POLICY ON INTERVENTIONS NOT NORMALLY UNDERTAKEN (INNU)
Reference Number
Version
Number
01
Documents to Read
alongside this Policy
All Wales Policy on Making
Decisions on Individual Patient
Funding Requests (IPFR)
Classification of Document:
Clinical Policy
Area for Circulation:
All Divisions; Executive; Clinical Referral Centre; Primary Care; Internet; Intranet
Author:
Senior Associate, Public Health Division
Executive Lead:
Director of Public Health
Group Consulted/Committee:
Legal Consultation via Morgan Cole Solicitors (v01)
Clinical Consultation via Local Medical Advisory Committee (v01)
Amendments via Clinical Effectiveness Group (v02)
Adopted from:
Cardiff and Vale University Health Board 11 May 2010 (v01)
Date Published:
12 May 2010 (v01)
23 August 2011 (v02)
Powys teaching Health Board December 2011
Ratified by:
Version
Control
v01
Review Date
Reviewer Name
Completed Action
Approved By
Date
Approved
New Review Date
December 2012
1
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
LIST OF INTERVENTIONS NOT NORMALLY UNDERTAKEN BY POWYS TEACHING HEALTH BOARD
The NHS has historically identified marginally effective and ineffective interventions (procedures and medicines) that are deemed to have
no or limited clinical value. These are routinely considered to be low priority and will not normally be provided by the NHS. This Policy
sets out the list of interventions considered to be low priority and not normally undertaken by the Powys teaching Health Board (‘the HB’).
It is important to note that some of the interventions in this policy will be undertaken by the HB in very specific clinical circumstances and
the criteria for doing this are explained here. Should an intervention not list any criteria for use, or should a patient not meet this criteria,
an exemption can be requested on the grounds of clinical exceptionality using the process set out in the All Wales Policy for Making
Decisions on Individual Patient Funding Requests.
If an intervention does not form part of the routine schedule of HB services, and is also not listed in this document (for example new and
experimental treatments yet to be assessed), requests for it to be undertaken can be made using the process set out in the All Wales
Policy for Making Decisions on Individual Patient Funding Requests.
How an Intervention is Categorised as ‘Not Normally Undertaken’
The HB Clinical Effectiveness Group considers the following sources of advice when assessing whether individual treatments and
procedures should be undertaken:
(a)
evidence published by NICE and the All Wales Medicine Strategy Group
(b)
evidence from peer reviewed clinical journals
(c)
evidence from clinical practice and local clinical consensus
(d)
Public Health Wales (PHW) reviews of evidence of a,b,c above.
It is acknowledged that the evidence base for some clinical practice is lacking and frequently has not been subject to review by the
National Institute of Clinical Excellence (NICE) or guidance in the form of a National Service Framework or the subject of peer-reviewed
journals of high scientific quality. In these circumstances, the available evidence-base, including an assessment of potential health gain
against potential harm, is considered along with an economic assessment of impact on a resource limited NHS.
Following detailed clinical discussion and consideration by the Group, a policy statement is drafted with the relevant clinical division. In
some cases, it is important to note that policy statements may be based on value judgements – these judgements will be based on the
same principles for decision making as set out in the All Wales Policy for Making Decisions on Individual Patient Funding Requests.
This Policy is a live document and will be routinely updated by the Clinical Effectiveness Group as new/updated evidence becomes
available. Each change to the Policy will be ratified by the Safety and Quality Committee.
2
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Children and
Women
R17.1
R17.2
R17.8
R17.9
R18.1
R18.2
R18.9
Obstetrics and
Gynaecology
Procedure /
Medicine
Elective
Caesarean
Section (CS)
INNU Policy
Statement_Elective C
Criteria for Use without an IPFR
Clinical Evidence Base
Can be undertaken when patients meet one or more of the following:
• HIV (only if recommended by a HIV consultant)
• Both HIV and Hepatitis C (as above, there is no evidence that CS
should be performed for Hepatitis C alone)
• Primary genital herpes in the third trimester (active genital herpes
at the onset of labour)
• Grade 3 and 4 placenta previa • Previous upper segment
caesarean section / type unknown
• Previous significant uterine perforation / surgery breaching the
cavity • A term singleton breech (if external cephalic version is
contraindicated, failed or declined) • A twin pregnancy regardless of
chorionicity with breech or smaller first twin • A monochorionic twin
pregnancy after appropriate discussion about the risks of acute
TTTS • A previous caesarean section if VBAC (Vaginal Birth after
Caesarean) has been declined or is felt to be inappropriate • A
previous traumatic vaginal delivery if VBAC has been fully explored
but declined • A fetus at high risk of fetal distress in labour e.g.
