The Clinical Senates will respond to requests for clinical advice on matters that will support commissioner decision making from Clinical Commissioning Groups, NHS England (Strategy and Transformation), health providers, Local Authority / Health & Wellbeing Boards and other stakeholders.

A request for advice can be made, and accepted, at any stage of service development. The Clinical Senates:


  • Provide commissioners with informal clinical advice in the early stages of consideration and while options are being considered. This advice can take several forms as:
    • sharing best practice from the pooled expertise of clinical senate members, informed by the learning of the combined clinical reviews they have undertaken.
    • providing a unique forum for the provision of impartial clinical and multi-professional expertise that understands the local challenges within the national context.
    • operating as ‘an honest broker’ to help create a forum where conflicting clinical views can be reconciled or issues that have become entrenched and block progress can be resolved.
  • Support commissioners where there is a need for advice or recommendations on complex clinical issues that would benefit from a whole system, strategic response.
  • At the request of NHS England as part of its service change assurance process, the Clinical Senates can provide independent clinical advice on a service change proposal. Involvement in this process does not preclude the Clinical Senates from offering formal or informal advice to commissioners at an earlier or developmental stage of the service change proposal. Current NHS England guidance on planning, assuring and delivering service change highlights the role of Clinical Senates in providing independent clinical advice that enables commissioners and transformation programmes to demonstrate compliance with the Five Tests for Service Change (particularly in regard to Test 3 – Clear Clinical Evidence Base) as they reconfigure services.  This more formal review role can take place either to inform the Stage 2 Assurance Gateway or after public consultation but prior to decision-making to enable commissioners to address the implications of any feedback submitted during the consultation process pertaining to the clinical element of the proposal. These formal clinical reviews help statutory commissioners make the right decisions for the right reasons in regard to often complex service changes by giving governing body members an independent view on the clinical components of their proposals whilst providing them with evidence that can be assessed as part of the regulatory process. This role takes on greater significance with the increasing complexity or level of contention associated with the service change proposals. This is particularly important in cases where there is a risk of local overview and scrutiny committees minded to referring commissioner decisions to the Secretary of State for possible judicial review.

Working with the lead commissioners, the appropriate Clinical Senate will agree terms of reference for a topic and then convene an Expert Review Panel (ERP) by bringing together the relevant expertise from its council, external experts and other relevant bodies clinical network. Members of the panel are required to submit both a declaration of interest, and a confidentiality agreement.