WOLVERHAMPTON CCG. Procedures of Limited Clinical Value Review. Sharon Sidhu, Head of Strategy & Transformation. Decision Assurance

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1 WOLVERHAMPTON CCG GOVERNING BODY 12 th January 2016 Agenda item 10a Title of Report: Report of: Contact: Procedures of Limited Clinical Value Review Sharon Sidhu, Head of Strategy & Transformation Sharon Sidhu, Head of Strategy & Transformation Governing Body Action Required: Decision Assurance Purpose of Report: Public or Private: Relevance to CCG Priority: Relevance to Board Assurance Framework (BAF): Domain 1: A Well Led Organisation Domain 2b: Quality (Improved Outcomes) Domain 3: Financial Management To present the outcome of the mid-year review of the Procedures of Low Clinical Value (PoLCV) policy and seek approval of the changes. Public Quality & Value, Health Improvement The development of this policy has been clinically led and has been developed in partnership and collabaration with a number of other CCGs and Public Health. The policy ensures commissioned procedures are evidence based, clinically effective and improve patient outcomes The policy ensures commissioned procedures are evidence based, clinically effective and provide value for money (Governing Body) Page 1 of 6

2 BACKGROUND AND CURRENT SITUATION 1.1. Since April 2013 Wolverhampton CCG has applied the Black Country Procedures of Limited Clinical Values (POLCV) policy to the contract to ensure that procedures being performed are evidenced as having clinical value In early 2014 Wolverhampton CCG was asked to participate in a harmonisation of policies across the West Midlands facilitated by Midlands and Lancashire Commissioning Support Unit The support unit provided administrative support to a panel made of primary care clinicians, contract managers, and public health representatives from across the region In January 2015 a harmonised set of clinical policies were produced and each area lead was tasked to take these back to the CCGs for a view on assurance and implementation RWTs acquisition of Cannock Chase Hospital in 2014 resulted in the Southern Staffordshire CCGs becoming significant partners in contracting discussions. Unfortunately these CCGs were not included as part of the membership in the West Midlands harmonisation group Wolverhampton CCG worked with the Southern Staffordshire CCGs to align their existing POLCV policy to the harmonised policy in order to ensure that a unified policy was implemented in the RWT contract The harmonised policy was approved by the Governing Body in March 2015 and was implemented in the contract from the 1 st April Following approval of the harmonised Procedures of Limited Clinical Value Policy (POLCV) it was agreed a mid-review review would take place in September 2015 to clarify any queries that arose from its implementation. 1.8 To date none of the other CCGs have approved and implemented the West Midlands harmonised policies, this has primarily been to the CSU not being able to provide the same level of facilitation to help drive the project forward Solihull CCG has taken the lead to revive the project with some support being provided from the CSU. The CCGs that form the membership of the West Midlands harmonisation group are going to commence key stakeholder engagement in January 2016 on the content of the policies and are actively working towards getting the final version of the policies approved and implemented in their main acute contracts from the 1 st April (Governing Body) Page 2 of 6

3 2. MAIN BODY OF REPORT 2.1 Following approval of the harmonised Procedures of Limited Clinical Value Policy (POLCV) it was agreed a mid-review review would take place in September 2015 to clarify any queries that arose from its implementation 2.2 The review group which included clinical representation from Dr Gary Free, Dr Marianne Holmes (Stafford), Dr Charles Pidsley (East Staffs) and Dr Kamran Ahmed (Wolverhampton) proposed the following changes: 2.3 The changes ensure that there are consistent thresholds in place across South Staffordshire and Wolverhampton and eventually across the other West Midlands CCGs following approval and implementation of the policies. 2.4 A number of changes have been made which are relevant for South Staffordshire only: 1.1 Minor skin lesions: added sentence stating cases based on functional problems must be prior approved by CCG - Already present in Wolves CCG policy as per agreement at Governing Body. 1.6 Abdominoplasty Inserted the South Staffordshire prior approval criteria. The criteria is present to ensure GPs are aware of targets within which procedure may be considered under a prior approval process. 2.3 The following changes are relevant to both Wolverhampton and South Staffordshire CCG: 5.1 Cataract: VA threshold lowered to 6/9 - this is in line with new recommendations from the royal college of ophthalmology. 6.4 Hip & Knee threshold: to clarify BMI of 35 applicable to all conditions listed. Additional statement added regarding prior approval cases. 7.1 Circumcision: Previous 4 policies to be merged into 1 as criteria are in essence the same. 7.8 Stress Incontinence Surgery Clarification around commissioning arrangements have been stated. 2.4 Additional policies that are not routinely commissioned have been added to this policy. These were previous PCT polices and omitted from version 1.5: Hysteroscopy for menorrhagia - Previous Black Country POLCV policy and currently being enforced at RWT Acupuncture 11.2 Complementary therapies 9.1 Closure of PFO for migraine Specialised Commissioning 9.2 Closure of PFO for stroke (CVA) Specialised Commissioning 10.1 Chronic Fatigue / ME Inpatient Stays 10.2 Borderline personality Disorder Inpatient Stays Only applies to the Southern Staffordshire CCGs 2.5 An Additional statement added: (Governing Body) Page 3 of 6

