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an Economist Intelligence Unit business healthcare

Commissioning Support Appraisals Service (CSAS)






Whenever NICE begins to develop a piece of guidance on whether or not a certain drug or other intervention 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 pay the bill – in this case the PCTs.

PCTs have a pre-defined budget to buy in all the health services that are needed for the population they serve – everything from basic quiting smoking programmes to very expensive high-tech intensive care. When NICE says that a drug must be funded, each PCT then has to find the money from within its existing budget- which usually means that it has to make knock-on reductions in services and drugs that NICE hasn’t looked at or ruled on. So it’s important that PCTs get around the table early on in the NICE process to discuss their population-level perspectives. After all, that’s why PCTs exist – to purchase the right mix of drugs and services to meet their population’s needs.


The problem

Up until now PCTs have not on the whole “taken up their seat” in this consultation process. It’s understandable why - they have a lot on their plate and the NICE process can be quite demanding: to be heard in the NICE Guidance process, a PCT must submit certain inputs within very specific (and sometimes short) timelines, and, quite rightly, PCT responses must be precise and accurate. It was evident that PCTs needed support.


Our solution

A collaboration between Bazian and Solutions for Public Health (an independent NHS agency hosted by NHS Milton Keynes) established the Commissioning Support Appraisals Service (CSAS) to help ensure that PCTs can be active and effective consultees to the NICE Technology Appraisal Guidance (TAG) process.

Bazian’s role in the collaboration is to provide, within short time frames, a range of clearly understood and usable deliverables and templates that can be easily and appropriately be used by PCTs when responding to NICE consultation documents.

For example, when NICE produce a draft scope for a new piece of guidance, Bazian will write for the PCTs a short and readable critique of the scope (in less than a week), suggesting ways in which it could be potentially modified and improved. We also carry out evidence reviews, which in effect are rapid and focussed systematic reviews on the efficacy, cost-effectiveness and epidemiology of interventions and procedures being investigated by NICE – usually an individual PCT may find this an onerous task, however because we are familiar with the processes and the outputs required we are able to turn these around in three or four weeks or less;

Draft scope critiques and rapid evidence reviews are two examples of the deliverables Bazian provide to PCTs at key steps in the consultation process. The support provided for PCTs ensures that they have an independent and understandable assessment of the evidence in order for them to better engage with NICE to encourage higher quality guidelines and ultimately better health outcomes for their populations.


The outcome

Before CSAS, PCT consultation in the NICE appraisal process was, well, pretty much negligible (If we’re being precise, PCTs consulted/engaged 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.



“CSAS has simplified a very complex area in commissioning.  This has provided PCTs with the knowledge and raised the importance of PCTs participating in NICE technology appraisals, which was not available prior to CSAS”

Andrew Donald, Director of GP Commissioning Development, South Staffordshire PCT

“CSAS has enabled me as the named PCT consultee to contribute to the consultation phases of NICE Technology Appraisals without the need for time consuming analysis of the data presented.  If it wasn’t for the input from CSAS I believe that most PCTs would not have the time or resource to actively engage with NICE.  CSAS has become a respected resource for evidence review.”

Helen Seymour, Senior Medicines Management Adviser - NHS North of Tyne, Newcastle and Northumberland

“CSAS has provided reliable and comprehensive reviews offering peer support to an important task that has traditionally received low priority in PCTs. CSAS’ role into the future will be to support the new NICE stakeholders in consultations, representing NHS budget holders.”

Dr Alexis Macherianakis, Consultant in Public Health Medicine, Sandwell PCT

“The provision of background evidence to appraisals by CSAS contributed significantly to directing further enquiry around the NICE appraisals of interest. CSAS [has] a continuing role in conducting reviews of evidence and helping to inform service commissioning across a number of areas relating to health and social care.”

Dr. Olufunke Adedeji, Consultant in Public Health Medicine-Health Protection, NHS Northamptonshire

“CSAS has provided me with timely, well researched information enhancing my knowledge and enabling me to adequately represent the views of this commissioning organisation at a scoping meeting. […] I have used CSAS resources to help me with assessing individual funding requests and to inform business cases for medicine use in the absence of NICE appraisals”

Robert Brown, Specialist Pharmaceutical Advisor, NHS Eastern and Coastal Kent

“I have found CSAS very useful when responding to a consultation from NICE as a PCT consultee. The content provided by CSAS has matched PCT issues being considered when evaluating the evidence and impact of a new technology. CSAS should be strengthened to support Local Authorities overseeing aspects of commissioning in the new landscape.”

Neeshma Shah, Head of MedicinesManagement and Pharmacy, and Deputy CD Accountable Officer Medicines Management Team, NHS Camden