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NHS England commissioning update

NHS England commissioning update. Mandy Matthews. 14 th December 2018. Use of immunoglobulin in England. NHS England is responsible commissioner for immunoglobulin 2017/18 annual spend approaching £190 million in England Commissioned in line with national Clinical Guidelines

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NHS England commissioning update

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  1. NHS England commissioning update Mandy Matthews 14th December 2018

  2. Use of immunoglobulin in England • NHS England is responsible commissioner for immunoglobulin • 2017/18 annual spend approaching £190 million in England • Commissioned in line with national Clinical Guidelines • Significant supply issues in 2018 • Patient care • Resources required to manage supplies

  3. Significant risks: Availability – nationally & globally On-going growth in use CART-T Market share of products and risk if a supply issue; product choice Variation in use, e.g. indication, dose, frequency Decision making – how robust, variation in IAPs, IFRs Data

  4. Steps to manage risk: Improved collaborative working – Commercial medicines unit, clinicians, NHS England, Public Health England, MDSAS Immunoglobulin project working group Review of the current Clinical Guidelines for Immunoglobulin use Sub-regional Immunoglobulin Panels Proposed CQUIN for 2019/20 Proposed prior approval

  5. Guidelines review: • Launching 1st four sections: • Haematology • Immunology • Infectious diseases (specific) • Neurology • Next steps: • Review use in “other” indications, including other infection-related use • Review evidence for grey indications

  6. Sub-regional Immunoglobulin Assessment Panels (SRIAPs): Improve scrutiny & stewardship of immunoglobulin use Support demand management Manage usage within allocated volumes Improve communication channels in times of supply issues Compliance with NHS England commissioning guidance; review of existing patients; new patients Support data collection

  7. Immunoglobulin CQUIN: Provide funding to support the development of SRIAPs Role of SRIAPs in stewardship of immunoglobulin Ensure compliance with commissioning guidance Support implementation of prior approval

  8. Prior approval: • Automated system to approve use of Ig in line with updated guidance • Approval required prior to use • Options: • MDSAS national immunoglobulin database • Blueteq • How to incorporate this into trust processes

  9. Key messages: Importance of SRIAPs in managing demand New patients to meet eligibility criteria Review of existing patents in line with updated guidance Alternative therapies Data is key – usage & outcomes must be reported on the database

  10. Prior Approval In your groups consider the following: • Options: • MDSAS national immunoglobulin database • Blueteq • Pros and cons of each system? • Issues for providers? • What would support implementation?

  11. Sub-regional Immunoglobulin Panels In your groups consider: Progress so far Issues, concerns Resources required to support the panel

  12. Useful links: Rituximab, as a treatment option, in : Anti-NMDAR autoimmune encephalitis Cytopaeniacomplicating primary immunodeficiency Dermatomyositisand polymyositis ImmunobullousDisease Commissioning policies and position statements are available at: https://www.england.nhs.uk/specialised-commissioning-document-library/routinely-commissioned-policies/ and https://www.england.nhs.uk/specialised-commissioning-document-library/policy-statements-urgent-policy-statements/ Public Health England provides advice on use of immunoglobulin at: https://www.gov.uk/government/publications/immunoglobulin-when-to-use

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