Procedures of Limited Clinical Effectiveness Phase 1
Consolidation and repository of the existing evidence-base
Meeyin Lam, Public Health Trainee
Jennie Mussard, Assistant Director (PCT Intelligence)
Updated to include procedure codes and information on outliers, October 2010
This report was produced with the support of the London Health Observatory team, which is part of the Clinical Health Intelligence Directorate, CSL.
Key Points

This table includes a list of 70 potentially avoidable procedures under 41 main procedure groupings, based on the master list provided in the DFI report. The
DFI codes have been included.

A total of 26 of the main procedure groups are listed by at least five London sectors (14 procedures), have NICE guidance (16 procedures) or both (4
procedures). This suggests that there is a reasonable evidence-base, or a strong foundation for consensus, for developing pan-London referral guidance.
These are shaded blue or green.

The remaining 15 procedures are listed by less than five London sectors and do not have NICE guidance, indicating that more extensive evidence appraisal
and clinical consultation is needed.

Three procedures have been identified as having higher potential or stretch savings across London as a whole AND are on less than five London sector lists.
These procedures are a priority for further evidence appraisal, as the savings may be greater. These are shaded yellow.

The Appendix reviews an additional list of procedures that are not included in commissioners’ list and include some outpatient procedures
1
Local reviews of evidence and referral guidance – London
ETR: Exceptional treatment reviews: procedures. Reviewer PCT listed in brackets
INEL: Inner North East London Low Priority/Excluded Restricted Procedures 2010-2011 (draft list)
NCL: North Central London Policy for Low Priority Treatments (draft 2)
NWL Policy: North West London’s ‘Interventions Not Normally Funded’ Policy. Includes hierarchy of evidence and grading of recommendation (A -D).
A: Based on evidence from systematic reviews, meta-analysis of randomised controlled trials or at least one randomised controlled trial
B: Based on evidence from at least one controlled study without randomisation or at least one other type of quasi experimental study
C: Based on evidence from non experimental descriptive studies, such as comparative studies, correlation studies and case control studies
D: Directly based on evidence from expert committee reports or opinions and/or clinical experience of respected authorities or extrapolated from hierarchy evidence from
above
ONEL: Outer North East London Procedures of Limited Clinical Effectiveness. April 2010 (draft policy). Provides evidence review. Does not include most
cosmetic procedures.
SEL: South East London Exceptional Treatments Commissioning Policy (not including dental and orthodontic)
Section 1 treatments require review and approval by the relevant group and prior funding agreed
Section 2 treatments do not require prior agreement; however they must be notified to the PCT along with details of how the access criteria were met.
SWL: South West London Effective Commissioning Initiative 2009/10. Provides evidence review.
Local reviews of evidence and referral guidance – outside London
C&M: Draft Cheshire and Merseyside Prior Approval Scheme, Incorporating Procedures of Lower Clinical Priority. A review and compilation of the policies of the 8
PCTs in Cheshire and Merseyside. Criteria were also informed by a review undertaken by the South West London Public Health Network on behalf of 5 PCTs in London
and the London Health Observatory. Criteria have been classified as either ‘not contentious’ as all current policies are very similar or ‘requires discussion to agree
criteria’ if there is significant variation between policies.
Brighton: NHS Brighton and Hove PCT policies - Procedures which require prior approval from the PCT
Evidence reviews and guidance in green text have been referenced by others (including Dr Foster Intelligence), but not cross-checked for this project. They may
have reviews of evidence.
-
Berkshire NHS Priorities Website
Brent PCT
Hampshire & Isle of Wight PCTs (South Central Priorities Committee) Policy
Norfolk Policy for Low Priority Procedures and Thresholds
Oxfordshire PCT
2
-
Suffolk Low Priority Treatment Policy
Waltham Forest Exceptional Treatments Policy 2008
West Essex PCT Surgical Threshold Policy
West Essex PCT Priorities Policy
West Sussex PCT Low Priorities Procedures and Other Procedures and Restrictions
Western Cheshire
Westminster PCT, 2007, Low priority procedures policy
Stratification of areas for further work
Procedures have been highlighted in the table in the following colours:
BLUE: all or most (5/6) London sectors have referral guidance for the procedure, though they may not be identical, and/or there is NICE guidance
YELLOW: the procedure has been identified to have a higher potential or stretch saving level across London as a whole (this may vary for different sectors and
PCTs). The levels of saving were identified by Dr Foster Intelligence.
GREEN: procedure meets both of the above criteria
WHITE: Four or less London sectors have referral guidance for the procedure AND there is no relevant NICE guidance
3
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Balance of clinical evidence: a planned procedure where evidence of clinical- and/or cost-effectiveness is either absent, or too weak for reasonable conclusions about efficacy and long term benefits/harms to be reached
Apicectomy
A01
OPCS
British Association Oral and Maxillofacial
Surgeons. Referral guidelines. Apical surgery.
Previously available at
http://www.baoms.org.uk/CDROM/guidelines/Apical%20surgery.pdf
(accessed 3rd October 2007)
F121
NWL Policy (D)
NWL with
exceptions
Barnet,
Bromley,
Croydon,
Enfield,
Haringey,
Waltham
Forest
NCL1
Royal College of Surgeons of England.
Guidelines for surgical endodontics.
http://www.rcseng.ac.uk/fds/clinical_guidelines/do
cuments/surg_end_guideline.pdf (accessed 1st
Oct 2007)
Autologous
chondrocyte
implantation
A02
OPCS
Barnet &
Chase Farm,
Ealing,
Homerton,
Mayday,
South London,
UCLH,
Whipps Cross
NICE Technology appraisal TA89
W853
C&M criteria
No PCT
Western
Cheshire
No provider
(Blue)
Injections and
fusion for back
pain
A03
HRG4
HC01Z, HC02B,
HC02C, HC03A,
HC03B, HC03C,
Gibson JNA, Waddell G. Surgical interventions for lumbar disc
prolapse. Cochrane Database of Systematic Reviews 2007, Issue
2.
Ibrahim T; Tleyjeh IM; Gabbar O. Surgical versus non-surgical
1
Minor oral surgery for retained roots
Spinal surgery for non-acute lumbar conditions
3
Discectomy for lumbar disc prolapse
2
4
NICE Clinical Guidance CG 88 (published May
2009)
ONEL
SWL
ONEL2
3
SWL critieria
Enfield,
Lewisham,
Tower
Hamlets,
Procedure
(Blue)
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
HC04A, HC04B,
HC04C, HC05B,
HC05C, HC07Z,
HC08Z, HC09Z
treatment of chronic low back pain: a meta-analysis of randomised
trials. International Orthopaedics, February 2008, vol./is. 32/1(10713), 0341-2695
OPCS
V221, V231,
V241, V251,
V253 ,V261,
V333, V335,
V336, V371,
V372, V373,
V374, V378,
V379, V381,
V382, V383,
V384, V388,
V389, V391,
V392, V393,
V394, V395,
V398, V399,
Formal recommendations (NICE, professional
bodies, etc)
Mirza SK; Deyo RA Systematic review of randomized trials
comparing lumbar fusion surgery to non-operative care for
treatment of chronic back pain. Spine, April 2007, vol./is. 32/7(81623), 1528-1159
Rivero-Arias O, Campbell H, Gray A et al. Surgical stabilisation of
the spine compared with a programme of intensive rehabilitation
for the management of patients with chronic low back pain: cost
utility analysis based on a randomised controlled trial. BMJ. 2005
May 28;330(7502):1239
Van Tulder M, Koes B, Seitsalo S, Malmivaara A. Outcome of
invasive treatment modalities on back pain and sciatica: an
evidence-based review. Volume 15, Supplement 1 / January, 2006
Can be purchased from
http://www.springerlink.com/content/718525118748783t/fulltext.pdf
For discectomy:
Butterman GR. Treatment of lumbar disc herniation: epidural
steroid injection compared to discectomy. J Bone and Joint
Surgery 2004; 86-a: 670-9
Greenfield K, Nelson RJ et al. Microdiscectomy and conservative
treatment for lumbar disc herniation with back pain and sciatica: a
randomized clinical trial. Proceedings of the International Society
for the Study of the Lumbar Spine, 2003: 245
Hoffman RM, Wheeler KJ, Deyo RA. Surgery for herniated lumbar
discs: a literature synthesis. J Gen Int Med 1993; 8: 487-96
Malter AD, Larson EB et al. Cost effectiveness of lumbar
discectomy for the treatment of herniated invertebral disc. Spine
1996; 21: 1048-55
4
Vertebroplasty
5
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Brighton4
Waltham
Forest
Suffolk
Barnet &
Chase Farm,
Barts, ESH,
GSTT,
Imperial,
King’s, St
George’s,
UCLH,
Whipps Cross
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
NICE, “Press release – guidance on hearing
aids”, 2000
ETR (Tower
Hamlets)5
Hampshire &
Isle of Wight
PCTs
No PCT
South
Gloucestershire PCT6
GSTT, Royal
Free
Weber H. Lumbar disc herniation. A controlled, prospective study
with ten years of observation. Spine 1983 8(2): 131-40
Weinstein JN, Torteson TD, Lurie JD et al. Surgical vs
Nonoperative Treatment for Lumbar Disk Herniation. JAMA 2006
296
Also see listing for Lumbar disc prolapse (A09)
Bilateral bone
anchored
hearing aid
(BAHA)
A04
OPCS
D131, D132,
D133, D134,
D135, D136,
D138, D139
Tower Hamlets provided the following sources (to support
funding?)
Dutt, S, et al, Patient satisfaction with bilateral bone-anchored
hearing aids: the Birmingham experience, J Laryngol Otol, 2002,
116, 37-45, p 41.
Snik, A, et al, Candidacy for the bone-anchored hearing aid, Audiol
Neurotol, 2004, 9, 190-96, p196.
Croydon list
Snik, A, et al, Consensus statements on the BAHA system: where
do we stand at present?, Ann Otol, Rhinol Laryngol, 2005, Dec,
114, 12, 2-12, p7.