4 4.5 Preservation of fertility (male and female patients) will be commissioned in accordance with the current CCG Assisted Conception Policy 2.6 In light of the current situation with the West Midlands Harmonisation Group a further review of our current policy will be need to be take place around April/May This will ensure any changes that have been made to the West Midlands Group policies following feedback from key stakeholders are taken into account and are in alignment with our policy. 2.7 The West Midlands Harmonisation Group continue to share with us the core POLCV policies and are close to implementation. Wolverhampton has been seen as a pioneer in getting these policies agreed, implemented and into contract successfully in 2015/16. As a result of implementing these policies 1.6 million pounds was removed upfront from the contract. 2.8 Wolverhampton CCG continues to work closely with the West Midlands group, Southern Staffordshire CCGs and RWT to ensure that we are abreast of guidance and respond to any questions or concerns around implementation in a robust and efficient manner. We will continue to monitor progress and ensure that joint working with RWT delivers these policies successfully and with clarity. 3. CLINICAL VIEW 3.1. The harmonisation process has utilised views from commissioners, public health, contract management and primary care clinicians across the region. 4. PATIENT AND PUBLIC VIEW 4.1. Extensive patient engagement and consultation took place when the original when the original Black Country Policy was developed in As the harmonisation of the policies has not resulted in significant changes to our current policy no patient consultation is required. 5. RISKS AND IMPLICATIONS Key Risks 5.1. Potential financial risk to CCG of non-adherence to policies This has been mitigated by the implementation of Blueteq which requires RWT to demonstrate that patients meet the eligibility criteria prior to them undertaking a procedure. 5.2 There is a risk of inequity across the region if the West Midlands Harmonisation Group policies are not approved. This is being mitigated by the fact that there is commitment across all the CCGs to complete the work with Solihull CCG taking the lead. In addition Wolverhampton CCG continues to attend the working group to ensure alignment is maintained with our existing policy. Financial and Resource Implications 5.2. Potential financial risk to CCG of non-adherence to polices. (Governing Body) Page 4 of 6

5 Quality and Safety Implications 5.3. None as policies are based on clinical evidence Equality Implications 5.4. Equality Impact Assessments have been undertaken by CSU Medicines Management Implications 5.5. Not applicable Legal and Policy Implications 5.6. No legal implications, this report recommends minor changes to the policy based on clinical evidence to ensure policies are harmonised across the wider region. RECOMMENDATIONS 5.7. Governing Body are asked to: Receive and discuss this report. Note the action being taken. To approve the changes made to the policy. Name: Sharon Sidhu Job Title: Head of Strategy & Transformation Date: 17 th December 2015 ATTACHED: POLCV Policy (Version 1.6) (Governing Body) Page 5 of 6

6 REPORT SIGN-OFF CHECKLIST This section must be completed before the report is submitted to the Admin team. If any of these steps are not applicable please indicate, do not leave blank. Details/ Date Name Clinical View Dr Ahmed 24/12/15 Public/ Patient View Finance Implications discussed with Finance Team Lesley Sawrey Quality Implications discussed with Quality and Risk Sarah Southall 24/1215 Team Medicines Management Implications discussed with n/a Medicines Management team Equality Implications discussed with CSU Equality and n/a Inclusion Service Information Governance implications discussed with IG n/a Support Officer Legal/ Policy implications discussed with Corporate Peter McKenzie 18/12/15 Operations Manager Signed off by Report Owner (Must be completed) Sharon Sidhu 24/12/15 (Governing Body) Page 6 of 6

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