NHS must find ways to speed access to new drugs and technologies

BMJ 2016; 355 doi: (Published 25 October 2016) Cite this as: BMJ 2016;355:i5760
  1. Nigel Hawkes
  1. London

New drugs, diagnostic tools, and healthcare technologies could be adopted more quickly if the NHS took a fresh approach, according to the final report of the Accelerated Access Review.1

Streamlining the drug approval process could cut four years off the time needed to bring new medicines to the clinic, the review said. This would be made up by saving 12-18 months in the drug approval process; by cutting delays in approval by the National Institute for Health and Care Excellence (NICE), which typically takes up to two years; and in NHS commissioning and adoption, which usually takes another two years.

“We need to act now to make the most of a tidal wave of new drugs and technologies that are being developed,” said Hugh Taylor, chair of Guy’s and St Thomas’ NHS Foundation Trust, who chaired the review.

Of the initiatives needed to speed access to drugs, only one—the Early Access to Medicines Scheme—is in place. The report credits the scheme with some successes, such as speeding access to pembrozilumab (Keytruda), a treatment for advanced melanoma.

The report said that the rest of the abbreviated timetable could be achieved by pinpointing key innovations earlier and giving them favoured status by designating them as “transformative.”

Each year between five and 10 products—which could be medical technologies, medicines, diagnostic techniques, or digital innovations—should be given the transformative designation to smooth their progress, it said.

Getting the designation would mean meeting a set of criteria, such as the magnitude of health gain, the impact on unmet health need, alignment with NHS England’s priorities, the cost impact, the opportunity to transform care pathways, and the innovative nature of the technology. In practice, these criteria were likely to contradict each other, as has already happened with some new treatments for hepatitis C.

Though approved by NICE, the treatments were being rationed by NHS England through the introduction of “run rates” that were designed to specify how quickly the medicines could be put into use and effectively slow down their adoption. This decision was not mentioned in the report, which did, however, include an introduction by Simon Stevens, chief executive officer of NHS England, that promised to use his best offices to “pull high value innovations through into mainstream care.”

Much of the work in the report was done by an advisory committee chaired by John Bell, Regius professor of medicine at Oxford. He said that a previous attempt to speed up the adoption of new technology by the NHS, Innovation, Health, and Wealth, encountered difficulties. To get it right this time, he said, it was crucial to get NHS England on board and he believed that that was now the case.

The vote to leave the EU has made the need even greater, Bell said, and the Accelerated Access Review “created a first essential step in ensuring that the UK builds a capability in life sciences that leads to strong economic growth and also provides patients and the NHS with much needed tools and technologies at an affordable cost.”

Lord Prior, the health minister, said, “We are determined to make the UK the best place in the world to develop new drugs and other products that can transform the health of patients.”

Charles Gore, the chief executive of the Hepatitis Trust, has written to England’s health secretary, Jeremy Hunt, asking for a meeting about what he said was the rationing of treatments for hepatitis C. “We understand the difficult financial context in which NHS England is currently operating,” he said. “However, we do not believe it is acceptable to ration treatment in this way.”

The trust sought a judicial review of NHS England’s decision but this was turned down.

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