Among many of the challenges facing Clinical Commissioning Groups is the need to balance increasing demand for services and implementation of national clinical priorities that include improving the quality of care the NHS delivers while making up to £20 billion of efficiency savings by 2014–2015.1 It is hoped that this will be achieved in part through innovation and service transformation.2 One element of service redesign that is being considered involves moving the prescribing and supply of a greater proportion of specialised medicines, previously the preserve of hospital providers, to a different setting. However, such changes must be in the best interest of patients and clinicians by guaranteeing safety, effectiveness, cost-effectiveness and sustainability.

Over recent years there has been substantial growth in the use …