Fit for the Future: decisions
A package of measures to put the local NHS on a more sustainable footing was agreed at a board meeting of NHS Basildon and Brentwood Clinical Commissioning Group (CCG) on Thursday 24 November.
This follows a nine week public consultation in which the CCG actively sought and listened to the views of local people on a range of proposed changes to the local Service Restriction Policy (SRP) and Intermediate Care Services.
Please scroll to the end of each table to see the relevant decision and the implementation date when any changes will come into effect.
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Intermediate Care Services |
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Proposal |
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The CCG proposes to commission a new model of Intermediate Care which aims to manage patients with a combination of care in pa persons own home and through investment in community services and a reduced bed base specifically, the closure of beds at Mayflower Community Hospital (Billericay) and by combining the beds in Meadowview and Mayfield Ward (Thurrock Community Hospital) commissioned by all south Essex CCGs. This will be undertaken by: Phase 1 Creating Community Capacity 1) The CCG intend to invest circa £900k in additional provision/capacity focussed on a new Rehabilitation Service aligned to the Single Point of Response within existing community services. This will be primarily therapy led and work in partnership with a number of other community services e.g. the Dementia Crisis Team, Integrated Care Teams and Reablement Service. Phase 2 Reduced bed base in line with delivery of option 2 2) Through the introduction of the proposed community rehabilitation model, the need for intermediate care beds will reduce as patients will be supported to become as independent as possible at home. This change allows a number of existing intermediate care beds to be closed. The CCG would cease commissioning beds at Mayflower Community Hospital (Billericay) and with the south Essex CCGs, consolidate the bed base on Meadowview and Mayfield Wards on the Thurrock Community Hospital site. The CCG would therefore commission: - The Community Rehabilitation Service - Thorndon Ward, Brentwood Community Hospital - Mountnessing Court in Billericay - In conjunction with south Essex CCGs, Meadowview Ward in Thurrock Community Hospital |
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Rationale: |
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The drivers that acted as a catalyst for the CCG to review the provision of inpatient Intermediate Care it commissions are: - The QIPP (Quality, Innovation, Prevention, Productivity) challenge faced by the CCG meant that all areas of spend required review to ensure that we commission best value care. - The Fit for the Future programme intention is that we commission a service model that supports patients to regain their optimum level of independence (this should be delivered in the patients normal place of residence) - Changes to the Essex County Council (ECC) reablement contract which BBCCG invest £900k per year via the Better Care Fund - ECC commissioning of 10 reablement beds in the community |
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Impact: |
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The efficiencies made through this proposed change would allow the CCG to increase the number of patients it supports within its Intermediate Care services – whilst the bed numbers will reduce, the number of patients that can be managed by the total system (home based and bed based care) would increase. In addition, the resulting saving from this new model will go towards bringing the CCG back to its statutory financial balance position which is vital in order for it to be viable organisation and fund future services for the local population. |
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Recommendation |
It is recommended that subject to:
The CCG would then commission; - The Community Rehabilitation Service - Thorndon Ward, Brentwood Community Hospital (including the 8 Stroke beds) - Mountnessing Court in Billericay - In conjunction with south Essex CCGs, Meadowview Ward in Thurrock Community Hospital - In conjunction with Thurrock CCG, the CCG continues to commission 8 stroke beds within Thorndon Ward, Brentwood Community Hospital |
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Decision |
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Recommendation agreed |
Service Restriction Policy Review
E-cigarettes |
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Proposal |
| Basildon and Brentwood CCG are proposing that e-cigarettes and other novel nicotine containing products are not prescribed on the NHS until they have been fully evaluated, their place in therapy established, and formulary processes have been followed. Smoking and stop smoking services fall under the remit of Public Health. NICE has issued guidance PH 45 https://www.nice.org.uk/Guidance/PH45 and associated quality standards. These recommend access to smoking cessation services, brief intervention and referral for smoking cessation. These services are available locally via Public Health. The CCG feels there is existing sufficient support available to aid with the cessation of smoking. |
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Rationale |