Bedfordshire
and
Hertfordshire7
REFER, Department of Health Research Findings Register, The
use of bone-anchored hearing aids, REFER Summary, 2001, 1-3,
p2. http://www.refer.nhs.uk/ViewRecord.asp?id=505
Doncaster
Primary Care
Trust8
Proops, D, The evidence base for aural rehabilitation with the
bone-anchored hearing aid, J Laryngol Otol, 2002, 28, p1.
Dutt, S, et al, The Glasgow Benefit Inventory in the evaluation of
patient satisfaction with the bone anchored hearing aid: quality of
life issues, J Laryngol Otol, 2002, June, 116, Supplement 28, 7-14,
5
The effectiveness of bone anchored hearing aids (BAHAs) for a patient who has profound mixed bilateral hearing loss
Minutes of meeting of exceptional funding panel 19th December 2005, EP263 Funding for Bone-Anchored Hearing Aid, p4
7
INTERIM Priorities Forum, Bone anchored hearing aids (BAHAs), Forum Statement 30, 2006, p 1.
8
Effective and appropriate healthcare, 2006, Bone anchored hearing aids, 6.1. http://www.doncasterpct.nhs.uk/yourhealth.asp?ArticleID=100029
6
6
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Coulter A, Kelland J, Long A. The management of menorrhagia.
Effective Health Care Bulletin 1995; (9).
NICE Clinical Guideline on heavy menstrual
bleeding CG44
ONEL
ONEL
Enfield
NWL Policy (D)
Emanuel MH, Wamsteker K, Lammes FB. Is dilatation and
curettage obsolete for diagnosing intrauterine disorders in
premenopausal patients with persistent abnormal uterine
bleeding? Acta Obstet Gynecol Scand 1997; 76: 65.
Royal College of Obstetricians and
Gynaecologists. Management of Menorrhagia in
Secondary Care. 1999
NWL with
exceptions
p10.
Dilatation and
curettage
A05
HRG4
MA10Z, MA13A,
MA13B,
(Blue)
OPCS4
Q103, Q108,
Q109
SEL criteria/
notification
NHS Institute for Innovation and Improvement.
NHS Better Care, Better Value Indicators:
Surgical thresholds indicators. 10 October 2007
At http://www.productivity.nhs.uk/Definitions.aspx
Accessed 26.3.08
BMJ Clinical Evidence: Menorrhagia. Sept 06.
INEL
NCL
C&M (req
discussion)
ICD10
Brighton
N920, N921,
N924, N925,
N926, N938,
N939
Croydon list
Berkshire
West Essex
Age <45 only
Ganglia
(Blue)
A06
OPCS4
T591, T592,
T593, T594,
T598, T599,
T601, T602,
T603, T604,
T608, T609
ICD10
M674
Barnet &
Chase Farm,
Dartford &
Gravesham,
Imperial,
North
Middlesex
Vroon P, Scholten RJ, van Weert HCPM. Interventions for ganglion
cysts in adults (Protocol). Cochrane Database of Systematic
Reviews 2005, Issue 2. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD005327/pdf_fs.html [Accessed 2nd Oct 2007]
NWL Policy (A)
ONEL
NWL with
exceptions
SEL
notification
Burke FD, Melikyan EY, Bradley MJ, Dias JJ. Primary care referral
protocol for wrist ganglia. Postgrad Med J 2003 79:329-331
ONEL
Bandolier. Wrist ganglia. Webpage. [Cited 19th Sept 2007].
Available at:
http://www.jr2.ox.ac.uk/bandolier/booth/miscellaneous/wristgang.ht
ml
NCL
Wildin C, Dias J, Heras-Palou C, Bradley M, Burke FD. Trends in
elective hand surgery referrals from primary care. Annals of The
Royal College of Surgeons of England 2006; 88 [6]: 543-546
Dias J, Buch K. Palmar wrist ganglion: does intervention improve
outcome? A prospective study of the natural history and patient-
7
INEL
Revised
Croydon list
Bromley,
Croydon,
Islington
Ashford & St
Peter’s,
Chelsea &
Westminster,
Darftord &
Gravesham,
Homerton,
Mayday,
Newham,
North
Middlesex,
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
reported treatment outcomes. J Hand Surg (Br) 2003;2: 172-6.
Grommets
(Blue)
A07
OPCS
D151, D158,
D159, D202,
D203, D208,
D209
South London,
Whittington,
West
Middlesex
Langton Hewer CD, McDonald S, Nunez DA. Grommets
(ventilation tubes) for recurrent acute otitis media in children.
Cochrane Database of Systematic Reviews 2004, Issue 2.
Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD004741/pdf_fs.html [Accessed 2nd Oct 2007]
NICE Clinical Guideline on surgical management
of otitis media with effusion CG60
Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson
I. Grommets (ventilation tubes) for hearing loss associated with
otitis media with effusion in children. Cochrane Database of
Systematic Reviews 2005, Issue 1. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD001801/pdf_fs.html [Accessed 2nd Oct 2007]
NHS Institute for Innovation and Improvement.
NHS Better Care, Better Value Indicators:
Surgical thresholds indicators. 10 October 2007
At http://www.productivity.nhs.uk/Definitions.aspx
Accessed 26.3.08
Maw, R., Wilks, J., Harvey, I. et al (1999) Early surgery compared
with watchful waiting for glue ear and effect on language
development in preschool children: a randomised trial [published
erratum appears in Lancet 1999 Oct 16;354(9187):1392]. Lancet
353(9157), 960-963
SIGN Guideline 66 (2003) Diagnosis and
management of childhood Otitis Media in Primary
Care
Centre for Reviews and Dissemination. The
treatment of persistent glue ear in children. 1992.
http://www.york.ac.uk/inst/crd/projects/glueear.ht
m
NWL Policy (A)
NWL
ONEL
SEL with
exceptions
SWL
ONEL
INEL
SWL criteria
NCL
C&M criteria
(req
discussion)
West Essex
Oomen k et al (2005) Effect of adenotonsillectomy on middle ear
status in children. Laryngoscope Apr;115(4):731-4
Paradise JL (2005) Developmental outcomes after early or delayed
insertion of typanostomy tubes. NEJM (353);6:576-589
Rosenfeld et al (2004) Clinical Practice Guideline: Otitis Media with
Effusion. Otolaryngology – Head and Neck Surgery (130);5;s95s118
Williamson I. Otitis media with effusion. Treatment. Surgery
(ventilation tubes, adenoidectomy, or both). BMJ Clinical Evidence
2006. Available
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Grommets
Yung MW, Arasaratnam R. Adult-onset otitis media with effusion:
results following ventilation tube insertion. J Laryngol Otol. 2001
8
London PCTs
and
providers
with
significantly
high SAR
2009/10:
NHS Institute for Innovation and Improvement.
NHS Better Care, Better Value Indicators:
Brighton
Bromley
ESH,
Kingston,
Royal Free,
Lewisham,
West
Middlesex,
Whipps Cross
Procedure
DFI
Code
HRG, OPCS, ICD
codes
(adults)
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Nov;115(11):874-8
Surgical thresholds indicators. 10 October 2007
At http://www.productivity.nhs.uk/Definitions.aspx
Accessed 26.3.08
Montandon P, Guillemin P, Häusler R. Prevention of vertigo in
Ménière's syndrome by means of transtympanic ventilation tubes.
ORL J Otorhinolaryngol Relat Spec. 1988;50(6):377-81.
Adenoidectomy for otitis
media in
children
Lous J, Burton MJ, Felding J, Ovesen T, Rovers M, Williamson I.
Grommets (ventilation tubes) for hearing loss associated with otitis
media with effusion in children. Cochrane Database of Systematic
Reviews 2005, Issue 1.Art.No.:CD001801.DOI:10.1002/
14651858.CD001801.pub2.
(Blue)
NICE Guidance CG60 (February 2008)
Local review of
evidence (by
sector or PCT)
Referral
guidance
ONEL
SEL criteria/
notification
London PCTs
and
providers
with
significantly
high SAR
2009/10:
ONEL
INEL
Rosenfeld et al (2004) Clinical Practice Guideline: Otitis Media with
Effusion. Otolaryngology – Head and Neck Surgery (130);5;s95s118
NCL
West Essex
Oomen k et al (2005) Effect of adenotonsillectomy on middle ear
status in children. Laryngoscope Apr;115(4):731-4
May be
included in
Grommets
guidance
Williamson I. Otitis media with effusion. Treatment. Surgery
(ventilation tubes, adenoidectomy, or both). BMJ Clinical Evidence
2006. Available
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Paradise JL (2005) Developmental outcomes after early or delayed
insertion of typanostomy tubes. NEJM (353);6:576-589
Knee washout
(Green)
A08
OPCS
NICE IPG230 Arthroscopic knee washout, with or
without debridement, for the treatment of
osteoarthritis. Aug 2007
W822, W833,
W851, W852,
W858,
NICE CG59 The care and management of
osteoarthritis in adults. Feb 2008
Clinical criteria – NICE restrict to pts with
mechanical locking. NICE have only commented
on use in OA, not other conditions eg RA
9
Barking &
Dagenham,
Bexley,
Bromley,
Havering,
Hounslow,
Sutton &
Merton
Ashford & St
Peter’s,
Barnet &
Chase Farm,
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Dartford &
Gravesham,
ESH, South
London,
Hillingdon,
Whittington,
West
Middlesex,
Whipps Cross
Lumbar disc
prolapse
A09
HRG4
HC01Z, HC02B,
HC02C, HC03A,
HC03B, HC03C,
HC04A, HC04B,
HC04C, HC05B,
HC05C, HC06A,
HC06B, HC06C
Surgical Disorders of the Thoracic and Lumbar Spine: A Guide For
Neurologists- Nitin Patel - J Neurol Neurosurg Psychiatry
2002;73:i42-i48 doi:10.1136/jnnp.73.suppl_1.i42
ONEL
ONEL9
Revised
Croydon list
Cochrane review of surgery for lumbar disc prolapse and
degenerative lumbar spondylosis. Spine (Phila Pa 1976). 1999
Sep 1;24(17):1820-32.
http://www.ncbi.nlm.nih.gov/pubmed/10488513
Ashford & St
Peter’s,
Barking,
Havering &
Redbridge,
Barts, ESH,
Imperial,
King’s,
Mayday,
Royal Free, St
George’s,
UCLH
Also see listing for Injections and fusion for back pain (A03)
OPCS
V331, V332,
V337, V338,
V339, V351,
V358, V359,
V583, V588,
V589
Spinal cord
stimulation10
9
A10
OPCS
A483
Barking &
Dagenham,
Bromley,
Croydon,
Havering,
Richmond &
Twickenham
McElveen WA. Postherpectic neuralgia. Emedicine review – last
updated in Sept. 2008. Available online at:
Spinal surgery for non-acute lumbar conditions
ONEL categorises this under ‘Functional Electrical Stimulation’
10
10
NICE - Pain (chronic neuropathic or ischaemic) spinal cord stimulation. Issue date October 2008.
http://guidance.nice.org.uk/TA159
ETR (Camden
PCT)
West Sussex
Original
No PCT
Procedure
(Blue)
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
http://www.emedicine.com/neuro/topic317.htm#section~Treatment
NICE Technology Appraisal TA159 - Spinal cord
stimulation for chronic pain of neuropathic or
ischaemic origin. Issue date October 2008.
http://www.nice.org.uk/nicemedia/live/12082/4236
7/42367.pdf
Kumar, K et al. Spinal cord stimulation versus conventional
medical management for neuropathic pain: a multicentre
randomised controlled trial in patients with failed back surgery
syndrome. Pain. 2007; 132: 179-88.
