Alongside the PCT Network's key priority areas, the Network also works on a number of other important issues for PCTs.

NHS Confederation response to NICE consultation

The NHS Confederation has response to NICE's recent consultation on proposals to supplement the advice it gives to its Appraisal Committees when they are asked to appraise life-extending medicines licensed for terminal illnesses affecting small numbers of patients. The issues highlighted in our response are that:

• the financial implications of the proposals are unclear, but could potentially be significant for PCTs;
• there is some concern that treatments and services that are more cost effective but not subject to NICE guidance will lose out to pay for high cost end-of-life drugs as a result of these proposals
• while we understand that these proposed change of policy is an attempt to respond to expressed public values, more research into this topic is required

For full response view the response on the publication panel.

NICE Consultation on Appraisal of End of Life Medicines

NICE intends to supplement the advice it gives to its Appraisal Committees when they are asked to appraise life-extending medicines licensed for terminal illnesses affecting small numbers of patients. The amended advice will ask Committees to consider recommending the use of medicines with an incremental cost effectiveness ratio (ICER) in excess of the upper end of the range normally approved (£30,000 per QALY), when certain criteria are met (see NICE website for details). Feedback we have received so far suggests the key issues for members are that:

• The extent of the likely financial impact for PCTs required to fund medicines that are approved under these criteria is unclear
• The presumption that the public are willing to pay a premium to extend life for a matter of months for small numbers of patients is at odds with some priority setting exercises undertaken by PCTs and cancer networks
• There is concern that the proposals could result in less cost-effective medicines being prioritised over those able to provide greater overall benefit
• There is concern that this change could encourage industry to focus on end of life research rather than other health priorities

Do these reflect the issues you have identified locally, or do you have any other comments on the Institute's proposals?

The consultation period closes on Wednesday 10th December. To share your PCT's responses to this consultation or to provide feedback via the PCT Network, please contact Elizabeth Wade elizabeth.wade@nhsconfed.org by Monday 8th December.

PCT financial management and value for money

The board members leading in this work area are John McIvor, Chief Executive of Lincolnshire PCT and Martin Drury, Chair of Leeds PCT. Initial work includes:

• John McIvor is now part of the PbR Programme Board
• Comments on ISTC wave 3 procurement fed into DH
• John McIvor has been nominated to sit on ISTC audit group

Service strategy and redesign

The board members leading work in this area are Alan Stephenson, Chair of Ashton, Wigan and Leigh PCT and Yasmin Chaudhry, Chief Executive of County Durham PCT. Initial work includes:

• Invitation to participate in an NHS Employers workshop on the future of the medical workforce
• Comments on the NHS Confederation input to the Darzi review

Public engagement

The board members currently leading work in this area are Eddie Anderson, Chair of Medway PCT and Pam Court, Chief Executive of South West Essex PCT.

The initial work includes an invitation to be part of a Foundation Trust Network event on role of FT governors.

Commissioning of primary care

The board members leading this work area are Richard Houlden, Chair of Northumberland Care Trust and Rebecca Burke-Sharples, Chief Executive of Halton and St Helens PCT.

Work currently underway in this area includes:

• Discussion with NHS Employers to ensure PCT input into next phase of GMS contract negotiations
• Input into the revised out of hours training of GP Specialty Registrar position paper
• David Stout wrote an opinion piece on GP access
• David Stout part of the DH National Implementation Team on GP access