Mr Ian Wren
Programme Manager
Specialised Commissioning
NHS England
Dr Tanya Bleiker
Clinical Lead Specialised dermatology
The specialised dermatology Clinical Reference Group has been re-established with its main aim being the amendment and development of specifications that sets the standards for specialised care (current and new). Prior to 2023, there were seven regional Specialised Commissioning teams (one per NHSE Region). The regional teams delivered the strategy developed by the national team and secured services in line with national standards. The Regions developed and monitored services from providers via contracts for specialised services (mainly hospitals); and for this, the ‘NHS Standard Contract’ was used. The important point being that interpretation and implementation of the specifications is a regional decision. Thus, exactly how the specification that informs local contracts has been interpreted may vary as each region interprets how the delivery of safe and effective care can be assured. An example of this recently occurred with biologic therapy in children and young people, whereby in some regions the interpretation is that such drugs can only be prescribed in specialised paediatric centres with consultant paediatricians in the relevant speciality.
From April 2023 the new commissioning arrangements have been implemented for all services contracted by NHS England and delivered at a regional (specialised) or local level (CCG). This includes commissioning of specialised dermatology. Importantly, the role which the national team held in the past namely, standard setting and specification development, remains in the new commissioning arrangements. The CRG are working closely with key stakeholders to review current legislation and amend/revise policy to provide more clarity on delivery of services. Equally, real world experience is now available since the specifications and policies were first devised which means increasing access to certain treatments is both safe and practical for the patient.
In relation to the specialised prescribing issues for children we are working with policy holders to amend the medicines for children policy. This should hopefully resolve issues that some specialised centres are having with prescribing biologics for children.
The CRG has also formed a Task and Finish Group who will be reviewing the current dermatology specification to ensure referral guidelines reduce ambiguity in terms of access to specialised treatment. We hope that this will improve the access issues for both adults and children that have arisen in a number of centres. Please be assured that we have been working hard to get to the bottom of the issues which, understandably, have been very frustrating.