Urgent and necessary measures

Next steps for urgent and necessary measures

Background

In October 2014 we announced a number of potential measures as part of our financial recovery programme.  This included publishing a list of services which were being considered for disinvestment.

This is because in 2013/14, the CCG’s financial position was in deficit by £14.5 million and a similar deficit was predicted for this financial year too.   

It was therefore decided that we had to take essential action to address this in order to prioritise the urgent care system, particularly during the difficult winter months, and to continue to achieve the guarantees that are made to patients in the NHS Constitution. 

Listening to feedback

The proposed measures were subject to clinical review during November, as well as Equality & Quality Impact Assessment.  Recommendations were reached to limit certain treatments on the basis of evidence and impact.  These were to be ‘Interim Commissioning Positions’ in force for around 18 months which would be further reviewed during that time.

However, in the course of the last two months, and following feedback and engagement from the public, stakeholders, clinicians and a range of organisations, the CCG’s approach has altered and some of the services under review are believed to be more suitable as referral guidance to clinicians, rather than enforced policy on the whole. 

For clarity, the proposed measures originally announced are now not being enforced.

Instead, we will develop guidance for clinicians and some measures will be considered via the usual Clinical Policy Committee (CPC) infrastructure and governance.  You can find out more about the CPC here.

Current status of proposed measures

The table below lists areas for which the CCG was considering interim commissioning positions.  The table also displays the way in changes to service provision in those areas will now be progressed.

Area under consideration Summary of proposed measure How this clinical area will now be progressed
Weight loss in obese patients prior to routine surgery Where surgery is not immediately clinically necessary and where weight loss would be beneficial for clinical outcomes and/or peri-operative risk, a requirement for patients to achieve 5% weight loss if they have a Body Mass Index greater than 35. To be developed as Referral Guidance to clinicians with supporting services for patients.  Patients will be encouraged but not required to lose weight.
8 weeks smoking cessation prior to routine surgery Where surgery is not immediately clinically necessary, a requirement for patients to cease smoking for 8 weeks prior to their operation. To be developed as Referral Guidance to clinicians with supporting services for patients.  Patients will be encouraged by not required to stop smoking.
Funding of 2nd hearing aid Unless other sensory or disabling factors exists, 2nd hearing aids would not be routinely funded. No actions to restrict hearing aids.
Ear microsuction for the removal of wax Unless for the treatment of infection or due to other factors which make ear syringing in primary care clinically inappropriate, no routine funding of wax removal by microsuction. To be developed as Referral Guidance to clinicians with non-hospital alternatives developed for patients.
Criteria for cataract surgery Enhancement of policy to bring in to line with more restrictive policies from elsewhere in the UK.  Driving level vision to be funded (for drivers and non-drivers).  Tighter restrictions than currently for the 2nd eye. To be considered by the usual Clinical Policy Committee route to arrive at a policy for the treatment of cataracts.
Shoulder surgery Prior approval by a CCG clinical panel required for shoulder surgery in recognition of the breadth of treatment options available for shoulder problems. No interim position being adopted.  Further work ongoing with the British Orthopaedic Association, the British Elbow & Shoulder Society, the Chartered Society of Physiotherpists and local clinicians to define best practice pathways to be commissioned.
Use of Avastin in the treatment of Wet Age-Related Macular Degeneration (Wet AMD) A switch to the treatment recommended by the World Health Organisation for this condition.  Requires a CCG position as the drug is unlicensed for that purpose in the UK, the manufacturers not having applied for a license. No deviation from NICE guidance.
Shockwave therapy in the treatment of tendinopathies Interim suspension of this service, in recognition of equivocal evidence and it not being universally available. No interim position being taken.  Referral guidance for clinicians being developed.  As these are researched any policy recommendations will be referred to the Clinical Policy Committee for consideration.

We continue to welcome feedback from members of the public, and the public are welcome to feedback to the CCG through the Patient Advice and Liaison Service (PALS) on 01392 267 665 or 0300 123 1672 or by email on pals.devon@nhs.net.

Useful links

Frequently asked questions (FAQs) - updated 19 December 2014 Requirements under NHS Constitution

CCG press releases

NEW Devon CCG asks people to take responsibility for their own health and wellbeing Weight management and smoking requirements to be introduced ahead of planned surgery in the NEW Devon CCG area Urgent and necessary measures to prioritise services Urgent and necessary measures to address patient demand

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