| Electronic cigarettes are novel devices that deliver nicotine by heating and vaporising a solution that typically contains nicotine, propylene glycol and/or glycerol and flavourings. A Public Health England (PHE) report1 has estimated that about 2.6 million adults used electronic cigarettes in 2015. The report concluded that as of yet the long term health harms are not known. The report also estimated that nationally there are currently 1.8m prescription items dispensed each year that relate to smoking cessation (of which about 50% are nicotine replacement therapies). The nicotine replacement therapies that can be prescribed include:
These can all be prescribed by your GP or can be purchased within pharmacies. Along with the prescribing of the above NRTs there is also the Public Health commissioned ‘NHS Stop Smoking Service’ that patients can access without having to contact their GP via telephone or the internet or via the online app. This service offers one-to-one sessions, group sessions or drop in services.The CCG is not currently responsible for the commissioning of e-cigarettes. E-cigarettes are not currently prescribed as a nicotine replacement. |
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Impact |
| The CCG believes that the proposed changes would have little impact on the local population as described above there are several NRTs available that support smoking cessation along with other therapies available from pharmacies. These methods are clinically proven to assist with the stopping of smoking altogether as opposed to moving to an alternative way of smoking. It has been estimated that costs for e-cigarettes would be around £1.1m per 100,000 population per year and that with a population of over 260,000 the CCG would face a significant financial pressures to an already challenged health system. |
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Recommendation |
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The recommendation to the Board is to support the following:
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Decision |
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Recommendation to not fund e-cigarettes was agreed |
Gluten-free prescribed foods |
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Proposal |
| As part of a wider review into service restrictions Basildon and Brentwood CCG is proposing to stop all gluten free products on prescription with exceptions of pregnant women (from the point of confirmed pregnancy) and under 18s. |
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Rationale |
| Initially gluten free products were added to the list of products available on NHS prescription when they were not easily available for patients to purchase. However, there are now a wide range of gluten free products available from supermarkets, the internet, health food stores and pharmacies. There are alternative products that are sold at prices that are considerably lower than the NHS is charged for prescribed foods. In addition to these products there is a wide variety of naturally gluten free food including; fresh fruit and vegetables, meat, poultry, fish, cheese and eggs. In October 2016 NICE published the first quality standard* for Coeliac disease (Appendix 4), this quality standard outlines that patients should be able to access support and guidance on how to follow a gluten free diet. |
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Rationale - post consultation |
| Gluten free products are now available to purchase, food products for other allergies are not funded on prescription and many not as accessible as Gluten Free foods for example soya, nut and dairy free. The consultation was seeking to ensure a reduction in inequity for our patient population and as such should ensure that the same position is taken for all of the population. |
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Impact |
| With the variety of gluten free products widely available to buy at a reasonable cost, the CCG believes there will be minimal impact to patients. |
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Recommendation |
The recommendation to Board is to:
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Decision |
| The following recommendation was approved: Support the proposal to stop all gluten free products on prescription with exceptions of pregnant women (from confirmation of pregnancy) and under 18s. In addition the CCG will take forward the identified mitigating actions. Implementation date: 1st January 2017 |
Toric Intraocular Lens Implants for Astigmatism |
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Proposal |
| As part of a wider review of service restrictions Basildon & Brentwood CCG are proposing to cease the funding of Toric intraocular lens implant (IOLs) for astigmatism. |
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Rationale |
| The standard IOLs design used for cataract surgery in the NHS is the monofocal IOLs. The Toric IOLs are the so called ‘premium lens’ however these come at a greater cost than the standard. The proposal the CCG is making isn’t to stop funding all procedures of IOLs and correction of cataracts just the Toric IOLs. The Toric IOLs works towards patients not requiring glasses as it potentially improves astigmatism however with limited funds the CCG aim is to bring people back to a pre cataract position not correction of astigmatism. The CCG’s approach to the current financial challenges is to prioritise the limited funding it has so that the local population has access to the healthcare that is most needed. This assessment of need is made across the whole population of Basildon & Brentwood CCG and, wherever possible, on the basis of best evidence on what is clinically proven to work. |
