Information for GPs on low priority procedures
Low priority procedures are generated by the clinical prioritisation process to advise on the
funding of certain treatments and interventions.
Partially excluded policies
A partially excluded policy is where treatment is not routinely funded but exceptional cases can
be considered. If a patient is regarded as having exceptional circumstances funding requests can
be considered by the NHS Suffolk Individual Funding Request (IFR) Panel and the panel abide by
NHSS Individual Funding Request Policy. This is enclosed in the accompanying document.
NHS Suffolk’s partially exclude policies includePE1 Treatment for soft-palate snoring
PE2 Benign skin lesions (this is currently being revised)
PE3 Filtered/Coloured lenses for scotopic sensitivity syndrome
PE4 Spinal surgery
PE5-20 Cosmetic and lifestyle procedure
PE21 Treatment for gender dysphoria
PE22 Bevacizumab (Avastin) for the treatment of colorectal carcinoma
PE23 Alemtuzumab for chronic lymphocytic leukaemia
PE24 Growth hormone for growth disturbances in children born small for gestation age
PE25 Bevacizumab (Avastin) in wet AMD
PE26 Homeopathy in secondary care
PE27 Sorafenib in advanced renal cell carcinoma
PE28 Specialised exercise therapy for scoliosis
Threshold policies
A threshold policy is where treatment is funded for any patient by whom specific criteria are
fulfilled. These eligibility criteria are detailed in the policy. All the many threshold policies are only
applicable to the acute providers there are nine policies where information from GPs is crucial to
determine whether patients fulfil the policy criteria. NHSS has developed checklists to aid both
the implementation and monitoring of these policies. Acute trusts have a contractual obligation to
demonstrate that they only treat patients who fulfil the policy criteria or risk financial
consequences as NHSS will not fund patients outside of the policies.
The nine policies which require active contribution from the GPs are listed below. GPs are
requested to use the checklists for these policies while referring patients for these procedures to
secondary care. However if there is a clinical uncertainty whether patients meet the criteria then
GPs can refer and the consultants will make the final decision. The policies and the checklists
can be found in the enclosed document.
T6 Varicose veins
Surgical treatment will only be offered for complicated varicose veins (complicated being
defined as having one or more of the 5 criteria), or patient with uncomplicated varicose veins in
patients that have developed a recognized psychiatric condition due to the varicose veins
T7 Grommets
NHS Suffolk will only fund grommet insertion for otitis media with effusion (OME) when
the 5 eligibility criteria are met. Children with hearing impairment should have a 3 month period of
watchful waiting OME.
T8 Male circumcision
Circumcision will only be funded for 4 locally agreed conditions.
T9 Common hand conditions (Dupuytren’s contracture, ganglion’s, trigger finger)
Intervention for Dupuytren’s contracture is almost exclusively surgical and should only be
considered when the patient is having functional difficulties as set out in the policy.
For ganglions a referral to secondary care should only be made when the eligibility criteria
are met as set out in the policy
For trigger finger referral to secondary care may only be considered when the 2 eligibility
criteria have been met
T9a Carpal tunnel syndrome
The NHS Suffolk (Suffolk PCT) will only fund Carpal Tunnel Surgery when one or more
of the 2 criteria are met
T12 Vasectomy under general anesthetic
Vasectomy should only be performed under general anesthetic if one the 3 circumstances are
met as set out in the policy
T13 Tonsillectomy
NHS Suffolk will only fund tonsillectomy when one or more of the 5 eligibility criteria have
been met as per the policy. A six month period of watchful waiting is recommended prior to referral for
tonsillectomy.
T14 Dilatation and curettage for heavy menstrual bleeding
Patients will not receive dilation and curettage (D&C) as a diagnostic tool ALONE for heavy
menstrual bleeding OR when used as a therapeutic treatment. Hysteroscopy should be used as a
diagnostic tool only when ultrasound results are inconclusive, for example to determine the location of
a fibroid or the exact nature of the abnormality.
T17 Spinal surgery for non-acute lumbar conditions
Patients will only receive non-acute spinal surgery under the circumstances set out in the
policy
T18a/T18bHip and knee replacement surgery
The NHS Suffolk (Suffolk PCT) will only fund hip replacement for osteoarthritis when
conservative measures have failed and one or more of the eligibility criteria have been met
T24 Botulinum toxin type A for detrusor over activity
Referral should not be considered unless the patient meets the eligibility criteria.
T26 Female surgical interval tubal sterilization
Referrals for sterilization will generally be accepted if 3 essential criteria and one or more
of the other criteria are met
T28 Benign skin lesions
T29 Cholecystectomy
T30 Hip and knee replacement revision
T31a Surgery for female urinary incontinence
T31b Surgery for pelvic organ prolapse
T32 Surgery for Hernia
Table of threshold policies and checklists for use in general practice
Policy name
T6 Varicose veins
Policy
Checklist
Varicose vein policy
Varicose vein
checklist
Grommet policy
Grommet checklist
Male circumscision
policy
Male circumcision
checklist.doc
T7 Grommets
T8 Male
circumcision
T9 Common hand
conditions
(Dupuytren’s
contracture,
ganglion’s, trigger
finger
T9a Carpal tunnel
syndrome
T12 Vasectomy
under general
anesthetic
Common Hand
Conditions Policy
Common Hand
Common Hand
Common Hand
Conditions Dupuytrens
Conditions
Checklist Ganglions Checklist
Conditions Trigger Finger Checklist
Carpal Tunnel Policy
Carpal Tunnel
Syndrome Surgery Checklist
Vasectomies under
GA policy
Vasectomies under
General Anaesthetic Checklist
T13 Tonsillectomy
Tonsilectomy policy
Tonsillectomy
Checklist
T14 Dilatation and
curettage for
heavy menstrual
bleeding
Dilatation and
D&C and
Curettage and hysteroscopy Hysteroscopy
for HMB policy for HMB Checklist
T17 Spinal surgery
for non-acute
lumbar conditions
Spinal surgery policy
T18a/T18bHip and
knee replacement
surgery
T24 Botulinum
toxin type A for
detrusor over
activity
T26 Female
surgical interval
tubal sterilization
Hip and Knee
replacement policy
Spinal Surgery for
Non Acute Lumbar Conditions Checklist
Hip Replacement
Checklist
Knee replacement
Checklist
Botulinum in detrusor
instability.pdf
Botulinum Toxin Type
A for Detrusor over Activity Checklist
Female surgical tubal
sterilisation policy
Female Surgical
Interval Tubal Sterilisation Checklist
T28 Benign skin
lesions
T28 Benign skin
lesions.doc
T29
Cholecystectomy
T29
cholecystectomy.doc
T30 Hip and knee
replacement
revision
T31a Surgery for
female urinary
incontinence
T31b Surgery for
pelvic organ
prolapse
T30 hip and knee
revision.doc
T31a Surgery for
female urinary incontinence.doc
T31b Surgery for
Pelvic organ prolapse checklist.doc
T32 Surgery for
Hernia
T32 Surgery for
Hernia.doc