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Prior Approval Policy Prior Approval Policy including Procedures of Limited Clinical Value (PLCV) Reference No: CG036 Version: Version 6 Ratified by: SWLCCG Executive; SLCCG Executive; WLCCG Executive Date ratified: 05.12.16 Ratified by: ELCCG Date Ratified: 19.12.16 Name of originator/author: Andrew Rix, Pat McClenaghan, Isabel Perez Name of responsible Governing Body (delegated to Executive Bodies) committee/individual: Date issued: 3 January 2017 Review date: April 2018 Target audience: All Providers for the NHS in Lincolnshire registered population Distributed via: Contracting Team to all Providers All CCG Websites All GP via Gateway Communication Intradoc Ophthalmologists The NHS in Lincolnshire (West Lincs CCG, East Lincs CCG, South West CCG, South Lincs CCG) Prior Approval Policy NHS Lincolnshire Prior Approval Policy Version Control Sheet Section/Para/ Version/Description of Author/Amende Version Date Appendix Amendments d by 1 Document Version 1 29 January Andrew Rix created 2010 2 Revised Version 2 9 June 2011 Andrew Rix document 3 Revised Version 3 25 April 2012 Andrew Rix document Version 4 4.1 Policy Amendments to reflect Nov 2014 Andrew Rix/ General change in organisations Pat McClenaghan /Isabel Perez 4.2 Section 1 Text amendment to reflect Nov 2014 Andrew Rix/ change in organisation Pat McClenaghan /Isabel Perez 4.3 Section 1 Update to Cosmetic Policy to Jan 2014 Andrew Rix/ reflect review undertaken Pat McClenaghan across East Midland area /Isabel Perez 4.4 Section 2 Amended to reflect change Nov 2014/ Andrew Rix/ to organisation Jan 2014 Pat McClenaghan /Isabel Perez 4.5 Section 3 Amended to reflect changes Nov 2014/ Andrew Rix/ in responsibility Jan 2014 Pat McClenaghan /Isabel Perez 4.6 Section 4 Amended to reflect changes Nov 2014/ Andrew Rix/ in responsibility Jan 2014 Pat McClenaghan /Isabel Perez 4.7 Section 5 Revised to reflect name Nov 2014/ Andrew Rix/ Pat change in service (previously Jan 2015 McClenaghan PCSS, now CSS) and / Isabel Perez provision under the scheme Version 5 5.1 All Sections Reviewed and amended by 2 Sept 2016 Kate Schroder county wide clinical review group as part of Turnaround programme The NHS in Lincolnshire (West Lincs CCG, East Lincs CCG, South West CCG, South Lincs CCG) Prior Approval Policy Page 2 of 63 Version 6 6.1 Introduction Minor changes to wording in Nov 2016 Pat McClenaghan Para 5. /Isabel Perez/ Matthew Broughton Section 3 Added further procedures/treatment to list. Section 4 Added further procedures/treatment to list and expanded criteria where appropriate. Removed Haemorrhoid Banding Section 5 CSS – have included criteria The NHS in Lincolnshire (West Lincs CCG, East Lincs CCG, South West CCG, South Lincs CCG) Prior Approval Policy Page 3 of 63 Prior Approval Policy - NHS Lincolnshire Content Page Policy Statement 5 Introduction 7 Purpose 7 Contents of This Schedule 8 Principles applied to treatments for which Prior Approval should be requested 8 Process to be followed 8 Section1: The NHS in Lincolnshire Policy for Cosmetic Procedures (All Ages) 10 Section 2: Procedures which fall under the remit of NHS England 30 Section 3: NHS in Lincolnshire Prior Approval List 33 Section 4: NHS in Lincolnshire Prior Approval List – not requiring PA 43 Section 5: Community Surgical Scheme 59 The NHS in Lincolnshire (West Lincs CCG, East Lincs CCG, South West CCG, South Lincs CCG) Prior Approval Policy Page 4 of 63 NHS Lincolnshire Prior Approval (PA) Policy Policy Statement Background In 1995 the Low Priority Procedures policy was introduced to the NHS in Lincolnshire as a first step in ensuring that the NHS only commissioned evidence based and clinically effective services. Subsequent initiatives, such as the Primary Care Surgical Scheme (PCSS), continued the move towards using the allocated budget as effectively as possible by enabling patients to be treated in the least intensive and least costly setting for selected procedures. Over the years all of the policies, that have been developed to serve these aims, have been reviewed and refined. The 4 Clinical Commissioning Groups (CCG’s) (East Lincolnshire CCG, Lincolnshire West CCG, South West Lincolnshire CCG and South Lincolnshire CCG) which make up the NHS in Lincolnshire have reviewed their position, for 2016/17 with regard to a selected portfolio of procedures it wishes to commission. This work has been undertaken collaboratively with the CCG’s which make up the East of Local Area Team Footprint and Procedures of Limited Clinical Value (PLCV) and Cosmetic Surgery Policy. This approach is aligned to the national Right Care programme. http://www.rightcare.nhs.uk/ Statement The document sets out to make explicit the position of the NHS in Lincolnshire with regard to which treatments will, or will not be, commissioned from providers and the criteria and thresholds to be applied. It further sets out the process to be followed should a Provider wish to undertake a treatment, or where a clinician wishes to refer to a Provider which