Not all treatments and medications are routinely funded on the NHS. This is because the effectiveness of certain procedures and medications can vary significantly amongst patients, so for some people treatments can be more harmful than they are helpful.
The NHS has a responsibility to make sure it is using its limited resources in a way that gives patients the most health benefits and best outcomes.
The CCG has a range of clinical policies which outline the treatments and procedures we fund and details of who may be eligible to receive them.
Treatments can be simply broken down into three areas:
- Treatments routinely available through the NHS
- Treatments available through the NHS by ‘prior approval process’ to those who meet key clinical policy criteria
- Treatments not currently funded and only available on the NHS through the process of an individual funding request
Your doctor will talk to you about your condition. If you do not meet the criteria for surgery this means that surgery could be more harmful than helpful. Your doctor will be able to suggest alternative non-surgical treatments which can also be highly effective at improving your symptoms.
If your GP thinks you do meet the criteria, you will be referred to a consultant for a specialist opinion
Seeing a specialist
The consultant will review your symptoms and history and if they think that you will benefit from surgery they will request funding from the CCG to perform the procedure. Your case will be reviewed by the prior approvals team to confirm that the criteria has been met and your consultant will be contacted as soon as possible to inform them of your eligibility for surgery.
If funding is approved you will be contacted by the hospital to arrange a further appointment.
If funding is not approved, you have not met the criteria. This means that surgery will not be the most effective treatment for your symptoms and could be more harmful than helpful. The hospital will contact you to inform you of the outcome and you will be advised of next steps regarding your treatment.
If your circumstances change, the consultant may be able to reapply for funding. Your GP will be able to advise you in these instances.
If your treatment has been subject to the prior approvals process and you would like to feedback or complain about the outcome, please visit the contact us section of this website.
If you have a medical condition you or your doctor feels is exceptional and might benefit from a treatment that falls under a clinical policy that does not allow for the prior approval process to be applied, and the treatment is not funded, an individual funding request is required.
The CCG is responsible for making decisions about whether these individual healthcare requests can be funded. Like any other organisation, the NHS has limited financial resources and we have a responsibility to make sure these resources are used carefully and responsibly. Read more information on the process for managing individual funding requests (PDF, 827KB).
To do this we have to:
- Look at the evidence of the safety and effectiveness of any services or treatment
- Make sure that the that the services and treatments we pay for will make a real difference to a patient's health
- Make sure that those services are fair and ethical
How do I apply for individual healthcare?
The best way to apply for individual healthcare is to speak to your GP or family doctor, who will be able to talk your options through with you, and if needed, make a request to the CCG on your behalf.
Funding for individual healthcare requests
For more information on funding meetings the following information leaflet is available:
Below lists those procedures that are not funded, or where funding will only be made available if specific criteria are met, and the policies attached to each. Please note this list is not an exclusive list of procedures and, different procedures within the same policy may have different criteria. Your local GP or CCG will be able to provide you with information on your specific medical need.
Here you can find our finalised policies, which provide a new framework to help aid the decision-making process for the funding of specific treatments or procedures:
- Clinical Guidance Policy (Word 77KB)
- General Policy IFR Decision Making (PDF 387KB)
- Policy for considering applications for exceptionality (PDF 316KB) Updated January 2017
- Statement of Principles (PDF 309KB)
Policy Equality Impact Assessments (EIA)
- Clinical Guidance Policy EIA (PDF file, 343KB)
- Policy for considering IFR EIA (PDF, 411KB)
- EIA Process for Clinical Policies September 2014.docx [docx] 114KB
- Principles for the commissioning of Health and Healthcare Policy EIA (PDF file, 347KB)
Technology Appraisal procedures
Cosmetic - policies below are being reviewed at a pan Lancashire level.
A draft will be available for public consultation at the appropriate stage of review.
- Pan-Lancashire policy for cosmetic procedures (pdf 190KB) - updated March 2018. Please note, this policy replaces individual policies for benign skin lesions, cosmetic breast procedures, cosmetic body contouring procedure, cosmetic facial procedures, hair depilation, hair loss correction and tattoo removal.
