Procedures of limited clinical value and clinical thresholds

Information on procedures of limited clinical value and clinical thresholds

Like every public service, the NHS in Doncaster is facing challenging times in trying to manage a rising demand for services from limited resources. It means making difficult choices about how to use those resources in a fair and efficient way so we can get the best possible health benefits for the more than 300,000 patients we serve.

We do this by following nationally and regionally agreed guidelines and paying for operations that are proven to be clinically effective and expected to improve your health and well-being. Unfortunately, some operations and treatments that we currently pay for do not meet this criteria and have what’s termed, ‘limited clinical value’.

What are procedures of limited clinical value?

They are operations or treatments that medical experts agree offer only limited or temporary benefit and will not necessarily help you maintain good health, such as acupuncture – except for migraine treatment.

What are clinical thresholds?

They are an agreed set of criteria that must be met before your GP can refer you for an operation or other treatment. A threshold could, for example, be that medication is able to manage your health problem in the first instance. Surgery has risks and health experts agree it should be a last resort for many conditions and should not be considered before trying other, reasonable, non-surgical options first.

Following a review by local GPs, hospital consultants and other health professionals, we have decided that the NHS in Doncaster will now only pay for the following procedures if you meet clinically appropriate criteria:

  • Arthroscopic decompression of the shoulder (surgery for shoulder pain)
  • Benign skin lesions (Non cancerous)
  • Blepharoplasty (Eyelid surgery)
  • Carpal tunnel syndrome
  • Cataract surgery
  • Chalazion (inflammation
  • Cholecystectomy (Removal of the gall bladder)
  • Circumcision (male)
  • Common hand conditions
  • Grommets
  • Hallux Vulgus (Bunions)
  • Hernia repair (inguinal, Umbilical, Para-umbilical, Incisional)
  • Hip replacement for osteoarthritis
  • Hysterectomy for heavy menstrual bleeding
  • In-growing toe nail – if surgery with general anaesthetic required
  • Interventional treatment for haemorrhoids (Piles)
  • Perianal skin tags (Non-cancerous)
  • Tonsillectomy (Removal of tonsils)
  • Varicose veins surgery

Your GP will be able to explain what these medial terms mean.

 This illustrates why we have clinical thresholds:

  • A large percentage of patients with carpal tunnel syndrome initially respond to non-surgical treatment, especially among young people and pregnant women.
  • Gallstones are often seen on scans but do not cause any symptoms or simply cause mild symptoms that can be controlled by diet.
  • Obese patients may suffer significant complications following hip / knee surgery, such as joint infections and poor healing.

What does this mean for you?

Your GP may not be able to refer you for a particular treatment because it is not funded by the NHS in Doncaster. Your GP has to follow this guidance because it is now an agreed policy of the local NHS.

However, in some ‘exceptional’ clinical circumstances your GP, hospital consultant, or health care professional may think you will benefit from a treatment that is not routinely provided. They can then make an Individual Funding Request application on your behalf, which will be considered by an independent panel.

How can you help?

Having discussions with your doctor or nurse can help you make better decisions about your care. Often, this will help to avoid tests, treatments or procedures that are unlikely to be of benefit to you. These are the five questions you should ask:

  1. Do I really need this test or procedure?
  2. What are the risks or downsides?
  3. What are the possible side-effects?
  4. Are there simpler, safer options?
  5. What will happen if I do nothing?

If you need independent advice

Healthwatch is an independent organisation, established in 2013, which uses the experiences and views of Doncaster people to try and improve local adults and children’s health and social care services. Ring freephone 0808 801 0391 for non-clinical advice and signposting or visit www.healthwatchdoncaster.org.uk