Three London CCGs working in partnership approached us to ensure that they had a robust decision making process when identifying and recommending any cessation or restriction of prescriptions, as part of their policy on spending NHS money wisely.

Our objective was to equip CCG Clinical Leads with the information, support and tools to make informed recommendations to the CCG governing bodies. We created an approach, a scoring procedure and a format for Clinical Evaluation Panels, to structure the debate around decisions on what treatments should be commissioned, and why.

We assembled a panel of local experts, including public health, medicines management, consultation and equalities specialists, who were on hand to provide clarity and insight (without voting).  This process was designed to ensure the panel had a clear understanding of the impact of restricting access to a number of procedures and prescriptions would have on the health and wellbeing of their local populations.

The panel considered 33 national proposals using this methodology in order to make recommendations to their local governing bodies.  Clinical leads valued the opportunity to discuss the impact and implications fully before making these difficult decisions.  Clinical leads, at times, changed their initial vote based on the constructive debate of the evaluation panel and the subject matter experts.

Senior leadership observed a distinct change in the quality of the conversations had by clinical leads, which has continued beyond our involvement. They continue to challenge effectively, debate more constructively and readily identify when they need more information on its wider impact in order to make a sound clinical decision.

Building on this success, the CCGs are using the same process to assess a further 21 proposals they are considering for consultation.  We are exploring a skills transfer process to enable the CCGs to manage the process themselves.