known severe placental insufficiency • A woman with tocophobia
who has requested caesarean section, providing that her concerns
have been fully explored and documented AND support and
counselling has been made available AND the patient has attended
the Birth Choices Clinic (she should have been offered a referral to a
healthcare professional with expertise in providing perinatal mental
health support to help her address her fears in a supportive manner.
If, after providing such support, a vaginal birth is still not an
acceptable option, an elective c-section can be supported). An IPFR
is required for all other circumstances.
NICE Clinical Guideline 13
http://www.nice.org.uk/page.a
spx?o=113190
NICE Consultation Draft
Clinical Guideline (May 2011)
http://www.nice.org.uk/newsr
oom/pressreleases/CSection
UpdateConsultation.jsp Last
considered by the UHB
Clinical Effectiveness
Group March 2011
3
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Children and
Women
Q37.
Q29.2
N18.1
Obstetrics and
Gynaecology
Procedure /
Medicine
Reversal of
Sterilisation
(male and
female)
Criteria for Use without an IPFR
Clinical Evidence Base
There are no agreed criteria for use without an IPFR.
Royal College of
Obstetricians and
Gynaecologists. Guideline
Summary.
http://www.rcog.org.uk/wome
ns-health/clinicalguidance/male-and-female
sterilisation Last considered
by the UHB Clinical
Effectiveness Group
November 2010
Children and
Women
Obstetrics and
Gynaecology
Q10.3
Q18.
Dilation and
Curettage (D&C)
and
Hysteroscopy for
Heavy Menstrual
Bleeding
D&C should not be used as a therapeutic treatment or as a
diagnostic tool for heavy menstrual bleeding. Hysteroscopy can be
undertaken when it is carried out: as an investigation for structural
and histological abnormalities where ultrasound has been used as
the first line diagnostic tool and where the outcomes are inconclusive
when undertaking endometrial ablation. An IPFR is required for all
other circumstances.
NICE Clinical Guideline 44
http://guidance.nice.org.uk/C
G44 Last considered by the
UHB Clinical Effectiveness
Group July 2011
Children and
Women
Q07.
Q08.
Hysterectomy for
Heavy Menstrual
Bleeding
Can be undertaken when a patient meet one or more of the following
criteria: • other treatment options have failed, are contraindicated or
are declined by the woman
NICE Clinical Guideline 44
Obstetrics and
Gynaecology
• there is a wish for amenorrhoea • the woman (who has been fully
informed) requests it • the woman no longer wishes to retain her
uterus and fertility. An IPFR is required for all other circumstances.
http://guidance.nice.org.uk/C
G44
Last considered by the
UHB Clinical Effectiveness
Group July 2011
4
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Therapeutics
and Clinical
Science
No
Code
INNU Open MRI Scans
Radiology
Therapeutics
and Clinical
Science
Procedure /
Criteria for Use without an IPFR
Medicine
Open MRI Scans Can be undertaken when patients meet one or both of the following
criteria:
No
Code
Complementary
Therapies
Clinical Evidence Base
Last considered by the
Clinical Effectiveness
Group May 2011
Criteria 1: Claustrophobia
Patients should have discussed their concerns about claustrophobia
and scanning with their General Practitioner in the first instance. The
patient should then be referred to the HB Radiology Department so
that a member of staff can describe the process and show them the
scanner. If their concerns cannot be alleviated by the Radiology
Department and the scan cannot be undertaken at that appointment,
there is an option for sedation. If clinically appropriate, the patient will
be referred back to their General Practitioner for a prescription of a
sedative which can be used during the scan. In most cases this is
sufficient to enable a conventional MRI scan to be performed.
