NHS Strategy for Personalised Medicine revealed

26 September 2015

The Medical Director of NHS England has outlined a broad strategy for shifting the National Health System (NHS) towards delivery of personalised medicine.

Sir Bruce Keogh told the NHS England Board that their role is to accelerate and capitalise on the transformations already underway related to the 100,000 Genomes Projectwithin a broader and more expansive strategy for personalised medicine” that is consistent with the Five Year Forward View and challenges and priorities for the NHS. These were noted to include improved prevention, earlier and more precise diagnosis of disease, and targeted interventions using companion diagnostics.

The Strategy for Personalised Medicine Board paper defines personalised medicine as the move away from a ‘one size fits all’ approach towards one that uses emergent technologies ‘such as diagnostic tests, functional genomic technologies, molecular pathway, data analytics and real time monitoring of conditions to better manage patients’ health and to target t herapies’ to deliver the best outcomes for patients with a disease or disease predisposition.

A new NHS Personalised Medicine service is to be built on four overarching principles:

  • Prediction and prevention of disease
  • More precise diagnoses
  • Targeted and personalised interventions
  • More participatory role for patients

Exploration of these principles with internal and external stakeholders will, the report says, underpin the creation of a work programme with four ‘critical and interdependent elements’:

  1. Building an infrastructure that includes informatics and data systems, commissioning, procurement and financial frameworks.
  2. Developing a clinical change model incorporating high impact commissioning challenges; changes to clinical pathways; pharmacogenomics and synergies between companion diagnostics and medicines optimisation; and links to the 100,000 Genomes Project and NHS transformation outcomes.
  3. Embracing technology and innovation and creating the knowledge base that will include advances in genomics and diagnostics; knowledge from NHS England Digital Health Services and the National Information Board; and growing artificial intelligence and machine learning applications. The NHS England integrated genomic and personalised medicine knowledge base is noted to require ‘complex analytical solutions to inform both clinical practice and research and development’.
  4. Policy and system alignment including the Five Year Forward View, Department of Health, Health Education England, National Institute for Health and Care Excellence (NICE) and the Medicines and Healthcare Products Regulatory Agency (MHRA).

Sir Bruce said that NHS England looked forward to working with stakeholders; the strategy notes that they will be working in partnership with the Academy of Medical Sciences on ‘exemplar clinical pathways’ and with the North West Coast, West Midlands and Imperial Academic Health Science Networks on a series of activities ‘from the perspective of commissioning, providers and research / innovation’ to examine the opportunities, challenges and impact of personalised medicine and the proposed work programme elements. Interaction with industry, patients and charities is said to be ‘on the application of molecular diagnostics and personalised medicine in a number of therapeutic areas and health care settings’.

The 100,000 Genomes Project, its designated Genomic Medicine Centres, and the planned reorganisation of genetics laboratories are noted to be critical strategic elements in themselves, with the requirement for development of other non-genomic diagnostics such as pathology and imaging in order to create an efficient and integrated service that can ‘integrate and analyse data in real time and to produce comprehensive individual patient diagnostic profiles’. This is where of artificial intelligence systems such as machine learning are believed to offer potential solutions. Alignment of the whole commissioning system is also said to be crucial to create a comprehensive genomic diagnostic testing service in the NHS for all relevant care pathways.

A detailed Personalised Medicine Strategy is to follow, which will include a five-year work plan, investment plan, and projected cost savings and efficiency gains. 

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