Service Restriction Policy Review 2016

Rapid demographic change has led to increasing pressure on health and care services which are not set up to cope with the corresponding growth in demand.

In response, the CCG has embarked on a programme of change, with new and expanded services providing high quality care, a stronger role for primary care and an increased focus on supporting people to maintain their health and independence. However, the growing costs of this rise in demand for health services mean that the CCG is facing a £14 million deficit in 2016/17. We are legally required to balance our books and live within our means so we have no choice but to take steps to tackle this deficit.

The difficulties we are facing in Basildon and Brentwood are not unique to us. Health and care organisations across mid and south Essex are facing similar problems. The Mid and South Essex Success Regime, created by NHS England, has been tasked with making a range of improvements to health services in the area to ensure they perform better to meet the needs of local people, and also to tackle a system-wide financial deficit which may reach £216 million across mid and south Essex by 2017/18.

Because of our financial situation we have had to review our local Service Restriction Policy (SRP). We are proposing a number of changes to the policy. We have carried out an impact assessment on each of our proposed changes, but before we make a decision we want to ensure we have a thorough understanding of the impact that these changes may have on local people

What is a Service Restriction Policy?

All Clinical Commissioning Groups have a Service Restriction Policy (SRP) which sets out the clinical criteria for a large range of medical treatments and procedures and is designed to help ensure they are only carried out where there is clinical evidence that they are effective, beneficial to patients, and also affordable within available funding.

As a CCG, we have always tried to ensure local patients have had access to the fullest range of treatments and procedures, in line with national guidance from the National Institute for Health and Care Excellence (NICE), as possible.

While this still remains our aim, the financial reality is that we have a statutory duty to remain within our allocated budget, around £325 million this year. This year the CCG is facing a £14 million deficit, which means that we must take action to reduce the amount we spend.
More detailed information on the CCG’s finances can be found in our Annual Report

What impact will these changes have on the local NHS?

Together with a number of other proposals and cost saving measures that the CCG will take this year, these changes will make a significant impact on our ability to meet our statutory duty to balance our books and reduce our projected £14 million deficit. Without taking steps to reduce the amount we spend each year, we may be unable to continue to provide a broader range of treatments and procedures as our financial situation worsens.

We have looked in detail at all the treatments and procedures in the current Service Restriction Policy and recommendation from Public Health. We believe that these proposals represent an opportunity to reduce the amount we spend each year on providing health services in a way which has the lowest impact on patient care that is possible. We understand however, that there will be an impact on those directly affected, and we are keen to find out what that impact will be before we make a decision

What are the proposed changes?

Summary of proposed changes to the Service Restriction Policy

The CCG is proposing the following changes to its Service Restriction Policy for residents within Basildon and Brentwood.
The table below sets out treatments and procedures that the CCG is proposing would no longer be available to residents in Basildon and Brentwood, except under exceptional circumstances*

Procedure/treatment Proposal
Male and female sterilisation To stop offering surgical male and female sterilisations
For males this comprises of both conventional and non-scalpel vasectomy and for females this will be the blocking or sealing of fallopian tubes
Gluten-free prescribed foods To stop offering all gluten free products on NHS prescription to over 18s, with the exception of pregnant women.
Travel vaccinations (Non NHS)

To stop offering the following travel vaccines on the NHS:

     Hepatitis B
     Meningitis ACWY
     Yellow Fever
     Japanese B encephalitis
     Tick borne encephalitis
     Rabies vaccine

The following vaccines will continue to be funded by the NHS:

      Hepatitis A vaccine
      Typhoid vaccine
      Combined hepatitis A and typhoid vaccine
      Combined Tetanus, Diptheria and Polio vaccine
      Cholera vaccine

In-vitro Fertilisation (IVF) and Assisted Conception (existing treatment) To limit treatment for assisted conception for those people already referred or receiving specialist fertility services. A previous consultation has been undertaken on ceasing new referrals for IVF services.
E-cigarettes  To not fund e-cigarettes and other novel nicotine containing products. This is a pre-emptive proposal as we do not currently fund e-cigarettes
Bariatric surgery (weight loss surgery)

To stop offering weight loss surgery:

     Gastric band
     Gastric bypass
     Sleeve gastrectomy

Cosmetic surgery

To stop offering the following cosmetic surgery procedures:

     Breast procedures* - Asymmetry/reduction/mastoplexy including revision/replacement
     Gynaecomastia (enlarged breast in men)
     Liposuction/Skin contouring/Body contouring
     Cosmetic Surgery

Funding for reconstructive surgery will continue, where this is not for cosmetic purposes

*This would also include no longer funding breast reconstruction following mastectomy (breast removal as part of a treatment process)

Toric intraocular lens implants for astigmatism To not fund Toric intraocular lens implants to for astigmatism. Instead, standard intraocular lens implants will be provided when patients have cataract surgery. A criteria change for cataract surgery has been proposed.
Simultaneous joint replacement (bilateral knee, bilateral hip & shoulder) To stop offering simultaneous joint replacement surgery – that is where both knees, hips or shoulders are replaced at the same time. Funding for single or staged joint replacement will continue.
Pain treatments (facet joint injection, hip and spinal injection and spinal cord stimulation) To stop offering facet joint injections, hip & spinal injections and spinal cord stimulation. Spinal cord stimulation is an NHS England commissioned service that will no longer be funded by the CCG. Where patients meet the criteria specified by NHS England, they will still be eligible for spinal cord stimulation at the designated centres.

 You can click on the links in the table to find more detailed information on the proposals or you can download the Service Restriction Policy review document here

*The procedures listed do not stop the referrer (GP or consultant) from being able to refer patients with suspected cancer.

Clinical Exceptions: Individual Funding Requests

If there is deemed to be a clinical exception to a treatment or procedure then an Individual Funding Request (IFR) can be made. Basildon and Brentwood CCG allows patients the opportunity to make specific funding requests via the Individual Funding Request team. Requests may include conditions for which the CCG does not fund or does not have an agreed policy. In instances in which eligibility is unclear the final decision is made through an application to the Individual Funding Requests team by contacting them at:This email address is being protected from spambots. You need JavaScript enabled to view it.

The Individual Funding Request policy and application forms can be found here

In addition, the CCG is proposing that the following treatments and procedures are subject to tighter restrictions than in the current policy:

  Hip arthoscopy   Hernia
  Knee arthroscopy (including knee washout)   Microsuction
  Shoulder arthroscopy Dupuytren's Contracture
  Carpal tunnel   Hysterectomy for menorrhagia
  Cholecystectomy (Gallstones)   Knee replacement – unilateral
  Cataract surgery   Minor skin lesions
  Diagnostic endoscopy – Dyspepsia   Sleep studies – snoring
  Diagnostic endoscopy – Colon (Colonoscopy for Irritable Bowel Syndrome - IBS)   Trigger finger
  Female genital prolapse/stress incontinence - surgical and non-surgical   Varicose veins
For further information:

Download the Service Restriction Policy Review document here

Download the Fit for the Future Event Discussion document here

See our information on Have your say on the Service Restriction Policy Review

Download our current  Service Restriction Policy

This email address is being protected from spambots. You need JavaScript enabled to view it. to ask for the information in an alternative accessible format

Find more information on existing local services at http://www.nhs.uk/service-search