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National influencing centres Wellard's NHS training wellards.co.uk 2007

National influencing centres Wellard's NHS training wellards.co.uk 2007. Overview. Introduction Recent changes Surveying the landscape The main NICs and ALBs The key role of healthcare managers NICE Conclusions. Introduction to NICs. Introduction to national influencing centres.

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National influencing centres Wellard's NHS training wellards.co.uk 2007

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  1. National influencing centres Wellard's NHS training wellards.co.uk 2007

  2. Overview • Introduction • Recent changes • Surveying the landscape • The main NICs and ALBs • The key role of healthcare managers • NICE • Conclusions

  3. Introduction to NICs

  4. Introduction to national influencing centres • There have been a growing number of national influencing centres (NICs) over the years • They have an important role within the NHS and have some influence on prescribing decisions • Some NICs are policy developers and some are policy implementers

  5. Surveying the landscape

  6. Starting at the beginning • There are a wide group of organisations which are increasingly influential, but… • What do they all do? • Which are involved in prescribing policies? • How should companies interact with them? • Do 'gatekeeper' relationships need to be assigned?

  7. Beginning the mapping process I • PrescribingAudit CommissionNational Prescribing Centre (NPC) National electronic Library for Medicines (NeLM)Medicines and Healthcare products Regulatory Agency (MHRA) • Health technology assessment (HTA)Scottish Medicines Consortium (SMC)National Horizon Scanning Centre (NHSC)Centre for Reviews and Dissemination (CRD)All-Wales medicines strategy group (AWMSG)National Coordinating Centre for HTA (NCCHTA)National Institute for Health and Clinical Excellence (NICE)

  8. Beginning the mapping process II • Therapy/clinical priority areasSainsbury Centre for Mental Health (SCMH)National Institute for Mental Heath in England (NIMHE) • Health policyKing's FundNHS ConfederationHealth Services Management Centre (HSMC)National Primary Care Research and Development Centre (NPCRDC)

  9. Beginning the mapping process III • Patient groupsRethinkCancerbackupLong-term Medical Conditions Alliance (LMCA) • Public healthNICEPublic health observatories • Primary carePrimary Care Contracting (PCC)National Primary Care Development Team (NPDT)National Primary Care Research and Development Centre (NPCRDC)

  10. Manager/healthcare professional groupsNHS AllianceNHS ConfederationRoyal College of Nursing (RCN)British Medical Association (BMA)Institute of Healthcare Management (IHM)National Association of Primary Care (NAPC) Beginning the mapping process IV

  11. Beginning the mapping process V • Performance managementHealthcare CommissionAudit CommissionNational Patient Safety Agency (NPSA)Monitor (independent regulator of NHS foundation trusts)  • ProcurementNHS Purchasing and Supplies Authority (PASA) • Modernisation agendaNHS Institute for Innovation and Improvement

  12. Prescribing

  13. Prescribing NICs • National Prescribing Centre • Coordinates the UKMIPG and National Collaborative MMS programmes Involved in nurse and pharmacist prescribing and produces MeReC bulletins • Dept. of Medicines Management, University of Keele • Midlands Therapeutic Review and Advisory Committee (MTRAC) • Prescribing Support Unit, Leeds • Works on prescribing indicators, etc. • Prescriptions Pricing Authority, Newcastle • Produces prescribing data, eg, PACTline • Audit Commission • Produces influential reports

  14. Audit Commission bulletin The efforts of the prescribing team need to be directed towards those actions that demonstrably lead to change. Where external pressure, such as pressure from representatives, is counter to the goals of the PCT, a strong line should be taken. This should involve encouraging practices to set down strict guidelines on dealing with pharmaceutical companies. As a result of this policy few GPs now receive these representatives directly. Primary care prescribing (2002)

  15. Clinical

  16. Clinical NICs • National Institute for Mental Health in England • The NIMHE has produced a useful partnership document: Meeting of minds • Sainsbury Centre for Mental Health • Has a number of regional development centres • Rethink • Has appointed new directors, regional managers and national clinical services managers • NICE • Produces evidence-based clinical practice guidelines

  17. Health policy

  18. Health policy NICs • King's Fund • Produce a wide range of reports. The CEO is Niall Dickson • Health Services Management Centre, University of Birmingham • The HSMC has evaluated PMS • Nuffield Institute, University of Leeds • Works on various DH tenders • Manchester Centre for Healthcare Management, University of • Manchester • Prof. Kieran Walsh. Also hosts the National Primary Care Research & Development Centre (NPCRDC) • Universities of Durham, Cambridge, London (LSE & LSH &TM) and Nuffield Trust and the Health Foundation

  19. Healthcare professional groups

  20. Healthcare professional NICs • NHS Alliance • PCT-focused. Chair: Mike Dixon. Annual conference a must • NHS Confederation • 'NHS family' focused. Nigel Edwards is director of policy Annual conference is the largest NHS gathering • British Medical Association • Health policy and economics research unit produces useful materials • Royal College of Nursing • Key around extended nurse prescribing • … and NAPC, BAMM, IHM, RCGP, RPSGB, NCCs, etc

  21. Health technology assessment

  22. HTA NICs • NICE, NHSQIS (SMC and SIGN), AWMSG • Well known NICs • National Coordinating Centre for HTA • Coordinates HTAs for NICE • Cochrane Centre and Collaboration, Oxford • Works on systematic reviews of the evidence base • Continued…

  23. National Electronic Library for Health (NeLH) Produces evidence-based syntheses (also BMA's Clinical evidence) National Horizon Scanning Centre/ UKMIPG/ NPC Produces 'vignettes' of emerging technologies. EWS Regional DESs and ARIF, MTRAC and health economic centres like HERG, ScHAAR, CHE, HERC HTA NICs

  24. The arrival of HTA 'Health technology assessment is the process by which evidence on the clinical effectiveness and the costs and benefits of transferring the technology into clinical practice is systematically evaluated and appropriate recommendations made.'