Criteria 2: Patient Size The size of a patient and the restriction of
the conventional MRI scanner tunnel will vary depending on the
patient and the circumstances. Some patients may be large but
would still be suitable for a conventional closed MRI. In the first
instance, the patient should be referred to the Radiology
Department, talked through the procedure, shown the scanner and
be formally assessed by MRI Radiographer for suitability. The
Radiographer will then make a judgement on whether to proceed
with the conventional MRI scan. An IPFR is required for all other
circumstances.
Can be undertaken as part of a mainstream NHS service care plan
(e.g. as part of an integrated multidisciplinary approach to symptom
control by a hospital based pain management team) and as such will
be used as part of an existing contract. The HB will not support
referral outside of the NHS for complementary therapies. An IPFR is
required for all other circumstances.
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
5
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Dental
F11.5
F11.6
Dental
F12.1
Procedure /
Medicine
Dental Implants
Criteria for Use without an IPFR
Clinical Evidence Base
Can be undertaken for patients who meet one or more of the
following: • require post cancer reconstruction • experience major
trauma with bone loss • endentulous in one or both jaws (severe
denture intolerance e.g. gagging or pain; prevention of severe
alveolar bone loss) • partially dentate (preservation of remaining
healthy teeth; complete unilateral loss of teeth in one jaw) •
maxillofacial and cranial defects (intraoral protheses e.g.
considerable amounts of missing hard and soft tissue;
extraoral/cranial prostheses e.g. partial or total loss of ears, eyes or
nose). An IPFR is required for all other circumstances.
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Royal College of Surgeons
guidelines for selecting
appropriate patients to
receive treatment with dental
implants
http://www.rcseng.ac.uk/fds/cl
inical_guidelines
Apicectomy
Can be undertaken for patients who meet one or more of the
following: • presence of periradicular disease, with or without
symptoms in a root filled tooth, where non surgical root canal retreatment cannot be undertaken or has failed, or where conventional
re-treatment may be detrimental to the retention of the tooth •
presence of periradicular disease in a tooth where iatrogenic or
developmental anomalies prevent non surgical root canal treatment
being undertaken. • where biopsy of periradicular tissue is needed •
where visualisation of the periradicular tissues and tooth root is
required when perforation, root crack or fracture is suspected •
where procedures are required that need either tooth sectioning or
root amputation • where it may not be expedient to undertake
prolonged nonsurgical root canal re-treatment because of patient
considerations. An IPFR is required for all other circumstances.
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Royal College of Surgeons of
England. Guidelines for
surgical endodontics
http://www.rcseng.ac.uk/fds/cl
inical_guidelines/documents/
surg_end_guideline.pdf
6
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Procedure /
Medicine
Orthodontic
Treatments of
Essentially
Cosmetic Nature
Criteria for Use without an IPFR
Clinical Evidence Base
Dental
F14
F16
Can be undertaken for patients who meet one or more of the
following: • have a high Index of Orthodontic Treatment Need Scores
-5, 4 and 3 where a significant aesthetic component can be
demonstrated • have other major conditions e.g. cancers,
craniofacial deformity. An IPFR is required for all other
circumstances.
Health Evidence Bulletin
Wales Oral Health
http://hebw.cf.ac.uk/oralhealt
h/index.html
Dental
F09.3
Removal of
Asymptomatic
Wisdom Teeth
Impacted wisdom teeth free from disease should not be operated on.
Can be undertaken in cases where there is evidence of pathology.
An IPFR is required for all other circumstances.
NICE Technology Appraisal 1
http://guidance.nice.org.uk/T
A1 London Health
Observatory
http://www.lho.org.uk/commis
sioning/PCTClinicalException
s.aspx
Surgery
Ophthalmology
C46.8
Y02.1
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
NICE Interventional
Procedure Guidance 225
http://guidance.nice.org.uk/IP
G225/guidance/pdf/English
Surgery
C55.4
Corneal Implants
for the
Correction of
Refractive Error
in the Absence
of other Ocular
Pathology
Scleral
Expansion
Surgery for
Presbyopia
Laser Therapy
for Short Sight
There are no agreed criteria for use without an IPFR.