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Impact |
| The efficiencies made by not funding this procedure will go towards bringing the CCG back to its statuary financial balance position which is vital in order for it to be viable organisation and fund future services for the local population. As there are alternative IOLs procedures available the CCG believes there would be limited impact to patients. |
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Recommendation |
| The recommendation to the Board is that Basildon and Brentwood CCG should not fund Toric Intraocular Lens Implants for Astigmatism. The basis for this recommendation is that the CCG already funds standard monofocal IOL and as the Toric lens is a premium lens it will be more expensive. |
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Decision |
| Recommendation approved Implementation date: 28th November 2016 |
In-vitro Fertilisation (IVF) and Assisted Conception (new referrals) |
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Proposal |
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In 2015 NHS Basildon and Brentwood CCG undertook a Public Consultation to cease specialist fertility service provision. No decision has yet been made following the consultation. The consultation was based on two options;Option 1 – No change to the existing policyMaintenance of the status quo. Assisted conception, including offering three cycles of IVF, would continue to be available to those who meet the eligibility criteria. Outside the agreed eligibility criteria, clinically exceptional cases would be considered by application to the CCG’s exceptional cases panel. Option 2 – Decommission Specialist Fertility ServicesUnder this option the CCG would cease commissioning specialist fertility services. Patients would only be able to access gynaecology services within local district general hospital. A summary of the fertility services that will be available under this option is defined in Appendix 1. If implemented, this policy would apply to only those patients referred onto specialist fertility pathways from the date of implementation. Any patient on an existing pathway would be able to conclude their pathway in line with the current restriction policy1. Clinically exceptional cases would be considered by application to the CCG’s Individual Funding Request Panel. The CCG would keep and monitor the impact of the change on both services and people with fertility problems. There would be a review of the policy annually and further changes could be applied, including a return to wider access to specialist fertility services, if this was considered to be affordable. The only exception to this would be to continue to commission fertility preservation.
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Rationale |
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| In 2015 the CCG’s Turnaround Programme required the CCG to review all of its commissioning arrangements to identify whether services commissioned are a priority for the CCG. Those that are not priorities need to be reviewed to seek opportunities for delivering savings to protect priority provision. As part of this review, the CCG has reviewed the provision of Specialist Fertility Services. | |||||||||
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Impact |
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| The efficiencies made by not funding this procedure will go towards bringing the CCG back to its statutory financial balance position which is vital in order for it to be viable organisation and fund future services for the local population. | |||||||||
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Recommendation |
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The recommendation to Board is to proceed with “Option 2” i.e. decommissioning specialist fertility Appendix 1
Day case - Laparoscopy + dye Inpatient - Myomectomy |
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Decision |
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| Amended recommendation approved - the CCG cease to commission specialist fertility for any individual referred to specialist fertility services on or after 1st December 2016 (those referred prior to this date will be treated as existing service users and provision will be in line with the policy decision for In-vitro Fertilisation (IVF) and Assisted Conception (existing treatment) Implementation date: 1st December 2016 |
In-vitro Fertilisation (IVF) and Assisted Conception (existing treatment) |
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Proposal |
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In 2015 NHS Basildon and Brentwood CCG undertook a Public Consultation to cease specialist fertility service provision. No decision has yet been made following the consultation. However, if the proposal (as per consultation in 2015) were to be approved by the CCG Board, then services would be decommissioned for those requiring referral for tests or procedures that were deemed specialist (specialist assisted conception services e.g. IVF).The CCG would continue to fund those tests or procedures that would diagnose fertility problems and those that can be undertaken in a local hospital to aid fertility. We are now consulting on proposals for people who have already been referred for specialist fertility treatment, for whom the decision of what the CCG will fund for them was not addressed in the original consultation.The proposals for people who have already been referred or are receiving treatment for specialist assisted conception services cover the following: • In Vitro Fertilisation (IVF) with or without Intracytoplasmic Sperm Injection (ICSI) • Frozen Embryo Transfer • Embryo/Blastocyst Freezing and Storage • Surgical Sperm Recovery (Testicular Epididymal Sperm Aspiration (TESA)/Percutaneous Sperm Aspiration (PESA) including storage where required) • Intrauterine Insemination (IUI) - unstimulated • Donor Oocyte Cycle • Donor Sperm Insemination • Egg Storage for Patients Undergoing Treatments likely to affect their fertility • Sperm Storage for Patients Undergoing Treatments likely to affect their fertility For those patients who have already been referred for specialist fertility treatment and are in the process of receiving the above specialist services, the CCG is proposing to introduce the following restrictions:
