A new public health network is to give primary care trusts advice on licensed drugs before the publication of NICE guidance, HSJ can reveal.

The advice will help PCTs avoid accusations that they are imposing a 'postcode lottery'.

But some primary care managers are questioning whether the network will be the right approach.

The national Public Health Commissioning Network is set to begin work this summer as a two-year pilot scheme. The network is in discussion with the Department of Health about how much funding it will provide.

It intends to boost access to expertise on specific commissioning topics and provide quicker evidence-based appraisals of new services, treatments, service redesign and disinvestment decisions.

Each participating PCT will take responsibility for producing advice on new drugs and treatments in specific areas.

A working group established to lead the project includes Association of Directors of Public Health president Tim Crayford, NHS chief knowledge officer Sir Muir Gray, and Birmingham East and North PCT chief executive Sophia Christie.

In a letter to PCT directors of public health Sir Muir and Mr Crayford said they wanted to increase the leverage of public health in commissioning. "NHS commissioning is weak where it needs to be strongest, namely with the major health and healthcare issues such as rheumatoid arthritis, epilepsy or the promotion of walking."

Public health directors needed to "focus and share", it added.

The network is an attempt to help commissioners share information before guidance is available from the National Institute for Health and Clinical Excellence, which has come under fire for the speed of its processes.

"The network would provide advice to the PCT to enable it to make a swift and pragmatic policy decision," Mr Crayford said.

Commissioners would be able to access the latest clinical evidence "next time someone comes up with the new Herceptin" from whichever PCT had volunteered to lead the work, he said.

"This proposal aims to formalise where [PCTs] can look for evidence."

Sir Muir Gray said the principle was "do once and share". Regional variations might remain but would be evidence based, he said. If advice contradicted final NICE guidance, the network's stance would "just have to change", he said.

York University professor of health economics Alan Maynard said the proposal sounded sensible.

He said: "The big challenge for local PCTs is whether you've got the analytical capacity to make evidence-based decisions."

NICE chief executive Andrew Dillon said: "Although NICE is working hard to reduce the time between a drug receiving its marketing authorisation and the availability of guidance, there will inevitably be gaps which PCTs will need to fill."

But some PCT managers raised doubts over aspects of the proposals.

Hull teaching PCT chief executive Chris Long questioned how the network would fit in with the work of specialist commissioning groups, saying there was "a real local-national tension" around the issue.

"It might cut across systems in place with existing specialist commissioning groups," he warned.

Sir Muir said: "Specialist commissioning has got a good grip on rare diseases and expensive interventions - we're dealing with the big chunky stuff."

Nottinghamshire County PCT medical director Doug Black said that while some information sharing would be useful, how this was achieved was "open to debate".

"PCT 'A' developing a specialist interest in a group of conditions doesn't feel quite right. What is helpful is sharing of previous decisions," he argued.

Another medical director, who asked not to be named, said: "I would be worried about parallel processes going on. [NICE is] successful because everybody trusts its evidence and evaluation."

How it will work

  • PCT members specialise in commissioning topics with individual leads on each topic.

  • Leading on a topic is a requirement of joining the network.

  • Members agree to provide a minimum time contribution each week.

  • Evidence and appraisals are shared through a web-based discussion forum.

  • Information will not routinely be available to non-members.

  • Quality assurance panel will review material for release to public.

  • Network acts as a "unified" voice to influence the national agenda.