NICE Interventional
Procedure Guidance 70
http://guidance.nice.org.uk/IP
G70
NICE Interventional
Procedure Guidance 164
http://www.nice.org.uk/nicem
edia/pdf/ip/IPG164publicinfo.
pdf
Ophthalmology
Surgery
Ophthalmology
C44
C45
Can be undertaken if the patient has a biometry error following
cataract surgery. An IPFR is required for all other circumstances.
7
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Surgery
C88.2
Ophthalmology
Surgery
K23.4
Y08.5
Cardiac/
Vascular
Surgery
K23.4
Y08.5
Cardiac
Surgery
Orthopaedic
U13.2
Z84.3
Z84.6
Procedure /
Medicine
Photodynamic
Therapy (PDT)
for Wet AgeRelated Macular
Degeneration
Criteria for Use without an IPFR
Clinical Evidence Base
Can be undertaken for patients who have a confirmed diagnosis of
classic with no occult subfoveal choroidal neovascularisation (CNV)
(that is, whose lesions are composed of classic CNV with no
evidence of an occult component) and best-corrected visual acuity
6/60 or better. An IPFR is required for all other circumstances. [NB:
PDT is NOT recommended for the treatment of people with
predominantly classic subfoveal CNV (that is, 50% or more of the
entire area of the lesion is classic CNV but some occult CNV is
present) associated with wet age related macular degeneration,
except as part of research]
NICE Technology Appraisal
68
http://guidance.nice.org.uk/T
A68
Percutaneous
Laser Revascularisation
for Refractory
Angina Pectoris
Transmyocardial
Laser Revascularisation
(TMLR) for
Refractory
Angina Pectoris
Therapeutic use
of Ultrasound in
Hip and Knee
Osteoarthritis
There are no agreed criteria for use without an IPFR
NICE Interventional
Procedure Guidance 302
http://www.nice.org.uk/nicem
edia/pdf/IPG302Guidance.pdf
There are no agreed criteria for use without an IPFR
NICE Interventional
Procedure Guidance 301
http://www.nice.org.uk/nicem
edia/pdf/IPG301FullGuidance
.pdf
There are no agreed criteria for use without an IPFR
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
8
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Surgery
T59.1
T59.2
T59.3
T59.4
T59.8
T59.9
Orthopaedic
Procedure /
Medicine
Surgical
Removal of
Ganglia
Criteria for Use without an IPFR
Clinical Evidence Base
The evidence suggests that there is a high rate of spontaneous
resolution for ganglia and that reassurance should be the first
therapeutic intervention for most patients and all children.
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
The Division agreed that the surgical removal of ganglia should
cease. There are no agreed criteria for use without an IPFR.
Reviewed by the Division in
May 2010 and policy
position confirmed
Surgery
Y71.4
Autologus
Can be used in research studies that are designed to produce good
Chrondrocyte
quality information about the results of this procedure.
Implantation
An IPFR is required for all other circumstances.
(ACI) -for knee/
ankle problems
caused by
damaged
articular cartilage
NO
CODE
Electrical &
Electromagnetic
Field Treatments
Bone Non-Union
There are no agreed criteria for use without an IPFR
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
NO
CODE
Abrasion
Arthroplasty
There are no agreed criteria for use without an IPFR
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Orthopaedic
Surgery
Orthopaedic
Surgery
Orthopaedic
NICE Technology Appraisal
89
http://www.nice.org.uk/page.a
spx?o=TA089 Public Health
Wales Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
9
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Surgery
U21.1
Z66.5
M45.59
(ICD10
code)
Orthopaedic
W581
Surgery
Orthopaedic
Procedure /
Medicine
Non Specific
Lower Back Pain
Hip Resurfacing
Techniques
Criteria for Use without an IPFR
Clinical Evidence Base
MRI scans can be undertaken in the context of a referral for an
opinion on spinal fusion or if one of the following diagnoses are
suspected: • Spinal malignancy • Infection • Fracture • Cauda Equina
Syndrome • Ankylosing Spondylitis or another Inflammatory Disorder
An IPFR is required for all other circumstances. The following
treatments should NOT be used for the early management of
persistent non-specific low back pain: • SSRIs for treating pain •
Injections of therapeutic substances into the back • Laser therapy •
Interferential therapy • Therapeutic ultrasound • TENS • Lumbar
supports • Traction An IPFR is required for their use. The following
referrals should NOT be offered for the early management of
persistent non-specific low back pain: • Radiofrequency facet joint
denervation • IDET • PIRFT An IPFR is required for their use.
