Clinical policies

LOWER CLINICAL PRIORITY POLICY

Bobath Therapy for Cerebral Palsy treatment is not routinely commissioned.  For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the policy:

Policy - pdf version:  Policy pdf

Policy - Word version:  Policy (Word)

For further information about Cerebral Palsy please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

For further information about Bobath Therapy please select the following external link: http://www.bobath.org.uk/for-commissioners/bobath-therapy/

SURGICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma). 

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net  for consideration by  the Exceptional Cases Panel.

Select the appropriate link to access the policy and referral proforma:

Policy - pdf version:   Policy (pdf)

Policy - Word version:   Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about Gallstones and relevant treatments please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx

SURGICAL THRESHOLD POLICY

NOTE:  If penile malignancy is suspected then referral should be via a two-week wait pathway for suspected cancer. 

In instances of traumatic foreskin injury it may be appropriate to refer to hospital as an emergency admission for surgery.

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net  for consideration by the Exceptional Cases Panel.

Select the appropriate link to access the policy and referral proforma:

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about Circumcision please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

Complementary and Alternative Therapies are not routinely commissioned.  For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the policy:

Policy - pdf version:  Policy pdf

Policy - Word version:  Policy (Word)

For further information about Complementary and Alternative Therapies please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

Information relating to the policy for CGMs has now moved to the Prescribing Information section of the CCG web site.

Link to the policy for CGM in adults 19 years and over

Link to the policy for CGM in children and young people up to the age of 19 years 

NOTE:  Group Prior Approval Forms for CGM and, under local agreement, for:  Freestyle Libra Glucose Scanning for Adults and for Children and Young People Under the Age of 19 years are available here

For further information about Diabetes and Continuous Glucose Montors please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx 

LOWER CLINICAL PRIORITY POLICY

Cosmetic/Aesthetic Surgery is not routinely commissioned.  Exceptional case funding is required prior to any Cosmetic/Aesthetic Surgery.  The GP must complete a referral proforma and submit it to the CCG Exceptional Cases Team for consideration by the Exceptional Cases Panel.  Follow the instructions on the proforma.

Select the appropriate link below to access the policy and referral proforma:

Policy - pdf version:  Policy (pdf)

Policy - Word version:   Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

*NOTE:  Referral proforma are now available in SystmOne

For further information about Cosmetic/Aesthetic Surgery please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

SURGICAL THRESHOLD POLICY

Management of Temporomandibular Disorders (TMD) - GP Advice

For patients who meet the policy criteria for referral, the dental practitioner will make the referral to secondary care services as per the NHS England pathway - NHS England are the responsible commissioner for TMD interventions.

For patients who do not meet the criteria:  application to the NHSE Individual Funding Request Panel can be made for patients who are considered exceptional to the criteria. See below*.

Select the appropriate link to access the policy

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

NOTE:  Botulinum toxin injections for TMD require CCG Exceptional Cases Panel approval - select this link to access the funding request form:  CPCCG Funding Request Form     

Dental Implants/Orthodontic Treatment and Wisdom Teeth Removal

NHS England local area teams are responsible for commissioning dental services please refer all exceptional case requests and enquiries to NHS England.

Select the link to access NHSE individual funding request documentation:  NHSE funding request information 

For further information about the above interventions and conditions please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx   

CLINICAL THRESHOLD POLICY AND SURGICAL THRESHOLD POLICIES

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net for consideration by  the Exceptional Cases Panel.

Select the appropriate link to access each policy and referral proforma:

CLINICAL THRESHOLD POLICY:

Earwax Removal - Referral for

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:   Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

SURGICAL THRESHOLD POLICIES: 

Grommets & Adenoidectomy (Surgical Treatment of Otitis Media)

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Nasal Surgery for Obstruction or Deformity

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Tonsillectomy (Surgery for Tonsillitis: Tonsillectomy and Adenoidectomy)

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual: Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Surgery for Obstructive Sleep Apnoea and Snoring

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about the above interventions and conditions please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx

SURGICAL THRESHOLD POLICIES

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net for consideration by  the Exceptional Cases Panel.

Select the appropriate link to access the policies and referral proforma:.

Upper GI Endoscopy - Management of Dyspepsia in Primary Care and Referral for Endoscopy

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Lower GI Endoscopy (Colonoscopy or Sigmoidoscopy)

Guidance:  IBS Guidelines and Calprotectin advice or visit the Digestive Diseases web page of the CCG web site.