Kumar K, Taylor RS, Jacques L, et al. The effects of spinal cord
stimulation in neuropathic pain are sustained: a 24-month follow-up
of the prospective randomized controlled multicenter trial of the
effectiveness of spinal cord stimulation. Neurosurgery.
2008;63(4):762-70.
Kemler MA, de Vet HC, Barendse GA, van den Wildenberg FA,
van Kleef M. Effect of spinal cord stimulation for chronic complex
regional pain syndrome Type I: five-year final follow-up of patients
in a randomized controlled trial. J Neurosurg. 2008; (2):292-8.
Manca A, Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, et
al. Quality of life, resource consumption and costs of spinal cord
stimulation versus conventional medical management in
neuropathic pain patients with failed back surgery syndrome
(PROCESS trial). Eur J Pain. 2008;12(8):1047-58.
Mekhail NA, Aeschbach A, Stanton-Hicks M. Cost benefit analysis
of neurostimulation for chronic pain. Clin J Pain. 2004; 20(6):462-8.
Harke H, Gretenkort P, Ladleif HH, et al. Spinal Cord Stimulation in
Postherpetic Neuralgia and in Acute Herpes Zoster Pain. Anesth
Analg 2002;94:694-700.
Meglio M, Cioni B, Prezioso A, Talamonti G. Spinal cord
stimulation (SCS) in the treatment of postherpetic pain. Acta
Neurochir Suppl (Wien) 1989;46:65-6.
Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for
chronic back and leg pain and failed back surgery syndrome: a
systematic review and analysis of prognostic factors. Spine.
11
NICE recommends SCC as treatment option with
clinical criteria
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Croydon list
Barts, GSTT,
Mayday,
UCLH
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
NWL Policy (D)
NWL with
exceptions
Barking &
Dagenham,
Enfield,
Havering,
Hounslow,
Newham,
Redbridge,
Waltham
Forest
2005;30(1):152-60.
Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, et al. EFNS
guidelines on neurostimulation therapy for neuropathic pain. Eur J
Neurol 2007;14(9):952-70.
Tonsillectomy
A11
(Green)
HRG4
CZ05S, CZ05T,
CZ05V, CZ05Y
McKerrow W. Tonsillitis. Tonsillectomy versus antibiotics in
children. BMJ Clinical Evidence 2006. Available at:
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Royal College of Paediatrics and Child Health.
Guidelines for good practice. Management of
acute and recurring sore throat and indications for
tonsillectomy. London: RCPCH; 2000
OPCS
Adenotonsillectomy for upper respiratory infections: evidence
based? Arch Dis Child 2005;90:19–25
Scottish Intercollegiate Guidance Network.
Management of sore throat and indications for
tonsillectomy. Edinburgh: SIGN guidance 34
(1999, reviewed 2005). Available at:
http://www.sign.ac.uk/guidelines/fulltext/34/index.
html [Accessed 19th Sept 2007]
E201, E208.
E209, F341,
F342, F343,
F344, F345,
F346, F347,
F348, F349,
F361, F368,
F369
Burton MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy
versus non-surgical treatment for chronic/recurrent acute tonsillitis.
Cochrane Database of Systematic Reviews 2009, Issue 1
ONEL
SWL
SEL with
exceptions
ONEL
INEL
SWL criteria
NCL
Van Staaij et al. Adeno-tonsillectomy for upper respiratory
infections: evidence based? Arch Dis Child 2005; 90:19–25.
C&M criteria
(req
discussion)
Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of
tonsillectomy for recurrent throat infection in severely affected
children. Results of parallel randomized and nonrandomized
clinical trials. N Engl J Med 1984; 310: 674-83.
Western
Cheshire
Cochrane Database of Systematic Reviews. Adeno-tonsillectomy
for obstructive sleep apnoea in children.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD003136/abstract.html
Raut VV, Yung MW. Peritonsillar abscess: the rationale for interval
tonsillectomy. Ear Nose Throat J. 2000; 79(3):206-9
Barking,
Havering &
Redbridge,
Barnet &
Chase Farm,
Barts, GSTT,
NWL, Royal
Free,
Lewisham,
West
Middlesex,
Whipps Cross
Ryan, C.F. Sleep 9:An approach to treatment of obstructive sleep
apnoea hypopnoea syndrome including upper airway surgery.
Thorax 2005; 60:595-604.
Trigger finger
(stenosing
tenosynovitis)
A12
OPCS
T652, T658,
T659, T691,
T698, T699,
Peters-Veluthamaningal C, van der Windt DAWM, Winters JC,
Meyboom- de Jong B. Corticosteroid injection for trigger finger in
adults. Cochrane Database of Systematic Reviews 2009, Issue 1.
Fleisch SB, Spindler KP, Lee DH (2007) Corticosteroid injections in
12
ONEL
SEL criteria/
notification
ONEL
Bromley,
Croydon,
Hillingdon,
Sutton &
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
T705, T708,
T709, T711,
T718, T719,
T721, T723,
T724, T728,
T729, T743,
T748, T749
the treatment of trigger finger: a level I and II systematic review. J
Am Acad Ortop Surg. 2007 Mar;15(3):166-71
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
INEL
Merton
NCL
Marks MR, Gunther SF: Efficacy of cortisone injection in treatment
of trigger fingers and thumbs. J Hand Surg [Am] 1989; 14:722–
727.
C&M criteria
(req
discussion)
Revised
Croydon list
ICD10
M653
Oxfordshire
PCT
Aesthetic/ cosmetic surgery: a largely cosmetic procedure
Aesthetic/
cosmetic
surgery
NHS Modernisation Agency. Action on plastic surgery. Referrals
and guidelines in plasticsurgery. Information for commissioners of
plastic surgery services. London: NHS Modernisation Agency;
2005.
NHS Modernisation Agency. Action on plastic surgery: a strategic
approach to the delivery of the NHS plastic, reconstructive and
aesthetic surgery service. London: NHS Modernisation Agency;
2005.
Department of Health. Cosmetic surgery and non-surgical
cosmetic treatments. Webpage.[Cited 19th Sept 2007] Available
at:
http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcareto
pics/CosmeticSurgery/index.htm
Fitzpatrick R, Klassen A, Jenkinson C, Goodacre T. Contrasting
evidence of the effectiveness of cosmetic surgery from two healthrelated quality of life measures. J Epidemiol Community Health
11
Listed as one entry, but HRG codes provided
13
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services Referrals and Guidelines in Plastic
Surgery‘.(national guidelines)
http://www.glospct.nhs.uk/pdf/publications/innf/co
mmissionersplasticsurgery.pdf
SEL with
exceptions
INEL11
NCL
Ashford & St
Peter’s,
Barnet &
Chase Farm,
Chelsea &
Westminster,
Dartford &
Gravesham,
Mayday,
South London,
Hillingdon,
Whittington,
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
NCL
Sutton &
Merton
1999; 53: 440-41.
U.S. Food and Drug Administration. FDA approves Botox to treat
frown lines. FDA Talk Paper 2002. Available at:
http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01147.html
[Accessed 19th Sept 2007]
Aesthetic/
cosmetic
genital surgery
Aesthetic
surgery –
breast
B01
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
OPCS
N281, N282,
N283, N284,
N285, N286,
N288, N289,
N291, N292,
N298, N299,
P011, P012,
P018, P019,
P055, P056,
P057, P153
12
C&M
Norfolk
Barnet &
Chase Farm,
Chelsea &
Westminster,
Dartford &
Gravesham,
ESH, St
George’s,
UCLH
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
B02
(Blue)
NWL Policy
SEL with
exceptions
Western
Cheshire
Bromley,
Kensington &
Chelsea
GSTT,
Imperial,
Royal Free, St
George’s
Breast
augmentation
(breast
12
13
B02a
OPCS
B312
Newham provided the following evidence sources (to support
funding?)
NWL Policy (D)
Dixon, J, et al, 1994, ABC of breast diseases: congenital problems
‘Penile implant’ listed
The impact of breast hypoplasia on the growth of breasts. Examples of policies from other PCTs looking at whether augmentation surgery might be funded
14
ETR (Newham
PCT)13
NWL with
exceptions
SEL with
Procedure
DFI
Code
HRG, OPCS, ICD
codes
enlargement)
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
and aberrations of normal breast development and involution, Br
Med J, 309, 24 September, 797-800.
(Blue)
Referral
guidance
exceptions
SWL criteria
Freitas, R, et al, 2007, Poland’s Syndrome: different clinical
presentations and surgical reconstructions in 18 cases, Aesthet
Plast Surg, 31, 140-46.
C&M criteria
Heimberg, D, et al, 1996, The tuberous breast deformity:
classification and treatment, Br J Plast Surg, 49, 339-45.
