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Low Priority Procedures

  

Information regarding Low Priority Procedures


Coventry and Rugby CCG receive a fixed budget to Commission Healthcare Services; and is therefore not able to routinely fund all treatments and procedures. The CCG may decide that a treatment or procedure should not be routinely funded because:

  • There is limited or no evidence of its effectiveness.
  • It is considered a low priority for funding (e.g. some cosmetic surgery) compared to other treatments.
  • Treatment is subject to a clinical eligibility threshold (the patient has to satisfy certain criteria to receive treatment.

Policies outlining any restrictions, thresholds for treatment and eligibility criteria for each procedure are available on the CCG website at: http://www.coventryrugbyccg.nhs.uk/About-Us/Publications-and-Policies/Policies

Responsibilities for GPs

GPs should be aware of the Low Priority Procedure policy before referring any patients and should ensure that patients understand when there is likely to be no treatment offered on the NHS. Patients ultimately have the right to a second opinion from a consultant, but in general we hope that the GPs explanation of the system will suffice.

GPs should ensure that any referral made, is compliant with the Low Priority Procedures policy, non-compliant referrals will be returned to the GP with the expectation that the GP will manage the patient.

Prior Approval Process

In general, when referring patients GPs should include patient history relevant to the policies to enable funding decisions to be made.

In order to streamline the process, the CCG has implemented a process for a number of GP referrals to be approved before an appointment is made with a provider.  This process will be used where the GP recognises that he/she is referring for a procedure which requires Prior Approval.

Ten procedures will be subject to prior approval via RSS before a patient is able to book an appointment, the ten procedures are:

  • Carpal Tunnel Syndrome
  • Dupuytren’s Disease Surgery
  • Gallstone Surgery
  • Grommets/Myringotomy for Children
  • Ganglion Treatment (Hand & Wrist)
  • Hallux Valgus- Bunion
  • Hernia Repair
  • Rhinoplasty/Septorhinoplasty
  • Tonsillectomy/Adenotonsillectomy
  • Trigger Finger Release
  • Varicose Vein Intervention

The RSS team will provide prior approval if appropriate, liaising with the CSU IFR team. Any referrals received by the RSS team which do not meet the referral criteria will returned to the GP for management of the patient in Primary Care.

Low Priority Procedures and their Status

The following list provides a summary of the treatments/procedures where the CCG considers:

  • There is limited or no evidence of its effectiveness.
  • It is considered a low priority for funding (e.g. some cosmetic surgery) compared to other treatments.
  • Treatment is subject to a clinical eligibility threshold (the patient has to satisfy certain criteria to receive treatment.
Prior approval required via RSS
Carpal Tunnel Syndrome Policy
Dupuytren’s Disease Surgery Policy
Gallstones Surgery Policy
Ganglion Treatment (Hand & Wrist) Policy
Grommets/Myringotomy for Children Policy
Hernia Repair
Rhinoplasty/Septorhinoplasty
Tonsillectomy/Adenotonsillectomy
Trigger Finger Release
Varicose Vein Intervention
Prior Approval Required
Aesthetic Treatments
Circumcision
CPAP
Hysterectomy for Menorrhagia Policy
Procedures that are Low Priority and not normally funded
Endoscopic Thoracic Sympathectomy (Facial Blushing and/or Sweating)
Hyperhidrosis (excess sweating) of the palms or axillae
Labiaplasty Policy
Penile Implantation Surgery
Procedures that are restricted and subject to patients meeting eligibility criteria
Arthroscopy of Knee Joint (Diagnostic/Therapeutic) Policy
Asymptomatic Carotid Artery Disease Policy
Cataract Policy
Dilation and Curettage for Menorrhagia Policy
Haemorrhoidectomy Policy
Male Circumcision
Prolapse (surgical management of female genital prolapse)

 

 

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