basin

Treatment policies new

Background

Since 2013 the following Clinical Commissioning Groups (CCG) and their respective Local Authority Public Health Commissioners have worked collaboratively to develop this harmonised core set of 21 treatment policies:

  • NHS Birmingham CrossCity CCG
  • NHS Birmingham South Central CCG
  • NHS Sandwell and West Birmingham CCG
  • NHS Solihull CCG
  • NHS Walsall CCG
  • NHS Wolverhampton CCG
The aim is to:

  • ensure policies incorporate the most up-to-date published clinical evidence so that we prioritise funded treatments that are are proven to have clinical benefit for patients.
  • stop variation in access to NHS funded services across Birmingham, Solihull and the Black Country (sometimes called the ‘postcode lottery’ in the media) and allow fair and equitable treatment for all local patients.
  • ensure access to NHS funded treatment is equal and fair, whilst considering the needs of the overall population and evidence of clinical and cost effectiveness.
Birmingham CrossCity, Birmingham South Central and Solihull CCGs undertook period of public engagement in early 2016 to ensure that patients and other stakeholders had the opportunity to give their views on the proposed new harmonised policies. 

The final engagement report can be read here

View the Harmonised Treatment Policies Equality Assessment Report here

View the Glossary of Terms for Treatment Policies here

View the Harmonised Treatment Policies Document here

View the Harmonised Treatment Policies Acute Provider Implementation notice letter here

View the Harmonised Treatment Policies Finance/Activity trend analysis - 17/18 latest here

View the Treatment Policies Reference Library here

Restricted procedures

Not normally funded procedures

Which treatments are covered by policies?

Policy Document Treatment Policy Category Treatment Policy Detail Patient Treatment Leaflet
Adenoidectomy Restricted  Adenoidectomy Adenoidectomy
Cosmetic Surgery Abdominoplasty / Apronectomy              Not routinely commissioned Abdominoplasty / Apronectomy Abdominoplasty / Apronectomy
Cosmetic Surgery Thigh lift, Buttock Lift and Arm Lift, Excision of Redundant Skin or Fat            Not routinely commissioned Thigh lift, Buttock Lift and Arm Lift, Excision of Redundant Skin or Fat   Thigh lift, Buttock Lift and Arm Lift, Excision of Redundant Skin or Fat
Cosmetic Surgery Liposuction Not routinely commissioned Liposuction Liposuction
Cosmetic Surgery Breast Augmentation
a) Non breast cancer
b) Breast cancer


Not routinely commissioned
Restricted
Breast Augmentation Breast Augmentation
Cosmetic Surgery Breast Reduction
a) Non breast cancer
b) Breast cancer      

Not routinely commissioned
Restricted 
Breast Reduction Breast Reduction
Cosmetic Surgery Mastopexy (Breast Lift)
a) Non breast cancer
b) Breast cancer


Not routinely commissioned
Restricted 
Mastopexy (Breast Lift) Mastopexy (Breast Lift)
Cosmetic Surgery Inverted Nipple Correction
a) Non breast cancer
b) Breast cancer