Westminster
Brent PCT
Pacifico, M, et al, 2007, The tuberous breast revisited, J Plast
Reconstruct Aesthet Surg, 60, 455-64.
North Derbyshire, South Derbyshire and Bassetlaw
Commissioning Consortium, 2007, Norcom commissioning policy –
specialist plastic surgery procedures”, 5-7.
Sadove, C, et al, 2005, Congenital and acquired pediatric breast
anomalies: a review of 20 years experience, Plast Reconstruct
Surg, April, 115(4), 1039-1050.
Vale of Glamorgan Local Health Board, 2006, Policy on the
commissioning of procedures of low priority or limited clinical
effectiveness not normally funded, Annex A, 3.36.
Mastopexy
(breast lift)
B02b
OPCS
NWL Policy (D)
B313
(Blue)
NWL with
exceptions
SEL with
exceptions
SWL criteria
C&M criteria
Breast
prosthesis
removal or
replacement
B02c
OPCS
NWL Policy (D)
B303, B308,
B309
NWL with
exceptions
SEL with
exceptions
(Blue)
SWL criteria
15
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
C&M criteria
Cosmetic
breast surgery
B02d
B301, B318,
B319
(Blue)
Inverted nipple
correction
OPCS
B02e
OPCS
NWL Policy (D)
B356
(Blue)
NWL with
exceptions
SEL no
exceptions
SWL
C&M criteria
Reduction
mammoplasty
(male or
female breast
reduction)
B02f
OPCS
NWL Policy (D) includes
Gynaecomastia
for
removal/mastecto
my of male
breast tissue
B311
(Blue)
NWL with
exceptions
SEL with
exceptions
(female). Not
funded for
males
SWL criteria
C&M criteria
(reqs
discussion)
Revision
mammoplasty
B02g
OPCS
NWL Policy (D)
B302, B314
(Blue)
Aesthetic
surgery – ENT
NWL with
exceptions
SEL with
exceptions
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic
B03
16
NWL Policy
Western
Cheshire
Barking &
Dagenham,
Barnet,
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
Surgery’(national guidelines)
(Blue)
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Camden,
Croydon,
Enfield,
Hammersmith
& Fulham,
Haringey,
Havering,
Islington,
Redbridge
Chelsea &
Westminster,
GSTT, Royal
Free, St
George’s,
Lewisham,
Whipps Cross
Cosmetic
operations on
external ear
including
pinnaplasty
(bat ears),
otoplasty and
split earlobes
B03a
OPCS
NWL Policy (D)
D031, D032,
D033, D038,
D039, D068,
D069, E078,
E079, E094
SEL with
exceptions
SWL criteria
C&M criteria
(reqs
discussion)
(Blue)
Cosmetic
operations on
nose including
Rhinoplasty
(Blue)
NWL with
exceptions
B03b
OPCS
NWL Policy (D)
E021, E022,
E023, E024,
E025, E026,
E027, E028,
E029
NWL with
exceptions
SEL with
exceptions
SWL criteria
C&M criteria
17
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Repair of
external ear
lobes
B03c
OPCS
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
NWL Policy (D)
NWL with
exceptions
D062, D063
SWL criteria
(Blue)
Meatoplasty of
external ear
London PCTs
and
providers
with
significantly
high SAR
2009/10:
C&M criteria
B03d
OPCS
D034
(Blue)
Aesthetic
surgery opthalmology
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
B04
NWL Policy
SEL
Western
Cheshire
Barnet,
Camden,
Enfield,
Islington,
Kingston,
Redbridge,
Richmond &
Twickenham,
Sutton &
Merton
Chelsea &
Westminster,
Kingston,
Moorfields,
Royal Free,
Whipps Cross
Blepharoplasty
(Blue)
B04a
OPCS
The British Association of Aesthetic Plastic
Surgeons www.baap.org.uk
C131, C132,
C133, C134,
C138, C139,
C168, C169
Exclusions to the range of cosmetic surgery
(procedures undertaken within the ASG Health
Authorities). Cambridgeshire and Huntingdon
Health Authority. April 2007
18
NWL Policy (D)
ONEL
NWL with
exceptions
SEL with
exceptions
ONEL with
exceptions
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
SWL criteria
C&M criteria
Waltham
Forest
West Essex
Correction of
ptosis
B04b
Laser surgery
for myopia
(short sight)
n/a
Aesthetic
surgery plastics
B05
OPCS
C181, C182,
C183, C184,
C186, C188,
C189
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
NWL Policy (A)
NWL
NWL Policy
Revised
Croydon list
Barnet,
Ealing,
Islington
Barts,
Chelsea &
Westminster,
GSTT, Royal
Free, St
George’s
Abdominoplasty /
apronectomy
B05a
OPCS
NWL Policy (D)
S021, S022,
S028, S029
NWL with
exceptions
SEL with
exceptions
(Blue)
SWL criteria
C&M criteria
(reqs
19
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
discussion)
Other skin
excision for
contour e.g.
buttock lift,
thigh lift, arm
lift
(brachioplasty)
B05b
OPCS
NWL Policy (D)
S031, S032,
S033, S038,
S039
SEL with
exceptions
SWL criteria
C&M (reqs
discussion)
(Blue)
Correction of
male pattern
baldness/
correction of
hair loss
(Alopecia)
Hair grafting
Hair
transplantation
(Blue)
B05c
OPCS
Islington provided following evidence sources (to support funding?)
NWL Policy (D)
S211, S212,
S218, S219,
S331, S332,
S333, S338,
S339
Otberg N, Wu WY, Kang H, Martinka M, Alzolibani AA, Restrepo I,
et al. Folliculitis decalvans developing 20 years after hair
restoration surgery in punch grafts: case report. Dermatol Surg
2009;35(11):1852-6
ETR (Islington
PCT)14
Otberg N, Kang H, Alzolibani AA, Shapiro J. Folliculitis decalvans.
Dermatol Ther 2008;21(4):238-44.
Listed
procedures need
clarification
Harries MJ, Sinclair RD, Macdonald-Hull S, Whiting DA, Griffiths
CE, Paus R. Management of primary cicatricial alopecias: options
for treatment. Br.J Dermatol. 2008 Jul;159(1):1-22.
Unger W, Unger R, Wesley C. The surgical treatment of cicatricial
alopecia. Dermatol Ther. 2008 Jul-Aug;21(4):295-311.
Wu WY, Otberg N, McElwee KJ, Shapiro J. Diagnosis and
management of primary cicatricial alopecia: part II. SKINmed
2008;7(2):78-83.
Chandrawansa PH, Giam Y-C, Folliculitis decalvans – a
retrospective study in a tertiary referred centre over five years.
Singapore Med J. 2003 44(2):84-87
14
NWL No
exceptions
Hair transplant surgery for a patient with extensive alopecia and unsightly scarring
20
NWL No
exceptions
SEL no
exceptions
SWL criteria
C&M criteria/
exceptions
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Cosmetic
excision of
skin of head or
neck: e.g. face
lift or brow lift
(rhytidectomy)
B05d
OPCS
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
NWL Policy (D)
NWL with
exceptions
S011, S012,
S013, S014,
S015, S016,
S018, S019
SEL with
exceptions
SWL
(Blue)
Aesthetic
surgery –
liposuction
London PCTs
and
providers
with
significantly
high SAR
2009/10:
C&M criteria
B06
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
OPCS
S621, S622
(Blue)
NWL Policy (D)
NWL no
exceptions15
SWL criteria
Croydon,
Hammersmith
& Fulham,
Hounslow
C&M criteria
Barts,
Chelsea &
Westminster,
GSTT,
Imperial,
Royal Free, St
George’s,
West
Middlesex
Minor skin
surgery for
non-cancerous
lesions16
(Green)
15
16
B07
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
HRG4
JC04A, JC04B,
JC04C, JC05A.
JC05B, JC05C,
JC06A, JC06B,
JC06C, JC07Z,
JC14Z, JC15Z,
JC16Z, JC17Z,
JC18Z, JC19Z,
NWL with
exceptions
C&M criteria
Revised
Croydon list
Liposuction is sometimes done as an adjunct to other surgical procedures. Liposuction simply to correct the distribution of fat may not be funded.
OPCS codes here are indicating an exclusion of all procedure codes used in intervention ―B09 Resurfacing/Other Minor Skin Procedures, for the purposes of avoiding duplication.
21
Barking &
Dagenham,
Barnet,
Bexley,
Bromley,
Camden,
Enfield,
Greenwich,
Haringey,
Havering,
Procedure
Orthodontic
treatments for
essentially
cosmetic
nature
DFI
Code
B08
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
JC20Z, JD04A,
JD04B, JD04C,
JD05A, JD05B,
JD05C, JD06A,
JD06B
Islington,
Lewisham,
Southwark
(EXCLUDE ALL
OPCS CODES
LISTED IN DFI
CODE B09 TO
AVOID
DUPLICATION
Barking,
Havering &
Redbridge,
Barnet &
Chase Farm,
Chelsea &
Westminster,
Ealing, King’s,
Kingston,
Royal Free,
South London,
St George’s,
Lewisham,
Whittington
HRG4
CZ01S, CZ01T,
CZ01V, CZ01Y
Brook PH, Shaw WC. The development of an index of orthodontic
treatment priority. Eur J Orthod 1989; 11: 309-20.
Richmond S, Shaw WC, Stephens CD et al. Orthodontics in the
general dental service of England and Wales: Critical assessment
of standards. Br Dent J 1993; 174: 315.
