NHS England has published its General Practice Forward View (GP Forward View), which outlines the organisation’s vision for future general practice. The report details a new package of investment for services totalling approximately £2.4 billion by 2020/21. The plans aim to enable the Government’s ambition to double the annual growth rate in GP numbers, as well as boost the recruitment of new, practice-based mental health therapists and practice clinical pharmacists.
Alongside measures to increase supply capacity in general practice, the GP Forward View also seeks to lessen the demand on individual GPs through the introduction of resilience packages for struggling services and a streamlined Care Quality Commission (CQC) inspection programme. Investment will also be directed into new IT infrastructure tools and the redesign of care arrangements, which will seek to better adapt access, to allow greater choice for patients at off-peak times.
“Taken together, these measures represent the most far-reaching support offered to general practice in a decade”, states the report. The plans are laid out in the report across five core themes: investment, workforce, workload, practice infrastructure and care redesign.
The full report can be accessed here.
This week, NHS England held its Board meeting in London. Of particular note, were discussions covering the devolution of health and social care to Greater Manchester, and a new framework for the management of conflicts of interest among the staff of Clinical Commissioning Groups (CCGs). The Board also approved NHS England’s 2016/17 Business Plan.
The Board papers can be accessed in full here.
This week, four reports have been published as part of the ongoing Accelerated Access Review (AAR). A note on each of the four reports listed is provided below:
- ‘Accelerated Access Review: Proposition 2: Getting ahead of the curve'
- 'Galvanising the NHS to adopt innovation: The feasibility and practicality of recommendations from the interim report of the Accelerated Access Review'
- ‘The Early Access to Medicine Scheme: An independent review’
- ‘Medicines Adaptive Pathways for Patients (MAPPs)’
‘Accelerated Access Review: Proposition 2: Getting ahead of the curve’
PricewaterhouseCoopers (PwC), in partnership with the Wellcome Trust, has published a report entitled ‘Accelerated Access Review: Proposition 2: Getting ahead of the curve’ which makes recommendations for accelerated access pathways and a flexible pricing and reimbursement framework. The report also includes feedback it has received from stakeholders and notes the need to strengthen infrastructure for data collection across all its pathways, with a focus on the benefits of real-world data. Of particular interest, there is no mention of the proposed new model for the Cancer Drugs Fund (CDF) or how the final report of the Accelerated Access Review AAR will align with the new Fund.
The report can be accessed here.
'Galvanising the NHS to adopt innovation: The feasibility and practicality of recommendations from the interim report of the Accelerated Access Review'
The AAR has published a report from RAND Europe, ‘Galvanising the NHS to adopt innovation: The feasibility and practicality of recommendations from the interim report of the AAR’. The reports' primary purpose is to examine perspectives on the feasibility of each recommendation from the AAR interim review and the potential opportunities to support enabling factors.
The report explores the implications of the propositions outlined in the interim AAR report. In particular, three key propositions of interest are examined:
- A new earmarked fund to encourage Academic Health Science Networks (AHSNs) and other key innovation actors to lead system redesign to embrace innovation and the adoption of evidence-based, high-impact innovations
- Mobilising the influence of clinical system leaders to champion change
- Encouraging secondary care organisations to take on ‘innovation champion’ roles linked to financial incentives and a new emphasis on accountable care organisations
‘The Early Access to Medicine Scheme: An independent review’
PwC has carried out an independent review of the 'Early Access to Medicines Scheme' (EAMS). The review makes seven recommendations that build on the work that EAMS has achieved to date. The recommendations are intended to accelerate the adoption of innovative medicines across the NHS, aligning EAMS with the early access and managed access pathways currently being developed as part of the AAR. The reports recommendations are listed below:
- Provide easier industry access to MHRA, NICE, NHS and the devolved administrations
- Provide updated guidance on the benefits and entry requirements of EAMS
- Track patient access of approved products during the EAMS period
- Earlier health technology assessment (HTA) of EAMS-approved products
- Rapid NHS uptake following a positive HTA to provide smooth transition to nationwide access
- Offer funding via application
- Use existing databases to collect real-world data
The full report can be accessed here.
‘Medicines Adaptive Pathways for Patients (MAPPs)’
The Centre for the Advancement of Sustainable Medical Innovation has released a supporting analysis of the underlying ethics of 'Medicines Adaptive Pathways for Patients (MAPPs)'. The report, which also analyses the use of real-world data, explores the views of patients and professionals to demonstrate the potential learnings from MAPPs for similar early access schemes proposed under the AAR, as well as the future CDF framework.
As you may be aware, MAPPs refers to a new, more adaptive approach to medicines development being discussed and piloted by the European Medicines Agency (EMA). The process allows for more timely access to medicines for patients.
The full MAPPs review is available online here.
This week the Chancellor of the Exchequer, Rt Hon George Osborne MP, delivered the 2016 Budget, laying out his spending plans to Parliament. The biggest announcements focused on pensions and education, with the Chancellor reiterating a theme of “putting the next generation first”. The Chancellor confirmed that the Department of Health budget will remain at £4.8 billion each year until 2020/21. Health in general did not feature heavily however.