NICE Clinical Guideline 88
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
http://www.nice.org.uk/nicem
edia/pdf/CG88NICEGuideline
.pdf
http://www.nice.org.uk/nicem
edia/pdf/CG88NICEGuideline
.pdf
NICE IP203 NICE TA44
10
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Procedure /
Medicine
Endoscopic
Lumbar
Decompression
and Laser Disc
Decompression
Laser Lumbar
MicroDiscectomy
Hip Arthroscopy
Debridement
Criteria for Use without an IPFR
Clinical Evidence Base
Surgery
Orthopaedic
V25
Y08
Y76.3
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
NICE IP027
Surgery
Orthopaedic
V33.7
Y08
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
NICE IP27
Surgery
Orthopaedic
W868
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
NICE IP213
Surgery
Orthopaedic
Hip Prostheses
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
NICE IP112 NICE TA02
Surgery ENT
W37
W38
W39
W93
W94
W95
F34
Tonsillectomy in
Children &
Adults
Tonsillectomy is one of the five surgical procedures that the
Department of Health monitors as indicators of excess surgical
activity. Can be undertaken if patients meet ALL of the following
criteria prior to referral: • Sore throat is due to tonsillitis • Five or
more episodes of sore throat per year • Symptoms for at least one
year • Episodes of sore throat are disabling and prevent normal
function An IPFR is required for all other circumstances.
Royal College of Paediatrics
and Child Health Guidelines
for Good Practice:
management of acute and
recurring sore throat and
indications for tonsillectomy
http://www.rcpch.ac.uk/doc.a
spx?id_Resource=1714
Surgery ENT
F32.8
Soft-Palate
Implants for
Obstructive
Sleep Apnoea
There are no agreed criteria for use without an IPFR
NICE Interventional
Procedure Guidance 241
http://www.nice.org.uk/nicem
edia/pdf/IPG241Guidance.pdf
11
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Surgery ENT
D15.1
Surgery
Vascular
Surgery
Gynaecology
Procedure /
Medicine
Grommets Drainage of
middle ear in
Otitis Media with
Effusion (OME)
Criteria for Use without an IPFR
Clinical Evidence Base
Insertion of grommets is one of the five surgical procedures that the
Department of Health monitors as indicators of excess surgical
activity. Can be undertaken when there has been a period of at least
three months watchful waiting from the date of the first appointment
with an audiologist or GP with special interest in ENT AND the child
is placed on a waiting list for the procedure at the end of this period
AND OME persists after three months AND the child (who must be
over three years of age) suffers from at least one of the following: -at
least 3-5 recurrences of acute otitis media in a year -evidence of
delay in speech development -educational or behavioural problems
attributable to persistent hearing impairment, with a hearing loss of
at least 25dB particularly in the lower tones (low frequency loss) -a
significant second disability such as Downs syndrome. An IPFR is
required for all other circumstances.
NICE clinical guideline 60
http://www.nice.org.uk/nicem
edia/pdf/CG60fullguideline.pd
f
L84
L85
L86
L87
L88
Varicose Veins:
asymptomatic &
mild / moderate
cases
Can be undertaken in the following circumstances:
• ulcers/history of ulcers secondary to superficial venous disease
• liposclerosis
• varicose eczema
• history of phlebitis. An IPFR is required for all other circumstances.
NICE Referral Advice
http://www.nice.org.uk/media/
A8F/DC/Referraladvice.pdf
A79.8
Y08
Laparoscopic
Uterine Nerve
Ablation (LUNA)
for Chronic
Pelvic Pain
There are no agreed criteria for use without an IPFR
London Health Observatory
http://www.lho.org.uk/commis
sioning/PCTClinicalException
s.aspx
NICE Interventional
Procedure Guidance 234
http://guidance.nice.org.uk/IP
G234
12
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Surgery
G80.2
Gastroenterology
Surgery
Gastro
enterology
Surgery
J18.1
J18.2
J18.3
J18.4
J18.5
J18.8
J18.9
H51.1
H51.3
Procedure /
Medicine
Capsule
Endoscopy /
Pillcam
Neurosurgery
Clinical Evidence Base
Can be undertaken for disease of the small bowel for: • overt or
transfusion dependant bleeding from GI tract, when
source not identified on OGD/ Colonoscopy
NICE Interventional
Procedure Guidance 101
http://guidance.nice.org.uk/IP
G101
• Crohns Disease in whom strictures are not suspected • hereditary
GI polyposis syndromes. An IPFR is required for all other
circumstances.
