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The Commissioning Support Appraisals Service (CSAS)

July 8th 2010

CSAS was one year old last week.

Who or what is CSAS? Well, CSAS stands for the Commissioning Support Appraisals Service, which was established to help ensure that PCTs are active and effective consultees to the NICE Technology Appraisal Guidance (TAG) process. That probably still leaves you none the wiser. In effect, whenever NICE develops a piece of guidance on whether or not a certain drug (new or old, but more often than not new) should be provided by the NHS, a key part of the process is to invite stakeholders to have their say. These stakeholders include the manufacturers of the drug, patient groups, carer groups, professional groups, as well as the people who foot the bill – in this case the PCTs.

“Why is it important that PCTs engage?” You might ask. Well, the fact is that PCTs have a budget to buy in all the health services that are needed for the population they serve – everything from quit smoking programmes to high-tech intensive care. When NICE says that a drug should be funded, then each PCT has to find the money from within its existing budget. Which means it might have to make knock-on reductions in services and drugs that NICE hasn’t looked at or ruled on. And we’re not talking loose change here. A PCT cluster we’ve spoken to described that the prescribing budget it sets aside for NICE-approved drugs is about £30 million a year and climbing. So it’s only correct, in our view, that PCTs get around the table to discuss their population-level perspectives. After all, that’s why PCTs exist – to purchase the right mix of drugs and services to meet the population needs (a process called commissioning).

Now, hitherto, PCTs have not on the whole “taken up their seat” in this consultation process. It’s understandable, they have a lot on their plate (commissioning all the services for the population, remember) and the NICE process is demanding: to be heard, you have to submit certain inputs within certain (sometimes short) timelines, and – quite rightly - you have to be precise and accurate in what you say (if you really want to you can read more about it here).

This is where CSAS comes in. CSAS provides a number of services, including:

  • Provision of timely documents to help PCTs frame their consultation inputs, including evidence reviews and critiques of scopes, evaluation reports, ACDs and FADs.
  • Early engagement training and mentoring for PCTs on how the NICE process works and how to engage
  • Specialist support for Appeals
  • Ensuring PCT presence and contribution to NICE Appraisal Committees

And it’s making a difference. For example, before CSAS, PCT consultation in the NICE appraisal process was, well, pretty much negligible (though, if we’re being precise – which in the spirit of CSAS we should be - PCTs consulted in the scoping stage in only 1 out of 90 technology appraisals published between October 2007 and April 2009).

Since CSAS came on the scene, there has been an average response rate of 23%, with an increasing trend too – PCT consultees for the most recent “wave” of technology appraisals responded over 40% of the time. There’s a way to go, but progress is good.

The team behind CSAS is a collaboration between us here at Bazian and Solutions for Public Health (SPH), an independent NHS agency hosted by NHS Milton Keynes.

Happy Birthday CSAS.