Category Archives: Medicines

Guest Post: Time to throw the CDF sticking plaster in the bin by Kevin Grogan

Kevin Grogan
Kevin Grogan

Cards on the table. I don’t like the Cancer Drugs Fund, never have. In fact, having reported on it extensively, I have never spoken to anyone, on the record or off, who thinks the CDF, introduced as a temporary fix, is a good idea.

Since its launch in 2011, while some patients have had access to life-extending innovative treatments, it became very clear very quickly that the £200 million set aside for the CDF would not be enough to meet demand. Even raising that to £340 million could not prevent the removal of some therapies, leaving patients in limbo.

It was therefore welcome news to hear that the National Institute for Health and Care Excellence and NHS England have begun a 12-week consultation on draft proposals outlining new arrangements for the CDF. Plainly put, the proposal is that the CDF will become a ‘managed access’ fund for new cancer drugs to give early access to those which appear promising but which have “currently uncertain evidence bases which are insufficient to support a recommendation for routine commissioning”, NICE notes.

New cancer drugs will normally receive a clear ‘yes’, ‘maybe’ (CDF funding for a time-limited period), or ‘no’ funding decision within 90 days of market authorisation. NICE says it will enable patients to receive new treatments that cannot yet be recommended for routine use but which have genuine promise, while real-world evidence is collected for up to two years on how well they work in practice.  The new scheme would operate from April 2016.

Some people believe this is a step in the right direction but I fear that we may be facing the wrong way. If we are looking to have early access to medicines, perhaps we should cast our eyes in the direction of the aptly-named Early Access to Medicines Scheme (EAMS).

Through EAMS, some patients have been receiving highly innovative cancer therapies before they had a licence and the scheme is complemented by a new NICE technology appraisal and NHS England commissioning process. It is currently funded by pharmaceutical companies and while such a financial arrangement is not sustainable long-term, it seems to me that this type of model  – with the government, pharma companies, NICE, the NHS and yes, patients –  working together to ascertain the real value of a medicine is one that is worth developing further.

The new CDF scheme is scheduled to begin at the same time as Sir Hugh Taylor’s Accelerated Access Review will present its report and recommendations. An interim report, published in October, set out five propositions to speed up access to transformative health technology and interestingly the first of those is “putting the patient centre-stage”.

Sir Hugh said patients were “vital at every step of the innovation pathway and that they needed to be supported to better understand and drive forward decisions about their treatment and care”. His team are looking at a structure that will “systematically facilitate patient feedback on and awareness of innovative products, as well as give innovators better opportunities to hear from patients about the innovations they want and need”. Could the same be said about the CDF? Nope.

The other four propositions are ‘getting ahead of the curve’, ’supporting all innovators’, galvanising the NHS and ‘delivering change’. Admirable sentiments and the interim report is the result of input by over 600 people and organisations working right across the development pathway, including clinicians, patients, the life sciences industry and researchers. You can read the interim report here.

Sir Hugh says he will work with his review team “to flesh out these propositions in ways that will be effective and will make a real and lasting difference to patients, system users, business and the NHS”.  We wish him well.

“Real and lasting”, something that the CDF will never be. As with other old sticking plasters, the best place for it is the bin.

About the author

Kevin Grogan has almost 20 years experience as a journalist writing about the pharmaceutical and healthcare sectors and was most recently senior news editor at PharmaTimes before going freelance earlier this year. He currently writes for a wide variety of publications on both sides of the Atlantic, advises companies about their communications strategies and often appears on television and radio to discuss the pharma industry. A fluent Spanish speaker, he likes Manchester United and listening to old men with funny voices, mainly Bob Dylan and Leonard Cohen.

Follow him at www.twitter.com/kevinatgrogan

Using the WWHAM Pathway in pharmacy to open up a sensitive conversation with patients

The WWHAM Pathway is a tool commonly used in pharmacy to support both pharmacists and counter assistants in opening up a conversation with patients and finding out more about their condition. Generally, pharmacy teams are familiar with the WWHAM questions and how they can be best used in order to deal with common ailments.

Understanding the WWHAM Pathway:

  1. Who is the medicine for? Customers may be asking on behalf of someone else
  2. What are the symptoms? Pharmacy staff can expand on this question to get a full understanding of the symptoms
  3. How long has the patient had the symptoms? Minor ailments can clear up within a few days. Somebody who is experiencing long term symptoms may need to speak to the pharmacist.
  4. What Action has been taken already? This will avoid recommending the same product that a customer has already tried. If a product hasn’t worked it may be best to refer them to the pharmacist.
  5. Are they taking any other medication? This includes prescribed medicines and OTC, herbal or other supplements which can interact with other medicines.

Continue reading Using the WWHAM Pathway in pharmacy to open up a sensitive conversation with patients

NICE and the Value of New Medicine

The great and good of the National Institute for Health and Care Excellence are today at their annual conference in Liverpool, so now feels like a good time to look at how the agency has developed since its launch in 1999 and its plans going forward.

NICE says its Health Technology Assessment (HTA) guidances and clinical guidelines help health and social care professionals deliver the best possible care based on the best available evidence and make the best use of their money in the NHS. However, the agency’s efforts to balance clinical and cost effectiveness and the methodology used in its HTAs regularly come under fire, especially by companies who have seen their treatments turned down for use on the National Health Service. One of the reasons for this is often that whilst NICE seek expert clinical and patient opinion, it can sometimes seem as if the patient’s voice is heard as a whisper compared to the weight of academic science taken in to consideration during the process. Continue reading NICE and the Value of New Medicine