Commissioning Policy Individual Funding Request

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Shavonne Powell
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1 Commissioning Policy Individual Funding Request Prior Approval Policy Date Adopted: 21 st August 2015 Version: Individual Funding Request Team - A partnership between Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups Commissioning Group

2 Document Control Title of document Authors job title(s) IFR Manager Document status v Supersedes v Clinical approval April 2015 Discussion and Approval by CPRG April 2015 Clinical Policy Review Group (CPRG) Discussion and Approval by CCG June 2015 Board Date of Adoption 21 st August 2015 Publication/issue date 3 rd September 2015 Review date September 2018 Application Form Version Control v Equality and Impact Assessment

3 TREATMENT UNDER THIS POLICY REQUIRES PRIOR APPROVAL FROM THE CCG THIS POLICY RELATES TO ALL PATIENTS Policy Statement - Date of Adoption: 21st August 2015 Ganglion referrals are not routinely funded by the CCG and are subject to this restricted policy. (If there is any uncertainty whether the ganglion may be malignant in nature, refer your patient via the 2 week wait referral route.) General Principles Funding approval will only be given in line with these general principles. Where patients are unable to meet these principles in addition to the specific treatment criteria set out in this policy, funding approval will not be given. 1. Funding approval must be secured by primary care prior to referring patients seeking corrective surgery. Referring patients to secondary care without funding approval having been secured not only incurs significant costs in out-patient appointments for patients that may not qualify for surgery, but inappropriately raises the patient s expectation of treatment. 2. On limited occasions, the CCG may approve funding for an assessment only in order to confirm or obtain evidence demonstrating whether a patient meets the criteria for funding. In such cases, patients should be made aware that the assessment does not mean that they will be provided with surgery and surgery will only be provided where it can be demonstrated that the patients meets the criteria to access treatment in this policy. 3. Where funding approval is given by the Individual Funding Panel, it will be available for a specified period of time, normally one year. 4. Funding approval will only be given where there is evidence that the treatment requested is effective and the patient has the potential to benefit from the proposed treatment. Where it is demonstrated that patients have previously been provided with the treatment with limited or diminishing benefit, funding approval is unlikely to be agreed. BACKGROUND The two main treatment options for a ganglion cyst are: draining fluid out of the cyst with a needle and syringe (the medical term for this is aspiration) cutting the cyst out by way of surgery

4 Having a ganglion cyst removed is a minor procedure, so complications are rare and seldom serious. However, a small number of people experience permanent stiffness and pain after surgery. There is always a chance that a ganglion cyst will come back after treatment. It's estimated that between one and four in every 10 cysts that are surgically removed will return. The cyst can be removed again with a good chance of success the second time round, although having further surgery does increase the risk of complications, such as damage to nearby nerves. Ganglions are generally harmless, but they can sometimes be painful, especially if they are next to a nerve. If they do not cause any pain or discomfort, they can be left alone and may disappear without treatment, although this can take a number of years. Policy - Criteria to Access Treatment PRIOR APPROVAL FUNDING REQUIRED Funding Approval for surgical treatment will only be provided by the NHS for patients meeting criteria set out below. The ganglion is causing significant functional impairment Significant functional impairment is defined by the BNSSG Health Community as: o Symptoms preventing the patient fulfilling routine work or educational responsibilities o Symptoms preventing the patient carrying out routine domestic or carer activities OR The individual is experiencing considerable pain as a result of the ganglion s size or position To enable the Commissioner to approve individual cases the following information, with examples of functional impairment using the guidance below, should be provided: Precise location of ganglion e.g. flexor tendon Size in cm/inches (length and width) How function of the area is impaired i.e. what is the patient unable to do as a result of the ganglion? Impact on work/studies/care i.e. is the patient unable to fulfil any work/study/carer activities and if so to what extent? Impact on daily activities i.e. is the patient unable to carry out domestic activities such as cooking, washing etc.? Degree of pain How long it has existed and treatments tried to date

5 Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes exceptional circumstances exist that warrant deviation from the rule of this policy. Individual cases will be reviewed at the CCG s Individual Funding Request Panel upon receipt of a completed application form from the patient s GP, Consultant or Clinician. Applications cannot be considered from patients personally. If you would like further copies of this policy or need it in another format, such as Braille or another language, please contact the Patient Advice and Liaison Service on or This policy has been developed with the aid of the following references: Ganglion Cyst - Approved by (committee): Clinical Policy Review Group Date Adopted: 21 August 2015 Version: Produced by (Title) Commissioning Manager Individual Funding EIA Completion Date: October 2014 Undertaken by (Title): IFR Co-ordinator Review Date: Earliest of NICE publication or three years from approval. CATEGORY VERSION CATEGORY VERSION CATEGORY VERSION Bristol Prior Approval North Somerset Prior Approval South Gloucestershire Prior Approval

Writing an access policy: summary May 2017

Writing an access policy: summary May 2017 www.nhsimas.nhs.uk/ist Contents Why is an access policy important? What should you include or exclude? Who should be involved in developing the policy? What questions