Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.
The following service specifications fall within the scope of the Dermatology CRG:
· Xeroderma pigmentosum service (All Ages)
· Specialised Dermatology Services (All Ages)
· Cancer Skin (Adult)
· Epidermolysis bullosa service (All Ages)
The NHS England Manual of Specialised services also includes, under specialised dermatology, cancer and Infections (including HIV). These are not specifically covered in the above specifications. However, there must be close links with these areas reflecting the importance of clinical collaboration across specialties in managing patients with cancer or infections such as HIV involving the skin.
Some dermatologists with expertise in a particular dermatological subspecialty manage adults and children, the latter in an appropriate specialised paediatric setting. The generic Specialised Paediatrics service specification will apply to patients up to the age of 19 years referred to the specialised dermatology service.
The following policies fall within the scope of the Dermatology CRG.
· Rituximab for immunobullous disease
Not routinely commissioned:
· Infliximab for the treatment of hidradenitis suppurativa
Providers of specialised services that utilise high-cost drugs will participate in CMU therapeutic tenders and comply with Pharmex data collection requirements as a condition of reimbursement. NHS England is also working with NICE and the newly reformed CRGs to ensure that treatment algorithms for drugs commissioned by NHS England reflect optimal use of the most cost-effective treatments. Trusts will be supported to address unwarranted variation.
In order to provide assurance that high cost drugs are being used appropriately and in line with commissioning policy, specialised centres will be required to act as gatekeepers to ensure appropriate use of resources and reduce unnecessary risk to patients. Where it may be more appropriate for drugs to be administered closer to home, specialised centres will be required to establish formal clinical network arrangements with local services to provide appropriate assurances.
Improving data quality associated with high-cost drugs remains a priority for NHS England. A standard drug minimum dataset (MDS) was introduced to all NHS England specialised services contracts in 2016/ 17.