Commissioning

Overview

Guidance and advice for clinicians on engaging with CCGs and specialist commissioners. Information on this page is currently England-specific.

With more than 200 distinct conditions covered within rheumatology, designing and commissioning rheumatology services presents a significant challenge.

Service design covers a broad range of concerns that professionals may encounter when reviewing the commissioning of rheumatology services within their trust.

The majority of rheumatic musculoskeletal diseases (RMDs) are long-term conditions that require regular, planned and strategic care by rheumatology specialist multidisciplinary teams.

People who may have RMDs initially require prompt assessment, accurate diagnosis and early medical management to reduce symptoms and morbidity and reduce the risk of long-term disability – as preventive medical management is key.

Resources on this page cover areas including access to care, delivery of services, rare conditions, working with primary care, workforce planning, and specialised commissioning. Specific queries on commissioning not covered by the general advice on this page should be directed to our External Affairs team.

What guidance is there for commissioning high-cost drugs?

There are a number of NHSE-approved clinical commissioning policies in place for the routine commissioning of high cost drugs. Each policy has specific criteria which include requirements for the patient to be managed at, or in conjunction with, a specialised rheumatology centre and, where indicated in each policy, a requirement for enrolment (subject to consent) in the appropriate registry:

Teriparatide for osteoporosis in men (adults)
Rituximab in ANCA-associated vasculitis
Sildenafil and bosentan for the treatment of digital ulceration in systemic sclerosis
Rituximab for the treatment of dermatomyositis and polymyositis (adults)
Tocilizumab for Takayasu arteritis (adults)
Rituximab for immunoglobulin G4-related disease
Anakinra and tocilizumab for adult-onset Stills Disease

Has NICE published any guidance on the use of biologics?

In June 2016, NICE published guidance for the use of belimumab for treating active auto antibody-positive SLE. It has taken extensive negotiation and discussion to reach this position, which the CRG has been very closely involved with. It's a significant success for patient care that rheumatology now has access to both biologic drugs. Please note the pathway which must be followed when considering the use of either belimumab or rituximab in SLE.

In April 2018, NICE published guidance for the use of tocilizumab in patients with refractory or relapsing giant cell arteritis (GCA).

What's the role of regional and specialty teams?
Regional networks and regional multidisciplinary/specialty team meetings are key to facilitating the delivery of specialised services for rheumatology patients, including the implementation of commissioning policies. The CRG has worked hard over the last six years to try and create the commissioning opportunities and levers to enable this network development.

Is there any guidance on how to complete the specialised rheumatology quality dashboard?

The completion of the quarterly specialised rheumatology quality dashboard is mandatory for specialised centres. It provides real-time data for providers and commissioners regarding waiting times for new patient appointments, use of high-cost drugs and enrolment of patients on the specified registries in the clinical commissioning policies and NICE guidance. If your centre requires advice about how to register to do this, please get in touch.

The work of NHS England’s specialised services is becoming more focused on patient outcomes, value for money and ‘getting it right first time’. The group will continue to develop commissioning policies for the use of drugs in patient cohorts that are included within the specialised rheumatology service specification, which is also currently being revised.

The need for policies is informed from multiple sources including horizon scanning and individual funding requests (IFR). If you have any suggestions for new policies that you think are required, please tell us.

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