The Cancer Drugs Fund

cancer-drugs-fund_155003654On 1 April 2013, NHS England took on responsibility for the operational management of the Cancer Drugs Fund (CDF). The NHS spends approximately £1.3 billion annually on the provision of cancer drugs within routine commissioning. The CDF was established as an additional funding source to this.

The CDF has provided an additional £200m each year since then to enable patients to access drugs that would not otherwise have been routinely available from the NHS. NHS England recently pledged an additional £160m over the next two years to strengthen the fund. It was established in 2010 and will run until the end of March 2016.

There is a single, national list of drugs and indications that the CDF will routinely fund and standard operating procedures for administration of the fund.

The list of drugs and indications has been originally compiled by NHS England Clinical Reference Group (CRG) for Chemotherapy working with the local clinician leads who oversaw the administration of the ten regional CDFs.

The Chemotherapy CRG continues to play a key role in the management of the CDF through the national CDF panel, a sub-group of the CRG. The chair makes recommendations to NHS England as to how the list should be developed and the group has adopted a formal process of horizon-scanning for new treatments which could have potential benefits for specific groups (cohorts) of patients.

NHS England oversees the fund, with day to day administration carried out by the four regional teams based in the following areas:

  • North of England: Cumbria, Northumberland, Tyne & Wear
  • Midlands and East: Leicestershire and Lincolnshire
  • South of England: Wessex
  • London: London

The list includes drugs and associated indications that will be routinely funded by the CDF. Additionally, NHS England will consider Individual CDF Requests (ICDFRs) for cancer medicines to treat individuals with rarer types of cancers including those affecting children.

Standard Operating Procedures

The Standard Operating Procedures for the CDF 2015/16 set out how the fund will be managed, as well as the process for applications – both for drugs with an identified cohort of patients and for individual CDF requests. The SOP was last revised in November 2014, following a period of public consultation. The changes made to the document at that time enabled the fund to achieve the best overall clinical benefit for patients, within the fund’s annual budget.

Experience of using the document highlighted a number of areas which require clarification and/or correction in order that the Cancer Drugs Fund can operate effectively.  Amendments such as these do not require consultation, and the document has now been amended for use during 2015/16. All of the adopted amendments fall into two categories, which are clearly marked in the document. They are:

  • Updates – factual changes e.g. date changes; names of regional teams/offices – these are highlighted in grey
  • Delegated authority amendments – these are points of clarification and/or correction which fall within the scope of NHS England’s delegated authority, as agreed by the NHS England Board in 2014. These are highlighted in blue.

There are a number of additional, proposed changes to the SOP, which are the subject of public consultation.

Applications to the fund must be made on behalf of patients by a recognised and accredited cancer specialist and must be supported by the NHS trust/foundation trust’s clinical cancer lead. Each drug and indication has its own application form and all relevant clinical criteria for use have to be satisfied.

Detailed information on eligibility, the evidence required and the procedure for applications can be found in the CDF Standard Operating Procedures. In summary, the process will follow the steps below.

  1. Applications for inclusion into the national list of cohort policies will be assessed primarily on the strength and quality of the evidence of clinical effectiveness and anticipated delivery of measurable outcomes such as improved survival rate and quality of life. This process will be conducted by the Chemotherapy CRG.
  2. Applications for individual patients will be processed by the four area teams and should be submitted according to the geographical location of the provider of treatment. Access to the application process is through the links set out at the foot of the page.
  3. If there is an agreed cohort policy for a drug to be funded by the CDF, applications should be submitted online and, where the relevant criteria are met, funding will be confirmed.
  4. ICDFRs for drugs outside the cohort policies will be assessed by the clinically led CDF panels which will be located within each of the four regions. These four panels will use a single, consistent assessment process harnessing a variety of technologies to share and discuss cases to ensure consistent outcomes for patients across England.
  5. The four regional panels will inform the national CRG for Chemotherapy, which will take decisions about new cohort policies when a group of patients requiring the same funding is identified.
  6. A request for review of a CDF decision may be made by the referring clinician to the NHS England Regional Medical Director. However, this can only be requested on the basis that the applying clinician believes the CDF panel failed to follow due process or did not take full account of all relevant evidence. The appeals process will not revisit the merit of the original application, only the process under which it was considered.

The Individual Cancer Drug Fund Request form can be found here. Application forms and details of how to submit requests to the CDF are also available:

Quarterly figures – including notifications and Individual Cancer Drug Fund Requests (ICDFRs)

CDF Financial Position