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Rationale |
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| The CCG believe that this decision supports transparency and equity of approach to the population and reduces the perception that for some people we are funding fully in line with NICE guidance whilst for others not supporting funding at all. | ||||||||||||||||||||||||||||||
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Impact |
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| The CCG also considers that withdrawing support for funding for those in the system is unfair without notification of this change in decision or approach. The efficiencies made by not funding this procedure will go towards bringing the CCG back to its statutory financial balance position which is vital in order for it to be viable organisation and fund future services for the local population. |
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Recommendation |
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The recommendation to the Board members is to:
o CCG writes a letter for Providers to send to existing patients outlining the outcome of the Amended recommendations: 1) Approve the redefinition of an IVF cycle as a maximum one fresh and one frozen transfer. 2) Amend the IVF section with: 3) Approve the funding of up to a maximum of six cycles of intrauterine insemination (IUI) prior to the first cycle of IVF. 4) Approve the implementation date for the storage of eggs and sperm as 1 December 2016. 5) Approve the cessation of funding for IVF and assisted conception treatment for all other individuals in the system. |
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Decision |
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Amended recommendation approved Detail: NICE definition of a full cycle of IVF The CCG Board decided that a cycle will be defined as a maximum of one fresh and one frozen transfer. Existing patients are defined as those who have had a referral made to a specialist provider on or before 30 November 2016. First cycle Individuals who have been referred to a specialist provider (on or before 30th November 2016) or who are receiving treatment from a specialist provider will be funded for intrauterine insemination (IUI) and for one cycle of IVF with a maximum of one fresh and one frozen transfer* but will not go on to subsequent IVF cycles and no further embryo transfers will be funded. Second cycle Individuals receiving active treatment for a second cycle on 1 January 2017 i.e. taking medication this second cycle will be funded to a maximum of one fresh and one frozen transfer*. The individuals will not go on to a third cycle and no further embryo transfers will be funded. Third cycle Individuals receiving active treatment for a third cycle on 1 January 2017 i.e. taking medication this third cycle will be funded to a maximum of one fresh and one frozen transfer*. No further embryo transfers will be funded. No further cycles will be funded. The CCG Board decided that it will fund a cycle defined as a maximum of one fresh and one transfer. However, if an individual is receiving active treatment i.e. taking medication in preparation for the transfer of a second or subsequent frozen embryo on 1 January 2017 this transfer for which the individual is receiving active treatment will be completed. No further transfers or cycles will be funded. Embryo storage Any extra embryos that have generated from an NHS funded cycle of IVF will have storage funded by the NHS for one year. From 1 February 2018 individuals will have the option to fund storage themselves if they wish storage to continue. Successful pregnancy If at any stage during the process a successful pregnancy occurs (even if it occurs naturally) any subsequent specialist fertility treatment will not be funded. |
Simultaneous joint replacement |
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Proposal |
| As part of a wider review of service restrictions Basildon & Brentwood CCG are proposing to cease the funding of the following joint replacement procedures: • simultaneous hip replacement i.e. replacing both hips at the same time • simultaneous knee replacement i.e. replacing both knees at the same time • simultaneous shoulder joint replacement |
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Rationale |
