Key documents

Roadmap for integrating specialised services within integrated care systems

NHS England and NHS Improvement have issued a letter to the system which sets out the next steps for the delegation of NHS England direct commissioning functions for April 2023, including a roadmap about integrating specialised services within Integrated Care Systems.

Specialised clinical commissioning document library

Our Specialised Clinical Commissioning document library includes:

  • non routinely commissioned policies
  • routinely commissioned policies
  • policy statements/urgent policy statements
  • service specifications.

Service development policy and methods

This service development policy sets out NHS England’s approach for making decisions about which new treatments and interventions to routinely commission, and the approach used for updating existing service specifications, or creating new ones.

It is intended to ensure that funding is allocated fairly and appropriately, with due regard to the competing demands on NHS England’s available funding.

The service development process has three phases:

  1. Clinical build: This phase is where new or amended clinical commissioning policies and new or amended service specifications are proposed and developed. Policy propositions are will need to be underpinned by a clinical evidence review.  NHS England’s specialised services Clinical Panel challenges and confirms whether the proposition has a sound evidence base. Service specifications do not normally require an evidence review and therefore are not normally considered by the Clinical Panel.
  2. Impact analysis: This stage identifies the financial and operational impacts of moving from current pathways of care to the pathways proposed in the draft policy proposition or service specification proposition. The proposed policy or service specifications then are also subject to stakeholder testing, and public consultation.
  3. Decision: For policy propositions and service specification propositions which are cost-neutral or cost-saving, the decision on whether to approve is based on an assessment of its clinical benefit. For propositions which require additional investment and where there is not sufficient funding available to cover all interventions being proposed, the policy propositions are assessed on their likely relative clinical benefit and relative value for money. Using this information, NHS England carry out twice a year a relative prioritisation process to determine which services will be routinely commissioned.

NHS England can rapidly assess policy propositions, for example where there is an urgent clinical case and it would not be appropriate to wait for a decision to be made through the full service development process.  In these circumstances a policy statement can be put in place to provide an interim commissioning position which allows interim access to the service, or to make it clear that there is no access to the service until a full assessment has been carried out. The policy may then be considered in full through the normal service development process.

The service development policy document, and supporting methods documents set out the policy and process for these in more detail.

In the event of non-submission of data to the National Institute of Health and Care Excellence (NICE), NHS England’s procedure is outlined in the document below:

View details of the current service specification and clinical commissioning policy work programmes.

Individual Funding Requests

Individual funding requests (or IFRs) are made to NHS England by clinicians when they believe that a patient’s clinical circumstances are exceptional and because of this, they would benefit from a treatment that isn’t usually available on the NHS. Applications are considered by an independent panel made up of doctors, nurses, public health experts, pharmacists, NHS England representatives and lay members. To find out more about what an IFR is, watch our short animation.

More detailed information about IFRs and how decisions are made is available in our patient guide and process map.

NHS England’s policy and standard operating procedure, which are used for decision making in the case of IFRs, are below.

These documents were consulted on with the public, and a range of other stakeholders, between October 2016 and March 2017. The aim of the revised IFR documents is to make sure there is a timely and consistent approach to managing requests.

You can read the detailed consultation response, which provides a summary of the key themes identified and how these have shaped the new policy and supporting documentation.

Online application form: The IFR team has been developing an online application form. Trusts can now register with the online portal and create IFR applications. The IFR Team will no longer accept a Word application from 1 December 2021. Following this date all submissions must be via the Apollo portal.

Please go to apollo.ardengemcsu.nhs.uk/PreReg to register with the Apollo portal. A user guide is also available on the Future NHS platform.

Terms of Reference for the Specialised Commissioning Oversight Group (SCOG)

SCOG is a decision-making group within NHS England, established in order to deliver the key priority of creating sustainable, clinically effective and affordable specialised services. It has operational oversight of specialised commissioning and holds to account the national and regional specialised commissioning teams in NHS England in delivering high quality specialised services within budget. SCOG also receives recommendations from the Clinical Priorities Advisory Group (CPAG) on the introduction of new clinical commissioning policies  and other service developments.

The Manual

The Manual is a technical document describing the 149 prescribed specialised services. It describes the rationale and which elements of specialised services are directly commissioned by NHS England and which are commissioned by Clinical Commissioning Groups (CCGs).  This document now combines the Manual and the Identification Rules Handbook (see below) and replaces all previous versions.

Identification Rules

The Identification Rules (IR) is a mechanism by which healthcare activities can be identified as specialised. The data flows used to support the commissioning process consist of both standard and non-standard flows of various quality and content. It is therefore not possible to have one single identification method for prescribed activity. There are two products that exist and are required to be used in tandem in order to identify specialised service activity:

Chemotherapy supportive drugs were recognised as an integral part of a chemotherapy regimen when the chemotherapy procurement bands were introduced into the tariff payment system. The drugs incorporated into these payment bands were those that were routinely used during the administration of chemotherapy and are a recognised part of the chemotherapy regimen. So, as examples, anti-emetics, low molecular weight heparin, G-CSF are routinely given as part of some chemotherapy regimens. Drugs which are given to patients outside a chemotherapy regimen to correct or treat cancer/chemotherapy-related complications such as infections and blood dyscrasias, for example, antibiotics and epoetin, are not considered supportive drugs in this context. The accompanying table provides a definitive list of supportive drugs that will be routinely reimbursed by NHS England when given as part of a chemotherapy regimen. These chemotherapy supportive drugs will be funded as part of a budget (block payment) provided to NHS Trusts to fund medicines.

Other NHS England Commissioning Policies

Specialised commissioning is supported by a range of NHS England generic commissioning (listed below) policies that are to be applied consistently and cover a range of areas.