Policy - pdf version:   Policy (pdf)

Policy - Word version:   Policy (Word)

Referral Proforma Manual:   Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about the above interventions and conditions please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx

SURGICAL THRESHOLD POLICIES AND LOWER CLINICAL PRIORITY POLICIES

SURGICAL THRESHOLD POLICIES:

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma or a funding request form CPCCG Funding Request Form and submit to the Exceptional Cases Team on secure email: 
cpccge-ifr@nhs.net for consideration by  the Exceptional Cases Panel.   

Select the appropriate link to access the policies and referral proforma: 

Cataracts:

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Cataract Referral Proforma - direct referral: pdf version

Cataract Referral Proforma - direct referral:  Word version

Chalazions

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Eyelid and Brow Surgery

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

LOWER CLINICAL PRIORITY POLICIES:

Treatment using coloured filters/tinted lenses for reading difficulties is not routinely commissioned.  For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form:   CPCCG Funding Request Form 

Coloured Filters/Tinted Lenses for Reading Difficulties

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word) 

Photodynamic Therapy for Age Related Macular Degeneration 

There is a Group Prior Approval (GPA) form available for this intervention for patients who meet the policy criteria.  Click here to access the GPA form.

For patients who do not meet the criteria an Exceptional/IFR Funding Request Form must be completed and submitted to the CCG Exceptional Cases Team - select this link to access the form: 
CPCCG Funding Request Form 

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

For further information about the above interventions and conditions please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

POSITION STATEMENT

Referral for breast screening and genetics services will be provided in accordance with the policy criteria.

For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the policy:

Policy - pdf version:  Position Statement (pdf)

Policy - Word version:  Position Statement (Word)

For further information about Familial Breast Cancer and genetic testing please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

Cambridgeshire and Peterborough CCG has suspended routinely commissioned specialised fertility services and will only review the decision again when it has achieved a financial surplus.  The following two specialised services will continue to be commissioned:

• Fertility preservation (cryopreservation) will be offered to patients undergoing cancer treatment, or who have a disease or a condition requiring medical or surgical treatment, that has a significant likelihood of making them infertile, eg patients who are or will be receiving:

  • specialist endocrinology services (hormonal imbalances); 
  • services for a rare mitochondrial disorder (a rare, long term, genetic disorder); or
  • endocrine treatment or surgery in relation to gender dysphoria (defined by a strong, persistent feeling of identification with another gender and discomfort with one's own assigned gender and sex).                          
    

Treatment for patients not covered by the treatment areas detailed above requires an application for funding to the Exceptional Cases Panel.

Cryopreserved material will be stored for an initial period of 10 years in line with recommendations in The Royal College of Physicians Working Party Report:  'The effects of cancer treatments on reproductive functions'. Guidance on management, 2007, and the Human Fertilisation and Embryology Authority (HFEA), Code of Practice, January 2019 guidance.  Extensions to the initial  period will be by exceptional funding request to the Exceptional Cases Panel.      

• Sperm washing will be provided to men who have a chronic viral infection (primarily HIV), and whose female partner does not, where intrauterine insemination is being considered.  This is a risk reduction measure to limit the transmission of a serious, pre-existing viral conditions such as HIV to the woman and, therefore, potentially her unborn baby.       

In line with the CCG Exceptional/Individual Funding Request Policy for treatments that are not normally funded on the NHS, patients/couples, supported by their clinician (primary or secondary care), may apply to the CCG’s Exceptional and Individual Funding Request Panel to request NHS funded IVF.  CPCCG Funding Request Form 

A range of services continue to be available to people who need help with fertility issues, both in primary care and in our local hospitals services such as:

• The standard investigation of causes of infertility.

• Non-specialist treatments such as physical and hormonal therapy.

• Management of ovulatory disorders.

• Management of tubal and uterine abnormalities. 
  Medical and surgical management of endometriosis.

• Medical and surgical management of male infertility.

• Management of ejaculatory failure.

GP Referral Form to Secondary Care for Fertility Assessment:  referral form        

Care Pathway for Fertility: care pathway
 

Pre Implantation Genetic Diagnosis (PGD) remains the responsibility of NHS England Specialised Commissioning Group.  Select the link to access the policy: NHSESCG Pre-implantation Genetic Diagnosis Policy

For further information about the above intervention and conditions please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

 NOTE:  This intervention is now covered in the Neurostimulation policy below.

NHS England are responsible for the provision of Gender Dysphoria services - select link to access the current NHSE clinical programme:

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/

SURGICAL THRESHOLD POLICIES

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).  

