Clinical policies

Clinical policies

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

 

Prior approval

Being referred

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.

Receiving approval

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.

Individual funding requests

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

View the funding framework for individual healthcare requests that Greater Preston uses (PDF file, 242 KB)

For more information on funding meetings the following information leaflet is available:

Meeting guidelines leaflet (pdf file, 36KB

 

Policies

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:

Policy Equality Impact Assessments (EIA)

Technology Appraisal procedures

Spinal cord stimulation - Technology Appraisal (PDF 148KB) 
Dupuytrens contracture - Technology Appraisal (PDF 162KB) 

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.

Ear, nose and throat

Gynaecology and obstetrics 

Trauma and orthopaedics

Urology

Vascular

Other