OPCS
F141, F142,
F143, F144,
F145, F148,
F149, F151,
F152, F154,
F155
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
NWL Policy (D)
NWL with
exceptions
Original
Croydon list
Barking &
Dagenham,
Brent,
Croydon,
Ealing,
Havering,
Hounslow,
Redbridge,
Richmond &
Twickenham
Ashford & St
Peter’s,
Barking,
Havering &
Redbridge,
Barnet &
Chase Farm,
Kingston,
22
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Mayday,
NWL, UCLH
Resurfacing/
other minor
skin
prodecures,
including
removal of
lipomata
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
B09
NWL Policy (D)
ONEL
SWL
NWL with
exceptions
SEL
ONEL
SWL criteria
C&M (reqs
discussion)
(Green)
Western
Cheshire
Norfolk
Waltham
Forest
West Essex
Berkshire
Resurfacing/
other minor
skin
procedures
B09a
OPCS
E094
(Green)
Dermabrasion
of skin of head
B09b
OPCS
SEL with
23
Barking &
Dagenham,
Barnet,
Camden,
Enfield,
Haringey,
Havering,
Islington,
Lambeth,
Lewisham,
Southwark
Barking,
Havering &
Redbridge,
Barnet &
Chase Farm,
Barts,
Chelsea &
Westminster,
Ealing, GSTT,
King’s, North
Middlesex,
Royal Free,
Lewisham,
Whittington
Procedure
DFI
Code
or neck
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
S601
Referral
guidance
exceptions
(Green)
INEL
C&M criteria
Dermabrasion
of skin NEC
B09c
OPCS
S602
(Green)
Removal of
tattoo
B09d
Modernisation Agency’s Action on Plastic Surgery
2005
OPCS
NWL Policy (D)
S603
(Green)
NWL with
exceptions
SEL no
exceptions
SWL
C&M criteria
Refashioning
of scar NEC
B09e
OPCS
SEL with
exceptions
S604
(Green)
NCL
C&M
Diagnostic
dermatoscopy
of skin
B09f
OPCS
S605
(Green)
Electrolysis of
hair
Also:
B09g
OPCS
S606
BMJ Clinical Evidence
(http://clinicalevidence.bmj.com/ceweb/conditions/woh/1408/1408,j
sp) – The latest clinical evidence on hirsutism
Hair depilation
/ Hursuitism
Haedersdal M, Gotzsche PC. Laser and photoepilation for
unwanted hair growth. Cochrane Database Syst Rev
2006;(4):CD004684
(Green)
Koulouri O, Conway G. S. Management of hirsutism. BMJ
Modernisation Agency’s Action on Plastic Surgery
2005
NWL Policy (D)
NWL with
exceptions
SWL criteria
C&M criteria
24
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
2009;338:b847
Other
specified other
operations on
skin
B09h
OPCS
S608
(Green)
Excision of
scar tissue
NOC
B09i
OPCS
Y064
(Green)
Other
specified laser
therapy to
organ NOC
B09j
INEL17
OPCS
Y088
(Green)
Unspecified
laser therapy
to organ NOC
B09k
OPCS
Y089
(Green)
Laser
treatment for
17
n/a
ONEL conclude there is a lack of long term clinical evidence on
this treatment. Despite this there is some evidence that treatment
Tunable dye laser
25
ONEL
ONEL case by
case
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Procedure
DFI
Code
HRG, OPCS, ICD
codes
B09l
Local review of
evidence (by
sector or PCT)
OPCS
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
SEL with
exceptions/
notification
S038, S039,
S041, S042,
S054, S064,
S083, S088,
S089, S091,
S092, S093,
S094, S095,
S098, S099,
S101, S102,
S103, S104,
S105, S108,
S109, S111,
S112, S113,
S114, S115,
S118, S119
(Green)
Removal of
birthmarks
n/a
Varicose veins
B10
(Green)
Formal recommendations (NICE, professional
bodies, etc)
can improve people’s physical, emotional and social wellbeing.
soft palate
(snoring)
Removal of
benign skin
lesions
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
SEL with
exceptions
HRG4
QZ06Z, QZ07B,
QZ08B, QZ09B,
QZ10B
Bradbury A, Evans C, Allan P et al. What are the symptoms of
varicose veins? Edinburgh vein study cross sectional population
survey. BMJ 1999;318:353-356 ( 6 February )
Campbell B. Varicose veins and their management. BMJ 2006;
333(7562): 287–292.
Cullum N, Nelson EA, Fletcher AW, Sheldon TA. Compression for
venous leg ulcers. Cochrane Database of Systematic Reviews
2001, Issue 2. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD002303/pdf_fs.html [Accessed 2nd Oct 2007]
Houghton AD, Panayiotopoulos Y, Taylor PR. Practical
management of primary varicose veins. Br J Clin Pract.
1996;50:103-105.
Kurz X, Kahn SR, Abenhaim L, et al. Chronic venous disorders of
26
Action On Plastic Surgery ‘Information for
Commissioners of Plastic Surgery Services –
Referrals and Guidelines in Plastic Surgery’
(national guidelines)
Simpson, S. & Roderick, P. in Stevens, A.,
Raftery, J., Mant, J. & Simpson, S. (eds) Health
Care Needs Assessment First Series, Volume 1,
Second Edition “Varicose Veins & Venous Ulcers”
(2004)
Department of Health. Healthcare Needs
Assessment. Accessible at http://hcna.radcliffeoxford.com/vvframe.htm
NICE “Referral Advice: a guide to appropriate
referral from general practice to specialist
NWL Policy (D)
ONEL
SWL
NWL criteria
for severe
cases (noncosmetic)
SEL with
exceptions/
notification
ONEL
INEL
NCL
SWL criteria
C&M criteria
(req
Barking &
Dagenham,
Brent, Ealing,
Hammersmith
& Fulham,
Harrow,
Havering,
Hounslow,
Islington,
Kensington &
Chelsea,
Lambeth,
Redbridge,
Southwark,
Sutton &
Merton,
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
the leg: Epidemiology, outcomes, diagnosis and management:
summary of an evidence-based report of the VEINES task force.
Int Angiol 1999;18:83-102.
services” London: National Institute for Clinical
Excellence, 2001
London NJM, Roddy Nash. Clinical review. ABC of arterial and
venous disease: Varicose Veins. BMJ May 2000; 320: 1392-94
Michaels JA, Campbell WB, Brazier JE et al. Randomised clinical
trial, observational study and assessment of cost-effectiveness of
the treatment of varicose veins (REACTIV trial). Health Technol
Assess 2006; 10(13).
Neglen P, Einarsson E, Eklof B. The functional long-term value of
different types of treatment for saphenous vein incompetence. J
Cardiovasc Surg 1993;34:295-301.
Nelson EA, Bell-Syer SEM, Cullum NA. Compression for
preventing recurrence of venous ulcers. Cochrane Database of
Systematic Reviews 2000, Issue 4. Available at :
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD002303/pdf_fs.html [Accessed 2nd Oct 2007]
Nelson EA, Cullum N, Jones J. Venous leg ulcers. BMJ Clinical
Evidence 2006. Available at:
http://clinicalevidence.bmj.com/ceweb/about/index.jsp [Accessed
19th Sept 2007]
Sowerby Centre for Health Informatics at Newcastle (SCHIN).
Thrombophlebitis. PRODIGY Guidance. Newcastle upon Tyne,
SCHIN. Updated July 2002. Available at:
http://www.cks.library.nhs.uk/help/about_us/what_is_schin
[Accessed 19th Sept 2007]
Tisi PV, Beverley CA. Injection sclerotherapy for varicose veins.
Cochrane Database of Systematic Reviews 2006, Issue 4.
Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD001732/pdf_fs.html [Accessed 2nd Oct 2007]
Tisi P. Varicose veins. Surgery. BMJ Clinical Evidence 2006.
Available at: http://clinicalevidence.bmj.com/ceweb/about/index.jsp
[Accessed 19th Sept 2007]
Van Rij AM et al. Obesity and impaired venous function. Eur J
27
NICE Interventional Procedures guidance IPG8
(September 2003)
NICE Interventional Procedures guidance IPG52
(March 2004)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
discussion)
Wandsworth,
Westminster
Barking,
Havering &
Redbridge,
Barnet &
Chase Farm,
Barts,
Chelsea &
Westminster,
Dartford &
Gravesham,
Ealing, GSTT,
Imperial,
Kingston,
NWL, Roral
Free, St
George’s,
Lewisham,
Whittington,
Whipps Cross
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
NWL no
exceptions
Bromley
Vasc Endovasc Surg 2008 Feb 272006; 333(7562): 287–292.
Weiss R. Commentary on endovenous laser. Dermatol Surg
2001;27:326-327.
Weiss RA, Weiss MA. Controlled radiofrequency endovenous
occlusion using a unique radiofrequency catheter under duplex
guidance to eliminate saphenous varicose vein reflux: A 2-year
follow-up. Dermatol Surg 2002;28:38-42.
Clinical criteria: a procedure where evidence of clinical- and/or cost-effectiveness exists but only in limited cases or when a person meets certain clinical criteria or thresholds
Caesarean
section for
non-clinical
reasons
C01
OPCS
R172, R178,
R179
(Blue)
Lavender T, Hofmeyr GJ, Neilson JP et al. Caesarean section for
non-medical reasons at term. Cochrane Database of Systematic
Reviews 2006, Issue 3. Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD004741/pdf_fs.html [Accessed 2nd Oct 2007]
NICE CG13 Caesarean section.
Castells X, Comas M, Alonso J, Espallargues M, Martinez V,
Garcia-Arumi J et al. In a randomized controlled trial, cataract
surgery in both eyes increased benefits compared to surgery in
one eye only. J Clin Epidemiol. 2006; 59(2):201-7.
NICE IPG209 Implantation of accommodating
intraocular lens for cataract. Feb 2007
NWL Policy (A)
South London
ICD10
EXCLUDE:
B20, B21, B22,
B23, B24, O32,
O33, O34, O44,
Z21
Cataract
surgery
(Yellow)
C02
HRG4
BZ01Z, BZ02Z,
BZ03Z
OPCS
C711, C712,
C713, C719,
C721, C729,
C731, C732,
C733, C734,
C738, C739,
C743, C748,
Laidlaw DA, Harrad RA, Hopper CD, Whitaker A, Donovan JL,
Brookes ST et al. Randomised trial of effectiveness of second eye
cataract surgery. Lancet. 1998; 19:(9132):925-9.
Busbee BG, Brown MM, Brown GC, Sharma S. Cost-utility
analysis of cataract surgery in the second eye. Ophthalmology.
2003; 110(12):2310-2317.