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email: cpccge-ifr@nhs.net for consideration by  the Exceptional Cases Panel. Select the appropriate link below to access the policy and associated document(s).

Select the link to access the policy and referral proforma:

Heavy Menstrual Bleeding (HMB)

Policy - pdf version: Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible: EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Female Pelvic Organ Prolapse (Management of)

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

For further information about Heavy Menstrual Bleeding, Female Pelvic Organ Prolapse and associated interventions and conditions please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx

CLINICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma). 

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net  for consideration by  the Exceptional Cases Panel.

Assessment of Haematuria (presence of red blood cells in urine) in Primary Care

NOTE:  referrals for 2WW Urology should be made using the 2WW form on SystmOne/EMIS or click here

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne 

SURGICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-iofr@nhs.net for consideration by the Exceptional Cases Panel.

Select the appropriate link to access the policy and referral proforma:

Policy - pdf version: Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE: Referral proforma are now available in SystmOne.

For further information about Haemorrhoids (Piles) please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).    

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net for consideration by the Exceptional Cases Panel.     

Select the link to access the policy and referral proforma: 

Policy - pdf version:  Policy (pdf)

Policy - Word version:   Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about Hernia and relevant treatments please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx

POSITION STATEMENT

This position statement covers the use of hydrotherapy in place of land-based physiotherapy.  It is the responsibility of the referring and treating physiotherapist to ensure compliance with this commissioning advice.

Hydrotherapy is not considered to be an essential service, this policy applies only where local provision is available.  Where local provision is not available, patients should receive land-based physiotherapy.

Policy - pdf version: Position Statement (pdf)

Policy - Word version: Position Statement (Word))

For further information about physiotherapy please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

There is a Group Prior Approval (GPA) form available for this intervention for patients who meet the policy criteria.  Select the here to access the GPA forms web page.

For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the policy:

Policy - pdf version: (Policy pdf)

Policy - Word version: (Policy Word)

For further information about Hyperhidrosis please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

Treatment for Lymphoedema is available locally and may be referred through the commissioned pathway.

Treatment provided by a specialist unit in the private sector will require the involvement of an appropriate local service and funding must be sought prior to referral by completing an Exceptional/IFR Funding Request Form and submitting it to the Exceptional Cases Team - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the policy:

Policy - pdf version:  Policy (pdf)

Poicy - Word version:  Policy (Word)

For further information about Lymphoedema and relevant treatments please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

POSITION STATEMENT

Neurostimulation interventions are not routinely commissioned.  For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form: CPCCG Funding Request Form 

This policy does not apply to neurostimulation for indications commissioned by NHS England or covered by NICE TAs.

Select the link to access the policy:

Policy - pdf version: Position Statement (pdf)

Policy - Word version:  Position Statement (Word)

For further information about neurostimulation interventions described in the policy please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

CLINICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email: cpccge-ifr@nhs.net for consideration by the Exceptional Cases Panel.

Select the appropriate link to access the policy and referral proforma:

Policy - pdf version:  Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about Obstructive Sleep Apnoea please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

Routine referral by clinicians in MSK Services or Secondary Care, for Open or Upright MRI (Magnetic Resonance Imaging), in all indications, is considered of low priority and will only be commissioned by the NHS on an individual case basis.  

Funding through the individual funding process must be sought prior to referral - MSK or Secondary Care clinicians should complete the referral proforma (see below) and submit it to the CCG Exceptional Cases/IFR Team - see proforma for details.

Applicants who receive approval of funding will be forwarded an MRI referral form applicable to the selected commissioned provider.

Select the link to access the policy and referral proforma:

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma:  Referral Proforma

Urgent Open or Upright MRI, in cases with red flag symptoms or signs, should be made urgently by MSK or Secondary Care clinician to the CCG commissioned provider and are excluded from the policy.  The referral proforma provides details of CCG commissioned providers.

For further information about Open/Upright MRI please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY AND SURGICAL THRESHOLD POLICIES

LOWER CLINICAL PRIORITY POLICY:

Extracorporeal Shockwave Therapy (ESWT) for Orthopaedic Indications

Referral for ESWT for orthopaedic indications is considered a low priority and will only be commissioned by the NHS on an individual basis.  Funding through the Exceptional Cases process must be sought prior to referral - clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team - select the link to access the funding request form:  CPCCG Funding Request Form 

Policy - pdf version:  Policy (pdf)

Policy - Word version: Policy (Word)

SURGICAL THRESHOLD POLICIES:

For patients who meet the policy threshold criteria complete the applicable sections of the relevant referral proforma below and send direct to MSK triage service for onward referral - see instructions on proforma. 