Not routinely commissioned 
Restricted
Inverted Nipple Correction Inverted Nipple Correction
Cosmetic Surgery Gynaecomastia (Male Breast Reduction) Not routinely commissioned  Gynaecomastia (Male Breast Reduction) Gynaecomastia (Male Breast Reduction)
Cosmetic Surgery Labiaplasty Restricted  Labiaplasty Labiaplasty
Cosmetic Surgery Vaginoplasty Restricted  Vaginoplasty Vaginoplasty
Cosmetic Surgery Pinnaplasty Not routinely commissioned  Pinnaplasty Pinnaplasty
Cosmetic Surgery Repair of Ear Lobes Not routinely commissioned  Repair of Ear Lobes Repair of Ear Lobes
Cosmetic Surgery Rhinoplasty Restricted  Rhinoplasty Rhinoplasty
Cosmetic Surgery Face Lift or Brow Lift (Rhytidectomy) Restricted  Face Lift or Brow Lift (Rhytidectomy)  Face Lift or Brow Lift (Rhytidectomy)
Cosmetic Surgery Hair Depilation (Hirsutism) Restricted Hair Depilation (Hirsutism)  Hair Depilation (Hirsutism)
Cosmetic Surgery Alopecia (Hair Loss) Not routinely commissioned Alopecia (Hair Loss) Alopecia (Hair Loss)
Cosmetic Surgery Removal of Tattoos / Surgical correction of body piercings and correction of respective problems Not routinely commissioned  Removal of Tattoos / Surgical correction of body piercings and correction of respective problems Removal of Tattoos / Surgical correction of body piercings and correction of respective problems 
Cosmetic Surgery Removal of Lipomata Restricted Removal of Lipomata Removal of Lipomata 
Cosmetic Surgery Removal of Benign or Congenital Skin Lesions Restricted  Removal of Benign or Congenital Skin Lesions Removal of Benign or Congenital Skin Lesions 
Cosmetic Surgery Medical and Surgical Treatment of Scars and Keloids Not routinely commissioned  Medical and Surgical Treatment of Scars and Keloids Medical and Surgical Treatment of Scars and Keloids 
Cosmetic Surgery Botulimium Toxin Injection for the Ageing Face Not routinely commissioned  Botulimium Toxin Injection for the Ageing Face Botulimium Toxin Injection for the Ageing Face
Cosmetic Surgery Treatment for Viral Warts Restricted  Treatment for Viral Warts Treatment for Viral Warts
Cosmetic Surgery Thread / Telangiectasis / Recticular Veins Not routinely commissioned  Thread / Telangiectasis / Recticular Veins Thread / Telangiectasis / Recticular Veins
Cosmetic Surgery Rhinophyma Not routinely commissioned  Rhinophyma   Rhinophyma 
Cosmetic Surgery Resurfacing Procedures: Dermbrasion, Chemical Peels and Laser Treatment Not routinely commissioned Resurfacing Procedures: Dermbrasion, Chemical Peels and Laser Treatment Resurfacing Procedures: Dermbrasion, Chemical Peels and Laser Treatment
Cosmetic Surgery Other Cosmetic Procedures Not routinely commissioned  Other Cosmetic Procedures Other Cosmetic Procedures 
Cosmetic Surgery Revision of Previous Cosmetic Surgery Procedures Not routinely commissioned  Revision of Previous Cosmetic Surgery Procedures Revision of Previous Cosmetic Surgery Procedures
Back Pain
Restricted  Back Pain
Back Pain 
Botulinium Toxin for Hyperhydrosis Not routinely commissioned  Botulinium Toxin for Hyperhydrosis
Botulinium Toxin for Hyperhydrosis
Cataracts   Restricted Cataracts
Cataracts
Cholecystectomy for Asymptomatic Gallstones   Not routinely commissioned Cholecystectomy for Asymptomatic Gallstones Cholecystectomy for Asymptomatic Gallstones
Male Circumcision   Restricted Male Circumcision Male Circumcision
Dilation and Curettage (D&C) for Menorrhagia   Not routinely commissioned Dilation and Curettage (D&C) for Menorrhagia Dilation and Curettage (D&C) for Menorrhagia
Eyelid Surgery (Upper and Lower) Blepharoplasty   Restricted Eyelid Surgery (Upper and Lower) Blepharoplasty Eyelid Surgery (Upper and Lower) Blepharoplasty
Ganglion    Restricted  Ganglion Ganglion
Grommets    Restricted  Grommets Grommets
Haemorrhoidectomy    Restricted  Haemorrhoidectomy
Haemorrhoidectomy
Hip Replacement Surgery   Restricted  Hip Replacement Surgery Hip Replacement Surgery
Hysterectomy for Heavy Menstrual Bleeding    Restricted  Hysterectomy for Heavy Menstrual Bleeding Hysterectomy for Heavy Menstrual Bleeding
Diagnostic Hysteroscopy for Menorrhagia    Not routinely commissioned  Diagnostic Hysteroscopy for Menorrhagia Diagnostic Hysteroscopy for Menorrhagia
Groin Hernia Repair    Restricted  Groin Hernia Repair Groin Hernia Repair
Knee Replacement Surgery   Restricted  Knee Replacement Surgery Knee Replacement Surgery
Penile Implants    Not routinely commissioned  Penile Implants Penile Implants
Tonsillectomy    Restricted  Tonsillectomy Tonsillectomy
Trigger Finger   Restricted  Trigger Finger Trigger Finger
Varicose Veins    Restricted  Varicose Veins Varicose Veins

What does each policy detail?

