Wales; CSAS represents only English PCTsUpto 30 consultee organisationsSpecial privileges to consultees; earlier opportunity to comment and influence appraisal, represented in person at the appraisal meeting.
  • Transcript

    • 1. NHS savings and NICE guidance: CSAS coordinated engagement with NICE
      Dr Mohit Sharma
    • 2. NICE process
      • Topics decided by ministers
      • 3. Two PCTs randomly selected to be consultees to represent commissioners from the scoping stage to the appraisal determination
      • 4. May be 30 other organisations involved
      • 5. Appraisal committee meeting
      • 6. Appraisal consultation document
      • 7. Consultee PCTs
      • 8. General public after 5 days (patients, public, clinicians and manufacturers)
      • 9. Tight (and inflexible) deadline for submission of comments
    • Problems encountered
      PCTs not engaging with NICE
      Unaware that they are consultees
      Capability, capacity
      Competing commitments / priorities
      Participation required a major resource commitment
    • 10. As a result…
      Of the first 176 TAGs produced by NICE, no PCT input
      7 PCT appeals against NICE guidance
    • 11. Commissioning Support, Appraisals Service (CSAS)
      Service delivered by Solutions for Public Health (NHS Milton Keynes)
      Lead commissioner NHS Birmingham East and North
      Commissioned jointly by all English PCTs (152)
      Set up in July 2009, operational from September 2009
    • 12. Rationale of CSAS
      Limited PCT capacity to release staff with the skills and expertise
      Infrequent involvement in the TAG process for an individual PCT
      Steep learning curve and tight timescales
      Random selection – selected PCT might not be the most the most appropriate for the topic
    • 13. Aims of csas
      Service to enable PCTs to contribute to and influence NICE technology appraisal guidance
      Engagement and mentoring of consultee PCTs
      Training to help understand the NICE process
      Provide documents (evidence synthesis reports and critique of draft scopes)
      Enable PCT presence and contribution to NICE appraisal committees
      Support for appeals
      Develop a relationship with NICE
    • 14. Appraisal consultation documents (ACD)
      These are released by NICE if the draft recommendation of the appraisal committee are likely to be ‘significantly restrictive’
      Initially embargoed for 5 days (apart from consultee PCTs)
      15 working days for all others to comment.
    • 15. Commentary on ACDs
      Based on the evidence available and the defined scope of the topic
      Produced by CSAS and Bazian
      Provides a commissioner’s perspective
      Easy to read and digest
      Set out as required for the feedback form
      QA prior to dissemination
      Sent directly to all PCTs and disseminated through other routes (NPA, ADPH)
    • 16. ACD commentaries to date
    • 17. Results so far…
      Four ACD communications so far
      2, 10, 14 and 13 responses
      …from 152 PCTs
      …but huge improvement on 0!
      Appreciative and constructive feedback from PCTs
    • 18. The future
      NICE will survive the changes
      Commissioning organisations will continue to exist (though may have different forms)
      Pressures on the NHS to deliver savings will mount
      The issue of affordability will need to be considered though it is currently outside of NICE’s remit