| Simultaneous joint replacement, both joints would be replaced at the same time. Whilst there may be an advantage that the surgery is undertaken in one go, it does pose greater risks. By having both joints replaced at the same time the surgery is therefore longer which alone can increase the risk of complications. Recovery and rehabilitation time may be increased when having simultaneous joint replacements and therefore this can place a greater demand on the body which in turn could lead to a complex and more expensive package of care being required. The CCG’s approach to the current financial challenges is to prioritise the limited funding it has so that the local population has access to the healthcare that is most needed. This assessment of need is made across the whole population of Basildon & Brentwood CCG and, wherever possible, on the basis of best evidence on what is clinically proven to work. The proposed change would mean that simultaneous joint replacement inserts would no longer be funded under the CCG however staged joint replacement would still be. |
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Impact |
| It is suggested that staged joint replacement poses less risk to older patients and patients with heart conditions whilst also reducing the length of time patients are in hospital. The majority of patients having total joint replacements are over the age of 65 and whilst having staged joint replacements will mean having two episodes of surgery the main advantage is that it reduces risks of complications. The efficiencies made by no longer funding these procedures will go towards bringing the CCG back to its statutory financial balance position which is vital in order for it to be viable organisation and fund future services for the local population. |
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Recommendation |
| The recommendation to the Board is that the CCG should not fund Simultaneous Joint Replacements. |
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Decision |
| Recommendation approved Implementation date: 1st January 2017 |
Pain treatments/injections (back, hip and leg) |
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Proposal |
| As part of a wider review of service restrictions Basildon & Brentwood CCG are proposing to cease the funding of pain insert procedures (facet joint injections, hip & spinal injections). For note: These procedures are not those available at General Practice but those that are required referral to be undertaken at an acute hospital. |
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Rationale |
| The CCG’s approach to the current financial challenges is to prioritise the limited funding it has so that the local population has access to the healthcare that is most needed. This assessment of need is made across the whole population of Basildon & Brentwood CCG and, wherever possible, on the basis of best evidence on what is clinically proven to work. As a result of this, the CCG has identified procedures that are of either limited clinical value or that does not cater for the wider needs of the population. Therefore it has been proposed to implement these changes in order for the local health economy and services to be sustainable. The CCG in consultation with the Dr Simon Thompson (Pain Specialist Consultant, Basildon Hospital) have developed a criteria (see below proposed criteria) for injections for diagnostic purposes that supports both current and proposed NICE Guidance and reflects the position of the British Pain Society. |
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Impact |
| The proposed changes would mean that secondary care (acute) pain injections (facet joint injection, hip and spinal injection) would no longer be funded by the CCG except as a diagnostic intervention. There will still be a range of pain relief interventions available that will be funded and/or can be prescribed. These may include (list not exhaustive):
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Recommendation |
The Board is asked to approve the following recommendations:
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Decision |
| Recommendation approved Implementation date: 1st January 2017 |
Spinal Cord Stimulation (SCS) |
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Proposal |
| As part of a wider review of service restrictions Basildon & Brentwood CCG are proposing to cease the funding of pain insert procedure (spinal cord stimulation). (Definition - spinal cord stimulation involves placing a series of electrical contacts in the spine near the region that supplies nerves to the painful area. The procedure is a minimally invasive surgical technique). |
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Rationale |
| The CCG’s approach to the current financial challenges is to prioritise the limited funding it has so that the local population has access to the healthcare that is most needed. This assessment of need is made across the whole population of Basildon & Brentwood CCG and, wherever possible, on the basis of best evidence on what is clinically proven to work. As a result of this, the CCG has identified procedures that are either limited clinical value or that does not cater for the wider needs of the population or therefore it has been proposed to implement these changes in order for the local health economy and services to be sustainable. |
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Impact |
| The proposed changes would mean that pain procedure (spinal injection) would no longer be funded by the CCG however there will still be a range of alternate pain relief methods available that will be funded and/or can be prescribed. For patients who already have a Spinal Cord Stimulator device in situ – they would continue to receive the on-going support they require. However, this proposal would determine where they would receive this support in the future. |
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Recommendation |
The Board is asked to approve the following:
