Why do we do Consultations?
At Wirral Clinical Commissioning Group, we are fully committed to communication and engaging with our patients and wider population in the decision that we need to make about commissioning (purchasing) of health services.
It is critical that our patient, stakeholders, staff and wider population feel involved in decisions made. Wirral CCG has established relationships with key partners as well as having structures in place to understand people’s views on an ongoing basis. The CCG wants to make sure we put patients at the heart of everything we do. We want to encourage local patients and their carers to be involved in how services are shaped and improved, and to work alongside us to make changes happen.
Service Review Consultation
The Governing Body of NHS Wirral CCG have reviewed the outcome of the recent Service Review Consultation and having discussed this and additional evidence before it reached the following decisions in relation to the clinical services included in the review.
These changes will be effective from 1st April 2017 for new patient referrals. Any patients who have already been referred by their GP for any of the following services will be continue to be treated. A copy of both of the revised commissioning policies following this consultation are available to view/download on this page.
- Stop routine funding of surgery for asymmetrical breasts
- Stop routine funding of surgery to reduce breast size
- Stop routing funding of surgery for enlarged breasts in men
- Stop routine funding of surgery for hair removal treatments for hirsutism
- Stop funding any procedures requested primarily for cosmetic purposes
Exclusions in place for:
- Cancer patients
- Burns/accident victims
- Birth defects
- PCOS for hirsutism - eligibility criteria will apply
- Musculoskeletal conditions – eligibility will apply
- Severe psychological impact – eligibility will apply
Introduce a threshold for surgery to remove benign skin lesions and to only allow routine funding for any of the following:
- Sebaceous cysts
- Lesions causing functional impairment
- Lesions on the face which could be regarded as a disfigurement
- Any lesion where there is a suspicion of cancer
Introduce a threshold for desensitising light therapy for PMLE (polymorphic light eruption) to only allow routine funding for the following (must meet all points below):
- Diagnosis made by dermatology consultant
- Functional impairment
- Symptoms remain severe despite preventative treatments
- Light therapy deemed likely to make significant improvement
Note: consideration of educating patients not to use sunbeds in an attempt to improve condition.
ENT (Ear, Nose and Throat)
Introduce threshold for ear wax removal in secondary care – including microsuction to only allow routine funding for any of the following:
- Perforated ear drum
- Otitis Externa
- Hearing loss and all other methods of ear wax removal have failed
- Enable inspection of ear drum due to clinical concern of other pathologies
- Clinical risk of other methods of removal
- Reduce the number of IVF cycles funded from 3 cycles to 2 cycles.
- Incorporate additional restrictions for IVF – BMI and smoking status to male partner (currently applies only to female partner)
- Eligibility threshold for IVF for period of trying to conceive to be increased from 2 years to 3 years for unexplained infertility (age to be taken into account)
- Stop routine funding of surgical sperm recovery, individual funding request for patients with genetic conditions
- Stop routine funding of donor oocyte cycle
- Stop routine funding of sperm insemination unless part of an IVF cycle
- Stop routine funding of intrauterine Insemination (IUI) unstimulated
- Stop routine funding male sterilisation (vasectomy) under general anaesthetic. Male sterilisation will be available under local anaesthetic. Female sterilisation is unchanged.
Trauma and Orthopaedics
Introduce a threshold for shoulder arthroscopy to stop routine funding unless all of the following have been tried and failed:
- Activity modification
- Physiotherapy and exercise programme
- Oral analgesia
- Intra-articular joint injections
- Frozen shoulder persistent for at least 12 months
Introduce a threshold for surgery for Dupuytrens Contracture to only allow routine funding if:
- Metacarpophalangeal joint and/or proximal IP joint contracture of 30+
- Severely impacting daily living and functional limitation
- Young person with early onset disease without family history, clinical assessment demonstrates they will benefit from surgery
- Stop routine funding of conservative treatments for Dupuytrens Contracture – note, the term conservative refers to interventions such as injections. Primary care management such as stretching exercises are not included
- Continue to fund knee replacement surgery as per the current policy – i.e. no change
- Introduce a threshold for hip injections to only allow routine funding for hip injections for any of the following:
- Diagnostic aid
- Introduce contract medium to the joint as part of hip arthrogram
- Inflammatory arthropathy
- Continue to fund pharmaceutical intervention for erectile dysfunction however a robust prescribing policy will be introduced
- Secondary care interventions for erectile dysfunction will be restricted to patients will certain medical conditions e.g. post cancer
- Stop funding circumcision for religious reasons. However a list will be drawn up of safe clinics; this will be shared with GPs, maternity units and local churches/organisations
- Continue funding percutaneous posterior tibial nerve stimulation (PTNS) for urinary and faecal incontinence
- Individual Funding Request (IFR) will be available for all procedures if the patient is deemed ‘clinically exceptional’.
- Robust outcomes quality monitoring for 12 months implementation including:
- Consideration of number and outcome of IFR requests
- Consideration of any unintended consequences, e.g. analysis of any post circumcision complications
NHS Wirral CCG – Governing Body Meeting 4/10/16
The Governing Body of NHS Wirral Clinical Commissioning Group met on 4/10/16 and considered four proposals that have been subject to public consultation. The following summary details the outcome of the discussions at the meeting:
Products of Limited Clinical Value – Prescribing Policy
Ref No GB16-17 0013 Item 2.1
Outcome – Approval to develop a policy that will cease the prescribing of items deemed to be of limited clinical value.
Self-Care Prescribing Policy – Over the Counter Products
Ref No GB16-17 0013 Item 2.2
Outcome – Approval to develop a self-care policy for minor ailments which will cease the prescribing of over the counter products to patients.
Gluten Free Prescribing Policy
Ref No GB16-17 0013 Item 2.3
Outcome – Approval to change the current Gluten Free Prescribing Policy to place further restrictions on the prescribing of certain gluten free products.
Following public consultation, Wirral CCG has now developed a new prescribing policy in relation to the prescribing of gluten-free products. This policy provides further restrictions on the prescribing of gluten-free products. The quantities of gluten free foods recommended by Wirral CCG have been adapted from those outlined by Coeliac UK to reflect limitations placed on prescribing.
There is further information outlined in our patient leaflet.
Homeopathy and Iscador Service Review
Ref No GB16-17 0013 Item 2.4
Outcome – Approval to cease the funding of the Homeopathy and Iscador Service.
To access a full version of the Governing Body agenda and papers please click here. This information is also available on NHS Wirral Clinical Commissioning Groups website.