Clinical commissioning groups (CCG) are groups of general practitioners that decide on which products and services are provided to their patients. They operate similar to NICE, except that NICE deals with extremely high priced drugs (mostly cancer and rare disease treatments). CCGs are more like insurance company panels that decide on whether Afrezza is on or off the formulary, except in the UK if you are not on the formulary then you are totally off. Since NHS is the single payor for most of the patients in the UK it pretty much comes down to having NHS coverage or going 100% self-pay.
Note that this is separate from the European Medicines Agency which, like the FDA, has to approve the drug in order for it to be sold legally. Obviously you need both the license to sell and a willing payor to have a business.
Forgive me Matt but my understanding is that NICE studies scientific evidence for all treatments to see if they are effective clinically and offer at least a minimum level of "QALYS" of cost effectiveness. Not exclusively high cost drugs (if that was your intended meaning, sorry if not). They also research any aspects of improving clinical practice.
www.nhs.uk/NHSEngland/thenhs/healthregulators/Pages/nice.aspxwww.nice.org.uk/ In the UK if the NHS will not cover something (which usually means it's not clinically effective or cost effective) then one does not necessarily have to self pay: just as in the US we can and do have health insurance either through employers or privately though many people don't bother with it unless they want eg more luxurious hospitals or shorter waiting times etc or more control of choice of specialist doctor. EG I pay about $6000 equivalent per annum to my insurers for comprehensive health insurance, on top of whatever part of my taxes goes to the nhs.
Also if the NHS should cover something but for some reason practically cannot, patients can have their treatment commissioned privately by the NHS including overseas if necessary. Rare but not unheard of.
On top of that, all EU states are all legally obliged to offer any visiting EU citizen access to their health service on the same basis as their own citizens, so if hypothetically the NHS decided not to offer a treatment when the German health system offers it, a person could seek treatment in Germany (producing their EHIC card, which is proof of entitlement) and the German system would provide treatment as if you are a German national, and then the UK state gets billed as part of inter-coutry balance adjustments in due course where health costs are set off against each other. Not ever heard of anyone needing to go that far, unless they happen to get ill while on holiday in europe but it could be used.
www.nhs.uk/NHSEngland/Healthcareabroad/EHIC/Pages/about-the-ehic.aspx in effect an EU wide health insurance scheme. Switzerland and the EEA countries also recognise EHIC. Until UK leaves EU in June of course, if that happens....
CCGS are summarised below with a link at the end. If a CCG doesn't routinely fund something locally they still have to consider it case by case or could be sued by the patient.
Text re CCGS:
"CCGs are:
Membership bodies, with local GP practices as the members;
Led by an elected Governing Body made up of GPs, other clinicians including a nurse and a secondary care consultant, and lay members;
Responsible for approximately 2/3 of of the total NHS England budget; or £71.9 billion in 2016/17;
Responsible for healthcare commissioning such as mental health services, urgent and emergency care, elective hospital services, and community care;
Independent, and accountable to the Secretary of State for Health through NHS England;
Responsible for the health of populations ranging from under 100,000 to 900,000, although the average population covered by a CCG is about a quarter of a million people.
CCGs work with closely with NHS England, who has three roles in relation to CCGs. The first is assurance: NHS England has a responsibility to assure themselves that CCGs are fit for purpose, and are improving health outcomes. Secondly, NHS England must help support the development of CCGs. Finally, NHS England are also direct commissioners, responsible for highly specialised services and primary care. As co-commissioners, CCGs work with NHS England’s Local Area Teams to ensure joined-up care."
See
www.nhscc.org/ccgs/Hence, nhs England is also a sort of mega commissioner on a national level so that complex treatments etc can be commissioned directly by them too, not just the local ccg.
Edit: oops I just clicked "like" on my own post by mistake!