Each treatment policy states whether the treatment or procedure is:
  • Not routinely commissioned: would require an Individual Funding request to demonstrate clinical exceptionality or
  • Restricted: funded if particular clinical criteriand thresholds apply
There are also:
  • Short summary explanation of what the procedure entails
  • For ‘Restricted’ procedures what the clinical thresholds for treatment are.
  • Summary of what clinical guidance commissioners have used to inform the detail of the commissioning policy, e.g. NICE, Royal Colleges or Other Clinical Associations
  • Each policy is then subject to an Equality Impact Assessment review.

What types of treatments do the policies cover?

The policies cover range clinical treatments which are:
  • procedures that are identified as being relatively ineffective (e.g. grommets and myringotomy, and certain spinal procedures for back pain) or;
  • identified cosmetic procedures or;
  • effective procedures in mild cases where the balance between benefit and risk is close (e.g. cataract surgery and primary hip or knee replacement) or;
  • effective, but where other cost-effective alternatives should be tried first (e.g. hysterectomy for heavy menstrual bleeding)

Principles underpinning each Treatment Policy

Commissioning decisions by CCG Commissioners are made in accordance with the commissioning principles set out below, and in the Birmingham, Solihull and Black Country CCGs’ Individual Funding Request Policy:
  • CCG Commissioners require clear evidence of clinical effectiveness before NHS resources are invested in the treatment.
  • CCG Commissioners require clear evidence of cost effectiveness before NHS resources are invested in the treatment
  • The cost of the treatment for this patient and others within any anticipated cohort is relevant factor.
  • CCG Commissioners will consider the extent to which the individual or patient group will gain benefit from the treatment
  • CCG Commissioners will balance the needs of each individual against the benefit which could be gained by alternative investment possibilities to meet the needs of the community
  • CCG Commissioners will consider all relevant national standards and take into account all proper and authoritative guidance
  • Where treatment is approved CCG Commissioners will respect patient choice as to where treatment is delivered.

Individual Funding Requests (IFR) and Exceptionality

We recognise there may be exceptional circumstances where it is clinically appropriate to fund each of the procedures listed in this policy and these will be considered on case-by-case basis. Funding for cases where either; a) the clinical threshold criteriis not met, or b) the procedure is not routinely funded, will be considered by the CCGs following application to the CCG’s Individual Funding Request Panel, whereby the IFR process will be applied.

This position is supported by the Birmingham CrossCity CCG ethical-framework-version-1-march-2013.

The Individual Funding Request Policy can be read here.

The Individual Funding Request Application Form can be read here.

Clinician's right to seek specialist advice

In cases of diagnostic uncertainty, the scope of this policy does not exclude the Clinician’s right to seek specialist advice.  This advice can be accessed through a variety of different mediums and can include both face to face specialist contact, as well as different models of consultant and specialist nurse advice and guidance virtually.

How does the IFR Application System work in practice?

Commissioners, GPs, service providers and clinical staff treating registered patients of the CCGs are expected to implement this policy.  When procedures are undertaken on the basis of meeting the criteria specified within the policy, this should be clearly documented within the clinical notes.  Failure to do so will be considered by the CCGs as lack of compliance.

Patients with problems or conditions that might require treatments included in this policy should be referred to a consultant or specialist only;

  • After a clinical assessment is made by the GP or Consultant; AND
  • The patient meets all the criteria set out in the policy.
GPs wishing to seek a specialist opinion for patients who meet the above criteria, should ensure the essential clinical information is included in the referral letter confirming the patient has been assessed in line with this policy.

GPs, Consultants in Secondary Care and provider finance departments need to be aware that the CCG will not pay for the procedures listed in this policy unless the patient meets the criteria outlined in this policy.

The CCGs recognise there will be exceptional, individual or clinical circumstances when funding for treatments designated as low priority will be appropriate.

