OBJECTIVES: With the current English NHS reforms will the new Clinical Commissioning Groups (CCGs) follow an Italian type regional approach to enable patient access to innovative and premium priced medicines when implementing patient access schemes. METHODS: We reviewed the current structures of the first wave CCGs and their association with the local oncology networks, new commissioning support bodies and oncology centres to assess the practicality of implementing current patient access schemes. We also reviewed new schemes approved by the Italian medicines agency, AIFA, to accelerate reimbursement for new drugs especially when there is limited availability at launch. RESULTS: It is clear that the suggested circa 200 proposed CCGs will have limited resources to fund suitable management structures to run risk share/patient access scheme effectively. Spend on pharmaceuticals, especially with public and physician demand, for innovative premium cost cancer treatments, will now be led and influenced by General Practitioners (GPs). The critical question facing family GPs will be how can they address the funding of these high cost treatments yet still satisfy patient demand.  One approach that could be adopted to a new type of patient access scheme is now being lead by AIFA who have developed an approach to enhance the reimbursement potential of innovative anti-cancer medicines. CONCLUSIONS: The new commissioning support bodies recently appointed by the English Department of Health’s, National Commissioning Board, could easily follow the Italian suggested approach; to help provide decision-making GPs with a framework to assess new premium prices medicines,   outside of the current support provided by NICE and the Patient Access Scheme Liaison Unit.