NICE IPG264 Implantation of multifocal (nonaccommodative) intraocular lenses for cataract
surgery: guidance
Department of Health. Commissioning Toolkit for
Community Based Eyecare Services (DH 2007)
NHS Executive. Action on Cataracts: Good
practice guidance (Jan 2003)
NHS Bedfordshire and Hertfordshire Priorities
Forum (accessed March 2010)
28
ONEL
ONEL
SWL
SWL criteria
Norfolk
ALL except for
Bexley and
Kensington &
Chelsea
Suffolk
Ashford & St
Peter’s,
King’s,
Kingston,
Mayday,
Moorfields,
North
Middlesex,
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
C749, C751,
C752, C753,
C754, C758
Circumcision
(Blue)
C03
OPCS
N303
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Royal Free,
South London,
Hillingdon,
Whipps Cross
Lerman SE, Liao J: Neonatal circumcision. Paediatric Clinics of
North America 2001; 48: 1539-57
Rickwood AMK. Medical indications for circumcision. Br J Urol
International 1999; 83(Suppl): 45-51
Gatrad AR, Sheikh A, Jacks H. Religious circumcision and the
Human Rights Act. Arch Dis Child 2002; 86; 76-80
English Court of Appeal – Re J (Specific Issue Orders: Child's
Religious Upbringing and Circumcision) Journal of Law and Med
2000; 9: 68 -75
Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, et al.
Male circumcision for prevention of heterosexual acquisition of HIV
in men. Cochrane Database of Systematic Reviews 2003, Issue 3.
Available at:
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/
CD003362/pdf_fs.html [Accessed 2nd Oct 2007]
Baillis SA, Halperin DT. Male circumcision: time to re-examine the
evidence. Student BMJ 2006; 14: 179
Ehman AJ. Cut circumcision from list of routine services,
Saskatchewan MDs advised. CMAJ 2002; 167:532. Available at:
http://www.cmaj.ca/cgi/reprint/167/5/532-a [Accessed 19th Sept
2007]
Busbee B Cost-utility analysis of cataract surgery in the second
eye. Ophthalmology, Volume 110, Issue 12, Pages 2310-2317
Tobacman JK, Lee P, Zimmerman B, Kolder H, Hilborne L,
Assessment of appropriateness of cataract surgery at ten
academic medical centers in 1990. Ophthalmology. 1996
Feb;103(2):207-15.
Choi YJ, Hong YJ, Kang H. Appropriateness ratings in cataract
surgery. Yonsei Med J 2004;45:396-405
29
“Statement on Male Circumcision”. Statement
from the British Association of Paediatric
Surgeons, The Royal College of Nursing, The
Royal College of Paediatrics and Child Health,
The Royal College of Surgeons of England and
The Royal College of Anaesthetists. 6 March
2001.
“The law and ethics of male circumcision guidance for doctors” BMA, June 2006
Berkshire NHS Priorities Website (accessed
March 2009)
NWL Policy (D)
ONEL
SWL
NWL with
exceptions
SEL with
exceptions
ONEL
Barking &
Dagenham,
Bexley,
Havering,
Tower
Hamlets
INEL
SWL criteria
NCL
C&M (reqs
discussion)
West Essex
Western
Cheshire
Barking,
Havering &
Redbridge,
Barnet &
Chase Farm,
Chelsea &
Westminster,
Darftord &
Gravesham,
Ealing, North
Middlesex,
Hillingdon,
Lewisham,
Whittington
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
NICE Technology Appraisal Guidance166.
Cochlear implants for children and adults with
severe to profound deafness. Issue date January
2009.
SWL
SEL with
exceptions/
notification
None
SWL criteria
GSTT, Royal
Free, St
George’s
Mangione CM, Oray EJ, Lawrence MG et al. Prediction of visual
function after cataract surgery. A prospectively validated model.
Arch Opthal. 1995;113:1305-1311.
Brogan C, Lawrence D, Pickard D, Benjamin L. Can the use of
visual disability questionnaires in primary care help reduce
inequalities in cataract surgery rates?–a long term cohort study. In
press
Cochlear
implant
C04
OPCS
D241, D242,
D249
(Green)
O’Donoghue GM, Nikolopoulos TP, Archbold SM, Tait M. Speech
perception in children after cochlear implantation. American
Journal of Otolaryngology. 1998 Nov; 19 (6): 762-67.
Summerfield AQ, Marshall DH. Cochlear
Implantation in the UK 1990-1994. Report by the
MRC Institute of Hearing research on the
evaluation of the national cochlear implant
programme. London: HMSO, 1995.
NCL
C&M criteria/
exceptions
West Sussex
Cochlear Implant and Bone Anchored Hearing
Aid Review Group. Provisional Report on the
need for Cochlear Implant Surgery in Avon.
RNID. Cochlear Implant Services Commissioning Guidelines. 2007.
Dental
implants
C05
OPCS
F115
Meraw SJ et al. Analysis of surgical referral patterns for
endosseous dental implants. The International Journal of Oral and
Maxillofacial Implants 14(2), 265-270, 1999.
Balshi TJ et al. Analysis of 356 pterygomaxillary implants in
edentulous arches for fixed prosthesis anchorage. International
Journal of Oral and Maxilofacial Implants 14 (3), 398-406, 1999.
Awad M A, Locker D, Korner-Bitensky N, Feine J S. Measuring the
effect of intra-oral implant rehabilitation on health related quality of
life in a randomised controlled clinical trial. J Dent Res 2000; 79(9):
1659-63.
Jonsson B, Karlsson G. Cost-benefit evaluation of dental implants.
Int J Technol Assess Health Care 1990; 6(4): 545-57.
30
Royal College of Surgeons 1997 Guidelines for
Selecting Appropriate Patients To Receive
Treatment With Dental Implants: Priorities For
The NHS
http://www.rcseng.ac.uk/dental/fds/pdf/ncg97.pdf
The Consort Group, The Consort Statement:
revised recommendations for improving the
quality of reports of parallel group randomised
trials 2001 http://www.consort-statement.org/
Scottish Needs Assessment Report. Dental
Implants. 2004.
NWL Policy (D)
NWL with
exceptions
INEL
SWL
NCL
Barnet, Brent,
Camden,
Ealing,
Enfield,
Haringey,
Harrow,
Islington,
Westminster
NWL, UCLH
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical Complications
of Osseointegrated Implants. The Journal of Prosthetic Dentistry
1999; 81(5): 537-52.
Need to review content of Consort Group and
Scottish Needs Assessment Report
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
ONEL
SEL criteria/
notification
Hillingdon
Lindh T, Gunne J, Tillberg A, Molin M. A meta-analysis of implants
in partial edentulism. Clinical Oral Implants Research 1998; 9: 8090.
Creugars N H, Kreulin C M, Snoek P A, de Kanter R J. A
systematic review of single-tooth restorations supported by
implants. J Dent Res 2000; 28(4): 209-17.
McCord JF, Michelinakis G. Systematic review of the evidence
supporting intra-oral maxillofacial prosthodontic care. European
Journal of Prosthodontics and Restorative Dentistry. 2004;12:12935.
Attard NJ, Zarb GA, Laporte A. Long-term treatment costs
associated with implant-supported mandibular prostheses in
edentulous patients. International Journal of Prosthodontics.
2005;18: 117-23.
Lekholm U. The Surgical Site. In Lindhe J, Karring K and Lang NP
(eds). Clinical Periodontology and Implant Dentistry. 3rd ed, p 890905. Copenhagen: Munksgaard, 1998.
Bory E, Durieux P. Oral implantology. Current state of knowledge.
Paris: Agence Nationale pour le Developement de l‘Evaluation
Medicale. L‘Agence Nationale d‘Accreditation d‘Evaluation en
Sante (ANAES). 1993; 87.
Dupuytren‘s
contracture
(Blue)
C06
OPCS
T521, T522,
T528, T529,
T541, T548,
T549
ICD10
M720
Bulstrode NW, Jemec B, Smith PJ. The complications of
Dupuytren's contracture surgery. J Hand Surg [Am] 2005
Sep;30(5):1021-5.
NICE Guidance CG34 (February 2004)
ONEL
Dias JJ and Braybrooke J. Dupuytren's contracture: an audit of
the outcomes of surgery. J Hand Surg [Br] 2006 Oct;31(5):514-21.
Bird B, Ball C, Balasuntharam P. Rehabilitation after surgery for
Dupuytren’s Contracture. (Protocol) Cochrane Database of
Systematic Reviews 2007, Issue 2.
Townley W A, Baker R, Sheppard N, Grobbelaar A O. Clinical
review: Dupuytren's contracture unfolded BMJ 2006;332:397-
31
INEL
NCL
Brighton
Revised
Croydon list
Chelsea &
Westminster,
Hillingdon,
Whittington
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Original
Croydon list
Bromley
400 (18 February)
Hindocha S, Stanley JK, Watson S, Bayat A. Dupuytrens’s
diathesis revisited: Evaluation of prognostic indicators for risk of
disease recurrence. J Hand Surg (Am) 2006 Dec;31(10):1626-34.
Surgical
treatment
female genital
prolapse/
stress
incontinence
C07
HRG4
MA03A, MA03B,
MA04A, MA04B
Thakar R, Stanton S. Management of genital prolapse. BMJ 2002;
324:1258-1262.2.18
Jackson S, Smith P. Diagnosing and managing genitourinary
prolapse. BMJ 1997;314:875-80.
M531, M538,
M539, P219,
P221, P222,
P223, P228,
P229, P231,
P232, P233,
P234, P238,
P239, P241,
P243, P244,
P248, P249,
P251
Hip
arthroplasty
Ashford & St
Peter’s,
Dartford &
Gravesham,
South London
Bump RC, Cundiff GW. Pelvic organ prolapse. In:
Stanton SL, Monga AK, eds.Clinical
urogynaecology. London: Churchill Livingstone,
2001.
OPCS
(Blue)
NICE CG40. Urinary incontinence - The
management of urinary incontinence in women –
October 2006
Cardozo L. Prolapse. In: Whitfield CR, ed.
Dewhurst's textbook of obstetrics and
gynaecology for postgraduates. Oxford: Blackwell
Science, 1995.
