We're supporting NHS England to develop specialised clinical commissioning policies. These are the documents we produce as part of our process.

You can read about our development process here.

Draft policy proposition

The policy working group’s recommendation to NHS England’s clinical panel on whether or not there is sufficient published evidence to justify routinely commissioning a medicine.

It forms the basis on which NHS England creates the final clinical policy within its specialised commissioning policy development process.

The recommendation must be based on the best available evidence. It includes detailed information on the proposed position of the medicine in the treatment pathway as well as the criteria for starting and stopping treatment, if appropriate.

This is the main document we produce.


Supporting documents


Sets out the focus for the clinical evidence review on which the draft policy proposition will be based.

Developed by the Commissioning Support Programme. It includes the population, intervention, main comparator(s) and outcomes of interest.

The scope should identify the outcomes of greatest importance to patients and their carers. We ensure the accuracy of the scope through robust internal quality assurance processes, and by seeking comment from members of the policy working group.

The company is also given the opportunity to comment on the scope before it is finalised.

Clinical evidence review

A summary of the clinical effectiveness and safety evidence on the medicine, together with information on the disease, epidemiology and the medicine’s expected place in the treatment pathway.

Evidence selection includes:

      • Searching – using a search strategy based on the scope.
      • Sifting – a 2-step review of documents to exclude duplicates and studies not fitting scope.
      • Study selection – full inclusion and exclusion criteria from the scope are applied to all full-text articles from sifting stage.
      • Company submission – used to check that all relevant studies have been identified during searching stages. The company may be asked to provide soon-to-be published data for inclusion in the review. Unpublished evidence which has been included in the evidence review will need to have been published before the policy proposition can be finalised. 
      • Data extraction – data from included studies are extracted into standardised tables.

Clinical Priorities Advisory Group (CPAG) summary for the clinical panel

A ‘plain English’ summary of the information in the clinical evidence review summarised for the NHS England clinical panel.

Stakeholder engagement report and comments table

The result of a 2-week stakeholder testing exercise to get feedback on the draft policy proposition and the clinical evidence review from stakeholders (that is, those individuals and organisations who have registered to be stakeholders with the relevant CRG) and CRG members.

  • Comments are collated and summarised by the CSP
  • Any issues which require further action or explanation are raised with the policy working group who provide responses to individual comments. These responses are included in the comments table.

Impact assessment report

A report which details the projected budget impact of implementing the medicine in line with the policy proposition.

Also known as the integrated impact assessment, this document contains information on:

  • 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). This information is obtained from the costing template.

We ask the policy working group to agree on the validity of the evidence in the impact assessment. We may also ask the company to comment on the accuracy of the data in the impact assessment report.

    Costing template

    A spreadsheet budget impact model developed by NICE which projects NHS England costs for the proposed treatment pathway compared to current practice.

      We ask the policy working group to agree the validity of the assumptions informing the costing template. We may also ask the company to comment on the accuracy of the data in the costing template.