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Home » Health Professionals » Clinical policies and thresholds » Clinical policies

Clinical policies

The policies below assist Cambridgeshire and Peterborough CCG to manage lower clinical priority treatments, and various surgical and clinical procedures.

We are currently changing the style of our policies.  There will be two documents applicable to each policy:  a criteria document (Part 1) and evidence document (Part 2).  Policy styles will be updated as and when policies are reviewed.

Referral proforma are available in various formats for ease of upload to GP software systems, eg EMIS Web - access the instructions here. 

Note the following:

Surgical Threshold Policies: 
  • If patient meets the criteria refer direct to the provider.
  • If does not meet criteria then referrer must apply for Exceptional Funding.
Lower Clinical Priority Policies: 
  • Require prior approval - apply to the Exceptional Cases Team for funding.

CCG Clinical Policies

Each referral proforma requires the completion of patient details, a patient consent section and whether the patient meets policy criteria or whether exceptional funding is being sought. 

The When To Apply For Funding document will provide clarification to referring clinicians on when they should apply for funding to the Exceptional Cases Panel relevant to policy type

Further information about the policies is also available.

Select a policy or policy group below to expand the selection to view and select associated documentation.

SURGICAL THRESHOLD POLICY

Note for GPs:  
The provider for Tier 3 weight management service across Cambridgeshire and Peterborough is as follows:

Patients who meet the referral criteria for bariatric surgery will be referred by the Tier 3 weight management service to the Tier 3 obesity management services.

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.  Complete Section 2 of the referral proforma and submit the proforma to the Exceptional Cases Team on secure email for consideration by the Exceptional Cases Panel.

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

Policy Criteria - Part 1 (pdf) 

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)       

Policy Evidence - Part 2 (Word) 

Manual Proforma

EMIS Web Proforma

Note:  Referral proforma are now available in SystmOne

Further information about bariatric surgery is available on the NHS website. 

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 the link to access the policy:

 Policy pdf

 Policy (Word)

SURGICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria for gallstones 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 Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

 Manual Proforma

 EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

 

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 for circumcision 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 Criteria - Part 1 (pdf) 

Policy Criteria - Part 1 (Word) 

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)   

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Further information on circumcision in men and boys is available on the NHS.uk web site.


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 the link to access the policy:

Policy pdf

Policy (Word)


Information relating to the policy for Continuous Glucose Monitors (CGMs) has now moved to the Prescribing Information section of the CCG website.

CGM in adults 19 years and over

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.

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)

Policy (Word)

Manual Proforma

EMIS Web Proforma

*NOTE:  Referral proforma are now available in SystmOne


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 Temporomandibular Disorder interventions.

For patients who do not meet the criteria:  application to the NHS England 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 Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)        

Policy Evidence - Part 2 (Word)

NOTE:  Botulinum toxin injections for TMD require CCG Exceptional Cases Panel approval 


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.

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  

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)                         

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

         

SURGICAL THRESHOLD POLICIES: 
Grommets and Adenoidectomy (Surgical Treatment of Otitis Media)

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


Nasal Surgery for Obstruction or Deformity 

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf) 

Policy Evidence - Part 2(Word)      

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


Tonsillectomy (Surgery for Tonsillitis: Tonsillectomy and Adenoidectomy)

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


OSA Pathway - Diagnostic Investigations and Treatments for Obstructive Sleep Apnoea/Hypopnoea Syndrome (OSAHS) in Adults

Policy (pdf)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


Surgery for Obstructive Sleep Apnoea (OSA) and Snoring

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


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 Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf) 

Policy Evidence - Part 2 (Word) 

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


Lower GI Endoscopy (Colonoscopy or Sigmoidoscopy)

Guidance:  Irritable Bowel Syndrome Guidelines  (known as IBS) and Calprotectin advice or visit the Digestive Diseases section of the CCG website. 

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)           

Policy Evidence - Part 2 (Word) 

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Further information is on the NHS.UK website.

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 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 Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Referral Proforma (pdf)

Referral Proforma (Word)


Chalazion 

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part  (Word)

Policy Evidence - Part 2 (pdf)  

Policy Evidence - Part 2 (Word)    

Manual Proforma

EMIS Web Proforma

  

Eyelid and brow surgery

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

 

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.

Coloured Filters/Tinted Lenses for Reading Difficulties

Policy (pdf)

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.

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.