Where a treatment is either not routinely funded, or the patient does not meet the specified clinical criteria, this means the CCG will only fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and that is supported by the CCG. 

Individual Funding Requests should only be sent to the respective ‘nhs.net’ accounts detailed below.  Guidance regarding IFRs and an application form, can be found here.

See separate  pdf leaflet (141 KB) for more information on Individual Funding Requests (IFRs).

IFR contact information

Lifestyle Factors and Surgery

Lifestyle factors can have an impact on the functional results of some elective surgery.  In particular, smoking is well known to affect the outcomes of some foot and ankle procedures.  In addition, many studies have shown that the rates of postoperative complications and length of stay are higher in patients who are overweight or who smoke.

Therefore, to ensure optimal outcomes, all patients who smoke or have a body mass index of 35 or greater and are being considered for referral to Secondary Care, should be able to access CCG and Local Authority Public Health commissioned smoking cessation and weight reduction management services prior to surgery.

Patient engagement with these ‘preventive services’ may influence the immediate outcome of surgery.  While failure to quit smoking, or lose weight will not be a contraindication for surgery, GPs and Surgeons should ensure patients are fully informed of the risks associated with the procedure in the context of their lifestyle.

Psychological Factors and Surgery

Commissioners acknowledge that there is a psychological dimension for patients in seeking or considering the option of treatment and surgery. However because there are no universally accepted and objective measures of psychological distress and therefore such factors are not taken in account in any policy clinical thresholds. Nevertheless there always remains the option of an application to demonstrate clinical exceptionality through IFR process as detailed above.

The following treatment policies are currently in development:

Other Existing Local CCG Policies

Treatment Policy Category Treatment Policy Detail Patient Treatment Decision Aid
Assisted Conception Restricted             Assisted conception   
Bariatric Surgery Restricted              Bariatric Surgery   
Carpal Tunnel Restricted              Carpal Tunnel Carpal Tunnel Syndrome
Complementary therapies and alternative medicines Not routinely commissioned Complementary therapies and alternative medicines   
Diagnostic Arthroscopy of the Knee Joint Not routinely commissioned Diagnostic Arthroscopy of the Knee Joint   
Facet joint and epidural injections Restricted              Facet joint and epidural injections   
Port Wine Stain Not routinely commissioned  
Rosecea – Laser Treatment Not routinely commissioned  
Planned caesarean section Restricted- RCOG Guidelines Birth options after previous C-Section
Laser treatment for myopia (keratoplasty) Not routinely commissioned  
Dupuytren Contracture Restricted Dupuytren Contracture   
Reversal of male and female sterilisation (including vasectomies) Not routinely commissioned  
Any treatment purporting to treat allergy as a cause of chronic (post-viral) fatigue syndrome Not routinely commissioned  
Treatment of myalgic encephalomyelitis Not routinely commissioned  
Any treatment of candida hypersensitivity syndrome Not routinely commissioned  
Radiotherapy for age-related macular degeneration of the eye Not routinely commissioned  
Nucleoplasty (percutaneous coblation disc herniation) Not routinely commissioned  
Arthroscopic washout Not routinely commissioned  
Use of dilators or microwaves for benign prostatic hyperplasia Not routinely commissioned  
Use of lithiotripsy to treat small asymptomatic renal calculi Not routinely commissioned  
Congenital vascular abnormalities Restricted  
Photodynamic therapy Restricted  
Surgical removal of mucoid cysts at DIP joint Restricted  
NIV & CPAP Machine Restricted  
Hyperbaric Oxygen Therapy Restricted  
Removal of ear wax Restricted (established primary  care pathway in Solihull)  
Allergy Testing Restricted  
Acupuncture Restricted  
Carotid artery surgery for asymptomatic patients with carotid artery disease Restricted  
Botulinum toxin for facial ageing Not routinely commissioned  
Non-emergency patient transport Restricted

NEPT - Patient Charter and Eligibility Criteria

NEPT on a page

 
Dilation of Cervix   Dilation of Cervix Uteri Curettage of Uterus   

Next treatment policies in development

Coming soon.

Supporting Patients and Clinicians in Shared Decision Making

View the Supporting Patients and Clinicians in Shared Decision Making webpage here.

Noticed an error or broken link? Let us know