When the NHS underwent it’s recent radical transformation,
the Health and Social Care Act (2012) decreed that “prescribed services” will now
be commissioned on a national level by the NHS Commissioning Board (now NHS
England).
However, what exactly are “prescribed services”? The Act stipulated the four criteria which
define these services and the Clinical Advisory Group for Prescribed Services
(CAG) was then established to review the fit of the ‘old’ list of specialised
services with these four criteria. This
body actually identified that the situation is nowhere near as simple as it
first appears. Ministers therefore agreed
that they would need additional advice.
Hence Clinical Reference Groups (CRGs) were born.
CRGs brought together clinicians, commissioners, public
health, patients and carers who all have
expertise in a particular specialised service area and who volunteered
to develop service specifications and contract products for specialised (prescribed)
services in the ‘new NHS’.
Originally there were 60 CRGs. Their work in the first year enabled NHS England to publish around 130 service specifications and 40 clinical commissioning policies for public consultation.
The success of the CRGs has resulted in their further growth
and development with CRGs now set to continue as the main source of clinical
advice for NHS England specialised commissioning. There
are now 75 CRGs, and counting. They will
be responsible for developing:Originally there were 60 CRGs. Their work in the first year enabled NHS England to publish around 130 service specifications and 40 clinical commissioning policies for public consultation.
·
Further service specifications which describe
what NHS England expects to commission for the population of England in terms
of standards and outcomes. These will form
part of the contract between commissioner and service provider;
· Commissioning policies which describe the
treatment that the NHS proposes to routinely commission for a defined patient
group with a particular illness;
· CQUINs to drive quality improvements through
incentive schemes for providers;
· QIPP plans for their particular service area;
and
· Identifying potential innovations with their
service area;
· Agreeing consistent measures of quality and provider
performance; and
· Developing a communication plan with
organisations and stakeholders that have an interest in the work of the CRG. Hopefully,
this will provide more clarity about how the different groups in the new NHS
landscape will interact and liaise with each other.
Each CRG can have up to 27 members:
· A chair who is a clinical leader in the field of
the specialised service.
· Representatives from each of the 12 clinical
senates, with three representatives from London
· Up to four patients or carers that have
experience of the specialised service;
· Up to four professional organisations that are
involved in the training or professional leadership of clinical staff in the
specialised service;
· An accountable commissioner from NHS England;
and
· Area Team public health or pharmacy leads –
depending on the needs of the work programme.
In discussions with Adelphi, CRG members have told us that things
are MOVING FAST!Whilst CRGs are not actual decision-making bodies, they are starting to have a considerable influence on the ‘look’ of specialised services. Indeed, due to the enthusiasm and expertise of the CRG members, here at Adelphi, we believe that CRGs may become much more influential over the next year – in some cases, even starting to focus on national-level medicines utilisation decisions. This raises key questions such as if a Trust doesn’t abide by the recommendations of the CRG – will it actually get funding for the treatment from NHS England’s Local Area Team in future?
In contrast to what our CRG member advisors often
anecdotally tell us, NHS England has stated that ‘clinical
advice related to drugs used in specialised services will be co-ordinated
nationally by a specialised commissioning pharmacist in the Clinical
Effectiveness Team collaborating with a pharmacist within each of the
specialised commissioning Area Teams.’
Consequently, it will actually be the role of the Clinical
Effectiveness Team to horizon scan for future NICE guidance that will impact on
specialised services and to identify new NICE Interventional Procedure Guidance
that may require clinical commissioning policies. The team will then advise CRGs if service
specifications or commissioning policies need to be reviewed.However, in the past couple of weeks Adelphi has learned that there is a proposed ‘Medicines Optimisation CRG’ on the horizon. This CRG is designed to provide medicines optimisation skills and expertise across specialist medicines commissioning. Rumour has it that this CRG will produce a commissioning policy to cover all specialised drugs that are not on the Payment By Results tariff, with a more streamlined pricing structure.
With all this conflicting information it is not surprising
that many stakeholders are confused and uncertain.
Regardless, it is a fact that the NHS prescribed services landscape is changing apace, so have you thought about what your strategy will be to stay ahead of the changes? Do you know which, if any, of your products may be impacted by the activities of a CRG, and if so, which CRG and in what way?
At Adelphi, we have a proven fast-track to conducting
interviews with CRG members around their focus and their vision. We can
help you to align your strategy with the NHS and make sure that you know who
the key decision makers and influencers will be and what the processes will really
look like.Regardless, it is a fact that the NHS prescribed services landscape is changing apace, so have you thought about what your strategy will be to stay ahead of the changes? Do you know which, if any, of your products may be impacted by the activities of a CRG, and if so, which CRG and in what way?
