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Background

2. Health Service Circular 2002/004, announcing the risk-sharing scheme, was issued to the NHS on 4 February. The scheme makes provision for an estimated 9,000 MS patients to be eligible for treatment on the NHS with disease modifying drugs. Most of these patients will be monitored in order to assess the long term cost effectiveness of the products.Ministers have expressed their commitment to seeing effective implementation. In England this has taken the form of directions to HAs and PCTs, equivalent in effect to the directions relating to positive recommendations from NICE.

3. The Directions require NHS bodies to fund the provision of treatment under the scheme from 6 May 2002 and the treatment for those patients paying privately on 4 February 2002. They relate not only to the costs of the drugs themselves but also to any infrastructure costs needed to assess and support patients.

Appointment of scheme co-ordinator

4. A consortium led by Professor Jon Nicholl of the School for Health and Related Research (ScHARR) of the University of Sheffield has been appointed to co-ordinate the monitoring under the scheme. Members of the consortium will shortly be approaching neurology centres about the data requirements of the scheme and the arrangements for transmitting these to ScHARR for analysis; in most cases this will involve an initial meeting to establish responsibilities, identify any obstacles and agree timelines.

Action for Strategic HAs

5. Strategic HAs are asked to ensure that local health communities have robust plans in place to implement the scheme and that the provision of funding is recognised as a statutory obligation. There should be an identified lead in each StHA who will take personal responsibility for ensuring implementation. It may be helpful for this person, or a deputy, to attend the initial meetings between the scheme co-ordinator and centres to ensure that any problems are swiftly identified and resolved.

Action for PCTs

6. PCTs should have instituted (or be instituting) the following action to implement the scheme:

- ensure patients already receiving treatment on the NHS or privately are known to the PCT;
- identify the funding from unified allocations to meet their statutory obligations;
- discuss and agree the service developments required to implement the scheme, including agreeing which centres will provide specialist services;
- ensuring arrangements are in place to identify those other patients potentially eligible under the scheme, and to initiate prescribing.

There should be an identified lead in each PCT with the responsibility for driving implementation and for liaison with local trusts, other PCTS, and the scheme co-ordinator.

Action for NHS Trusts

7. The scheme envisages prescribing being undertaken by specialist centres agreed locally. NHS Trusts already designated as specialist centres should:

- estimate infrastructure developments required to implement the scheme;
- negotiate appropriate arrangements for funding with PCTs (making use where appropriate of the available resources described below); and
- formulate plans to initiate prescribing for eligible patients at the earliest opportunity.

NHS Trusts which have the capability of offering an MS service but are not yet designated should make early contact with their commissioning PCTs.

Resources available

8. The MS Society, companies providing MS drugs and the NHS have now jointly agreed partnership funding for 21 MS nursing posts this year. Other sources of funding remain available - companies providing drugs for MS are committed to providing funding for infrastructure to support implementation, including MS nurses, additional consultant sessions, and other clinical and administrative posts. Trusts providing MS services are encouraged to make full use of these additional resources. Where matching NHS funding is required, commissioners should consider whether this could be a cost-effective way of meeting their statutory obligations.

Timetable

9. Strategic Health Authorities have been asked to notify their lead official to:

Colin Pearson, MPI-CCE, Room 6/E/59, Quarry House.
Tel: 0113 254 5975
E-mail: colin.pearson@doh.gsi.gov.uk

StHAs should ensure that a name is put forward by 31 July 2002 copied to each of their PCTS. Similarly, PCT leads should be notified to the appropriate StHA lead by 31 August 2002. We will be seeking an assurance from StHAs by 15 September 2002 that suitable arrangements are in place in each PCT as outlined in para [6] above.