Swift S, Theofrastous J. Aetiology and
classification of pelvic organ prolapse. In:Cardozo
L, Staskin D, eds. Textbook of urology and
urogynaecology. London, 2001.
Continence Foundation (www.continencefoundation.org.uk )
C08
Scottish Arthroplasty project
ONEL18
No PCT
Suffolk
Asgford & St
Peter’s,
Dartford &
Gravesham,
ESH,
18
‘Hip surgery’ is on draft list, but evidence review and recommendations have not yet been written
32
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Hillingdon
Hip
arthroplasty
C08a
OPCS
W371, W378,
W379, W381,
W388, W389,
W391, W398,
W399, W461,
W468, W469,
W471, W478,
W479, W481,
W488, W489
(Green)
OR ANY OF THE
BELOW PAIRED
WITH OPCS
Z843
W431, W438,
W439, W441,
W448, W449,
W451, W458,
W459, W521,
W528, W529,
W531, W538,
W539, W541,
W548, W549,
W551, W558,
W559, W562,
W568, W569
Hip
resurfacing
C08b
Alberta Bone and Joint Institute. Evidence Review:
Appropriateness Criteria for THA and TKA. Version 1: May
17,2006.
NICE. Guidance on the use of metal on metal hip
resurfacing arthroplasty. Technology Appraisal
Guidance No 44, 2002.
Busato A; Roder C; Herren S; Eggli S Influence of high BMI on
functional outcome after total hip arthroplasty. Obesity Surgery,
May 2008, vol./is. 18/5(595-600), 0960-8923
NICE. Consensus Development programme. Dec
2003
Dowsey MM; Choong PF. Obesity is a major risk factor for
prosthetic infection after primary hip arthroplasty. Clinical
Orthopaedics & Related Research, January 2008, vol./is.
466/1(153-8)
Field R et al. 11th European Forum on Quality in Health
Care.Dixon T, Shaw M, Ebrahim S, Dieppe P. Trends in hip and
knee joint replacement: socioeconomic inequalities and projections
of need. Ann rheum Dis 2004;63;825-830.
Field RE, Cronin MD, Singh PJ. The Oxford hip scores for primary
and revision hip replacement. Journal of Bone and Joint Surgery
[Br]2005;87-B:618-22
Murray DW, Fitzpatrick R, Rogers K, Pandit H et al. Journal of
Bone and Joint Surgery [Br] 2007; 89:8:pg 1010, 5pags
Patel AD; Albrizio M. Relationship of body mass index to early
complications in hip replacement surgery: study performed at
Hinchingbrooke Hospital, Orthopaedic Directorate, Huntingdon,
Cambridgeshire. International Orthopaedics, August 2007, vol./is.
31/4(439-43), 0341-2695
OPCS
W581, W582
PAIRED WITH
OPCS Z843
33
Department of Health,2006. The Musculoskeletal
Services Framework – A joint responsibility: doing
it differently.
SWL
SWL criteria
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Hybrid hip
replacement
C08c
OPCS
Hip revision
C09
Hip revision
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Lubbeke A; Moons KG; Garavaglia G; Hoffmeyer P Outcomes of
obese and non-obese patients undergoing revision total hip
arthroplasty. Arthritis & Rheumatism, May 2008, vol./is. 59/5(73845), 0004-3591
Scottish Arthroplasty project
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Suffolk
No PCT
W931, W938,
W939, W941,
W948, W949,
W951, W958,
W959
C09a
OPCS
W372, W373,
W374, W382,
W383, W384,
W392, W393,
W395, W462,
W463, W472,
W473, W482,
W483
OR ANY OF THE
BELOW PAIRED
WITH OPCS
Z843
W433, W443,
W453, W523,
W533, W543,
W552, W553,
W563, W564
Hybrid hip
revision
Local review of
evidence (by
sector or PCT)
C09b
OPCS
W932, W933,
W942, W943,
34
Ashford & St
Peter’s, Barts,
ESH
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
ONEL19
Bexley,
Greenwich,
Kingston
W952, W953
Knee
arthroplasty
C10
Scottish Arthroplasty project
Suffolk
(Yellow)
Ashford & St
Peter’s,
Dartford &
Gravesham,
Ealing, ESH,
South London,
Hillingdon,
Whittington,
Whipps Cross
Knee
arthroplasty
(Yellow)
C10a
OPCS
W401, W408,
W409, W411,
W418, W419,
W421, W428,
W429
OR ANY OF THE
BELOW PAIRED
WITH OPCS
Z787, Z844,
Z845 OR Z846
W431, W438,
W439, W441,
W448, W449,
W451, W458,
W459, W521,
19
Escobar A, Quintana JM, Arostehui I, Azkarate J, Güenaga,
Arenaza JC, Garai I. Development of explicit criteria for total knee
replacement. International Journal of Technology Assessment in
Healthcare, 2003; 19: 57-70
Field R et al. 11th European Forum on Quality in Health Care.
Hawker G, Wright J, Coyte P et al. Health related quality of life
after knee replacement . Results of the knee replacement patient
outcomes research team study. J Bone Joint Surg Am
1998;80A:163-803.
Hunter DJ, Felson DT. Osteoarthritis. BMJ 2006; 332:639-642
Jordan K M, Arden N K, Doherty M, Bannwarth B et al. EULAR
Recommendations 2003: an evidence based approach to the
management of knee osteoarthritis: Report of a Task Force of the
Standing Committee for International Clinical Studies Including
Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62;1145-1155
On draft list as ‘knee procedure’, but evidence review and recommendations have not yet been written
35
NHS Institute for Innovation and Improvement.
Delivering Quality and Value. Focus on:
Productivity and Efficiency. 2006
Department of Health, 2006. The Musculoskeletal
Services Framework – A joint responsibility: doing
it differently.
NICE. Consensus Development programme. Dec
2003
SWL
SWL criteria
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
W528, W529,
W531, W538,
W539, W541,
W548, W549,
W551, W558,
W559, W562,
W568, W569
Quintana JM, Escobar A, Arostegui I, Bilbao A, Azkarate J,
Goenaga I and Arenaza J. Health related quality of life and
appropriateness of knee or hip joint replacement. Archives of
Internal Medicine, 2006; 166: 220-226.
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Suffolk
City &
Hackney,
Hillingdon
Yasunaga H; Tsuchiya K; Matsuyama Y; Ohe K Analysis of factors
affecting operating time, postoperative complications, and length of
stay for total knee arthroplasty: nationwide web-based survey.
Journal of Orthopaedic Science, January 2009, vol./is. 14/1(10-6),
0949-2658
Yong PFK, Milner PC, Payne JN, Lewis PA, Jennison C.
Inequalities in access to knee joint replacements for people in
need. Ann Rheum Dis 2004;63:1483-1489
Hybrid knee
arthroplasty
C10b
O181, 0188,
O189
(Yellow)
Knee revision
OPCS
C11
Scottish Arthroplasty project
(Yellow)
ESH, GSTT,
Homerton,
Hillingdon
Knee revision
(Yellow)
C11a
OPCS
W402, W403,
W404, W412,
W413, W414,
W422, W423,
W425
OR ANY OF THE
BELOW PAIRED
WITH OPCS
Z787, Z844,
36
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Norfolk
Barking &
Dagenham,
Havering
Z845 OR Z846
W433, W443,
W453, W523,
W533, W543,
W552, W553,
W563, W564
Hybrid knee
revision
C11b
O180, O182,
O183
(Yellow)
Surgery for
asymptomatic
gallstones
Wisdom teeth
extraction
(Green)
20
OPCS
C12
OPCS
J181, J182, J183,
J184, J185, J188,
J189, J211, J212,
J213, J218, J219
C13
HRG4
CZ02S, CZ02T,
CZ02W, CZ02X,
Fazili, FM. To operate or not to operate on asymptomatic gallstone
in laparoscopy, May 2010. On World Association of Laparoscopic
Surgeons website. http://www.wals.org.uk/article.htm (review
article)
Ashford & St
Peter’s,
Barnet &
Chase Farm,
Dartford &
Gravesham,
Ealing, ESH,
Homerton,
Newham,
South London,
Hillingdon,
Lewisham,
West
Middlesex
Hugoson A Kugelberg C F. The prevalence of third molars in a
Swedish population epidemiological study: Community Dental
Health 1988:5; 121-138.
‘Knee procedures’ are on draft list, but evidence review and recommendations have not yet been written
37
NICE Technology Appraisal TA 1. Guidance on
the Removal of Wisdom Teeth, March 2000
‘Management of Unerupted and Impacted Third
ONEL
ONEL20
SWL
INEL
Barnet,
Bromley,
Camden, City
& Hackney,
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
CZ02Y
Shepherd J P, Brickley M. Surgical removal of third molars. British
Medical Journal 1994:309; 620-621
http://www.bmj.com/cgi/content/full/309/6955/620
Molar Teeth’, SIGN Publication No. 43, March
2000
http://www.sign.ac.uk/guidelines/fulltext/43/index.
html
OPCS
F091, F093,
F099
Song F, Landes D P, Glenny A M. Sheldon T A. Prophylactic
removal of impacted third molars: an assessment of published
reviews. British Dental Journal 1997:182(9):339 – 346.
Toth B. The appropriateness of prophylactic extraction of impacted
third molars: a review of the literature. Health Care Evaluation Unit,
University of Bristol 1993.
Daley T D. Third molar prophylactic extractions: a review and
analysis of the literature. General Dentistry 1996: 44(4); 310-320.
British Association of Oral Surgeons - ‘Removal
of wisdom teeth’ (accessed 1:10:08)
http://www.baos.org.uk/info.cfm
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
SWL criteria
Enfield,
Hammersmith
& Fulham,
Haringey,
Hounslow,
Islington,
Lambeth,
Lewisham,
Southwark
NCL
C&M criteria
(req
discussion)
Royal College of Surgeons of England, Faculty of
Dental Surgery, clinical guidelines, ‘The
management of patients with third molar teeth’,
1997
Barnet &
Chase Farm,
Ealing, GSTT,
Homerton,
King’s,
Kingston,
Mayday,
South London,
UCLH, West
Middlesex,
Whipps Cross
Cost-effective alternative: a procedure which is clinically effective but more cost-effective alternatives should be tried first
Anal
procedures
(Green)
21
D01
HRG4
FZ22A, FZ22B,
FZ23Z, FZ41A,
FZ41B, FZ41C
Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I.
