We work within the existing framework for specialised clinical commissioning policies set out by NHS England.
Our role is to review the published clinical evidence base for each topic and summarise the main benefits and strength of the evidence. We coordinate the work of the policy working group which provides input into the draft policy proposition.
We also assess the impact of adopting a new product. We do this by modelling the financial impact over 5 years and considering the implications for existing services.
We manage each topic to the point of handing over documents to NHS England for public consultation. These documents include:
- a summary of the clinical evidence
- a draft policy proposition (outlining the policy working group’s recommendation to NHS England on whether the medicinal product should be routinely commissioned)
- the potential resource impact.
How topics are selected
Not all medicinal products can be considered by the Commissioning Support Programme. They must:
- Be directly commissioned by NHS England.
- Already have, or soon be expected to receive, a UK marketing authorisation in the indication of interest.
- Have already been considered, and not selected, for either the NICE technology appraisal or highly specialised technology programmes.
- Be referred to us by NHS England's clinical panel.
Topics are referred to the Commissioning Support Programme by NHS England’s clinical panel. Once a topic is added to our work programme, we notify the company and policy working group members to organise their participation.
We create a scope which outlines the remit for the topic. Where possible, a draft version of this will be issued to the company in advance of the work starting on the topic; this is to give as much notice as possible before an evidence submission is requested. This scope may vary from the final scope.
The topic start date depends on licensing timelines, availability of published evidence and programme capacity. NHS England may indicate that a topic should be treated as a priority.
We develop the documents over a period of 20 weeks from topic start date. After this, we remain involved with the topic until NHS England’s public consultation.
Our process in depth
Full details of the stages and principles we use to help develop commissioning policies:
Search for evidence
The company is invited to provide an evidence submission using our template
We search for published clinical evidence.
Clinical evidence review
- sift the clinical evidence search results
- summarise the clinical evidence using our clinical evidence review template
- grade the clinical evidence (in line with NHS England’s methods).
Policy working group
We arrange a face-to-face meeting with the policy working group for each topic (chaired by the policy working group clinical lead). Working group members can ask questions of the clinical evidence base.
The policy working group will consider whether the evidence shows any clinical benefit for the technology. They will also discuss any appropriate starting or stopping criteria or commissioning arrangements that should be taken into account by NHS England when deciding on the final policy recommendation.
Find out more about policy working groups.
Draft policy proposition
After the meeting, we work with the policy working group to create the draft policy proposition document that reflects the discussions that took place at the meeting.
This is not the final policy position - NHS England’s clinical panel may ask the policy working group to reconsider the draft policy proposition if the evidence does not appear to support the policy proposition contained within the document.
Impact assessment developed
NICE’s Resource Impact Assessment team builds a financial model and tests the assumptions with the policy working group based on feedback received during the policy working group meeting.
Clinical panel reviews the draft policy proposition
The clinical evidence review, draft policy proposition and CPAG summary report are submitted to NHS England’s clinical panel.
For more information see step A7 in Methods: National Clinical Policies.
From this point, exact dates will depend on the outcome of the clinical panel. The week numbers shown are approximate and should only be taken as a guide.
Review of impact assessment documents
We ask the policy working group and the company to comment on a first draft of the impact assessment documents. A timeframe of 2 weeks is given for comments to be returned to us.
The policy working group discussion may cover the following:
- Patient numbers (current patient population, expected growth in patient numbers, current treatment options, patient pathway, treatment setting, coding and monitoring).
- Service impact (implications for the existing clinical services that would be affected by the introduction of the new medicine).
- Financial implications of implementing the draft policy proposition (average cost per patient, overall cost to NHS England and to the NHS as a whole, funding implications and financial risks).
We do not search for any evidence of, or comment on, the cost-effectiveness of the medicine under consideration.
Stakeholder engagement exercise
NHS England run a 2-week stakeholder engagement exercise to get feedback on the draft policy proposition and the clinical evidence review.
After the 2-week deadline has passed, we notify the policy working group of the comments and ask for responses to the main issues raised.
The following documents are circulated by NHS England to registered Clinical Reference Group stakeholders:
- the clinical evidence review
- the draft policy proposition.
We produce a brief engagement report for NHS England, summarising the feedback received and any actions taken to address the comments.
Any amendments to the documentation following stakeholder testing are agreed by the clinical lead. The revised documents are sent to the company for information.
Handover to National Programme of Care
Following an internal quality assurance process, we pass the commissioning support documents for the topic to the relevant NHS England National Programme of Care senior manager for review.
The documents handed over to NHS England include the following:
- clinical evidence review
- draft policy proposition
- CPAG summary for the clinical panel
- engagement report
- comments table, including policy working group responses
- impact assessment report
- costing template
- CPAG summary report (parts 1 and 2).
The programme of care manager submits the relevant documentation to the programme of care board, who will confirm the length of consultation. The programme of care senior manager will then run a public consultation on the documents (see Methods: National Clinical Policies).
We review any comments received during the consultation that challenge the evidence review, factual accuracy or completeness of the commissioning support documents. Otherwise, we have no further role in developing the NHS commissioning policy.
Completed documents uploaded to NICE website
After publication of the consultation findings by NHS England, the documents are added to the NICE Commissioning Support Programme website.
The suite of documents excludes the comments table to protect data relating to individuals who have commented during stakeholder engagement.