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Consultation begins on commissioning guidance for limited value treatments

Covers 17 interventions in bid to cut waste and divert funds to higher priority areas

Caroline White

Friday, 06 July 2018

NHS Clinical Commissioners and NHS England have launched a consultation on a range of treatments considered to be of limited or no clinical value, such as varicose vein surgery and breast reduction, with a view to curbing waste and diverting NHS funds to higher priority areas, such as primary care and mental health.

The consultation, which falls under the Evidence-Based Interventions programme, covers an initial list of 17 treatments and procedures which add up to more than 100,000 unnecessary procedures a year at a cost of around £200 million.

The programme is a collaboration between NHS England, NICE, CQC, the Academy of Medical Royal Colleges and the relevant Royal Colleges, and follows similar joint consultations over the past year on items that should no longer be routinely prescribed in primary care and conditions for which over the counter items should no longer be prescribed.

The Evidence-Based Interventions programme will consider 17 treatments and procedures, which includes four proposed to be offered only when a patient makes an individual request: snoring surgery; dilatation and curettage for heavy menstrual bleeding; knee arthroscopies for osteoarthritis; injections for non-specific back pain

It is proposed that 13 others should be offered when specific criteria are met: breast reduction; removal of benign skin lesions; grommets for glue ear; tonsillectomy for sore throats; haemorrhoid surgery; hysterectomy for heavy menstrual bleeding; chalazia (lesions on eyelids) removal; arthroscopic compression for subacromial shoulder pain; carpal tunnel syndrome release; Dupuytren’s contracture release; ganglion excision; trigger finger release; and varicose vein surgery.

NICE has recommended that many of the procedures should be used as a last resort or even not at all, due to harmful side-effects.

While the procedures will not be banned outright, NHS England wants to ensure that they are carried out only where there is compelling evidence that they will benefit patients.

In most of the 17 interventions, alternative treatments like physiotherapy, a minor injection or change of diet are likely to be effective.

Any patient at risk of serious harm from their condition will continue to be offered treatment, and medical professionals will continue to follow guidelines from NICE when recommending treatment.

Dr Graham Jackson, NHSCC co-chair, said: “This is the start of an ambitious programme of evidence-based work to focus on a range of interventions that should not be provided or only provided on the NHS in certain circumstances.

“There have been a number of attempts to implement this before but this is the first time we have had a national clinical consensus across commissioners, providers and national bodies to make sure the procedures we are offering on the NHS are safe for patients, deliver good outcomes and, are both clinically and cost-effective in order to secure the very best value for the limited NHS pound.”

He added: “It is important that we have an honest conversation with the public, patients and clinicians about what can be expected from the NHS within the constrained funds it has available.”

NHS England national medical director, Professor Steven Powis, said: “If we want the very best clinical care for our patients, we need to stop putting them through treatments where risks and harms outweigh the benefits. By reducing unnecessary or risky procedures for some patients we can get better outcomes while reducing waste and targeting resource to where it is most needed.”

The consultation runs from 4th July to 28th September. The full consultation document can be found here, and further documents and FAQ’s are on the NHS England website.

Complete the online survey; or send written feedback to: england.EBinterventions@nhs.net ; or attend one of the events and / or webinars, details of which can be found on the NHS England website.

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