Procedures of Limited Clinical Value (PoLCV) – MK CCG

A Procedure of Limited Clinical Value (PoLCV) is a procedure where the clinical effectiveness of that procedure is either absent or evidence shows weak efficacy. The CCG has developed a number of PoLCV policies based upon the evidence to evaluate a procedures clinical effectiveness. Each policy is categorised as either ‘Subject to Audit’, ‘Restricted’ or ‘Not Routinely Funded’. These are further defined as follows:

• Subject to Audit – This is a policy with clinical thresholds for treatment, which need to be fully met in order for treatment. However, there are no Prior Approval requirements for this policy but a retrospective audit will be undertaken.
• Restricted – This means the CCG will fund treatment if the patient meets the stated clinical threshold for care. Before the procedure is undertaken Prior Approval must be sought and obtained. Prior Approval means that a GP or Consultant must seek approval for an individual before treatment is carried out.
• Not Routinely Funded means the CCG will not usually fund the treatment. A clinician may still request funding for that treatment but this will only be approved if an Individual Funding Request (IFR) proves exceptional clinical need and is approved by the IFR panel (Please refer to IFR Policy).

Policy development is an on-going process resulting from the publication of new evidence regarding clinical effectiveness. Policy reviews are undertaken in response fo NICE Guidance/Guidelines, health technology assessments etc.

New policies or reviews on existing policies will be published on the MKCCG website.

Exceptional cases must have exceptional clinical circumstances supported by robust clinical evidence. MKCCG has defined exceptionality as an unusual clinical factor (or factor affecting the clinical condition) about the patient that suggests that they are:

The Equality Act 2010 protects people against unfair treatment (discrimination) on the ground of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. The Equality Act defines ‘disability’ as a physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day to day activities.

Providers are reminded that under this Act they must make adequate and reasonable adjustment to services, which includes provision for interpreters, carers and for others from whom patients may require assistance, providing information and/or signage in an appropriate range of formats, media and languages. Providers shall ensure that service and customer care is delivered in an inclusive manner which respects the diversity of users. It is therefore unlikely that an application for additional funding for such adjustments will be successful.

The responsibility for adherence to these policies lies with the treating clinician and failure to adhere to these criteria may result in non-payment of the activity.

All patients being referred for non-urgent elective surgery who are smokers should be referred to smoking cessation services by the GP at the time of referral, and should be non-smokers at the time of surgery.  There is strong evidence of higher risks and worse surgical outcomes when a patient continues to smoke. The risks associated with smoking mean that it is not always safe for surgery to take place when a patient continues to smoke and, as a result, some surgeons will not carry out procedures until a patient is able to abstain from smoking.  For smokers who are unable to quit, the Royal College of Anaesthetists advises that smokers should give up smoking for at least several weeks before surgery and certainly not to smoke on the day of an operation.  Smokers are 38% more likely to die after surgery than non-smokers.

There is strong clinical evidence that obese patients undergoing surgery are at significantly higher risk of getting infections and suffering heart, kidney and lung problems than people who are a healthy weight.  They are also likely to have to spend more time in hospital recovering and their risk of dying as a result of surgery is higher compared to patients with a normal weight.  Overweight patients are strongly encouraged to lose weight BEFORE their operation and should consider delaying referral for non-urgent elective surgery; this is particularly applicable to patients who have a BMI over 40 or those with a BMI between 30 and 40 who have metabolic syndrome – a combination of diabetes, high blood pressure and obesity.  Patients should aim to reduce their weight by at least 10% over 9 months or to a BMI of less than 30.

There are a number of interventions which are the responsibility of NHS England as part of their Specialised Commissioning service.

Specialised sevices are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialised hospital trusts that can recruit a team of staff with the appropriate expertise and enable them to develop their skills.

