National Programmes of Care and Clinical Reference Groups

What are national programmes of care?

The specialised services commissioned by NHS England have been grouped into six national programmes of care (NPoC). Each has an NPoC that coordinates work across the services in that programme of care.

The six NPoCs have been identified as:

The following four NPoCs are grouped together as acute programmes of care:

Each NPoC brings together clinical and commissioning leadership, an empowered patient and public voice, and policy expertise to:

  • Contribute to the development and delivery of strategy and policy objectives, such as the NHS Long Term Plan.
  • Support regions to commission specialised services which meet population needs, provide consistently high-quality care and excellent patient experience, as part of an integrated care system and patient pathway transformation.

The NPoCs principally operate through a network of affiliated clinical reference groups and task and finish groups.

Clinical Reference Group Model

There are three different models of Clinical Reference Groups (CRG), aligned to the programme of work within each service area. The models are allocated to each service area to ensure that commissioning support provided to CRGs is aligned to prioritised work programmes. Programme of Care teams agree which CRGs within their programme will operate inside each model and this is kept flexible, in line with the commissioning agenda related to that service.


The services led by a Transform CRG are major NHS England priority areas, usually with a national transformation programme in place. These CRGs comprise a fully constituted group that is actively engaged with and advises the national change programme. These groups are led by either a National Clinical Director (NCD) or National Speciality Advisor (NSA).

Lead and inform

The services led by a Lead and Inform CRG have an agenda that requires this group to be active. These CRGs have a full work programme agreed through the relevant Programme of Care (which might include policy development and service specification development). These CRGs comprise a fully constituted group, led by a National Speciality Advisor (NSA).

Respond and advise

Services under the Respond and Advise Model are responsive to requests for expert advice from national, regional teams or ICSs. Services do not have a fully constituted group; instead there is a named lead who will draw on a wider network of sub-specialist advice when required. However, if specific tasks are identified then ad hoc groups may be established for specific tasks on a time limited basis.

Clinical reference groups not affiliated to a specific NPoC

Most of the clinical reference groups (CRGs) are linked to specific NPoCs for guidance and oversight. However, several CRGs have developed over time and stand alone. These are:

The CRG works across all the service-specific CRGs. One of its key roles, working with experts from around the country, is to ensure that the systems and levers currently in place for the procurement, selection and use of medicines in secondary care are as effective as possible in supporting patients to take their medicines; in reducing harm from medicines while ensuring best value.

Getting involved with clinical reference groups

  • NHS England welcome the involvement of interested members of the public and health care staff in the work of the CRGs and is keen to work with all stakeholders including individual patients and carers, charities, patient groups, staff from service providers and commercial organisations.
  • If you would like to get involved you can become a registered stakeholder. You will be kept up to date about the work of the CRGs as well as having the opportunity to get involved in a range of ways.