Of interest to cancer:
- The Chancellor announced that £12 million from the so-called “tampon tax” will be spent on womens’ charities across the UK, including Breast Cancer Care, Jo’s Cervical Cancer Trust and Ovarian Cancer Action
- £5 million will go towards establishing a National Mesothelioma Centre for research into the lung cancer
- At time of writing it has been reported that a deal has been reached to end the tax. It is therefore unclear how the funding for women's charities will be affected by this development
Of interest to public health:
- The Chancellor announced that a sugar levy is to be introduced in two years time, assessed on the volume of sugar in food and drinks. The details are as follows:
- There will be two bands in the sugar levy. One for total sugar content above 5 grams per 100 millilitres and a second, higher band for the most sugary drinks, with more than 8 grams per 100 millilitres
- The Office for Budget Responsibility (OBR) estimates that this levy will raise £520 million, which will be spent on funding school sport in primary and secondary schools
- Duty on manufactured cigarettes will increase by 2 per cent above inflation while duty on hand-rolled tobacco will increase by 5 per cent. This is equivalent to a 21p increase on a pack of 20 cigarettes or a 44p increase on a 30g pack of hand-rolled tobacco
- The duty rates on beer, spirits and most ciders will be frozen this year. The duty rates on most wines and higher strength sparkling cider will increase from 21 March 2016
Of interest to scientific research:
- Science funding will be protected in real terms, with the Government committing to a £6.9 billion investment for research infrastructure by 2021
- The Government will contribute £50 million to the Quadram Institute, a new world-leading centre for food and health research at the Norwich Research Park
The Department of Health, in partnership with NHS England and UK Trade and Investment, has published a prospectus, Genomics and personalised medicine - how partnership with the UK can transform healthcare, detailing the UK’s approach to genomics and personalised medicine, aimed at identifying overseas external partners to invest in the UK life sciences industry.
The document provides an overview of the 100,000 Genomes project, including the network of integrated Genomic Medicine Centres and the UK’s research capabilities.
In the forward, the Minister for Life Sciences, George Freeman MP says, "The UK is investing heavily to set up the necessary infrastructure and levels of service integration to deliver population-wide benefits from genomics. We are in the process of creating an unparalleled end-to-end service, integrating every step of the genomic pathway to maximise patient benefit."
The full document can be accessed here.
New research could lead to "revolutionary bespoke treatments for patients with advanced cancer", which could enter trials within two years, reports The Guardian.
Researchers at University College, London (UCL) have developed a way of finding unique markings within a tumour, its "Achilles heel", allowing the body to target the disease.
The researchers found rare "flag" proteins that act as immune system targets and are displayed on the surface of all of a patient's tumour cells, wherever they might be in the body. Normally they are shielded from the immune system, or missed because rapidly evolving cancers present too many constantly changing targets. These omnipresent proteins, or "antigens", can be "fished out" of the body and multiplied in a lab, in theory allowing scientists to create a targeted treatment for cancer.
But the personalised method would be expensive and has not yet been tried in patients. Experts have said the idea made sense, but warned that it could be more complicated in reality. However, the researchers, whose work was funded by Cancer Research UK, believe their discovery could form the backbone of new treatments and hope to test it in patients within two years.
Professor Charles Swanton, from the UCL Cancer Institute said, "This is exciting. Now we can prioritise and target tumour antigens that are present in every cell - the Achilles heel of these highly complex cancers."
On Thursday 25 February 2016, NHS England held their second board meeting of the year at which they published a board paper on the proposed changes to the Cancer Drugs Fund (CDF). The proposed changes followed an NHS England and NICE consultation from 19 November 2015 to 11 February 2016.
The board paper outlines the responses submitted to the consultation, and recommends that NHS England “agrees to establish the CDF as a new managed access process with clear entry and exit criteria as set out in the consultation document”.
Significantly, the CDF paper also states that the new scheme will go live from Friday 1 July 2016, not on Friday 1 April 2016 as was proposed in the consultation. A detailed standard operating procedure (SOP) for the new CDF will be submitted to the Specialised Services Commissioning Committee for approval, and will be published by June 2016.
The paper also summarises the submissions to the consultation, outlining that 286 responses were received in total, with three key themes emerging:
- There is significant support for change and a move to a managed access process
- There is need to conduct further work to refine and clarify operational detail regarding the management of the new CDF, specifically the entry and exit criteria
- Further detail is needed on the transition between the old and new operating models
Broadly, respondents agreed with most of the questions, although concern was expressed about whether the proposals would lead to more, or less access to cancer drugs compared to the current system. There were also calls for more general reform of NICE and NICE procedures.
Sky News reported on an 'extraordinary' cancer breakthrough after research from the U.S demonstrated a 'potentially revolutionary cancer therapy'.
The research, presented at the American Association for the Advancement of Science in Washington DC, relates to a new technique that involves the removal of immune cells from patients with certain blood cancers, then modifying these T-cells to target the cancerous cells in the body.
Tests on patients with different blood cancers saw response rates for some of more than 80 percent while for others over half of them had a complete remission. However, there were reports of severe side effects such as an over-powerful immune response called cytokine release syndrome. The Huffington Post also noted the small patient numbers involved in the research.
Lead scientist Professor Stanley Riddell, of the Fred Hutchinson Cancer Research Center in Washington State, said "We have a long way to go. The response is not always durable, some of these patients do relapse. But the early data is unprecedented."
The study was also reported by a number of media outlets, including The Guardian.