Policy (pdf)

Policy (Word)

For further information about the above interventions and conditions please go to the NHS.UK website. 

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 the link to access the policy:

Position Statement (pdf)

Position Statement (Word)

For further information about Familial Breast Cancer and genetic testing 

On 3 August 2021 Cambridgeshire and Peterborough Clinical Commissioning Group Governing Body approved the reinstatement of the referral for Assisted Conception Policy as of the 4 August 2021.

Policy Criteria (Word)

Policy Criteria (pdf)

Manual proforma  - GP Referral to Secondary Care for Fertility Assessment

EMIS Web proforma  - GP Referral to Secondary Care for Fertility Assessment

Secondary Care Consultant proforma for referral to IVF provider

Couples who do not meet the criteria and consider they have exceptional circumstances, which suggests that they are likely to gain significantly more benefit than might generally be expected, can be referred to the CCG's Exceptional Cases Panel using the Exceptional/IFR Funding Request Form                   

Treatments excluded from the Assisted Conception Policy:

Egg, sperm and oocyte storage is available for adolescent/adult men and women preparing for medical treatment or other conditions known to cause premature infertility.  Following cancer treatment, couples seeking fertility treatment must meet the defined eligibility criteria.

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.  See Assisted Conception Policy for further information.

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.

For further information about the above interventions and conditions please go to the NHS.UK website. 

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

NHS England are responsible for the provision of Gender Dysphoria services

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 Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

 

Female Pelvic Organ Prolapse (management of)

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

 NOTE:  Referral proforma are now available in SystmOne

Further information about Heavy Menstrual Bleeding, female pelvic organ prolapse and associated interventions and conditions is on the NHS.UK website.

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.

NOTE:  referrals for 2-week-wait Urology should be made using the 2-week-wait form on SystmOne/EMIS 

Policy (pdf)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne 

 

SURGICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria for piles (haemorrhoids) 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 Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

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.     

Select the link to access the policy and referral proforma: 

Policy Criteria - Part 1 (pdf) 

Policy Criteria - Part 1 (Word) 

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)         

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

Further information is available on the NHS.UK website.

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.

Position Statement (pdf)

Position Statement (Word)

LOWER CLINICAL PRIORITY POLICY

Go to the clinical policies page of the NHS Cambridgeshire & Peterborough (ICB) web site

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.

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 submit it to the CCG Exceptional Cases Team to secure funding approval before referral.

Select the link to access the policy:

Policy (pdf)

Policy (Word)


LOWER CLINICAL PRIORITY POLICY

The treatments below 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 the links below to access the relevant policy:

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)

Policy (pdf)
Policy (Word)

Treatment for Dissociative Identity Disorder (DID)

Policy (pdf)

Policy (Word)

 

Repetitive Transcranial Magnetic Stimulation for Depression (rTMS)

Policy (pdf)

Policy (Word)

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.

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

Select the link to access the policy:

Position Statement (pdf)

Position Statement (Word)

Further information and associated interventions and conditions is on the NHS.UK website.

CLINICAL THRESHOLD POLICY

Please go to the Ear, Nose and Throat (ENT) drop down section above

LOWER CLINICAL PRIORITY POLICY

Routine referral by clinicians in Musculoskeletal Services or Secondary Care, for Open or Upright MRI (MRI is short for 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 - Musculoskeletal or Secondary Care clinicians should complete the referral proforma (see below) and submit it to the CCG Exceptional Cases/Individual Funding Request 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)

Policy (Word)

Referral Proforma

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

Further information about Open/Upright MRI is available on the NHS.UK website.

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.

Policy (pdf)

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 the Musculoskeletal 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:

Note: the Bunions (Surgical Referral for Hallux Valgus) Policy is merged with the Podiatry Policy to become the Foot Care Interventions Policy - see below

Carpal Tunnel Syndrome

Policy (pdf)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.


Chronic Hip Pain 

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.   


Dupuytren's Contracture

Policy Criteria - Part 1 (pdf) 

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)  

Policy Evidence - Part 2 (Word)  

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.

NOTE:  Clinicians should note that NICE have withdrawn Technology Appraisal Guidance TA549, Collagenase clostridium histolyticum for treating Dupuytren's contracture, published 26 July 2017 - as of February 2020.  The policy has been edited to reflect the NICE TA549 withdrawal.  The GPA is no longer available on Blueteq or as a prior approval application on the CCG Prescribing webpage.


