NHS England Specialised Commissioning is the responsible commissioner for all radiotherapy services across England. The exact scope of NHS England’s commissioning responsibility is set out in the Manual for Prescribed Specialised Services.
This includes all forms of radiotherapy including brachytherapy and associated outpatient activity. In addition, the service includes all provision of intracranial stereotactic radiosurgery/radiotherapy and extracranial stereotactic radiotherapy. This applies to provision in adults and children.
Radiotherapy clinical reference group
This service area is supported by a Clinical Reference Group (CRG). The main function of a CRG is to provide the primary source of clinical advice for specialised services and the membership comprises clinical, Patient and Public Voice (PPV) representatives and professional associations. Each CRG is also supported by an NHS England Commissioning Lead and Public Health Lead.
Membership of radiotherapy clinical reference group
- Imogen Locke, Chair
- Carol Scott, Clinical Member
- Christopher Scrase, Clinical Member
- Christopher Walker, Clinical Member
- Petra Jankowska, Clinical Member
- Rachel Cooper, Clinical Member
- Ramkumar Shanmugasundaram, Clinical Member
- Sarah Helyer, Clinical Member
- Rose Gray, Patient and Public Voice Representative (Cancer Research UK)
- Julie Wolfarth, Patient and Public Voice Representative
- Georgina Wiley, Patient and Public Voice Representative
- Charlotte Beardmore, Affiliate Member (Society of Radiographers)
- Spencer Goodman, Affiliate Member (Society of Radiographers)
- Tom Roques, Affiliate Member (Royal College of Radiologists)
A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the Regional Commissioning Teams to contract services.
Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.
The following service specifications fall within the scope of this CRG:
- External beam radiotherapy services delivered as part of a radiotherapy network (adults)
- Operational delivery networks for external beam radiotherapy services (adults)
- Stereotactic radiosurgery/radiotherapy – intracranial (all ages)
- Breast Radiotherapy Injury Rehabilitation Service (Adult)
- Brachytherapy and Molecular Radiotherapy (All Ages)
- Proton Beam Therapy NHS Service (All ages)
- Proton Beam Therapy Service – Overseas programme (Adults and children)
Clinical commissioning policies
A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.
The following policies fall within the scope of this CRG:
- Brachytherapy dose escalation with external beam radiotherapy for intermediate and high-risk localised prostate cancer
- Proton beam therapy for breast cancer (all ages)
- External beam radiotherapy for patients presenting with hormone sensitive, low volume metastatic prostate cancer at the time of diagnosis
- Selective internal radiation therapy for chemotherapy refractory intolerant metastatic colorectal cancer (adults) (effective from 1 April 2019)
- Selective internal radiation therapy (SIRT) for the treatment of chemotherapy refractory or intolerant, unresectable primary intrahepatic cholangiocarcinoma (all ages)
- Stereotactic radiosurgery and radiotherapy for pituitary adenomas (RC)
- Hypofractionated external beam radiotherapy in the treatment of localised prostate cancer (adults)
- Proton Beam Therapy for cancer of the prostate
- The use of Stereotactic Ablative Radiotherapy (SABR) in the treatment of prostate cancer
- The use of Stereotactic Ablative Radiotherapy (SABR) in the treatment of previously irradiated tumours of the pelvis, spine and nasopharynx
- The use of Stereotactic Ablative Radiotherapy (SABR) as a treatment option for patients with Hepatocellular carcinoma or Cholangiocarcinoma
- The use of Stereotactic Ablative Radiotheraly (SABR) as a treatment option for patients with oligometastatic disease
- The use of Stereotactic Ablative Radiotherapy (SABR) as a treatment option for patients with Renal Cancer
- Stereotactic ablative radiotherapy (SABR) for Hepatocellular Carcinoma (adults)
- Stereotactic ablative radiotherapy (SABR) for patients with metachronous extracranial oligometastatic cancer (all ages)
- Stereotactic ablative radiotherapy (SABR) for patients with previously irradiated, locally recurrent primary pelvic tumours (all ages)
- Stereotactic Ablative Body Radiotherapy for Non-Small-Cell Lung Cancer (Adult)
- Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) to the surgical cavity following resection of cerebral metastases (All ages)
- Proton beam therapy for children, teenagers and young adults in the treatment of malignant and non-malignant tumours
- Proton Beam Radiotherapy (High Energy) for Skull Base Tumour Treatment – NHS Overseas Programme (Adult)
- Pallative radiotherapy for bone pain
- Radiotherapy after primary surgery for breast cancer
- Stereotactic Radiosurgery/Stereotactic Radiotherapy for Cerebral Metastases
- Stereotactic radiosurgery/radiotherapy for ependymoma, haemangioblastoma, pilocytic astrocytoma and trigeminal schwannoma
- Stereotactic radiosurgery (SRS) for adults with Parkinson’s tremor and familial essential tremor
Clinical commissioning policy statements
Policy statements are brief documents that define the current commissioning position to support service contracting.
The following policy statements fall within the scope of this CRG:
- Proton Beam Therapy for Adult Lymphoma
- Proton Beam Therapy for Head and Neck Cancer in Adults
- Proton Beam Therapy for Hepatocellular Carcinoma
- Proton Beam Therapy for Lung Cancer (Adults)
- Proton Beam Therapy for Oesophageal Cancer in Adults
- Selective Internal Radiotherapy (SIRT) (for review from 1 April 2019) | Appendix A – Selective Internal Radiotherapy
- Stereotactic ablative radiotherapy (SABR) for patients with previously irradiated, locally recurrent para-aortic tumours (All ages)
Commissioning through evaluation
NHS England’s Commissioning through Evaluation (CtE) scheme for the use of Selective Internal Radiation Therapy (SIRT) to treat cancerous tumours in the liver is now complete. The independent evaluation of the scheme led by the National Institute for Health and Care Excellence (NICE) has now been published.
NHS England’s Commissioning through Evaluation (CtE) scheme for the use of Stereotactic Ablative Radiotherapy (SABR) to treat cancer is now complete. The independent evaluation of the scheme led by the King’s Technology Evaluation Centre (KiTEC) is expected to be published shortly.