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Treatment Policies

Since 2013 NHS Birmingham and Solihull CCG and NHS Sandwell and West Birmingham CCG have worked collaboratively to develop a common set of evidence-based clinical treatment policies. Our aim has been to:

  • Ensure policies incorporate the most up-to-date published clinical evidence so that we prioritise funded treatments that are proven to have clinical benefit for patients
  • Stop variation in access to NHS-funded services across Birmingham, Solihull and Sandwell (sometimes called a postcode lottery) and allow fair and equitable treatment for all local patients
  • Ensure access to NHS-funded treatment is equal and fair, whilst considering the needs of the overall population and evidence of clinical and cost effectiveness.

Our treatment policy development work is informed by the work of our Clinical Priorities Advisory Group (CPAG) which makes recommendations for prioritisation in the best interests of people living in Birmingham and Solihull.

Each treatment policy states whether the treatment or procedure is:

  • Not routinely commissioned:Would require an Individual Funding Request to demonstrate clinical exceptionality or
  • Restricted: Funded if particular clinical criteria and thresholds apply.

Each policy includes:

  • A short summary explanation of what the procedure entails
  • For ‘Restricted’ procedures, what the clinical thresholds for treatment are
  • Summary of what clinical guidance commissioners have used to inform the detail of the commissioning policy, e.g. NICE, Royal Colleges or Other Clinical Associations
  • An Equality Impact Assessment review.

Find out more

The commissioning principles underpinning each treatment policy include:

  • CCG commissioners require clear evidence of clinical effectiveness before NHS resources are invested in the treatment
  • CCG commissioners require clear evidence of cost effectiveness before NHS resources are invested in the treatment
  • The cost of the treatment for this patient and others within any anticipated cohort is relevant factor
  • CCG commissioners will consider the extent to which the individual or patient group will gain benefit from the treatment
  • CCG commissioners will balance the needs of each individual against the benefit which could be gained by alternative investment possibilities to meet the needs of the community
  • CCG commissioners will consider all relevant national standards and take into account all proper and authoritative guidance
  • Where treatment is approved, CCG commissioners will respect patient choice as to where treatment is delivered.

Individual Funding Requests (IFR) and exceptionality

We recognise there may be exceptional circumstances where it is clinically appropriate to fund each of the procedures listed in this policy and these will be considered on case-by-case basis.

Funding for cases where either a) the clinical threshold criteria is not met, or b) the procedure is not routinely funded, will be considered by the CCGs following application to the CCG’s Individual Funding Request Panel, whereby the IFR process will be applied. 

Find out more here.

Clinician’s right to seek specialist advice

In cases of diagnostic uncertainty, the scope of this policy does not exclude the clinician’s right to seek specialist advice. This advice can be accessed through a variety of different mediums and can include both face-to-face specialist contact, as well as different models of clinical specialist advice and guidance virtually through e-referrals, Consultant Connect or other tele-medicine services locally commissioned.

Lifestyle factors and surgery

Lifestyle factors can have an impact on the functional results of some elective surgery. In particular, smoking is well known to affect the outcomes of some foot and ankle procedures. In addition, many studies have shown that the rates of postoperative complications and length of stay are higher in patients who are overweight or who smoke.

Therefore, to ensure optimal treatment outcomes, patients who smoke or have a body mass index of 35 or greater and are being considered for referral to secondary care, should be able to access CCG and Local Authority Public Health smoking cessation and weight reduction management services prior to surgery where commissioned.

Patient engagement with these ‘preventive services’ may influence the immediate outcome of surgery. While failure to stop smoking, or lose weight will not be a contraindication for surgery, GPs and surgeons should ensure patients are fully informed of the risks associated with the procedure in the context of their lifestyle.

Psychological factors and surgery

Commissioners acknowledge that there is a psychological dimension for patients in seeking or considering the option of treatment and surgery. However, because there are no universally accepted and objective measures of psychological distress and therefore such factors are not taken in account in any policy clinical thresholds. Nevertheless, there always remains the option of an application to demonstrate clinical exceptionality through IFR process as detailed above.

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