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Procedures of Low Clinical Priority

Information on procedures of limited clinical priority and clinical thresholds

Like every public service, the NHS in Wirral is facing challenging times in trying to manage a rising demand for services from limited resources. It means making difficult choices about how to use those resources in a fair and efficient way, whilst ensuring that procedures offered are evidence based, so we can get the best possible health benefits for the patients we serve.

We do this by following nationally and regionally agreed guidelines and paying for operations and treatments that are proven to be clinically effective and expected to improve your health and well-being. Some operations and treatments do not meet this criteria and have what’s termed, ‘limited clinical priority’. 

The policy “Procedures of Low Clinical Priority” sets out thresholds and an agreed set of criteria which must be met before your GP can refer you for an operation or treatment.  A threshold could, for example, be that medication to manage your health problem should be considered in the first instance. Surgery has risks and health experts agree for many conditions surgical procedures should be considered after trying other, reasonable, non-surgical options first.

What does this mean for you?

Your GP may not be able to refer you for a particular treatment because it is not funded by the NHS in Wirral. Your GP has to follow this guidance because it is now an agreed policy of the local NHS.

However, in some exceptional clinical circumstances your GP, hospital consultant, or health care professional may think you will benefit from a treatment that is not routinely provided. They can then make an Individual Funding Request application on your behalf, which will be considered by an independent panel.

The current policy was revised in 2015 following extensive consultation, since then there have been a number of updates with the most recent being in response to NHS England’s guidance for Evidence Based Interventions.

 

The current policy can be downloaded here.

 

Please click here for the Wirral NHS Funded Treatment for Subfertility Policy.

 

Individual Funding Requests

An Individual Funding Request is a request to funded specialist healthcare for an individual who falls outside the range of services and treatments that CCGs have agreed to commission. An individual funding request is only regarded as such when a case can be set out by a patients clinicians that they have exceptional clinical circumstances which make their case different to other patients with the same condition and at the same stage of their disease or for a request for a treatment that is regarded as new or experiment and where there are no other similar patients who would benefit from this treatment.

Requests will only be considered if made by a secondary or community care consultant, a general practitioner or a general dental practitioner (where appropriate) for registered patients of NHS Wirral Clinical Commissioning Group.

To submit an individual funding request your clinician(s) should complete an Individual Funding Request proforma supported by relevant clinical assessments.