The Department of Health has kicked off a consultation over proposals to improve the existing process for making funding decisions on very specialised new technologies not covered by the National Institute for Health and Clinical Excellence.

The plans focus on expanding the scope of the current national commissioning system to enable it to consider a small number of technologies that are not appropriate for assessment by the National Health Service cost watchdog the National Institute for Health and Clinical Excellence.

While the Institute is able to assess the vast majority of new technologies launched onto the market, problems can arise when interventions are designated for very small groups of patients, as their cost can substantially overshoot the cost-effective threshold if NICE’s decision models are used.

Now, in order to ensure “consistency in accessing and prescribing services for very rare conditions” across the country, the DH is proposing that the National Commissioning Group (NCG), which commissions specialist services, be dissolved and a new body - the National Commissioning Advisory Group (NCAG) - be established in its place.

It envisages that the NCAG will “consider clinical, cost effectiveness and affordability issues alongside best practice in service delivery; and provide a single source of robust and transparent advice direct to Ministers on which services should be considered for national commissioning”.

“By strengthening the National Commissioning system, patients will be able to be confident that there is a transparent system in place for deciding which specialised services are commissioned nationally,” explained health minister Mike O’Brien. However, he also stressed that the “vast majority” of new technologies will continue to go through NICE’s existing appraisals process.

The DH is also consulting on the Innovation Pass in parallel, under which patients with rare diseases will be given access to certain innovative medicines on the NHS for a time-limited period before being assessed by the cost watchdog in order to allow manufacturers to garner sufficient evidence to support their use.

The Department stressed that the Innovation Pass consultation is different to this proposal for a new commissioning body and the proposed criteria are designed to avoid duplication, but it added that together the two proposals “will clearly complement one another in ensuring access for patients to innovative medicines”.

The consultation will run until February 2010.