is not commissioned to provide the treatment. Treatments, and services, referred to in this Policy should not be undertaken or provided without prior approval being obtained or as indicated. Where prior approval has not been appropriately obtained, then any treatments or services provided will have not been legitimately delivered, and will not be paid for by the responsible Clinical Commissioning Group. Responsibilities The responsibility for the implementation, delivery and monitoring and review of the PA Policy is led by Lincolnshire East Clinical Commissioning Group on behalf of all the CCGs which make up the NHS in Lincolnshire. The NHS in Lincolnshire (West Lincs CCG, East Lincs CCG, South West CCG, South Lincs CCG) Prior Approval Policy Page 5 of 63 Dissemination The policy will be distributed to all providers via the contracting route as it will set out what will, and will not, be commissioned. Resource There are no additional resource implications associated with implication implementation of the policy ii. EQUALITY STATEMENT The NHS in Lincolnshire is committed to ensuring equality of access and non-discrimination for all its registered population. People who need help to access NHS services are advised to contact POHWER, who deliver information, advice, support and advocacy services and aim to support people who face difficult issues and want to make their voice heard. This is a free, independent and confidential service. They can be contacted on 0300 456 2376 (charged at local rate) or [email protected]. The NHS in Lincolnshire (West Lincs CCG, East Lincs CCG, South West CCG, South Lincs CCG) Prior Approval Policy Page 6 of 63 1. Introduction The NHS in Lincolnshire exists to serve the needs of all of its patients but also has a statutory duty financially to break even (National Health Service Act 2006). Clinical commissioning group are established under the Health and Social Care Act 2012 (“the 2012 Act”). The 4 Clinical Commissioning Groups (CCG’s) are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 (“the 2006 Act”). The duties of the Clinical Commissioning Group to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations under that provision. The Clinical Commissioning Group has a responsibility to provide health benefit for the whole of their population, whilst commissioning appropriate care to meet the clinical needs of individual patients. The CCG receives a fixed budget from the Department of Health and is required to ensure that expenditure does not exceed the aggregate of its allotments for the financial year (See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act) Commissioned services include those provided through primary, secondary and tertiary care NHS providers, the independent sector, voluntary agencies and independent NHS contractors and in house service providers. The mechanism through which investment, and disinvestment, decisions are taken is the CCG Operational Plan. The CCG does not expect to make significant decisions outside this process and in particular does not expect to commit significant new resources in year to the introduction of new healthcare technologies (including drugs, surgical procedures, public health programmes) since to do so risks ad hoc decision making and can destabilise previously identified priorities. The CCG Operational Plan by its very nature focuses on cohorts of patients with the more common clinical conditions. It cannot meet every healthcare need of all patients in any one clinical group or address the specific needs of patients with less common clinical conditions. The fact that the CCG is not meeting a healthcare need due to resource constraints is an inevitable fact of life in the NHS and does not indicate that the CCG is breaching its statutory obligations. Given the longer term financial prospects of the CCG, related to QIPP, and the subsequent reduction in funding, it is essential that the CCG seeks to further maximise the number of patients treated within a sustainable financial envelope. This means: Only evidence based clinically effective services will be commissioned. Patients should be treated in the least intensive and least costly setting. 2. Purpose The contents of the ‘Prior Approval Policy’ forms part of the contract between the NHS in Lincolnshire, as the Commissioner, and all Providers for the registered population of Lincolnshire as defined in Who Pays? Determining Responsibility for payment tp Providers.1 The Policy subsumes a number of existing documents into one overarching point of reference. Given this there will be clear signposts to the full documents referred to. 1 http://www.england.nhs.uk/wp-content/uploads/2014/05/who-pays.pdf The NHS in Lincolnshire (West Lincs CCG, East Lincs CCG, South West CCG, South Lincs CCG) Prior Approval Policy Page 7 of 63 It sets out to make explicit the position of the CCG with regard to what treatments will, or will not be, commissioned from providers and the criteria and thresholds to be applied.
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