NHS England has published a new system of ‘dose banding’ for the 19 most commonly used cancer drugs, moving away from a system where doses are individually calculated for each patient.
NHS England have cited reduced variation and wastage as key benefits of moving to dose banding, as well as reduced waiting times and greater flexibility in terms of where and when a patient can receive treatment. According to NHS England, dose banding will help speed up plans currently being developed as part of the Chemotherapy Services Review to deliver chemotherapy in a range of community and health settings other than hospitals, closer to people’s homes.
Commenting on the announcement Cally Palmer CBE, NHS England’s National Cancer Director, said: “This is an important initiative which will contribute to continuing efforts across the health service to meet the ambitions set out in our Cancer Strategy to improve outcomes and quality of life for cancer patients. By embracing this approach, providers can support patients to receive chemo at appropriate times and in places which are more convenient for them, at the same time as reducing workload for professionals.”
Chemotherapy accounts for approximately £1.4 billion of spending each year, according to NHS England.
This week, 15 cancer charities have written to the Prime Minister, David Cameron MP, expressing “deep concern” about the reforms to the Cancer Drugs Fund (CDF) due to a lack of proposed changes to NICE’s wider appraisal process for cancer treatments. Baroness Delyth Morgan, Chief Executive of Breast Cancer Now, has said “Not a single breast cancer drug has been considered cost-effective by NICE in the last seven years”.
Mark Flannagan, Chief Executive of Beating Bowel Cancer, commented saying that: “Putting NICE back in the driving seat of the new fund, while they still use outdated methods of assessing drugs, will take us right back to the dark ages for cancer drugs funding.”
The signatories of the letter, copied below in full, are as follows:
- Mark Flannagan, Chief Executive at Beating Bowel Cancer
- Cathy Gilman, Chief Executive at Bloodwise
- Baroness Delyth Morgan, Chief Executive at Breast Cancer Now
- Deborah Alsina, Chief Executive at Bowel Cancer UK
- Jane Lyons, Chief Executive at Cancer52
- Kate Lee, Chief Executive at CLIC Sargent
- Monica Izmajlowicz, Chief Executive at Leukaemia Care
- Louise Bayne, Chief Executive at Ovacome
- Alex Ford, Chief Executive at Pancreatic Cancer UK
- Angela Culhane, Chief Executive at Prostate Cancer UK
- Dr Jesme Fox, Medical Director at Roy Castle Lung Cancer Foundation
- Lindsey Bennister, Chief Executive at Sarcoma UK
- Rowena Bartlett, Chief Executive at Tackle Prostate Cancer
- Annwen Jones, Chief Executive at Target Ovarian Cancer
- Sarah Lindsell, Chief Executive at The Brain Tumour Charity
The Cancer Transformation Board, led by Cally Palmer, National Cancer Director at NHS England, has published, Achieving World-Class Cancer Outcomes: Taking the strategy forward, setting out how NHS England plans to implement the recommendations in Achieving World-Class Cancer Outcomes: A strategy for England 2015-2020.
The NHS’s Independent Cancer Taskforce estimates 30,000 lives can be saved each year by 2020 through earlier diagnosis and better treatment and care.
NHS England has also published a blog from Ms Palmer, which can be read here, in which she discusses the implementation plan. Specifically, Ms Palmer outlines that NHS England are "making an additional £15 million initial and immediate investment to explore how we can improve access to diagnostics for those suspected of having cancer, both by looking at new models of delivery and by increasing current capacity."The Daily Mail and The Times were among the news outlets who reported on the publication of the implementation plan.
The Times reports that a new study shows that cancer could be “spotted” early using DNA testing. The article explains that, using a new method, researchers were able to identify one cancer cell among thousands of healthy ones, offering a way to find the disease before it spreads.
The study compared women with ovarian cancer to healthy women with researchers finding low-level genetic mutations linked to cancer in all women, which was higher among those women with ovarian cancer.
Researchers involved in the study believe that this new method could also lead to the development of “liquid biopsies” for a range of other cancers.
You can read the full article here.
The All-Party Parliamentary Group on Cancer (APPGC) has published a report: Britain Against Cancer 2015: Transforming Cancer Outcomes: How can we deliver world-class cancer services?
The report makes eight recommendations, informed by the 17th annual Britain Against Cancer conference in December 2015, and reports the outputs and discussion from the event.
The recommendations are broken down under eight themes:
Access to treatment
- The report outlines the discussion around the Cancer Drugs Fund (CDF), calling for the reforms to the Fund to “focus on evaluation, data collection and transparency”
- The report states that a Question and Answer document published by NHS England alongside the consultation on the CDF, “seemed to suggest that only patients who would be useful to data collection would have access to drugs on the new CDF”
- The APPGC recommends that NHS England and NICE conduct an annual review of the efficacy and impact of the new CDF process
- Focusing on the use of data in improving cancer outcomes, the report calls for the Government to take a “pragmatic approach” to the use of patient data, supporting the role of Cancer Registries whilst addressing concerns over privacy and consent
- Indicators on patient experience and quality of life should be included within the Cancer Dashboard
Funding and accountability
- The APPGC calls on the Department of Health and NHS England to set out their plans for funding and delivering the Cancer Strategy over the next five years, highlighting the uncertainty around the amount of funding available
- The report calls on NHS England and the Vaccination Advisory Committee to ensure that the review into extending Human Papillomavirus (HPV) vaccination to boys reports in 2016, adding that the review’s recommendations should then be implemented rapidly
- The report also highlights smoking, obesity and alcohol as causes of preventable cancer
- The APPGC calls on all parliamentarians to work with their “local health economies” to ensure that improvements in one year cancer survival are delivered by all Clinical Commissioning Groups (CCGs)
- The report discusses the importance of using data to hold CCGs to account for their performance on cancer care
Living with and beyond cancer
- The report calls on NHS England to set out how it will ensure everyone living with and beyond cancer has access to tailored support that addresses their needs, through a recovery package
- The APPGC calls on Health Education England (HEE) to conduct a review of the “cancer workforce” in 2016 to ensure that long term solutions for the cancer workforce can be implemented
New models of care
- The report recommends that NHS England ensures that Cancer Alliances are established in 2016, with “the capacity and capability” to carry out functions including leadership, co-ordination of pathways, patient involvement and data analysis
- The report states that Cancer Alliances will be a “crucial enabler of improvements in cancer care”
The report can be accessed in full here.
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.