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Stakeholder Updates

July 2018

Commissioning Policies

The clinical commissioning groups (CCGs) in the Humber area have worked together to review their clinical commissioning policies. As part of this process clinical policies have been amended and updated and brought into line wherever possible across the CCGs.

The aim for establishing harmonised clinical commissioning policies is to reduce the variation in the content and implementation of adopted policies, in terms of the ability of people to access certain treatments in the different CCG areas where treatments are not routinely commissioned or restricted.

This work is ongoing and further policies are set for review – when new policies are published on this page, communications will be sent to the CCGs to identify any changes. All other CCG clinical commissioning policies can be found on the respective CCG websites.

Future work is planned to align across the Partnership following completion of a similar policy review being undertaken by Vale of York CCG and Scarborough and Ryedale CCG.

Understanding Individual Funding Requests and Commissioning Policies

CCGs need to make decisions on the range of health services and treatments that they commission. This includes ensuring that the services and treatments commissioned meet the needs of our population and offer value for money. The majority of services or treatments commissioned are available for the whole population, however, some are only clinically effective in very specific clinical situations, or for a very narrow group of patients.

In these instances there is often considerable variation in the evidence of clinical effectiveness for these treatments, while costs also vary. In these cases CCGs commission the service or treatment on a named individual (patient) basis, having first assessed that there is evidence that the proposed treatment is clinically effective to address the individual patient’s need, and that the patient should see a demonstrable benefit from receiving the treatment.

Each CCG in Humber, Coast and Vale operates an individual funding request (IFR) process for people living within their CCG area. As part of that process, CCGs often produce commissioning statements, which set out their position on a number of more common clinical conditions and treatments. The policies listed on this website should be read alongside the relevant IFR policy for each CCG.

Details of how the IFR process works can be found here:

The following revised policies have been approved by each of the four CCGs in the Humber area and are now in use for decisions about treatment and medicines provided to patients.

All Humber-aligned commissioning policy statements can be found in this policy document, and have also been classified as follows:

Category 1 Interventions

Interventions that are not routinely commissioned, considered through the Individual Funding Request (IFR) process

Abdominoplasty / Apronectomy Illizarov Technique
Adult Snoring Surgery (non OSA) Knee Arthroscopy
Arthroscopic Shoulder Decompression Liposuction for Lipoedema
Breast Correctional Surgery for Asymmetry Pinnaplasty / Otoplasty
Breast Enlargement Surgery Refractive Error Surgery
Dilatation and Curettage Replacement of Breast Implants
Endoscopic Thoracic Sympathectomy for Hyperhidrosis Reversal of Sterilisation

Spinal Injections for non-specific Low Back Pain

Gynaecomastia Surgery Tattoo Removal
Hip Arthroscopy Varicose Veins Surgical Intervention (C0-C3)
Hysterectomy for Heavy Menstrual Bleeding Wireless/Implantable FES

Category 2 Interventions

Interventions are restricted and should only be performed after specific criteria are met via the Prior Approval process (VBC Checker)

Anal Fissure Surgery for Adult Ganglion – Surgical Excision
Anal Fissure Surgery for  Child Grommets for Glue Ear in Children
Benign Skin Lesions – Surgical Removal Haemorrhoidectomy and Haemorrhoidopexy
Blepharoplasty Hair Removal for Hirsutism
Breast Revision Surgery (Prosthesis Removal) Labiaplasty / Vaginaplasty
Breast Reduction Surgery Rhinoplasty / Septorhinoplasty / Septoplasty
Bunion Surgery Sacral Nerve Stimulation for Faecal Retention
Carpal Tunnel Syndrome Release Sacral Nerve Stimulation for Urinary Retention (men)
Cataracts Surgery

Chalazion Removal

Sacral Nerve Stimulation for Urinary Retention (women)
Cholecystectomy Second Eye Cataracts Surgery
Circumcision – male adults Sleep Studies
Circumcision – male child Tonsillectomy for recurrent Tonsillitis
CPAP Continued for Obstructive Sleep Apnoea Trigger Finger/Thumb Surgery
CPAP Trial for Obstructive Sleep Apnoea Varicose Veins Surgical Intervention (C4)
Dupuytren’s Contracture Release for Adults Varicose Veins Surgical Intervention (C5-C6)
Functional Electrical Stimulation for Dropped Foot Vasectomy Under General Anaesthetic

No Category 1 or Category 2 intervention must be undertaken before securing CCG IFR approval or Prior Approval – activity will be monitored and audits will be regularly undertaken.

Please note the lists of commissioning policy statements above are not exhaustive of all interventions not routinely commissioned by the CCG. For any medical procedure or treatment that is not routinely commissioned where there is not a specific policy statement, a request via the IFR process must still be made.