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net for consideration by the Exceptional Cases Panel.

Select the appropriate link to access each policy and referral proforma:

Bunions (Surgical Referral for Hallux Valgus)

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Carpal Tunnel Syndrome

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Chronic Hip Pain 

Policy - pdf version:  Policy (pdf)

Policy Word Version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

Dupuytren's Contracture

Policy - pdf version: Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Ganglion

Policy - pdf version: Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual: Manual Proforma

Referral Proforma EMIS Web compatible: EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Hip Replacement (Primary)

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Knee Arthroscopy

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Knee Replacement (Primary)

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Low Back Pain - Surgery and Other Invasive Interventions   

Policy - pdf version: Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual:   Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne
     

Shoulder Pain - Management of (including referral for surgical assessment)

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Shoulder Replacement for Chronic Shoulder Pain

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Trigger Finger

Policy - pdf version: Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual: Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about the interventions and conditions above please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

Referrals for treatment should be made through the local commissioned service pathway where available.

Where a local commissioned service pathway is not available funding must be sought by completing an Exceptional/IFR Funding Request Form and submitting it to the Exceptional Cases Team - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the policy:

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

For further information about anticoagulation therapy please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

Treatment in secondary care is via the routinely commissioned pathway.

Treatment provided in tertiary centres, such as spinal cord stimulation, is commissioned by NHS England.  Click here for the NHS Pain Management Specification:  
https://www.england.nhs.uk/wp-content/uploads/2013/06/d08-spec-serv-pain-mgt.pdf

Select the link to access the policy:

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

For further information about pain relief and interventions please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

CLINICAL THRESHOLD POLICY

*Please note this policy was previously classified as a lower clinical priority policy and known as the Chiropody Services Policy

Patients can be referred for podiatry where the patient has a high podiatric need or moderate podiatric need and a medical condition that increases their risk - see the policy for clarification. 

All other requests for treatment require the completion of an Exceptional/IFR Funding Request Form that must be submitted to the Exceptional Cases Team to secure funding approval prior to referral - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the policy:

Policy - pdf version:  Policy (pdf)

Policy - Word version: Policy (Word) 

For further information about Chiropody/Podiatry please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

Treatment is available locally and may be referred through local pathways.

For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form:  CPCCG Funding Request Form 

Select the link to access the Policy:

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

For further information about Post Traumatic Stress Disorder please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

Note:  NHSE are responsible for commissioning post-traumatic stress disorder services for veterans from Highly Specialist Veteran's Post-Traumatic Stress Disorder Centres.  The veteran's post-traumatic stress disorder programme provides inpatient treatment for service veterans who have complex post-traumatic stress disorder as a result of multiple traumas whilst in service.

SURGICAL THRESHOLD POLICY - this policy links to the Low Back Pain Surgical Threshold policy.

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email: cpccge-ifr@nhs.net for consideration by the Exceptional Cases Panel.  

Policy - pdf version: Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual: Manual Proforma

Referral Proforma EMIS Web Compatible: EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about back and neck pain please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

PRIMARY CARE PATHWAY POLICY, LOWER CLINICAL PRIORITY POLICIES AND SURGICAL THRESHOLD POLICY

Select the appropriate link to access each policy and referral proforma:

PRIMARY CARE PATHWAY POLICY: 

If treatment for a patient deviates from this pathway an Exceptional/IFR Funding Request Form must be completed and submitted to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form: CPCCG Funding Request Form 

Basal Cell Carcinoma:

Policy - pdf version:  Policy (pdf)

Policy - Word version: Policy (Word)

LOWER CLINICAL PRIORITY POLICIES: 

The lower clinical priority treatments below are not routinely commissioned for cosmetic reasons.  Exceptional case funding is required prior to any Benign Skin or Soft Tissue Lesion Surgery, or Laser Treatment for Skin Conditions.  The GP must complete a referral proforma and submit it to the CCG Exceptional Cases Team for consideration by the Exceptional Cases Panel.  Follow the instructions on the proforma.

Benign Skin or Soft Tissue Lesions:

Policy - pdf version:  Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

East of England Strategic Clinical Networks:  Skin Suspected Cancer Proforma:  Proforma

Laser Treatment for Skin Conditions:

Policy - pdf version:  Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

SURGICAL THRESHOLD POLICY:

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email: cpccge-ifr@nhs.net  for consideration by the Exceptional Cases Panel.