Surgical decompression versus local steroid injection in carpal
tunnel syndrome: a one-year, prospective, randomized, open,
controlled clinical trial. Arthritis Rheum 2005;52: 612-9
OPCS
J W H H Dammers, M M Veering, and M Vermeulen, Injection with
methylprednisolone proximal to the carpal tunnel: randomised
double blind trial BMJ 1999 319: 884-886.
H482, H511,
H512, H518,
H519, H521,
A.C.F. Hui, S. Wong, C. H. Leung, P. Tong, V. Mok, D. Poon, C.
W. Li-Tsang, L. K. Wong, and R. Boet. A randomized controlled
trial of surgery vs. steroid injection for carpal tunnel syndrome.
On draft list, but evidence review and recommendations have not yet been written
38
NICE Technology Appraisal TA 128. Stapled
haemorrhoidopexy for the treatment of
haemorrhoids, Sep 2007
ONEL21
C&M criteria
(req
discussion)
Norfolk
Barking &
Dagenham,
Barnet,
Bexley,
Bromley,
Ealing,
Havering,
Lambeth,
Redbridge,
Southwark,
Waltham
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
H522, H523,
H524, H528,
H529, H531,
H532, H533,
H538, H539,
H558, H559,
H568, H569
Neurology, June 28, 2005; 64(12): 2074 - 2078.
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Forest
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for
carpal tunnel syndrome. The Cochrane Database of Systematic
Reviews 2002, Issue 4.
Ashford & St
Peter’s,
Barnet &
Chase Farm,
Dartford &
Gravesham,
Ealing,
Homerton,
King’s, NWL,
South London,
Hillingdon,
Lewisham,
Whittington,
West
Middlesex,
Whipps Cross
O'Connor D, Marshall S, Massy-Westropp N. Non-surgical
treatment (other than steroid injection) for carpal tunnel syndrome.
The Cochrane Database of Systematic Reviews 2003, Issue 1.
Verdugo RJ, Salinas RS, Castillo J, Cea JG. Surgical versus nonsurgical treatment for carpal tunnel syndrome. The Cochrane
Database of Systematic Reviews 2003, Issue 3
Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E,
Milcan A Long-term effectiveness of steroid injections and splinting
in mild and moderate carpal tunnel syndrome. Neurol Sci. 2004
Jun;25(2):48-52.
Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom
MC, Bouter LM.Splinting vs. surgery in the treatment of carpal
tunnel syndrome: a randomized controlled trial. JAMA. 2002 Sep
11;288(10):1245-51.
Celiker R, Arslan S, Inanici F. Corticosteroid injection vs. nonsteroidal anti-inflammatory drug and splinting in carpal tunnel
syndrome. Am J Phys Med Rehabil. 2002 Mar;81(3):182-6.
Carpal tunnel
procedures
D02
OPCS
A651, A658,
A659
ICD10
G56
Scholten RJPM, Mink van der Molen A, Uitdehaag BMJ, Bouter
LM, de Vet HCW. Surgical treatment options for carpal tunnel
syndrome. Cochrane Database of Systematic Reviews 2007, Issue
4.
Ly-Pen D, Andreu JL, de Blas G, Sanchez-Olaso A, Millan I.
Surgical decompression versus local steroid injection in carpal
tunnel syndrome: a one-year, prospective, randomized, open,
controlled clinical trial. Arthritis Rheum 2005;52: 612-9
J W H H Dammers, M M Veering, and M Vermeulen, Injection with
methylprednisolone proximal to the carpal tunnel: randomised
double blind trial BMJ 1999 319: 884-886.
A.C.F. Hui, S. Wong, C. H. Leung, P. Tong, V. Mok, D. Poon, C.
W. Li-Tsang, L. K. Wong, and R. Boet. A randomized controlled
39
ONEL
ONEL
SEL
notification
INEL
Barking &
Dagenham,
Bromley,
Lewisham,
Sutton &
Merton
NCL
C&M criteria
(req
discussion)
Revised
Croydon list
Ashford & St
Peter’s,
Barnet &
Chase Farm,
Chelsea &
Westminster,
Dartford &
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
trial of surgery vs. steroid injection for carpal tunnel syndrome.
Neurology, June 28, 2005; 64(12): 2074 - 2078.
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Brent
Gravesham,
ESH, Mayday,
North
Middlesex,
South London,
Hillingdon,
Lewisham,
Whittington
NWL with
exceptions
Barnet,
Bromley,
Camden,
Harrow
Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for
carpal tunnel syndrome. The Cochrane Database of Systematic
Reviews 2002, Issue 4.
O'Connor D, Marshall S, Massy-Westropp N. Non-surgical
treatment (other than steroid injection) for carpal tunnel syndrome.
The Cochrane Database of Systematic Reviews 2003, Issue 1.
Verdugo RJ, Salinas RS, Castillo J, Cea JG. Surgical versus nonsurgical treatment for carpal tunnel syndrome. The Cochrane
Database of Systematic Reviews 2003, Issue 3
Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E,
Milcan A Long-term effectiveness of steroid injections and splinting
in mild and moderate carpal tunnel syndrome. Neurol Sci. 2004
Jun;25(2):48-52.
Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW, de Krom
MC, Bouter LM. Splinting vs. surgery in the treatment of carpal
tunnel syndrome: a randomized controlled trial. JAMA. 2002 Sep
11;288(10):1245-51.
Celiker R, Arslan S, Inanici F. Corticosteroid injection vs. nonsteroidal anti-inflammatory drug and splinting in carpal tunnel
syndrome. Am J Phys Med Rehabil. 2002 Mar;81(3):182-6.
Hyperhidrosis
treatment with
botulinum
toxin
D03
OPCS
S532
ICD10
R61
Naumann M, Lowe NJ. Botulinum toxin type A in treatment of
bilateral primary axillary hyperhidrosis: randomised, parallel group,
double blind, placebo controlled trial. BMJ 2001;323: 596 - ?
Haidar A, Solish N. Focal hyperhidrosis: diagnosis and
management. CMAJ 2005; 172: doi10.1503/cmaj.1040708.
Available at: http://www.cmaj.ca/cgi/content/full/172/1/69
[Accessed 19th Sept 2007]
NWL Policy (D)
INEL
NCL
Vangelova L. Botulinum toxin: a poison that can heal. US Food
and Drug Administration. Available at:
www.fda.gov/fdac/features/095_bot.html [Accessed 19th Sept
2007]
International Hyperhidrosis Society. Hyperhidrosis treatment.
40
Barnet &
Chase Farm,
NWL, Royal
Free, St
George’s,
Lewisham
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
NICE CG44 Heavy menstrual bleeding:
investigation and treatment – Jan 2007
ONEL
SEL with
exceptions/
notification
Greenwich
ONEL
Dartford &
Gravesham,
Homerton,
South London,
Hillingdon
Botulinum Toxin Injections (Botox®). Webpage. [Cited 19th Sept
2007] Available at:
www.sweathelp.org/English/HCP_Treatment_Botox.asp
International Hyperhidrosis Society. Hyperhidrosis treatment.
Botulinum Toxin Injections (Botox®): Safety. Webpage. [Cited 19th
Sept 2007]
http://www.sweathelp.org/English/HCP_Treatment_Botox_Safety.a
sp
Cost-effectiveness compared to other treatment options is yet to e
established
Hysterectomy
for noncancerous
heavy
menstrual
bleeding
D04
OPCS
Q071, Q072,
Q073, Q074,
Q075, Q078,
Q079, Q081,
Q082, Q083,
Q088, Q089
(Blue)
Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical
therapy for heavy menstrual bleeding. Cochrane Database of
Systematic Reviews 2006, Issue 2.
Nieboer TE, Johnson N, Barlow D, Lethaby A, Tavender E, Curr E,
Garry R, van Voorst S, Mol BWJ, Kluivers K. Surgical approach to
hysterectomy for benign gynaecological disease. Cochrane
Database of Systematic Reviews 2006, Issue 2.
Royal College of Obstetricians and
Gynaecologists (1999). Management of
Menorrhagia in Secondary Care
SWL
INEL
SWL criteria
NCL
ICD10
C&M criteria
(req
discussion)
N920, N921,
N924, N925,
N926, N938,
N939
NWL/Brent
West Essex
EXCLUDING ALL
SPELLS WITH
CANCER AS
PRIMARY OR
SECONDARY
DIAGNOSIS
(C00-C99, D00D48)
Hysteroscopy
D05
Berkshire
HRG4
NICE CG44 Heavy menstrual bleeding:
41
Norfolk
Barking &
Procedure
DFI
Code
(Green)
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
investigation and treatment – Jan 2007
MA10Z
OPCS
Q181, Q188,
Q189
ICD10
N920, N921,
N924, N925,
N926, N938,
N939
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Suffolk
Dagenham,
Barnet,
Bexley, Brent,
Bromley,
Ealing,
Enfield,
Greenwich,
Harrow,
Kensington &
Chelsea,
Lewisham,
Redbridge,
Waltham
Forest,
Westminster
Barking,
Havering &
Redbridge,
Barnet &
Chase Farm,
Ealing, ESH,
Imperial,
NWL, South
London,
Lewisham,
Whittington,
West
Middlsex,
Whipps Cross
Cancelled
procedures
E01
HRG4
Not applicable
Not applicable
WA14Z
Not applicable
ALL except
Bexley and
Richmond &
Twickenham
ALL except
Care UK,
42
Procedure
DFI
Code
HRG, OPCS, ICD
codes
Published evidence and reviews eg original studies,
systematic reviews, meta-analyses, journal articles, text
books
Formal recommendations (NICE, professional
bodies, etc)
Local review of
evidence (by
sector or PCT)
Referral
guidance
London PCTs
and
providers
with
significantly
high SAR
2009/10:
Moorfields
and UCLH
43