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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

Novel Oral Anti-coagulants (NOAC's)


NIC imageNICE Technology Appraisal guidance 249, 256 and the draft guidance for apixaban deal with the novel oral anticoagulants dabigatran etexilate and rivaroxaban and their use to prevent stroke and and systemic embolism in people with atrial fibrillation. Stroke is the third largest cause of death in England and costs the NHS £2.8 billion each year. Atrial Fibrillation (AF) is a known risk factor for stroke, increasing its risk and severity.

Over the last few years novel oral anticoagulants (NOACs) have become available, and in the last 12 months three have been recommended by NICE as cost effective for prevention of stroke in people living with AF, meaning that here are now effective choices for patients and healthcare professionals beyond the established use of warfarin.

The NIC has adopted Novel Oral Anti-Coagulants as one of its four pilots because of the potential for significant health benefits from improved uptake. Additionally, the fact that this NICE TA guidance is recently published (March 2012, May 2012 and February 2013) gives the NIC the opportunity to better understand barriers that exist to the uptake of new treatments.

Key Facts

  • AF causes an irregular and often abnormally fast heart rate. It is the most commonly sustained cardiac arrhythmia and affects up to 750,000 people in the UK
  • AF increases the risk of stroke by up to five times
  • It is estimated that 12,500 strokes are directly attributable to AF each year.
  • AF accounted for 5.7 million days in hospital beds and a total direct cost to the NHS of £2.2 billion.
  • NICE estimates that 46% of patients that should be on treatment (the most commonly prescribed treatment for stroke prevention in AF) are not receiving it.
  • Alongside the inconvenience of attending a clinic for regular follow-up, evidence suggests that in ‘real-life’ studies (outside of the confines of clinical trials) patients may stay within acceptable INR limits for less that 50% of the time.

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 use of novel oral anticoagulants. These include:
  • low awareness and confidence on how best to use these new treatments leading to an absence of clinical advocacy (currently only 34% GPs happy to initiate)
  • the patient voice is not being heard sufficiently
  • a lack of clarity and understanding on who is accountable for implementation of guidance especially as service moves into primary care
  • full cost of strokes and anti-coagulation services is not widely understood

To address many of these barriers the NIC launched a NIC NOAC Consensus Statement on the 18th of June 2014. Click on the link to find out more and download the document.

More information on the current uptale of NOACs 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