o The Trust (BTUH) can’t evidence with a project plan detailing the milestones to delivery (agreed with NHS England) the progression of the BTUH Pain service becoming accredited
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Decision |
| Recommendation approved Implementation date: 1st January 2017 |
Travel Vaccinations |
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Proposal |
| In line with national recommendations from PrescQIPP, Basildon and Brentwood CCG is proposing to put in place a policy which clarifies the position of certain vaccines when requested in relation to travel abroad. This is to ensure that certain vaccines which are not allowed on the NHS for travel purposes, are not prescribed on FP10 prescription. |
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Rationale |
| NHS patients are entitled to receive free advice on travel vaccinations, however, only some vaccinations required for travel are available on the NHS. This includes Hepatitis A vaccine, Typhoid vaccine, combined hepatitis A and typhoid vaccine, combined Tetanus, diphtheria and polio vaccine and Cholera vaccine. Other vaccines such as Hepatitis B, Meningitis ACWY, Yellow fever, Japanese B encephalitis, Tick bourne encephalitis and Rabies vaccine are not remunerated by the NHS as part of additional services in relation to travel abroad, and these vaccines should not be prescribed on FP10 prescription. It is proposed that a GP practices may charge a registered patient for the immunisation if requested for travel, or the patient may be given a private prescription to obtain the vaccines. In addition, the combined hepatitis A/hepatitis B vaccine is prescribable on the NHS because it contains hepatitis A. However, because hepatitis B is not commissioned by the NHS as a travel >vaccine, Basildon and Brentwood CCG does not support the prescribing of this item. Patients requiring both vaccines for travel purposes should receive hepatitis B privately. |
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Impact |
| There is currently very little prescribing of Meningitis ACWY, Yellow fever, Japanese B encephalitis, Tick bourne encephalitis and Rabies vaccines on FP10 prescription in BBCCG, and therefore this policy would help to ensure no new prescribing. There is however a BBCCG spend of almost £75k per year associated with Hepatitis B vaccine, as well as the combined hepatitis A/hepatitis B vaccine. It is envisaged that implementation of local policy would reduce any inappropriate prescribing for travel abroad, and could produce annual savings to the CCG of approximately £75k across the course of a year. |
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Recommendation |
| The recommendation to the Board is that Basildon and Brentwood CCG should not fund the following travel vaccinations as these are not standard NHS vaccines:
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Decision |
| Recommendation approved Implementation date: 28th November 2017 |
Bariatric surgery |
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Proposal |
| As part of a review into service restrictions Basildon and Brentwood CCG was proposing not to fund bariatric surgery. NHS England transferred responsibility for commissioning Bariatric surgery to the CCG from 1 April 2016. This service is provided from specialised centres so patients must travel to London for this surgery. Whilst the funding will return with the service, the CCG feel that it should consult on not providing this service to the population and instead work with Public Health to promote healthier lifestyles and tackle obesity rather than managing the problem once it occurs. However, as stipulated in the latest NICE guidance (CG189; 2014), there will be a group of patients, especially people of different ethnicity, who may benefit from bariatric surgery as they are likely to develop more complex health conditions (especially Diabetes) if they are already significantly overweight. Obesity Weight Management Obesity rates have doubled in 20 years (men 24%, women 26%) but Basildon (30.2%) has a greater percentage of adults that are classified as obese or excess weight compared to the regional and national average, in sharp contrast with Brentwood (18.6%). In regards to children, the rate of obesity is higher in Basildon than Brentwood with both tracking the general upward trend in the past few years but levelling off now. There is over 10% decrease in children with ‘healthy weight’ between Reception year and Year 6 cohorts. Definition - Bariatric surgery This type of surgery is only available on the NHS to treat people with potentially life-threatening obesity when other treatments, such as lifestyle changes, haven't worked. Potentially life-threatening obesity is defined as:
assessment for weight loss surgery if they have a BMI of 30-34.9. |
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Rationale |
| The CCG wish to support people to self-manage their condition, empowering them to have greater control over their lives’. Where there is a pressing clinical need, cases will be considered on an exceptional basis. The CCG feel that through working with Public Health and our providers to support people to better manage their conditions and engage and participate in improving their wellbeing the need for bariatric surgery should decrease whilst outcomes for patients should improve. Both Basildon and Brentwood Health and Well Being Boards (HWB) support the need to prevent obesity and manage it so as to reduce the need to progress onto surgical intervention. |
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Impact |
