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NOTE: Clinicians should note that NICE have withdrawn Technology Appraisal Guidance TA549, Collagenase clostridium histolyticum for treating Dupuytren's contracture, published 26 July 2017 - as of February 2020.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.