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NICE Implementation Collaborative (NIC)

The NIC is a unique partnership between the NHS, Life Sciences industry, Healthcare professional bodies, key health organisations and Patient groups. NIC partners are committed to working together to support a system where patients have faster and more consistent access to NICE-recommended medicines, treatments and technologies and is a collaboration which completely re-draws the landscape. Industry will now work with academia, clinical groups, NHS England, NICE and representative bodies to drive compliance with NICE recommendations.

The partnership underpinned by the signing of a concordat in March 2013. The Concordat is made up of the following members:

  • Academy of Medical Royal Colleges
  • Association of British Healthcare Industries (ABHI)
  • Foundation Trust Network
  • NHS Alliance NHS
  • Commissioning Assembly
  • NHS Confederation
  • NHS England
  • National Institute for Health and Care Excellence (NICE)
  • Patients Involved in NICE
  • Royal Pharmaceutical Society
  • The Academy of Medical Sciences
  • The Association of the British Pharmaceutical Industry (ABPI)
  • The British In Vitro Diagnostics Association (BIVDA)

What does the NIC do?

  1. Identify practical measures that support and promote timely and consistent implementation of NICE Technology Appraisals throughout the NHS in England
  2. Work jointly to support and promote the adoption of all other forms of NICE guidance that apply to the NHS in England, and to drive the uptake of innovation, in a way that is consistent with local health needs and priorities
  3. Understand the barriers that restrict expected levels of implementation and uptake, including the requirement for CCGs to provide care for their populations taking into account local affordability and clinical need. The NIC will identify practical measures that its members and all organisations providing NHS services to patients can take to help overcome these barriers
  4. Support a culture shift within the NHS in favour of clinically- and cost-effective innovation


Small arrow Latest NIC work streams

Nalmefene (NICETA 325)

Nalmefene (NICE TA 325) for reducing alcohol consumption in people with alcohol dependance. The NIC currently has a work stream looking at the implementation...

Non-ST-Elevation Acute Coronary Syndromes

Improving NSTEACS patient outcomes and experience. The 2013 Cardiovascular Outcomes Strategy report highlighted that there is scope for improvement in the...
Small arrow Recent NIC work streams

Denosumab (NICE TA204)

Small arrow Denosumab (Prolia) is indicated for the treatment of osteoporosis in postmenopausal women at increased risk of fractures and is administered in the form of a 6-monthly subcutaneous injection. It is a £1/day treatment for osteoporosis, recommended in NICE Technology Appraisial 204.

Denosumab is a treatment option for the primary prevention of osteoporotic fragility fractures in postmenopausal women at increased risk of fractures who are unsuitable (contraindicated,intolerant or unable to comply with special instructions for administration) to oral bisphosphonates (alendronate and either risedronate or etidronate) and have a combination of T-score, age and number of independent clinical risk factors for fracture, and for secondary prevention of osteoporotic fragility fractures in postmenopausal women at increased risk of fractures who are unsuitable to oral bisphosphonates. NICE TA 204 was published on October 2010. However in early 2013 only 11% of PCTs had any guidance or formulary inclusion for denosumab and 28% continue to have denosumab restricted to secondary care use only. In 47% of PCTs there continues to be no funding agreed for denosumab, and in 55% of hospitals have no or limited funding in place.

This inconsistency of availability to patients, balanced by the benefits of treatment is why Denosumab was selected as one of the NIC pilots.

Key Facts

  • 1 in 2 women and 1 in 5 men over 50 in the UK will break a bone mainly due to poor bone health
  • The total cost to the UK economy is in excess of £2.3 billion per year
  • For women over 60 years of age, fragility fractures account for more days spent in hospital than many other chronic diseases
  • Hip fracture patients occupy more than one in five orthopaedic beds
  • The incidence of 89,000 a year is predicted to rise to 140,000 by 2036, causing substantial increased morbidity and mortality
  • Thirty percent of hip fracture sufferers die within one year and over 50% remain permanently disabled with an impaired quality of life, compounded by fear of falling

What are the barriers to uptake of NICE guidance?


The NIC has worked with the system to better understand the barriers that exist to the adoption of Denosumab in the treatment of osteoporosis. These include:

  • Uncertainty around exact patient groups & eligibility when initiated in primary care
  • Benefit of treatment to patients and the local economy is not always realised
  • Implementers struggle to own the need and understand roles and responsibility to implement NICE guidance and be accountable for such
  • Lack of clinical advocacy that will drive change requiring a statement from clinical experts/organisations on best use and pathway
  • Insufficient measurement of implementation and understanding of what good implementation is, including detail on patient numbers expected
  • Redesign of current services required and removal of some perverse incentives in places to revamp patient pathway especially through use of Fracture Liaison Services to maximise benefit of new medicine.
More information on the current uptale of Denosumab can be found in the most recent Innovation Scorecard publication

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Small arrow Relevant NIC documents

Innovation Scorecard - Challenging Variation Report

Many of the medicines and medical technologies reviewed by the NIC are included in the quarterly Innovation Scorecard publication. The NHS England Innovation team produce a quarterly summary...

NICE Implementation Collaborative Concordat

Click here to download a copy of the NICE Implementation Collaborative Concordat which was signed by NIC partners in 2013.

Getting cost effective technologies into practice

This draft report produced for the NIC looks at a framework to assess the value to the NHS of investing in the implementation of NICE technologies. The report looks how the model could be applied...

Other relevant initiatives 

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Road map link

Innovation Compass link