The Innovation Exchange supports the adoption of innovations identified by the Accelerated Access Collaborative as well as identifying and supporting the adoption of innovations on a regional and cross-regional basis.
Accelerated Access Collaborative
The Accelerated Access Collaborative (AAC) aims to make the process of getting transformative technologies to patients quicker, cheaper and easier for innovators and the NHS.
The government and its partners, of which the Oxford AHSN is one, aim to bring forward patient access to selected, highly beneficial and affordable innovations.
The AAC is currently supporting the rapid uptake of 7 high-potential technology areas with full evidence bases already within the system. These AAC rapid uptake products will enable patients with conditions such as cancer, heart disease and multiple sclerosis to access new treatments faster.
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The rapid uptake products are:
- Heartflow – A non-invasive personalized cardiac test that reduces the need for unnecessary procedures
- Placental growth factor(PIG-F) based testing for suspected pre-eclampsia – tests for early diagnosis of pre-eclampsia in pregnant women, which if unmonitored, can cause serious complications for mother and baby. Two tests are available.
- PCSK9 inhibitors for treatment of primary hypercholesterolaemia and mixed dyslipidaemia– Two cost-effective drugs that significantly lower cholesterol.
- High sensitivity troponin testsfor early rule out of myocardial infarction (acute) – two diagnostic tests are available that detect whether or not a patient is at risk or previously had a heart attack.
- Quantitative faecal immunochemical tests forcolorectal cancer – Diagnostic tests that reduce referrals for patients with suspected colorectal cancer. Three tests are available for adoption.
- Cladribine (Brand name: Mavenclad) for treatinghighly active relapsing-remitting multiple sclerosis in adults – A drug for multiple sclerosis with a novel mode of action, high efficacy and a low treatment and monitoring burden
- Urolift forlower urinary tract symptoms of benign prostatic hyperplasia.
Innovation and Technology Payment
The Innovation and Technology Payment (ITP) 2019/20 was launched at Expo 2018. This programme supports NHS England’s commitment to accelerate the adoption and spread of proven and affordable innovations, as set out as part of the Five Year Forward View and NHS Long Term Plan. The ITP aims to remove the financial and procurement barriers to support the NHS adopt innovative medical devices, diagnostics, and digital products at scale.
For the 2019/20 selection, the following themes are being supported from 1 April 2019
- Non-invasive vagus nerve stimulation therapy for the treatment of cluster headaches.
- Absorbable spacer to reduce rectum radiation exposure during prostate radiation therapy.
- Placental growth factor (PIGF) based test for the rule out of pre-eclampsia.
- High sensitivity troponin assay in a rapid rule out protocol for acute myocardial infarction.
Two further themes, with limited roll-out and more intensive evaluation support, are being supported through the Evidence Generation Fund:
- Digital apps to support emergency/crisis mental health assessments
- Interoperable personal health record tool.
In 2017, Oxford AHSN initiated a project to drive the uptake and adoption of Placental Growth Factor (PlGF) based testing across the Thames Valley region. Working through the Oxford Maternity Patient Safety Network and in conjunction with clinical leads, head of laboratories, finance and management functions, Oxford AHSN were successful in helping the first three hospital Trusts in England to adopt PlGF-based testing into standard clinical practice.
In June 2019, and partially driven by the success of the Oxford AHSN project, NHS England announced the availability of both Innovation Technology Payment (ITP) funding and Accelerated Access Collaborative (AAC) funding and support to help accelerate the adoption of PlGF-based testing for pre-eclampsia in all hospital Trusts across England. Oxford AHSN are now actively supporting the AHSN Network in the national roll-out and adoption of PlGF-based testing into standard clinical practice.
Whilst assessing which diagnostics recommended by NICE that had limited uptake, faecal calprotectin (FCal) testing was identified by York and Humber AHSN (Y&H AHSN). NICE recommends FCal testing as an option to help doctors distinguish between inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, and non-inflammatory diseases, such as irritable bowel syndrome, with the presence of FCal in in stool samples being an indicator of an inflammatory disease.
Working with the Diagnostic Evidence Co-operative (DEC) in Leeds, a clinical study was undertaken by Dr James Turvill from York Teaching Hospital on the use of FCal testing, the development of a revised clinical pathway and the use of the test as a “rule-in” as opposed to a “rule-out” test, as it had been used previously.
Together, Y&H AHSN and Dr Turvill standardised the new FCal pathway across CCG’s in the Y&H region, liaising with eMBED Health Consortium to create SystemOne and EMIS templates and to guide GP’s through the new pathway. In parallel with this work, a consensus paper to support the use of FCal testing was commissioned by NHS England and endorsed by the Chief Scientific Officer.
The FCal project has been picked up by Oxford AHSN, and we have been working to roll-out the standardised York pathway with CCG’s across the Thames Valley, and in 2018 the project has now been adopted nationally by the AHSN network.
Clostridium difficile (CD) is the leading cause of antibiotic-associated diarrhoea, affecting mainly the elderly and those with underlying co-morbidities and is associated with 90-day mortality rates of up to 13.5%. Recurrent Clostridium difficile infection (CDI) can be a serious, life threatening condition. It can occur in patients undergoing antibiotic treatment, in particular those on broad-spectrum antibiotics.
Frozen Faecal Microbiota Transplantation (FMT) is supplied thorough the last ITP programme for use in management of patients with recurrent CDI. It is an effective alternative to antibiotic treatment for CDI at a comparable cost. The high cure rates (90%) and reduced use of antibiotics equal a win-win for patients and the NHS.
Oxford AHSN are working with Oxford University Hospitals NHS Foundation Trust for adoption of FMT to be embedded into their standard operating procedures.