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Restricted and not routinely funded procedures

(previously known as Procedures of Limited Clinical Value and Cosmetics)

CCGs have a duty to ensure that NHS resources are used as wisely as possible to maximise health benefit for the population. We have therefore looked at the evidence surrounding a number of treatments to see which ones are most effective and whether outcomes could be improved in certain circumstances. For example, we know that people can benefit more from their operations if they take steps to improve their health before their operation, giving them the best chance to fully recover and get benefit from their treatment. This may include things like controlling blood pressure, stopping smoking, taking more exercise to improve fitness levels and losing some weight. Each case is individual and requires medical advice. Lifestyle support may also be required.

 The NHS has defined treatments that are funded for a number of years. For example, cosmetic procedures are only funded for a limited number of circumstances. All areas of the country have developed policies that describe what is normally covered by NHS funding and the procedures that normally fall outside of mainstream funding policies. From the 3rd September 2018 Newark and Sherwood CCG  will be implementing an updated policy which sets out what procedures and treatments are restricted. 

Below you can see a list of the procedures and treatments included in the policy:

 

Nottinghamshire Service Restriction Policy (2018)

Nottinghamshire Service Restriction Policy (2018) Additional Information 

This Restricted Policy is for adoption across the Nottinghamshire STP from the 3rd of September 2018. The policy will be presented to NHS Mansfield and Ashfield and Newark and Sherwood CCG's Governing Bodies on 6th September for discussion and ratification.

The RESTRICTED policy outlines all procedures where limitations apply.

Procedures in the policy are divided into:

  1. Restricted - NOT COMMISSIONED
  2. Restricted - CRITERIA based for which PRIOR APPROVAL or AUDIT is required

For restricted procedures the details of the clinical criteria that must be meet is available by clicking on the relevant link.

 

Procedure  Commissioning Position
Abdominoplasty  NOT COMMISSIONED
Acupuncture for all purposes  NOT COMMISSIONED
Adenoids/Grommets

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Aesthetic operations on the umbilicus NOT COMMISSIONED
Alexander technique

 

 NOT COMMISSIONED

Alternative therapies not explicitly listed in this policy 

NOT COMMISSIONED
Anal rectal skin tags  NOT COMMISSIONED
Any other purely cosmetic/aesthetic procedure that is not mentioned withing the policy NOT COMMISSIONED
Applied kinesiology NOT COMMISSIONED
Aromatherapy NOT COMMISSIONED
Arthroscopic Subacromial Decompressions (for Subacromial shoulder pain)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Autogenic training NOT COMMISSIONED
Autologous Chondrocyte Implantation NOT COMMISSIONED
Ayurveda NOT COMMISSIONED
Back pain - x ray for axial low back pain NOT COMMISSIONED
Benign skin lesion excision (also see Congenital pigmented lesions (treatment of))

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Biological Mesh 

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Blephatoplasty (also see Occuloplastic procedures)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Body Contouring NOT COMMISSIONED
Botulinum Toxin treatment for wrinkles frown lines or ageing neck NOT COMMISSIONED
Brachioplasty/Upper arm lift NOT COMMISSIONED
Breast asymmetry

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Breast Enlargement (Female)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Breast implant removal (+/-re-insertion)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Breast Reduction

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Breast Uplift (Mastoplexy) NOT COMMISSIONED
Buttock Lift NOT COMMISSIONED
Calf implants NOT COMMISSIONED
Carpal Tunnel

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Cataracts

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here - First Eye

Link to Prior Approval Declaration form here - Second eye

Cheek Implants – (A) except in post-trauma cases and/ or part of planned reconstruction following surgery e.g. for cancer NOT COMMISSIONED
Chemical peels NOT COMMISSIONED
Chin implant (genioplasty, mentoplasty) NOT COMMISSIONED
Chinese medicine NOT COMMISSIONED
Chiropractic therapy NOT COMMISSIONED
Cholecystectomy (asymptomatic gallstones)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Circumcision

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Circumcision for non-medical reasons NOT COMMISSIONED
Collagen implant- cosmetic (except in post-trauma cases and/ or part of planned reconstruction following surgery e.g. for cancer NOT COMMISSIONED
Complimentary therapy healing NOT COMMISSIONED
Congenital pigmented lesions (treatment of)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Cosmetic Surgery (unless specified elsewhere) NOT COMMISSIONED
Cranial banding for positional plagiocephaly NOT COMMISSIONED
Diagnostic investigations for IBS NOT COMMISSIONED
Dilatation and Curettage for menorrhagia

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Dupuytrens Contracture (Surgical treatment)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Dupuytrens Contracture (Collagenase injections and radiation therapy)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Earlobe repair NOT COMMISSIONED
Electrolysis for any condition NOT COMMISSIONED
Endoscopic thoracic sympathectomy NOT COMMISSIONED
Environmental medicine  NOT COMMISSIONED
Epidural injections for low back pain

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Epidural injections non-radicular/axial pain and failed back surgery syndrome NOT COMMISSIONED
Excimer laser - Astugmatism and Xanthelasma NOT COMMISSIONED
Excimer laser for corneal erosions NOT COMMISSIONED
Exogen bone healing  NOT COMMISSIONED
Extracorporeal shock-wave therapy for planta fasciitis NOT COMMISSIONED
Face lifts –unless part of the treatment of facial nerve palsy/congenital facial abnormalities/treatment of specific facial skin condition (e.g. Cutis Laxa) NOT COMMISSIONED
Facet joint injections (therapeutic low back pain) NOT COMMISSIONED
Fat Grafts NOT COMMISSIONED
Forearm implants NOT COMMISSIONED
Functional electrical stimulation (Orthotic)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Link to the East Midlands FES EMACC policy