Further information on Specialised Commissioning can be found on:

https://www.england.nhs.uk/commissioning/spec-services/

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/06/pss-manual-may16.pdf

• The Ethical Framework that the Bucks/Milton Keynes Priorities Committee adopted when considering all policies
• Implementation of NICE interventional Procedures Guidance (IPGs) MOBBB Policy 33
• Implementation of NICE Medical Technologies Guidance (MTGs) and Diagnostic Technologies Guidance (DTGs) MOBBB Policy 50

Policies for Clinicians

• IFR Guidance for Clinicians and Request Form
• Milton Keynes Hospital Day Surgery Patients Undergoing General Anaesthetic / Sadation policy (2014)
• Optics – information to access ophthalmology services by opticians in Milton Keynes
• Individual Funding Requests (IFR) – A brief guide for patients

MK CCG Policies

• Individual Funding Request Policy

• Milton Keynes Formulary
• The NHS Milton Keynes General Policy for Funding Medicines (Jan 2016)

Please note that the Milton Keynes Joint Trusts Formulary Website cannot currently be accessed. If you have any queries about the formulary, please contact the CCG Pharmaceutical Advisers using [email protected]

The Primary Care process is available to download here.

The Secondary Care process is available to download here.

MKCCG POLCV policies apply to patients registered with a Milton Keynes GP Practice regardless of where their care is delivered. Where prior approval is required, Healthcare Providers should seek approval via the IFR team/Blueteq System.

The exception to this is Milton Keynes Hospital where an audit approach will apply to all policies, with the audit methodology determined by Milton Keynes Hospital and MKCCG.

“Cosmetic” surgery means procedures to improve appearance. It is also known as “aesthetic” surgery. Conditions resulting from major trauma or burns, which need reconstructive surgery, will usually be funded by the NHS.

Here you can access the Master Policy detailing The Provision of Cosmetic Treatments and Surgery.

The guidance lists procedures that are judged to be cosmetic and will not normally be funded by the NHS. The guidance applies to cosmetic surgery irrespective of the sub specialty of the surgeon concerned, including plastic surgery, ear nose and throat surgery, oral and maxillofacial surgery, dermatology, and other surgical specialties.

MKCCG has developed referral proformas for all policies categorised as Restricted – where Prior Approval is required. These electronic referral forms are also available on GP clinical system – SystmOne, once completed they need to be sent to [email protected]. Further policy details can be obtained by ‘clicking on’ the procedure name.

The referral proformas include all of the criteria which need to be met before a referral is made to secondary care and the proformas can be accessed by ‘clicking on’ the relevant policy PA Form. The requesting clinician will receive a letter/email giving the outcome of their Prior Approval submission. If approval is granted, the requesting clinician is responsible for sending the referral, along with proof of the approval to RMS. For those policies categorised as ‘Not Routinely Funded’ the referral requires approval from the Individual Funding Request (IFR) team.

The IFR form is available here and it is also available on GP clinical system – SystmOne.  This form is to be completed by the GP/Consultant when applying for funding for individual patients for clinical procedures which are categorised as Not Routinely Funded.

For more information, click here to view the NHS Milton Keynes CCG Policy for IFRs (November 2017) and IFR Guidance for Clinicians. Supporting information can be provided to evidence assessment within the form. Forms should be typed and signed, then send securely to [email protected]. The requesting clinician will receive a letter/email giving the outcome of their IFR submission. If approval is granted, the requesting clinician is responsible for sending the referral, along with proof of the approval to RMS.

Lenses – Filtered – Coloured

The Milton Keynes IMSK Service is a single point of access for musculoskeletal conditions. GPs should not refer outside of this pathway unless there are red flags that necessitate an urgent referral to secondary care. This service began on 1st April 2017. From this date, all patients over 16 years old with an MSK condition registered with a Milton Keynes GP should be referred to Ravenscroft for triage and where necessary treatment. Referrals should be sent to the RMS via E-Referral. Referrals will be triaged by specialist MSK Extended Scope Physiotherapists and where care is needed outside of the IMSK service, patients will be offered a choice of provider, where available. If prior approval is needed for a procedure, the IMSK service will undertake this assessment and complete the necessary forms. No prior approval form is required at the GP referral stage, however the forms remain here for secondary care clinicians needing to seek prior approval.