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NHS Wirral CCG Governing Body Meeting - 7th February 2017

30 March 2017

Summary of decisions made in relation to the Service Review Consultation

The Governing Body of NHS Wirral CCG today 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 continue to be treated.

Cosmetic Procedures

  • 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

Dermatology

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
  • Severe
  • 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

 

Fertility

  • 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

Sterilisation

  • 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
  • Manipulation
  • 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
  • Bursitis

Urology/ Uro-gynae

  • 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

Additional comments:

  • 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