Information for GPs on low priority procedures

Low priority procedures are generated by the clinical prioritisation process to advise on the funding of certain treatments and interventions.

Partially excluded policies

A partially excluded policy is where treatment is not routinely funded but exceptional cases can be considered. If a patient is regarded as having exceptional circumstances funding requests can be considered by the NHS Suffolk Individual Funding Request (IFR) Panel and the panel abide by NHSS Individual Funding Request Policy. This is enclosed in the accompanying document.

NHS Suffolk’s partially exclude policies include-

PE1 Treatment for soft-palate snoring

PE2 Benign skin lesions (this is currently being revised)

PE3 Filtered/Coloured lenses for scotopic sensitivity syndrome

PE4 Spinal surgery

PE5-20 Cosmetic and lifestyle procedure

PE21 Treatment for gender dysphoria

PE22 Bevacizumab (Avastin) for the treatment of colorectal carcinoma

PE23 Alemtuzumab for chronic lymphocytic leukaemia

PE24 Growth hormone for growth disturbances in children born small for gestation age

PE25 Bevacizumab (Avastin) in wet AMD

PE26 Homeopathy in secondary care

PE27 Sorafenib in advanced renal cell carcinoma

PE28 Specialised exercise therapy for scoliosis

Threshold policies

A threshold policy is where treatment is funded for any patient by whom specific criteria are fulfilled. These eligibility criteria are detailed in the policy. All the many threshold policies are only applicable to the acute providers there are nine policies where information from GPs is crucial to determine whether patients fulfil the policy criteria. NHSS has developed checklists to aid both the implementation and monitoring of these policies. Acute trusts have a contractual obligation to demonstrate that they only treat patients who fulfil the policy criteria or risk financial consequences as NHSS will not fund patients outside of the policies.

The nine policies which require active contribution from the GPs are listed below. GPs are requested to use the checklists for these policies while referring patients for these procedures to secondary care. However if there is a clinical uncertainty whether patients meet the criteria then GPs can refer and the consultants will make the final decision. The policies and the checklists can be found in the enclosed document.

T6 Varicose veins

Surgical treatment will only be offered for complicated varicose veins (complicated being defined as having one or more of the 5 criteria), or patient with uncomplicated varicose veins in patients that have developed a recognized psychiatric condition due to the varicose veins

T7 Grommets

NHS Suffolk will only fund grommet insertion for otitis media with effusion (OME) when the 5 eligibility criteria are met. Children with hearing impairment should have a 3 month period of watchful waiting OME.

T8 Male circumcision

Circumcision willonly be funded for 4 locally agreed conditions.

T9 Common hand conditions (Dupuytren’s contracture, ganglion’s, trigger finger)

Intervention for Dupuytren’s contracture is almost exclusively surgical and should only be considered when the patient is having functional difficulties as set out in the policy.

For ganglions a referral to secondary care should only be made when the eligibility criteria are met as set out in the policy

For trigger finger referral to secondary care may only be considered when the 2 eligibility criteria have been met

T9a Carpal tunnel syndrome

The NHS Suffolk (Suffolk PCT) will only fund Carpal Tunnel Surgery when one or more of the 2 criteria are met

T12 Vasectomy under general anesthetic

Vasectomy should only be performed under general anesthetic if one the 3 circumstances are met as set out in the policy

T13 Tonsillectomy

NHS Suffolk will only fund tonsillectomy when one or more of the 5 eligibility criteria have been met as per the policy. A six month period of watchful waiting is recommended prior to referral for tonsillectomy.

T14 Dilatation and curettage for heavy menstrual bleeding

Patients will not receive dilation and curettage (D&C) as a diagnostic tool ALONE for heavy menstrual bleedingOR when used as a therapeutic treatment. Hysteroscopy should be used as a diagnostic tool only when ultrasound results areinconclusive, for example to determine the location of a fibroid or the exact nature of the abnormality.

T17 Spinal surgery for non-acute lumbar conditions

Patients will only receive non-acute spinal surgery under the circumstances set out in the policy

T18a/T18bHip and knee replacement surgery

The NHS Suffolk (Suffolk PCT) will only fund hip replacement for osteoarthritis whenconservative measures have failed and one or more of the eligibility criteria have been met

T24 Botulinum toxin type A for detrusor over activity

Referral should not be considered unless the patient meets the eligibility criteria.

T26 Female surgical interval tubal sterilization

Referrals for sterilization will generally be accepted if 3 essential criteria and one or more of the other criteria are met

T28 Benign skin lesions

T29 Cholecystectomy

T30 Hip and knee replacement revision

T31a Surgery for female urinary incontinence

T31b Surgery for pelvic organ prolapse

T32 Surgery for Hernia

Table of threshold policies and checklists for use in general practice

Policy name / Policy / Checklist
T6 Varicose veins / /
T7 Grommets / /
T8 Male circumcision / /
T9 Common hand conditions (Dupuytren’s contracture, ganglion’s, trigger finger / /
T9a Carpal tunnel syndrome / /
T12 Vasectomy under general anesthetic / /
T13 Tonsillectomy / /
T14 Dilatation and curettage for heavy menstrual bleeding / /
T17 Spinal surgery for non-acute lumbar conditions / /
T18a/T18bHip and knee replacement surgery / /
T24 Botulinum toxin type A for detrusor over activity / /
T26 Female surgical interval tubal sterilization / /
T28 Benign skin lesions /
T29 Cholecystectomy /
T30 Hip and knee replacement revision /
T31a Surgery for female urinary incontinence /
T31b Surgery for pelvic organ prolapse /
T32 Surgery for Hernia /