 Gamete Storage

PRIOR APPROVAL is required

 Link to Prior Approval Declaration form here

Ganglion Cysts 

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Gender reassignment procedures not part of the original package of care

NOT COMMISSIONED

Grommets 

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Gynaecomastia (male breast enlargement) surgery)

NOT COMMISSIONED

Haemorrhoidectomy

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Hair depilation (removal) for excessive hair growth (hirsutism) NOT COMMISSIONED
Hair transplant NOT COMMISSIONED
Hallux Valgus (bunions)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Herbal medicine NOT COMMISSIONED
Hip arthroscopy 

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Hip replacement – primary

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Hip resurfacing  NOT COMMISSIONED
Homeopathy NOT COMMISSIONED
Hydrotherapy unless part of an contracted service NOT COMMISSIONED
Hymen reconstruction NOT COMMISSIONED
Hyperhydrosis treatments, non-pharmacological (Botulinum toxin treatment, iontophoresis or surgical treatments for axillary hyperhydrosis) NOT COMMISSIONED
Hypnosis- complimentary therapy  NOT COMMISSIONED
Hysterectomy for menorrhagia 

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Inguinal/Umbilical/Ventral hernia repair

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Insulin Pump

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

IUI/AI/DI (Prior to IVF)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Link to the East Midlands EMACC policy

IVF

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Link to the NHS England Commissioning Policy

Joint Injections completed in Secondary Care (excluding spinal injections)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Joint prostheses (other)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Joint revisions, using non-standard prostheses specifically mentioned in contractual agreement, including hip and knee NOT COMMISSIONED
Knee Arthroscopy  PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Knee - Diagnostic Arthroscopy NOT COMMISSIONED
Knee replacement (primary)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Labiaplasty NOT COMMISSIONED
Laser Treatment - skin (including tattoo)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Laser Treatment for cosmetic reason NOT COMMISSIONED
Laser Treatment for facial hyperpigmentation NOT COMMISSIONED
Laser treatment for myopia  NOT COMMISSIONED
Laser Treatment for skin conditions causing scarring including post acne and post traumatic scarring NOT COMMISSIONED
Laser Treatment/ therapy/ tunable dye laser for aesthetic reasons  NOT COMMISSIONED
Lipoma

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Lizarov treatment / Taylor spatial frame NOT COMMISSIONED
Lymphoedema treatment in private specialist units NOT COMMISSIONED
Massage- complimentary medicine  NOT COMMISSIONED
Medial branch block (for low back pain)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Meditation NOT COMMISSIONED
Micro-suction for the removal of earwax

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Mirena IUS / IUD insertion in secondary care

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

MRI low back pain

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Myopia (short sighted) - surgical treatment NOT COMMISSIONED
Natruropathy NOT COMMISSIONED
Neck Lift NOT COMMISSIONED
Nipple inversion correction NOT COMMISSIONED
Nutritional therapy NOT COMMISSIONED
Occuloplastic procedures

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here - Chalazion Meibomion cyst

Link to Prior Approval Declaration form here - Epiphora

Link to Prior Approval Declaration form here - Ectropion/Entropion

Osteopathy NOT COMMISSIONED
Out of area (OOA) referrals for chronic fatigue/ME treatment NOT COMMISSIONED
Out of area referrals to independent sector for autism NOT COMMISSIONED
Patella resurfacing  NOT COMMISSIONED
Pelvic organ prolapse

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Penile Implants NOT COMMISSIONED
Phalloplasty NOT COMMISSIONED
Pinnaplasty (“correction” of prominent ears) - cosmetic  NOT COMMISSIONED
Reflexology NOT COMMISSIONED
Reiki NOT COMMISSIONED
Removal of excess skin following weight loss by whatever means NOT COMMISSIONED
Removal of Supernumerary Nipples NOT COMMISSIONED
Repair of chronic clefts due to avulsion of body piercing  NOT COMMISSIONED
Residential pain management programmes NOT COMMISSIONED
Respirate device for hypertension  NOT COMMISSIONED
Resurfacing Botulinum Toxin for the following indications: wrinkles, frown lines and ageing neck NOT COMMISSIONED
Reversal of Female or male (vasectomy) Sterilization NOT COMMISSIONED
Rhionophyma - Surgical correction

NOT COMMISSIONED

Septo-Rhinoplasty

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Sacrel Nerve Stimulation NOT COMMISSIONED
Shiatsu NOT COMMISSIONED
Shoulder arthroscopy 

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Sleep Studies 

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Sleep studies for parasomnia, periodic limb movement disorder or chronic insomina

NOT COMMISSIONED

Snoring - surgical treatment including reduction of the tongue

NOT COMMISSIONED

Spinal fusion/Lumber Decompression

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Spinal injections for low back pain other than the two restricted procedures; medial branch block injection and epidural injection.

NOT COMMISSIONED

Sterilisation in men (vasectomy) and women

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Suction assisted lipectomy (liposuction) except as part of planned reconstruction surgery for the treatment of cancer or a congenital syndrome

NOT COMMISSIONED

Surgical discectomy/Lumbar decompression surgery for sciatica (standard or micro-discectomy)

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Surrogacy

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Refer to the following policy:

Link to the East Midlands EMACC policy

Therapeutic community method for treatment of borderline personality disorder NOT COMMISSIONED
Therapeutic use of ultrasound in hip and knee OA NOT COMMISSIONED
Tonic intraoccular lens implant for astigmatism

NOT COMMISSIONED

Tonsillectomy as a treatment for snoring

NOT COMMISSIONED

Tonsillectomy and adeniodectomy

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Trigger finger

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

Vaginaplasty NOT COMMISSIONED
Varicose Veins

PRIOR APPROVAL is required

Link to Criteria here

Link to Prior Approval Declaration form here

 

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