Cholecystectomy Can be used in patients who are at increased risk of developing
for
gallbladder carcinoma or gallstone complications.
Asymptomatic
Gall Stones
An IPFR is required for all other circumstances.
Haemorrhoidectomy
Can be used in cases of: • Recurrent haemorrhoids
• Persistent bleeding
• Failed conservative treatment An IPFR is required for all other
circumstances.
Gastro
enterology
Surgery
Gastroenterology
Surgery
Criteria for Use without an IPFR
No
code
No
code
PH/Mannometry
Impedance
Studies
Subthalamic
Nucleotomy for
Parkinson’s
Disease
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
There are no agreed criteria for use without an IPFR
Evidence yet to be formally
released
Can be undertaken in line with NICE guidance.
NICE IP65
An IPFR is required for all other circumstances.
13
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Procedure /
Medicine
Treatment for
Erectile
Dysfunction
Criteria for Use without an IPFR
Clinical Evidence Base
Medicine
Urology
N29.1
Can be undertaken in accordance with the agreed service
specification of: • assessment by specialist ED providers for men
with ED referred by GPs • treatment (drug or mechanical device) for
ED in line with WHC (1999) 06 i.e. for men suffering from ED who
fall into the eligible groups for NHS prescriptions from GPs •
treatment (drug or mechanical device) by specialist ED providers for
men categorised as suffering with ED and severe distress who do
not fall into 1(b). An IPFR is required for all other circumstances.
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Medicine
D93.3
(ICD10
code)
Chronic Fatigue
Syndrome
There are no agreed criteria for treatment without an IPFR
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Medicine
Rheumatology
M79.09
(ICD10
code)
Fibromyalgia in
Adults
There are no agreed criteria for use without an IPFR
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Medicine
A54.2
Intrathecal
Baclofen
Therapy
There are no agreed criteria for use without an IPFR
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
14
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Division
Code
Medicine
No
code
Medicine
No
code
X66
Mental Health
Mental Health
A83.8
A83.9
MEDICINES
-
Procedure /
Medicine
Melatonin for
Delayed Sleep
Phase Disorder
Criteria for Use without an IPFR
Clinical Evidence Base
There are no agreed criteria for use without an IPFR
Public Health Wales
Evidence Statement
http://www2.nphs.wales.nhs.u
k:8080/healthserviceqdtdocs.
nsf/PublicPage?OpenPage
Mirror Therapy
There are no agreed criteria for use without an IPFR
Computer Based
Cognitive
Behavioural
Therapy
ElectroConvulsive
Therapy (ECT)
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
Evidence yet to be formally
released
NICE TA97
Can be undertaken in line with NICE guidance. An IPFR is required
for all other circumstances.
NICE 59
-
Please refer to the latest Powys Prescribing Formulary for a
list of medicines that can be routinely prescribed and the
associated indications and criteria An IPFR is required for all
other circumstances.
-
15
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
INNU Procedures within WHSSC Commissioning Remit
Division
Code
Procedure / Medicine
Policy Statement
Children and Women
Y96.
Surgery
E02.
Assisted conception techniques – IVF,
http://www.wales.nhs.uk/sites3/Documents/898/IVF%20P
ICSI, Donor Insemination, MESA, TESE, olicy%20Version%204.0.pdf
PESA. Egg sperm & gonadal tissue
cryostorage, Other micro-manipulation
techniques, Egg donation where no other
treatment is available, IVF surrogacy
Nose -Rhinoplasty
Surgery
D24.1 D24.2
Ear-Cochlear Implants
Surgery
D03.3
Ear -Correction of prominent ears
(Pinnaplasty)
WHSSC Policy on Plastic Surgery
http://www.wales.nhs.uk/sites3/Documents/898/CP35%2
0Cochlear%20Implants.pdf
WHSSC Policy on Plastic Surgery
Surgery
D03.2
Ear -Remodelling of lobe of external ear
WHSSC Policy on Plastic Surgery
Surgery
Surgery
Face -Face or Brow lift (Rhytidectomy)
S01.1 S01.2
S01.4 S01.5
S01.6
C13.