- The previous policy on 'cosmetic procedures for hair, skin and subcutaneous lesions' is no longer valid as it is covered by the policy above. In relation to the use of Botulinum Toxin, which is not covered by the policy above, CCGs in Lancashire are now following guidance from the Lancashire Medicines Management Group (external website - opens in same window).
Ear, nose and throat
- Pan-Lancashire policy for tonsillectomy, adeno-tonsillectomy (pdf 136KB) - updated October 2017
- Surgery for Snoring clinical policy - Final (pdf 229KB) - ratified by the CCG's Governing Body in September 2017.
- Pan-Lancashire policy for the management of otitis media with effusion (OME) using grommets (PDF 163KB) - updated October 2018
Gynaecology and obstetrics
- Pan-Lancashire policy for dilatation and curettage (pdf 138KB) - updated March 2018
- Pan-Lancashire policy for hysteroscopy (pdf 137KB) - updated March 2018
- Pan-Lancashire policy for the excision of the uterus (PDF 163KB) - updated October 2018
- Pan-Lancashire policy for assisted conception services (PDF 299KB) - Please note, this is a new policy that was ratified by the Joint Committee of Clinical Commissioning Groups in November 2018. Click here for an easy-read version of this policy (PDF 2MB)
Trauma and orthopaedics
- Pan-Lancashire policy for surgical treatment of carpal tunnel syndrome (pdf 154KB) - updated October 2017
- Pan-Lancashire policy for endoscopic procedures on the knee joint cavity (pdf 143KB) - updated October 2017
- Pan-Lancashire policy for surgical release of trigger finger (pdf 135KB) - updated October 2017
- Pan-Lancashire policy for hip arthroscopy (pdf 135KB) - updated March 2018
- Hallux Valgus clinical policy (PDF 245KB) - ratified by the CCG's Governing Body in September 2017
- Pan-Lancashire policy for commissioning spinal injection & radiofrequency denervation for low back pain (PDF 275KB) - Please note, this is a new policy that was ratified by the Joint Committee of Clinical Commissioning Groups in November 2018
- Total hip replacement clinical policy (PDF 241KB) - ratified by the CCG's Governing Body in November 2017
- Total knee replacement clinical policy (PDF 226KB) - ratified by the CCG's Governing Body in November 2017
- Policy for Shoulder Surgery for Rotator Cuff Repair (PDF 136KB)
- Pan-Lancashire policy for subacromial decompression (PDF 232KB) - ratified at JCCCG March 2019
- Pan-Lancashire policy for Dupuytren's contracture release (PDF 222KB) - ratified at JCCCG March 2019
- Pan-Lancashire policy for male circumcision (pdf 188KB) - updated October 2017
- Policy for Reversal of Sterilisation (PDF 150KB) - updated May 2019
- Policy for varicose veins (PDF 137KB) - updated May 2019
- Pan-Lancashire policy for complementary and alternative therapies (PDF 182KB) - updated January 2018
- Pan-Lancashire policy for rehabilitation after damage to facial nerve (PDF 161KB) - updated January 2018
- Pan-Lancashire policy for chalazia removal (PDF 93KB) [pdf] 93KB - ratified at JCCCG March 2019
- Pan-Lancashire policy for ganglia excision (PDF 83KB) - ratified at JCCCG March 2019
- Pan-Lancashire policy for Haemorrhoid surgery (PDF 143KB) - ratified at JCCCG March 2019
- Hernia clinical policy - Final (PDF 217KB) - ratified by the CCG's Governing Body in September 2017.
- Policy for commissioning photorefractive surgery for the correction of refractive error (PDF 153KB) - updated October 2018
- Policy for the provision of insulin pumps (PDF 209KB) - updated October 2018
- Policy for Glucose Monitoring Devices (March 2019 amends) (PDF 319KB)
- Policy for hysteroscopy (PDF 159KB)