  25. HTA and managed entry 'Science has two functions: a) it enables us to know thingsb) it enables us to do thingsBut unfortunately lack of knowing has not inhibited doctors from doing' DH R&D director The evaluation by pass Unevaluated procedure Uptake into healthcare system Enthusiasms convictions Should be Useful Evaluated procedure Not Useful

  26. NICE 'NICE may on occasion advise that certain new treatments would not be cost effective. There is no absolute right for new medicines to get onto the market; they have to compete with all the other forms of investment that the NHS has to make. I understand that it would be galling, after investigating large sums of money in the development of new treatments, to find that the institute does not endorse their use in the NHS.' Professor Mike Rawlins, chairman of NICE

  27. Market access • EL (95) 72 first used the phrase 'managed entry' • So this is the 'controlled diffusion' of new technologies • NHS managed entry opposes market access strategies • So some rethinking is required… • The two need to be better 'aligned' • Market access is national key account management • Now a range of influencer organisations involved • HCMs have a unique role to play here

  28. NICE in 2006/07 • National Institute for Health and Clinical Excellence (NICE) • Over 90 TAGsand more CPGs • NICE as a managed entry organisation • Acute trusts and PCTs are struggling • Deinvestment? • PBR, FTs and NICE • Wales and NICE guidance?

  29. A boost to implementation 'When NICE was set up, implementation of NICE guidance was specifically excluded from our terms of reference. In retrospect this was a mistake – and one for which I must take some responsibility.' Prof. Sir Michael Rawlins NICE conference, December 2004

  30. Effort and penalties 'National standards are a public pledge, a statement of entitlement; we have to mean what we say. We are going to have to put more effort into implementation' Andrew Dillon 'The new proposed NHS performance rating system will penalise trusts that fail to implement NICE guidance – so implementation must be taken very seriously' Anna Walker NICE conference, December 2004

  31. Implementation of NICE guidance 'NICE can only fulfil its promise if its "products" are implemented within a "system" which fully supports the changes that NICE promotes. At present this is not the case. There is still ambiguity about how NICE reaches its conclusions and uncertainty about the impact of guidance on the NHS and about who is monitoring compliance. Sharp criticism indicates that NICE's honeymoon period is long over and that there is, or will be, resistance to implementation of pieces of guidance that are particularly expensive or clinically unpersuasive.' From guidance to practice: why NICE is not enough

  32. The atypicals decision: for and against 'The jury is still out on the quality of these treatments. There have not been any systematic independent trials – most have been done for licensing purposes. 'There is evidence that RCT methodology does not suit research into mental health, where outcomes are less clear… mental health is one area of research where the user voice must prevail. The evidence is not thin. Give a room full of health economic decision-makers the choice between a dose of haloperidol and a dose of olanzapine and you’ll be killed in the rush for the latter.'

  33. CRD baggage '… the pharmaceutical industry's decades of research into drug treatments for schizophrenia have failed to answer which drugs cause fewer adverse effects and are more acceptable to users. In the absence of this evidence, the pharmaceutical industry expects the NHS to fund these drugs as a first-line treatment for schizophrenia. We wonder what aspects of clinical services should be withdrawn to fund these drugs. Randomised evidence should form the basis of mental health policy but our review shows we cannot depend on the pharmaceutical industry to produce this.'

  34. HSC NICE inquiry: NHS Confederation views 'The Confederation is concerned that mandatory guidance may distort local priorities. The paradox arises that the government will mandate the funding of a marginally cost-effective drug and local NHS organisations may have to achieve this by not supplying drugs which are much more effective and would benefit more people. Just because a treatment is found to be cost effective does not mean that it would be a good use of resources to fund it if there are more pressing priorities locally'.

  35. The assessment/appraisal gap 'It is difficult to quantify benefits from the evidence available in the literature… The implications of the use of donepezil, rivastigmine and galantamine are unclear. The main issue is whether the modest benefits seen in outcome measures used in the trials would translate into benefits significant to patients.' Health technology assessment (2000)

  36. ICERs 'These results show that an important role of NICE's appraisal committee, and of decision makers in general, is to determine which economic evaluations, or parts of evaluations, should be given more credence.' BMJ, 2005; 330:65.

  37. New paradigms • Registration: the end of the beginning • Efficacy versus effectiveness& new trial designs • Growing need for outcomes research • Economics and epidemiology • Differences between HTA and appraisal • Back to the future on drug safety • New customers for the medical department?

  38. The key role for HCMs • HCMs speak the complex NHS language • HCMs are geographically based • HCMs may have some networks in place already • The role of HCMs as intelligence collectors • The role of HCMs as 'lobbyists'

  39. HTA overview • Additional barriers to market • How to continue to ensure market access? • Growing need for effectiveness data • Growing impact of economic evaluation • Growing impact of NICE and other HTA agencies • Now a real need for industry/HTAA collaboration • Will NICE get much tougher (SMC)? • HCMs should be the 'agents' of market access?

  40. Conclusions • There is a wider range of NICs/ALBs than ever before • The landscape continues to change • Working out what they all do is important • Working out the most influential is key • A watching brief versus an active brief • Key account management strategies • Role of HCMs

  41. Final comments ?

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