| It is suggested that the proposal should not greatly impact patients with obesity and weight issues as there are already various weight management services available that teach nutrition and lifestyle changes rather than opting for surgery. With any surgery there are risks and if patients can lose weight themselves naturally with the support of local services they are not going to be exposed to the risks of bariatric surgery and any possible complications. |
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Recommendation |
The recommendation to the Board is that they:
Surgery should only be considered as a treatment option for people with morbid obesity providing all of the following criteria are fulfilled: • The individual is considered morbidly obese. For the purpose of this guidance and in accordance with previous and current NICE Guidance, obesity surgery will be offered to adults with a BMI of 40kg/m2 or more, or between 35 kg/m2 and 40kg/m2 or greater in the presence of other significant diseases. However, NICE have recently updated their guidance on obesity surgery (NICE CG189). This expands the above criteria - to the consideration of newly diagnosed diabetics ( 30 to < 35, for assessment of obesity surgery. Moreover, patients with newly diagnosed diabetes within the former group (≥35) should be expedited for consideration of obesity surgery. All groups will have been treated in a Tier 3 specialist weight management service. NICE guidance also includes consideration of assessment of newly diagnosed Asian diabetes patients at BMI levels2.5 kg/m2 less. • There must be formalised MDT led processes for the screening of comorbidities and the detection of other significant diseases. These should include: • Disease / condition / Risk factor identification, diagnosis, severity / complexity assessment, risk stratification/scoring and appropriate specialist referral for specialist medical management. Such medical evaluation and optimization is mandatory prior to entering a surgical pathway. • The individual has recently received and complied with a local specialist weight management programme (non-surgical Tier 3 mostly and Tier 4 in some urgent or complex cases) described as follows:
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Decision |
| Recommendation approved Date of implementation: 28th November 2016 (no change to existing criteria) |
Cosmetic surgery |
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Proposal |
| That the CCG no longer commission Cosmetic Surgery procedures: • Breast Procedures – asymmetry / reduction / mastoplexy including revision / replacement • Gynaecomastia • Liposuction / skin contouring / body contouring • Cosmetic Surgery Funding for reconstructive surgery will continue, where this is not for cosmetic purposes. |
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Rationale |
| The CCG has a current financial deficit and is having to make decisions about ceasing funding of services and therefore has to review funding of all procedures of low/limited clinical value. |
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Impact |
| There should be limited impact on patients as these procedures are thought to be of low clinical value. Cosmetic surgery is a choice rather than a clinical need and should therefore be self-funded. Efficiencies made will go towards the CCGs financial deficit position and work towards bringing the CCG back to its statutory requirement to achieve financial balance. |
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Recommendation |
The recommendation is:
o Acne – resurfacing for severe post-acne facial scarring o Aesthetic facial surgery o Rhinoplasty o Body contouring o Breast procedures o Breast augmentation / breast reconstruction o Breast lift / mastoplexy o Breast reduction o Gynaecomastia o Hair depilation o Hymenorrhaphy o Laser treatment for tattoo removal o Liposuction / liposculpture / body contouring o Pinnaplasty / otoplasty o Plagiocephaly o Repair of ear lobes – post trauma o Rhinophyma o Scar revision – keloid o Scar revision – other o Septoplasty / septorhinoplasty o Vaginal labia refashioning |
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Decision |
| Recommendations approved Implementation date: New referrals after 1st December 2016 will have to comply with the new criteria. Individuals booked for a date by 1st December 2016 will have the procedure carried out in line with the previous criteria as long as the procedure is complete by 30th June 2017 (no further procedure after this date) |
Service Restriction Policy criteria changes |
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Purpose, brief description and overview |
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| As part of the Fit For Future engagement, the CCG consulted on changes to current SRP criteria in addition two new areas for adding to the current policy. The following chart shows those areas where changes have been made to the proposed criteria following public feedback and those where no change is required as a result of public engagement therefore the CCG intends to adopt the revised criteria. |
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Recommendation |
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| The Board is asked to approve the change in criteria and additions to the SRP following public engagement | ||||||||||||||||||||||||||||||||||||||
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Decision |
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| Recommendation approved as per Fit for the Future board paper 24 November 2016 Implementation date: 1st December 2016 |