WHSSC Policy on Plastic Surgery
Eyelid -Blepharoplasty
WHSSC Policy on Plastic Surgery
16
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Surgery
No code
Facial Atrophy – New-Fill Procedures
WHSSC Policy on Plastic Surgery
Surgery / Medicine
S60.7 L68.0
Hair: Treatment for Hirsutism
(ICD10 Code)
WHSSC Policy on Plastic Surgery
Surgery
No code
Hair: Correction of Hair Loss (Alopecia)
Surgery
No code
Hair: Transplantation
Surgery
S62.1 S62.2
Liposuction
Surgery
S09.2
Rhinophyma – Surgery or Laser
Treatment
Surgery
S60.4
Scar revision
Surgery
L81.9 (ICD10)
Skin hypo-pigmentation
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
17
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Surgery
S60.1 S60.2
Skin “Resurfacing Techniques” – laser,
dermabrasion & dermal peels
WHSSC Policy on Plastic Surgery
Surgery
S09.
Tattoo Removal
Surgery
I99 (ICD10)
Vascular skin lesions
Surgery
C13.
Xanthelasma Palpebrum (Fatty deposits
on the eyelids)
Surgery
S06.8
Benign skin conditions – Removal of
Lipomata
Surgery
S06.8
Benign skin conditions – Removal of
Viral warts
Surgery
S06.9
Benign skin conditions – other e.g.
benign pigmented moles, milia, skin
tags, molluscum contagiosum, keratoses
(basal cell papillomata), sebaceous
cysts, corns/callous, dermatofibromas,
comedones
Breast -Female Breast Reduction
(Reduction mammoplasty)
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
Surgery
B31.1
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
18
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Surgery
B30.2 B30.3
B3.04
Breast -Prosthesis Removal or
Replacement
WHSSC Policy on Plastic Surgery
Surgery
B27.5
Breast -Male Reduction for
Gynaecomastia
WHSSC Policy on Plastic Surgery
Surgery
B31.2
Breast -Enlargement (Augmentation
Mammoplasty)
WHSSC Policy on Plastic Surgery
Surgery
B31.4
Breast-Revision of Mammoplasty
Surgery
B35.6
Breast-Correction of Nipple Inversion
Surgery
B31.3
Breast – Breast Lift (Mastopexy)
Surgery
X15
Gender Reassignment Surgery
Surgery
No code
Bariatric Surgery
Surgery
S02.1
Body Contouring -‘Tummy Tuck’
(Apronectomy or Abdominoplasty
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
WHSSC Policy on Plastic Surgery
http://www.wales.nhs.uk/sites3/Documents/898/CP21%2
0-%20Gender%20Dysphoria.pdf
http://www.wales.nhs.uk/sites3/Documents/898/CP29%2
0Bariatric%20Surgery.pdf
WHSSC Policy on Plastic Surgery
19
Policy on Interventions Not Normally Undertaken (INNU)
December 2011
Surgery
S03.1 S03.2
S03.8
Body Contouring – Other e.g. Buttock lift,
Thigh lift, Arm lift (brachioplasty)
WHSSC Policy on Plastic Surgery
Surgery
No code
Correction of male pattern baldness
Surgery
N30.3
Paediatric Circumcision
Medicine
X52.1
Medicine
X85.1
Hyperbaric Oxygen Therapy (HBOT) for
all indications
Botulinum Toxin
WHSSC Policy on Plastic Surgery
http://www.wales.nhs.uk/sites3/Documents/898/CP34%2
0Circumcision.pdf
http://www.wales.nhs.uk/sites3/Documents/898/CP7%20
Hyperbaric%20Oxygen%20Therapy.pdf
http://www.wales.nhs.uk/sites3/page.cfm?orgid=898&pid
=46592
20
Policy on Interventions Not Normally Undertaken (INNU)
December 2011