Chalazions

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma Manual:  Manual Proforma

Referral Proforma EMIS Web Compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about any of the interventions above please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY

This policy has now been merged with the Surgery for Obstructive Sleep Apnoea Surgical Threshold Policy.  See Ear Nose and Throat (ENT) policies drop down section above.

For further information about snoring, sleep problems and interventions please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

LOWER CLINICAL PRIORITY POLICY AND SURGICAL THRESHOLD POLICY

Select the appropriate link to access each policy and referral proforma:

LOWER CLINICAL PRIORITY POLICY:

Reversal of Sterilisation is not routinely commissioned.  For patients who are considered to be exceptional to the policy clinicians should complete an Exceptional/IFR Funding Request Form and submit it to the CCG Exceptional Cases Team to secure funding approval before referral - select this link to access the funding request form:  CPCCG Funding Request Form 

Reversal of Sterilisation Lower Clinical Priority Policy

Reversal of Sterilisation Policy - pdf version:  Policy (pdf)

Reversal of Sterilisation Policy - Word version:  Policy (Word)

SURGICAL THRESHOLD POLICY:

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below and send direct to the secondary care specialist (see instructions on proforma).  

For patients who do not meet the policy threshold criteria treatment is considered of low priority and will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email:  cpccge-ifr@nhs.net for consideration by the Exceptional Cases Panel. 

Sterilisation

Sterilisation Policy - pdf version: Policy (pdf)

Sterilisation Policy - Word version: Policy (Word)

Referral Proforma Manual: Manual Proforma

Referral Proforma EMIS Web Compatible: EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about male and female sterilisation please select the following link to the NHS.UK web site:  http://www.nhs.uk/Conditions/Pages/hub.aspx

CLINICAL POLICY

This policy covers the pre-operative referral of patients who smoke to a stop smoking service (SSS).  It includes patients undergoing elective surgery.  It does not include patients undergoing urgent non-elective surgery.

Note:  There is no requirement for a patient  to have stopped smoking, but contact with a SSS is mandated prior to surgery.

Stop Smoking Services - contact details:

Referrals by email: 
Cambridgeshire - CAPCCG.camquit@nhs.net 
Peterborough - livehealthy@peterborough.gov.uk

Telephone:
Cambridgeshire - 0800 018 4304
Peterborough - 0800 376 5655

Online:
Cambridgeshire -  http://www.camquit.nhs.uk/

Where a  within-surgery, pharmacy, hospital or equivalent service is available, refer to a service as per patient choice.

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Patient leaflet:  'Stop Before Your Op' Patient information leaflet

For further information about help to stop smoking and treatments please select the following link to the NHS.UK web site:  https://www.nhs.uk/conditions/stop-smoking-treatments/

SURGICAL THRESHOLD POLICY

Tongue-tie surgery will be funded for infants 0-4 months that meet the policy criteria.  Complete the applicable sections of the referral proforma in order the make the referral.

For patients who do not meet the policy threshold criteria and for indications other than feeding difficulties, eg speech problems, treatment is considered a low priority and will only be commissioned by the NHS on an exceptional basis.  Funding through the Exceptional Cases process must be sought prior to referral.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team by secure email:  cpccge-ifr@nhs.net for consideration by the Exceptional Cases Panel.

Select the appropriate link to access the policy and referral proforma:

Policy - pdf version:  Policy (pdf)

Policy - Word version: Policy (Word)

Referral Proforma Manual: Manual Proforma

Referral Proforma EMIS Web compatible: EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about Tongue-tie please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx

SURGICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria complete the applicable sections of the referral proforma below, providing full clinical detail and send direct to secondary care (see instructions on proforma).

For patients who do not meet the policy threshold criteria and who have signs and symptoms as defined by the policy as low clinical priority, treatment will only be commissioned by the NHS on an exceptional case basis.  Funding through the Exceptional Cases process must be sought prior to referral to secondary care.  Complete the relevant section of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email: cpccge-ifr@nhs.net  for consideration by the Exceptional Cases Panel.

Select the appropriate link to access the policy and referral proforma:

Policy - pdf version:  Policy (pdf)

Policy - Word version:  Policy (Word)

Referral Proforma:  Manual Proforma

Referral Proforma EMIS Web compatible:  EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information about Varicose Vein interventions please select the following link to the NHS.UK web site: http://www.nhs.uk/Conditions/Pages/hub.aspx