NHS England has recently completed a public consultation on a revised service specification for stereotactic radiosurgery/stereotactic radiotherapy for intracranial conditions. This can be accessed at:
The consultation contained reference to the 4 Tier clinical model and proposed a service model as follows:
- 17 services delivering both Tier 1 and 2 activity;
- 2 services delivering both Tier 3 and 4 activity; and
- 2 services delivering paediatric oncology activity.
Tier 1 and Tier 2 activity predominantly includes oncology indications, whilst Tier 3 and Tier 4 activity contains benign indications. Therefore, NHS England has not proposed to commission only two services to deliver complex brain tumour treatments.
Tiers 3 and 4 are focused on patients with benign non-cancer lesions that are extremely small in number per year, not life threatening, and will generally be treated at a single visit. These patients are not managed as part of a “cancer centre” but, following consultation, the consensus was to concentrate these patients into a small number of very experienced centres.