Clinical Commissioning Group (CCG) Procedures of Lower Clinical Value Policy NHS Birmingham Cross City Clinical Commissioning Group NHS Birmingham South Central Clinical Commissioning Group NHS Sandwell and West Birmingham Clinical Commissioning Group NHS Solihull Clinical Commissioning Group NHS Walsall Clinical Commissioning Group NHS Wolverhampton Clinical Commissioning Group Policy for Procedures of Lower Clinical Value Name of Responsible Board / Walsall CCG Governing Body Committee for Ratification: Date Issued: 31st March 2016 Review Date: TBC Page 1 of 88 Clinical Commissioning Group (CCG) Procedures of Lower Clinical Value Policy Contents INTRODUCTION ....................................................................................................................................... 4 BACKGROUND ......................................................................................................................................... 4 SCOPE ...................................................................................................................................................... 5 IMPLEMENTATION .................................................................................................................................. 7 MONITORING and REVIEW ..................................................................................................................... 8 COPIES OF THIS POLICY ........................................................................................................................... 8 GLOSSARY OF TERMS .............................................................................................................................. 9 Policy for Adenoidectomy ..................................................................................................................... 11 Policy for Cosmetic Surgery .................................................................................................................. 13 Abdominoplasty/Apronectomy........................................................................................................ 14 Thigh Lift, Buttock Lift and Arm Lift, Excision of Redundant Skin or Fat .......................................... 14 Liposuction........................................................................................................................................ 15 Breast Augmentation........................................................................................................................ 15 Breast Reduction............................................................................................................................... 16 Mastopexy......................................................................................................................................... 18 Inverted Nipple Correction............................................................................................................... 18 Surgery for Gynaecomastia............................................................................................................... 19 Labiaplasty ........................................................................................................................................ 19 Vaginoplasty...................................................................................................................................... 20 Pinnaplasty........................................................................................................................................ 21 Repair of Ear Lobes ........................................................................................................................... 21 Rhinoplasty ....................................................................................................................................... 22 Face Lift or Brow Lift (Rhytidectomy) ............................................................................................... 23 Hair Depilation (removal).................................................................................................................. 24 Alopecia (Hair Loss)........................................................................................................................... 25 Removal of Tattoos/Surgical correction of body piercings and correction of respective problems 25 Removal of Benign (non-cancerous) or Congenital Skin Lesions ...................................................... 26 Removal of Lipomata ........................................................................................................................ 27 Medical and Surgical treatment of Scars and Keloids....................................................................... 28 Botulinum Toxin Injection for the Ageing Face................................................................................. 29 Treatment for Viral Warts................................................................................................................. 30 Thread/ Telangiectasis/ Reticular veins (Spider Angiomas) ............................................................. 30 Rhinophyma (bulbous, red nose)...................................................................................................... 31 Resurfacing Procedures: Dermabrasion, Chemical Peels and Laser Treatment............................... 32 Other Cosmetic Procedures .............................................................................................................. 33 Revision of Previous Cosmetic Surgery Procedures.......................................................................... 35 Policy for Back Pain ............................................................................................................................... 36 Policy for Botulinum Toxin for Hyperhidrosis ..................................................................................... 42 Policy for Cataracts ............................................................................................................................... 44 Policy for Cholecystectomy for Asymptomatic Gallstones ................................................................... 46 Policy for Male Circumcision................................................................................................................. 49 Policy for Dilation and Curettage (D&C) for Menorrhagia.................................................................... 51 Policy for Eyelid Surgery (Upper and Lower) ........................................................................................ 53 Policy for Ganglion ................................................................................................................................ 56 Policy for Groin Hernia Repair .............................................................................................................. 58 Policy for Grommets ............................................................................................................................. 60 Policy for Haemorrhoidectomy............................................................................................................. 62 Policy for Hip Replacement Surgery ..................................................................................................... 64 Page 2 of 88 Clinical Commissioning Group (CCG) Procedures of Lower Clinical Value Policy Policy for Hysterectomy for Heavy Menstrual Bleeding....................................................................... 68 Policy for Diagnostic Hysteroscopy for Menorrhagia Policy ................................................................. 72 Policy for Knee Replacement Surgery ................................................................................................... 74 Policy for Penile Implants...................................................................................................................... 77 Policy for Tonsillectomy ........................................................................................................................79 Policy for Trigger Finger ........................................................................................................................ 81 Policy for Varicose Veins .......................................................................................................................83 Policy for Dupuytren’s Disease...........................................................................................................86 Policy for Carpal Tunnel Syndrome....................................................................................................88 Page 3 of 88 Clinical Commissioning Group (CCG) Procedures of Lower Clinical Value Policy INTRODUCTION The purpose of this policy is to describe the access and exclusion criteria which the CCGs listed below will apply to Procedures of Lower Clinical Value (PLCV). The term ‘Procedures of Lower Clinical Value’, refers to procedures that are of value, but only in the right clinical circumstances. The main objective for having PLCV policies is to ensure that: • Patients receive appropriate health treatments in the right place and at the right time • Treatments with no or a very limited evidence base are not used • Treatments with minimal health gain are restricted. The procedures this relates to are listed in the “Scope” section below. BACKGROUND The following Clinical Commissioning Groups (CCG) and their respective Local Authority Public Health Commissioners