Foot Care Interventions:  Podiatry, Laser, Injections and Surgery

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word) 

Manual Proforma

EMIS Web Proforma



Ganglion

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.


Hip Replacement (Primary)

Policy Criteria - Part 1 (pdf) 

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.


Knee Arthroscopy for Chronic Knee Pain

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.



Knee Replacement (Primary)

Policy (pdf)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.

 

Low Back Pain - Surgery and Other Invasive Interventions     

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)  

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.  
     

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

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.


Shoulder Replacement for Chronic Shoulder Pain

Policy Criteria - Part 1 (pdf)

Policy Criteria - Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.


Trigger Finger

Policy (pdf)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne.

For further information is on the NHS.UK website.

LOWER CLINICAL PRIORITY POLICY

Referrals for treatment for anticoagulant medicines 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 the link to access the policy:

Policy (pdf)

Policy (Word) 

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.  The NHS Pain Management Specification is available online.

Select the link to access the policy:

Policy (pdf)

Policy (Word)

Further information and associated interventions and conditions is on the NHS.UK website.

The Podiatry Policy has been merged with the Bunions Policy to become the Foot Care Interventions Policy.  See the Orthopaedic drop down section above.

LOWER CLINICAL PRIORITY POLICY

Treatment for PTSD 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 the link to access the policy:

Policy (pdf)

Policy (Word)

Note:  NHS England 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)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

For further information is on the NHS.UK website.

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.

Basal Cell Carcinoma:

Policy (pdf)

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)

Policy (Word)

Manual Proforma

EMIS Web Proforma

East of England Strategic Clinical Networks:  Skin Suspected Cancer Proforma

NOTE:  Referral proforma are now available in SystmOne


Laser Treatment for Skin Conditions:

Policy (pdf)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne

 

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.

Further information about snoring, sleep problems and interventions is on the NHS.UK website.

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.

Reversal of Sterilisation Lower Clinical Priority Policy

Policy (pdf)
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

Policy (pdf)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


Further information about male and female sterilisation is available on the NHS UK website.

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.

Policy (pdf)

Policy (Word)

Stop Smoking Service:

Cambridgeshire Peterborough residents can access the free stop smoking service at Healthy You (formerly known as CAMQUIT): 

Web site:  https://healthyyou.org.uk

Telephone number:  0333 005 0093

Self referral using the Healthy You  contact form

Email:  healthyou@healthyyou.org.uk

Text:  Healthyu to 60777

Email address for Health Professionals:  eh.healthyyou@nhs.net or to self refer a patient please use the referral form:  referral form

General NHS advice about stopping smoking and treatments 

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

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 criteria - Part 1 (pdf)

Policy Criteria -Part 1 (Word)

Policy Evidence - Part 2 (pdf)

Policy Evidence - Part 2 (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


SURGICAL THRESHOLD POLICY

For patients who meet the policy threshold criteria for varicose veins 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)

Policy (Word)

Manual Proforma

EMIS Web Proforma

NOTE:  Referral proforma are now available in SystmOne


NHS England Specialised Commissioning Group Policies - select policy link below to access NHS England National Programmes of Care.  Each national programme provides details on NHSE policies relevant to that particular programme of care.

NHS England policies for routinely commissioned treatments: 

Generic policy information that includes NHSE Individual Funding Request information - and the process for making an individual funding request application is also available on this link (select the Individual funding policy link located under the 'Key Documents' heading to quickly jump down the page to the Individual Funding Request section).  

NHS England Evidenced Based Interventions (EBI) Guidance in association with the Academy of Medical Royal Colleges

The EBI Programme is overseen by NHS Clinical Commissioners, the Academy of Medical Royal Colleges, The National Institute for Health and Care Excellence, and NHS England and NHS Improvement.

The guidance is addressed to CCGs, to assist them in fulfilling their duties relating to securing continuous improvements in the quality of services for patients and in outcomes, particularly regarding appropriate clinical interventions. This guidance is issued as general guidance under S14Z8 of the NHS Act 2006. The objective of the guidance is to support CCGs in their decision-making, to address unwarranted variation, and to provide national advice to make local clinical decision-making more appropriate.

CCGs are expected to have regard to the guidance in formulating local policies and for clinicians to reflect the guidance in their clinical practice. The guidance does not remove the clinical discretion of clinicians in accordance with their professional duties.